Schedule - Part A - Prostheses List	February 2014
01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.01.01 - Aphakic
	01.01.01.01 - Rigid
	Alcon Laboratories (Aust.) Pty Ltd
AL003	MTA2UO - MTA6UO	PMMA	+5 to +30 D	$156.00
	Bausch & Lomb (Australia) Pty Ltd
BL005	Storz (Coburn) Intraocular Lens  	PMMA Anterior Chamber Intraocular 	13.75mm length. 6.0mm 	$156.00
	121UV; L122UV PMMA Anterior 	lens 1 piece	optic size, diopter range 3-
	Chamber Lens	30d. L122UV: 6.0mm optic, 
	13.75mm length, power 
	range; 5.0 to 30.0 Diopters
	Emagin Pty Ltd
EG009	Artisan Anterior Chamber 	Aphakia ModelComposition: PMMA	5.00mm Optic Diameter x 	$156.00
	Intraocular Lens	8.5 in overall length
	ifc
	AMO Australia Pty Ltd
AO019	Verisyse AC IOL	Aphakic Model	5mm Optic Diameter x 8.5 	$250.00
	overall length
	m
	AMO Australia Pty Ltd
AO001	Intraocular Lens: Model  AC 51L	Duralens  PMMA, Anterior Chamber 	6.00 mm Optic Diameter x 	$198.00
	IOL	13.0mm in overall length
01.01.02 - Phakic
	01.01.02.01 - Rigid
	AMO Australia Pty Ltd
AO016	Verisyse AC IOL	Phakic Intraocular Lens: Model 	5mm Optic Diameter x 8.5 	$680.00
	Myopia.  Composition: PMMA	overall length; 6mm Optic 
	Diameter x 8.5 overall 
AO017	Verisyse AC IOL	Phakic Intraocular Lens: Model 	5mm Optic Diameter x 8.5 	$680.00
	Hyperopia.  Composition: PMMA	overall length
Prostheses List by Category, Groups and Sponsor	Page 1 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emagin Pty Ltd
EG012	Artisan Anterior Chamber IOL	Phakic Intraocular Lens Myopic / 	5.00mm Optic Diameter x 	$680.00
	Hyperopic	8.5 in overall length;
	t1
	AMO Australia Pty Ltd
AO030	Verisyse Toric (Custom)	Phakic intraocular lens: Model toric	5mm Optic Diameter x 	$1,056.00
	7.5mm overall length
	Emagin Pty Ltd
EG008	Artisan Anterior Chamber 	Phakic Intraocular Lens: Model Toric	5.00mm Optic Diameter x 	$1,056.00
	Intraocular Lens	Composition: PMMA	7.5 in overall length
	t2
	AMO Australia Pty Ltd
AO029	Verisyse Toric (Custom)	Phakic intraocular lens: Model toric	5mm Optic Diameter x 	$1,358.00
	7.5mm overall length
	01.01.02.02 - Foldable
	Alcon Laboratories (Aust.) Pty Ltd
AL034	AcrySof Cachet Phakic Lens	Anterior chamber foldable, acrylic, 	-6.0 to -16.5 diopters, in 0.5	$723.00
	single piece phakic lens	 diopter increments
	AMO Australia Pty Ltd
AO025	VeriFlex Foldable Phakic IOL	Anterior chamber foldable phakic 	-2  to -14.5d in 0.5d 	$723.00
	silicone intraocular lens	increments.  Overall 
	diameter 8.5mm. Optic 
	6.0mm
	Emagin Pty Ltd
EG010	Artiflex Anterior Chamber 	Optic: Hydrophobic Polysiloxane. 	6mm optic diameter x 8.5 in 	$723.00
	Intraocular Lens	Haptic: PMMA	overall length
01.02.01 - Rigid
	Alcon Laboratories (Aust.) Pty Ltd
AL002	Models MZ60BD, MC50BD, CZ70BD	Other:PMMA	Range of Powers:-10 to +34	$156.00
	 D
Prostheses List by Category, Groups and Sponsor	Page 2 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.02.02 - Foldable
	01.02.02.01 - Microincision
	at
	Carl Zeiss Pty Ltd
CZ016	CT ASPHINA 409M	ZEISS Micro Incision Aaspheric 	6mm optic, 11mm overall 	$364.00
	(aberration neutral) IOL: Foldable, 	diameter. Diopter range 0.0 
	square-edged, single piece IOL for 	to +32.0D (0.5D steps from 
	capsular bag fixation	10.0 to 30.0D, 1.0D outside
	 this range)
CZ017	CT ASPHINA 509M	ZEISS Micro Incision Aspheric 	6mm Optic, 11mm overall 	$364.00
	(aberration correcting) IOL: Foldable,	diameter. Diopter range 0.0 
	 square-edged, single piece IOL for 	to +32.0D (0.5D steps from 
	capsular bag fixation	10.0 to 30.0D, 1.0D outside
	 this range)
	at, pl
	Bausch & Lomb (Australia) Pty Ltd
BL026	Akreos AO Micro Incision Lens	Micro Incision, posterior chamber, 	6mm optic overall diameter 	$374.00
	foldable acrylic, aphakic, anterior & 	11.0mm(10D-15D), 10.7mm 
	posterior edge modification, 	(15.50-22D), 10.5mm 
	preloaded, with aberration contro, 	(22.50-30D)
	Carl Zeiss Pty Ltd
CZ028	CT ASPHINA 409MP	Preloaded, micro incision, aspheric 	Diopter range: 0.0 to 	$374.00
	(aberration neutral), foldable square-	32.0D; Optic size: 6.0mm; 
	edged single piece inraocular lens for 	Overall length: 11.0mm
	capsular bag fixation.
CZ037	CT ASPHINA 509MP	Preloaded, micro incision, aspheric 	Diopter range: 0.0 to + 	$374.00
	(aberration correcting), foldable 	32.0D; Optic Size: 6.0mm; 
	square-edged single-piece intraocular 	Overall length: 11.0mm
	lens for capsular bag fixation
	at, pl, t1
	Carl Zeiss Pty Ltd
CZ031	AT TORBI 709MP (Standard 	Bitoric, preloaded, micro incision, 	Diopter range: Sph -10.0 to 	$760.00
	aspheric (aberration neutral), foldable,	32.0, Cyl +1.0 to 6.5
	 square-edged, single-piece IOL for 	Optic size: 6.0mm, Overall 
	capsular bag fixation	length: 11.0mm
Prostheses List by Category, Groups and Sponsor	Page 3 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	at, pl, t2
	Carl Zeiss Pty Ltd
CZ032	AT TORBI 709MP (high cyl)	Bitoric, preloaded, micro incision, 	Diopter range: Sph -10.0 to 	$1,061.00
	aspheric (aberration neutral), foldable,	32.0, Cyl +7.0 to 12.0, 
	 square-edged, single-piece IOL for 	Optic size: 6.0mm. Overall 
	capsular bag fixation	Length 11.0mm
	at, t1
	Carl Zeiss Pty Ltd
CZ020	AT TORBI 709M	STANDARD RANGE BITORIC - 	6mm optic, 11mm overall 	$740.00
	ZEISS Micro Incision Aspheric 	diameter. Diopter range: 
	(abberation neutral) IOL: Foldable, 	Sph -10.0 to +32.0D, Cyl 
	square-edged, single piece IOL for 	+1.0 to 6.5D (all 0.5D 
	capsular bag fixation
	t2, at
	Carl Zeiss Pty Ltd
CZ027	AT TORBI 709M	HIGH CYLINDER BITORIC - ZEISS 	6mm optic, 11mm overall 	$1,041.00
	Micro Incision Aspheric (aberration 	diameter.  Diopter range: 
	neutral) IOL: Foldable square edged, 	Sph -10.0 to +32.0D, +7.0 
	single piece IOL for capsular bag 	to 12.0D (all 0.5D steps)
	fixation
	01.02.02.02 - No edge modification
	Ellex Australia Pty Ltd
XE002	Staar foldable silicone intraocular 	Polyimide haptics 6.3mm optic - low 	14.0mm length	$281.00
	lens: Model AQ 5010V	diopters
	t1
	Ellex Australia Pty Ltd
XE001	Staar Toric foldable silicone 	Plate haptics 6.0mm optic	10.8mm - 11.2mm length	$579.00
	intraocular lens: Model AA4203TF;
	 Model AA4203TL
	01.02.02.03 - Edge modification
	Alcon Laboratories (Aust.) Pty Ltd
AL004	 Acrysof Multipiece Models 	Foldable Acrylic Multi-piece Lens	 -5 D to +30 D	$322.00
	MA50BM, MA60AC
Prostheses List by Category, Groups and Sponsor	Page 4 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AL011	Acrysof Model SA60AT	Foldable Acrylic Single-piece Lens, 	Range of Powers: +6 to +40 D	$322.00
	asymmetric optic/consistent edge
	AMO Australia Pty Ltd
AO002	Sensar  AR40 Monofocal Acrylic 	Soft Acrylic, Foldable, UV 	6 mm Optic Diameter x 	$322.00
	IOL,  Sensar OptiEdge AR40e 	Absorbing, Posterior	13mm in overall length.      
	Foldable Acrylic IOL
	Carl Zeiss Pty Ltd
CZ029	CT 53N	Foldable, 3-piece, monofocal, square-	Diopter range: 0.0 to 40.0, 	$322.00
	edged, hydrophilic acrylic (with 	Optic size: 6.0mm, Overall 
	hydrophobic surface properties) 	length: 13.0mm
	intraocular lens for capsular bag or 
	sulcus fixation.
	Device Technologies Australia Pty Ltd
DE398	Oculentis LENTIS L-302-1	Foldable one-piece monofocal C loop 	Optic Size 6.0mm, Overall 	$322.00
	acrylic IOL.	Length 12.00mm. +-0.0D to 
	+35.0D (1.0D steps) and 
	+15.5D to +26.5D (0.5D 
	steps).
	Ellex Australia Pty Ltd
XE003	Staar foldable silicone IOLs: 	Plate haptics 6.0mm; Polymide 	10.8mm 0 13.5mm length	$322.00
	Models AQ2010V, AQ2017V and 	haptics 5.5 or 6.3mm optic;
	Kevin Grundy (IBD) Pty Ltd
KG001	Rayner C-Flex	Hydrophilic HEMA-MMA 	5.75mm dia optic, 12.00mm 	$322.00
	copolymer, foldable with injector	dia overall
KG002	Superflex	Hydrophilic HEMA-MMA 	6.25mm dia optic, 12.5mm 	$322.00
	copolymer, foldable with injector	dia overall
	at
	AMO Australia Pty Ltd
AO014	TECNIS™ Intraocular Lens (Z9002 	Foldable Intraocular Lenses - 	5-10 dioptre in 1.0 dioptre 	$364.00
	& ZA9003)	Ultraviolet light absorbing posterior 	increments; 10.5 - 30 
	chamber intraocular lenses, 	dioptre in 0.5 increments
	Silicone/Acrylic
AO024	Tecnis™ One Piece (ZCB00)	One piece intraocular lens with edge 	+5 diopters to +34 diopters 	$364.00
	modification and 360 degree square 	in 0.5d increments
	edge
Prostheses List by Category, Groups and Sponsor	Page 5 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Bausch & Lomb (Australia) Pty Ltd
BL022	SofPort Advanced Optic (AO)	Posterior chamber, foldable silicone 	0 D to 30.0 D	$364.00
	IOL with anterior optic-haptic square 
	edge, posteriof optic-haptic square 
	edge, 360-degree optic square edge 
	and asperic optic for aberration control
BL023	Akreos Advanced Optic	Posterior chamber, foldable acrylic 	0 D to 30.0 D	$364.00
	IOL, with anterior optic-haptic square
	 edge, posterior optic-haptic square 
	edge, 360 degree optic square edge 
	and aspheric optic for aberration 
BL030	enVista	The enVista, Model MX60, is an ultra-	Overall diameter 12.5mm, 	$364.00
	violet-absorbing, posterior chamber, 	optic body diameter 6.0mm 
	hydrophobic acrylic one-piece 	in dioptric powers ranging 
	foldable intraocular lens (IOL)  Has 	from +0.0 to +34D
	an aspheric lens optic, square 	0.0D to 10.0D in 1 Diopter 
	posterior edge, modified C haptics and	increments
	 available in dioptric powers ranging 	11.0D to 30.0D in 0.5 
	from +0.0 to +34.0D.	Diopter increments
	31.0D to 34.0D in 1 
	Diopter increments
	Carl Zeiss Pty Ltd
CZ030	CT ASPHINA 404	Small incision, foldable, single piece, 	Diopter range: -10.0 to 	$364.00
	monofocal, aspheric (aberration 	42.0, Optic size: 6.0mm, 
	neutral), square-edged, hydrophilic 	Overall length: 11.0mm
	acrylic (with hydrophobic surface 
	properties) intraocular lens for 
	capsular bag fixation. (Monofocal lens
	 for powers outside standard 409MP 
	MICS range).
	Device Technologies Australia Pty Ltd
DE399	Oculentis LENTIS L-312	Foldable one-piece monofocal acrylic 	Optic size 6.0mm, Overall 	$364.00
	C Loop IOL	Length 12.00mm. Central 
	Thickness 1.02mm 
	(+22.0D). Available 
	Diopters: -10.0D to35.0D 
	(1.0D steps). +10.5D to 
Prostheses List by Category, Groups and Sponsor	Page 6 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE400	Oculentis LENTIS L-313	Foldable one-piece monofocal acrylic 	Optic size 6.0mm, Overall 	$364.00
	plate haptic  IOL	Length 11.00mm. Available 
	Diopters: +-0.0D to 35.0D 
	(1.0D steps). +10.5D to 
	29.5D (0.5D steps)
DE401	Oculentis LENTIS L-402	Foldable three piece monofocal acrylic	Optic Size 6.0mm, Overall 	$364.00
	 IOL.	Length 13.00mm. +-0.0D to 
	+35.0D (1.0D) + 15.5D to 
	+26.5D (0.5D). Minus range
	 on demand.
	IQ Medical
IQ004	Softec	Acrylic, single piece, foldable 	Available in dioptric 	$364.00
	intraocular lens with anterior and 	powers from -5.0 to +36.0, 
	posterior optic-haptic square edge, 	1D steps: -5.0 to +10.0 and 
	360 degree optic square edge design, 	+31.0 to +36.0; 0.5D steps: 
	precision power calculation and 	+10.5 to +18.0 and +25.0 to 
	aberration technology	+29.5; 0.25D steps: +18.0 
	to +25.0
IQ013	PreciSAL 302AC	Acrylic, single piece, foldable 	Available in dioptric 	$364.00
	intraocular lens with anterior and 	powers from 0.0 to +30.0. 
	posterior optic-haptic square edge, 	1D steps: 0.0 to +10.0; 
	360 degree optic square edge design, 	0.5D steps: +10.5 to + 17.5 
	precision power calculation, 	and +28.5 to +30.0; 0.25D 
	aberration technology and UV light 	steps: +18.0 to +28.0
	Kevin Grundy (IBD) Pty Ltd
KG012	Rayner "C-Flex" and Superflex" 	Aspheric Intra Ocular Lenses with 	C-Flex -970C + 22.5D to 	$364.00
	Aspheric IOL	Amon-Apple enhanced 360 Degree 	+34D Superflex-920H - 10D
	square edge, Anti-vaulting Haptics	 to +22D
	at, pl
	AMO Australia Pty Ltd
AO034	TECNIS® 1-Piece Pre-Loaded IOL	1-piece IOL Posterior Chamber 	+5.0 to +34.0 diopter 	$374.00
	Intraocular lens, incorporates a 	powers in 0.5 diopter 
	proprietary wavefront-designed 	increments.  Overall 
	aspheric optic with a squared 	diameter 13mm, Optic size 
	posterior optic edge designed to 
	provide a 360 degree barrier. The edge
	 of the optic has a frosted design to 
	reduce potential edge glare effects. 
	Supplied pre-loaded in a screw style 
	disposable injector.
Prostheses List by Category, Groups and Sponsor	Page 7 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ellex Australia Pty Ltd
XE004	Preloaded Aspheric Intraocular 	Silicone intraocular lens	6.0mm	$374.00
	IQ Medical
IQ014	PreciSAL P302AC	Preloaded Acrylic, single piece, 	Available in dioptric 	$374.00
	foldable intraocular lens with anterior	powers from 0.0 to +30.0. 
	 and posterior optic-haptic square 	1D steps: 0.0 to +10.0; 
	edge, 360 degree optic square edge 	0.5D steps: +10.5 to + 17.5 
	design, precision power calculation, 	and +28.5 to +30.0; 0.25D 
	aberration technology and UV light 	steps: +18.0 to +28.0
	at, pl, t1
	Bausch & Lomb (Australia) Pty Ltd
BL032	enVista Toric	The enVista toric (Model MX60T) is a 	Overall diameter is 12.5mm 	$760.00
	one-piece glistening-free 	for the entire lens power 
	hydrophobic foldable IOL. The 	range, with spherical 
	enVista Toric, model MX60T IOL has 	equivalent powers from +6.0
	a Toric aspheric lens optic, a square 	 to +30.0 Diopters in 0.5 
	posterior edge and modified C haptics,	Diopter steps and cylinder 
	 an overall diameter of 12.5mm and an 	powers from +1D to 6D  
	optic body of 6.0mm.  It is available in	Diopters (at the IOL plane).
	 multiple spherical and cylindrical 
	powers.
	IQ Medical
IQ017	PreciSAL Toric T302AC	Acrylic single piece, foldable 	Available in spherical 	$760.00
	intraocular lens with anterior and 	dioptric powers from 0.0 to 
	posterior optic-haptic square edge, 	+30.0. 1D steps: 0.0 to 
	360 degree optic square edge design, 	+10.0; 0.5D steps: +10.5 to 
	precision power calculation, 	+17.5 and +28.5 to +30.0; 
	aberration technology, toric 	0.25D steps: +18.0 to 
	correction on anterior surface with 	+28.0; Cylinder powers 
	cylinder marks to indicate flat 	from 1.0D to 6.0D
	meridian plus the cylinder axis to 
	allow alignment for astigmatic 
	correction, and UV filter.
Prostheses List by Category, Groups and Sponsor	Page 8 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
IQ018	PreciSAL Toric PT302AC	Pre-loaded acrylic single piece, 	Available in spherical 	$760.00
	foldable intraocular lens with anterior	dioptric powers from 0.0 to 
	 and posterior optic-haptic square 	+30.0. 1D steps: 0.0 to 
	edge, 360 degree optic square edge 	+10.0; 0.5D steps: +10.5 to 
	design, precision power calculation, 	+17.5 and +28.5 to +30.0; 
	aberration technology, toric 	0.25D steps: +18.0 to 
	correction on anterior surface with 	+28.0; Cylinder powers 
	cylinder marks to indicate flat 	from 1.0D to 6.0D
	meridian plus the cylinder axis to 
	allow alignment for astigmatic 
	correction, and UV filter.
	at, pl, t1, vblf
	Design for Vision Pty Ltd
DV253	HOYA AF-1 351 Toric 	Preloaded injector system, correct 	IOL Power: + 10.0 to 30.0 	$800.00
	T3/T4/T5/T6/T7/T8/T9	corneal astigmatism micro-incision, 	(0.5 steps), IOL Cylinder 
	ashperic, blue-blocker, single piece 	power: 1.50D (351T3), 
	hydophobic.	2.25D (351T4), 3.00D 
	(351T5), 3.75D (351T6), 
	4.50D (351T7), 5.25D 
	(351T8), 6.00D (351T9)
	at, pl, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL024	AcrySert model SN60WS	Foldable Acrylic Single-piece Lens 	+6 to +30 D	$405.00
	with Blue light protection and 
	aspheric correction, in cartridge.
AL031	AcrySert C Model SN6CWS	Posterior chamber, UV absorbing, 	+6.0 to +30.0 D	$405.00
	foldable, acrylic, single piece lens 
	with blue light protection and 
	aspheric correction, in cartridge
	Design for Vision Pty Ltd
DV250	Hoya-PS AF-1 (UY) PY-60AD	Preloaded in cartridge, Aspheric, Blue	+6.0D to +30.0D (0.5D 	$405.00
	 blocker, Foldable, Single-Piece, 
	Hydrophobic Acrylic
DV252	HOYA iSert® 251	Preloaded injector system, Micro-	+6.0D to 30.0D (5 steps)	$405.00
	incision, Aspheric, Blue-Blocker, 
	Single Piece, Hydrophobic
Prostheses List by Category, Groups and Sponsor	Page 9 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	IQ Medical
IQ016	PreciSAL P302A	Preloaded Acrylic, single piece, 	Available in dioptric 	$405.00
	foldable intraocular lens with anterior	powers from 0.0 to +30.0. 
	 and posterior optic-haptic square 	1D steps: 0.0 to +10.0; 
	edge, 360 degree optic square edge 	0.5D steps: +10.5 to +17.5 
	design, precision power calculation, 	and +28.5 to +30.0; 0.25D 
	aberration technology and blue light 	steps: +18.0 to +28.0
	at, t1
	AMO Australia Pty Ltd
AO031	TECNIS® Toric 1-Piece IOL	1-piece IOL Posterior chamber 	+5.0 to +34.0 diopter 	$740.00
	Intraocular lens, incorporates a 	powers in 0.5 diopter 
	proprietary wavefront designed toric 	increments.  Cylinder 
	aspheric optic with a squared 	power: 1.00 diopter, 1.50 
	posterior optic edge designed to 	diopter, 2.25 diopter, 3.00 
	provide a 360 degree barrier. The edge	diopter and 4.00 diopter (as 
	 of the optic has a frosted design to 	measured at the IOL plane). 
	reduce potential edge glare effects.	Overall diameter 13mm, 
	Optic size 6mm.
	Device Technologies Australia Pty Ltd
DE390	Oculentis LENTIS Tplus LU-313T	Patient Specific: Foldable one-piece 	Optic Size 6.0mm, overall 	$740.00
	monofocal toric acrylic IOL	length 11.0mm. Sph +/-0.0D
	 to +35.0D (in 0.01D 
	increments) Cyl +0.25 to 
	+6.99D cyl (in 0.01D 
	increments)
DE397	Oculentis LENTIS Tplus LS-313 	Foldable one-piece monofocal toric 	Optic Size 6.0mm, Overall 	$740.00
	T1-T6	acrylic IOL.	Length 11.00mm. Available 
	diopters: +10.0D to +30.0D
	 (0.5D). Cyl: (T1 +1.5D) (T2
	 +2.25D) (T3 +3.0D) (T4 
	+3.75D) (T5 +4.5D) (T6 
	+5.25D)
Prostheses List by Category, Groups and Sponsor	Page 10 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	at, t1, pl, vblf
	IQ Medical
IQ020	PreciSAL Toric PT302A	Pre-loaded acrylic single piece, 	Available in spherical 	$800.00
	foldable intraocular lens with anterior	dioptric powers from 0.0 to 
	 and posterior optic-haptic square 	+30.0. 1D steps: 0.0 to 
	edge, 360 degree optic square edge 	+10.0; 0.5D steps: +10.5 to 
	design, precision power calculation, 	+17.5 and +28.5 to +30.0; 
	aberration technology, toric 	0.25D steps: +18.0 to 
	correction on anterior surface with 	+28.0; Cylinder powers 
	cylinder marks to indicate flat 	from 1.0D to 6.0D
	meridian plus the cylinder axis to 
	allow alignment for astigmatic 
	correction, and UV and blue light 
	filters.
	at, t1, vblf
	Device Technologies Australia Pty Ltd
DE392	Oculentis LENTIS LU-313-TY	Patient Specific: Foldable one-piece 	Optic Size: 6.0mm, overall 	$780.00
	monofocal toric acrylic IOL. Violet 	length 11.00mm. Sph +/-
	Light Filter	0.0D to +35.0D (in 0.01D 
	increments) Cyl +0.25D to 
	+6.99D cyl (in 0.01D 
	increments)
	IQ Medical
IQ019	PreciSAL Toric T302A	Acrylic single piece, foldable 	Available in spherical 	$780.00
	intraocular lens with anterior and 	dioptric powers from 0.0 to 
	posterior optic-haptic square edge, 	+30.0. 1D steps: 0.0 to 
	360 degree optic square edge design, 	+10.0; 0.5D steps: +10.5 to 
	precision power calculation, 	+17.5 and +28.5 to +30.0; 
	aberration technology, toric 	0.25D steps: +18.0 to 
	correction on anterior surface with 	+28.0; Cylinder powers 
	cylinder marks to indicate flat 	from 1.0D to 6.0D
	meridian plus the cylinder axis to 
	allow alignment for astigmatic 
	correction, and UV and blue light 
	filters.
Prostheses List by Category, Groups and Sponsor	Page 11 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	at, t2
	Device Technologies Australia Pty Ltd
DE391	Oculentis LENTIS Tplus LU-313T	Patient Specific: Foldable one-piece 	Optic Size: 6.0mm, overall 	$1,042.00
	monofocal toric acrylic IOL	length 11.00mm. Sph +/-
	0.0D to +35.0D (in 0.01D 
	increments) Cyl +6.99D to 
	+12.0D cyl (in 0.01D 
	increments)
	at, t2, vblf
	Device Technologies Australia Pty Ltd
DE393	Oculentis LENTIS T plus LU-313-TY	Patient Specific: Foldable one-piece 	Optic Size: 6.0mm, overall 	$1,084.00
	monofocal toric acrylic IOL. Violet 	length 11.00mm. Available 
	Light Filter.	diopters: Cyl +7.00D to 
	+12.0D inclusive in 0.01D 
	increments.
	at, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL021	Alcon AcrySof SN60WF	Foldable Acrylic Single-piece Lens 	+ 6.0 D to +30.0 D	$385.00
	with Blue Light Protection and 
	Aspheric Correction
	Bausch & Lomb (Australia) Pty Ltd
BL025	SofPort Advanced Optic (AO) 	Posterior chamber, aphakic, foldable 	6mm optic 13mm overall 	$385.00
	Violet Shield	silicone, anterior & posterior edge 	lengthModified  C 5 
	modification intraocular lens with 	degree angulation 0-30D, 
	aberration technology, a violet light	0.5D steps
	Design for Vision Pty Ltd
DV247	HOYA AF-1  iMics1 NY-60	Mini Incision, Aspheric, Blue-	+6.0D to 30.0D (0.5 steps)	$385.00
	blocker, Single-piece, Hydrophobic
	Device Technologies Australia Pty Ltd
DE402	Oculentis LENTIS LS-312Y	Foldable one-piece monofocal C Loop	Optic Size 6.0mm, Overall 	$385.00
	 Acrylic IOL. Violet Light filter.	Length 12.0mm. Available 
	Diopters: +-0.0D to 35.0D 
	(1.0D steps) +15.5D to 
	26.5D (0.5D steps).
Prostheses List by Category, Groups and Sponsor	Page 12 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE403	Oculentis LENTIS LS-313Y	Foldable one-piece monofocal acrylic 	Optic Size 6.0mm, Overall 	$385.00
	plate haptic IOL. Violet Light Filter	Length 11.00mm. Available 
	Diopters: +-0.0D to 35.0D 
	(1.0D steps). +15.5D to 
	26.5D (0.5D steps).
	IQ Medical
IQ009	Softec HDY	Acrylic, single piece, foldable 	Available in dioptric 	$385.00
	intraocular lens with anterior and 	powers from -5.0 to + 36.0, 
	posterior optic-haptic square edge, 	1D steps: -5.0 to +10.0 and 
	360 degree optic square edge design, 	+31.0 to +36.0; 0.5D steps: 
	precision power calculation, 	+10.5 to +18.0 and +25.0 to 
	aberration technology and blue light 	29.5; 0.25D steps: + 18.0 to
	 +25.0
IQ015	PreciSAL 302A	Acrylic, single piece, foldable 	Available in dioptric 	$385.00
	intraocular lens with anterior and 	powers from 0.0 to +30.0. 
	posterior optic-haptic square edge, 	1D steps: 0.0 to +10.0; 
	360 degree optic square edge design, 	0.5D steps: +10.5 to +17.5 
	precision power calculation, 	and +28.5 to +30.0; 0.25D 
	aberration technology and blue light 	steps: +18.0 to +28.0
	pl
	Ellex Australia Pty Ltd
XE005	Staar KS-Xs Preloaded Acrylic 	Preloaded acrylic lens with anterior 	Optic diameter 6.0mm, 	$332.00
	Intraocular Lens	and posterior edge modification	overall length 12.5mm, 
	diopter range +10 to +28.0
	t1
	Kevin Grundy (IBD) Pty Ltd
KG003	Rayner Standard Toric C-Flex	Hydrophilic HEMA-MMA 	5.00mm dia optic, 12.00mm 	$698.00
	copolymer, foldable with injector	dia overall, cyls 2.0D to 
	6.0D in 2D increments
	t1, at, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL032	AcrySof IQ Toric IOL	Posterior chamber, UV absorbing, 	+6 to +30 D spherical; 1.00 	$780.00
	foldable, acrylic, toric, single piece 	to 6.00 D cylinder.
	lens with blue light protection and 
	aspheric correction
Prostheses List by Category, Groups and Sponsor	Page 13 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Design for Vision Pty Ltd
DV251	HOYA AF - 1 311 Toric T3/T4/T5	Correct Corneal Astigmatism, Micro-	lOL Power: 6.0D to 30.0D 	$780.00
	incision,Aspheric, Blue-Blocker, 	(0.5 steps)lOL Cylinder 
	Single Piece, Hydrophobic	Power: 1.50D (311T3), 
	2.25D (311T4), 3.00D 
	(311T5)
	t1, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL023	Alcon AcrySof Toric PC IOL Models	Posterior chamber, UV absorbing, 	+6 to +34 D spherical; 1.50 	$740.00
	foldable, acrylic, toric, single piece 	to 6.00 D cylinder
	lens with blue light protection
	t2
	Kevin Grundy (IBD) Pty Ltd
KG004	Rayner Premium Toric C-Flex	HEMA-MMA copolymer, foldable 	5.75mm dia optic, 12.00mm 	$1,000.00
	with injector	dia overall, cyls 1.5D to 
	11.0D in 0.5D increments
KG013	Rayner Super Premium Toric I.O.L.	Acrylic foldable toric single piece 	-10.0D to 0.00D Sphere: 1D	$1,000.00
	 to 11.00D Cylinder in 0.25 
	steps                                            
	               +31.00D to +35.00 
	Spit: 1D to 11.00D 
	Cylinder in 0.25steps
	vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL016	Alcon Acrysof Natural Model 	Foldable Acrylic Single-piece Lens, 	+6 to +40D	$364.00
	SN60AT	asymmetric optic/consistent edge, 
	with blue light protection
AL025	AcrySof Multipiece Models 	Foldable Acrylic multi-piece Lens 	- 5 D to + 30 D	$364.00
	MN60MA, MN60AC	with Blue light Protection
Prostheses List by Category, Groups and Sponsor	Page 14 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.02.02.04 - Multifocal or bifocal
	at
	AMO Australia Pty Ltd
AO026	TECNIS™ Multifocal Intraocular 	Posterior chamber lens with UV light-	+5 diopters to +34 diopters 	$822.00
	Lens (ZMA00)	absorbing, foldable acrylic, 3-piece 	in 0.5d increments
	with a diffractive posterior optic and a
	 modified anterior surface technology 
	with edge modification and 360 
	degree square edge.
AO027	Tecnis Multifocal 1-Piece Lens, 	A multifocal posterior chamber lens 	6.0mm Optic Diameter x 	$822.00
	Models ZMB00, ZKB00, ZLB00	with UV-blocking, foldable acrylic, 1-	13.0mm in overall length.  
	piece with a diffractive posterior optic	+5.0 Diopter to +34.0 
	 and a modified anterior surface 	Diopter in 0.5 Diopter 
	technology with edge modification 	increments. ZCB00 +4.00 
	and a 360 degree square edge.	Diopter add, ZKB00 +2.75 
	add, ZLB00 +3.25 add
	Carl Zeiss Pty Ltd
CZ015	AT LISA 809M	ZEISS micro incision, aspheric 	6mm optic, 11mm diameter.  	$822.00
	multifocal IOL.  Diffractive bifocal 	Diopter range 0.0D to 
	anterior surface with asymmetric light 	+32.0D (0.5D steps)
	distribution (65% distance / 35% 
	near), 3.75D addition for near focus.
	Device Technologies Australia Pty Ltd
DE396	Oculentis LENTIS Mplus LS-313 	Foldable one-piece multifocal plate 	Overall Length 11.0mm and 	$822.00
	haptic acrylic IOL.	Optic Size 6.0mm Available 
	diopters +-0.0D to +36.0D 
	(0.05D steps)
	IQ Medical
IQ021	Lenstec SBL-3	Acrylic single piece, foldable 	Available in dioptric 	$822.00
	intraocular lens with anterior and 	powers from 10.0 to +36.0. 
	posterior optic-haptic square edge, 	1D steps: 30.0 to +36.0; 
	360 degree optic square edge design, 	0.5D steps: +10.0 to +15.0 
	precision power calculation, 	and +25.0 to +29.5; 0.25D 
	aberration technology, segmented bi-	steps: +15.25 to +24.75
	focal optic with +3.0 D of near power, 
	and UV filter.
Prostheses List by Category, Groups and Sponsor	Page 15 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Kevin Grundy (IBD) Pty Ltd
KG009	Rayner "M-Flex" Mulitfocal 	Acrylic, Foldable, Single piece multi-	6.5mm Optic-Overall 	$822.00
	Foldable IOL	zoned refractive aspheric multifocal 	diameter 12.5mm: +3D or + 
	with Amon-Apple 360 Degree Square 	4D Addition: +14D to 
	edge, Anti Vaulting Haptics	+25D in 1.0D increments: 
	+8.5D to +23.5D in 0.5D 
	at, pl
	Carl Zeiss Pty Ltd
CZ033	AT LISA 809MP	Preloaded, micro incision, aspherical 	Diopter range: 0.0 to 32.0	$842.00
	bifocal, square edged, single-piece 	Optic size: 6.0mm.  Overall 
	IOL for capsular bag fixation. The 	length: 11.0mm
	anterior aspheric bifocal surface has an
	 asymmetric light distribution 65/35 
	for distance/near vision, and 3.75D 
	add for the near focus.
CZ034	AT LISA tri 839MP	Trifocal (aspheric) micro incision, 	Diopter range: 0.0 to 	$842.00
	single-piece IOL for capsular bag 	+32.0D (0.5D increments). 
	fixation, implantable with preloaded 	Optic size: 6.0mm. Overall 
	injector system.  The trifocal (anterior)	Length: 11.0mm
	 optic provides two diffractive focal 
	points (+3.33D near focus and +1.66D
	 intermediate focus) with asymmetric 
	light distribution 50% distance / 20%
	 intermediate / 30% near vision.
	at, pl, t1
	Carl Zeiss Pty Ltd
CZ035	AT LISA toric 909MP	ZEISS pre-loaded, micro incision, 	6mm optic, 11mm diameter. 	$1,218.00
	multifocal toric IOL. Aspheric toric 	Diopter range: Sph +6.0D 
	anterior surface, diffractive bifocal 	to 24.0D, Cyl +1.0 to 4.0D 
	posterior surface with asymmetric 	(all 0.5D steps)
	light distribution (65% distance/ 35%
	 near), and 3.75D addition for near 
Prostheses List by Category, Groups and Sponsor	Page 16 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
CZ036	AT LISA tri Toric 939MP	Trifocal (aspheric), bitoric, micro 	Diopter range -10.00 to 	$1,218.00
	incision, single-piece IOL for 	+28.0 and +1 to +4.0 DC 
	capsular bag fixation, implantable 	Optic size: 6..00mml; 
	with preloaded injector system. The 	Overall length: 11.mm
	trifocal (anterior) optic provides two 
	diffractive focal points (+3.33D near 
	focus and + 1.66D intermediate focus) 
	with asymmetric light distribution 
	50% distance / 20% intermediate / 
	30% near vision,
	at, t1
	AMO Australia Pty Ltd
AO033	Tecnis Multifocal Toric	Toric Multifocal Intraocular Lens	+5.0 Diopters to +34.0 	$1,198.00
	Diopters in 0.5 Diopter 
	increments.  Cylinder 
	powers 1.50D, 2.25D, 
	3.00D and 4.00D
	Carl Zeiss Pty Ltd
CZ038	AT LISA tri toric 939M low cylinder	Trifocal (aspheric), bitoric, micro 	Diopter range: -10.00 to + 	$1,198.00
	incision, single-piece IOL for 	32.0 DS and +1 to +6.5DC
	capsular bag fixation.  The trifocal 	Optic Size: 6.0mm. Overall 
	(anterior) optic provides two 	Length: 11.0mm
	diffractive focal points (+3.33D near 
	focus and +1.66D intermediate focus) 
	with asymmetric light distribution 
	50% distance / 20% intermediate / 
	30% near vision.
	Device Technologies Australia Pty Ltd
DE388	Oculentis LENTIS Mplus Toric LU-	Patient specific one-piece multifocal-	Overall Length 11.0mm and 	$1,198.00
	313MFT	toric plate haptic acrylic IOL	Optic Size 6.0mm + 0.0D to 
	+36.0D inclusive in 0.01D 
	increments. Cyl +0.25 to 
	+6.99D inclusive in 0.01D 
	increments
Prostheses List by Category, Groups and Sponsor	Page 17 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	at, t1, vblf
	Device Technologies Australia Pty Ltd
DE394	Oculentis LENTIS Mplus Toric LU-	Patient specific one-piece multifocal-	Overall Length 11.0mm and 	$1,240.00
	313 MF30TY	toric plate haptic acrylic IOL.	Optic Size 6.0mm, +-0.0D to
	 +36.0D inclusive in 0.01D 
	increments. Cyl +0.25D to 
	+6.99D inclusive in 0.01D 
	increments.
	at, t2
	Carl Zeiss Pty Ltd
CZ039	AT LISA tri toric 939M high 	Trifocal (aspheric), bitoric, micro 	Diopter range: -10.00 to + 	$1,500.00
	powered cylinder	incision, single-piece IOL for 	32.0 DS and +7 to +12 DC
	capsular bag fixation. The trifocal 	Optic Size: 6.0mm. Overall 
	(anterior) optic provides two 	Length: 11.0mm
	diffractive focal points (+3.33D near 
	focus and +1.66D intermediate focus) 
	with asymmetric light distribution 
	50% distance / 20% intermediate / 
	30% near vision.
	Device Technologies Australia Pty Ltd
DE389	Oculentis LENTIS Mplus LU-	Patient specific one-piece multifocal-	Overall Length 11.0mm and 	$1,500.00
	313MFT	toric acrylic plate haptic IOL	Optic size 6.0mm +-0.0D to 
	+36.0D inclusive in 0.01D 
	increments. Cyl +6.99D to 
	+12.0D inclusive in 0.01D 
	increments
	at, t2, vblf
	Device Technologies Australia Pty Ltd
DE395	Oculentis LENTIS Mplus LU-313 	Patient specific one-piece multifocal 	Overall Length 11.00mm 	$1,542.00
	MFTY	toric plate haptic acrylic IOL. Violet 	and Optic Size 6.0mm +-
	Light Filter	0.0D to +36.0D inclusive in
	 0.01D increments.  Cyl 
	+7.00D to +12.0D inclusive
	 in 0.01D increments.
Prostheses List by Category, Groups and Sponsor	Page 18 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	at, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL028	AcrySof IQ ReSTOR SN6AD3	Posterior Chamber, UV absorbing, 	+6 D to + 34 D	$864.00
	foldable, acrylic, single piece lens 
	with apodised diffractive optic and 
	blue light protection
AL030	AcrySof IQ ReSTOR SN6AD1, 	Posterior Chamber, UV absorbing, 	+6 D to + 34 D	$864.00
	SV25T0 and MN6AD1	foldable, acrylic, single piece lens 
	with apodised diffractive optic and 
	blue light protection
	Bausch & Lomb (Australia) Pty Ltd
BL033	FineVision POD F	Posterior chamber, UV absorbing, 	An overall diameter of 	$864.00
	foldable, aspheric, acrylic, single 	11.40mm and optic diameter 
	piece lens with apodised diffractive, 	of 6.00mm. From 0 to +35 
	trifocal optic and blue light 	diopters with 0.5 diopters 
	with 0.5 diopter increments.
BL034	FineVision Micro F	Posterior chamber, UV absorbing, 	An overall diameter of 	$864.00
	foldable, aspheric, acrylic, single 	10.75mm and optic diameter 
	piece lens with apodised diffractive , 	of 6.15mm. From 0 to +35 
	trifocal optic and blue light 	dopters with 0.5 diopter 
	increments.
	Design for Vision Pty Ltd
DV248	HOYA PY-60MV	Preloaded in cartridge, Multifocal, 	+14.0D to 27.0D (0.5 steps)	$864.00
	Aspheric, Blue-blocker, Single Piece, 
	Hydrophobic
	t1, at
	Carl Zeiss Pty Ltd
CZ025	AT LISA toric 909M	ZEISS micro incision, multifocal toric 	6mm optic, 11mm diameter.  	$1,198.00
	IOL (standard cyl range). Aspheric 	Diopter range: Sph -10.0D 
	toric anterior surface, diffractive 	to +32.0D, Cyl +1.0 to 6.5D
	bifocal posterior surface with 	 (all 0.5D steps)
	asymmetric light distribution (65% 
	distance / 35% near), 3.75D addition 
	for near focus.
Prostheses List by Category, Groups and Sponsor	Page 19 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Kevin Grundy (IBD) Pty Ltd
KG010	Rayner M-Flex Toric (Standard)	Acrylic, Foldable, Single Piece, 	5.75mm / 12.0mm: 6.25mm / 	$1,198.00
	Multi-zoned Refractive Aspheric 	12.5mm +3.00D or +4.00D 
	Toric Mulitfocal with Amon-Apple 	Addition FAR: +14.0D to 
	enhanced 360 degree Square edge, 	+32.00D in 0.5 STEPS: 
	Anti Vaulting Haptics	+2.00D +3.00D  +4.00D 
	Cylinder. NEAR: +14.0D to
	 27.0D in 0.5 STEPS: 
	+2.00D +3.00D  +4.00D 
	Cylinder
KG011	Rayner "M-Flex" Toric (Non 	Acrylic, Foldable, Single Piece, Muli-	5.75/12.0mm: 6.25/12.5mm 	$1,198.00
	Standard)	Zoned Refractive, Toric Multifocal 	+3.00D to +4.00D Addition
	with Amon-Apple enhanced 360 	 FAR: +14.0D to +32.0D in 
	Degree square edge, Anti-vaulting 	0.5D Increments: NEAR: 
	Haptics, Patient Specific.	+14.0D to +27.0D in 0.50D 
	Increments Cylinder: 1.0D 
	to 1.5D and 2.5D to 6.00D 
	in 0.5 increments
	t1, at, vblf
	Alcon Laboratories (Aust.) Pty Ltd
AL033	AcrySof IQ ReSTOR multifocal toric	Posterior chamber UV absorbing 	+6  to +34 D spherical; 1.00	$1,240.00
	 IOL (SND1T2-5; SV25T2-6)	foldable, acrylic, aspheric, toric single	 to 3.00 D cylinder
	 piece lens with apodised diffractive 
	optic and blue light protection.
	t2, at
	Carl Zeiss Pty Ltd
CZ024	AT LISA toric 909M	ZEISS micro incision, multifocal toric 	6mm optic, 11mm diameter.  	$1,500.00
	IOL (high cyl range). Aspheric toric 	Diopter range: Sph -10.0D 
	anterior surface, diffractive bifocal 	to +32.0D, Cyl +7.0 to 
	posterior surface with asymmetric 	12.0D (all 0.5D steps)
	light distribution (65% distance / 
	35% near), 3.75D addition for near 
Prostheses List by Category, Groups and Sponsor	Page 20 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.02.02.05 - Accommodative
	at, pa, pl
	AMO Australia Pty Ltd
AO035	Synchrony Vu Accommodating IOL	Synchrony Vu Dual Optic 	5.50mm Anterior Optic, 	$822.00
	Accommodating Posterior Chamber 	6.00mm Interior Optic, 
	IOL	9.80mm Overall Length, 
	Diopter Range: +16.00 to 
	+28.00 in 0.5D Increments
	at, pa, t1
	Bausch & Lomb (Australia) Pty Ltd
BL031	TruLign Toric	The TruLign Toric IOL, Models 	Overall diameter is 11.5mm 	$1,198.00
	BL1AT/BL2AT and BL1UT/BL2UT 	(BL1AT,BL1UT,AT50T) or 
	is an accommodating IOL 	12.0mm (BL2AT/BL2UT) 
	incorporating a toroidal posterior 	for the entire lens power 
	surface. The foldable IOL has a square 	range. Spherical equivalent 
	posterior edge with polyimide 	powers range from +5.0 to 
	footplates and is available in multiple 	+33.0 Diopters in 0.5 
	spherical and cylindrical powers.	Diopter steps and cylinder 
	powers of +1.25, +2.00 and 
	+2.75 Diopters (at the IOL 
	plane).
	pa
	Bausch & Lomb (Australia) Pty Ltd
BL027	Crystalens HD	Accommodating lens with > 3 	10.0 to 33.0 Dioptres in .05 	$780.00
	Dioptres of accommodation with dual 	Dioptre steps
	mechanism of action: (1) forward axial 
	movement of lens and (2) 
	accommodative arching of optic.  
	Posterior chamber, polyspheric 
	optics, 3-piece, plate haptic, foldable 
	UV light filtering, bic
	IQ Medical
IQ003	Tetraflex	Acrylic single piece, foldable 	Available in dioptric 	$780.00
	accommodating intraocular lens with 	powers from +5.0 to +36.0, 
	sqare edge design, custom control 	1D steps: +31.0 to +36.0; 
	precision and closed loop haptic 	0.5D steps: +5.0 to +18.0 
	and +25.0 to +30.0; 0.2D 
	steps; +18.0 to +25.0
Prostheses List by Category, Groups and Sponsor	Page 21 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	pa, at
	Bausch & Lomb (Australia) Pty Ltd
BL029	Crystalens AO	Accommodating lens designed to 	10.0 to 33.0 D in 0.50 	$822.00
	provide > 3 Diopters of 	Diopter steps.  10.0 - 16.5 
	accommodation with dual mechanism 	Diopters (12mm length) and
	of action: (1) forward axial movement 	 17.0 - 33.0 Diopters 
	of lens and (2) accommodative arching	(11.5mm length).
	 of optic.  Posterior chamber, aspheric, 
	aberration free optics, 3-piece, plate 
	haptic, fol
01.02.03 - Pseudo-phakic, piggy-back
	01.02.03.01 - Monofocal
	Design for Vision Pty Ltd
DV246	Rayner Sulcoflex Ashperic 	Pseudophakic Supplementary 	-10.0D to -5.50D in 0.5D 	$323.00
	(Premium) I.O.L.	I.O.L.O.L.	increments.                +5.50D 
	to 10.00D in 0.5D 
	at
	Kevin Grundy (IBD) Pty Ltd
KG008	Rayner "Sulcoflex" Pseudophakic 	Sulcoflex Aspheric Pseudophakic I.O.L	-5D to +5D	$365.00
	I.O.L.
	t1, at
	Kevin Grundy (IBD) Pty Ltd
KG005	Rayner Sulcoflex Aspheric Toric 	Acrylic, Aspheric, Toric 	SE -3 to +3 in 0.5 D steps	$698.00
	Pseudophakic Secondary I.O.L - 	Pseudophakic Secondary IOL :  	Cyl +1 to +3 in 1D steps
	Standard	Sulcus fixated with undulating 
	Haptics and Posterior Haptic 
KG007	Rayner Sulcoflex Aspheric Toric 	Acrylic, Aspheric, Toric 	SE -6.00 to +6.00 in 0.5 D 	$698.00
	Pseudophakic Secondary IOL 	Pseudophakic Secondary IOL: Sulcus	steps Syl +1.00 to +6.00 in 
	(Premium)	 fixated with undulating Haptics and 	0.5D steps
	Posterior Haptic Angulation 
Prostheses List by Category, Groups and Sponsor	Page 22 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.02.03.02 - Multi-focal
	at
	Kevin Grundy (IBD) Pty Ltd
KG006	Rayner "Sulcoflex" Aspheric Multi-	Acrylic, Aspheric Multi-focal 	6.5mm / 13.5mm - 	$822.00
	focal Pseudophakic Secondary IOL	Pseudophakic Secondary IOL: 	5.00D+5.00D sphere with  
	Sulcus-Fixated with Undulating 	+ 3.00 Addition
	Haptics and Posterior Haptic 
	at, t1
	Design for Vision Pty Ltd
DV254	Rayner Premium Sulcoflex 	653Z-Premium Multifocal Toric 	-7D to +7D (Spherical 	$1,198.00
	Multifocal Toric Supplementary IOL	Supplementary IOL	Equivalent) Cylinder 1D, 
	4D, 5D, 6D Addition 3.5D
DV255	Rayner Standard Sulcoflex 	653Z-Standard Multifocal Toric 	-3D to +3D (Spherical 	$1,198.00
	Multifocal Toric Supplementary IOL	Supplementary IOL	Equivalent) Cylinders 2D 
	and 3D Addition 3.5D
01.03.01 - Viscoelastic
	Alcon Laboratories (Aust.) Pty Ltd
AL006	PROVISC VISCOELASTIC 	PROVISC contains sodium 	0.85mL pack	$80.00
	SOLUTION
AL007	VISCOAT Viscoelastic Fluid	Chondroitin sulfate and sodium 	0.75mL	$80.00
	hyaluronate
AL015	Cellugel viscoelastic fluid	Hypromellose 2%	.	$80.00
AL029	DisCoVisc Ophthalmic 	Sodium hyaluronate 17 mg/mL and 	0.5 mL and 1.0 mL	$80.00
	Viscosurgical Device	chondroitin sulfate 40mg/mL
	AMO Australia Pty Ltd
AO008	Healon, Intraocular Viscoelastic 	Sodium Hyaluronate 10mg/ml	Healon 0.4ml, 0.55ml & 	$80.00
	0.85ml
AO032	Healon Endocoat	Viscoelastic	0.85ml	$80.00
	Bausch & Lomb (Australia) Pty Ltd
BL008	Ocucoat Intraocular Fluid	20mg/mL hydroxypropylmethyl 	1ml and 2ml Sterile	$80.00
	cellulose for intraocular use
Prostheses List by Category, Groups and Sponsor	Page 23 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BL015	Amvisc Plus injection	15mg/mL Sodium Hyaluronate for 	0.5mL and 0.8mL	$80.00
	intraocular use
	Carl Zeiss Pty Ltd
CZ012	Z-HYALIN Viscoelastic	Cohesive Viscoelastic Solution - 	Volume 1.0ml	$80.00
	sodium hyaluronate 10mg/ml.  
	(previously called Ophthalin)
CZ013	Z-HYALIN Plus Viscoelastic	Cohesive Viscoelastic Solution - 	Volume 1.0ml	$80.00
	sodium hyaluronate 15mg/ml.  
	(previously called Opthalin Plus)
CZ022	VISTHESIA 1.5%	VISCOANAESTHETIC syringe 	0.8ml syringe & 2x0.3ml 	$80.00
	contains sodium hyaluronate (NaHA, 	ampoules
	1.5%) and lidocaine hydrochloride 
	(1%). Also contains two topical 
	ampoules with NaHA (0.3%) and 
	lidocaine (2%)
	IQ Medical
IQ002	Ocuvis and Ocumax 2% 	20mg/mL hydroxypropylmethyl 	2mL sterile	$80.00
	Hydroxypropylmethylcellulose	cellulose for intraocular use. Pre-
	loaded in a sterile syringe with one 
	cannula for injection, in a sterile 
	Tyvek pouch
	hmw
	AMO Australia Pty Ltd
AO009	Healon 5, Intraocular Viscoelastic 	HEALON5- Sodium hyaluronate 	0.6ml	$85.00
	Fluid	23mg/ml .
AO010	Healon GV Intraocular Viscoelastic 	Sodium Hyaluronate 14mg/mL	0.5mm and 0.85ml	$85.00
	Fluid
	01.03.01.01 - Dual Fluids
	Alcon Laboratories (Aust.) Pty Ltd
AL005	DUOVISC VISCOELASTIC SYSTEM	PROVISC contains sodium 	Small & large packs	$110.00
	hyaluronate, VISCOAT contains 
	chondroitin sulfate and sodium 
	hyaluronate
Prostheses List by Category, Groups and Sponsor	Page 24 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Carl Zeiss Pty Ltd
CZ019	TWINVISC Viscoelastic	TWINVISC includes a cohesive and a 	Total volume 1.4 ml	$110.00
	dispersive viscoelastic in one 
	syringe, separated by a valve.  
	Dispersive: sodium hyaluronate 
	(2.2%).  Cohesive: sodium 
01.03.02 - Non Viscous
	Design for Vision Pty Ltd
DV231	Vision Blue	Trypan blue dye for ophthalmic 	0.5ml syringe	$48.00
	applications
01.04.01 - Simple
	Alcon Laboratories (Aust.) Pty Ltd
AL001	Capsular Tension Rings	-	10.0 - 12.0 compressed,  	$159.00
	12.3 - 14.5 uncompressed
	AMO Australia Pty Ltd
AO021	Stabileyes Capsular Tension Ring	Polymethylmethacrylate (PMMA) 	12mm ring, and 13mm ring	$159.00
	Implant
	Carl Zeiss Pty Ltd
CZ002	Tensiobag: Capsular Tension Ring	PMMA	Diameter 10 - 14mm	$159.00
	Design for Vision Pty Ltd
DV009	Morcher Capsular Tension Ring	PMMA Implant	14, 14A, 14C	$159.00
	Emagin Pty Ltd
EG001	Capsular Tension Rings Clear	PMMA Implant	10/08, 12/10, 13/11mm	$159.00
	pl
	Design for Vision Pty Ltd
DV029	Eyejet CRT	Capsular tension ring made of PMMA 	14 (10mm), 14C (11mm), 	$243.00
	per-load on disposable injector	14A (12mm)
Prostheses List by Category, Groups and Sponsor	Page 25 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Insight Surgical Pty Ltd
IS001	Preloaded Capsulan Tension Ring	Capsular tension ring preloaded 	13/11mm	$243.00
	(acrylic)
01.04.02 - Complex
	Design for Vision Pty Ltd
DV010	Morcher Coloboma Diaphram 	PMMA Implant	96G, 96L	$334.00
01.05.01 - Long Tube
	AMO Australia Pty Ltd
AO012	Baerveldt Glaucoma Implant BG 	Non-valved artificial drainage device, 	Surface area 250, 350, 	$425.00
	101-350, Baerveldt Glaucoma 	composition silicone - smooth, 	425mm2
	Implant BG 103-425, Baerveldt 	tumble-polished finish
	Glaucoma Implant BG 103-250
	Design for Vision Pty Ltd
DV020	Molteno Implant	Double plate - dual chamber	One size only	$425.00
DV242	Molteno Implant	Glaucoma Drainage Device - Single 	N/A	$425.00
	Plate/Single Plate-Dual 
	Chamber/Double Plate
	v
	Design for Vision Pty Ltd
DV230	Molteno 3	Drainage implant for glaucoma, made 	2 Sizes: *230 mm square 	$625.00
	of silicon	*175mm square
01.05.02 - Short Tube
	01.05.02.01 - Cannulated
	Alcon Laboratories (Aust.) Pty Ltd
AL037	ExPress Minature Glaucoma Shunt	Miniature Glaucoma Shunt	50 & 200 microns	$715.00
Prostheses List by Category, Groups and Sponsor	Page 26 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.05.03 - Ab Interno Glaucoma Drainage Device
	RQSolutions Medical Devices Distribution Support
RQ072	iStent Trabecular Micro-Bypass 	The iStent GTS100R and GTS100L 	1.0mm in length, 0.33mm in 	$800.00
	are micro-invasive glaucoma surgical 	height with a snorkel 
	devices which are implanted in an "ab 	length of 0.25mm
	interno" procedure into the trabecular 
	meshwork to create a bypass through 
	the trabecular meshwok to Schlemm's 
	Canal to improve aqueous outflow 
	through the natural physiologic 
	pathway.
01.06.01 - Spacers
	Spectrum Surgical
SO017	FCI Ptose-up	Expanded PTFE	15cm long x 2 or 3mm wide 	$348.00
	x 0.35mm thick
01.06.02 - Weights
	01.06.02.01 - Gold <1.8 grams
	Design for Vision Pty Ltd
DV260	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Gold Thin 0.6, 0.8, 1.0, 1.2, 	$425.00
	patients with facial palsy	1.4, 1.6g
	Device Technologies Australia Pty Ltd
DE183	Lid Load Gold Eyelid Weights;	Gold	0.6, 0.8, 1.0, 1.2, 1.4, 1.6 	$425.00
	grams
	Spectrum Surgical
SO047	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Gold Thin 0.6, 0.8, 1.0, 1.2, 	$425.00
	patients with facial palsy	1.4, 1.6g
Prostheses List by Category, Groups and Sponsor	Page 27 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.06.02.02 - Gold ≥1.8 grams
	Design for Vision Pty Ltd
DV259	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Contour Gold 0.6, 0.8, 1.0, 	$800.00
	patients with facial palsy.	1.2, 1.4, 1.6, 1.8g
	Device Technologies Australia Pty Ltd
DE182	Lid Load Gold Eyelid Weights;	Gold	1.8, 2.0, 2.2, 2.4, 2.6, 2.8 	$800.00
	grams
	Spectrum Surgical
SO046	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Contour Gold 0.6, 0.8, 1.0, 	$800.00
	patients with facial palsy.	1.2, 1.4, 1.6, 1.8g
	01.06.02.03 - Platinum
	CoreMed Pty Ptd
RC001	LIDCHAIN Platinum Eyelid Implant	Platinum	Weights - 0.8, 1.0, 1.2, 1.4, 	$1,300.00
	1.6, 1.8 grams
	Design for Vision Pty Ltd
DV261	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Platinum Thin 0.6, 0.8, 1.0, 	$1,300.00
	 Platinum	patients with facial palsy	1.2, 1.4, 1.6g
	Contour Platinum 0.6, 0.8, 
	1.0, 1.2, 1.4, 1.6, 1.8g
	Spectrum Surgical
SO048	Meddev Eyelid Weight, Implantable	Thin Profile eyelid implants for 	Platinum Thin 0.6, 0.8, 1.0, 	$1,300.00
	 Platinum	patients with facial palsy	1.2, 1.4, 1.6g
	Contour Platinum 0.6, 0.8, 
	1.0, 1.2, 1.4, 1.6, 1.8g
01.07.01 - Intracanalicular
	Design for Vision Pty Ltd
DV022	Eyetec DCR Tubes	Stainless steel, silicone tubing, 	30cm	$135.00
	Bodkin lacrimal intubation set
DV241	Eyetec DCR Tubes	Crawford and Cannaliculus 	N/A	$135.00
	Intubation Sets
Prostheses List by Category, Groups and Sponsor	Page 28 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DV256	LIS 052 "StenTube"	Large Diameter Lachrymal Intubation 	1.32mm Tube diameter	$135.00
	Set
	Device Technologies Australia Pty Ltd
DE191	Canaliculus Intubation Sets 	Silicone, SS & Nylon	17.7 x .064 x 29cm, 15.5 x 	$135.00
	.051 x 33cm
DE278	BD Visitec Lacrimal Intubation Sets	Stainless steel probes with solid 	1. Probes 0.90mm x 4.5cm, 	$135.00
	silicone rods or silicone tubing - 	rod 40cm x 0.80mm. 2. 
	packaged sterile	Probes 0.40mm x 11cm, 
	tubing 35cm x 0.64mm. 
	Probes 0.60mm x 11mm, 
	tubing 35cm x 0.30mm.
	Spectrum Surgical
SO021	FCI Lacrimal Intubation Set	PVP Coated Silicone Tubing/PVP 	PVP Bika: 0.64mm O.D. 	$135.00
	Coated Silicone Plug/Metal 	Tube/80 x 0.8mm probes, 
	Probes/Polypropylene Thread	PVP Differential Bika: 0.64 
	& 1.18mm O.D. Tube/40 x 
	1.2mm probes, PVP Bika for 
	DCR: 0.94mm O.D. Tube/50
	 x 0.8mm probes, PVP Infant 
	Bika 0.64mm O.D. Tube/55 
	x 0.7mm probes, PVP Infant 
	Bika II: 0.64mm O.D. Tube/
SO043	FCI Bi-Canalicular Lacrimal 	Silicone tubing swaged, imbedded 	Probes: 40mm to 120mm x 	$135.00
	Intubation Set	into or around malleable and flexible 	0.7mm to 1.2mm.  Tube: 
	stainless steel probes. PEEK thread.	0.64mm to 1.18mm x 25mm 
	to 400mm.  PEEK Thread: 
	0.2mm to 0.4mm x 500mm.
	mc
	Spectrum Surgical
SO044	FCI Mono-Canalicular Lacrimal 	Silicone tubing with plug swaged, 	Probes: 40mm to 120mm x 	$180.00
	Intubation Set	imbedded into or around malleable or 	0.7mm to 1.2mm.  Tube: 
	flexible stainless steel probes or 	0.64mm to 1.18mm x 30mm 
	guides. PEEK thread. Introducer.	to 350mm.  PEEK Thread: 
	0.2mm to 0.4mm x 500mm.  
	Plug Collar: 2mm to 4mm.
Prostheses List by Category, Groups and Sponsor	Page 29 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.07.02 - Extracanalicular
	Device Technologies Australia Pty Ltd
DE177	Lester Jones Tear Duct Tubes	Glass	3 x 9 to 16mm, 3.5 x 9 to 	$84.00
	18mm, 4.0 x 9 to 24mm, 5.0 x
	 9mm
01.07.03 - Balloon Dilatation Catheters
	Design for Vision Pty Ltd
DV258	Lacricath Lachrymal Duct Balloon 	Unilateral Lachrymal Duct Balloon 	2mm, 3mm & 5mm	$485.00
	Catheter	Catheter system including inflation 
	device
	bilateral
	Design for Vision Pty Ltd
DV257	Lacricath Lachrymal Duct Balloon 	Bilateral Lachrymal Duct Balloon 	2mm, 3mm and 5mm	$879.00
	Catheter	Catheter System including inflation 
	device.
01.08.01 - Intrascleral
	Device Technologies Australia Pty Ltd
DE188	Acrylic Implant	Acrylic	12, 14, 16, 18, 20mm.	$55.00
DE202	John Weiss Glass Mule Globes	Glass	No: 12, 14, 16, 18, 20mm	$55.00
	Spectrum Surgical
SO040	FCI Orbital Implants	Silicone - Sterile	12mm to 22mm	$55.00
	vp
	Spectrum Surgical
SO006	FCI Orbital Implants	Orbital Implant, Bioceramic 	Bioceramic diameter, 12, 14, 	$1,200.00
	(Aluminium Oxide)/Hydroxyapatite 	16, 18, 20, 21, 22mm; 
	(Synthetic)	Synthetic Diameter, 10, 12, 
	14, 16, 18, 20, 22mm
Prostheses List by Category, Groups and Sponsor	Page 30 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.08.02 - Extrascleral
	01.08.02.01 - Complex and permeable
	Stryker Australia Pty Ltd
SK521	Sphere	Orbital Sphere Models 6316, 6326, 	Orbital Sphere Models 	$785.00
	6327, 6317 and 6322 8702-8704. 	6316: 14mm, 6326: 16mm, 
	COI implant, models 7222, 7223 & 	6327: 18mm, 6317: 20mm, 
	80026. MCOI implant, models 7207 - 	6322: 22mm, 8702: 19mm, 
	7209 Quad Motility Implants 9866 - 	8703: 21mm, 8704: 23mm, 
	9868 & 80022	COI Implants 7222: Approx
	 4ml, 7223: Approx 5ml, 
	80026: Approx 6ml, MCOI 
	7207: Approx 3ml, 7208: 
	Approx 4.2ml,  7209: 
	Approx 5.6ml, QUAD 
	Motility Small 16ml, 
	Medium: 18ml, Large: 20ml,
	 Extra Large: 22ml.
	ha
	Spectrum Surgical
SO007	FCI Orbital Implants	Mesh wrapped orbital implant: mesh 	Bioceramic diameter: 16, 18,	$1,600.00
	wrapped bioceramic (aluminium 	 20, 22mm; Synthetic 
	oxide), mesh wrapped hydroxyapatite 	Hydroxyapatite diameter: 
	(synthetic), mesh wrap (polyglycolic 	16, 18, 20, 22mm
	acid)
	vp
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW002	Biopore Sphere	An implantable device made of high-	14mm, 16mm, 18mm, 20mm, 	$1,930.00
	density polyethylene material with an	22mm, 24mm (diameter)
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in sizes to meet the 
	patient's specific needs.  Used for 
	orbital reconstruction following 
	enucleation and evisceration 
	procedure.
Prostheses List by Category, Groups and Sponsor	Page 31 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.08.02.02 - Multi-component
	Spectrum Surgical
SO019	FCI Orbital Implants	Peg & Sleeve	Standard Large	$863.00
01.08.03 - Fascial - solid and permeable
	Device Technologies Australia Pty Ltd
DE277	Frontalis Suspension Set	Stainless steel needles with solid 	needles 0.90mm x 6.5cm, rod	$315.00
	silicone rods and silicone tubing - 	 40cm - 0.80mm, sleeve 10 x 
	packaged sterile	2mm
	Spectrum Surgical
SO045	FCI Ptosis Probes	Stainless steel needle probes swaged 	80mm x 0.8mm needle 	$315.00
	with silicone tubing.	probes, 280mm 0.64mm 
	tubing.
01.09.01 - Buckles, bands, tyres and sponges
	Austmed Pty Limited
AP003	Mira: Scleral Implants	Solid Silicone-	Tires-Mira 286 Wendel 	$45.00
	Tire/Meridional/Wedge/Pad. Retinal 	Symmetrical Oval Tire 6mm, 
	Implant used in Scleral Buckling 	Mira Symmetrical Oval Tire 
	(Dimethylmethylvinyl Siloxane 	7mm, Mira 287WG Murray 
	Copolymer)	wide (3.5mm) grooved 
	symmetrical tire, 10mm 
	wide, Mira 288 ross 
	symmetrical grooved tire, 
	low profile 10mm wide by 
	2.5mm, Mira 289 
	Symmetrical oval tire 10m
AP004	Mira: Scleral Implants	Solid Silicone-Sleeve. Retinal Implant	Sleeves-Mira 70 Sleeve 1mm	$45.00
	 used in Scleral Buckling 	 I.D., Mira 71 Sleeve 1mm 
	(Dimethylmethylvinyl Siloxane 	I.D., Mira 72 McNutt Sleeve
	Copolymer)	 1.57mm I.D., Mira 270 
	Sleeve 0.76mm I.D.
Prostheses List by Category, Groups and Sponsor	Page 32 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AP006	Mira: Scleral Implants	Solid Silicone-Band/Strip/Boat/Clip. 	Bands-Mira 40 Circling 	$45.00
	Retinal Implant used in Scleral 	Band 2mm, Mira 240 
	Buckling (Dimethylmethylvinyl 	Circling Band 2.5mm. 
	Siloxane Copolymer)	Strips-Mira 41 Strip 3.5mm, 
	Mira 42 Strip 4mm, Mira 20 
	Strip 4mm, Mira 219 Strip 
	4.5mm, Mira 31 Strip 4.5mm,
	 Mira 32 Strip 5mm, Mira 
	225 Oval Strip 5mm, Mira 
	220 Strip 6mm. Boats-Mira 
	60 Boat 
	Device Technologies Australia Pty Ltd
DE179	Silicon Retinal Implant	Tire 	7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm	$45.00
DE181	Silicon Retinal Implant	Band	0.75 x 2.0 x 125mm, 0.60 x 	$45.00
	2.5 x 125mm, 0.75 x 2.5 x 
	125mm
	Spectrum Surgical
SO009	FCI Scleral Buckling Devices	Band/strip: solid silicone	Band - 2.0 x 0.75mm Type 	$45.00
	40, 3.5 x 0.75mm Type 41, 
	4.0 x 1.25mm Type 42, 2.5 x 
	0.6mm Type 240, Morin 3.5 
	x 0.6mmStrip - 5.7mm Type
	 20, 7.2mm Type 31, 9.2mm 
	Type 32, 6mm Type 219, 
	7.5mm Type 220, 8mm Type 
	225
SO011	FCI Scleral Buckling Devices	Tire: Solid Silicone	Symmetrical: (2.5 mm 	$45.00
	Groove, 7 to 9mm wide), 
	Biconvex: (2.5mm Groove, 7
	 to 10mm wide), 
	Asymetrical: (2.5mm 
	Groove, 7 to 10mm wide)
SO013	FCI Scleral Buckling Devices	Strip: Solid Silicone	Strip: 1.4 x 4.4 x 100mm, 	$45.00
	Morin Strip: 7mm wide x 
	100mm long, Caputo Zip 
	Strip: 7 to 9mm wide x 
	120mm long, Korobelnik 
	Oval Strip: 2 x 5mm
Prostheses List by Category, Groups and Sponsor	Page 33 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	01.09.01.01 - Sponges
	Austmed Pty Limited
AP002	Mira: Scleral Implants	Silicone Sponge- Retinal Implant 	Sponge- Mira 502 Cylinder 	$90.00
	Used in Scleral Buckling (Silicone 	2mm, Mira 5025 Cylinder 
	Elastomer Sponge)	2.5mm, Mira 503 Cylinder 
	3mm, Mira 504 Cylinder 
	4mm, Mira 505 Cylinder 
	5mm, Mira 505G Grooved 
	cylinder 5mm, Mira 505T 
	Packer tunnel cylinder 5mm,
	 Mira 510 Half cylinder 
	5mm, Mira 515 Brucker two-
	thirds cyl
	Device Technologies Australia Pty Ltd
DE178	Silicon Retinal Implant	Sponge	2.5 x 4.0 x 80mm, 3.0 x 5.0 x 	$90.00
	100mm, 3.25 x 7.0 x 80mm, 
	5.5 x 7.5 x 80mm, 1.5 x 
	80mm, 2.0 x 80mm, 2.5 x 
	80mm, 3.0 x 80mm, 4.0 x 
	80mm, 5.0 x 80mm, 7.0 x 80mm
	Spectrum Surgical
SO012	FCI Scleral Buckling Devices	Sponge/Cord: Silicone	Cord: 1.0 to 5.0mm O.D. x 	$90.00
	150mm length; Half Cord: 
	3.0mm to width x1.5mm to 
	2.5mm height x150mm; 
	Circular Sponge: 3 to 5mm; 
	Oval Sponge: 2 to 5.5mm x 
	4 to 12mm; Half Sponge: 2 
	to 3.1mm x 4 to 7.5mm; 
	Grooved Sponge: 3 to 5mm 
	x 5 to  12mm; Gain Sponge: 
	6 x 
Prostheses List by Category, Groups and Sponsor	Page 34 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.09.02 - Clips and tacks
	Device Technologies Australia Pty Ltd
DE201	Labtician Tantalum Clips	Tantalum	2, 2.5mm	$50.00
01.09.03 - Sleeves
	Device Technologies Australia Pty Ltd
DE180	Silicon Retinal Implant	Sleeve	1mm, .76mm, 1.5mm	$25.00
	Spectrum Surgical
SO010	FCI Scleral Buckling Devices	Fixation Sleeve: Solid silicone	O.D: 1.65 to 2.41mm, 	$25.00
	Length 30mm
01.09.04 - Intraocular Gases
	Alcon Laboratories (Aust.) Pty Ltd
AL035	ISPAN Retinal Gases for 	Tamponade gases for retinal surgery 	125g cylinder, dispensed in	$75.00
	Constellation® Vision System	C3F8 and SF6	 single dose syringe
AL036	ISPAN retinal gases	Tamponade gases for retinal surgery 	125 g cylinder, dispensed 	$75.00
	C3F8 and SF6	in single dose syringe
	Device Technologies Australia Pty Ltd
DE284	Single Dose Ophthalmic Gases	Single dose tamponading gas for 	30ml	$75.00
	retinal surgery
	IQ Medical
IQ012	EasyGas	Endotamponade Gases for Retinal 	60ml dispensed in a single 	$75.00
	Surgery, EasyGas SF6, C2F6 or C3F8,	dose, sterile syringe
	 each supplied in a 60ml syringe, 
Prostheses List by Category, Groups and Sponsor	Page 35 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
01.09.05 - Intraocular Heavy Liquids
	Alcon Laboratories (Aust.) Pty Ltd
AL013	Perfluoron Kits	Perfluoro-n-octane for use as a retinal 	5mL	$240.00
	surgery additive
AL014	Perfluoron Kits	Perfluoro-n-octane for use as a retinal 	7mL	$240.00
	surgery additive
	Bausch & Lomb (Australia) Pty Ltd
BL017	Perfluo-octane (Oktaline) Okta-	Perfluorocarbon Liquid  for use as a 	5mL	$240.00
	retinal surgery additive
BL018	DK Line 100% purified 	Perfluorodecalin	7ml	$240.00
	perfluorodecalin
	Design for Vision Pty Ltd
DV244	D.O.R.C. Eftiar	Eftiar Decaline and Octane 5ml	5ml	$240.00
	Device Technologies Australia Pty Ltd
DE204	Arcaline (Perfluorodecaline)	Liquid perfluorocarbon aid for retinal 	3ml, 5ml, 7ml	$240.00
	surgery, operative device for retinal 
	surgery, in particular retinal 
	detachment (RD), RD with giant tear 
	etc.
DE205	Arcotane (Perfloro-N-Octane)	Liquid perfluoro-N-Octane aid for 	5ml, 7ml	$240.00
	retinal surgery, pre-operative device 
	for retinal surgery, in particular retinal
	 detachment (RD), RD with giant tear, 
	RD with proliferative vitreal 
	retinopathy (PVR) etc.
	IQ Medical
IQ005	Densiron	Heavy Tamponade Liquid Medium, 	10 ml, Sterile	$240.00
	Postoperative
IQ008	Octane & Decalin	Perfluorocarbon retinal tamponade 	5ml & 7ml, Sterile	$240.00
	medium, intraoperative
	Spectrum Surgical
SO023	FCI - DECA, FCI - OCTA	FCI - DECA: Purified 	5ml	$240.00
	perfluorodecalin, FCI - OCTA: 
	Purified perfluoro-N-octane
Prostheses List by Category, Groups and Sponsor	Page 36 of 1059

01 - OPHTHALMIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SO024	FCI - DECA, FCI - OCTA	FCI - DECA: Purified 	7ml	$240.00
	perfluorodecalin, FCI - OCTA: 
	Purified perfluoro-N-Octane
01.09.06 - Intraocular Silicone Oils
	Bausch & Lomb (Australia) Pty Ltd
BL016	Oxane LMWC Fractioned Silicone 	Purified fractioned silicone oil	10mL	$195.00
	Oil
BL024	Oxane HD	Silicone oil - RMN3 mixture	10ml	$195.00
	Design for Vision Pty Ltd
DV243	D.O.R.C. Silicon Oil	D.O.R.C. Silicon Oil 1000/5000CS	10ml	$195.00
	Device Technologies Australia Pty Ltd
DE228	LSO Silicone Oil	Silicone oil for tamponade use in 	10ml, vial or syringe	$195.00
	vitreoretinal surgery
	IQ Medical
IQ006	Siluron 1000 & Siluron 5000	Silicone Oils	10 ml, Sterile	$195.00
	Spectrum Surgical
SO022	FCI Purified Silicone Oil (Solvent 	Viscosity: 1000 cst/5000 cst: solvent	10ml	$195.00
	Free)	 free purified silicone oil
Prostheses List by Category, Groups and Sponsor	Page 37 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
02.01.01 - Cochlear Implants
	Advanced Bionics Australia Pty Ltd
BD006	Harmony ™ HiResolution® Bionic 	The HiRes 90K with HiFocus 1j 	Straight array (1j).  56.0mm 	$13,570.00
	Ear System - HiRes 90K Implant 	Electrode is the implanted component 	(L) x 28.0mm (W) x 3.0mm 
	Cochlear Stimulator with HiFocus 	of the HiResolution Bionic Ear 	(D)
	1j Electrode	System. It receives information 
	through an RF transmission coil, 
	processes the information and then 
	sends the resulting signal to an 
	electrode array implanted in the 
	cochlea. It consists of 
	receiving/transmitting coil, 
	Stimulator electrodes and HiFocus 1j 
	Electrode array.
BD007	Harmony ™ HiResolution® Bionic 	The HiRes 90K with HiFocus Helix 	Helix (coiled) electrode 	$13,570.00
	Ear - HiRes 90K Implant Cochlear 	Electrode is the implanted component 	array - 56.0mm (L) x 28.0mm 
	Stimulator with HiFocus Helix 	of the HiResoulution Bionic Ear 	(W) x 3.0mm (D)
	Electrode	System. It receives information 
	through an RF tranmission coil, 
	precesses the information and then 
	sends the resulting signal to an 
	electrode array implanted in the 
	cochlea. It consists of 
	receiving/transmitting coil, 
	Stimulator electronics and HiFocus 
	Helix Electrode array
	Cochlear Limited
CO043	Nucleus Hybrid L 24 Implant	A Nucleus Freedom cochlear implant 	One size	$13,570.00
	featuring a special 16mm, 22 contact 
	point electrode array
CO046	Cochlear™ Nucleus® CI512 	Model CI512, 5th generation cochlear	One Size	$13,570.00
	Cochlear Implants with Contour 	 implant with perimodiloar electrode 
	Advance Electrode	array. Titanium casing, removable 
	magnet, 22 half-banded platinum 
	electrodes, moulded in a durable 
	silicone seal.
Prostheses List by Category, Groups and Sponsor	Page 38 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Med-El Implant Systems Australasia Pty Ltd
US008	Mi1000 CONCERTO/ Mi1000 	Ultra small minimally invasive 	Stimulator Housing: L 17.3 	$13,570.00
	Concerto PIN	titanium cochlear implant with six 	mm, W 25.4 mm, Thin 4.5 mm
	atraumatic electrode options.  	 (Weight 7.6g)
	Includes sequential and parallel 	Electrode: Standard (26.4 
	stimulation, comprehensive 	mm), FLEXsoft (26.4 mm), 
	diagnostic toolkit and safety features 	Medium (20.9mm), FLEX24 
	such as unique implant ID and output 	(20.9mm), Compressed 
	capacitors for each channel	(12.1mm), FLEX28 
	(23.1mm)
	Cochlear Limited
CO021	Nucleus Freedom Implant with 	Model C124RE (CA), Generation 4 	one size only	$13,570.00
	Contour Advance Electrode	Cochlear implant with perimodiolar 
	electrode array.  Titanium casing, 
	removable magnet, 22 half-banded 
	platinum electrodes, moulded in a 
	durable silicone seal
CO024	Nucleus Freedom Implant with 	Speech processor and accessories - 	One size only	$13,570.00
	Straight Electrode	Initial
CO057	Cochlear™ Nucleus® CI422 	Model CI422, 4th generation cochlear	One size	$13,570.00
	cochlear implant with Straight 	 implant with straight array.  Titanium 
	casing, removable magnet.  22 half 
	banded platinum intracochlear 
	electrodes moulded with a silicone 
	elastomer carrier and spaced over a 
	20mm active array.  The electrode 
	diameter is 0.6mm at the badal end, 
	tapering to 0.3mm at the apical 
	electrode band.
Prostheses List by Category, Groups and Sponsor	Page 39 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
02.01.02 - Speech Processors
	02.01.02.01 - Initial
	Advanced Bionics Australia Pty Ltd
BD008	Harmony™ HiResolution® Bionic 	The Auria Harmony Processor is an 	Sound Processor Size 54 	$11,500.00
	Ear System - Behind The Ear Sound 	external component of the HiRes 	mm (H) x 13mm (TH) x 21 
	Processor - Auria Harmony Sound 	Bionic Ear System. This processor is 	mm (w). Headpiece 
	Processor (INITIAL Order)	intended to deliver HiResolution 	Diameter: 28.1 mm
	sound to a cochlear implant by 
	converting sound waves (received via
	 a microphone) into an electrical 
	signal which is then transmitted to 
	the implant via a headpiece. This 
	listing includes sound processor, 
	headpiece, earhooks, powercels, 
	rechargers, cables and essential 
	accessories.
BD011	Harmony™ HiResolution® Bionic 	The Platinum Sound Processor is a 	PSP only one size; 2.69' x 	$11,500.00
	Ear System -Body worn sound 	body worn component of the HiRes 	2.19" x 0.81"                        
	processor - Platinum Series 	Bionic Ear System. This processor is 	Headpiece cable : options 
	Processor (PSP) INITIAL Order	intended to deliver HiResolution 	18, 24, 32, 42 and 48 inches
	sount to a cochlear implant by 
	converting soundwaves (received via 
	a microphone in the Platinum 
	Headpiece) into an electrical signal 
	that is then transmitted to the implant 
	via the headpiece. This listing 
	consists of the sound processor, 
	headpiece, connecting cables, and 
	essential accessory kit.
BD014	Neptune Sound Processor and 	The Neptune Processor is an external 	One size only and varying 	$11,500.00
	Headpiece (UHP) initial order 	component of the HiRes Bionic Ear 	cable lengths.
	includes Neptune Accessory Kit, 	System. This processor is intended to 
	these devices are the external part of 	deliver HiResolution sound to a 
	a cochlear implant system.	cochlear implant.
	System Composed of: Processor and 
	Universal Headpiece and Cable 
	(UHP) with Neptune Accessory kit 
	comprising : Neptune Connect , 
	Neptune Cover, Neptune cable for 
	AquaMic, Thin magnet, Foam 
	Spacer, Aquamic Color caps.
Prostheses List by Category, Groups and Sponsor	Page 40 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BD017	Naida CI Q70 Sound Processor	The Naida CI sound processor is one 	Measurements Size H x W x 	$11,500.00
	part of a cochlear implant system that 	D in mm:
	enables hearing. The other necessary 	Processor Only 26 x 9 x19
	parts of the system are the Implantable 	- with Off-the-Ear Adaptor 
	Cochlear Stimulator (ICS), headpiece 	40 x 9 x 19
	and headpiece cable. The sound 	- with 110 mAh 49 x 9 x 19
	processor consists of two parts: the 	
	sound processor and battery power 	- with 170 mAh 55x 9 x 19
	source. There are five battery options, 	- with 230 mAh 59 x 9 x 19
	including three sizes of Lithium Ion 	
	rechargeable PowerCel™ batteries 	- with Zn-Air Battery Pak 
	and a Zn-Air Battery Pak
	Cochlear Limited
CO022	Nucleus Freedom Speech Processor 	Speech processor (modular) and 	One size only	$11,500.00
	- Initial	accessories
CO048	Cochlear™ Nucleus® CP810 	The ear level sound processor of the 	One size	$11,500.00
	Sound Processor - INITIAL	Nucleus 5 cochlear implant system 
	with multiple wearing options and a 
	remote control.
CO069	Cochlear ™ Nucleus® CP910 	The Cochlear Nucleus CP910 Sound 	There is only one size of the 	$11,500.00
	Sound Processor (Initial)	Processor is a behind-the-ear sound 	processing unit and coil.
	processor two built-in directional 	There are two sizes for 
	microphones	battery holder and cover.
CO071	Cochlear ™ Nucleus® CP920 	The Cochlear Nucleus CP920 Sound 	There is only one size of the 	$11,500.00
	Sound Processor (Initial)	Processor is a behind-the-ear sound 	processing unit and coil.
	processor with two built-in 	There are two sizes for 
	directional micophones.	battery holder and cover.
	Med-El Implant Systems Australasia Pty Ltd
US004	OPUS 2 Speech Processor	Cochlear implant speech processor, 	54.0mm x 35.1mm x 8.7mm	$11,500.00
	fine structure speech processing, 
	remote control, interface for assistive 
	listening devices according to the 
	international hearing aid standard 
	(initial patient kit)
US009	RONDO Audio Processor	Single Unit audio processor for the 	One size - 44.1mm (l) x 	$11,500.00
	MED-EL Cochlear Implant System, 	37.2mm (w) x 11.8mm (h)
	integrating coil cable & electronics 
	package worn off the ear it is held in 
	place by magnetic attraction
Prostheses List by Category, Groups and Sponsor	Page 41 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Electroacoustic
	Cochlear Limited
CO044	Freedom Hybrid Sound Processor 	The modular sound processor of the 	One size	$12,950.00
	(Initial)	Cochlear Hybrid system provides 
	dual electrical and acoustic 
	processing within a single device. 
	Acoustic amplication is delivered 
	through the acoustic component and 
	electrical stimuation via the Nucleus 
	Hybrid L24 implant.
CO064	Cochlear ™ Nucleus® CP910 	The Cochlear Nucleus CP910 Sound 	There is only one size of the 	$12,950.00
	Sound Processor Hybrid™ Mode 	processor in "Hybrid Mode" facilitates	processing unit and coil.
	 electroacoustic stimulation of the 	There are two sizes for the 
	cochlea	battery holder and cover.
CO066	Cochlear™ Nucleous® CP920 	The Cochlear Nucleous CP920 Sound	There is only one size of the 	$12,950.00
	Sound Processor - Hybrid™ Mode 	 Processor in "hybrid Mode" 	processing unit and coil. 
	facilitates electroacoustic stimulation 	There are two sizes for 
	of the cochlea	battery holder and cover.
	Med-El Implant Systems Australasia Pty Ltd
US006	DUET 2	Audio Processor for Electric and 	50.6mm x 8.5mm x 59.7mm	$12,950.00
	Acoustic Stimulation (2nd 
	Generation EAS)
	02.01.02.02 - Replacement
	Generation 3
	Cochlear Limited
CO019	ESPrit 3G Speech Processor - 	Speech processor, Generation 3	Cable lengths: 6, 8, 10, 20, 	$6,790.00
	Replacement	28cm
Prostheses List by Category, Groups and Sponsor	Page 42 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Generation 4
	Advanced Bionics Australia Pty Ltd
BD009	Harmony™ HiResolution® Bionic 	The Auria Harmony Processor is an 	Sound Processor - one size 	$8,050.00
	Ear System -Behind The Ear Sound 	external component of the HiRes 	54 mm (H) x 13mm (TH) x 21
	Processor - Auria Harmony Sound 	Bionic Ear System. This processor is 	 mm (W)
	Processor (REPLACEMENT Order)	intended to deliver HiResolution 
	sound to a cochlear inplant by 
	converting sound waves (received via
	 a microphone) into an electrical 
	signal which is then transmitted to 
	the implant via a headpiece. This 
	listing Processor only.
BD012	Harmony™ HiResolution® Bionic 	The Platinum Sound Processor is a 	PSP: one size; 2.69' x 2.19" 	$8,050.00
	Ear System - Body worn Platinum 	body worn component of the HiRes 	x 0.81"
	Sound Processor (PSP) 	Bionic Ear System. This processor is 
	REPLACEMENT Order	intended to deliver HiResolution 
	sount to a cochlear implant by 
	converting soundwaves (received via 
	a microphone in the Platinum 
	Headpiece) into an electrical signal 
	that is then transmitted to the implant 
	via the headpiece. This listing comes 
	with the processor only.
BD015	Neptune Sound Processor 	The Neptune Processor is an external 	One size. 	$8,050.00
	replacement part is the external part 	component of the HiRes Bionic Ear 	Processor: H x W X D: 26 x 
	of the cochlear implant system. Also 	System. The processor is intended to 	18 x 60mm
	includes Neptune Connect	deliver HiResolution sound to a 	Neptune Connect Size:  H x 
	cochlear implant. Also includes 	W x D: 17 x 18 x 58mm
	Neptune Connect.
Prostheses List by Category, Groups and Sponsor	Page 43 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BD018	Naida CI Q70 Sound Processor	The Naida CI sound processor is one 	Measurements Size H x W x 	$8,050.00
	part of a cochlear implant system that 	D in mm
	enables hearing. The othere necessary 	Processor Only 26 x 9 x 19
	parts of the system are the Implantable 
	Cochlear Stimulator (ICS), headpiece 
	and headpiece cable. The sound 
	processor consists of two parts: the 
	sound processor and the battery 
	power sournce. There are five battery 
	options, including three sizes of 
	Lithiu Ion rechargeable PowerCel™ 
	batteries and a Zn-air Battery Pak - 
	this listing is for processor only
	Cochlear Limited
CO023	Nucleus Freedom Speech Processor	Speech processor, and accessories - 	one size only	$8,050.00
	REPLACEMENT
CO049	Cochlear™ Nucleus® CP810 	The ear level sound processor of the 	One size	$8,050.00
	Sound Processor - 	Nucleus 5 cochlear implant system 
	with multiple wearing options and a 
	remote control.
CO070	Cochlear ™ Nucleus® CP910 	The Cochlear Nucleus CP910 Sound 	CO049	$8,050.00
	Sound Processor (Replacement)	Processor is a behind-the-ear sound 
	processor with two built-in 
	directional microphones
CO072	Cochlear ™ Nucleus® CP920 	The Cochlear Nucleus CP920 Sound 	There is only one size of the 	$8,050.00
	Sound Processor (Replacement)	Processor  is a behind-the-ear sound 	processing unit and coil.
	processor with two built-in 	There are two sizes for 
	directional microphones. It has no 	battery holder and cover.
	accessory port for cables.
	Med-El Implant Systems Australasia Pty Ltd
US005	Opus 2 Speech Processor 	Cochlear implant speech processor, 	54.0mm x 35.1mm x 8.7mm	$8,050.00
	Replacement	fine structure speech processing, 
	remote control, interface for assistive 
	listening devices according to the 
	international hearing aid standard 
	(replacement kit)
Prostheses List by Category, Groups and Sponsor	Page 44 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Generation 4 Electroacoustic
	Cochlear Limited
CO065	Cochlear™ Nucleus CP910 Sound 	The Cochlear Nucleus CP910 Sound 	There is only one size of the 	$9,065.00
	Processor Hybrid™ Mode 	Processor in "Hybrid Mode" 	processing unit and coil.
	(Replacement)	facilitates electroacoustic stimulation 	There are two sizes for the 
	to the cochlea	battery holder.
CO067	Cochlear™ Nucleous® CP920 	The Cochlear Nucleous CP920 Sound	There is only one size of the 	$9,065.00
	sound Processor - Hybrid™ Mode 	 Processor in "Hybrid Mode" 	processing unit and coil. 
	(Replacement)	facilatates electroacoustic stimulation 	There are two sizes for 
	of the cochlea.	battery holder and cover.
	Generation 4, Electroacoustic
	Cochlear Limited
CO045	Freedom Hybrid Sound Processor 	The modular sound processor of the 	One size	$9,065.00
	(Replacement)	Cochlear Hybrid system provides 
	dual electronic and acoustic 
	processing within a single device. 
	Acoustic amplication is delivered 
	through the acoustic component and 
	electrical stimulation is delivered via 
	the Nucleus Hybrid L24 implant.
	Med-El Implant Systems Australasia Pty Ltd
US007	DUET 2 Replacement	The DUET 2 speech processor adds 	Dimensions: 50.6mm x 	$9,065.00
	hearing aid processing, power and 	8.5mm x 59.7mm
	audio input. The DUET 2 directly 
	amplifies the acoustic sound in the 
	low frequencies of the OPUS2 
	Processor to the recipient. It is 
	intended to evoke auditory 
	sensations via electrical stimulation 
	or via combined electro acoustic 
	stimulation (EAS) of the auditory 
	pathways for partially deaf 
	individuals who obtain benefit from 
	acoustic amplification in the lower 
	frequencies only.
Prostheses List by Category, Groups and Sponsor	Page 45 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
02.01.03 - Sound Processor Accessory Kit
	Advanced Bionics Australia Pty Ltd
BD010	Harmony ™ HiResolution® Bionic 	1x HPwcable; 1x direct connect	various	$500.00
	Ear System - Behind the Ear Sound 	earhook; 1x standard earhook;
	Processor Auria Harmony Essential 	1x audio cable; 1x monitor
	Accessory Kit	earphone.
BD013	Harmony ™ HiResolution® Bionic 	1x HP cable; 1x Auxiliary	various	$500.00
	Ear System - Body worn Sound 	microphone; 1x telephone
	Processor - Platinum Series 	adaptor; 1x monitor earphone
	Processor (PSP) Essential 
BD016	Neptune Accessory Kit. 	The essential accessories to support 	Various sizes. AquaMic 	$500.00
	Comprising: Listening Earphones, 	hearing through the Neptune 	Physical properties: 
	Audio Cable, Neptune Clip, 	Processor comprising: listening 	Dimensions: 40 x 35 x 
	Aquamic cable OR UHP cable, 	earphones, audio cable, Neptune Clip,	14mm. UHP:  Dimensions: 
	Aquamic headpiece OR UHP 	 Aquamic Cable OR UHP cable, 	32mm diameter including 
	AquaMic headpiece OR UHP 	color cap x 10mm.
	Cochlear Limited
CO020	Nucleus Cochlear Implant 	Accessory set consists of accessory 	Lapel microphone comes in 	$500.00
	Accessory Kit - ESPrit 3G Speech 	adapter cable, lapel microphone & 	lengths of 40-150cm
	lapel clip, battery cover set and 
	accessory case
	Advanced Bionics Australia Pty Ltd
BD019	Naida CI Q70 Accessory Kit	Universal Headpiece (UHP), UHP 	Various, Further details:	$500.00
	cable and either a T-Mic OR a battery 	UHP physical properties: 
	(either PowerCel or Zn-Air battery 	Dimensions: 32mm diameter
	Pack)	 including colour cap x 
	10mm
	Cables come in 9, 11, 14, 24 
Prostheses List by Category, Groups and Sponsor	Page 46 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
02.01.04 - Implantable Bone Conduction Hearing System
	02.01.04.01 - Sound Processor
	Cochlear Limited
CO033	Baha Cordelle II sound processor	A powerful sound processor for the 	One Size	$6,000.00
	Baha hearing system with a bodyworn
	 unit and a head worn transducer.  
	Available in three colours. Body 
	worn sound processor for the Baha 
	hearing system.
CO040	Baha Divino sound processor	Head worn digital sound processor 	One Size	$6,000.00
	for the Baha hearing system.  
	Available in four colours and left and 
	right side orientations.
CO041	Baha Intenso sound processor	Head worn digital sound processor 	One size	$6,000.00
	for the Baha hearing system.  
	Available in four colours.
	Programmable
	Cochlear Limited
CO047	Cochlear™ Baha® BP100 sound 	Fully programmable head worn sound 	One size - 30 x 21 x 12mm	$6,500.00
	processor	processor for the Baha implantable 
	bone conduction hearing system
CO056	Cochlear™ Baha®  BP110 sound 	Fully programmable head worn sound 	One size	$6,500.00
	processor	processor for the Baha implantable 
	bone conduction hearing system
CO073	Cochlear™ Baha® 4 Sound 	The Cochlear Baha 4 Sound Processor	One size.	$6,500.00
	 is a wireless-enabled, fully 
	programmable head-worn digital 
	sound processor for the Baha 
	Implantable Bone Conduction 
	Fusion Healthcare
FH001	Sophono Alpha Bone Conduction 	Alpha Sound Processor	-	$6,500.00
	Hearing System, Sound Processor
Prostheses List by Category, Groups and Sponsor	Page 47 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Med-El Implant Systems Australasia Pty Ltd
US002	Bonebridge - Amadé BB audio 	The Amadé audio processor is an 	29.1 mm (d), 8.8 mm (h), 	$6,500.00
	processor	external part of the Bonebridge and 	weight ≤ 8 grams
	connects to the implant through 
	magnetic attraction. Fitting the Amadé
	 audio processor activates the 
	Bonebridge
	Oticon Australia
OI023	Ponto Sound Processor	Fully programmable head worn sound 	Ponto: 34 x 21 x 11mm	$6,500.00
	processor for bone conduction 	Ponto Pro: 34 x 21 x 11mm
	hearing systems	
	Ponto Power Pro; 34 x 21 x 
	02.01.04.02 - Osseointegration
	Abutment
	Cochlear Limited
CO025	Baha Abutment Snap Coupling	Titanium abutment delivered with a 	5.5mm - 9035, 8.5mm - 	$895.00
	gold screw and holder, individually 	90410
	packaged and sterile.  The 5/5mm is for
	 standard use and the 8.5mm for 
	patients that have persistent regrowth
	 of subcutaneous tissue
CO050	Baha BA210 Abutment	Titanium abutments compatible with 	5.5mm and 8.5mm	$895.00
	hexagonal coupling Baha implants
	Oticon Australia
OI025	Ponto Abutment	Bone anchor abutment with 	Length: 6 - 12mm	$895.00
	connection screw	Straight and angled
	Abutment & Fixture
	Cochlear Limited
CO032	Flange fixture - self tapping fixture 	Self tapping titanium flange fixture 	Self Tapping 4mm and 3mm 	$1,930.00
	with pre-mounted abutment	with abutment in two sizes:  3mm and 	with BAHA Abutment
	4mm
	Fusion Healthcare
FH002	Sophono Alpha Bone Conduction 	Alpha Implant	-	$1,930.00
	Hearing System, Implant
Prostheses List by Category, Groups and Sponsor	Page 48 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Med-El Implant Systems Australasia Pty Ltd
US001	Bonebridge- Bone Conduction 	Active bone conduction implant 	28.6 (w) x 69 (l) x 8.7 (h) mm	$1,930.00
	Implant Kit	consisting of magnet, receiver coil, 
	electronics package (demodulator), 
	bendable transition to FMT, floating 
	mass transducer
	Oticon Australia
OI026	Ponto Abutment and Implant	Bone anchor implant and abutment 	Diameter: 3.75 - 4.5mm	$1,930.00
	with connection screw	Length: Fixture 3 - 4mm, 
	Abutment 6 -12mm
	Abutment & Fixture, HA
	Cochlear Limited
CO063	Cochlear ™ Baha® BIA400 Implant	Pre-mounted self-tapping titanium 	4mm implant with pre-	$2,197.00
	 with Abutment	implant with TiOblast™ surface and 	mounted 6mm, 8mm, 10mm, 
	coated Abutment with hydroxyapatite	or 12mm abutment
	 (HA) coating for Baha FAST surgery
	Abutment, Concave
	Cochlear Limited
CO052	Baha BA300 abutment.	Titanium abutment of the Baha BI300 	6 mm and 9 mm	$936.00
	implant system.
	Abutment,Fixture, Concave,
	Cochlear Limited
CO053	Baha BIA300 implants with 	Self tapping titanium implant with 	3mm implant with 6mm 	$2,017.00
	abutments	pre-mounted abutment of the Baha 3  	abutment, 4mm implant with
	system, for the Baha FAST surgery.	 6mm abutment, 4mm implant
	 with 9mm abutment.
	Fixture
	Oticon Australia
OI024	Ponto Implant	Bone anchor implant	Diameter: 3.75 - 4.5mm	$1,035.00
	Length: 3 - 4mm
	Fixture, Concave
	Cochlear Limited
CO051	Baha® BI300 Implant	Titanium self-tapping implant with 	3mm and 4 mm	$1,082.00
	TiOblast surface of the Baha 3 system
Prostheses List by Category, Groups and Sponsor	Page 49 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	HA
	Cochlear Limited
CO062	Cochlear™ Baha®  BA400 	Titanium abutment with 	6mm, 8mm, 10mm, 12mm	$1,115.00
	DermaLock™ Abutment	hydroxyapatite (HA) coating
	Magnetic Coupling
	Cochlear Limited
CO068	Cochlear™ Baha® BIM400 Implant 	The Cochlear Baha BIM400 is an 	One size	$895.00
	Magnet	implantable magnet that lies 
	completely under the skin
	02.01.04.03 - Cover Screw
	Cochlear Limited
CO028	BAHA - Cover screw unigrip	Titanium cover screws, individually 	One size only	$142.00
	packaged and delivered sterile.  The 
	cover screws are used to prevent bone 
	overgrowth of the implant.
CO054	Baha Cover Screw conical	Titanium cover screw of the Baha 	One size	$142.00
	BI300 implant system used in the 
	two-stage surgery.
	Med-El Implant Systems Australasia Pty Ltd
US003	Bonebridge - Cortical screws 	Titanium cortex screws have a length 	6mm (length) x 2 - 2.4mm 	$142.00
	(Bonebridge Surgical Tool Kit)	of 6mm and are self-tapping, providing	(outer edge)
	 fixation of the BCI implant to the 
	bone through osseo-integration
	Oticon Australia
OI027	Ponto Healing Cap	Cover screw	One size only	$142.00
OI028	Ponto Cover Screw	Cover screw	One size only	$142.00
02.01.05 - Ossicle/Middle Ear Prosthesis
	02.01.05.01 - Stapes
	Endotherapeutics Pty Ltd
ET072	Eclipse Piston	Stapes: Nitinol, Fluroplastic	Diameter 0.5mm: 3.75mm - 	$104.00
	6.00mm
Prostheses List by Category, Groups and Sponsor	Page 50 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMA PacMed Pty Ltd
PM032	Stapes	a) NiTiBOND 	a) Diameter - 0.4 or 0.6mm in	$104.00
	b) Soft CliP 	 lengths - 3.5 to 5.5mm 
	c) K-Piston 	b)  Diameter - 0.4 or 0.6mm 
	d) Angular Piston 	in lengths 3.5 to 5.5mm 
	e) CliP Piston aWengen 	c) Diameter - 0.4 or 0.6mm in
	f) CliP Piston MVP	 lengths 3.5 to 10mm 
	g) Lenticle Cup	d) Diameter 0.4 or 0.6mm in 
	lengths 4.25, 4.5, 4.75mm 
	e) Diameter - 0.4mm or 
	0.6mm in lengths 3.5 to 
	5.5mm 
	f) Diameter 0.4 or 0.6mm in 
	lengths - 5 to 6.25mm
	g) lengths - 3 to 4.5mm
	Medtronic Australasia Pty Ltd
MC918	The Big Easy Piston	Big Easy Range - MRI Safe, Triple 	0.4 - 1.17mm x 0.9 - 4.0mm x 	$104.00
	Width Platinum Band, Double Width 	4.0 x 10.2mm; 4.0 - 4.75mm
	Platinum Shaft with Offset Versions
MI079	Middle ear prostheses	Stapes	0.4-1.17mm x 0.9-4.0 x 4.0 	$104.00
	x4.0-10.2mm; 4.0 - 4.75mm
	Olympus Australia
OL012	Canal Wall Prosthesis	Grote, HA	Small - Large	$104.00
OL014	Ossicular Prosthesis	Attic Defect Plate, HA	7-14mm	$104.00
OL018	Piston: Stapes Prosthesis	a) Schuknecht Malleus att Piston. 	a) 0.6x5.5mm-0.8x6.5, b) 	$104.00
	Stainless steel, b) Cawthorne. 	0.3x0.8x3.5-0.3x0.8x6mm, c)
	Fluoroplastic, c) Fluoroplastic, d) 	 0.6x0.6x3.5-0.8x0.6x6mm, 
	Schuknecht. Stainless steel, e) Causse.	d) 0.4x3.5-0.5x5mm, e) one
	  Fluoroplastic	 size only
OL022	Piston: Stapes Prosthesis	a) Armstrong. Platinum, b) McGee. 	a) 0.6x3.5-0.8x5mm, b) 	$104.00
	Stainless steel, c) Richards.  Teflon & 	0.6x3.25-0.8x5.5mm, c) 
	platinum	0.4x4-0.4x5mm
OL023	Piston: Stapes Prosthesis	Fisch-Type Platinum or Stainless Steel	0.4mm  x 6mm	$104.00
OL024	Piston: Stapes Prosthesis	Platinum Fluoroplastic	0.6x3.5mm - 0.8x5mm	$104.00
OL025	Piston: Stapes Prosthesis	Platinum Fluoroplastic	0.6x3mm - 0.8x5.75mm	$104.00
OL075	Piston: Stapes Prosthesis	Smart: Nitinol/Flouroplastic	0.5, 0.6, 0.8 x 3.75-4.75mm	$104.00
Prostheses List by Category, Groups and Sponsor	Page 51 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	02.01.05.02 - Malleus
	Medtronic Australasia Pty Ltd
MC919	Middle Ear Prosthesis	Malleus	0.6 - 4.0mm x 2.7 - 5.0mm x 	$190.00
	1.5 - 10.0mm
	02.01.05.03 - Partial Ossicle Replacement (one or two)
	Endotherapeutics Pty Ltd
ET073	Eclipse Malleus Piston	Malleus & Stapes: Nitinol, 	Diamater 0.6mm: 5.5mm-	$360.00
	Fluoroplastic	8.00mm
	LMA PacMed Pty Ltd
PM028	Partial Ossicle Replacement	a) TTP Tuebingen Type bell 	a) length - 1.75 to 3.5mm	$360.00
	b) CliP Dresden Type 	b) Length 1.75 to 3.5mm 
	c) Malleus 	c) 1075 to 3.5mm 
	d) Angular Plester 	d) length 2.25 or 3.25mm 
	e) Angular CliP 	e) length 2.25 or 3.25mm 
	f) TTP - Vario Bell TTP - Variac 	f) one size
	System, Partial	g) lengths - 1.75 to 3.5mm
	g) CliP Partial FlexBAL	h) lengths - 1.75 to 4.5mm
	h) Duesseldorf Type Partial
	Medtronic Australasia Pty Ltd
MI076	Middle Ear Prostheses	Partial Ossicular Reconstruction 	0.6-2.5 x 2.2-8.8 x 3.5 -	$360.00
	Implant - malleus + incus	10mm
	Olympus Australia
OL016	Ossicular Prosthesis - PORP	Sheehy plastipore, Drum to stapes, 	One size only	$360.00
	Grote Malleus to stapes, modified, 
	centered or offcentered
OL017	Ossicular Prosthesis - PORP/TORP	Goldenberg Malleable/HA	One Size Only	$360.00
	02.01.05.04 - Total Ossicle Replacement (three)
	Kevin Grundy (IBD) Pty Ltd
KG014	ALTO Prosthesis	Adjustable Length Titanium 	Head Size 2.5mm x 3.5mm; 	$404.00
	Ossicular Chain Reconstruction 	Length 2.0mm - 8.0mm; 
	Distal Diameter 0.8mm - 
	1.2mm
Prostheses List by Category, Groups and Sponsor	Page 52 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMA PacMed Pty Ltd
PM119	Total Ossicle Replacement	a) TTP Tuebingen Type Aerial Type 	a) Length - 3 to to 7mm 	$404.00
	b) TTB-Vario Aerial  	b) one size only 
	c) TTP Variac System Total 	d) Length - 3 to 7mm 
	d) Malleus Notch Prosthesis 	e) Length - 4 to 5mm
	e) Regensburg Type Titanium 	f) one size only
	Prosthesis	g) lengths - 4 to 5mm
	f) Malleus Replacement	h) lengths - 3 to 7mm
	g) Regensburg Type Total
	h) Duesseldorf Type Total
	Medtronic Australasia Pty Ltd
MI075	Middle Ear Prostheses	Total Ossicular Reconstruction 	0.6-0.8mm x 3.0-4.0mm x 	$404.00
	7.0-8.0mm
	Olympus Australia
OL013	Ossicular Prosthesis Malleus, Incus	Goldenberg Footplate - HA	One size only	$404.00
	 and Stapes
OL015	Ossicular Prosthesis Incus 	a) Applebaum HA,  b) Goldenberg 	a) small - large, b) one size 	$404.00
	HA,  c) Kartusch HA , d) Grote HA, e)	only, c) short, medium, long,
	 Wehrs (single & double notched) HA	 d) 7-10mm, e) short, 
	average, medium, long
OL019	Ossicular Prosthesis -TORP 	a) black spanner strut HA, b) black 	a) one size only, b) 7-10mm, 	$404.00
	oval top TORP HA, c) black oval top 	c) 0.5-0.7mm
	PORP, universal, HA/fluoroplastic
OL020	Ossicular Prosthesis -TORP 	Fisch plastipore, Causse modified 	One size only	$404.00
	plastipore, Shea modified plastipore/ 
	fluoroplastic, Austin modified 
	plastipore, Tilt top plastipore
OL021	Ossicular Prosthesis -TORP 	a) Shea malleable, HA/plastipore, b) 	a) one size only, b) 4-8mm	$404.00
	Shea plastipore
OL073	Dornhoffer Prostheses	Hydroxyapetite head/HAPEX shaft 	0.8mm Shaft Dia TORP, 	$404.00
	PORP and TORP	1.3mm Shaft Diameter PORP
OL074	Ossicular Chain Prosthesis	Micron adjustable TORP/PORP. 	2-10mm, 2-5mm	$404.00
	Titanium
Prostheses List by Category, Groups and Sponsor	Page 53 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
02.01.06 - Ventilation Tube/Grommet
	CoreMed Pty Ptd
RC002	Ventilation tube	Ventilation tube - Silicone - T-tube, T-	1.1mm; 1.27mm lumen	$20.00
	tube grommet
RC003	Ventilation Tubes - Collar Button	Teflon, w/o wire	1.10mm, 1.25mm, 1.50mm 	$20.00
	lumen
RC004	Ventilation Tubes - Collar Button	Teflon w/wire, and titanium w/o wire	0.76mm, 1.00mm, 1.25mm, 	$20.00
	1.50mm lumen
RC005	Ventilation Tubes - Collar Button	Titanium w wire	1.00mm, 1.25mm, 1.50mm 	$20.00
	lumen
RC006	Ventilation Tubes - Shepherd	Teflon, w or w/o wire	1.15mm lumen	$20.00
RC007	Ventilation Tubes - Shepherd	Titanium, w/o wire	1.00mm, 1.25mm lumen	$20.00
RC008	Ventilation Tubes - Shepherd	Titanium with wire	1.00mm, 1.25mm lumen	$20.00
RC009	Ventilation Tubes - Silicone	Armstrong Grommet, Donaldson w & 	1.1mm & 1.5mm lumen	$20.00
	w/o Tab, Paparella 1 and Paparella 2 
	(1.5mm)
	Endocorp Pty Ltd
EC018	Exmoor Plastics Ear Vent Drains -  	Without hole, teflon	1.14 mm lumen dia x 2.54 	$20.00
	Reuter Bobbin 	mm inner flange dia x 2.54 
	mm outer flange dia x 0.76 
	inter flange. 1.52mm total 
	length
EC019	Exmoor Plastics Ear Vent Drains -  	Teflon 	1.14 mm lumen dia x 2.24 	$20.00
	Collar Button	mm inner flange dia x 2.24 
	mm outer flange dia x 1.27 
	inter flange. 1.78 mm total 
	length
EC020	Exmoor Plastics Ear Vent Drains  -  	Teflon 	1.14 mm lumen dia x 3.0 mm 	$20.00
	Collar Button	inner flange dia x 3.0 mm 
	outer flange dia x 1.27 inter 
	flange. 1.78 mm total length
Prostheses List by Category, Groups and Sponsor	Page 54 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
EC021	Exmoor Plastics Ear Vent Drains  -  	Teflon 	1.4 mm lumen dia x 2.55 mm 	$20.00
	Collar Button	inner flange dia x 2.55 mm 
	outer flange dia x 0.85 inter 
	flange. 1.35 mm total length
EC022	Exmoor Plastics Ear Vent Drains - 	Teflon 	1.75 mm lumen dia x 2.85 	$20.00
	Collar Button 	mm inner flange dia x 2.85 
	mm outer flange dia x 0.95 
	inter flange. 1.46 mm total 
	length
EC024	Exmoor Plastics Ear Vent Drains - 	Teflon Shephards Drain	1.14 mm lumen dia x 2.36 	$20.00
	Shepards Drain	mm inner flange dia x 2.36 
	mm outer flange dia x 1.42 
	inter flange. 2.41 mm total 
	length
EC026	Exmoor Plastics Ear Vent Drains - 	Teflon Shephards Drain with wire	0.97 mm lumen dia x 2.08 	$20.00
	Teflon Shephards Drain with wire 	mm inner flange dia x 2.08 
	grasping feature	mm outer flange dia x 1.42 
	inter flange. 2.41 mm total 
	length
EC031	Exmoor Plastics Ear Vent Drains - 	With tab, silicone rubber	1.1 mm lumen dia x 2.25 mm 	$20.00
	Donaldson Grommet	inner flange dia x 2.25 mm 
	outer flange dia x 0.76 inter 
	flange. 2.25 mm total length
	Intermed
IR002	NeoZoline Otological Ventilation 	Armstrong, Collar Button, Shepard, 	1.10mm, 1.14mm, 1.27mm, 	$20.00
	Tubes	Reuter, Donaldson, Paparella, Shah	1.40mm, 0.76mm
	Medical Specialties Australia Pty Ltd
MS057	NeoZoline Otological Ventilation 	Armstrong, Collar Button, Shepard, 	1.10mm, 1.14mm, 1.27mm, 	$20.00
	Tubes	Reuter, Donaldson, Paparella, Shah	1.40mm, 0.76mm
	Medtronic Australasia Pty Ltd
MC268	Medtronic Vent Tubes	Fluoroplastic	0.76 - 1.52mm x 2.1 - 9.5mm 	$20.00
	x 1.0 - 12.0mm
MC927	Medtronic Vent Tube	.	1.02 - 1.52mm x 1.3 - 	$20.00
	12.0mm
MI078	Medtronic Ventilation Tubes	Medium to Long term vent tube	0.76-1.52mm x0.9-12.0mm	$20.00
Prostheses List by Category, Groups and Sponsor	Page 55 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG037	Micromedics Ventilation Tubes	Silicone and fluroplastic ventilation 	Lumen size: 0.76mm, 1.0mm,	$20.00
	tubes	 1.14mm, 1.27mm, 1.42mm
	Olympus Australia
OL027	Ventilation Tube	Shepard grommet, fluoroplastic or 	1.02 -1.14mm	$20.00
	silicon, vent tube w/wire. 
OL028	Ventilation Tube	Shepard, fluoroplastic, w/Tab & wire	1.02 -1.14mm	$20.00
OL032	Ventilation Tube	T-Tube Richards Modified Soft 	1.32mm	$20.00
OL035	Ventilation Tube	Grommet - Sha Mini. Teflon	0.76mm	$20.00
OL036	Ventilation Tube	Shah. Teflon, Silicon	5.1mm	$20.00
OL037	Ventilation Tube	Shah. Teflon, Fluorplastic w/Wire	1.14mm	$20.00
OL038	Ventilation Tube	Shah. Teflon, Fluorplastic without 	1.14mm	$20.00
OL039	Ventilation Tube	Armstrong Beveled Plain End 	One size only	$20.00
	Fluoroplastic
OL040	Ventilation Tube	Armstrong Beveled Plain End Silcon	One size only	$20.00
OL041	Ventilation Tube	Bobbin - Reuter Stainless Steel	1mm  	$20.00
OL042	Ventilation Tube	Bobbin - Reuter Stainless Steel	Without Wire 1.14-1.27mm,	$20.00
	 w/wire 1mm
OL043	Ventilation Tube	Bobbin - Reuter Fluoroplastic 1mm I.F	1mm	$20.00
	 Without Holes
OL044	Ventilation Tube	Bobbin - Reuter Fluoroplastic 1mm I.F	1.14mm	$20.00
	 Without Holes
OL045	Ventilation Tube	Bobbin - Reuter Fluoroplastic 1mm I.F	1.14mm	$20.00
	 w/wire
OL046	Ventilation Tube	Bobbin - Reuter Fluoroplastic 1mm I.F	1.14mm	$20.00
OL047	Ventilation Tube	Bobbin - Reuter Fluoroplastic 0.5mm 	1.27mm	$20.00
	I.F
OL048	Ventilation Tube	Collar Bobbin Fluoroplastic 	1.27mm	$20.00
OL049	Ventilation Tube	Collar Bobbin Fluoroplastic 	0.75mm	$20.00
OL050	Ventilation Tube	Collar Bobbin Fluoroplastic 	1.14mm	$20.00
OL051	Ventilation Tube	Collar Bobbin Fluoroplastic 	1.27x0.5mm	$20.00
OL053	Ventilation Tube	Collar Button Fluoroplastic Blue	1.27mm	$20.00
Prostheses List by Category, Groups and Sponsor	Page 56 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OL054	Ventilation Tube	Collar Button Fluoroplastic w/Wire	1.27mm	$20.00
OL055	Ventilation Tube	Collar Button Silicon	1.27mm	$20.00
OL056	Ventilation Tube	Collar Button Titanium	1.14mm	$20.00
OL057	Ventilation Tube	Collar Button Titanium	1.27mm	$20.00
OL058	Ventilation Tube	Donaldson Silicon	1.14mm	$20.00
OL059	Ventilation Tube	Donaldson Soft Silicon	1.14mm	$20.00
OL060	Ventilation Tube	Donaldson Silicon w/Tab	1.14mm	$20.00
OL061	Ventilation Tube	Donaldson Fluoroplastic	1.14mm	$20.00
OL063	Ventilation Tube	Duravent Silicon	1.27mm	$20.00
OL066	Ventilation Tube	Shea  w/Tab - Silicone	0.76mm	$20.00
OL067	Ventilation Tube	Shea Parasol w/Tab Small Flange - 	1.02mm	$20.00
	Silicone
OL068	Ventilation Tube	Shea Parasol w/Tab - Silicone	1.02mm	$20.00
OL069	Ventilation Tube	Shea Parasol w/Tab - Silicone	1.52mm	$20.00
OL070	Ventilation Tube	Straight Fluoroplastic or 	0.89 x 12mm, 0.86 x 7mm, 	$20.00
	1.14 x 12mm, 1.14 x 7mm
	Antibiotic
	Medtronic Australasia Pty Ltd
MC269	Medtronic Vent Tubes	Activent Antimicrobial Ventilation 	1.02 - 1.27mm x 0.9 - 2.4mm	$22.00
	Tube
MI077	Medtronic  Ventilation Tube	Medium to long term, antimicrobial 	1.02 - 1.52mm x 1.3-12.0mm	$22.00
	vent tube
	Olympus Australia
OL029	Ventilation Tube	Shepard, Ultrasil Silicon & Blue Poly	1.02 - 1.14mm	$22.00
OL030	Ventilation Tube	T-Tube Richards Silicon, Soft Silicon, 	1.14mm	$22.00
	Ultrasil
OL031	Ventilation Tube	T-Tube Richards Modified Silicon & 	1.32mm	$22.00
	Ultrasil
OL033	Ventilation Tube	Butterfly T-Tube Silicon & Ultrasil	Silicon - one size only. 	$22.00
	Ultrasil - one size only.
OL034	Ventilation Tube	Armstrong Beveled Grommet Ultrasil 	1.14mm	$22.00
	Silicon w/Tab
Prostheses List by Category, Groups and Sponsor	Page 57 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OL052	Ventilation Tube	Collar Button Ultrasil Silicon	1.27mm	$22.00
OL062	Ventilation Tube	Donaldson Ultrasil Silicon	1.14mm	$22.00
OL064	Ventilation Tube	Duravent Blue Ultrasil	1.27mm	$22.00
OL065	Ventilation Tube	Paparella w/tab Fluoroplastic, 	1.02 - 2.03mm	$22.00
	Silicon, Soft Silicon, Ultrasil
	LMA PacMed Pty Ltd
PM065	Ventilation Tubes / Grommet	a) Tubingen Gold Type 	a) I.D.  1.25mm w/w, 	$20.00
	b) Tubingen Titanium Type 	I.D.1.25mm wo/w, I.D. 
	c) T Tube 	1.5mm wo/w 
	d) Reuter Bobbin Type 	b) one size only 
	e) Paparella Type	c) L- 6, 7.5, 12 
	f) Collar Button Type 	d) I.F.O.D 2.5mm, 2.7mm 
	g) Star Tube 	e) one size only  
	h) Bevel Buttton Tube	f) one side only 
	i) Straight Tube 	g) one size only 
	j) Armstrong Type 	h) one size only 
	k) Shepard Type 	i) i.d.-0.9mm,1.1mm,1.15mm 
	l) Donaldson Type	
	m) Angular Type	j) L-3.8mm, 3.7mm, 10mm 
	n) Myringotomy Tube with Trocar	k) L- 2.2mm w/t, 2.2mm 
	o) Ventilation Tubes with Eyelets	wo/t,2.4mm w/t 
	p) Minimal Type	l) S- one size only, F one 
	size only
	m) one size only
	n) Silver or Titanium
	o) one or two
	p) one size only
02.01.07 - Bone Cement
	Endotherapeutics Pty Ltd
ET031	Serenocem Cement	Reaction bonded polymer composite 	One size only - box of 2	$1,560.00
	formed by the neutralisation 
	gelletation of a basic inorganic 
Prostheses List by Category, Groups and Sponsor	Page 58 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ET032	Serenocem Granules	Reaction bonded polymer composite 	0.5 - 1mm granules, 1gm or 	$1,560.00
	formed by the neutralisation 	5gm; 2 - 3mm granules, 1gm 
	gelletation of a basic inorganic 	or 5gm - 3 pouches
02.02.01 - Septal Button
	Medtronic Australasia Pty Ltd
MC264	Septal Button 	Silicone	3cm 	$149.00
	Olympus Australia
OL026	Septal Button	Plastipore	One size only	$149.00
02.03.01 - Tracheal Speaking Valve
	LMA PacMed Pty Ltd
PM057	Tracheal Speaking Valve	1. Passy -Muir - a) Purple  b) Clear c) 	1. One size only 	$102.00
	Aqua 	2. a) 4.5, 6, 8, 10, 12.5, 
	2. Provox - a) Two b) Vega c)  Vega 	15mm
	Puncture Set	    b) 17, 20, 22.5Fr in 4, 6, 8,
	 10, 12.5, 15mm
	    c) 17, 20, 22.5Fr in 8, 10, 
	12.5, 15mm
02.03.02 - Vocal Chord Medialisation Implant
	Medtronic Australasia Pty Ltd
MC265	Silicone Blocks 	Netterville Phonoform Block - Right, 	Right - One size only, Left - 	$275.00
	Left, Wedge & Strip	One size only, Wedge - One
	 size only & Strip - One size
	 only
	Olympus Australia
OL071	Vocal Cord Medialisation Implant	Vocom Larynx Medial Implant - 	3 - 7mm Head	$275.00
	Hydroxylapatite
OL072	Vocal Cord Medialisation Implant	Vocom Shim for Medial Implant - 	1mm - 3mm Offset	$275.00
	Hydroxylapatite
Prostheses List by Category, Groups and Sponsor	Page 59 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMA PacMed Pty Ltd
PM107	Vocal Chord Medialisation Implant	Montgomery Laryngeal Keel	12, 14, 16 - Clear and 	$275.00
	Radiopaque
02.03.03 - Tracheal Stents
	Nitinol
	Medical Vision Australia Cardiology Thoracic Pty Ltd
MY002	Tracheobronxane Silmet	Nitinol wire - tracheal and bronchial 	12 - 20mm diameter, 20 - 	$2,500.00
	stents - Dumon	90mm length
	Silicone
	Medical Vision Australia Cardiology Thoracic Pty Ltd
MY001	Endoxane	Silicone tracheal and bronchial stents 	10 - 20mm diameter, 20 - 	$1,000.00
	- Dumon	60mm length
02.03.04 - Thyroplasty
	LMA PacMed Pty Ltd
PM033	Thyroplasty	Montgomery Thyroplasty Implant 	male - 8,9,10,11,12,13	$1,172.00
	System	female - 6,7,8,9,10
02.03.05 - Cannula
	Extra-tracheal
	LMA PacMed Pty Ltd
PM102	Extra-tracheal Cannula	a) Montgomery Short-Term Cannula 	a) 4, 6, 8, 10 b) 4, 6, 8, 10 for	$298.00
	b) Montgomery Long-Term Cannula	 Stoma Sizes 17-25, 25-33, 
	33-41, 41-49, 49-57, 57-
	65mm
Prostheses List by Category, Groups and Sponsor	Page 60 of 1059

02 - EAR, NOSE & THROAT
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Intra-tracheal
	LMA PacMed Pty Ltd
PM104	Intra-tracheal Cannula	Montgomery Safe-T-Tubes Clear and 	a) 6, 7, 8, 9 	$471.00
	Radiopaque except c) 	b) 10, 11, 12, 13, 14. 15, 16
	a) Paediatric 	
	b) Standard 	c) 12, 15, 18 
	c) Hebeler  	d) 10, 11, 12, 13, 14, 15, 16 
	d) Thoracic  	
	e) Extra-Long  	e) 10, 11, 12, 13, 14, 15, 16 
	f) Tapered 	
	g) Montgomery Salivary Bypass Tube 	f) 8/10, 10/13 
		g) 8, 10, 12, 14, 16, 18, 20 
	h) Har-el Pharyngeal Tube 	h) one size only 
	i) Montgomery Esophageal Tube	i) one size only
	j) Trachael Fenestrator
	k) Moore Trache
02.03.06 - Injectable Material for Vocal Fold Augmentation / Laryngeal
	Endotherapeutics Pty Ltd
ET040	Vox Implants	Vox Implants are solid, irregularly 	One size only	$8,200.00
	textured, medical grade 
	Polydimethylsiloxane Elastomer 
	implants suspended in a hydrogel 
	carrier
Prostheses List by Category, Groups and Sponsor	Page 61 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.01.01 - Hepatic, Yttrium 90, Standard Dose
	Sirtex Medical Products
SE001	SIR-Spheres including Delivery 	Biocompatible microspheres 20-60mm	One size only	$8,230.00
	Apparatus	 (microns) in diameter containing 
	yttrium-90. Delivery apparatus is 
	PVC tubing, ABS stopcocks, acrylic 
	holders and stainless steel needles 
03.01.02 - Prostatic I-125
	03.01.02.01 - Standard Dose
	CMS Alphatech Pty Ltd
CL001	Advantage I-125 Pre-load	Advantage I-125 Pre-load consists of 	Stranded seeds are pre-	$6,500.00
	stranded Advantage I-125 seeds pre-	loaded in brachytherapy 
	loaded on prescription into 	needles in a prescribed 
	brachytherapy needles specifically for 	configuration; up to 120 
	treatment of an individual patient.  	seeds
	They arrive sterile and pre-packaged 
	ready for use in theatre
CL002	Advantage I-125 Seed	Advantage I-125 seeds are sealed 	3mm x 0.5mm silver rod 	$6,500.00
	radioactive sources containing 	within 4.5 x 0.8mm sealed 
	Iodine-125 for interstitial 	titanium capsule, up to 120 
	seeds
	Emergo Asia Pacific Pty Ltd
ER145	TheraStrand Rx with AgX100 	The ?TheraStrand RX? brachytherapy 	The seed includes a silver 	$6,500.00
	Brachytherapy Kit	kit is prescription-loaded and 	rod with I 125 contained in 
	supplied sterile.  The prescription 	a sealed titanium capsule of 
	generally comprises 25 needles 	4.5 mm length and 0.8 mm in
	containing the brachytherapy I-125 	 diameter.
	sources (80-100 seeds) sequenced per 
	the physician?s treatment plan.  All 
	sources are of the same 
	activity/strength.
Prostheses List by Category, Groups and Sponsor	Page 62 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ER146	I-Seed AgX100 Cartridge 	The I-Seed AgX100 Cartridge 	The I-Seed AgX100 	$6,500.00
	Brachytherapy Kit	brachytherapy kit comprises 8 or 	Cartridge Brachytherapy 
	fewer cartridges (max. 20 seed) in a 	Kit generally contains 8 or 
	vertical seed magazine, VSM20. The 	fewer cartridges, each a max. 
	kit is supplied sterile and is 	20 seeds, a total of 80-100 
	compatible with the Mick applicator.	seeds. Each seed comprises 
	a silver rod with the source 
	within 4.5 x 0.8mm sealed 
	titanium capsule.
	GE Healthcare
GC001	Iodine 125 - 'Rapid Strand' 	Rapid Strand consists of 10 welded 	One size each	$6,500.00
	Brachytherapy Implant, Iodine 125 -	titanium capsules containing iodine-
	 'OncoSeeds' Brachytherapy Implant	125 absorbed onto a silver rod.  
	OncoSeeds consists of the loose seeds
	 only. Per Patient up to 120 seeds.
GC004	RAPID Strand Rx™	Pre-loaded, variable per patient 	The number of seeds per 	$6,500.00
	prescription version of RAPID 	needle, the spacing between
	Strand.  Price as shown is for up to 	 seeds (suture length) and 
	number of needles required 
	is customised per patient. 
	Seed size is standard as is 
	the needle gauge
	MD Solutions Pty Ltd
MB001	Vari-Strand	Vari-Strand consists of variable 	Variable (individually 	$6,500.00
	stranded seed configurations in pre-	prescribed) stranded seed 
	loaded needles for the purpose of 	configurations in pre-
	delivering radioactive seeds for the 	loaded needles delivered in 
	treatment of prostate cancer. 	a sterilized tray.
	Varistrand Multiple is delivered in a 
	sterilized tray opened in the operating
	03.01.02.02 - Single Seed or Partial Dose
	CMS Alphatech Pty Ltd
CL003	Advantage I-125 Seed	The Advantage I-125 seed is a sealed 	3mm x 0.5mm silver rod 	$82.00
	radioactive source containing Iodine-	within 4.5 x 0.8mm sealed 
	125 for interstitial brachytherapy	titanium capsule
Prostheses List by Category, Groups and Sponsor	Page 63 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	GE Healthcare
GC002	Iodine 125 - Rapid Strand 	I-125 Rapid Strand, code IMC 7000, 	One size only	$82.00
	Brachytherapy Implant; OncoSeeds 	consists of 10 welded titanium 
	Brachytherapy Implant	capsules containing iodine 125. This 
	assembly is sterile, the activity of the 
	capsules "seeds" is available from 
	0.18mCi to 0.70mCi.  Individual I-125
	 capsules (seeds) are also available as 
	OncoSeeds IMC6711.  To be used 
	only if more than 120 seeds are used 
	per patient.
GC003	RAPID Strand Rx Seeds	I-125 RAPID Strand Rx, pre-loaded 	Custom	$82.00
	titanium capsules containing iodine 
	125.  To be used only if more than 100
	 seeds are used per patient.  Benefit is 
	per seed.
	MD Solutions Pty Ltd
MB002	Vari-Strand	Vari-Strand consists of a single 	Single (individually 	$82.00
	stranded seed in a pre-loaded needle 	prescribed) seed in a pre-
	for the purpose of delivering a 	loaded needle delivered in a
	radioactive seed for the treatment of 	 sterilized tray.
	prostate cancer.
	Varistrand Single is delivered in a 
	sterilized tray.
	Nucletron Pty Limited
NU001	selectSeed	Nucletron selectSeed Model # 	One size only	$82.00
	130002 consists of cylindrical silver 
	rod, coated with radioactive Iodine-
	125 layer. Active silver rod is 
	encapsulated in hollow titanium tube.
	 Laser welding, using spherical 
	shaped end welds, seals the tube.
Prostheses List by Category, Groups and Sponsor	Page 64 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.01.03 - Tissue Expander/Separator, Gel
	MD Solutions Pty Ltd
MB017	SpaceOAR System	The SpaceOAR System consists of 	10CC	$1,950.00
	components for preparation of a 
	synthetic, absorbable hydrogel spacer
	 and a delivery mechanism packaged 
	in a single kit. The hydrogel spacer 
	creates a temporary space between the 
	prostate and rectum during radiation 
	therapy.
03.02.01 - Infusion Ports
	03.02.01.01 - Single Lumen
	B Braun Australia Pty Ltd
BB082	Celsite Epoxy Single Access Port	Epoxy/titanium	Standard/small/baby	$485.00
BB084	Celsite Single Access Port	MBS/PSU	Standard/small	$485.00
BB086	Celsite Epoxy Peritoneal Port	Epoxy/titanium	32x27x13mm	$485.00
	Covidien Pty Ltd
AS052	Chemosite Implantable Venous 	Port - Single Lumen (ChemoSite*)	7-9 french; 10.5 french.	$485.00
	Access System
	Smiths Medical Australasia Pty Ltd
SI001	Injection/Infusion Ports, Sterile - 	Port - single lumen	One size only	$485.00
	PORT-A-CATH II Trans Arterial 
	Percuataneous System
SI003	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.9 mm O.D. PolyFlow 	$485.00
	PORT-A-CATH P.A.S Port T2 	Polyurethane Catheter
	System
SI005	Injection/Infusion Ports, Sterile - 	Port - single lumen	One size only	$485.00
	PORT-A-CATH Peritoneal System
SI007	Injection/Infusion Ports, Sterile - 	Port - single lumen	2.3 mm silicone catheter	$485.00
	PORT-A-CATH Arterial Titanium 
	System
Prostheses List by Category, Groups and Sponsor	Page 65 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SI008	Injection/Infusion Ports, Sterile - 	Power Port - single lumen	1.9 mm polyurethane 	$485.00
	PORT-A-CATH Power Titanium 	catheter & 6 French 
	Venous Portal	introducer set
SI010	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.9mm polyurethane 	$485.00
	PORT-A-CATH Implantable Access
	 System - Venous Portal, with 
	introducer set
SI012	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.9 mm polyurethane catheter	$485.00
	PORT-A-CATH Low Profile 
	Implantable Venous System, with 
	introducer set
SI014	Injection/Infusion Ports, Sterile - 	Port - single lumen	2.8 mm silicone catheter	$485.00
	PORT-A-CATH II Titanium Venous 
	System, with introducer set 
SI016	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.9 mm polyurethane catheter	$485.00
	PORT-A-CATH II Titanium Venous 
	System with introducer set
SI017	Injection/Infusion Ports, Sterile - 	Port - single lumen	2.6 mm polyurethane catheter	$485.00
	PORT-A-CATH Power Titanium 
	Venous Portal with introducer set
SI019	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.9 mm polyurethane catheter	$485.00
	PORT-A-CATH II Low Profile 
	Titanium Venous System with 
	introducer set
SI020	Injection/Infusion Ports, Sterile - 	Port - single lumen	1.2 mm O.D. polyurethane 	$485.00
	PORT-A-CATH II Epidural Low 	catheter
	Profile System
SI021	Injection/Infusion Ports, Sterile - 	Port - single lumen	0.9 mm O.D. polyurethane 	$485.00
	PORT-A-CATH II Intraspinal Low 	catheter
	Profile System
	03.02.01.02 - Multiple Lumen
	B Braun Australia Pty Ltd
BB083	Celsite Epoxy Dual Access Port	Epoxy/titanium	Standard/small/baby	$615.00
Prostheses List by Category, Groups and Sponsor	Page 66 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smiths Medical Australasia Pty Ltd
SI023	Injection/Infusion Ports, Sterile - 	Port - dual lumen	3.4 mm silicone catheter	$615.00
	PORT-A-CATH II Dual Lumen 
	Titanium Venous system and 
	introducer set
03.02.02 - Infusion Pumps, Balloon Based
	03.02.02.01 - Fixed Flow Rate
	Nipro Australia
RN005	Easyfuser	Elastomeric balloon driven, 	50ml, 100ml, 250ml	$85.00
	ambulatory infusion pump with fixed 
	infusion rate. Short, fast infusion from 
	30 minutes to 2 hours, commonly used
	 for a short antibiotic infusion and IV 
	Vitamin Infusion therapy
RN006	Surefuser+ Fixed Flow	Elastomeric balloon driven, 	50ml, 100ml, 250ml	$85.00
	ambulatory infusion pump with a 
	variety fixed infusion rates.
	Bolus
	MobiLIFE Pty Ltd
LF001	mobiFUSER	Disposable sterile non electronic 	Maximum Capacity 275ml	$84.00
	elastomeric infusion device. Variable 
	flow rates available. For continuous 
	fluid/medication delivery
	Set
	ClaveGuard Pty Ltd
CJ001	AutoFuser Continuous	Continuous flow rate ambulatory and 	Volume 60ml, 100ml, 150ml,	$260.00
	disposable silicone balloon infusion 	 275ml, 400ml, 550ml
	pump
	Fresenius Kabi Australia Pty Ltd
FK001	Accufuser Continuous	Continuous flow rate ambulatory and 	Volume 60ml, 100ml, 300ml,	$260.00
	disposable silicone balloon infusion 	 600ml
	pump
	Orthocare Pty Limited
OC016	Advanced Infusion	ALPHA 200ml Capacity Infusion 	140 x 80 x 30 mm	$260.00
OC017	Advanced Infusion	ALPHA 450ml Capacity Infusion 	180 x 100 x 45 mm	$260.00
Prostheses List by Category, Groups and Sponsor	Page 67 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ036	Painbuster C bloc	Continuous Nerve Block kit - 	100-400ml	$260.00
	provides continual flow of local 
	anaesthetic near a nerve
	03.02.02.02 - Variable Flow Rate
	Admedus (Australia) Pty Ltd
AH006	Dosifuser	Non electronic, elastomeric balloon 	65ml - 140mm x 45mm x 	$165.00
	driven, ambulatory infusion pump, 	40mm; 100ml - 140mm x 
	which can be supplied in a variety of 	52mm x 50mm; 150 - 140mm 
	volumes and flow rates to meet 	x 55mm x 55mm; 250ml - 
	different clinical applications.  Its 	140mm x 60mm x 60mm
	primary purpose is for continuous 
	delivery of fluids/medications.
	Nipro Australia
RN004	Surefuser+	Elastomeric balloon driven, 	100ml, 250ml	$165.00
	ambulatory infusion pump with 
	variable infusion rate
	Bolus
	ClaveGuard Pty Ltd
CJ003	AutoSelector + PCM Button, 	Ambulatory and disposable silicone 	Volume 60ml, 100ml, 150ml,	$450.00
	AutoFuser + PCM Button	balloon infusion pump with bolus 	 275ml, 400ml, 550ml,
	function
	Fresenius Kabi Australia Pty Ltd
FK003	Accufuser Plus, Accufuser 	Ambulatory and disposable silicone 	Volume 60ml, 100ml, 300ml,	$450.00
	EasyBolus, Accufuser Omnibus	balloon infusion pump with bolus 	 600ml
	function
	Surgical Specialties
SQ037	Painbuster C Bloc	Continuous Nerve Block Kit -	270-600ml	$450.00
	provides continual flow of local 
	anaesthetic near a nerve, with options 
	of variable flow rate, bolus or dual 
Prostheses List by Category, Groups and Sponsor	Page 68 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Set
	ClaveGuard Pty Ltd
CJ002	AutoSelector	Variable flow rate ambulatory and 	Volume 60ml, 100ml, 150ml,	$375.00
	disposable silicone balloon infusion 	 275ml, 400ml, 550ml
	pump
	Fresenius Kabi Australia Pty Ltd
FK002	Accufuser Selectus, Accufuser 	Ambulatory and disposable silicone 	Volume 60ml, 100ml, 300ml,	$375.00
	Varicon	balloon infusion pump	 600ml
03.02.03 - Infusion Pumps, Battery Powered
	03.02.03.04 - Other Pharmacology
	Admedus (Australia) Pty Ltd
AH004	AMBIT Infusion Pump	The AMBIT PCA is an external 	55mm x 36mm x 175mm	$4,950.00
	programmable electronic ambulatory 
	infusion pump used for the delivery of 
	fluid and medications via intravenous,
	 epidural, subcutaneous or regional 
	routes.  It can be programmed with 
	different delivery profiles which 
	include basal rate only, basal rate 
	with PCA (Patient Controlled 
	Analgesia) or PCA Bolus Only.  It is 
	operated in conjunction with a 
	AMBIT disposable administration 
	cassette
	Fresenius Kabi Australia Pty Ltd
FK004	Accumate 1100 Infusion Pump	Ambulatory infusion pump	One size only	$4,950.00
	Hospira Pty Limited
HO001	GemStar Infusion Pump	Infusion pump, general purpose	Approx. 14.0 cm H x 9.7 cm 	$4,950.00
	W x 5.1cm D
HO002	Crono Pump	Ambulatory infusion pump - Models:  	10-50 ml	$4,950.00
	Crono 50, Crono PCA and Crono 
	APO-go II
Prostheses List by Category, Groups and Sponsor	Page 69 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HO006	Sapphire Infusion System	The Sapphire Infusion System is a new	Size (in), Weight (oz) 5.6 x 	$4,950.00
	 device for ambulatory infusion and 	3.8 x 1.9 in. 14.7 oz 
	acute pain management. It is an 	(including battery)
	infusion pump designed for the 
	volumetric delivery of medications to 
	patients at a programmable rate. 
	Sapphire is the first pump to offer an 
	intuitive, full colour touch screen 
	interface in an ambulatory package, 
	along with best-in-class +/-2.5% 
	product delivery accuracy
	Medical Specialties Australia Pty Ltd
MS021	Medical Specialties "Walkmed 	Ambulatory Infusion Pump System, 	Walkmed Infusion Pump 	$4,950.00
	Infusion Pump System" Powered 	Administration Sets and Accessories	System
	Drug Infusion System and Ancillary
	 Equipment (McKinley, USA)
	Rollex Medical
RX001	Medical Specialties "Walkmed 	Ambulatory Infusion Pump System, 	Walkmed Infusion Pump 	$4,950.00
	Infusion Pump System" Powered 	Administration Sets and Accessories	System
	Drug Infusion System and Ancillary
	 Equipment (McKinley, USA)
	Smiths Medical Australasia Pty Ltd
SI034	CADD-Solis VIP Model 2120 	Ambulatory Infusion Pump	One size only	$4,950.00
	Ambulatory Infusion Pump
SI037	CADD Legacy 1 Model 6400 	Pump	One size only	$4,950.00
	Ambulatory Infusion Pump
SI038	CADD Legacy Plus Model 6500 	Pump	One size only	$4,950.00
	Ambulatory Infusion Pump
SI039	CADD Legacy PCA Model 6300 	Pump	One size only	$4,950.00
	Ambulatory Infusion Pump
Prostheses List by Category, Groups and Sponsor	Page 70 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.02.03.05 - Programmable/Reprogrammable Flow Rate and Bolus
	Admedus (Australia) Pty Ltd
AH008	Ambit Preset Single Use Kit	The Ambit Preset Single use Kit 	"Ambit Preset Single use 	$450.00
	contains: a Single use Ambit Pump, 	Pump - 55mm x 36mm x 
	Single use administration cassette 	175mm
	with male luer lock, 420ml Medibag, 	Ambit Single use luer lock 
	the choice of 75mm, 127mm or 154mm 	administration cassette - 
	fenestrated nerve/wound catheter, a 	20mm x 10mm x 15mm
	peel away introducer sheath, and 	420ml Medibag - 250mm x 
	patient carry bag.	30mm
	Introducer sheath - 233mm 
	17 gauge
	Nerve/Wound catheters - 
	75mm Fenestrations , 
	127mm fenestrations or 
	154mm fenestrations 19 
	gauge, 914mm in length
	Patient carry bag - 450mm x 
	400mm
	Stryker Australia Pty Ltd
SK461	PainPump 2	Programmable or Preset pump with 	250ml & 400ml kits	$450.00
	bolus option and digital display 
	providing controlled infusion of a 
	Local Anaesthetic directly into a 
	surgical site for post-operative pain 
	management
SR068	PainPump 2 Continuous Peripheral 	Re-programmable & refillable pumps 	400ml kits	$450.00
	Nerve Block Kit & PainPump 2 	with bolus option nd digital display 
	BlockAid Kit	providing controlled infusion of a 
	local anaesthetic directly innervating 
	the surgical site for post-operative 
	pain management.
SR069	Painpump 2	Programmable pump with bolus 	250ml & 400ml Dual Site 	$450.00
	option and digital display providing 	kits
	controlled infusion of a local 
	anaesthetic directly into dual surgical
	 sites for post-operative pain 
Prostheses List by Category, Groups and Sponsor	Page 71 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.02.04 - Infusion Pumps, Spring Powered
	03.02.04.01 - Fixed Flow Rate
	Baxter Healthcare Pty Ltd
BX246	Infusor	Sterile infusor devices, spring or 	SV Half day, 5ml/hr, 60ml 	$85.00
	elastomeric driven	vol. LV 10, 10ml/hr, 240ml 
	vol. SV Single day, 2ml/hr, 
	48ml vol. LV 5, 5ml/hr, 
	240ml vol.
BX247	Intermate	Sterile infusor devices, spring or 	SV 200 - 200ml/hr, 100ml 	$85.00
	elastomeric driven	vol. SV 100 - 100ml/hr, 
	100ml vol. LV 250, 
	250ml/hr, 275ml vol. SV 50 
	- 50ml/hr, 100ml vol.  LV 
	100  - 100ml/hr, 275ml vol. 
	LV 50, 50ml/hr, 275ml vol
BX248	Infusor	Sterile infusor devices, spring or 	LV 2, 2ml/hr, 275 ml vol; 	$85.00
	elastomeric driven	LV 1.5, 1.5ml/hr, 275ml vol;
	 SV Multi day, 0.5ml/hr. 
	60ml vol; SV Seven day, 
	0.5ml/hr, 96ml vol
BX281	Baxter Folfusor	Folfusor SV 0.5mL/hr 120mL (Baxter 	120mL Maximum Volume	$85.00
	Code 2C4700K), Folfusor SV 
	2.5mL/hr 120mL (Baxter Code 
	2C4711K), Folfusor SV 5mL/hr 
	120mL (Baxter Code 2C4705K). The 
	Baxter Folfusor is a disposable 
	infusion pump used in an ambulatory 
	setting for the continuous infusion of 
	intravenous medications. The codes 
	listed above represent three separate 
	flow rates specific to Chemotherapy 
	protocols.
Prostheses List by Category, Groups and Sponsor	Page 72 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BX287	Intermate XLV 250	The Intermate XLV 250 is an 	Volume 500mL. 	$85.00
	ambulatory device utilising 	Approximate infusion time 
	elastomeric technology to deliver 	for IVIG solutions is 4.2 
	continuous infusion of parenteral 
	therapy to patients in an ambulatory 
	setting. The device is specifically 
	suitable for patients requiring 
	intravenous immunoglobulin therapy.
	 The nominal flow rate of the Intermate 
	XLV 250 is 250mL/hr, however when 
	used for the administration of IVIG the
	 flow rate is reduced to approximately 
	120mL/hr.
	Bolus
	Baxter Healthcare Pty Ltd
BX250	Basal/Bolus and Multirate Infusors	Sterile infusor devices, spring or 	Basal/Bolus 60, Basal 	$260.00
	elastomeric driven	0.5ml/hr, Bolus 0.5ml/hr x 
	65ml; Basal/Bolus 15, Basal
	 0.5ml/hr, Bolus 2ml/hr x 
	65ml; Basal/Bolus infusor, 
	Basal 2ml/hr, Bolus 2ml/hr x
	 65ml; Multirate 5, 7 or 12 
	ml/hr x 300 ml; Multirate 2, 
	4, or 6 ml/hr x 300 ml; 
	Multirate 2, 3, o
	Set
	Cosuda Pty Ltd
CU001	BeeLINE MotIV Infusion Pump 	External infusion pump, spring 	275ml infuser reservoir = 	$260.00
	(275ml)	powered, fixed flow rate, 275ml set: 	19cm (7.5") x 7cm (2.8")
	set includes reservoir, introducer 
	needle, tubing set, priming/flushing 
	syringes, saturation catheter, 
	dressing, syringes.  30min - 7 day 
CU002	BeeLINE MotIV Infusion Pump 	External infusion pump, spring 	100ml infusor reservoir = 	$260.00
	(100ml)	powered, fixed flow rate, 100ml set: 	13cm (5.1") x 7cm (2.8")
	set includes reservoir, introducer 
	needle, tubing set, priming/flushing 
	syringes, saturation catheter, 
	dressing, syringes.  30min - 7 day 
Prostheses List by Category, Groups and Sponsor	Page 73 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ030	PainBuster	Kit includes catheter, introducer 	270ml volume x 2 lines x 2 	$260.00
	needle, flow restrictor, filter, bolus	ml per hour; 270ml x 2ml, 
	5ml bolus; 270ml x 1-7ml/hr
SQ031	PainBuster	Kit includes catheter, introducer 	100ml volume x 2 ml per 	$260.00
	needle, flow restrictor, filter	hour
SQ032	PainBuster	Kit includes catheter, introducer 	270ml volume x 2 ml per 	$260.00
	needle, flow restrictor, filter	hour
SQ033	PainBuster	Kit includes catheter, introducer 	270ml volume x 5 ml per 	$260.00
	needle, flow restrictor, filter	hour
SQ034	Painbuster	Kit includes catheter, introducer 	270ml x 4ml/hr, dual; 400ml	$260.00
	needle, flow restrictor, filter	 x 4ml per hour, dual
SQ035	Painbuster	Kit includes catheter, introducer 	400ml	$260.00
	needle, flow restrictor, filter, 2 - 
	14ml/hour
	03.02.04.02 - Variable Flow Rate
	Baxter Healthcare Pty Ltd
BX249	Multirate with PCM	Sterile infusor devices, spring or 	Multirate 5, 7 or 12 ml/hr 	$300.00
	elastomeric driven	with PCM
03.02.05 - Infusion Pump Accessories
	03.02.05.01 - Kit
	Baxter Healthcare Pty Ltd
BX286	Painfusor Catheter	The Painfusor Catheter is an extended 	Catheters are 35cm + 	$80.00
	fenestration catheter for the 	Fenestrated section:     
	administration of analgesic drugs into	(35cm + 2.5cm) - total 
	 surgical wounds to manage acute 	length 37.5cm, (35cm + 
	post-operative pain. Pack contains 	7.5cm) - total length 42.5cm,
	fenestrated catheter, peel away 	 (35cm + 15cm) - total 
	introducer needle accommodating 	length 50cm, (35cm + 
	19Ga (100 mm length), 3M Tegaderm 	22.5cm) - total length 
	IV Transparent Film Dressing with 	57.5cm, (35cm + 30 cm) - 
	border 1633, and GripLok catheter 	total length 65cm
	securement device
Prostheses List by Category, Groups and Sponsor	Page 74 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	ClaveGuard Pty Ltd
CJ004	Ace Catheter Set	The Ace Catheter Set is an extended 	Catheter - 19Ga, 	$80.00
	fenestration catheter. The Ace Catheter	fenestration lengths: 2.5cm 
	 Pack contains fenestrated catheter, 	(8 hole), 5cm (10 hole), 
	peel away introducer needle, tubing 	6.5cm (15 hole), 10cm (20 
	set, priming/flushing syringes, 	hole), 12.5cm (25 hole), 
	dressing, and Ace Lock-Catheter 	15cm (30 hole) and 30cm 
	securement device.
	03.02.05.02 - Administration Cassette
	Admedus (Australia) Pty Ltd
AH005	AMBIT Infusion Pump Cassette	Single use sterile disposable 	20mm x 10mm x 15mm	$28.00
	administration set for use with the 
	AMBIT Infusion Pump.  The cassette 
	contains a rotary mechanism that 
	pumps the infusion solution at an 
	accurate and controlled rate.  The 
	cassette includes an administration 
	line with a solution bag spike and an 
	inline air filter
	Baxter Healthcare Pty Ltd
BX245	Patient Control Module	Sterile infusor devices, spring or 	Module 0.5ml dose, Module	$28.00
	elastomeric driven	 2 ml dose
	Hospira Pty Limited
HO003	Gemstar infusion system 	Administration cassette and set for 	2.2 micron filter	$28.00
	administration cassette and set	use with Gemstar infusion pump 
HO007	Sapphire Infusion Cassette and Set	The Sapphire Infusion Cassette and 	210cm	$28.00
	set is a one piece microfibre infusion 
	set with non vented spike, pinch 
	clamp, administration cassette, female 
	luer lock, entrance with a back check 
	valve, pinch clamp and spin male leur 
	lock for use with the sapphire 
	infusion system. The materail 
	components are made from PVC-Non 
	DEHP (tubing, connectors), silicon 
	(Y site and tubing and polypropylene
	 (valves)
	Smiths Medical Australasia Pty Ltd
SI024	Medication Cassettes (50ml & 	Pump	50 mL	$28.00
Prostheses List by Category, Groups and Sponsor	Page 75 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SI025	Medication Cassettes (50ml & 	Pump	100 mL	$28.00
	03.02.05.03 - Administration Reservoir
	Australasian Medical & Scientific Ltd
AN006	Animas IR 1200/2020 Insulin 	Sterile, indicated as reservoir for 	Cartridge Capacity - 2.0mL 	$8.00
	Infusion Cartridge (Insulin Infusion 	insulin by the Animas Infusion Pump,	or 200 units. Packs of 10
	Pump IR1200/2020 Series)	 not intended for use with any other 
	infusion device.
	Fresenius Kabi Australia Pty Ltd
FK006	Accumate 1100 Reservoir Bag	Reservoir bag	150ml, 250ml, 500ml	$8.00
	Medical Specialties Australia Pty Ltd
MS022	Medical Specialties "Walkmed Drug	Ambulatory Infusion Pump System, 	Walkmed Drug 	$8.00
	 Administration Reservoir" 	Administration Sets and Accessories	Administration Reservoirs
	(McKinley, USA)
	Rollex Medical
RX002	Medical Specialties "Walkmed Drug	Ambulatory Infusion Pump System, 	Walkmed Drug 	$8.00
	 Administration Reservoir" 	Administration Sets and Accessories	Administration Reservoirs
	(McKinley, USA)
	Smiths Medical Australasia Pty Ltd
SI036	Flexible Medication Reservoir, 	Pump	250 mL	$8.00
	250ml Model 21-6167-24
	03.02.05.04 - Administration Set
	Australasian Medical & Scientific Ltd
AN003	Animas Insulin Infusion Sets	(INFUSION SET, COMFORT, 23", 	Packs of 10	$7.00
	HOSP 10, INFUSION SET, 
	COMFORT 43", HOSP 10. Inset II, 
	6mm and 9mm. Inset 30, 13mm) Needle
	 guard, soft cannula, adhesive tape, 
	introducer needle, cannula housing, 
	tubing, connector needle, circular 
	protective cap and disconnect cover.
Prostheses List by Category, Groups and Sponsor	Page 76 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AN004	Animas Insulin Infusion Set	(INFUSION SET, COMFORT, 23", 	Packs of 10	$7.00
	STD 5/5 AND INFUSION SET, 
	COMFORT, 43" STD 5/5) Needle 
	guard, soft cannula, adhesive tape, 
	introducer needle, cannula housing, 
	tubing, connector needle, circular 
	protective cap and disconnect cover.
	Fresenius Kabi Australia Pty Ltd
FK005	Accumate 1100 Tubing Set	A-type (Luer type) tubing set, B-type 	160.5 cm, 174cm	$7.00
	(spike type) tubing set
	Hospira Pty Limited
HO005	Crono infusion system syringes	Infusion syringes for use with the 	10-50 ml	$7.00
	Crono pump
	Medical Specialties Australia Pty Ltd
MS023	Medical Specialties "Walkmed Drug	Ambulatory Infusion Pump System, 	Walkmed Drug 	$7.00
	 Administration Sets"  (McKinley, 	Administration Sets and Accessories	Administration Sets
	USA)
	Smiths Medical Australasia Pty Ltd
SI026	CADD Administration Set 175cm 	For use with SI036	250 mL	$7.00
	TOTM tubing
SI027	CADD Administration Sets, 198cm, 	Pump	198 cm	$7.00
	with Bag Spike & Add-on Anti-
	siphon Valve, TOTM Plasticized 
	Tubing, Model No. 21-7057-24
SI028	Extention Set (30" & 60")	Pump	76 cm	$7.00
SI029	Extension Set (30" & 60")	Pump	152 cm	$7.00
SI040	Administration Set	Bag Spike, Integral Anti-Siphon 	196cm Bag Spike, Box of 12	$7.00
SI041	Administration Set	High Volume, with 0.2 Micron Filter, 	Box of 15	$7.00
	Male Luer, Add On Anti Syphon 
SI042	Extension Set	Microbore TOTM with 0.22 Filter, 	152cm	$7.00
	M/M Luers, for Flolan
SI044	Administration Set	High Volume, TOTM- Plasticized 	305cm	$7.00
	Blue Striped with 1.2 Micron Filter, 
	Male Luer, Add On Anti-Siphon Valve
Prostheses List by Category, Groups and Sponsor	Page 77 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.02.05.05 - Other
	ClaveGuard Pty Ltd
CJ005	Ace Tunneler System	Tunneler and sheath to assist in 	30cm x 11GA, 30cm x 16GA	$50.00
	placing catheter in close proximity to 
	key nerve bundles
	Orthocare Pty Limited
OC018	Advanced Infusion	Multi-Drip Catheter 2.0ml/hr flow rate	0.8 x 1200 mm	$50.00
OC019	Advanced Infusion	Mulit-Drip Catheter 4.0ml/hr flow rate	.08 x 1200 mm	$50.00
	 12cm drip area
	Surgical Specialties
SQ069	Painbuster Tunneler & Sheaths	Introducer Sheath to enable deeper 	20cm x 11GA, 20cm 	$50.00
	placement of catheter in close 	X17GA, 30cm x 11GA, 
	proximity to key nerve bundles	30cm X 17GA
SQ070	Painbuster Soaker Catheter	Soaker Catheter Kit- multiple hole 	2.5, 6.5, 12.5 & 25cm 	$50.00
	silver antimicrobial catheter, 	infusion segment
	introducer needle & sheath
03.02.06 - Pharmaceutical Beads
	03.02.06.01 - Single Units
	Device Technologies Australia Pty Ltd
DE275	DC Bead	Drug delivery embolisation system	70-150, 100-300, 300-500, 	$1,950.00
	500-700, 700-900 (microns)
	Endotherapeutics Pty Ltd
ET052	Hepasphere	Expanding microspheres designed for 	50 - 200 microns	$1,950.00
	chemic0-embolisation with 
	chemotherapeutic agents such as 
	Ethiodil, Cisplatin, Epirubicin, 
	Mitomycin, etc.
	03.02.06.02 - Chains
	Biomet Australia Pty Ltd
BI280	Septopal Chain Septopal Beads	PMMA, Stainless Steel	30 bead chain	$750.00
Prostheses List by Category, Groups and Sponsor	Page 78 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.03.01 - Feeding Tubes
	Thermo Fisher Scientific Australia Pty Ltd
FT003	Corflo Max 20fg PEG Kit Complete 	Sterile enteral feeding tube with  	20fg	$178.00
	with 7fg Snare - "Pull Type"	accessories
FT004	Corflo Max 20fg PEG Kit "Pull 	Sterile enteral feeding tube with  	20fg	$178.00
	accessories
03.03.02 - Gastrostomy Tubes
	03.03.02.01 - Initial
	Abbott Australasia Pty Ltd
AY002	Flexiflo inverta PEG kit Basic, 	Composition - biocompatible silicone	20F	$205.00
	Flexiflo inverta PEG kit with snare	 tube.  Items included in kit/product - 
	Sliding retention disc, Insertion wire, 
	Gastrostomy tube with attached 
	Dilator Catheter, seldinger needle 
	14g, magna port connector, scalpel, 
	Snare (in kit with snare)
	Bard Australia Pty Ltd
BA047	Gastrostomy Tube	Silicone Tubes and Replacement 	12Fr - 28Fr	$205.00
	Boston Scientific Australia Pty Ltd
BS141	EndoVive Initial Feeding Tube	Silicone enteral feeding tube	Up to 24 Fr	$205.00
	Cook Medical Australia Pty Ltd
WC072	Passport Low Profile Device	Enteral/Gastrostomy	FEEDING TUBE French 	$205.00
	Sizes: 20.0, 24.0 Length: 
	1.2,1.7,2.4,3.4,4.4 cm
WC185	Percutaneous Endoscopic 	PEG Enteral Feeding Kit - Push or 	18, 20, 24 FR	$205.00
	Gastrostomy (PEG) System	Pull System
WC199	Cook Gastronomy Tubes	Russell Gastronomy Set	14fr, 17cm	$205.00
WC298	Wills-Oglesby Percutaneous 	Used for the percutaneous placement 	12-14Fr, Length 30-35cm	$205.00
	Gastronomy Set	of a catheter for gastroenteric feeding
Prostheses List by Category, Groups and Sponsor	Page 79 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE296	Pull PEG System	Initial placement percutaneous 	20Fr; 60cm	$205.00
	endoscopic gastrostomy kit
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA015	Entristar Skin Level Gastrostomy 	Skin level non-balloon internal 	12fg x 1.2cm, 12fg x 1.5cm, 	$205.00
	retention bolster gastrostomy kit, 	12fg x 2.0cm, 12fg x 2.5cm, 
	including Entristar gastrostomy tube, 	12fg x 3.0cm, 12fg x 3.5cm, 
	accessory bolus and continuous 	12fg x 4.0cm, 12fg x 4.5cm, 
	feeding tubes, syringes for inflation 	12fg x 5.0cm, 16fg x 1.5cm, 
	and flushin. Patient handbook	16fg x 1.7cm, 16fg x 2.0cm, 
	16fg x 2.4cm, 16fg x 2.7cm, 
	16fg x 3.0cm, 16fg x 3.5cm, 
	20fg x 1.5cm, 20fg x 2.0cm, 
	20fg x 2.5cm, 20fg x 3.0cm, 
	20fg x 3.5cm, 20fg x 4.0cm, 
	20fg x 4.5cm, 20fg x 5.0cm
KA017	NutriPort Balloon Skin Level 	Skin level silicone balloon 	12fg x 0.8 - 5.0cm, 14fg x 0.8	$205.00
	Gastrostomy Kit	gastrostomy kit, including NutriPort 	 - 5.0cm, 16fg x 0.8 - 5.0cm
	gastronomy tube, accessory bolus and
	 continuous feeding tubes, syringes 
	for inflation and flushing, Patient 
	Kimberly-Clark Australia Pty Limited
KI001	Kimberly-Clark Aust Pty Ltd 	68914 MIC Gastrostomy Tubes 	MIC* Percutaneous 	$205.00
	Enteral Feeding Kit	Model 100 Series	Endoscopic Gastrostomy 
	(P.E.G) Feeding Tubes/Kits
	 14, 20, 24 French #0630 
	Series PUSH (OTW) 
	Method & #0640Series 
	PULL Method
KI002	Kimberly-Clark Aust Pty Ltd 	68914 MIC Gastrostomy Tubes 	MIC* Percutaneous 	$205.00
	Enteral feeding kit, Mic* 	Model 100 Series	Endoscopic Gastrostomy 
	Percutaneous Endoscopic 	(P.E. G) Feeding BASIC 
	Gastrostomy (P.E.G) Feeding 	Tubes/Kits 14, 20, 24 
	French#0644 Series PULL 
	Method
KI004	Kimberly-Clark Aust Pty Ltd 	68914 MIC Gastrostomy Tubes 	MIC-KEY* Low Profile 	$205.00
	Enteral feeding kit, MIC-KEY Low 	Model 100 Series	Gastrostomy Feeding 
	Profile Gastrostomy Feeding 	Tubes/Kits 14 - 24 French, 
	0.8 cm - 4.5 cm
Prostheses List by Category, Groups and Sponsor	Page 80 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sherwood Davis & Geck
SG001	Gastrostomy Tube	EntriStar Single Pass PEG	16fg, 20fg	$205.00
	Thermo Fisher Scientific Australia Pty Ltd
FT001	Corflo Cubby LPGD Kit	Low profile gastronomy device	12 - 24fg x 1.0 - 4.5cm	$205.00
	03.03.02.02 - Subsequent
	Abbott Australasia Pty Ltd
AY005	Flexiflo balloon gastrostomy tube	Composition - biocompatible 	16 french, 18 french, 20 french	$90.00
	silicone.  Items included in 
	kit/product - sliding retention disc 
	and opened edged feeding port
	Boston Scientific Australia Pty Ltd
BS142	EndoVive Replacement Feeding Tube	Silicone enteral feeding tube	Up to 28 Fr	$90.00
	Cook Medical Australia Pty Ltd
WC070	Gastrostomy Tube	PEG Balloon Replacement Tube - 	14, 18, 24fr	$90.00
	Single
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA016	Kangaroo Gastrostomy Feeding 	100% silicone gastrostomy with 	12fg, 14fg, 16fg, 18fg, 20fg, 	$90.00
	internal retention balloon	22fg, 24fg
	Kimberly-Clark Australia Pty Limited
KI003	Kimberly-Clark Aust Pty Ltd 	68914 MIC Gastrostomy Tubes 	Feeding Adaptors 	$90.00
	Enteral feeding kit, Mic* 	Model 100 Series	(Universal or Bolus) for use 
	Percutaneous Endoscopic 	with 14, 20 &24 F MIC* 
	Gastrostomy (P.E.G) Feeding 	PEG's#0135 &#0136 
KI005	Kimberly-Clark Aust Pty Ltd 	68914 MIC Gastrostomy Tubes 	SECUR-LOK* Extension 	$90.00
	Enteral feeding kit, MIC-KEY Low 	Model 100 Series	Sets & Bolus Feeding Sets 
	Profile Gastrostomy Feeding 	30.5 cm & 60.9 cm
Prostheses List by Category, Groups and Sponsor	Page 81 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
KI007	MIC* Gastrostomy Feeding Tube; 	Medical Grade Silicone Construction.	12fr - 3-5ml balloon, 14fr - 	$90.00
	MIC* Bolus Gastrostomy Tube	 Silicone Internal Inflatable Retention 	3-5ml balloon, 16fr - 3-5ml 
	Balloon, SECU-LOK* External 	balloon, 18fr - 7-10ml 
	Retention Ring, Universal Feeding 	balloon, 20fr - 7-10ml 
	Port Connector, Medication Port, 	balloon, 22fr - 7-10ml 
	Dual Exit Ports, Tapered Distal Tip, 	balloon, 24fr - 7-10ml 
	Radiopaque Strip, Sterile.	balloon, 26fr - 7-10ml 
	balloon, 28fr - 7-10ml 
	balloon, 30fr - 7-10ml 
	balloon,
	Nutricia Australia Pty Ltd
NF001	Flocare Gastrostomy tube (G-tube)	The Flocare Gastrostomy tube can be 	Ch10, 14, 18, 20	$90.00
	used as a replacement of an existing 
	gastrostomy tube (PEG or G-tube) or 
	as an initial gastrostomy tube during 
	a surgical intervention. This balloon 
	tube is made of medical grade silicone.
	Thermo Fisher Scientific Australia Pty Ltd
FT002	Corflo Gastronomy Replacement 	Dual and triple gastronomy tubes	Dual 12 - 24fg 5 - 20cc 	$90.00
	Device	balloon; Triple 16 - 24fg 
	20cc balloon
03.03.03 - Jejunostomy Tubes
	Cook Medical Australia Pty Ltd
WC098	Cook Jejunostomy Catheters	Composition - Catheter Radiopaque 	12fr, length 60cm	$170.00
	Stripe, includes Wireguide, Airplug, 
	Fixation Device
WC099	Cook Jejunostomy Catheters	Composition - Catheter Radiopaque 	9fr, Length 60cm	$170.00
	Stripe, includes Wireguide, Airplug, 
	Fixation Device
	Port
	Cook Medical Australia Pty Ltd
WC292	Shetty Single Lumen 	The Shetty Gastrojejunostomy set 	14 Fr, Length: 63cm	$500.00
	Gastrojejunostomy Set	consists of an Ultrathane 
	Gastrojunostomy Catheter, Peel- 
	Away introducer, and Cope 
	Gastrointestinal Suture Anchor Set.
Prostheses List by Category, Groups and Sponsor	Page 82 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Kimberly-Clark Australia Pty Limited
KI006	Kimberly-Clark MIC* Transgastric-	Medical Grade Silicone Construction,	16-22 French - 45cm jejunal	$500.00
	Jejunal Feeding Tubes (Surgical 	 Silicone Internal Retention Balloon, 	 length - 7-10ml balloon
	Placement Kits)	SECUR-LOK* External Retention 
	ring, Universal Jejunal Feeding Port 
	Connector, Gastric Decompression 
	Port, Multiple Gastric & Jejunal Exit 
	Ports, Tungsten Weighted Jejunal 
	Portion, Tapered Distal Tip, 
	Radiopaque Stripe, Sterile
KI008	MIC-KEY Low Profile 	100% medical grade silicone tube. 	16, 18 and 22Fr, 1.0 to 	$500.00
	Transgastric-Jejunal Feeding Tube	40/60 tungsten weighted jejunal post	3.5cm stomal length, 15 to 
	 pyloric feeding tube. Gastric drainage	45cm jejunal length
	 ports, jejunal feeding ports
KI009	MIC Transgastric-Jejunal Feeding 	100% medical grade silicone tube. 	16, 18, 22Fr, 15 to 45cm 	$500.00
	Tube	40/60 tungsten weighted jejunal post	jejunal length, 7-10ml 
	 pyloric feeding tube. Gastric drainage	balloon volume
	 ports, jejunal feeding ports
03.03.04 - Caecostomy Tubes
	Cook Medical Australia Pty Ltd
WC197	Cook Irrigation Catheter	Chait Percutaneous Cecostomy 	10fr, Standard or Extra Long	$355.00
03.04.01 - Adjustable Gastric Band with Port
	Allergan Australia Pty Limited
AW001	Lap-Band Adjustable Gastric 	-	AP-small and AP-large	$3,300.00
	Banding (LAGB) System
AW016	Lap-Band AP with RapidPort EZ	Adjustable gastric banding system 	AP small and AP large	$3,300.00
	with Rapid Port EZ access port.  The 
	Rapid Port EZ access port allows for a
	 sutureless fixation of the port of the 
	Lap-Band to the stomach fascia or 
	muscle
Prostheses List by Category, Groups and Sponsor	Page 83 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Alliance Surgical
AA009	Bioring Gastric Band	Adjustable gastric banding kit	Small, Large and Extra 	$3,300.00
AA010	Adhesix Bioring Gastric Band	Adjustable gastric band system with 	Small, Large and Extra 	$3,300.00
	mesh fixation of port
	Endotherapeutics Pty Ltd
ET042	Soft Gastric Banding System	Sterile long term implant for the 	One size only	$3,300.00
	treatment of obesity.  Supplied in kit 
	format with catheter, port and huber 
	needles
ET058	Soft Basket Band	Adjustable Gastric Band Implant	115 MM CUFF	$3,300.00
	Johnson & Johnson Medical Pty Ltd
JJ831	Ethicon Endo-Surgery curved 	Silicone	One size only	$3,300.00
	adjustable gastric band with 
	sutureless port and applier
JJ832	Swedish Adjustable Gastric Band	Silicone	One size only	$3,300.00
	Lifehealthcare Pty Ltd
LH003	Adjustable Peri Gastric Belt-	Silicon moulded peri gastric band and	Peri gastric band - 2.2 x 	$3,300.00
	 implantable chamber	17.5 x 0.8cm, Implantable 
	chamber - one size only
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG002	Heliogast Adjustable Gastric Band	Silicone and Titanium	HAGE (evolution), small 	$3,300.00
	band - inner diameter 26mm;
	 HAGA (advanced), large 
	band - inner diameter 28mm
	Sphere Surgical
RS002	MiniMizer gastric band.	Adjustable Silicone band which is 	The gastric band comes in 	$3,300.00
	placed around the upper part of the 	one size, but could come 
	stomach to reduce the volume and 	with a small or medium 
	speed of intake of food.	sized port.
	14mm wide, 16.6cm band 
	two phase closure, 1: 31mm 
	inner diameter, phase 2: 
	26mm inner diameter. 40cm 
	silicon tube attached.
Prostheses List by Category, Groups and Sponsor	Page 84 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.04.02 - Gastric Band without Port
	Sphere Surgical
RS001	Minimizer Ring	Adjustable Gastric Ring	One size ranging from 6.5cm	$2,000.00
	 to a 8.0cm diameter
	Surgeons Choice Australia Pty Ltd
SH011	GaBP Ring	Adjustable Gastric Ring	Differing sizes	$2,000.00
03.04.03 - Replacement Injection Ports
	Allergan Australia Pty Limited
AW002	Lap-Band Access Port	For use with the Lap-Band 	Standard, low profile	$620.00
	Adjustable Gastric Banding System
AW017	RapidPort EZ (replacement port)	Replacement port for use with the 	Access port assembly	$620.00
	Lap-Band adjustable gastric banding 	Access port 3cm diameter x 
	1.2cm
	Septum 1.4cm diameter
	Alliance Surgical
AA008	Bioring Gastric Band Replacement 	Bioring gastric band access port with 	Diameter 34mm; height 	$620.00
	Port	catheter and connector	10.4mm
	Endotherapeutics Pty Ltd
ET056	Soft Basket Band. INFUSION PORT.	TITANIUM PORT	9.8CMS/13.3CMS	$620.00
	Johnson & Johnson Medical Pty Ltd
JJ444	Ethicon Endo-Surgery Gastric band	Implantable infusion port & locking 	One size only	$620.00
	 sutureless port and applier	connector for adjustable gastric band. 
	Replacement port & locking 
	connector for use with adjustable 
Prostheses List by Category, Groups and Sponsor	Page 85 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH413	Miband Access Port (replacement)	A device, metallic or non- metallic, 	Port Size - 10.6mm High, 	$620.00
	implanted in a patient for a short or 	24.7mm Base width- One 
	long-term delivery of fluid or 	Size only
	medications to the vascular system  or 
	other anatomical region. The device 
	consists of a housing, self-sealing 
	septum and a catheter connection 
	mechanism. The device may be 
	implanted in a variety of anatomical 
	locations.
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG018	HAGA Access Port	Access Port contains Titanium and 	Standard	$620.00
	Silicone
	Sphere Surgical
RS003	MiniMizer gastric band (injection 	Adjustable Silicone band which is 	Small or medium sized port.	$620.00
	port)	placed around the upper part of the 
	stomach to reduce the volume and 
	speed of intake of food. The injection 
	port is used to inflate or deflate the 
	gastric band therefore adjusting the 
	diameter of the band.
03.04.04 - Accessories
	Allergan Australia Pty Limited
AW003	Rapid Port Tack	Implantable acetal copolymer disk 	Outside diameter for the 	$170.00
	assembly, rotor assembly with three 	tack 30.5mm diameter by 
	stainless steel fasteners.  The fasteners,	5.6mm Height.  The wires 
	 when deployed by rotating the rotor, 	extend 3mm below the 
	extend about 3mm below the 	bottom surface.
	undersurface of the Tack
Prostheses List by Category, Groups and Sponsor	Page 86 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.05.01 - Occluder Pin
	Design for Vision Pty Ltd
DV024	Haemorrhage Occluder Pin with 	Designed to control severe presacral 	Two sizes: 10mm and 14mm	$430.00
	applicator	bleeding during pelvic surgery.
03.05.02 - Powder
	Johnson & Johnson Medical Pty Ltd
JJ636	Spongostan Absorbable 	1 g Porcine Absorbable Haemostatic 	1 gram	$50.00
	Haemostatic Gelatin Powder	Gelatin Powder
	Lifehealthcare Pty Ltd
LH408	Geli Putty(Powder, 1g)	Geli Putty is a single- use, water 	1 gram	$50.00
	insoluble, fully bioabsorbable gelatin
	 powder comprising milled sponges 
	(Gelita-Spon) made from 100% 
	pharmaceutical grade porcine gelatin 
	mixed with sterile liquid (e.g. saline 
	or antibiotic solution) prior to use.
	Surgical Specialties
SQ072	HaemoCer Haemostatic Powder	Absorbable Polysaccharide Haemostat	2gms	$100.00
SQ073	HaemoCer Haemostatic Powder	Absorbable Polysaccharide Haemostat	5gms	$250.00
	Tag Medical
TM047	PerClot Standard	PerClot Polysaccharide Hemostatic 	1 gram	$50.00
	System
TM048	PerClot Standard	PerClot Polysaccharide Hemostatic 	3 gram	$150.00
	System
03.05.03 - Sponges
	03.05.03.01 - Absorbable ≤75cm²
	Johnson & Johnson Medical Pty Ltd
JJ003	Spongostan Absorbable Haemostat	Standard (Box of 20)	70 x 50 x 10mm	$10.00
Prostheses List by Category, Groups and Sponsor	Page 87 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ005	Spongostan Absorbable Haemostat	Special (Box of 20)	70 x 50 x 1mm	$10.00
JJ015	Spongostan Absorbable Haemostat	Dental (Box of 24)	10 x 10 x 10mm	$10.00
	Lifehealthcare Pty Ltd
LH405	Gelita-Spon Absorbable Gelatin 	Gelita- Spon IR is a sterile, single-	GS-322-Gelita-Spon IR 	$10.00
	Sponge-Gelita- Spon IR Sponge	use, fully bioabsorbable gelatin 	Sponge; 200s-3x2x2mm        
	sponge indicated to achieve rapid 	                                                
	haemostasis(e.g. surgically or trauma 	GS- 344- Gelita- Spon IR 
	induced) by tamponade, and arterial 	Sponge; 100s-4x4x4mm
	embolisation. also indicated for use as
	 a vehicle for a wide range of 
	therapeutic agents including 
	antibiotics, thrombin and 
	chemotherapeutics without reduction 
	in the sponge's haemostatic effect.
LH410	Gelita-Spon Absorbable Gelatin 	'Gelita-Spon Anal-Vaginal Tampon is 	3x8cm	$10.00
	Sponge Anal-Vaginal Tampon	a sterile, single use, fully 
	bioabsorbable gelatin sponge  
	indicated to achieve rapid 
	haemostasis by tamponade, also 
	indicated for use as a vehicle for a 
	wide range of therapeutic agents, 
	including antibiotics, thrombin and 
	chemotherapeutics without reduction 
	in the sponge's haemostatic effect.
LH411	Gelita-Spon Absorbable Gelatin 	GelitaSpon  ENT Sponge is a sterile, 	8x5x1 cm & 1x1x1cm	$10.00
	Sponge - Gelita-Spon ENT Sponge	single use, water insoluble, fully 
	bioabsorbable, firm, high-density 
	gelatin sponge  indicated to achieve 
	rapid haemostasis during ENT 
LH412	Gelita-Spon Absorbable Gelatin 	Gelita-Spon Dental Cube is a  sterile, 	GS-310 - Gelita-Spon 	$10.00
	Sponge-Gelita- Spon Dental Cube	single-use, indicated to achieve rapid 	Dental Cubes; 50s - 10 x 10 
	haemostasis dental surgery (oral bone 
	and soft tissue), a void filler to 
	mitigate against the risk of sclerosis 
	created by tooth extraction, root 
	amputations, and the removal of cysts, 
	tumours and impacted teeth.  its 
	absorptive capacity being a function 
	of the amount of gelatin incorporated 
	and, hence, the physical size of the 
	sponge. also indicated for use as a 
	vehicle for a wide range of therapeutic 
	agents.
Prostheses List by Category, Groups and Sponsor	Page 88 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LH414	Gelita-Spon Absorbable Gelatin 	Gelita-Spon Standard is a sterile, 	GS-010-Gelita-Spon 	$10.00
	Sponge-Gelita- Spon Standard	single- use, fully bioabsorbable 	Standard; 10s-80x50x10m    
	gelatin sponge indicated to achieve 	   GS-060-Gelita-Spon 
	rapid haemostasis(e.g. surgically or 	Standard Size 12-7; 10s-
	trauma induced)by tamponade, and 	60x20x7mm                               
	arterial embolisation . also indicated 	                                        GS-
	for use as a vehicle for a wide range of 	060-Gelita-Spon Standard 
	therapeutic agents, including 	Size 12-7; 10s-60x20x7mm  
	antibiotics, thrombin and 	                                                      
	chemotherapeutics without reduction 	               GS-650- Gelita 
	in the sponge's haemostatic effect.	Spon Standard Size 200; 
	10s-125x80x10mm                  
	                                                
	GS-110-Gelita-Spon 
	Standard Size Special 20; 
	20s-80x50x1mm                       
	                                       GS-
	950-Gelita-Spon Standard 
	Film; 20s-200x70x0.5mm
	Anatomically Conforming
	Johnson & Johnson Medical Pty Ltd
JJ006	Spongostan Absorbable Haemostat	Anal 20s (Box of 20)	80 x 30mm	$17.00
JJ007	Spongostan Absorbable Haemostat	Anal 5s (Box of 5)	80 x 30mm	$17.00
	Low Antigenicity
	Pfizer Australia Pty Ltd
PU059	Gelfoam Sterile Sponge	Sterile, pliable, nonantigenic surgical 	12 - 20mm x 60mm x 7mm, 	$17.00
	sponge prepared from specially treated	individually packaged for 
	 purified gelatine solution
	03.05.03.02 - Absorbable >75cm²
	Johnson & Johnson Medical Pty Ltd
JJ004	Spongostan Absorbable Haemostat	Film (Box of 20)	200 x 70 x 0.5mm	$30.00
Prostheses List by Category, Groups and Sponsor	Page 89 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Low Antigenicity
	Pfizer Australia Pty Ltd
PU060	Gelfoam Sterile Sponge	Sterile, pliable, nonantigenic surgical 	100 - 80mm x 125mm x 	$72.00
	sponge prepared from specially treated	10mm in individual packet
	 purified gelatine solution
03.05.04 - Pliable Patches
	03.05.04.01 - Absorbable ≤75cm²
	Lifehealthcare Pty Ltd
LH424	Gelitacel Oxidised Resorbable 	Gelitacel is a white, single-use, non-	5 x 7 cm	$10.00
	Cellulose Gauze (15)	toxic, sterile, bioarbsorbable, weakly 
	acidic, viscose-free, knitted 
	haemostatic fabric (USP)
	Antimicrobial, Low Antigenicity
	Johnson & Johnson Medical Pty Ltd
JJ013	Surgicel ORIGINAL Absorbable 	Oxidised regenerated cellulose gauze, 	5 x 7.5cm	$22.00
	Haemostat	the material is biocompatible and also 
	bactericidal
JJ014	Surgicel ORIGINAL Absorbable 	Oxidised regenerated cellulose gauze, 	1.25  x 5cm	$22.00
	Haemostat	the material is biocompatible and also 
	bactericidal
	Antimicrobial, Low Antigenicity, Micro-fibrous
	Johnson & Johnson Medical Pty Ltd
JJ009	Surgicel Fibrillar Absorbable 	Fibrous fleece, oxidised regenerated 	2.5 x 5.1cm	$40.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal
JJ030	Surgicel Fibrillar Absorbable 	Fibrous fleece, oxidised regenerated 	5.1 x 10.2cm	$40.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal
MN112	Surgicel Non-Woven (SNoW) 	Absorbable haemostat, Structured 	2.5 x 5cm	$40.00
	Absorbable Haemostat	Non-Woven
MN116	Surgicel Non-Woven (SNoW) 	Absorbable haemostat, Structured 	5 x 10.2cm	$40.00
	Absorbable Haemostat	Non-Woven
Prostheses List by Category, Groups and Sponsor	Page 90 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Antimicrobial, Low Antigenicity, Woven
	Johnson & Johnson Medical Pty Ltd
JJ008	Surgicel Nu-Knit Absorbable 	High density, oxidised regenerated 	7.5 x 10cm	$38.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal
JJ023	Surgicel Nu-Knit Absorbable 	High density, oxidised regenerated 	2.5 x 2.5cm	$38.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal
JJ432	SURGICEL Nu knit Absorbable 	High density , oxidised regenerated 	2.5 x 8.75cm	$38.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal.
	03.05.04.02 - Absorbable >75cm²
	Lifehealthcare Pty Ltd
LH423	Gelitacel Oxidised Resorbable 	Gelitacel is a white, single use, non-	5 x 35 cm, 10 x 20 cm	$30.00
	Cellulose Gauze (10)	toxic, sterile, hydrophilic 
	bioabsorbable, weakly acidic, 
	viscose-free, knitted haemostatic 
	Antimicrobial, Low Antigenicity
	Johnson & Johnson Medical Pty Ltd
JJ012	Surgicel ORIGINAL Absorbable 	Oxidised regenerated cellulose gauze, 	5-10.2 x 20-35cm	$40.00
	Haemostat	the material is biocompatible and also 
	bactericidal
	Antimicrobial, Low Antigenicity, Micro-fibrous
	Johnson & Johnson Medical Pty Ltd
JJ029	Surgicel Fibrillar Absorbable 	Fibrous fleece, oxidised regenerated 	10.2 x 10.2cm	$114.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal
MN117	Surgicel Non-Woven (SNoW) 	Absorbable haemostat, Structured 	10.2 x 10.2cm	$114.00
	Absorbable Haemostat	Non-Woven
	Antimicrobial, Low Antigenicity, Woven
	Johnson & Johnson Medical Pty Ltd
JJ433	SURGICEL Nu knit Absorbable 	High density , oxidised regenerated 	15.2 x 22.9cm	$106.00
	Haemostat	cellulose, the material is 
	biocompatible and also bactericidal.
Prostheses List by Category, Groups and Sponsor	Page 91 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.05.05 - Matrix
	03.05.05.01 - Liquid ≤6ml
	Johnson & Johnson Medical Pty Ltd
JJ640	Surgiflo Haemostatic Matrix	Absorbable Porcine Gelatin Matrix 	6ml of gelatin gel per kit.  	$450.00
	Pre-packaged in a Syringe	Mixing with 2ml-5ml of 
	saline or thrombin produces
	 8ml-11ml of haemostatic 
	matrix.
	Complete Biomaterial
	Baxter Healthcare Pty Ltd
BX258	FloSeal Hemostatic Matrix	FloSeal is a proprietary combination 	5ml	$700.00
	of collagen-derived particles and 
	topical thrombin. It is not sponge, but
	 is a high viscosity gel for 
	haemostasis.  Clinical proven to 
	control bleeding from capillary 
	oozing to arterial spurting, FloSeal 
	Johnson & Johnson Medical Pty Ltd
MN151	Evicel®	Haemostatic matrix composed of 	4mL kit	$700.00
	human fibrinogen and thrombin
	03.05.05.02 - Liquid >6ml
	Complete Biomaterial
	Baxter Healthcare Pty Ltd
BX259	FloSeal Hemostatic Matrix	FloSeal is a proprietary combination 	10ml	$1,000.00
	of collagen-derived particles and 
	topical thrombin. It is not sponge, but
	 is a high viscosity gel for 
	haemostasis.  Clinical proven to 
	control bleeding from capillary 
	oozing to arterial spurting, FloSeal 
	Johnson & Johnson Medical Pty Ltd
MN152	Evicel®	Haemostatic matrix composed of 	10mL kit	$1,000.00
	human fibrinogen and thrombin
Prostheses List by Category, Groups and Sponsor	Page 92 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.05.05.03 - Non-liquid ≤50cm²
	Antibiotic
	Australasian Medical & Scientific Ltd
AN009	Collatamp G	Biodegradeable collagen implant with	5cm x 5cm x 0.5cm	$135.00
	 gentamicin
	03.05.05.04 - Non-liquid >50cm²
	Antibiotic
	Australasian Medical & Scientific Ltd
AN008	Collatamp G	Biodegradable collagen implant with 	10cm x 10cm x 0.5cm, 20cm x	$307.00
	gentamicin	 5cm x 0.5cm
	03.05.05.05 - Accessory Extender
	Johnson & Johnson Medical Pty Ltd
MN041	Endoscopic Applicator	Extender used as an adjunct to 	34cm extender	$31.00
	haemostasis when control of bleeding 
	by ligature or conventional surgical 
	procedures is ineffective or impractical
MN153	Evicel® 35cm Rigid Tip	Triple lumen, clog resistant rigid tip 	35cm	$31.00
	for drip or spray applications
MN154	Evicel® 45cm Flexible Tip	Triple lumen, clog resistant flexible 	45cm	$31.00
	tip for drip or spray applications
03.05.06 - Foam
	Alliance Surgical
AA014	SealFoam, High Density	SealFoam is an absorbable 	60mm x 40mm x 2mm	$150.00
	Polysaccharide Haemostat	60mm x 40mm x 4mm
03.06.01 - Biliary Stents
	03.06.01.01 - Non-reinforced Wall
	Boston Scientific Australia Pty Ltd
BS066	Biliary Drainage Stent, Amsterdam 	C-Flex or Polyurethane Biliary Stent	Diameters up to 12Fr & 	$82.00
	Biliary Stent	lengths up to 15cm
Prostheses List by Category, Groups and Sponsor	Page 93 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS184	Advanix Plastic Stent	Plastic stent manufactured 	5-18cm length, 7-10 FR 	$82.00
	diameter
	CK Surgitech Pty Ltd
AK003	Biliary Stents	Biliary stent, straight, curved, bended,	5.0 to 11.5 french	$40.00
	 pigtails and double pigtail
	Cook Medical Australia Pty Ltd
WC001	Cotton-Huibregste Biliary Stent Set	.	7 - 11.5Fr, Length 5 - 15cm	$82.00
WC006	Cotton-Leung Biliary Stent Only	.	6 - 11.5Fr, Length 3 - 20cm	$82.00
WC008	Cotton-Huibregste Biliary Stent 	.	7 - 11.5Fr, Length 5 - 21cm	$82.00
WC012	Zimmon Biliary Stent Only	.	5 - 11.5Fr, Length 3 - 18cm	$82.00
WC064	Tannenbaum Biliary Stent only	Plastic biliary stent with proximal 	Diameter: 8.5,10,11.5 FR. 	$82.00
	and distal flaps	Length Between Flaps: 5 --
	>15 cm
WC267	Cotton-Leung Biliary Stent Only	Cotton-Leung Biliary Stent Only	6 - 11.5 Fr; Length 3 - 20cm	$82.00
	Olympus Australia
OL003	Bile Duct Stent	Polyethylene Stents	7FR - 12FR 3cm - 15cm	$82.00
OL008	Olympus Biliary Stent Set	Radio-opaque Polyethglare Stent Set	7Fr 3cm - 15cm, 8Fr 3cm - 	$82.00
	15cm, 10Fr 3cm - 15cm
	Delivery System
	Boston Scientific Australia Pty Ltd
BS054	Flexima Biliary Stent	Polyurethane Biliary Stent	Diameters up to 12Fr & 	$200.00
	lengths up to 15cm
BS055	RX Biliary Stent	Polyurethane Biliary Stent	Diameters up to 12Fr & 	$200.00
	lengths up to 15cm
BS173	Advanix Plastic Stent with Naviflex	Plastic stent manufactured pre loaded 	5-18cm length, 7-10 FR 	$200.00
	 Delivery System	on a delivery catheter	diameter
	Cook Medical Australia Pty Ltd
WC013	Zimmon Biliary Stent Set	Double pigtail plastic biliary stent 	5 - 11.5Fr, Length 2 - 18cm	$200.00
	with delivery system
WC017	Cotton-Leung Biliary Stent Set	Set includes stent, positioning sleeve 	7 - 11.5Fr, Length 5 - 18cm	$200.00
	to collapse the duodenal flap, 170cm 
	pushing catheter and 320cm guiding 
	catheter. 7Fr stents do not include 
	guiding catheter.
Prostheses List by Category, Groups and Sponsor	Page 94 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC078	Cook Biliary Stents	Composition Plastic, includes Stent, 	French 7.0, length 4cm	$200.00
	Wireguide & Positioner
WC106	Cotton-Leung Biliary Stent Set	Polyethylene Stent preloaded on an 	Diameter 7 - 11.5 FR,  	$200.00
	Oasis Introduction System	length 5 - 15cm
WC108	Geenan Pancreatic Stent Set	Radiopaque Polyethylene Stent with 	Diameter 3 - 11.5 FR, 	$200.00
	or without ductal flaps - includes 	Length 2 - 15cm
	pushing catheter
WC166	Solus Biliary Stent  Set	Double Pigtail with OASIS 	Diameter 10 FR, Length:1 - 	$200.00
	introducer. Sof-flex material - with 	15 cm Between pigtails
	radiopaque bands.
WC216	Fanelli Laparoscopic Endobiliary 	Fanelli stent (double flange white 	7.0 French diameter x 6cm 	$200.00
	Stent Set	polyehtylene), tracer Hybrid 	length double flange stent 
	.035"X150cm Guide (slippery wire), 	loaded in an 8.5 fr delivery 
	8.5 Fr Introducer and Pusher Catheter 	system.
	(TFE) System with four radiopaque 
	accuracy markers, two way terminal 
	adapter
WC228	Tannenbaum Biliary Stent Set 	Plastic Biliary Stent	8.5 - 11.5 Fr,   5 - 15 cm	$200.00
	preloaded on the OASIS 
	Introduction System
WC269	Fusion Marathon Biliary Stent	Biliary Plastic Stent with anti-reflux 	Stent diameter: 10FR; 	$200.00
	sleeve preloaded on the OASIS 	Lengths 5 to 15cm
	delivery device
	03.06.01.02 - Reinforced Wall, Uncovered/Bare Metal
	Bard Australia Pty Ltd
BA124	Memotherm Biliary Stent	Nitinol. Includes deployment system	Sizes - Diameter 8 - 10mm, 	$2,225.00
	Length 40 - 100mm
	Boston Scientific Australia Pty Ltd
BS051	Wallstent Biliary Stent	Monofilament wire, self-expanding 	Diameters up to 10mm & 	$2,225.00
	stent	lengths up to 100mm
BS215	WallFlex Biliary Stent	Bare Metal Stent	6 - 10 x 40 - 120mm	$2,225.00
	Cook Medical Australia Pty Ltd
WC174	Zilver Biliary Stent System	Self expanding Metal Biliary Stent 	Diameters: 6, 8, 10mm; 	$2,225.00
	System	Lengths: 4, 6,8cm
WC200	Fusion Zilver Biliary Stent System	Self expanding Metal Biliary Stent 	Diameters: 6, 8 & 10mm; 	$2,225.00
	with Fusion Introducer System	length: 4, 6 & 8cm
Prostheses List by Category, Groups and Sponsor	Page 95 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC270	Zilver Biliary Stent System	Self expanding metal biliary stent 	Diameters 6, 8, 10mm; 	$2,225.00
	system	Lengths 4, 6, 8 cm
WC308	Evolution Biliary Stent System 	Self expanding bare metal biliary stent	Diameters :8 -10mm	$2,225.00
	(uncovered)	 system.	Lengths: 40 -100mm
	Covidien Pty Ltd
AS199	Protege™GPS™ Self-expanding 	Nitinol self expanding stent pre-	Diameter (mm) 6 -14, Length	$2,225.00
	Billary Stent System	mounted on 6F OTW delivery system	 (mm) 20 - 150
AS200	VisiPro™ Balloon-Expandable 	Stainless Steel balloon expandable 	Diameter (mm) 5 - 10, 	$2,225.00
	Biliary Stent System	stent mounted onto a non-compliant 	Length (mm) 12 -57
	balloon catheter
	Device Technologies Australia Pty Ltd
DE408	Bonastent Biliary Stent	Self-expanding metal biliary stents	10mm diameter and length 	$2,225.00
	varies from 60mm to 100mm
	Endotherapeutics Pty Ltd
ET039	SX-Ella Tips Stent	Uncovered, self-expanding nitinol 	Dia 10-14mm, length 52-	$2,225.00
	77mm
	Mayo Healthcare Pty Ltd
YO014	Alimaxx-B Uncovered Biliary Stent 	Biliary stent, radiopaque, self 	Diameter 8mm-10mm. 	$2,225.00
	System	expanding nitinol and premounted on 	Length 40mm-80mm
	delivery system
	Olympus Australia
OL011	X-Suit NIR Biliary Metal Stent	The Medinol X-Suit® Biliary Metallic	8 or 10mm diameter - 40, 60, 	$2,225.00
	 Stent consists of a self-expanding 	80 or 100 mm length, 7.5F
	noncovered Nitinol stent integrated 
	into a delivery system.
	Pyramed Pty Limited
PY038	Niti-S Biliary Stent (D, Y, T, S-	Niti-S Biliary Stent. Deployed via 	6-10mm Diameter x 40 - 	$2,225.00
	Type, Comvi)	stent delivery system for use TTS or 	120mm Length
	percutaneously
	03.06.01.03 - Reinforced Wall, Covered
	Boston Scientific Australia Pty Ltd
BS052	Wallstent Biliary Stent	Monofilament wire, self-expanding 	Diameters up to 10mm & 	$3,025.00
	stent	lengths up to 100mm
BS070	Wallstent RX Biliary Stent	Monofilament wire, self-expanding 	Diameters up to 10mm & 	$3,025.00
	stent	lengths up to 100mm
Prostheses List by Category, Groups and Sponsor	Page 96 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS214	WallFlex Biliary Stent	Stent with permalume covering	6 - 10 x 40 - 120mm	$3,025.00
	Cook Medical Australia Pty Ltd
WC309	Evolution Biliary Stent System 	Self expanding partially or fully 	Diameters: 8 - 10mm	$3,025.00
	(covered)	covered biliary stent system.	Lengths: 40 - 80mm
	Device Technologies Australia Pty Ltd
DE404	Bonastent Biliary Stent	Self-expanding covered metal biliary 	10mm diameter and length 	$3,025.00
	stents	varies from 60mm to 100mm
	Endotherapeutics Pty Ltd
ET038	SX-Ella Biliary Stent	Uncovered, self-expanding nitinol 	Dia 8-12mm, length 50-77mm	$3,025.00
	MD Solutions Pty Ltd
MB023	Allium Biliary Stent	Endoscopic or Transhepatic biliary 	Stent length - 60, 80, 100, 	$3,025.00
	stent made of nitinol with copolymer 	120mm. Diameter  - 8, 10mm.
	covering and unraveling technology 	 Anchor optional
	for atraumatic removal
	Pyramed Pty Limited
PY020	Niti-S Biliary Covered Stent	Niti-S Biliary self expanding nitinol 	Diameter: 4mm-28mm	$3,025.00
	Stent fully covered with a silicone 	Length: 10-120mm
	membrane, PTFE, polyurethane layer 
	to prevent tumor ingrowth. Has nylon
	 drawstring for removal. Stent delivery
	 system is designed for use TTS for 
	endoscopic or percutaneous 
PY027	Niti-S Biliary Covered and Partially	The Niti-S Biliary Stent (fully and 	6mm to 12mm diameter x 4cm	$3,025.00
	 Covered Stents	partially covered) is comprised of 1 	 to 12cm length
	Nitinol S0-type stents with a layer of 
	polytetraethylene (PTFE) between 
	that fully envelopes the proximal and 
	distal ends of the stent, resulting in an
	 integrated structure designed to 
	prevent tissue invasion.
	W L Gore & Associates
GT116	Gore Biliary Endoprostheses	ePTFE	Short or Long Catheter 8-	$3,025.00
	10mmx4-8cm
Prostheses List by Category, Groups and Sponsor	Page 97 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.06.02 - Colonic Stents
	Self Expanding
	Bard Australia Pty Ltd
BA088	Memotherm Stents 	Colorectal, Nitinol, Self-expanding	25-30mm D, 60-100mm 	$3,060.00
	Length
	Boston Scientific Australia Pty Ltd
BS071	Ultraflex Precision Colonic Stent	Nitinol, self expanding stent	Diameters up to 30mm & 	$3,060.00
	lengths up to 150mm
	Pyramed Pty Limited
PY023	Niti-S Colorectal Stent D-type	Niti-S D- type Colorectal self-	Diameters: 18 - 28mm 	$3,060.00
	expanding metal stent made from 	Lengths: 60 - 120mm
	Nitinol in unique D mesh 
	construction, uncovered OTW or TTS.
	  With string for ease of removal.
PY024	Niti-S Colorectal Stent	Niti-S Colorectal self-expanding metal	Stent Dimensions mm: 	$3,060.00
	 stent made from Nitinol.  Stent PTFE 	18x26x30, 18x24x30, 
	covered and uncovered OTW or TTS 	20x26x30, 22x30x30, 
	with string for ease of removal.	24x30x30, 20x28x30 
	Length mm: 30-90
	Self-expanding
	Device Technologies Australia Pty Ltd
DE409	Bonastent Colo-Rectal Stent	Self-expanding covered metal colo-	22mm-24mm diameter and 	$3,060.00
	rectal stents	length varies from 60mm to 
	160mm
DE410	Bonastent Colo-Rectal Stent	Self-expanding metal colo-rectal 	22mm-26mm diameter and 	$3,060.00
	length varies from 30mm to 
	160mm
03.06.03 - Oesophageal Stents
	03.06.03.02 - Reinforced Wall, Uncovered/Bare Metal
	Boston Scientific Australia Pty Ltd
BS046	Ultraflex Oesophageal Stent; 	Nitinol, self expanding stent	Diameters up to 30mm & 	$2,500.00
	Ultraflex Oesophageal NG Stent	lengths up to 150mm
Prostheses List by Category, Groups and Sponsor	Page 98 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE406	Bonastent Oesophageal Stent	Self-expanding metal oesophageal 	18mm-22mm diameter and 	$2,500.00
	length varies from 80mm to 
	160mm
	Mayo group
CM025	ALIMAXX-E Esophageal Stent 	Esophageal stent, radiopaque, self 	Diameter 18-22mm, Length 	$2,500.00
	System	expanding nitinol covered stent, 	70-120mm
	premounted on a delivery system
	03.06.03.03 - Reinforced Wall, Covered
	Boston Scientific Australia Pty Ltd
BS089	WallFlex Oesophageal Stent	Nitinol, self expanding stent	Diameters up to 30mm & 	$3,500.00
	lengths up to 150mm
BS102	Polyflex Oesophageal Stent	Polyester braided material 	Diameters up to 30mm & 	$3,500.00
	encapsulated with silicone, self 	lengths up to 150mm
	CK Surgitech Pty Ltd
AK002	Stent, oesophageal, dudodenal, 	self expandable nitinol stent with 	20,30,40,50,60,70,80,90,10	$1,200.00
	rectal, biliary	introducer system	0,110,120mm
	Cook Medical Australia Pty Ltd
WC246	Evolution Oesophageal Metal Stent	Oesophogeal Self Expanding Metal 	8, 10, 12.5 and 15cm 	$3,500.00
	Stent with controlled release delivery 	Lengths, 25mm flared ends 
	system	with 20mm body or 23mm 
	flared ends with 18mm body
WC310	Evolution Oesophageal Stent 	Oesophageal self expanding metal 	Diameters:18 - 20mm	$3,500.00
	System (Fully covered)	stent with controlled release delivery 	Lengths: 80 - 120mm
	Device Technologies Australia Pty Ltd
DE405	Bonastent Oesophageal Shim Anti-	Self-expanding metal oesophageal 	22mm diameter and length 	$3,500.00
	Reflux Valve Stent	shim stents with anti-reflux valve	varies from 90mm to 150mm
	Endotherapeutics Pty Ltd
ET001	Ferx Ella Esophageal Stent	Kit includes esophageal stent, 	Diam 20mm, Length 80 - 	$3,500.00
	introducer, balloon catheter	160mm
ET045	Boubella Esophageal Stent	Self expandable stainless steel wire 	Length 90 - 195mm	$3,500.00
	stent with anti-reflux valve
Prostheses List by Category, Groups and Sponsor	Page 99 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ET069	SX - ELLA Stent Esophageal HV 	The SX-ELLA Atent Esophageal HV 	Stent body diameter = 	$3,500.00
	(HV Stent Plus)	(HV Stent Plus) is a self-expandable, 	20mm; Stent flares = 25mm 
	fully covered nitinol stent, pre-loaded	diameter; Stent nominal 
	 on a delivery system. The stent is 	length = 
	designed to provide relief from 
	malignant or benign strictures in the 
	oesophagus, or treating anastomic 
	leaks. HV Stent Plus includes an anti-
	migration collar & is also available 
	with an anti-reflux valve
ET070	SX- ELLA Stent Danis	The Danis Procedure Pack Basic 	One size: Stent flares 	$3,500.00
	contains the SX-ELLA Stent Danis, a 	diameter 30mm; Stent body 
	nitinol wire that is compressed & 	diameter 25mm; Nominal 
	preloaded within a delivery system, 	length 135mm
	along with various instruments 
	necessary for the stent implantation. 
	The Stent Denis is a removable stent 
	system for the treatment of bleeding 
	esophageal varices. It is intended to 
	be implanted and then removed within
	 seven days of the date of implantation
	 in order to avoid the risk of in-
	growth into the stent mesh
	Mayo Healthcare Pty Ltd
YO013	EndoMaxx Fully Covered 	Oesophageal stent, radiopaque, self 	Diameter 19mm-23mm. 	$3,500.00
	Oesophageal Stent	expanding nitinol covered and 	Length 70mm-150mm.
	premounted on delivery system
	Pyramed Pty Limited
PY021	Niti-S Oesophageal Fully Covered 	Niti-S Oesophageal fully covered self 	Diameter: 10mm - 36mm	$3,500.00
	Stent	expanding nitinol stent with covering	Length: 60mm - 230mm
	 of PTFE, silicone, a polyurethane 
	layer. Nylon drawstring for removal or
	 repositiong
Prostheses List by Category, Groups and Sponsor	Page 100 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
PY022	Niti-S Oesophageal Double and 	Niti-S Oesophageal Double & 	Diameter: 16-28mm	$3,500.00
	Double Double, Beta & Beta-2 stents	Double Double Beta self-expanding 	Length: 40-200mm
	metal stent made from Nitinol, with an 
	antimigration outer uncovered wire 
	construction to allow the mesh embed 
	in the oesophageal wall. Also with 
	anti reflux valve inner polyurethane 
	layer, PTFE & silicone covering to 
	prevent tumor ingrowth. String for 
	retrieval or repositioning
03.06.04 - Pancreatic Stents
	Cook Medical Australia Pty Ltd
WC079	Zimmon Pancreatic Stent	Single pigtail with radio-opaque 	Diameter 4 - 10FR, Length 2	$85.00
	 - 18cm
WC123	Geenen Pancreatic Stent	Straight plastic pancreatic stent with 	Diameter 3 - 11.5 FR, length	$85.00
	or without ductal flaps	 2 - 20cm
WC212	Zimmom Pancreatic Stent	Single pigtail radio-opaque 	Diameter 3 - 7 FR, Length 3 	$85.00
	Polyethylene Stent with or without 	- 18cm
	ductal flaps
WC271	Geenen Pancreatic Stent	Straight plastic pancreatic stent with 	Diameter 3 - 10 Fr; length 2 	$85.00
	or without ductal flaps	- 15cm
03.06.05 - Enteral Stents
	Boston Scientific Australia Pty Ltd
BS053	Wallstent Enteral Stent	Monofilament wire, self-expanding 	Diameters up to 30mm & 	$3,500.00
	stent	lengths up to 150mm
BS090	WallFlex Enteral Stent 	Nitinol, self expanding stent	Diameters up to 30mm & 	$3,500.00
	(Duodenal/Colonic)	lengths up to 150mm
	Cook Medical Australia Pty Ltd
WC268	Evolution Enteral Metal Stent	Enteral Metal Stent	Diameter 22 to 25mm body; 	$3,500.00
	27 to 30mm flanges. Length:
	 6 to 12cm
Prostheses List by Category, Groups and Sponsor	Page 101 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Pyramed Pty Limited
PY017	Niti-S Pyloric Stent D-type	Niti-S Pyloric self-expanding metal 	Diameter:  16 - 18mm 	$3,500.00
	stent D-type made from Nitinol in D 	Length: 40 - 120mm
	mesh construction, uncovered, OTW 
	or TTS
03.06.06 - Tracheobronchial Stents
	Boston Scientific Australia Pty Ltd
BS047	Ultraflex Tracheobronchial Stent	Nitinol, self expanding stent	Diameters up to 25mm & 	$3,000.00
	lengths up to 80mm
BS101	Polyflex Airway Stent	Polyester braided material 	Diameters up to 25mm & 	$3,000.00
	encapsulated with silicone, self 	lengths up to 80mm
BS103	Dynamic (Y) Stent	Bifurcated Tracheobronchial stent. 	Diameters up to 25mm & 	$3,000.00
	Bronchial Limbs made of silicone and 	lengths up to 120mm
	tracheal stem made of silicone with 
	embedded stainless steel c-shape 
	Pyramed Pty Limited
PY025	Niti-S Tracheal Stent	Tracheal Nitinol Self Expanding 	16mm to 20mm diameter x 	$3,000.00
	Metal Stent, ePTFE covered with 	3cm to 10cm length
	retrieval suture
PY026	Niti-S Bronchial Stent	Bronchial Nitinol Self Expanding 	10mm to 14mm diameter x 	$3,000.00
	Metal Stent, Expanded Poly Tetra 	3cm to 6cm length
	Fluoro Ethylene (ePTFE) covered, 
	with retrieval suture
	Mayo group
CM026	AERO Tracheobronchial Stent 	Radiopaque self-expanding nitinol 	Diameter 10-20mm, length 	$3,000.00
	stent and delivery system	20-80mm
Prostheses List by Category, Groups and Sponsor	Page 102 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.06.07 - Nerve Repair Stents
	Integra Neurosciences Pty Ltd
IG002	NeuraGen	NeuraGen is a semi-permeable Type 1 	2mm x 2cm, 3mm x 2cm, 4mm 	$1,500.00
	collagen tube for peripheral nerve 	x 2cm, 5mm x 2cm, 6mm x 
	repair. It provides a protective 	2cm, 7mm x 2cm, 1.5mm x 
	environment and conduit for axonal 	3cm, 2mm x 3cm, 3mm x 3cm, 
	regrowth across a nerve gap.  It is 	4mm x 3cm, 5mm x 3cm, 6mm 
	biocompatible and completely 	x 3cm, 7mm x 3cm
	resorbed. The open collagen structure 
	facilitates suture placement. It has a 
	resilient structure that maintains an 
	open lumen throughout the process of 
	axonal growth.
IG003	NeuraWrap	NeuraWrap nerve protector is 	3mm x 2cm, 3mm x 4cm, 5mm 	$1,500.00
	designed to provide an interface 	x 2cm, 5mm x 4cm, 7mm x 
	between the nerve and the 	2cm, 7mm x 4cm, 10mm x 
	surrounding tissues. NeuraWrap 	2cm, 10mm x 4cm
	remains in place during the active 
	phase of tissue healing and is 
	completely resorbed after tissue 
	response has resolved. The porous 
	outer layer of NeuraWrap comprises a 
	tubular matrix that mechanically 
	resists compression from surrounding 
	tissue and excludes scar tissue 
	ingrowth. The semi-permeable inner 
	membrane allows passage of small 
	molecules (ie water, ions, metabolites, 
	nutrients) but prevents the escape of 
	endogenous growth factors (Nerve 
	Growth Factor). NeuraWrap provides 
	a new alternative for the treatment of 
	peripheral nerve injuries.
	LMT Surgical Pty Ltd
LM017	Neurotube	Bioabsorbable nerve conduit made of 	2.3mm - 8mm	$1,500.00
	polyglycolic acid
LM080	Neurolac	A bioresorbable tension-less Nerve 	1.5mm x 3cm to 10.0mm x 	$1,500.00
	repair guide	3cm
Prostheses List by Category, Groups and Sponsor	Page 103 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.07.01 - Drainage Catheters
	03.07.01.01 - Pleural
	CareFusion Australia 316 Pty Ltd
ZQ005	Pleurx	Pleurx Pleural Catheter Mini Kit	Catheter 24cm x 15.5Fr	$425.00
	N Stenning & Co Pty Ltd
NG065	TRU-CLOSE THORACIC VENT	Device for the treatment of 	Catheter outer diameter = 11	$425.00
	spontanious, traumatic or iatrogenic 	 French, catheter length = 
	simple pneumothorax.Allowing for 	10cm
	amubulation during resolution and 	Catheter outer diameter = 11
	the aspiration of small amount of 	 French, catheter length = 
	13cm
	Catheter outer diameter = 13
	 French, catheter length = 
	10cm
	Catheter outer diameter = 13
	 French, catheter length = 
	13cm
	Rocket Medical
RK001	Rocket IPC Pleural/Peritoneal 	Rocket IPC Pleural/Peritoneal 	16fg x 69cm silicone 	$180.00
	Tunnelled Catheter Insertion kit	Tunnelled Catheter Insertion kit with 	catheter with cuff
	catheter
	03.07.01.02 - Intraperitoneal
	Boston Scientific Australia Pty Ltd
BS227	Flexima All-Purpose Drainage 	All-purpose drainage catheters for 	Length up to 25cm	$120.00
	Catheter	abscesses and fluid collections.
BS229	Flexima vanSonnenburg Sump 	Dual lumen catheters that drain cavity	Length up to 35cm	$425.00
	Catheter	 contents by application of suction
BS230	Percuflex vanSonnenburg Sump 	Dual lumen catheters that drain cavity	Length up to 35cm	$425.00
	Catheter	 contents by application of suction
	CareFusion Australia 316 Pty Ltd
ZQ004	Pleurx	Pleurx Peritoneal Catheter Mini Kit	Catheter 71.0cm x 15.5 Fr	$425.00
	Cook Medical Australia Pty Ltd
WC315	Multipurpose Drainage Catheter	Catheter used in a variety of drainage 	8.5-14 Fr, Length: 15-45cm	$120.00
	applications
Prostheses List by Category, Groups and Sponsor	Page 104 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.07.01.03 - Biliary
	Boston Scientific Australia Pty Ltd
BS250	Flexima Biliary Drainage Catheter	Biliary drainage catheters for drainage	Length up to 35cm	$120.00
	 of the biliary tree
BS251	Percuflex Biliary Drainage Catheter	Biliary drainage catheters for drainage	Length up to 15cm	$120.00
	 of the biliary tree
	Cook Medical Australia Pty Ltd
WC317	Ultrathane Biliary Drainage 	Used for biliary drainage 	8.5-14 Fr, 40cm length 	$120.00
03.07.02 - Endobronchial Valve
	Olympus Australia
OL081	IBV Valve in Cartridge	A one-way valve placed in the lung 	5mm, 6mm and 7mm	$6,300.00
	airway intended to treat diseased lung
	 in emphysematous patients or 
	damaged lung resulting in air leaks by
	 limiting airflow to selected areas.
	PulmonX Australia
PX001	Pulmonx	Valve intended to improve lung 	4.0 (4 to 7 mm) and 5.5 (5.5 	$6,300.00
	function in patients with 	to 8.5mm)
	heterogeneous emphysema by 
	controlling air flow with a one-way 
	valve and to treat patients with 
03.07.03 - Drainage Shunts, Peritineovenous
	CareFusion Australia 316 Pty Ltd
ZQ008	Denver Ascites Shunt, (PAK), 	Ascite Shunt - Double Valved 	Double-valved, 42-2050	$2,200.00
	Double-valved	Percutaneous Access Kit (PAK). A 
	fenestrated peritoneal catheter, a 
	venous catheter, and a flexible pump 
	chamber containing two miter valves, 
	provided with a Percutaneous Access 
	Kit.
Prostheses List by Category, Groups and Sponsor	Page 105 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZQ009	Denver Ascites Shunt, (PAK), 	Ascites Shunt - Single Valved 	Single valved, 42-2055	$2,200.00
	Single-valved	Percutaneous Access Kit (PAK). A 
	fenestrated peritoneal catheter, a 
	veneous catheter, and a flexible pump 
	chamber containing one miter valve, 
	provided with a Percutaneous Access 
	Kit (PAK).
03.08.01 - Adhesion Barriers
	03.08.01.01 - Sheet ≤100cm2
	Johnson & Johnson Medical Pty Ltd
JJ010	Interceed Absorbable Adhesion 	Oxidized Regenerated Cellulose	7.6cm x 10.2cm	$175.00
	Barrier
JJ464	Divide Absorbable Adhesion Barrier	Oxidised regenerated cellulose	3.8 x 5.1cmm	$175.00
	03.08.01.02 - Sheet >100cm2
	Genzyme Australasia Pty Ltd
GE006	Seprafilm Adhesion Barrier	Sodium hyaluronate 	13cm  x 15cm	$345.00
	carbomethylcellulose membrane
	Complex
	Covidien Pty Ltd
AS138	Prevadh	Adhesion Prevention film	12x12cm, 17x12cm	$500.00
	Complex, Bioresorbable
	Endotherapeutics Pty Ltd
ET051	Surgiwrap	Bio Absorbable Antiadhesion Barrier	All sizes with and without 	$1,300.00
	suture holes
	LMT Surgical Pty Ltd
LM084	Polyganics Vivosorb	A bioresorbable co polyester sheet	2cm x 3cm to 13cm x 20cm	$1,300.00
Prostheses List by Category, Groups and Sponsor	Page 106 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.01.03 - Spray
	Baxter Healthcare Pty Ltd
BX260	ADEPT Adhesion Reduction 	ADEPT Adhesion Reduction 	1500ml	$250.00
	Solution is a single use, sterile fluid 
	for intraperitoneal administration. 
	ADEPT is intended to be used as an 
	instillate for the reduction of 
	adhesions following abdominal 
	03.08.01.04 - Gel/Liquid
	Covidien Pty Ltd
AS178	SprayShield Adhesion Barrier System	Polymer Kit with Air Assisted 	10ml	$500.00
	Sprayer, Single-use.
	Johnson & Johnson Medical Pty Ltd
JJ700	Ethicon Intercoat Absorabable 	Combination of Polyethylene Oxide 	2 x 20ml Sterile Syringes, 1x	$500.00
	Adhesion Barrier Gel	(PEO) and Sodium 	 Applicator
	Carboxymethylcellulose stabilised 
	with Calcium and made isotonic with 
	Sodium Chloride. Kit contains 2 x 
	20ml Sterile Syringes, 1 x Applicator
	Complex
	Lifehealthcare Pty Ltd
LH001	Oxiplex Absorbable Adhesion 	Oxiplex Absorbable Adhesion Barrier	3ml in sterile 3ml syringe	$1,300.00
	Barrier Gel	 gel (Oxiplex is a co-polymer gel 
	composed of carboxymethylcellulose 
	and polyethylene.)
	Medtronic Australasia Pty Ltd
MC618	Medishield Anti-Adhesion Gel	MediShield Anti-Adhesion Gel is an 	3cc Syringe	$1,300.00
	adhesion barrier gel for prevention of 
	complications after spinal surgery.  
	MediShield is a co-polymer gel 
	composed of carboxymethylcellulose 
	and polyethylene oxide.
Prostheses List by Category, Groups and Sponsor	Page 107 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.08.02 - Internal Adhesives
	03.08.02.01 - Adhesive ≤2ml
	Biological
	Advanced Biomedical Pty Ltd
AB075	BioGlue Surgical Adhesive - 2ml 	Model No BG3502-5-A (BioGlue 	2ml	$380.00
	Syringe System	Surgical Adhesive)
	Baxter Healthcare Pty Ltd
BX214	TISSEEL Two Component Fibrin 	Active ingedients:Sealer Protein 	2.0 ml (containing 1.0 ml of 	$380.00
	Sealant Syringe	Solution & Thrombin Solution - deep-	Sealer Protein Solution and 
	frozen	1.0 ml of Thrombin 
BX283	ARTISS Fibrin Sealant 2ml	ARTISS is a proprietary fibrin sealant 	The two components are 	$380.00
	with 4UI/ml human thrombin.  It is 	formulated as two sterile 
	two-component fibrin sealant made 	frozen solutions.  Each 
	from pooled human plasma, a double 	solution is presented in a 
	virus-inactivated (vapour heated and 	separate pre-loaded chamber
	solvent/detergent treated) and frozen 	 (1ml) of a double chamber 
	(≤ -20°C) plasma derived biological 	syringe.  One chamber 
	agent.	contains sealer protein 
	solution with aprotinin 
	while the other chamber 
	contains thrombin solution 
	with calcium chloride, 
	resulting in a 2ml total 
	volume of product for use.
	Synthetic
	Baxter Healthcare Pty Ltd
BX252	CoSeal Surgical Sealant	Composition: two synthetic 	2ml	$300.00
	polyethelene glycols (PEG's), 
	COH102 and COH206, premixed and 
	filled into one syringe, a dilute 
	hydrogen chloride solution and a 
	sodium phosphate/sodium carbonate 
	Johnson & Johnson Medical Pty Ltd
JJ576	Ethicon Omnex Surgical Sealant	Omnex Surgical Sealant	0.5 ml	$300.00
Prostheses List by Category, Groups and Sponsor	Page 108 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG038	Glubran 2	Synthetic cyanoacrylic surgical glue: 	0.25 ml, 0.5 ml, 1 ml	$300.00
	N-Butyl (2) cyanoacrylate and 
	methacryloxysulfolane co-monomer
	03.08.02.02 - Adhesive >2-5ml
	Biological
	Advanced Biomedical Pty Ltd
AB003	BioGlue Surgical Adhesive - 5ml 	Model No BG3515-5-A (BioGlue 	One size only	$700.00
	Syringe System	Surgical Adhesive)
	Baxter Healthcare Pty Ltd
BX215	TISSEEL Two Component Fibrin 	Active ingedients:Sealer Protein 	4.0 ml (containing 2.0 ml of 	$700.00
	Sealant Syringe	Solution & Thrombin Solution - deep-	Sealer Protein Solution and 
	frozen	2.0 ml of Thrombin 
BX284	ARTISS Fibrin Sealant 4ml	ARTISS is a proprietary fibrin sealant 	The two components are 	$700.00
	with 4UI/ml human thrombin.  It is 	formulated as two sterile 
	two-component fibrin sealant made 	frozen solutions.  Each 
	from pooled human plasma, a double 	solution is presented in a 
	virus-inactivated (vapour heated and 	separate pre-loaded chamber
	solvent/detergent treated) and frozen 	 (2ml) of a double chamber 
	(≤ -20°C) plasma derived biological 	syringe.  One chamber 
	agent.	contains sealer protein 
	solution with aprotinin 
	while the other chamber 
	contains thrombin solution 
	with calcium chloride, 
	resulting in a 4ml total 
	volume of product for use.
	Synthetic
	Baxter Healthcare Pty Ltd
BX253	CoSeal Surgical Sealant	Composition: two synthetic 	4ml	$600.00
	polyethelene glycols (PEG's), 
	COH102 and COH206, premixed and 
	filled into a syringe, a dilute 
	hydrogen chloride solution and a 
	sodium phosphate sodium carbonate 
	Covidien Pty Ltd
AS163	Vacuseal  Vascular Sealant System	5ml Polymer Kit, Sterile, Single-use	1 kit/box	$600.00
Prostheses List by Category, Groups and Sponsor	Page 109 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.02.03 - Adhesive >5ml
	Biological
	Advanced Biomedical Pty Ltd
AB004	BioGlue Surgical Adhesive - 10ml 	Model No BG3510-5-A (BioGlue 	One size only	$1,400.00
	Syringe System	Surgical Adhesive)
	Baxter Healthcare Pty Ltd
BX216	TISSEEL Two Component Fibrin 	Active ingedients:Sealer Protein 	10.0 ml (containing 5.0 ml 	$1,400.00
	Sealant Syringe	Solution & Thrombin Solution - deep-	of Sealer Protein Solution 
	frozen	and 5.0 ml of Thrombin 
BX285	ARTISS Fibrin Sealant 10ml	ARTISS is a proprietary fibrin sealant 	The two components are 	$1,400.00
	with 4UI/ml human thrombin.  It is 	formulated as two sterile 
	two-component fibrin sealant made 	frozen solutions.  Each 
	from pooled human plasma, a double 	solution is presented in a 
	virus-inactivated (vapour heated and 	separate pre-loaded chamber
	solvent/detergent treated) and frozen 	 (5ml) of a double chamber 
	(≤ -20°C) plasma derived biological 	syringe.  One chamber 
	agent.	contains sealer protein 
	solution with aprotinin 
	while the other chamber 
	contains thrombin solution 
	with calcium chloride, 
	resulting in a 10ml total 
	volume of product for use.
	Synthetic
	Baxter Healthcare Pty Ltd
BX254	CoSeal Surgical Sealant	Composition: two synthetic 	8ml	$1,120.00
	polyethelene glycols (PEG's), 
	COH102 and COH206, premixed and 
	filled into a syringe, a dilute 
	hydrogen chloride solution and a 
	sodium phosphate sodium carbonate 
	03.08.02.04 - Adhesive Accessory
	Applicator Tip
	Advanced Biomedical Pty Ltd
AB008	BioGlue Surgical Adhesive - 	Model No BGAT-SY (BioGlue 	Standard Applicator Tip	$26.00
	Syringe Standard Applicator Tip	Surgical Adhesive)
Prostheses List by Category, Groups and Sponsor	Page 110 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Baxter Healthcare Pty Ltd
BX266	TISSEEL DUPLOSPRAY MIS 	Two component Fibrin Sealant 	Packs of 10 sterile packs 	$26.00
	APPLICATOR REPLACEMENT 	containing human derived fibrinogen 	each containing 2 tips and 
	TIPS	and thrombin.	an installation tool
BX278	Floseal Curved Applicator Tip 10 	FLOSEAL is used as an adjunct to 	A 10cm long curved metal 	$26.00
	haemostasis when control of bleeding 	applicator tip
	by ligature or conventional surgical 
	procedures is ineffective or 
	impractical.  This applicator is an 10 
	cm curved metal tip, which is attached 
	to the FLOSEAL syringe (sold 
	separately) 
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG034	Glubran 2 Applicators	Dispensing tip/Drop control device 	5-6 and 7-8 French	$26.00
	for applying Glubran 2.
	Complex Delivery Device
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG036	Glubran 2 Spray Device	Spray device for application of 	One size only	$62.00
	Glubran 2
	Extender
	Advanced Biomedical Pty Ltd
AB009	BioGlue Surgical Adhesive - 	Model No BGAT-10-SY (BioGlue 	10cm Extender	$31.00
	Syringe 10cm Extender	Surgical Adhesive)
AB010	BioGlue Surgical Adhesive - 	Model No BGAT-27-SY (BioGlue 	27cm Extender	$31.00
	Syringe 27CM Extender	Surgical Adhesive)
AB076	BioGlue Surgical Adhesive - 	Spreader (extender) Tips (various 	12mm, 16mm	$31.00
	Spreader Tips	sizes), (Pack of 3)
	Baxter Healthcare Pty Ltd
BX261	Tisseel Duplospray MIS Applicator 	Two component Fibrin Sealant 	A 20cm long dual lumen 	$31.00
	20cm	containing human derived fibrinogen 	metal cannula
	and thrombin.
BX262	TISSEEL DUPLOCATH 180cm	Two component Fibrin Sealant 	A 180cm long double lumen	$31.00
	containing human derived fibrinogen 	 flexible application catheter
	and thrombin.
Prostheses List by Category, Groups and Sponsor	Page 111 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BX263	COSEAL Spray Accessory Kit	A hydrogel that acts as a sealant by 	One size available	$31.00
	adhering to itself and the tissues it 
	contacts.  COSEAL is designed to 
	completely seal suture lines along 
	vascular reconstructions to prevent 
	fluids from leaking.
BX264	TISSEEL DUPLOTIP 20g x 26.4cm	Two component Fibrin Sealant 	A 26.4cm long dual umen 	$31.00
	containing derived fibrinogen and 	applicator
	thrombin.
BX265	TISSEEL DUPLOTIP 5mm x 31.8cm	Two component Fibrin Sealant 	A 31.8cm long dual lumen 	$31.00
	containing human derived fibrinogen 	applicator
	and thrombin.
BX267	TISSEEL DUPLOSPRAY MIS 	Two component Fibrin Sealant 	A 40 cm long dual lumen 	$31.00
	APPLICATOR 40 cm	containing human derived fibrinogen 	metal cannula
	and thrombin, with or without a 
	malleable tip.
BX268	TISSEEL DUPLOCATH 35cm 	Two component Fibrin Sealant 	A 35cm long double lumen 	$31.00
	MIC/MIS	containing human derived fibrinogen 	flexible application catheter
	and thrombin.
BX269	TISSEEL Easyspray Set	Two component Fibrin Sealant 	One size	$31.00
	containing human derived fibrinogen 
	and thrombin.
BX270	COSEAL Applicator Tips 7 cm	COSEAL, which is listed on the 	A 7cm long applicator tip	$31.00
	Prostheses List, is a hydrogel that 
	acts as a sealant by adhering to itself 
	and the tissues it contacts.  COSEAL 
	is designed to completely seal suture 
	lines along vascular reconstructions 
	to prevent fluids from leaking.
BX271	TISSEEL DUPLOTIP 20g x 10.4cm	Two component Fibrin Sealant 	10.4cm long dual lumen 	$31.00
	containing human derived fibrinogen 	applicator
	and thrombin.
BX272	TISSEEL DUPLOCATH 25cm	Two component Fibrin Sealant 	A 25cm long double lumen 	$31.00
	containing human derived fibrinogen 	flexible application catheter
	and thrombin.
BX273	Floseal Endoscopic Applicator	Used as an adjunct to haemostasis 	A 41cm - 47cm long 	$31.00
	when control of bleeding by ligature 	disposable cannulated 
	or conventional surgical procedures 	applicator, with or without 
	is ineffective or impractical.	malleable tip.
Prostheses List by Category, Groups and Sponsor	Page 112 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BX274	TISSEEL DUPLOTIP 20G x 5.3cm	Two component Fibrin Sealant 	A 5.3 cm long dual lumen 	$31.00
	containing human derived fibrinogen 	applicator.
	and thrombin.
BX275	COSEAL Extended Applicator 22 cm	COSEAL, which is listed on the 	A 22 cm long malleable 	$31.00
	Prostheses List, is a hydrogel that 	applicator
	acts as a sealant by adhering to itself 
	and the tissues it contacts.  COSEAL 
	is designed to completely seal suture 
	lines along vascular reconstructions 
	to prevent fluids from leaking.
BX276	Floseal Curved Applicator TIP 8 cm	FLOSEAL, which is listed on the 	An 8cm long curved metal 	$31.00
	Prostheses List, is used as an adjunct 	applicator tip
	to haemostasis when control of 
	bleeding by ligature or conventional 
	surgical procedures is ineffective or 
BX277	TISSEEL DUPLOSPRAY MIS 	Two component Fibrin Sealant 	A 30 cm long dual lumen 	$31.00
	APPLICATOR 30 cm	containing human derived fibrinogen 	metal cannula
	and thrombin.
BX279	Coseal Duplospray Applicator 	COSEAL, which is listed on the 	30cm	$31.00
	Prostheses List, is a hydrogel that 
	acts as a sealant by adhering to itself 
	and the tissues it contacts.  COSEAL 
	is designed to completely seal suture 
	lines along vascular reconstructions 
	to prevent fluids from leaking.
BX280	Coseal Duplospray Applicator 	COSEAL, which is listed on the 	20 cm	$31.00
	Prostheses List, is a hydrogel that 
	acts as a sealant by adhering to itself 
	and the tissues it contacts. COSEAL 
	is designed to completely seal suture 
	lines along vascular reconstructions 
	to prevent fluids from leaking. This a
BX282	Floseal Special Applicator Tips	Floseal Malleable and Trimmable 	14cm	$31.00
	Applicator Tips specifically designed 
	for use with Floseal Haemostatic 
	Johnson & Johnson Medical Pty Ltd
JJ910	Evicel 4cm Control Tip	Evicel 4cm Control Tip	4cm	$31.00
Prostheses List by Category, Groups and Sponsor	Page 113 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG035	Glubran 2 Catheter for Laparoscopy	Catheter for laparoscopic application 	One size only	$31.00
	of Glubran 2.
	Laparoscopic Extender
	Advanced Biomedical Pty Ltd
AB065	BioGlue Delivery Tip Extension 	Rigid Extender Tip (BGDTE range)	10cm, 27cm, 35cm	$62.00
	(various sizes)
	03.08.02.05 - Adhesive Peristrips
	Baxter Healthcare Pty Ltd
BX288	Peri-Strips Dry	Model No PSD 4506	One size only	$350.00
BX289	Peri-Strips Dry	Model No PSD 6006	One size only	$350.00
BX290	Peri-Strips Dry	Model No PSD 4506	One size only	$350.00
BX291	Peri-Strips Dry	Model No PSD 8006	One size only	$350.00
	Five Corners Pty Ltd
FC005	Peri-strips dry with Veritas 	Peri-Strips Dry with Veritas is a 	One circular stapler firing: 	$350.00
	Collagen Matrix Circular Staple 	remodelable material designed to 	20-400mm diameter
	Line Reinforcement	increase staple line strength for 
	surgical repair of soft tissue 
FC006	Peri-Strips dry with Veritas 	Peri-Strips Dry with Veritas is a 	 30-130mm	$700.00
	Collagen Matrix Linear 2 Firings	remodeable material designed to 
	increase staple line strength for 
	surgical repair of soft tissue 
FC007	Peri-Strips dry with Veritas 	Peri-Strips Dry with Veritas is a 	 30-130mm	$2,100.00
	Collagen Matrix 6 Firings	remodeable material designed to 
	increase staple line strength for 
	surgical repair of soft tissue 
	03.08.02.06 - Pleurodesis Powder
	Medical Vision Australia Cardiology Thoracic Pty Ltd
MY003	Steritalc	Sterile granules of talc implanted in 	3 grams & 4 grams	$60.00
	pleural space to act as permanent 
	adhesive
Prostheses List by Category, Groups and Sponsor	Page 114 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.02.07 - Sponge ≤10cm²
	Takeda Pharmaceuticals Australia Pty Ltd
YN003	TachoSil	TachoSil is a broad use haemostat for 	One small patch: 3.0cm x 	$79.00
	intra-operative tissue management. 	2.5cm
	The TachoSil sponge is off-white, 
	with yellow colouring on the active 
	side (coated with fibrinogen and 
	thrombin), and is ready to use (store at
	 room temperature).
	03.08.02.08 - Sponge 10-40cm²
	Takeda Pharmaceuticals Australia Pty Ltd
YN002	TachoSil	TachoSil is a broad use haemostat for 	One medium patch: 4.8cm x 	$242.00
	intra-operative tissue management. 	4.8cm
	The TachoSil sponge is off-white, 
	with yellow colouring on the active 
	side (coated with fibrinogen and 
	thrombin), and is ready to use (store at
	 room temperature).
	03.08.02.09 - Sponge >40cm²
	Takeda Pharmaceuticals Australia Pty Ltd
YN001	TachoSil	TachoSil is a broad use haemostat for 	One large patch: 9.5cm x 	$479.00
	intra-operative tissue management. 	4.8cm
	The TachoSil sponge is off-white, 
	with yellow colouring on the active 
	side (coated with fibrinogen and 
	thrombin), and is ready to use (store at
	 room temperature).
	03.08.02.10 - Synthetic Patch ≤25cm²
	Tag Medical
TM044	TissuePatch3	Synthetic Self-Adhesive Surgical 	50mm x 25mm	$550.00
	Sealant Film
Prostheses List by Category, Groups and Sponsor	Page 115 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
TM045	TissuePatch3	Synthetic Self-Adhesive Surgical 	50mm x 50mm	$550.00
	Sealant Film
	03.08.02.11 - Synthetic Patch >25cm²
	Tag Medical
TM046	TissuePatch3	Synthetic Self-Adhesive Surgical 	50mm x 100mm	$755.00
	Sealant Film
03.08.03 - Ligating Devices
	03.08.03.01 - Clips
	B Braun Australia Pty Ltd
BB294	Aesculap Ligating Clips	Aesculap Ligating Clips- Ligation 	PL561T- Large; 6 	$12.00
	Clips Titanium;	clips/cartridge
BB297	Aesculap Ligating Clips	Aesculap Ligating Clips Titanium	PL565T - Small; 6 	$12.00
	clips/cartridge
BB298	Aesculap Ligating Clips	Aesculap Ligating Clips Titanium	PL566T - small cardiopack 	$48.00
	of 24
BB299	Aesculap Ligating Clips	Aesculap Ligating Clips Titanium	PL567T - medium; 6 	$12.00
	clips/cartridge
BB300	Aesculap Ligating Clips	Aesculap Ligating Clips Titanium	PL568T - medium/large; 6 	$12.00
	clips/cartridge
	Device Technologies Australia Pty Ltd
DE445	Vesocclude Ligating Clips	Titanium Ligating Clips	Small, Narrow (6 per 	$12.00
	cartridge), Small, wide (6 
	per cartridge)
DE446	Vesocclude Ligating Clips	Titanium ligating Clips	Small, Narrow (24 per 	$48.00
	cartridge), Small, Wide   (24 
	per Cartridge)
DE447	Vesocclude Ligating Clips	Titanium ligating Clips	Medium (6 per cartridge)	$12.00
DE448	Vesocclude Ligating Clips	Titanium Ligating Clips	Medium (24 per cartridge)	$48.00
DE449	Vesocclude Ligating Clips	Titanium Ligating Clips	Medium Large (6 per 	$12.00
	cartridge)
DE450	Vesocclude Ligating Clips	Titanium Ligating Clips	Medium large (24 per 	$48.00
	cartridge)
Prostheses List by Category, Groups and Sponsor	Page 116 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE451	Vesocclude Ligating Clips	Titanium Ligating Clips	Large (6 per cartridge)	$12.00
DE452	Vesocclude Ligating Clips	Titanium Ligating Clips	Large (24 per cartridge)	$48.00
	Johnson & Johnson Medical Pty Ltd
JJ033	Ligaclip* Ligating Clips - titanium	Titanium clips contained in a plastic 	3-5mm; 6 clips per cartridge	$12.00
	cartridge
JJ034	Ligaclip* Ligating Clips - titanium	Titanium clips contained in a plastic 	9-12 mm; 6 clips per cartage	$12.00
	cartridge
JJ035	Ligaclip* Ligating Clips - titanium	Titanium clips contained in a plastic 	3-5 mm; 20 clips per 	$40.00
	cartridge	cartridge
	LMT Surgical Pty Ltd
LM042	Synovis Microclip	Malleable titanium clip	1.5-2.5mm x 2-3.5mm	$12.00
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG030	Haemostatic Ligating Clips	Titanium Ligating Clips	Small - Large (6 Clips per 	$12.00
	cartridge)
MG031	Haemostatic Ligating Clips	Titanium Ligating Clips	Small, medium (24 clips per 	$48.00
	pouch)
	N Stenning & Co Pty Ltd
NG006	Horizon Ligating Clips  	Ligation Clips Titanium 	Small (6 per cartridge)  	$12.00
NG007	Horizon Ligating Clips  	Ligation Clips Titanium 	Small  (24 per cartridge)	$48.00
NG008	Horizon Ligating Clips  	Ligation Clips Titanium 	Medium (6 per cartridge), 	$12.00
	Micro (6 per cartridge)
NG009	Horizon Ligating Clips  	Ligation Clips Titanium 	Medium  (24 per cartridge)	$48.00
NG010	Horizon Ligating Clips  	Ligation Clips Titanium 	Medium/Large (6 per 	$12.00
	cartridge)
NG011	Horizon Ligating Clips  	Ligation Clips Titanium 	Medium/Large (24 per 	$48.00
	cartridge)
NG012	Horizon Ligating Clips  	Ligation Clips Titanium 	Large (6 per cartridge)	$12.00
NG013	Horizon Ligating Clips  	Ligation Clips Titanium 	Large (24 per cartridge)	$48.00
NG014	Hemoclip 	Titanium Clips	Small, Medium (25 per 	$30.00
	cartridge); Large (15 per 
	cartridge)
NG016	Hemoclip 	Titanium Clips	Medium  (10 per cartridge) 	$20.00
NG017	Hemoclip 	Titanium Clips	Small (10 per cartridge) 	$20.00
Prostheses List by Category, Groups and Sponsor	Page 117 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NG018	Hemoclip  	Titanium Clips	Med-large (10 per cartridge)	$20.00
NG019	Hemoclip 	Titanium Clips	Large (10 per cartridge) 	$20.00
NG020	EZLoad Ligating Clips  	Titanium Clip 	Small (25 per cartridge); 	$50.00
	Med-Large, Large (10 per 
	cartridge) 
NG021	EZLoad Ligating Clips  	Titanium Clip 	Medium (25 per cartridge) 	$50.00
NG022	EZLoad Ligating Clips  	Titanium Clip 	Small, Medium (10 per 	$20.00
	cartridge) 
	Olympus Australia
OL001	Individual Ligating Clip	Rotatable Clip Fixing Device. Pack of 	MD-59 - 90 degree, 	$100.00
	50 clips	standard; MD-850 - 135 
	degree, standard; HX-600-
	090 - standard, sterile; HX-
	600-135 - standard, sterile
	Reid Healthcare
RH006	Vitalitec Titanium Hemostatic Clips	The SLS titanium (grade 1) hemostatic	Micro, Small, 	$12.00
	 clips are designed to securely grip 	Small/Medium, Medium, 
	the vessel in order to provide a 	Medium/Large and Large. 6 
	complete and final occlusion 	clips per cartridge
RH007	Vitalitec Titanium Hemostatic Clips	The SLS titanium (grade 1) hemostatic	Small & Medium Clips (24 	$48.00
	 clips are designed to securely grip 	clips per pouch - 6 clips per 
	the vessel in order to provide a 	cartridge, 4 cartridges per 
	complete and final occlusion 	pouch)
RH008	Vitalitec Titanium Hemostatic Clips	The SLS titanium (grade 1) hemostatic	Micro, Small, 	$18.00
	 clips are designed to securely grip 	Small/Medium, Medium (9 
	the vessel in order to provide a 	clips per cartridge)
	complete and final occlusion 
RH009	Vitalitec Titanium Hemostatic Clips	The SLS titanium (grade 1) hemostatic	Small and Medium (27 clips 	$54.00
	 clips are designed to securely grip 	per pouch - 9 clips per 
	the vessel in order to provide a 	cartridge, 3 cartridges per 
	complete and final occlusion 	pouch)
	Polymeric Non-resorbable
	N Stenning & Co Pty Ltd
NG025	Hem-o-Lok Polymer Non-	Hem-o-lok Medium (M), Medium-	Small, Medium, Medium-	$46.00
	Absorbable Ligating Clip	Large (ML) and Large (L) Polymer 	Large, Large (6 
	Clips	clips/cartridge)
Prostheses List by Category, Groups and Sponsor	Page 118 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NG044	Hem-o-lok Polymer Non-	Hem-o-lok Extra-large (XL) Polymer 	Extra-large (XL) (6 	$46.00
	Absorbable Ligating Clip	Clips	clips/cartridge)
	Resorbable
	Johnson & Johnson Medical Pty Ltd
JJ036	Absolok* Extra Absorbable 	Polydioxanone clips contained in a 	Small to Extralarge	$94.00
	Ligating Clips 	plastic cartridge
	03.08.03.02 - Clip Applier
	CK Surgitech Pty Ltd
AK005	Clip applier	Automatic clip applier with trigger 	Shaft diameter 10mm, length 	$145.00
	handle 10mm x 33cm with 	33cm, medium/large clips
	medium/large clips
	ConMed Linvatec Australia Pty Ltd
LV081	Open Clip Applier	Titanium	25 medium size titanium 	$145.00
	03.08.03.03 - Clips with Disposable Applier
	C. R. Kennedy
CK003	Endox Visu-Loc Clip Applier	Single-use laparoscopic clip applier	Medium, Large	$250.00
	ConMed Linvatec Australia Pty Ltd
LV127	Touchstone Linear Cutter Stapler 	A device that incorporates a 	60mm length in staple line 	$250.00
	60mm	disposable staple cartridge that lays a 	with choice of 2.5mm, 3.8mm
	double staggered row of staples on 	 and 4.5mm titanium staples
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
LV128	Touchstone Linear Cutter Stapler 	A device that incorporates a 	80mm length in staple line 	$250.00
	80mm	disposable staple cartridge that lays a 	with choice of 3.8mm and 
	double staggered row of staples on 	4.5mm titanium staples
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
Prostheses List by Category, Groups and Sponsor	Page 119 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LV129	Touchstone Linear Cutter Stapler 	A device that incorporates a 	100mm length in staple line 	$250.00
	100mm	disposable staple cartridge that lays a 	with choice of 3.8mm and 
	double staggered row of staples on 	4.5mm titanium
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
LV134	Touchstone Linear Stapler	A device housing a staple cartridge 	30, 45, 60 and 90mm staple 	$250.00
	that places a double staggered row of 	lines in 2.5, 3.5 or 4.8mm 
	staples into appropriate target tissue.	staples
	Covidien Pty Ltd
AS006	Ligation Clips - Disposable clip 	Surgiclip	Small	$250.00
	applier and ligating clips
AS131	Ligation Clips - Disposable clip 	Surgiclip	Medium	$250.00
	applier and ligating clips
AS132	Ligation Clips - Disposable clip 	Surgiclip	Large	$250.00
	applier and ligating clips
	Endotherapeutics Pty Ltd
ET061	Stomaphyx, Stomaphyx Serosafuse 	Stomaphyx Serosafuse Fasteners	One Size	$250.00
	Fasteners
ET062	Stomaphyx	Stomaphyx	One Size	$250.00
	Johnson & Johnson Medical Pty Ltd
JJ037	Ligaclip* Multiple Clip Applier 	Metal/plastic applier preloaded with 	3-12 mm; 20 clips per applier	$250.00
	titanium clips
JJ038	Ligaclip* Multiple Clip Applier 	Metal/plastic applier preloaded with 	3-12 mm; 30 clips per applier	$250.00
	titanium clips
JJ039	Ligaclip* Multiple Clip Applier 	Metal/plastic applier preloaded with 	5-6mm; 20 clips per applier	$250.00
	titanium clips; reloadable 
JJ187	Ligaclip Allport 5mm Clip Applier	Metal/plastic stapler with titanium 	5mm shaft diameter	$250.00
	Med-Chem Surgical Pty Ltd
ML004	Touchstone Linear Cutter Stapler 	A device that incorporates a 	60mm length in staple line 	$250.00
	60mm	disposable staple cartridge that lays a 	with choice of 2.5mm, 3.8mm
	double staggered row of staples on 	 and 4.5mm titanium staples
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
Prostheses List by Category, Groups and Sponsor	Page 120 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ML005	Touchstone Linear Cutter Stapler 	A device that incorporates a 	80mm length in staple line 	$250.00
	80mm	disposable staple cartridge that lays a 	with choice of 3.8mm and 
	double staggered row of staples on 	4.5mm titanium staples
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
ML006	Touchstone Linear Cutter Stapler 	A device that incorporates a 	100mm length in staple line 	$250.00
	100mm	disposable staple cartridge that lays a 	with choice of 3.8mm and 
	double staggered row of staples on 	4.5mm titanium
	each side of a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
ML011	Touchstone Linear Stapler	A device housing a staple cartridge 	30, 45, 60 and 90mm staple 	$250.00
	that places a double staggered row of 	lines in 2.5, 3.5 or 4.8mm 
	staples into appropriate target tissue.	staples
	N Stenning & Co Pty Ltd
NG023	Hemoclip Plus 	Ligation System Small and Medium	15 small preloaded clips 	$250.00
	and 20 medium preloaded 
	Doppler Guided
	Endotherapeutics Pty Ltd
ET064	AMI HAL-RAR Flexi Procedure Kit	Doppler guided Haemorrhoidal 	One size, several components	$980.00
	Arterial Ligation and Recto-Anal 
	Repair System.
	HAL Haemorrhoidal Ligating 
	sutures, doppler/ultrasound 
	proctoscope, flexiprobe, knot pusher
	Doppler Guided, Endoscopic
	Medical Specialties Australia Pty Ltd
MS056	THD Slide	Transanal Haemorrhoidal 	one size only	$980.00
	Dearterilisation and Pexis System
	Endoscopic
	Applied Medical Australia Pty Ltd
MH014	Direct Drive laparoscopic clip 	Single-use, sterile 10mm laparscopic 	10mm shaft diameter with 	$145.00
	applier with TiGold titanium clips	clip applier with 20 medium-large size	medium-large size clips.
	 titanium clips
MH015	Epix™ Disposable Laparoscopic 	Epix™ Disposable Laparoscopic 	5mm	$145.00
	Clip Applier w/ TiGold M/L 	Clip Applier w/ TiGold M/L titanium 
	clips 5mm
Prostheses List by Category, Groups and Sponsor	Page 121 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Boston Scientific Australia Pty Ltd
BS082	Resolution Clip Device	Pre-loaded endoscopically applied 	7Fr, 11mm jaw opening	$145.00
	clip, radiopaque stainless steel & 
	cobalt chrome.
BS171	Resolution II Haemostasis Clip	Pre-loaded endoscopically applied 	7Fr, 11mm jaw opening	$145.00
	clip, radiopaque stainless steel & 
	cobalt chrome.
	CK Surgitech Pty Ltd
AK007	Hemoclip Clip Applicator	A device consisting of, a plastic 	Applicator length 230cm, 	$80.00
	handle with thumb ring and slider, a 	clip length sizes 4mm, 5mm 
	230cm hollow plastic tube with metal 	and 6mm with clip opening 
	clip in at the distal end.	sizes of 90 degree to 135 
	degree
	ConMed Linvatec Australia Pty Ltd
LV076	Reflex ELC 530 Automatic Clip 	Titanium Endoscopic Clip Applier	Medium/Large, 10mm, 20 	$412.00
	Applier	Clips
LV086	Reflex 5mm Automatic Clip Applier	Autofeeding disposable clip applier. 	medium/large	$412.00
	Contains 15 non absorbable polymer 
	locking clips
	Cook Medical Australia Pty Ltd
WC213	Endoscopic Clipping Device	TriClip Endoscopic Clipping Device	7Fr - 3 Prong 12mm, 8Fr - 3 	$145.00
	prong 12mm
WC311	Instinct Endoscopic Hemoclip	Endoscopic hemoclip used within the	Opening span up to 16mm.	$412.00
	 GI tract
	Covidien Pty Ltd
AS073	ENDOCLIP*; Acuclip Single use 	Titanium Surgical Stapler	5mm (12 clips); One size 	$412.00
	Endoscopic Multiple Clip Applier.	only.
AS074	ENDOCLIP*	Titanium Surgical Stapler	10mm (ML, M, L)-(20 clips)	$412.00
AS137	Endo Clip III	Laparoscopic 5mm Clip Applier	5mm	$412.00
	Johnson & Johnson Medical Pty Ltd
JJ186	Ligaclip Endoscopic Multiclip 	Metal/plastic stapler with titanium 	10-12 mm shaft diameter, 	$412.00
	medium to large clip
JJ482	LIGAMAX 5mm Endoscopic Clip 	LIGAMAX 5mm Endoscopic Clip 	Medium / Large	$412.00
	Applier	Applier
	N Stenning & Co Pty Ltd
NG043	Weck Hem-o-lok	Hem-o-lok Automatic Endo Applier	15 Clips per applier	$412.00
Prostheses List by Category, Groups and Sponsor	Page 122 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Olympus Australia
OL009	Rotatable Clip fixing device	Disposable pre-loaded clip applier	Standard or long clip 	$145.00
	length, 9 or 11mm jaw 
OL010	Ligation device	Disposable pre-assembled applier and	Sheath Length 1650-2300mm	$145.00
	 ligating loop
	Endoscopic, OTS
	Endotherapeutics Pty Ltd
ET067	OTSC Clip	The OTSC Clip is a superelastic 	OTSC Clip is available in 	$950.00
	Nitinol clip which compresses the 	three sizes: 9mm, 10mm and 
	tissue between its teeth. Therefore it 	11mm
	enables hemostasis as well as closing 
	of perforations
ET068	OTSC System	Has two components:	OTSC Clip is available in 	$3,000.00
	1. The OTSC Clip is a superelastic 	three sizes: 9mm, 10mm and 
	Nitinol clip which compresses the 	11 mm.
	tissue between its teeth; enables 	Ovesco Twin Graspers : 
	hemostasis as well as closing 	165mm or 220mm
	performations.	Ovesco Anchor: 165mm
	
	2. Grasping and Anchoring Tool. 
	Ovesco Twin Graspers – to 
	approximate wound edges.. Ovesco 
	Anchor- to grasp fibrous tissue or 
	fistulas
	03.08.03.04 - Reload Cartridge
	B Braun Australia Pty Ltd
BB016	Challenger Ligating Clips	Challenger Ligating Clips Titanium 	Medium-large	$65.00
	Multifire
BB301	Challenger Ligating Clips	Challenger Ligating Clips Titanium 	PL572T - small/medium	$65.00
	Multifire
BB321	Pneumatic Challenger Multifire Clips	Challenger TI-P SM-Ligat. Clips 12 	small-medium, medium-large	$65.00
	Cartridge (PL574T)  Challenger TI-P 
	ML-Ligat. Clips 12 Cartridge 
	C. R. Kennedy
CK001	Microline Pentax Disposable 10ml 	Disposable cartridge containing 19 	medium/large clip	$65.00
	Titanium K2 Clip Cartridge	surgical grade titanium clips 
	delivered using a re-usable hand piece
Prostheses List by Category, Groups and Sponsor	Page 123 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
CK002	Microline Pentax Disposable 10ml 	Disposable cartridge containing 10 	Medium/Large Clip	$65.00
	Titanium K2 clip Cartridge	surgical grade titanium clips 
	delivered using a reusable hand piece 
CK004	System: Microline Pentax 	Disposable cartidge, containing 18 	Large clip - 10mm clip 	$65.00
	Reposable "Gemini-L Clip Applier"	large surgical grade titanium clips 	applier
	delivered using a re-usable hand piece
	 applier
	Covidien Pty Ltd
AS001	Endoclip Disposable Loading 	Single use loading unit with 8 	One size only	$65.00
	Unit; MultApplier Disposable 	titanium clips; Disposable clip 
	cartridge with 8 titanium clips
	Johnson & Johnson Medical Pty Ltd
JJ040	Ligaclip* 20/20 Reload Unit	Metal reload cartridge containing 	5 mm; 20 clips	$65.00
	titanium clips
	03.08.03.05 - Sutures
	Endotherapeutics Pty Ltd
ET065	HAL-RAR	HAL-Ligating Suture, AMI HAL-	One size	$100.00
	Ligating suture, prosthetic 
	component of AMI HAL-RAR 
	03.08.03.06 - Ligating Bands with Disposable Applier
	Boston Scientific Australia Pty Ltd
BS225	Speedband Superview Super 7	Multiple Band Ligator	7 bands per unit, compatible	$275.00
	 with scopes with outer 
	diameter of 8.6mm - 11.5mm
	Cook Medical Australia Pty Ltd
WC314	Saeed Multi-band Ligator	Multiple Band Ligator	4, 6 or 10 bands per unit, 	$275.00
	compatible with scopes 
	with outer diameter of 
	8.6mm - 14mm
WC318	ShortShot Saeed Hemorrhoidal 	The ShortShot Saeed Haemorrhoidal 	4 bands per ligator, 15mm in	$65.00
	Multi-Band Ligator	Multi-Band Ligator is used to ligate 	 diameter
	internal haemorrhoids and is available
	 with or without the TriView 
	Anoscope.  
Prostheses List by Category, Groups and Sponsor	Page 124 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Gallay Medical & Scientific
GR001	EndoChoice Autoband Ligator	Endoscopic band ligation device 	One size (7 bands) to fit 	$275.00
	including seven pre-loaded bands to 	gastroscopes with an outer 
	fit gastroscopes with an outer 	diameter of 8.6-11.5mm
	diameter of 8.6-11.5mm
03.08.04 - Staples & Tackers
	03.08.04.01 - Staples, Non-bone (Reload)
	ConMed Linvatec Australia Pty Ltd
LV130	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	60mm length in staple line 	$244.00
	Cartridge (Reloads) 60mm	conjunction with a matched 	with choice of 2.5mm, 3.8mm
	Touchstone Linear Cutter Stapler that 	 and 4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
LV131	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	80mm length in staple line 	$244.00
	Cartridge (Reloads) 80mm	conjunction with a matched 	with choice of 3.8mm and 
	Touchstone Linear Cutter Stapler that 	4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
LV132	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	100mm length in staple line 	$244.00
	Cartridge (Reloads) 100mm	conjunction with a matched 	with choice of 3.8mm and 
	Touchstone Linear Cutter Stapler that 	4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
LV133	Touchstone Linear Stapler Cartridge	A device housing a staple cartridge 	30, 45, 60 and 90mm staple 	$244.00
	that places a double staggered row of 	lines in 2.5, 3.5 or 4.8mm 
	staples into appropriate target tissue.	staples
Prostheses List by Category, Groups and Sponsor	Page 125 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Covidien Pty Ltd
AS013	ILA* 52 Reloading Unit	Titanium. Multifire 60 Cartridge 90 	50 - 60mm (2.5mm, 3.8mm)	$244.00
	Premium Disposable Loading Unit 
	with Titanium Staples,  50 Premium 
	Disposable Loading Unit with 
	Titanium Staple,  Inverted Linear 
	Anastomosis Cartridges 3944, 3943, 
	3978, 3946, 3945, 3976, 3977
AS016	GIA*, ILA* Reloading Unit 	Titanium. Multifire 60 Cartridge,  	90mm (3.8, 4.8mm)	$244.00
	Inverted Linear Anastomosis 
	Cartridges 3944, 3943, 3978, 3946, 
	3945, 3976, 3977
AS017	GIA*, ILA* Reloading Unit 	Titanium. Multifire 60 Cartridge, 	100mm (3.8,4.8mm)	$244.00
	Inverted Linear Anastomosis 
	Cartridges 3944, 3943, 3978, 3946, 
	3945, 3976, 3977
AS025	TA* Reloading Units; DST Series* 	Premium Multifire TA* Disposable 	30mm (2.5, 3.5, 4.8mm); DST	$244.00
	Linear Stapler Disposable Loading 	Surgical Stapler and Loading Unit; 	 TA90-3.5 DLU; DST 
	Units	Titanium staples used for hemostatic 	TA90-4.8 DLU; DST TA45-
	closure of specific organs and blood 	3.5 DLU; DST TA45-4.8 
	vessels (ex bowel, stomach and lung)	DLU; DST TA60-3.5 DLU; 
	DST TA60-4.8 DLU; DST 
	TA30-3.5 DLU; DST TA30-
	4.8 DLU; DST TA30V3 
	DLU.
AS026	PI*, Reloading Unit	Premium Multifire TA* Disposable 	30mm (2.5, 3.5, 4.8mm)	$244.00
	Surgical Stapler and Loading Unit
AS030	TA* Reloading Units	Premium Multifire TA* Disposable 	90mm (3.5mm, 4.8mm)	$244.00
	Surgical Stapler and Loading Unit
AS076	ENDO TA* reloading unit	Titanium Surgical Stapler DLU	30mm -2.5, 30mm-3.5	$244.00
AS081	ENDO GIA* reloading unit	Titanium Surgical Stapler DLU	30 - 35mm; 45mm; 60mm.	$244.00
AS092	ENDO - Herna reloading unit; 	Titanium Surgical Stapler DLU	4mm, 4.8mm (10 staples).	$244.00
	VERSA TACK* reloading unit.
AS114	DST Series* GIA* Linear Cutter 	Single Use Loading Units	60mm length: Sizes 2.5mm, 	$244.00
	Stapler and single use loading units	3.8mm, 4.8mm
AS116	DST Series* GIA* Linear Cutter 	Single Use Loading Units	80mm length: Sizes 3.8 and 	$244.00
	Stapler and single use loading units	4.8mm
Prostheses List by Category, Groups and Sponsor	Page 126 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS118	DST Series* GIA* Linear Cutter 	Single use loading units	100mm length: Size 3.8 and 	$244.00
	Stapler and single use loading units	4.8mm
	Johnson & Johnson Medical Pty Ltd
DY539	EES Linear Cutter	Single Use Loading Units	55mm	$244.00
DY540	EES Linear Cutter	Single Use Loading Units	75mm	$244.00
JJ046	Proximate* Linear Cutter  Staple 	Plastic linear cutter reload cartridge 	50 - 60mm	$244.00
	Reload Unit 	containing titanium staples
JJ047	Proximate* Linear Cutter  Staple 	Plastic linear cutter reload cartridge 	75 - 80mm	$244.00
	Reload Unit 	containing titanium staples
JJ048	Proximate* Linear Cutter Staple 	Plastic linear cutter reload cartridge 	100mm	$244.00
	Reload Unit	containing titanium staples
JJ053	Proximate* Linear Stapler Reload 	Plastic linear stapler reload cartridge 	30mm	$244.00
	Unit 	containing titanium staples
JJ054	Proximate* Linear Stapler Reload 	Plastic linear stapler reload cartridge 	55 - 60mm	$244.00
	Unit 	containing titanium staples
JJ055	Proximate* Linear Stapler Reload 	Plastic linear stapler reload cartridge 	90mm	$244.00
	Unit 	containing titanium staples
JJ190	Endopath ETS Linear Cutter reload	Titanium staple cartridge	45mm	$244.00
JJ192	Endopath ETS Linear Cutter reload	Titanium staple cartridge	35mm	$244.00
JJ564	Echelon Endocutter Reload	Echelon Endocutter Reload	60 and 45mm	$244.00
	MD Solutions Pty Ltd
MB010	Panther Linear Stapler, Panther 	The PANTHER SSAB surgical stapler	FLSL Linear 	$244.00
	Linear Cutter Stapler and reloads	 and SADB Reloading Staples Unit 	Stapler/Reloading Unit 
	place two double staggered rows of 	30mm 3.5/4.8mm; 45mm 
	titanium staples & simultaneously cut	3.5/4.8mm; 60mm 
	 and divided tissue between the two 	3.5/4.8mm; 90mm 3.5/4.8mm
	double rows. The stapler is available 	 staple height.
	in 60mm, 80mm, and 100mm lengths, 	SSAB Linear Cutter 
	and in two staple sizes, 3.8mm and 	Stapler/Reloading unit 
	4.8mm to accommodate various tissue 	60mm 3.8/4.8mm; 80mm 
	thickness. Each stapler may be 	3.8/4.8mm; 100mm 
	reloaded up to 7 times for a total of 8 	3.8/4.8mm height
	firings on one patient in one 
	operation.
Prostheses List by Category, Groups and Sponsor	Page 127 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Med-Chem Surgical Pty Ltd
ML007	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	60mm length in staple line 	$244.00
	Cartridge (Reloads) 60mm	conjunction with a matched 	with choice of 2.5mm, 3.8mm
	Touchstone Linear Cutter Stapler that 	 and 4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
ML008	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	80mm length in staple line 	$244.00
	Cartridge (Reloads) 80mm	conjunction with a matched 	with choice of 3.8mm and 
	Touchstone Linear Cutter Stapler that 	4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
ML009	Touchstone Linear Cutter Stapler 	A disposable staple cartridge used in 	100mm length in staple line 	$244.00
	Cartridge (Reloads) 100mm	conjunction with a matched 	with choice of 3.8mm and 
	Touchstone Linear Cutter Stapler that 	4.5mm titanium staples
	lays a double staggered row of staples
	 on each side a cutting knife.  Used for 
	extensive bowel, gastric, 
	gynaecological and thoracic surgical 
	stapling procedures.
ML010	Touchstone Linear Stapler Cartridge	A device housing a staple cartridge 	30, 45, 60 and 90mm staple 	$244.00
	that places a double staggered row of 	lines in 2.5, 3.5 or 4.8mm 
	staples into appropriate target tissue.	staples
	N Stenning & Co Pty Ltd
NG062	Frankenman Linear Stapler Reloads	Linear stapler single use reload with 	32mm; 46mm; 60mm; 90mm	$244.00
	titanium staples
NG064	Frankenman Linear Cutter Reloads	Single use, linear cutter reload 	61mm; 81mm; 100mm	$244.00
	cartridge containing titanium staples
	Curved
	ConMed Linvatec Australia Pty Ltd
LV138	Touchstone Curved Linear Cutter 	Reload for Touchstone Curved Linear 	20mm-46mm	$263.00
	Reload	Cutter
Prostheses List by Category, Groups and Sponsor	Page 128 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ475	Proximate Contour Curved 	Contour Curved Cutter/Stapler 30 & 	Blue (3.85mm) & Green 	$263.00
	Cutter/Stapler	40mm reload cartridges	(4.5mm)
	Endoscopic, Articulating/Roticulating
	Covidien Pty Ltd
AS186	Endo GIA™ Reload with 	Covidien's Endo GIA™ Reload with 	30mm, 45mm, 60mm	$375.00
	TriStaple™ Technology	TriStaple™ Technology provides 
	outstanding performance across a 
	broader range of tissue thickness, 
	thereby simplifying the cartridge 
	selection process. With its stepped 
	cartridge face, TriStaple™ 
	Technology delivers graduated 
	compression, optimising interaction 
	between the tissue and the stapler
	03.08.04.02 - Staplers
	Johnson & Johnson Medical Pty Ltd
DY541	EES Linear Cutter	Single use, reloadable stapler	Length 55mm	$80.00
DY542	EES Linear Cutter	Single Use, reloadable stapler	Length 75 mm	$80.00
	Endoscopic
	Covidien Pty Ltd
AS134	DST Series EEA Or Vil	Accessory	21mm, 25mm	$415.00
	Johnson & Johnson Medical Pty Ltd
JJ896	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; long shaft	$415.00
	titanium staples
JJ903	Echelon Endocutter	Multifire disposable surgical stapling	60mm and 45mm	$415.00
	 instrument 60mm and 45mm
	Endoscopic, Articulating/Roticulating
	Covidien Pty Ltd
AS046	Endo GIA* Universal Stapling 	Multifire 30 disposable stapler with 	12mm; One size only.	$415.00
	System; Versafire GIA*.	titanium staples; Disposable surgical 
	stapling instruments or cartridges.
Prostheses List by Category, Groups and Sponsor	Page 129 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ892	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; short shaft	$415.00
	titanium staples
JJ894	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; long shaft	$415.00
	titanium staples
JJ904	Echelon Flex Endocutter	Articulating Multifire disposable 	60mm and 45mm	$415.00
	surgical stapling instrument 60mm 
	and 45mm
	Endoscopic, Articulating/Roticulating, Powered
	Johnson & Johnson Medical Pty Ltd
MN134	Powered ECHELON FLEX™ 	Powered, articulating, endoscopic 	45 or 60 mm lengths	$520.00
	ENDOPATH Endocutter	linear cutter
	03.08.04.03 - Staples, Reinforcer
	Cook Medical Australia Pty Ltd
WC304	Biodesign Staple Line Reinforcement	Used for reinforcement of the gastric 	Complex 3D shape, lengths 	$230.00
	staple line during bariatric surgical 	60 - 160mm and widths 11 - 
	procedures and also for buttressing 	12mm
	staple lines during lung resection
	W L Gore & Associates
GT224	GORE SEAMGUARD® 	As packaged, GORE SEAMGUARD 	Ethicon Endo-Surgery 	$230.00
	Bioabsorbable Staple Line 	Bioabsorbable Staple Line 	Endopath ETS45; Ethicon 
	Reinforcement	Reinforcement constitutes preformed 	Endo-Surgery Endopath 
	porous bioabsorbable sheets held 	ETS45; Ethicon Endo-
	into the form of sleeves (one cartridge 	Surgery Endopath EZ45; 
	device, one anvil device) through the 	Ethicon Endo-Surgery 
	use of a non-absorbable polyester 	Endopath Echelon 45, 
	braided suture. A TY	Ethicon Endo-Surgery 
	Endopath Echelon 60; 
	Ethicon Endo-Surgery 
	Endopath ETS Flex 60; USS
	 Endo GIA Unive
Prostheses List by Category, Groups and Sponsor	Page 130 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT228	GORE SEAMGUARD® 	As packaged, GORE SEAMGUARD 	Ethicon Endo-Surgery 	$230.00
	Bioabsorbable Staple Line 	Bioabsorbable Staple Line 	ENDOPATH 25 and 
	Reinforcement, Endoscopic Staplers	Reinforcement constitutes preformed	PROXIMATE 25; Ethicon 
	Endo-Surgery ENDOPATH
	 29 and PROXIMATE 29; 
	Ethicon Endo-Surgery 
	ENDOPATH 33 and 
	PROXIMATE 33; 
	Autosuture CEEA 25; 
	Autosuture CEEA 28; 
	Autosuture CEEA 31; 
	Autosuture CEEA 34; 
	Autosuture DST Series 
	Integrated
	Covidien Pty Ltd
AS177	Duet TRS Reload with Tissue 	Single use loading units with tissue 	45mm and 60mm staple line 	$456.00
	Reinforcement	reinforcement material for use with 	length; 3.5mm and 4.8mm 
	Endo GIA Universal stapling devices	staple leg-length
	03.08.04.04 - Staples, Non-bone with Disposable Applier
	Covidien Pty Ltd
AS011	GIA*, ILA* Staplers	Titanium	75mm (3.8mm, 4.8mm)	$370.00
AS018	TA* Stapler; DST Series* Linear 	Premium Multifire TA* Disposable 	DST TA60-3.5; DST TA60-	$370.00
	Staplers	Surgical Stapler and Loading Unit; 	4.8
	Titanium staples used for hemostatic 
	closure of specific organs and blood 
	vessels (ex bowel, stomach and lung).
AS019	PI*, Stapler	Premium Multifire TA* Disposable 	30mm (2.5, 3.5, 4.8mm)	$370.00
	Surgical Stapler and Loading Unit
AS033	Power Stapler and Staples (Powered	LDS Instrument & Cartridges 	One size only	$370.00
	 LDS*)	(Disposable Loading Unit)
AS102	DST Series* Linear Staplers	Titanium staples used for hemostatic 	DST TA90-3.5; DST TA90-	$370.00
	closure of specific organs and blod 	4.8
	vessels (ex bowel, stomach and lung)
AS110	DFS Disposable Fascia Stapler	Stainless Steel	One Size Only	$370.00
AS113	DST Series* GIA* Linear Cutter 	single use, reloadable stapler	60mm length: sizes 2.5mm, 	$370.00
	Stapler and single use loading units	3.8mm, 4.8mm
Prostheses List by Category, Groups and Sponsor	Page 131 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS115	DST Series* GIA* Linear Cutter 	Single use, reloadable stapler	80mm length; Sizes 3.8 and 	$370.00
	Stapler and single use loading units	4.8mm
AS117	DST Series* GIA* Linear Cutter 	Single use, reloadable stapler	100mm length: Sizes 3.8 	$370.00
	Stapler and single use loading units	and 4.8mm
AS133	TA* Stapler; DST Series* Linear 	Premium Multifire TA* Disposable 	30mm (2.5, 3.5, 4.8mm);  	$370.00
	Staplers	Surgical Stapler and Loading Unit; 	DST TA45-3.5;  DST TA45-
	Titanium staples used for hemostatic 	4.8;  DST TA30-3.5;  DST 
	closure of specific organs and blood 	TA30-4.8;  DST TA30V3.
	vessels (ex bowel, stomach and lung).
	Endotherapeutics Pty Ltd
ET066	Insorb Subcuticular Stapler	A subcuticular (dermal) surgical 	Each staple is 5mm x 3mm	$370.00
	delivery system loaded with 
	resorbable staples/prostheses
	Johnson & Johnson Medical Pty Ltd
JJ043	Proximate* Linear Cutter with 	Metal/Plastic linear cutter preloaded 	50 - 60mm	$370.00
	Staples 	with titanium staples
JJ044	Proximate* Linear Cutter with 	Metal/Plastic linear cutter preloaded 	75 - 80mm	$370.00
	Staples 	with titanium staples
JJ045	Proximate* Linear Cutter with 	Metal/Plastic linear cutter preloaded 	100mm	$370.00
	Staples 	with titanium staples
JJ049	Proximate* Linear Stapler	Metal/Plastic linear stapler preloaded 	30mm	$370.00
	with titanium staples
JJ050	Proximate* Linear Stapler	Metal/Plastic linear stapler preloaded 	55 - 60mm	$370.00
	with titanium staples, manual closure
JJ051	Proximate* Linear Stapler	Metal/Plastic linear stapler preloaded 	55 - 60mm	$370.00
	with titanium staples, automatic 
JJ052	Proximate* Linear Stapler	Metal/Plastic linear stapler preloaded 	90mm	$370.00
	with titanium staples
	N Stenning & Co Pty Ltd
NG061	Frankenman Linear Cutter Stapler	Single use, reloadable, linear cutter 	61mm; 81mm; 100mm	$370.00
	stapler containing titanium staples
NG063	Frankenman Linear Stapler	Linear stapler preloaded with 	32mm; 46mm; 60mm; 90mm	$370.00
	titanium staples
	Articulating/Roticulating
	Covidien Pty Ltd
AS035	Roticulator*	Roticulator 30	30mm (3.5, 4.8mm)	$770.00
Prostheses List by Category, Groups and Sponsor	Page 132 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS036	Roticulator*	Roticulator 55	55mm (3.5, 4.8mm)	$770.00
AS037	ROTICULATOR*	Polysorb 55 Disposable Loading 	55mm (3.5, 4.8mm)	$770.00
	Johnson & Johnson Medical Pty Ltd
JJ056	Proximate Articulating Linear 	Articulating linear stapler preloaded 	55mm	$770.00
	with titanium staples
	Circular
	ConMed Linvatec Australia Pty Ltd
LV135	Touchstone Circular Stapler	A surgical implanting device for 	external dimesnion - 25mm, 	$754.00
	placing s specific size of double 	29mm or 33mm
	staggered row of titanium staples in a 
	circular fashion in the large bowel, 
	small bowel or oesophagus to 
	maintain function of the digestive 
	tract.  A suitable size is used to match 
	the lumen size of the patient's 
	digestive tract
LV136	Touchstone Prolapse Haemorrhoid 	A surgical implanting device for 	33mm and 36mm	$754.00
	Stapler	placing a specific size of double 
	staggered row of titanium staples in a 
	circular fashion in the Anal and/or 
	Rectal region for the circumferential 
	excision of the prolapsed distal rectal 
	muscosa, as described by Dr. Longo, 
	Italy.
	Covidien Pty Ltd
AS179	EEA Haemorrhoid and Prolapse 	Stapling instrument for control of 	33mm Circular Stapling 	$754.00
	Stapler	rectal prolapse and haemorrhoid 	line, 3.5 mm and 4.8mm 
	Staple leg length.
	Johnson & Johnson Medical Pty Ltd
JJ443	Proximate Intraluminal Stapler PPH	Proximate Hemorrhoidal Circular 	One Size Only	$754.00
	Stapler PPH
Prostheses List by Category, Groups and Sponsor	Page 133 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Med-Chem Surgical Pty Ltd
ML012	Touchstone Circular Stapler	A surgical implanting device for 	external dimesnion - 25mm, 	$754.00
	placing s specific size of double 	29mm or 33mm
	staggered row of titanium staples in a 
	circular fashion in the large bowel, 
	small bowel or oesophagus to 
	maintain function of the digestive 
	tract.  A suitable size is used to match 
	the lumen size of the patient's 
	digestive tract
ML013	Touchstone Prolapse Haemorrhoid 	A surgical implanting device for 	33mm is the external 	$754.00
	Stapler	placing a specific size of double 	diameter of the device.
	staggered row of titanium staples in a 
	circular fashion in the Anal and/or 
	Rectal region for the circumferential 
	excision of the prolapsed distal rectal 
	muscosa, as described by Dr. Longo, 
	Italy.
	N Stenning & Co Pty Ltd
NG059	Frankenman Circular Stapler	Curved intraluminal stapler preloaded	21mm; 25mm; 28mm; 32mm	$754.00
	 with titanium staples.
NG060	Frankenman Haemorrhoidal (CPH) 	Circular stapler for rectal prolapse and	Outside diameter: 32.5mm; 	$754.00
	Stapler	 haemorrhoids preloaded with 	34.5mm
	titanium staples
	Curved
	ConMed Linvatec Australia Pty Ltd
LV137	TOUCHSTONE Curved Linear 	The Curved Linear Cutter is supplied 	20mm-46mm	$650.00
	sterile with a single-patient use 
	cartridge with 4 staggered rows of 
	titianium staples. The sizes are 20mm, 
	30mm, 37mm, 40mm, 43mm, 46mm to fit
	 different tissues and surgical 
	procedures. Among them, the CLC20, 
	CLC25 and CLC30 are packaged with
	 2 inter-changeable cartidges
	Johnson & Johnson Medical Pty Ltd
JJ812	CONTOUR Curved Cutter Stapler	Curved cutter and stapler for 	40mm	$650.00
	gastrointestinal transaction and 
	resection.
Prostheses List by Category, Groups and Sponsor	Page 134 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Endoscopic
	Covidien Pty Ltd
AS075	ENDO TA*	Titanium Surgical Stapler	30mm	$550.00
AS077	ENDO GIA*	Titanium Surgical Stapler	30 - 35mm	$550.00
	Johnson & Johnson Medical Pty Ltd
JJ184	Endopath Multi Stapler	Endoscopic titanium stapler with 	11mm shaft diameter	$550.00
JJ895	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; long shaft	$550.00
	titanium staples
JJ898	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	35mm	$550.00
	titanium staples
	Endoscopic, Articulating/Roticulating
	Johnson & Johnson Medical Pty Ltd
JJ891	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; short shaft	$770.00
	titanium staples
JJ893	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	45mm; long shaft	$770.00
	titanium staples
JJ897	Endopath Linear Cutter	Metal/plastic cutter-stapler with 	35mm	$770.00
	titanium staples
	Endoscopic, Circular
	Covidien Pty Ltd
AS072	Staples and Disposable Stapler 	Titanium, curved, PPCEEA*; 	21-34mm; 21, 25, 28, 31, 	$780.00
	Applier and staples; PPCEEA*.	Titanium Surgical Stapler.	34mm.
AS119	DST Series* EEA* Circular Stapler	Circular staplers	21mm to 33mm	$780.00
AS135	DST™ Series EEA™ XL	Circular Stapler	5 sizes	$780.00
	Johnson & Johnson Medical Pty Ltd
JJ041	Proximate* Intraluminal Stapler	Metal/plastic circular straight stapler 	21 - 33 mm	$780.00
	preloaded with titanium staples
JJ042	Proximate* Intraluminal Stapler	Metal/plastic circular curved stapler 	21 - 33mm	$780.00
	preloaded with titanium staples
Prostheses List by Category, Groups and Sponsor	Page 135 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	MD Solutions Pty Ltd
MB011	Panther Circular Stapler	The Panther circular stapler places 	There are five sizes of the 	$780.00
	circular, double staggered rows of 	FCLWBE and FCSME: 
	titanium staples in the tissue and 	24mm, dual safety; 26mm, 
	resects the excess tissue to create a 	dual safety; 29mm, dual 
	circular anastomosis. The instrument 	safety; 32mm, dual safety 
	is activated when handle is squeezed 	and 34mm, dual safety
	firmly. There are five diameters which 
	are able to be deployed form the 
	device - 24mm, 26mm, 29mm, 32mm, or 
	34mm
	03.08.04.05 - Tackers
	Covidien Pty Ltd
AS091	VERSA TACK* stapler	Titanium Surgical Stapler	4, 4.8mm (10 staples)	$272.00
AS095	STATTACK™	STATTACK™ Titanium Helical 	One size only	$272.00
	Absorbable
	Bard Australia Pty Ltd
BA204	SorbaFix	Open of Laparoscopic Absorbable 	15 Fasteners; 30 Fasteners	$550.00
	Fixation System.
	Covidien Pty Ltd
AS158	ABSORBATACK ™	Larposcopic Absorbable Fixation 	5mm, 15 tacks	$550.00
	Device
AS160	ABSORBATACK ™	Laparoscopic Absorbable Fixation 	5mm, 30 tacks	$550.00
	Device
	Johnson & Johnson Medical Pty Ltd
MN115	SECURESTRAP™	5mm Absorbable Strap Fixation Device	5mm	$550.00
	Endoscopic
	Bard Australia Pty Ltd
BA203	PermaFix	Open or Laparoscopic Permanent 	15 Fasteners; 30 Fasteners	$435.00
	Fixation System.
	Covidien Pty Ltd
AS045	PROTACK*; Endoscopic Tacker 	Endoscopic; Titanium Surgical Tacker	20 tacks; 30 tacks; 5mm; 	$435.00
	Device; ENDO UNIVERSAL*	4mm, 4.8mm (10 staples).
Prostheses List by Category, Groups and Sponsor	Page 136 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
03.08.05 - Polypropylene/Polyester Mesh
	03.08.05.01 - ≤200cm²
	Atrium Australia - Pacific Rim Pty Limited
AC061	Atrium polypropylene mesh	Polypropylene mesh	0-200cm²	$80.00
	B Braun Australia Pty Ltd
BB088	Premilene Mesh	Polypropylene	3x10cm	$80.00
BB089	Premilene Mesh	Polypropylene	4.5x10cm	$80.00
BB090	Premilene Mesh	Polypropylene	4.5x10cm	$80.00
BB091	Premilene Mesh	Polypropylene	4.5x10cm	$80.00
BB092	Premilene Mesh	Polypropylene	5x30cm	$80.00
BB093	Premilene Mesh	Polypropylene	6x14cm	$80.00
BB094	Premilene Mesh	Polypropylene	6x13.5cm	$80.00
BB095	Premilene Mesh	Polypropylene	7.5x7.5cm	$80.00
BB096	Premilene Mesh	Polypropylene	4.5x105cm	$80.00
BB097	Premilene Mesh	Polypropylene	7.5x15cm	$80.00
BB098	Premilene Mesh	Polypropylene	10x10cm	$80.00
BB099	Premilene Mesh	Polypropylene	6x14cm	$80.00
BB100	Premilene Mesh	Polypropylene	10x15cm	$80.00
BB181	OPTILENE MESH	Polypropylene Mesh	5x30cm, 5 pieces	$80.00
BB183	OPTILENE MESH	Polypropylene Mesh	7.5x7.5cm, 5 pieces	$80.00
BB186	OPTILENE MESH	Polypropylene Mesh	5 x 10cm, 5 pieces	$80.00
BB187	OPTILENE MESH	Polypropylene Mesh	10 x 15cm, 5 pieces	$80.00
BB188	OPTILENE MESH	Polypropylene Mesh	4.5x10cm, 5 pieces	$80.00
BB189	OPTILENE MESH	 Polypropylene Mesh.	7.5 x 15cm, 5 pieces	$80.00
BB190	OPTILENE MESH	Polypropylene Mesh	4.5x10cm	$80.00
BB191	OPTILENE MESH	Polypropylene Mesh	6x14cm, 5 pieces	$80.00
Prostheses List by Category, Groups and Sponsor	Page 137 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Bard Australia Pty Ltd
BA070	Bard Mesh  	Flat mesh	2.5x10cm, 4.5x10cm, 	$80.00
	5x10cm, 6x13.7cm, 
	7.5x15cm, 10x15cm, 5x30.5cm
	Covidien Pty Ltd
AS055	Mesh Polyproplene; Monofilament 	Multifilament Polypropylene; 	7.6cm x 12.7cm Surgipro* 	$80.00
	Polyproplylene.	Monofilament Polypropylene.	mesh (3 x 5 inch)
AS057	Mesh Polyproplene; Monofilament 	Multifilament Polypropylene; 	2.5cm x 10.2cm Surgipro* 	$80.00
	Polyproplylene.	Monofilament Polypropylene.	mesh (1 x 4 inch)
AS164	Parietex Multifilament Polyester 	Parietex-Multifilament Polyester 	13 x 09 cms, 15 x 10 cms	$80.00
	Standard Mesh/Bidimensional rigid, 
	Three dimensional
AS172	Mesh Polyproplene; Monofilament 	Multifilament Polypropylene; 	15.3cm x 15.3cm Surgipro* 	$80.00
	Polyproplylene; SURGIPRO* Non 	Monofilament Polypropylene; 	mesh (6 x 6 inch); 
	Absorbable Monofilament 	SURGIPRO, Non-Asborbable 	SPMM46: 10.2cm x 15.3cm 
	Polypropylene Mesh	Polypropylene Monofilament Mesh.	(4 x 6 inch).
AS174	Parietene-Monofiliment 	Parietene-Monofiliment 	6 x 11cm, 15 x 10, 15 x 15cm	$80.00
	Polypropylene Mesh	Polypropylene standard mesh/light 
AS175	Parietene-Monofiliment 	Parietene-Monofiliment 	15 x 10cm	$80.00
	Polypropylene Mesh	Polypropylene standard mesh/light 
	EMT Healthcare Pty Ltd
EM021	Biomesh P1/P3 Reinforcement Mesh	Macro porous 100% polypropylene 	8 x 13cm	$80.00
	mesh for laproscopic and open 
	surgical approaches
EM023	Biomesh P1/P3 Reinforcement Mesh	Macro porous 100% polypropylene 	2.3 x 10cm	$80.00
	mesh for laproscopic and open 
	surgical approaches
EM024	Biomesh P1/P3 Reinforcement Mesh	Macro porous 100% polypropylene 	5 x 10cm	$80.00
	mesh for laproscopic and open 
	surgical approaches
EM025	Biomesh P1/P3 Reinforcement Mesh	Macro porous 100% polypropylene 	7 x 15cm, 10 x 15cm	$80.00
	mesh for laproscopic and open 
	surgical approaches
	Johnson & Johnson Medical Pty Ltd
JJ174	Prolene Mesh 	Small polypropylene monofilament 	2.5cm x 10cm	$80.00
	non absorbable mesh
Prostheses List by Category, Groups and Sponsor	Page 138 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ175	Prolene Mesh	Medium polypropylene monofilament 	7.6cm x 15cm	$80.00
	non absorbable mesh
JJ177	Prolene Mesh	Small keyhole polypropylene 	4.6cm x 10.2cm	$80.00
	monofilament non absorbable mesh
JJ178	Prolene Mesh	Large keyhole polypropylene 	6cm  x 13.7cm	$80.00
	monofilament non absorbable mesh
JJ566	PROLENE Mesh	Polypropylene Mesh	10 x 15cm	$80.00
MN159	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	2.54cm x 10cm	$80.00
	Mesh 2.54 x 10cm
MN160	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	5cm x 10cm	$80.00
	Mesh 5 x 10cm
MN161	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	7.6 x 15cm	$80.00
	Mesh 7.6 x 15cm
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG039	Surgimesh WN	Non-woven, non-knitted 	4.5cmx10cm, 6x13cm, 	$80.00
	reinforcement mesh	9x13cm, 11x15cm, 10x15cm
MG043	Aspide Surgimesh	Monofilament polypropylene	6 x 11cm, 8 x 12cm, 10 x 	$80.00
	13cm, 10 x 15cm
	Anti-inflammatory
	Atrium Australia - Pacific Rim Pty Limited
AC058	C-QUR Mesh	Sterile, knitted polypropylene 	0 - 200cm2	$755.00
	monofilament mesh material for tissue 
	reinforcement with a coating derived 
	from a biological oil composed of fatty
	 acids, lipids and glycerides (BAO - 
	Bioabsorbable Oil Coating)
	Coated
	Bard Australia Pty Ltd
BA224	Bard Mesh	Kugel Patch	8x12cm oval; 9.5x13cm 	$350.00
	oval; 11x14oval; 8cm 
	circle; 10.2cm circle; 12cm 
Prostheses List by Category, Groups and Sponsor	Page 139 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Contoured
	Covidien Pty Ltd
AS128	Parietex-Multifilament Polyester 	Parietex-Multifilament Polyester 	13 x 09 cm, 15 x 10 cm, 16 x 	$205.00
	Mesh	Anatomical Mesh Standard / With Slit	12cm
	 and Folding / With Slit and No 
	Touch System
AS166	Parietex Multifilament 	Parietex-Multifilament Polyester 	12 x 08 cms	$205.00
	Preshaped Mesh Three-
	dimensional/Ease Grip, with Slit
AS167	Parietex Multifilament Polyester 	Parietex-Multifilament Polyester 	13 x 09 cms, 14 x 09 cms	$205.00
	Mesh Three-dimensional/Ease Grip, 
AS168	Parietex Multifilament Polyester 	Parietex-Multifilament Polyester 	14x10cms	$205.00
	Folding Mesh/Bidimensional with 
	integrated folding system with slit
AS169	Parietex Multifilament Polyester 	Parietex-Multifilament Polyester 	14x10cms	$205.00
	Mesh Anatomical	Anatomical 
	Mesh/Bidimensional/Three 
	dimensional with integreated folding 
	Johnson & Johnson Medical Pty Ltd
JJ180	Prolene Hernia System	BI-LAYER POLYPROPYLENE 	MEDIUM TO EXTENDED	$205.00
	NON ABSORBABLE
JJ413	Prolene *3D Patch Polypropylene 	Sterile Three-dimensional device 	5.49cm x 12.50cm 3DPatch 	$205.00
	Mesh	consisting of a flat mesh onlay patch 	large with preshaped 
	secured to a formed expandable 
	diamond-shaped mesh patch 
	component.
JJ414	Prolene *3D Patch Polypropylene 	Sterile Three-dimensional device 	5.49cm x 12.50cm 3D Patch 	$205.00
	Mesh	consisting of a flat mesh onlay patch 	with medium preshaped 
	secured to a formed expandable 	overlay
	diamond-shaped mesh patch 
	component.
JJ415	Prolene *3D Patch Polypropylene 	Sterile Three-dimensional device 	5.49cm x 12.50cm 3D Patch 	$205.00
	Mesh	consisting of a flat mesh onlay patch 	medium with extended 
	secured to a formed expandable 	overlay
	diamond-shaped mesh patch 
	component.
Prostheses List by Category, Groups and Sponsor	Page 140 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ416	Prolene *3D Patch Polypropylene 	Sterile Three-dimensional device 	5.49cm x 12.50cm 3D Patch 	$205.00
	Mesh	consisting of a flat mesh onlay patch 	large with extended overlay
	secured to a formed expandable 
	diamond-shaped mesh patch 
	component.
	Contoured, Without Fixation
	Bard Australia Pty Ltd
BA222	Bard 3D Max Mesh	3D Mesh	Medium left, Medium Right, 	$263.00
	large Left, Large Right
	03.08.05.02 - 201-400cm²
	Atrium Australia - Pacific Rim Pty Limited
AC007	Atrium polypropolene mesh - 	Polypropolene	15cm x 15cm	$85.00
	surgical mesh
	B Braun Australia Pty Ltd
BB101	Premilene Mesh	Polypropylene	15x15cm	$85.00
BB184	OPTILENE MESH	Polypropylene Mesh	15x15cm, 5 pieces	$85.00
	Bard Australia Pty Ltd
BA157	Bard Mesh	Flat Mesh	15X15cm	$85.00
	Covidien Pty Ltd
AS122	Parietene-Monofilament 	Parietene-Monofilament 	20 x 20 cm	$85.00
	Polypropylene mesh	Polypropylene standard mesh / light 
AS165	Parietex Multifilament Polyester 	Parietex-Multifilament Polyester 	15 x 15 cms	$85.00
	Mesh Anatomical	Standard Mesh/Bidimensional Rigid, 
	Three dimensional
AS170	Parietex-Multifilament Polyester 	Parietex-Multifilament Polyester 	20 x 20cm	$85.00
	Mesh	Standard Mesh/Bi-dimensional, Bi-
	dimensional Rigid, Three dimensional
AS173	Mesh Polyproplene; Monofilament 	Multifilament Polypropylene; 	15.3cm x 15.3cm Surgipro* 	$85.00
	Polyproplylene; SURGIPRO* Non 	Monofilament Polypropylene; 	mesh (6 x 6 inch)
	Absorbable Monofilament 	SURGIPRO, Non-Asborbable 
	Polypropylene Mesh	Polypropylene Monofilament Mesh.
AS176	Parietene-Monofilament 	Parietene-Monofilament 	15 x 15cm	$85.00
	Polypropylene Mesh	Polypropylene standard mesh/light 
Prostheses List by Category, Groups and Sponsor	Page 141 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	EMT Healthcare Pty Ltd
EM022	Biomesh P1/P3 Reinforcement Mesh	Macro porous 100% polypropylene 	15 x 15cm	$85.00
	mesh for laproscopic and open 
	surgical approaches
	Johnson & Johnson Medical Pty Ltd
JJ222	Prolene Mesh - medium	Constructed of knitted filaments of 	Medium - 6" x 6"	$85.00
	extruded polypropylene identical to 
	that used in Prolene suture.  Material 
	is approx. 0.027mm thick.  Non-
	absorbable mesh for tension free-
	inguinal hernia techniques.
MN162	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	15cm x 15cm	$85.00
	Mesh 15 x 15cm
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG007	Aspide Surgimesh	Monofilament polypropylene	15 x 15cm Thread 0.14mm	$85.00
MG042	Surgimesh WN	Non-woven, non-knitted 	14x15cm, 15x15cm	$85.00
	reinforcement mesh
	Anti-inflammatory
	Atrium Australia - Pacific Rim Pty Limited
AC060	C-QUR Mesh	Sterile, knitted polypropylene 	201 - 400cm2	$955.00
	monofilament mesh material for tissue 
	reinforcement with a coating derived 
	from a biological oil composed of fatty
	 acids, lipids and glycerides (BAO - 
	Bioabsorbable Oil Coating)
	Coated
	Bard Australia Pty Ltd
BA084	Bard Mesh  	Kugel Patch	Large Oval 14 x 18cm	$555.00
	Contoured, Without Fixation
	Bard Australia Pty Ltd
BA223	Bard 3D Max Mesh	3D Mesh	Extra Large Left, Extra 	$300.00
	Large Right
Prostheses List by Category, Groups and Sponsor	Page 142 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.05.03 - 401-600cm²
	B Braun Australia Pty Ltd
BB182	OPTILENE MESH	Polypropylene Mesh	20x30cm, 5 pieces	$229.00
	Anti-inflammatory
	Atrium Australia - Pacific Rim Pty Limited
AC059	C-QUR Mesh	Sterile, knitted polypropylene 	401 - 600cm2	$1,625.00
	monofilament mesh material for tissue 
	reinforcement with a coating derived 
	from a biological oil composed of fatty
	 acids, lipids and glycerides (BAO - 
	Bioabsorbable Oil Coating)
	03.08.05.04 - >600cm²
	Atrium Australia - Pacific Rim Pty Limited
AC062	Atrium polypropylene mesh	Polypropylene mesh	>600cm²	$275.00
	B Braun Australia Pty Ltd
BB102	Premilene Mesh	Polypropylene	26x36cm	$275.00
BB103	Premilene Mesh	Polypropylene	30x30cm	$275.00
BB185	OPTILENE MESH	Polypropylene Mesh	30x30cm, 5 pieces	$275.00
	Bard Australia Pty Ltd
BA158	Bard Mesh	Flat Mesh	25x35.5cm	$275.00
	Covidien Pty Ltd
AS056	Mesh Polyproplene; Monofilament 	Multifilament Polypropylene; 	35.6cm x 22.9cm Surgipro* 	$275.00
	Polyproplylene.	Monofilament Polypropylene.	mesh (14 x 9 inch).
AS123	Parietene-Monofilament 	Parietene-Monofilament 	30 X 30 cm, 30 x 32 cm	$275.00
	Polypropylene mesh	Polypropylene standard mesh / light 
	mesh/ X-shaped mesh
AS171	Parietex-Multifilament Polyester 	Parietex-Multifilament Polyester 	30 x 30cm	$275.00
	Mesh	Standard Mesh/Bi-dimensional, Bi-
	dimensional Rigid, Three dimensional
	Johnson & Johnson Medical Pty Ltd
JJ172	Mersilene Mesh	Non-absorbable polyester mesh	30cm x 30cm	$275.00
Prostheses List by Category, Groups and Sponsor	Page 143 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ176	Prolene Mesh	Large polypropylene monofilament 	30cm x 30cm	$275.00
	non absorbable mesh
MN163	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	25cm x 25cm	$275.00
	Mesh 25 x 25cm
MN164	PROLENE™ Soft Polypropylene 	Nonabsorbable Synthetic Surgical 	35.6cm x 30cm	$275.00
	Mesh 35.6 x 30cm
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG040	Surgimesh WN	Non-woven, non-knitted 	30x30cm	$275.00
	reinforcement mesh
	Anti-inflammatory
	Atrium Australia - Pacific Rim Pty Limited
AC051	C-QUR Mesh	Sterile, knitted polypropylene 	>600cm²	$3,370.00
	monofilament mesh material for tissue 
	reinforcement with a coating derived 
	from a biological oil composed of fatty
	 acids, lipids and glycerides (BAO - 
	Bioabsorbable Oil Coating)
03.08.06 - Composite Mesh
	03.08.06.01 - ≤200cm²
	Johnson & Johnson Medical Pty Ltd
JJ240	VYPRO II Mesh	Composition - equal part Vicryl 	Small 6 x 11cm	$95.00
	polyglactin yarn - non-absorbable 
	Prolene polypropylene yarn.  Partly 
	absorbable lightweight mesh for 
	tension free-inguinal hernia 
JJ241	VYPRO II Mesh	Composition - equal part Vicryl 	Medium 12 x 10cm	$95.00
	polyglactin yarn - non-absorbable 
	Prolene polypropylene yarn.  Partly 
	absorbable lightweight mesh for 
	tension free-inguinal hernia 
JJ242	VYPRO II Mesh	Composition - equal part Vicryl 	Large 15 x 10cm	$95.00
	polyglactin yarn - non-absorbable 
	Prolene polypropylene yarn.  Partly 
	absorbable lightweight mesh for 
	tension free-inguinal hernia 
JJ465	ULTRAPRO Mesh	ULTRAPRO Mesh S3	6 x 11cm	$95.00
Prostheses List by Category, Groups and Sponsor	Page 144 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ466	ULTRAPRO Mesh	ULTRAPRO Mesh P3	10 x 12cm	$95.00
JJ467	ULTRAPRO Mesh	ULTRAPRO Mesh N3	10 x 15cm	$95.00
JJ565	ULTRAPRO Mesh	Composite Mesh	7.6cm x 15cm	$95.00
	Coated
	Bard Australia Pty Ltd
BA186	Bard Sepramesh IP	Bioresorbable Coating/Permanent 	7.6cm x 15.2cm	$390.00
BA187	SEPRAMesh IP Bioresorbable 	Polypropylene & polyglycolic acid 	4 x 8 inch	$390.00
	Coating/Permanent Mesh	polymer mesh coated with a 
	biopolymer: a bioresorbable coating 
	of modified sodium hyaluronate, 
	carboxymethylcellulose & 
	polyethylene glycol based hydrogel.
BA226	Bard Mesh	Ventralex Patch	4.3cm circle, 6.4cm circle, 	$390.00
	8cm circle
BA227	Bard Mesh	Ventrio patch	7.6cm circle, 11.4cm circle, 	$390.00
	8x12cm oval, 11x14cm oval
BA228	Bard Mesh	Composite Mesh	7.6x15.2cm, 8x12cm, 	$390.00
	11x14cm, 11.4x11.4cm, 
	10x15cm, 10.8x15.9cm
BA234	Bard CK Parastomal Patch	Bard CK Parastomal Patch	12.5 x 15.5cm	$390.00
BA236	Ventralex ST	Bioresorbable Barrier/Permanent 	4.3cm circle, 6.4cm circle, 	$390.00
	8.0cm circle
BA237	Ventralight ST	Bioresorbable Barrier/Permanent 	11.4cm circle, 10.2 x 15.2cm 	$390.00
	oval
BA246	Ventrio ST	Bioresorbable Barrier/Permanent 	7.6cm circle, 11.4cm circle, 8	$390.00
	 x 12cm oval, 11 x 14cm oval
	Covidien Pty Ltd
AS143	Parietex Composite 1510F	Dual sided polyester meshes with a 	15x10cm square	$390.00
	resorbable adhesion -prevention 
	hydrophilic film
AS151	Parietex Composite Hiatal Hernia 	Composite Mesh	8x8cm, 9x8cm, 8.5x8cm	$390.00
	Mesh
AS153	Parietene Composite 1510	Dual sided polypropylene mesh with 	15x10cm Square	$390.00
	resorbable adhesion-prevention 
	hydrophilic film
Prostheses List by Category, Groups and Sponsor	Page 145 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS162	Parietene ProGrip Mesh (FLAT)	Mesh with self gripping FLAT	15 x 9cm RECTANGLE	$390.00
	Johnson & Johnson Medical Pty Ltd
JJ446	PROCEED Surgical Mesh	PROCEED Surgical Mesh B1	2x4 (inches)	$390.00
JJ447	PROCEED Surgical Mesh	PROCEED Surgical Mesh R1	3x6 inches	$390.00
JJ448	PROCEED Surgical Mesh	PROCEED Surgical Mesh N1	4x6 inches oval	$390.00
JJ449	PROCEED Surgical Mesh	PROCEED Surgical Mesh D1	4x8 inches	$390.00
JJ816	Proceed™ Ventral Patch	3D, sterile, self expanding, partially 	medium (6.4cm x 6.4cm)	$390.00
	absorbable, flexible laminate mesh for 
	hernia or other abdominal, fascial 
	defect repair that require addition of a 
	reinforcing or bridging material to 
	obtain the desired surgical result.
JJ817	Proceed™ Ventral Patch	3D, sterile, self expanding, partially 	small (4.3cm x 4.3cm)	$390.00
	absorbable, flexible laminate mesh for 
	hernia or other abdominal, fascial 
	defect repair that require addition of a 
	reinforcing or bridging material to 
	obtain the desired surgical result.
MN091	PHYSIOMESH	Flexible composite mesh	7x15cm, rectangular shape	$390.00
MN092	PHYSIOMESH	Flexible Composite Mesh	10x15cm, oval shape	$390.00
	Medical Specialties Australia Pty Ltd
MS030	TiMESH light	Prosthetic warp-knitted fabric made of	10 x15 cm TiMESH light	$390.00
	 monofil polypropylene threads with 
	an encapsulating titanic coating
MS044	TiPLUG/TiPATCH System	Titanized polypropylene composite. 	TiPATCH	$390.00
	Prosthetic warp-knitted fabric made of
	 monofilament polypropylene threads 
	with an encapsulating titanic coating.
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG020	Surgimesh XB non-adherent	Intra-abdominal implant biface	Tintra R 12.5cm, 15cm	$390.00
	Coated, Contoured
	Covidien Pty Ltd
AS140	Parietex Composite 12F	Dual sided polyester meshes with a 	12cm round	$450.00
	resorbable adhesion-prevention 
	hydrophlic film
Prostheses List by Category, Groups and Sponsor	Page 146 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS141	Parietex Composite 15F	Dual sided Polyester meshes with a 	15cm round	$450.00
	resorbable adhesion-prevention 
	hydrophilic film
AS152	Parietene Composite 12	Dual sided polypropylene mesh with 	12cm round	$450.00
	resorbable adhesion-prevention 
	hydrophilic film
	Coated, Integrated Delivery System
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG041	Surgimesh XB non-adherent with 	Intra-abdominal implant biface	Tintra P diameter 7cm, 	$510.00
	introducer	Tintra PXL diameter 9cm
	Contoured
	Johnson & Johnson Medical Pty Ltd
JJ585	Ultrapro Hernia System	Ultrapro Hernia System. Mesh Made 	Small to Large Oval	$300.00
	From Composite of Monocryl & 
	Prolene
	Surgeons Choice Australia Pty Ltd
SH006	Swing-Contact Mesh Flat	Three-Dimensional polyester 	8cm x 13cm, 9cm x 13cm, 	$300.00
	prosthesis with grips, coated with 	10cm x 15cm, 15 x 15cm, 
	polyurethane for Open and 	15cm x 20cm
	laparoscopic surgery, 142g/m2
SH007	Swing-Contact Mesh Pre Shaped 	Three-Dimensional polyester 	10cm x 13cm, 11cm x 14cm, 	$300.00
	Anatomical Reversible	prosthesis with grips, coated with 	12 x 15cm, 12cm x 16cm, 
	polyurethane for Open and 	10cm x 13cm, 11cm x 15cm
	laparoscopic surgery, 142/m2
SH008	Swing-Contact Mesh Pre Shaped 	Three-Dimensional anatomical 	11cm x 15cm, 12cm x 16cm	$300.00
	Anatomical with/without slit	polyester prosthesis coated with 
	polyurethane for pre-peritoneal 
	placement with grips, 142g/m2
	Contoured, Coated
	Covidien Pty Ltd
AS139	Parietex Composite 9F	Dual sided polyester meshes with a 	9cm round	$450.00
	resorbable adhesion-prevention 
	hydrophilic film
AS148	Parietex Composite 1510OS	Dual sided polyester meshes with a 	15x10cm square	$450.00
	resorbable adhesion-prevention 
	hydrophilic film
Prostheses List by Category, Groups and Sponsor	Page 147 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS161	Parietene ProGrip Mesh (PRE-	Pre-Cut, slit mesh with self gripping 	12 x 8cm elliptic	$450.00
	SHAPED)	overlapping flap - right or left
	MDJ Australia (PTY) Ltd
DJ014	CABS Air Composit	Umbilical hernia, Parietal Prosthesis 	5cm, 7cm, 9cm (all sizes in 	$450.00
	with inflatable expansion Balloon	diameter)
	03.08.06.02 - 201-400cm²
	Johnson & Johnson Medical Pty Ltd
JJ173	VICRYL Mesh	Polyglactin 910 - synthetic 	15cm x 15cm	$152.00
	absorbable mesh.
JJ243	VYPRO II Mesh	Composition - equal part Vicryl 	Extra large 15 x 15cm	$152.00
	polyglactin yarn - non-absorbable 
	Prolene polypropylene yarn.  Partly 
	absorbable lightweight mesh for 
	tension free-inguinal hernia 
JJ468	ULTRAPRO Mesh	ULTRAPRO Mesh M3	15 x 15cm	$152.00
	Coated
	Bard Australia Pty Ltd
BA188	Bard Sepramesh IP	Bioresorbable Coating/Permanent 	10.2cm x 20.3cm; 15.2cm x 	$799.00
	20.3cm
BA207	Ventrio Hernia Patch	Three layer, mesh/ePTFE with 	14x18cm	$799.00
	absorbable polydioxanone 
	monofilament.
BA229	Bard Mesh	Composite Mesh	13.8cmx17.8cm, 15x20cm, 	$799.00
	15.9x21cm
BA235	Bard CK Parastomal Patch	Bard CK Parastomal Patch	15.5 x 20.5cm	$799.00
BA238	Ventralight ST	Bioresorbable Barrier/Permanent 	15.2 x 20.3cm oval, 15.2 x 	$799.00
	25.4cm oval
BA247	Ventrio ST	Bioresorbable Barrier/Permanent 	13.8 x 17.8cm oval, 15.5 x 	$799.00
	25.7cm oval
	Covidien Pty Ltd
AS144	Parietex Composite 2015F	Dual sided polyester meshes with a 	20x15cm square	$799.00
	resorbable adhesion-prevention 
	hydrophilic film
Prostheses List by Category, Groups and Sponsor	Page 148 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS154	Parietene Composite 1515	Dual sided polypropylene mesh with 	15x15cm	$799.00
	resorbable adhesion-prevention 
	hydrophilic film
AS155	Parietene Composite 2015	Dual sided polypropylene mesh with 	20x15cm Oval	$799.00
	resorbable adhesion-prevention 
	hydrophilic film
	Johnson & Johnson Medical Pty Ltd
JJ450	PROCEED Surgical Mesh	PROCEED Surgical Mesh M1	6x6 inches	$799.00
JJ451	PROCEED Surgical Mesh	PROCEED Surgical Mesh G1	6x8 inches oval	$799.00
MN093	PHYSIOMESH	Flexible Composite Mesh	15x15cm, square shape	$799.00
MN094	PHYSIOMESH	Flexible Composite Mesh	15x20cm, rectagular shape	$799.00
MN095	PHYSIOMESH	Flexible Composite Mesh	15x20cm, Oval Shape	$799.00
	Medical Specialties Australia Pty Ltd
MS033	TiMESH light	Prosthetic warp-knitted fabric made of	15 x 15cm TiMESH light	$799.00
	 monofil polypropylene threads with 
	an encapsulating titanic coating
MS035	TiMESH light	Prosthetic warp-knitted fabric made of	20 x 15cm TiMESH light	$799.00
	 monofil polypropylene threads with 
	an encapsulating titanic coating
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG021	Surgimesh XB non-adherent	Intra-abdominal implant biface	Tintra M 22x15x10cm	$799.00
	Surgeons Choice Australia Pty Ltd
SH010	INTRA-SWING	Intraperitoneal Prosthesis for wall 	20cm x 15cm	$799.00
	reinforcement / composite structure 
	/polyester multifilaments 
	(Polyethylene terephthalate PET), 
	coated with, on one side, a thin 
	membrane of aliphatic polyurethylene 
	(PEU) / Precut and entirely macro-
	perforated prothesis. This mesh also 
	has pre-attached sutures used to hold 
	the mesh in place until it is fixated
Prostheses List by Category, Groups and Sponsor	Page 149 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Coated, Contoured
	Covidien Pty Ltd
AS142	Parietex Composite 20F	Dual sided polyester meshes with a 	20cm round	$799.00
	resorbable adhesion-prevention 
	hydrophilic film
	Coated, Integrated Delivery System
	Bard Australia Pty Ltd
BA242	Ventralight ST with ECHO PS 	Bioresorbable Barrier/Permanent 	15.2 x 20.3cm oval, 15.2 x 	$919.00
	Positioning System	25.4cm oval
	Contoured, Coated
	Covidien Pty Ltd
AS149	Parietex Composite 2015OS	Dual sided polyester meshes with a 	20x15cm square	$799.00
	resorbable adhesion-prevention 
	hydrophilic film
	03.08.06.03 - 401-600cm²
	Johnson & Johnson Medical Pty Ltd
JJ469	ULTRAPRO Mesh	ULTRAPRO Mesh T1	15x30cm	$220.00
	Coated
	Bard Australia Pty Ltd
BA206	Ventrio Hernia Patch.	Three layer, mesh/ePTFE with 	16x31cm, 20x25cm.	$1,050.00
	absorbable polydioxanone 
	monofilament.
BA230	Bard Mesh	Composite Mesh	15.9x26.1cm, 16x31.2cm, 	$1,070.00
	18x23cm, 18.4x23.5cm, 
	19.6x24.6cm 20x25cm, 
	21x26.1cm, 22.1x27.1cm
BA239	Ventralight ST	Bioresorbable Barrier/Permanent 	17.8 x 22.9cm oval, 20.3 x 	$1,070.00
	25.4cm oval
BA248	Ventrio ST	Bioresorbable Barrier/Permanent 	19.6 x 24.6cm oval, 22.1 x 	$1,070.00
	27.1cm oval
	Covidien Pty Ltd
AS145	Parietex Composite 2520F	Dual sided polyester meshes with a 	25x20cm Oval	$1,050.00
	resorbable adhesion-prevention 
	hydrophilic film
Prostheses List by Category, Groups and Sponsor	Page 150 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AS146	Parietex Composite 3020F	Dual sided polyester meshes with a 	30x20cm oval	$1,050.00
	resorbable adhesion-prevention 
	hydrophilic film
AS156	Parietene Composite 2520	Dual sided polypropylene mesh with 	25x20cm Oval	$1,050.00
	resorbable adhesion-prevention 
	hydrophilic film
AS157	Parietene Composite 3020	Dual sided polypropylene mesh with 	30x20cm Oval	$1,050.00
	resorbable adhesion-prevention 
	hydrophilic film
	Johnson & Johnson Medical Pty Ltd
JJ452	PROCEED Surgical Mesh	PROCEED Surgical Mesh H1	8x10 inches oval	$1,050.00
JJ453	PROCEED Surgical Mesh	PROCEED Surgical Mesh J1	8x12 inches	$1,050.00
MN096	PHYSIOMESH	Flexible Composite Mesh	20x25cm, oval shape	$1,050.00
MN097	PHYSIOMESH	Flexible Composite Mesh	20x30cm, rectangular shape	$1,050.00
	Coated, Integrated Delivery System
	Bard Australia Pty Ltd
BA243	Ventralight ST with ECHO PS 	Bioresorbable Barrier/Permanent 	17.8 x 22.9cm oval, 20.3 x 	$1,190.00
	Positioning System	25.4cm oval
	Contoured, Coated
	Covidien Pty Ltd
AS150	Parietex Composite 2520OS	Dual sided polyester meshes with a 	25x20cm Square	$1,050.00
	resorbable adhesion-prevention 
	hydrophilic film
	03.08.06.04 - 601cm²-1000cm²
	Johnson & Johnson Medical Pty Ltd
JJ020	Vicryl Mesh	1 sheet/box	Large - 30cm x 30cm	$300.00
JJ470	ULTRAPRO Mesh	ULTRAPRO Mesh L1	30x30cm	$300.00
	Coated
	Bard Australia Pty Ltd
BA205	Ventrio Hernia Patch	Three layer, mesh/ePTFE with 	22x27cm, 27x35cm.	$1,122.00
	absorbable polydioxanone 
	monofilament.
Prostheses List by Category, Groups and Sponsor	Page 151 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BA231	Bard Mesh	Composite Mesh	25x33cm, 25x36cm, 	$1,122.00
	26.1x33.7cm, 26.1x36.2cm, 
	
BA232	Bard Sepramesh IP	Bioresorbable Coating/Permanent 	20.3cm x 30.5cm	$1,122.00
BA240	Ventralight ST	Bioresorbable Barrier/Permanent 	22.4 x 33.0cm oval	$1,122.00
BA249	Ventrio ST	Bioresorbable Barrier/Permanent 	27.4 x 34.9cm oval	$1,122.00
	Johnson & Johnson Medical Pty Ltd
JJ454	PROCEED Surgical Mesh	PROCEED Surgical Mesh T1	10x13 inches oval	$1,122.00
JJ455	PROCEED Surgical Mesh	PROCEED Surgical Mesh W1	10x14 inches	$1,122.00
JJ456	PROCEED Surgical Mesh	PROCEED Surgical Mesh L1	12x12 inches	$1,122.00
MN098	PHYSIOMESH	Flexible Composite Mesh	25x35cm, oval shape	$1,122.00
	Medical Specialties Australia Pty Ltd
MS038	TiMESH Extra Large	Prosthetic warp-knitted fabric made of	Extra Large TiMESH	$1,122.00
	 monofil polypropylene threads with 
	an encapsulating titanic coating
	Morton Surgical Pty Ltd ta Matrix Surgical Company
MG022	Surgimesh XB non-adherent	Intra-abdominal implant biface	Tintra L 30x30x20cm	$1,122.00
	Coated, Integrated Delivery System
	Bard Australia Pty Ltd
BA244	Ventralight ST with ECHO PS 	Bioresorbable Barrier/Permanent 	25.4 x 33.0cm oval	$1,242.00
	Positioning System
	03.08.06.05 - >1000cm²
	Coated
	Bard Australia Pty Ltd
BA233	Bard Sepramesh IP	Bioresorbable Coating/Permanent 	30.5cm x 35.6cm	$3,200.00
BA241	Ventralight ST	Bioresorbable Barrier/Permanent 	30.5 x 35.6cm oval	$3,200.00
	Covidien Pty Ltd
AS147	Parietex Composite 3728F	Dual sided polyester meshes with a 	37x28cm oval	$3,200.00
	resorbable adhesion-prevention 
	hydrophilic film
	Johnson & Johnson Medical Pty Ltd
MN099	PHYSIOMESH	Flexible Composite Mesh	30x35cm, rectangular shape	$3,200.00
MN100	PHYSIOMESH	Flexible Composite Mesh	30x50cm, rectangular shape	$3,200.00
Prostheses List by Category, Groups and Sponsor	Page 152 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Coated, Integrated Delivery System
	Bard Australia Pty Ltd
BA245	Ventralight ST with ECHO PS 	Bioresorbable Barrier/Permanent 	30.5 x 35.6cm oval	$3,320.00
	positioning System
03.08.07 - Complete Biomaterial Mesh
	03.08.07.01 - ≤200cm²
	Coated
	Cook Medical Australia Pty Ltd
WC177	Surgisis Soft Tissue Graft	Surgical Mesh composed of Sub-	Length - 10cm, Width - 	$786.00
	Intestinal Submucosa (SIS)	7cm; Length - 7cm, Width - 
WC242	Biodesign Surgisis Hernia Graft	Biodesign Hernia Graft is 8-layer 	13cm x 15cm	$786.00
	perforated and quilted porcine sis 
	collagen matrix, non cross-linked, 
	remodelable and resorbable tissue graft
WC255	Surgisis Biodesign 4-layer Tissue 	Surgisis Soft Tissue Graft	Length 20cm, Width 7cm	$786.00
	Graft
WC265	Biodesign Surgisis Inguinal Hernia 	Biodesign Surgisis Inguinal Hernia 	10cm  x 15cm	$786.00
	Graft	Graft is a biologically derived 
	[porcine] sis collagen, non cross-
	linked graft, that remodels into strong 
	host tissue reinforcement for the 
WC266	Biodesign Surgisis Inguinal Hernia 	Biodesign Surgisis Inguinal Hernia 	8cm  x 15cm	$786.00
	Graft	Graft is a biologically derived 
	[porcine] sis collagen, non cross-
	linked graft, that remodels into strong 
	host tissue reinforcement for the 
WC284	Surgisis Biodesign Hiatal Hernia 	Surgisis Biodesign Hiatal Hernia 	7 x 10cm rectangular and U-	$786.00
	Graft is an extracellular collagen 	shaped
	matrix, non cross-linked sterile graft 
	material, that provides support for 
	damaged tissues and assists in host 
	tissue regeneration and remodelling of
	 the diaphragmatic wall following 
	surgical repair for paraoesophageal 
	and hiatal hernia.
Prostheses List by Category, Groups and Sponsor	Page 153 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Covidien Pty Ltd
AS182	Permacol™ Biological Implant	Flat sheet of acellular porcine three-	3 x 3cm, 5 x 5cm, 2 x 20cm, 5 	$786.00
	dimensional, crosslinked, dermal 	x 10cm, 4 x 18cm, 10 x 10cm,
	collagen.	 10 x 15cm (all 1mm 
	thickness) & 6 x 3cm, 10 x 
	15cm (all 1.5mm thickness)
	Five Corners Pty Ltd
FC003	Veritas Collagen Matrix - Small	Bovine pericardium biologic mesh for 	RM-0208 2cm x 8cm; RM-	$786.00
	the repair of soft tissue for size < 	0304 3cm x 4cm; RM-0407 
	200cm²	4cm x 7cm; RM-0416 4cm X 
	16cm; RM-0608 6cm x 8cm; 
	RM-0618 6cm x 18cm; RM-
	0816 8cm x 16cm; RM-0818
	 8cm x 18cm; RM1016 10cm 
	x 16cm; RM-1212 12cm x 
	12cm
	Contoured
	W L Gore & Associates
GT256	BIO-A Tissue Reinforcement	BIO-A Tissue Reinforcement	8cm x 8cm	$800.00
GT257	BIO-A Tissue Reinforcement	BIO-A Tissue Reinforcement	9cm x 15cm	$800.00
GT258	BIO-A Tissue Reinforcement	BIO-A Tissue Reinforcement - 	7cm x 10cm	$800.00
	Configured for Hiatal Hernia
	03.08.07.02 - 201-400cm²
	Coated
	Cook Medical Australia Pty Ltd
WC247	Biodesign Surgisis 8-Layer Tissue 	Biodesign Surgisis 8-layer Tissue 	13cm x 22cm	$1,486.00
	Graft	Graft is 8 layers of compressed and 
	perforated porcine sis collagen matrix, 
	non cross-linked, remodelable and 
	resorbable tissue graft
WC249	Biodesign Surgisis Hernia Graft	Biodesign Hernia Graft is 8-layer 	13cm x 22cm	$1,486.00
	perforated and quilted porcine sis 
	collagen matrix, non cross-linked, 
	remodelable and resorbable tissue graft
Prostheses List by Category, Groups and Sponsor	Page 154 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC250	Biodesign Surgisis Hernia Graft	Biodesign Hernia Graft is 8-layer 	20cm x 20cm	$1,486.00
	perforated and quilted porcine sis 
	collagen matrix, non cross-linked, 
	remodelable and resorbable tissue graft
	Covidien Pty Ltd
AS183	Permacol™ Biological Implant	Flat sheet of acellular porcine three-	15 x 20cm (1mm thickness) 	$1,486.00
	dimensional, crosslinked, dermal 	& 15 x 20cm (1.5mm 
	collagen.	thickness)
	Five Corners Pty Ltd
FC004	Veritas Collagen Matrix- Large	Bovine pericardium biologic mesh 	12cm x 25cm	$1,486.00
	repair of soft tissue    > 200cm²
	Contoured
	W L Gore & Associates
GT267	Bio A Tissue Reinforcement	Bio A Tissue Reinforcement	10cm x 30cm	$1,550.00
	03.08.07.03 - 401-600cm²
	Coated
	Cook Medical Australia Pty Ltd
WC251	Biodesign Surgisis  Hernia Graft	Biodesign Hernia Graft is 8-layer 	20cm x 30cm	$3,450.00
	perforated and quilted porcine sis 
	collagen matrix, non cross-linked, 
	remodelable and resorbable tissue graft
	Covidien Pty Ltd
AS184	Permacol™ Biological Implant	Flat sheet of acellular porcine three-	18 x 28cm (1mm thickness) 	$3,450.00
	dimensional, crosslinked, dermal 	& 18 x 28cm, 20 x 30cm 
	collagen.	(1.5mm thickness)
	Contoured
	W L Gore & Associates
GT268	Bio A Tissue Reinforcement	Bio A Tissue Reinforcement	20cm x 30cm	$3,550.00
	03.08.07.04 - 601-800cm²
	Coated
	Covidien Pty Ltd
AS187	Permacol™ Biological Implant	Flat sheet of acellular porcine three-	20 x 40cm	$4,500.00
	dimensional, crosslinked, dermal 
	collagen.
Prostheses List by Category, Groups and Sponsor	Page 155 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.07.05 - >800cm²
	Coated
	Covidien Pty Ltd
AS188	Permacol™ Biological Implant	Flat sheet of acellular porcine three-	20 x 50cm	$5,500.00
	dimensional, crosslinked, dermal 
	collagen.
03.08.08 - PTFE/ePTFE Mesh
	03.08.08.01 - ≤200cm²
	Bard Australia Pty Ltd
BA225	Bard Mesh	Crurasoft Patch	7x6cm, 11x8cm	$350.00
	W L Gore & Associates
GT092	Gore-Tex Dual Mesh	ePTFE	1mm Thickness 7.5 x 10cm	$350.00
GT093	Gore-Tex Dual Mesh	ePTFE	1mm Thickness 8 x 12cm	$350.00
GT094	Gore-Tex Dual Mesh	ePTFE	1mm Thickness Oval 10 x 	$350.00
	15cm
GT104	Gore-Tex DualMesh PLUS  	ePTFE	1mm Thickness 7.5 x 10cm	$350.00
	2mm thickness
	W L Gore & Associates
GT099	Gore-Tex Dual Mesh 	ePTFE	2mm Thickness Oval 10 x 	$923.00
	15cm
	Coated
	W L Gore & Associates
GT201	Dualmesh Plus Biomaterial	ePTFE	8cm x 12cm x 1mm	$390.00
GT202	Dualmesh Plus Biomaterial	ePTFE, oval	10cm x 15cm x 1mm	$390.00
	Coated, 2mm thickness
	W L Gore & Associates
GT206	Dualmesh Plus Biomaterial	ePTFE, oval	10cm x 15cm x 2mm	$1,020.00
Prostheses List by Category, Groups and Sponsor	Page 156 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.08.02 - 201-400cm²
	W L Gore & Associates
GT095	Gore-Tex Dual Mesh	ePTFE	1mm Thickness Oval 15.0 x 	$1,040.00
	19.0cm
GT107	Gore-Tex DualMesh PLUS  	ePTFE	15.0 x 19.0cm x 1mm Oval	$1,040.00
	2mm thickness
	W L Gore & Associates
GT100	Gore-Tex Dual Mesh 	ePTFE	2mm Thickness Oval 15 x 	$1,846.00
	19cm
	Coated, 2mm thickness
	W L Gore & Associates
GT207	Dualmesh Plus Biomaterial	ePTFE, oval	15cm x 19cm x 2mm	$2,029.00
	03.08.08.03 - 401-600cm²
	W L Gore & Associates
GT096	Gore-Tex Dual Mesh	ePTFE	1mm Thickness 18 x 24cm	$1,622.00
GT097	Gore-Tex Dual Mesh	ePTFE	1mm Thickness 20 x 30cm	$1,622.00
	2mm thickness
	W L Gore & Associates
GT101	Gore-Tex Dual Mesh 	ePTFE	2mm Thickness 18 x 24cm	$2,430.00
GT102	Gore-Tex Dual Mesh 	ePTFE	2mm Thickness 20 x 30cm	$2,430.00
	Coated
	W L Gore & Associates
GT203	Dualmesh Plus Biomaterial	ePTFE	18cm x 24cm x 1mm	$1,823.00
GT204	Dualmesh Plus Biomaterial	ePTFE	20cm x 30cm x 1mm	$1,823.00
	Coated, 2mm thickness
	W L Gore & Associates
GT208	Dualmesh Plus Biomaterial	ePTFE,	18cm x 24cm x 2mm	$2,952.00
GT209	Dualmesh Plus Biomaterial	ePTFE,	20cm x 30cm x 2mm	$2,952.00
Prostheses List by Category, Groups and Sponsor	Page 157 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.08.04 - >600cm²
	W L Gore & Associates
GT098	Gore-Tex Dual Mesh	ePTFE	1mm Thickness Oval 26 x 	$2,960.00
	34cm
	2mm thickness
	W L Gore & Associates
GT103	Gore-Tex Dual Mesh 	ePTFE	2mm Thickness Oval 26 x 	$4,440.00
	34cm
	Coated
	W L Gore & Associates
GT205	Dualmesh Plus Biomaterial	ePTFE, oval	26cm x 34cm x 1mm	$3,373.00
	Coated, 2mm thickness
	W L Gore & Associates
GT210	Dualmesh Plus Biomaterial	ePTFE, oval	26cm x 34cm x 2mm	$5,192.00
03.08.09 - Plugs
	Atrium Australia - Pacific Rim Pty Limited
AC011	Atrium polypropolene mesh - 	Polypropolene mesh plug	Small, Medium, Large and 	$263.00
	surgical mesh	Extra Large
	B Braun Australia Pty Ltd
BB104	Premilene Mesh	Self Forming Plug	All sizes, small, medium, 	$263.00
	large
BB192	Premilene Mesh	Premilene Nonabsorbable 	Self-Forming Plug-Small, 5 	$263.00
	Polypropylene Surgical Suture 	pieces
	Material Low Profile.
BB193	Premilene Mesh	Premilene Nonabsorbable 	Self-Forming Plug-Medium, 	$263.00
	Polypropylene Surgical Suture 	5 pieces
	Material Low Profile.
BB194	Premilene Mesh	Premilene Nonabsorbable 	Self-Forming Plug-Large, 5 	$263.00
	Polypropylene Surgical Suture 	pieces
	Material Low Profile.
Prostheses List by Category, Groups and Sponsor	Page 158 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB195	OPTILENE MESH	Polypropylene Mesh	Self-Forming Plug-Large, 5 	$263.00
	pieces
	Bard Australia Pty Ltd
BA061	Bard Mesh 	PerFix Plug	Small, Medium, Large	$263.00
	Covidien Pty Ltd
AS068	Surgipro Non Absorbable 	Polypropylene	Medium and Large	$263.00
	Polypropylene Hernia Mate Plug 
	System 
AS124	Parietene-Monofilament 	Parietene-Monofilament 	06 x 12 cm	$263.00
	Polypropylene mesh	Polypropylene mesh Plug and Patch
AS130	Parietex-Multifilament Polyester 	Parietex-Multifilament Polyester 	6 cm, 8 cm	$263.00
	Mesh	Mesh Plug
	Johnson & Johnson Medical Pty Ltd
JJ602	ULTRAPRO Plug	Partially Absorbable Synthetic 	Small- Onlay patch plug: 	$263.00
	Surgical Mesh Device	12cm x 7.5cm, 5cm rim 
	diameter, 3cm anchor 
	diameter; Medium- Onlay 
	patch plug: 12cm x 7.5cm, 
	5cm rim diameter, 4cm 
	anchor diameter; Large- 
	Onlay patch plug: 12cm x 
	7.5cm, 5cm rim diameter, 5cm
	 anchor diameter
	Medical Specialties Australia Pty Ltd
MS043	TiPLUG/TiPATCH System	Titanized polypropylene composite. 	TiPLUG	$263.00
	Prosthetic warp-knitted fabric made of
	 monofilament polypropylene threads 
	with an encapsulating titanic coating.
	Anti-inflammatory
	Atrium Australia - Pacific Rim Pty Limited
AC050	C-QUR Mesh Plug	Sterile, knitted polypropylene 	Small, Med, Large, Extra 	$1,220.00
	monofilament mesh material for tissue 	Large
	reinforcement with a coating derived 
	from a biological oil composed of fatty
	 acids, lipids and glycerides (BAO – 
	Bioabsorbable Oil Coating)
Prostheses List by Category, Groups and Sponsor	Page 159 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.09.01 - Fistula Closure
	Cook Medical Australia Pty Ltd
WC243	Surgisis Biodesign Anal Fistula 	Surgisis Biodesign Anal Fistula Plug	0.6cm Width Tapering to 	$1,000.00
	 is a small intestine submucosal 	0.2cm Width x 9.5cm 
	porcine derived, rolled and shaped 	Length. Conical Shape
	collagen matrix, non cross-linked, that
	 signals the body and provides 
	support for native tissue remodeling, 
	healing and closure of anal fistulas
WC245	Surgisis Biodesign Recto-Vaginal 	Small intestine submucous porcine 	2mm width x 5.5cm length; 	$1,000.00
	Fistula Plug	collagen matrix, non-crosslinked, 	4mm wide tapering to 2mm 
	supports native tissue remodelling, 	wide x 5.5cm length; 7mm 
	healing and closure of recto-vaginal 	wide tapering to 2mm wide 
	fistulas. Conical shape with attached 	x 5.5 length.
	button.
	W L Gore & Associates
GT266	Gore®Bio-A® Fistula Plug	Gore®Bio-A® Fistula Plug	Six 9cm Tubes, 16mm disk	$1,000.00
03.08.10 - Anastomosis Clip
	Tag Medical
TM049	Anastoclips	Vessel Closure System (VCS)	Small, Medium, Large, Extra 	$450.00
	Large
03.08.11 - Dynamic Wound Closure Devices
	03.08.11.01 - Closure Set
	Medigroup Australia
MZ010	ABRA Abdominal Wall Closure Set	Abdominal Wall Closure System, for 	For wounds up to 30cm 	$7,000.00
	primary closure of large full thickness 	long up 30cm across.
	retrated adbominal wounds.
Prostheses List by Category, Groups and Sponsor	Page 160 of 1059

03 - GENERAL MISCELLANEOUS
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	03.08.11.02 - Extension Kit
	Medigroup Australia
MZ011	ABRA Abdominal Wall Closure Set	Extention Kit for use with ABRA 	Extention Kit, used when 	$2,000.00
	 (Extension Kit Only)	Abdominal Wall Closure Set CWK08.	wounds to be closed are 
	 Used when width or length of open 	larger than 30cm long 
	abdomen exceeds 30cm. ABRA is for 	and/or 30cm across.
	the primary closure of large full 
	thickness retracted abdominal 
03.09.01 - Inflatable
	03.09.01.01 - Pump
	American Medical Systems Pty Ltd
AM032	Acticon Artificial Bowel Sphincter 	Control Pump	One Size	$6,432.00
	Pump
	03.09.01.02 - Occlusive Cuff
	American Medical Systems Pty Ltd
AM002	Acticon Artificial Bowel Sphincter 	Occlusive Cuff	9, 10, 11, 12, 13, 14cm 	$3,574.00
	Cuff	(available in both 2.0cm & 
	2.9cm widths)
	03.09.01.03 - Regulating Balloon
	American Medical Systems Pty Ltd
AM033	Acticon Artificial Bowel Sphincter 	Pressure Regulating Balloon	81-90cm, 91-100cm, 101-	$3,500.00
	Pressure Regulating Balloon	110cm, 111-120cm
	03.09.01.04 - Accessory Kit
	American Medical Systems Pty Ltd
AM034	Acticon Artificial Bowel Sphincter 	Accessory Kit	One Size	$689.00
	Accessory Kit
Prostheses List by Category, Groups and Sponsor	Page 161 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.01.01 - Aneurysm Clip
	B Braun Australia Pty Ltd
BB108	Aneurysm Clip	Yasargil	4.5mm x 150g to 25.0mm x 	$258.00
	200g
BB109	Aneurysm Clip	Yasargil Phynox Mini	2.8mm x 110g to 7.0mm x 	$258.00
	130g
BB110	Aneurysm Clip	Yasargil Titanium	4.9mm x 150g to 20.0mm x 	$258.00
	200g
BB111	Aneurysm Clip	Yasargil Titanium Mini	2.8mm x 110g to 7.0mm x 	$258.00
	110g
BB112	Aneurysm Clip	Yasargil Reinforcing, 	One size only	$258.00
BB175	Yasargil Aneurysm Clip System	Phynox temporary clips are 	3mm - 20mm length, phynox 	$258.00
	manufactured from phynox.	temporary clips.
BB176	Yasargil Aneurysm Clip System	Titanium temporary clips are 	3mm- 25mm length, titanium	$258.00
	manufactured from titanium	 temporary clips.
	Johnson & Johnson Medical Pty Ltd
JJ134	Aneurysm Clips	Stainless Steel clip, various shapes 	2-20mm	$258.00
	including mini
JJ155	Aneurysm Clips	Stainless Steel, various shapes	21-25mm length	$258.00
	Lifehealthcare Pty Ltd
LH119	Aneurism Clip - T2	Sugita Clips, Titanium2. Slim, mini, 	One Size Each	$258.00
	curved and L-shape.
LH147	Aneurism Clip - T2	Sugita Clips, Titanium 2. L-shape, 	One Size Each	$258.00
	bayoneted, slightly curved, curved.
LH148	Aneurism Clip - T2	Sugita Clips, Titanium 2. Mini, temp, 	One Size Each	$258.00
	straight.
LH170	Aneurism Clip - T1	Sugita Clips, Titanium 1. Titanium 	One Size Each	$258.00
	alloy (Ti-6AI-4V)
LH494	Aneurism Clip - Elgiloy	Sugita Clips, Elgiloy. Cobalt Chrome 	One size each	$258.00
	alloy.
Prostheses List by Category, Groups and Sponsor	Page 162 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Complex
	B Braun Australia Pty Ltd
BB290	T-Bar Yasargil Aneurysm Clip	T-Bar Yarsargil Aneurysm Clip, 	5mm-9mm, 45 Deg	$378.00
	Titanium, Permanent Standard 
	Fenestrated
BB291	T-Bar Yasargil Aneurysm Clip	T-Bar Yarsargil Aneurysm Clip, 	5mm-13mm, 90 Deg	$378.00
	Titanium, Permanent Standard 
	Fenestrated
BB292	T-Bar Yasargil Aneurysm Clip	T-Bar Yarsargil Aneurysm Clip, 	5mm-9mm, 45 Deg	$378.00
	Pyhnox Cobalt Alloy, Permanent 
	Standard Fenestrated
BB293	T-Bar Yasargil Aneurysm Clip	T-Bar Yarsargil Aneurysm Clip, 	5mm-13mm, 90 Deg	$378.00
	Pyhnox Cobalt Alloy, Permanent 
	Standard Fenestrated
	Johnson & Johnson Medical Pty Ltd
JJ131	Aneurysm Clips	Stainless steel Graft Clip (with teflon 	Blade 2-5mm diameter, 3-	$378.00
	graft)	7mm length 
JJ141	Aneurysm Clips	Fenestrated Clips	Length 21-25mm	$378.00
JJ142	Aneurysm Clips	Fenestrated Clips	Length 6-21mm	$378.00
	Lifehealthcare Pty Ltd
LH294	Aneurism Clip - T2	Sugita Clips, Titanium 2, Fenestrated 	One size each	$378.00
	and Crankshaft.
04.01.02 - AVM Clip
	B Braun Australia Pty Ltd
BB218	Kopitnik Microneurosurgical AVM 	Composition: Phynox (Cobalt-base-	2mm, 3mm, 4mm, 5mm - 	$270.00
	Clips	alloy)	straight. 2mm, 3mm, 4mm, 
	5mm - curved.
	Johnson & Johnson Medical Pty Ltd
JJ130	Aneurysm Clips	Stainless steel alloy AVM Micro Clip	Blade length 1-5mm	$270.00
	Lifehealthcare Pty Ltd
LH155	Sugita Microneurosurgical AVM 	Composition: Cobalt-Chromium-	One Size Each	$270.00
	Clips	molybdenum based alloy
Prostheses List by Category, Groups and Sponsor	Page 163 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.02.01 - Repair, Graft, Small (≤10cm²)
	B Braun Australia Pty Ltd
BB118	Neuropatch Dura Substitute	Polyurethane	1.5 x 3cm	$72.00
	Biological
	Integra Neurosciences Pty Ltd
IG038	DuraGen	Collagen dural graft matrix	2.5cm x 2.5cm	$360.00
IG039	DuraGen Plus	Collagen dural graft matrix	2.5cm x 2.5cm	$360.00
	Johnson & Johnson Medical Pty Ltd
JJ740	Duraform Dural Graft Implant - 1" x 	Collagen-based dural graft implant	1'x1' (2.5x2.5cm)	$360.00
	1" (2.5x2.5cm)
	Medtronic Australasia Pty Ltd
MC750	Durepair	Dura Substitute, Collagen	1" x 1"	$360.00
	Stryker Australia Pty Ltd
SK492	DuraMatrix	Resorbable Collagen Dura Substitute 	1" x 1" (2.5cm x 2.5cm)	$360.00
	Membrane
04.02.02 - Repair, Graft, Medium (>10 to 50cm²)
	B Braun Australia Pty Ltd
BB114	Neuropatch Dura Substitute	Polyurethane	6 x 8cm	$472.00
BB115	Neuropatch Dura Substitute	Polyurethane	4 x 10cm	$472.00
BB116	Neuropatch Dura Substitute	Polyurethane	4 x 5cm	$472.00
BB117	Neuropatch Dura Substitute	Polyurethane	2 x 10cm	$472.00
	Lifehealthcare Pty Ltd
LH467	HydroFix Spine Shield medium	The HydroFix Spine Shield is 	5cmx6cmx1.0mm	$472.00
	indicated for use in specific locations 	5cmx6cmx0.6mm
	as a cover of the spine to provide a 
	plane of dissection during revision 
	W L Gore & Associates
GT054	Preclude Spinal Membrane	ePTFE	0.7mm Thickness 6 x 6cm	$472.00
Prostheses List by Category, Groups and Sponsor	Page 164 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT056	Preclude  Dura Substitute	ePTFE	0.3mm Thickness 2 x 10cm	$472.00
GT057	Preclude Dura Substitute	ePTFE	0.3mm Thickness 5 x 6 cm	$472.00
GT233	Gore Preclude® Vessel Guard	Gore Preclude® Vessel Guard is an 	5cm x 6cm	$472.00
	ePTFE Membrane with a tight 
	microstructure providing a vessel 
	friendly interface while preventing 
	penetration of fibroblasts. It is 
	indicated as a cover for vessels 
	following anterior vertebral surgery 
	to reduce the risk of potential vessel 
	damage during a revision surgery by 
	providing a plane of dissection.
	Biological
	Integra Neurosciences Pty Ltd
IG040	DuraGen	Collagen dural graft matrix	2.5cm x 7.5cm	$545.00
IG041	DuraGen Plus	Collagen dural graft matrix	2.5cm x 7.5cm	$545.00
IG042	DuraGen Suturable	Collagen dural graft matrix	2.5cm x 7.5cm	$545.00
IG043	DuraGen	Collagen dural graft matrix	5cm x 5cm	$545.00
IG044	DuraGen Plus	Collagen dural graft matrix	5cm x 5cm	$545.00
IG045	DuraGen Suturable	Collagen dural graft matrix	5cm x 5cm	$545.00
	Johnson & Johnson Medical Pty Ltd
JJ860	Duraform	Collagen-based dural graft implant	2.5 x 7.5cm (1" x 3") to 5 x 	$545.00
	5cm (2" x 2")
	Medtronic Australasia Pty Ltd
MI081	Durepair	Dura Substitute, Collagen	1"-2" x 2"-3"	$545.00
	Stryker Australia Pty Ltd
SK493	DuraMatrix	Resorbable Collagen Dura Substitute 	1" x 3" (2.5cm x 7.5cm)	$545.00
	Membrane
SK496	DuraMatrix	Resorbable Collagen Dura Substitute 	2" x 2" (5cm x 5cm)	$545.00
	Membrane
Prostheses List by Category, Groups and Sponsor	Page 165 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.02.03 - Repair, Graft, Large (>50 to 100cm²)
	B Braun Australia Pty Ltd
BB113	Neuropatch Dura Substitute	Polyurethane	6 x 14cm	$785.00
	Lifehealthcare Pty Ltd
LH466	Hydrofix Spine Shield Large	The Hydro Fix Spine shield is 	6cmX10cmX1.0mm	$785.00
	indicated for use in specific locations 	6cmX10cmX0.6mm
	as a cover of the spine to provide a 
	plane of dissection during revision 
	W L Gore & Associates
GT055	Preclude Spinal Membrane	ePTFE	0.7mm Thickness 6cm x 	$785.00
	12cm
GT058	Preclude  Dura Substitute	ePTFE	0.3mm thickness 6 x 10cm	$785.00
GT232	Gore Preclude® Vessel Guard	Gore Preclude® Vessel Guard is an 	6cm x 10cm	$785.00
	ePTFE Membrane with a tight 
	microstructure providing a vessel 
	friendly interface while preventing 
	penetration of fibroblasts.  It is 
	indicated as a cover for vessels 
	following anterior vertebral surgery 
	to reduce the risk of potential vessel 
	damage during a revision surgery by 
	providing a plane of dissection.
	Biological
	Integra Neurosciences Pty Ltd
IG046	DuraGen	Collagen dural graft matrix	7.5cm x 7.5cm	$1,120.00
IG047	DuraGen Plus	Collagen dural graft matrix	7.5cm x 7.5cm	$1,120.00
IG048	DuraGen Suturable	Collagen dural graft matrix	7.5cm x 7.5cm	$1,120.00
	Johnson & Johnson Medical Pty Ltd
JJ743	Duraform Dural Graft Implant - 3" x 	Collagen-based dural graft implant	3" x 3" (7.5 x 7.5cm)	$1,120.00
	3" (7.5 x 7.5cm)
	Medtronic Australasia Pty Ltd
MC753	Durepair	Dura Substitute, Collagen	3" x 3"	$1,120.00
Prostheses List by Category, Groups and Sponsor	Page 166 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK495	Dura Matrix	Resorbable Collagen Dura Substitute 	3" x 3" (7.5cm x 7.5cm)	$1,120.00
	Membrane
04.02.04 - Repair, Graft, Extra Large (>100cm²)
	B Braun Australia Pty Ltd
BB015	Neuro-Patch	Polyesterurethane	12 x 14cm	$655.00
	W L Gore & Associates
GT059	Preclude Dura Substitute	ePTFE	0.3mm thickness 10 x 12cm	$655.00
	Biological
	Integra Neurosciences Pty Ltd
IG049	DuraGen	Collagen Dural graft matrix	10cm x 12.5cm	$1,890.00
IG051	DuraGen Suturable	Collagen dural graft matrix	10cm x 12.5cm	$1,890.00
IG059	DURAGEN PLUS	Collagen Dural Graft Matrix	10cm x 12.5cm	$1,890.00
IG060	DURAGEN PLUS	Collagen Dural Graft Matrix	12.5cm x 17.5cm	$1,890.00
	Johnson & Johnson Medical Pty Ltd
JJ744	Duraform Dural Graft Implant - 4" x 	Collagen-based dural graft implant	4" x 5" (10x12.5cm)	$1,890.00
	5" (10x12.5cm)
	Medtronic Australasia Pty Ltd
MC754	Durepair	Dura Substitute, Collagen	4" x 5"	$1,890.00
	Stryker Australia Pty Ltd
SK494	DuraMatrix	Resorbable Collagen Dura Substitute 	4" x 5" (10cm x 12.5cm)	$1,890.00
	Membrane
04.02.05 - Repair, Liquid Sealant (0 to 3ml)   
	MD Solutions Pty Ltd
MB018	Adherus Spinal Sealant	Hydrogel sealant with minimally 	1.5 mL	$800.00
	invasive applicator
Prostheses List by Category, Groups and Sponsor	Page 167 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Covidien Pty Ltd
AS181	DuraSeal Xact Spinal Dural Sealant	Xact Dural Sealant for spine 	2ml vial	$800.00
	)Packaged in sterile single use 
	disposable tray with MicroMyst 
	Applicator & precurser syringes)
04.02.06 - Repair, Liquid Sealant (>3 to 6ml)
	MD Solutions Pty Ltd
MB007	ADHERUS Dural Sealant	Dural sealant	6ml	$835.00
MB019	Adherus AutoSpray	Hydrogel sealant with automatic 	6mL	$835.00
	applicator.
	Covidien Pty Ltd
AS180	Duraseal Dural Sealant	DuraSeal is a Synthetic, absorbable, 	5ml of hydrogel sealant	$835.00
	Polyethylene Glycon, hydrogel 
	sealant used as an adjunct to sutured 
	dural repair to achieve watertight 
04.02.08 - Repair, Self-Adhesive Membrane Sealant, Medium (>10 to 
	Tag Medical
TM052	Obex Neurofilm	Synthetic Self-Adhesive Barrier and 	50mm x 100mm	$560.00
	Sealant for Cerebrospinal Fluid Leaks
TM053	Obex Neurofilm	Synthetic Self-Adhesive Barrier and 	50mm X 50mm	$560.00
	Sealant for Cerebrospinal Fluid Leaks
TM054	Obex Neurofilm	Synthetic Self-Adhesive Barrier and 	50mm x 25mm	$560.00
	Sealant for Cerebrospinal Fluid Leaks
Prostheses List by Category, Groups and Sponsor	Page 168 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.02.09 - Repair, Self-Adhesive Membrane Sealant, Large (>50 to 
	Tag Medical
TM055	Obex Neurofilm	Synthetic Self-Adhesive Barrier and 	100 x 100mm	$1,020.00
	Sealant for cerebrospinal fluid leaks
04.03.01 - Valves
	04.03.01.01 - Valve, Externally Adjustable
	Johnson & Johnson Medical Pty Ltd
JJ158	Hakim Programmable Valve System	Valve only	One size only	$2,020.00
	Antisyphon functionDistal catheterProximal catheter
	Johnson & Johnson Medical Pty Ltd
JJ219	Hakim Programmable Valve System	Fixed pressure hydrocephalus shunt, 	One size only	$3,200.00
	packaged sterile, stainless steel and 
	ruby valve mechanism, silicone rubber
	 ventricular and peritoneal catheters.  
	In line or right angled with reservoir.  
	Valve can be reprogrammed non-
	invasively 18 pressure settings a
	Antisyphon functionReservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ437	Codman Hakim Programmable 	18 different pressure settings and 	One Size Only	$2,870.00
	Valves with Siphonguard	SIPHONGUARD technology
	Antisyphon function, Coating, Distal catheter, Proximal 
	Medtronic Australasia Pty Ltd
MC641	Strata Valve Unitised with Bioglide	CSF Flow Valve. Polypropylene and 	One size only	$3,310.00
	 PSM range	acetal plastic base. Silicone elastomer 
	dome.
	Antisyphon function, Coating, Distal catheter, 
	Medtronic Australasia Pty Ltd
MC642	Strata Valve Assembly with 	CSF Flow Valves. Polypropylene and 	One size	$3,165.00
	Bioglide PSM range	acetal plastic base. Silicone elastomer 
	dome.
Prostheses List by Category, Groups and Sponsor	Page 169 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Antisyphon function, Coating, Reservoir/Priming function
	Medtronic Australasia Pty Ltd
MI019	Strata Valve with Bioglide	Adjustable CSF Valve with five 	13-16mm x 35-47mm	$2,980.00
	symmetric performance level steps, 
	surface of valve bonded with hydrogel
	Antisyphon function, Distal catheter, Proximal catheter, 
	B Braun Australia Pty Ltd
BB337	Miethke proGAV Shunt System	Shunt system containing an 	Shunt system with Sprung 	$3,200.00
	adjustable valve with a gravitational 	reservoir.
	unit, a distal catheter, a ventricular 	Adjustable valve: diameter 
	catheter and a reservoir. There are 	18mm, opening pressure 0-
	different types of reservoirs available: 	20 cmH2O, height 4.5mm.
	Sprung / Control / Flushing or 	Gravitational unit: length 
	Burrhole reservoir. The shunt system 	14.9mm, height 4.6mm, 
	is used for the treatment of pediatric 	opening pressure 0-35 
	and adult hydrocephalus. The 	cmH2O.
	adjustable valve, the gravitational 	Distal catheter: length 
	unit and the reservoir are made of 	1200mm, inside diameter 
	titanium. The catheter is made of 	1.2mm, outside diameter 
	silicone. The shunt is MR safe up to 3 	2.5mm.
	tesla.	Reservoir: diameter 
	14/20mm.
	Ventricular catheter: 
	180/250mm.
	Medtronic Australasia Pty Ltd
MC640	Strata Shunt, Unitised	Adjustable CSF valve with five 	8-13.5cm x 9-120cm	$3,200.00
	symmetric performance level steps.  
	Includes strata valve, pre-attached 
	ventricular catheter, and a pre-
	attached peritoneal catheter. Right 
	Angle Clip. Disposable Quick 
	Release Ventricular Catheter 
Prostheses List by Category, Groups and Sponsor	Page 170 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Antisyphon function, Distal catheter, Reservoir/Priming function
	B Braun Australia Pty Ltd
BB335	Miethke proGAV with distal 	Adjustable valve with a gravitational 	FV417T: gravitational unit, 	$3,055.00
	unit and a distal catheter for the 	opening pressure - .
	treatment of pediatric and adult 	FV418T: gravitational unit, 
	hydrocephalus. The valve is made from	opening pressure 10 
	 titanium and is MR safe up to 3 tesla. 	cmH2O.
	In combination with its integrated, 	FV419T: gravitational unit, 
	well establsihed Miethke Shunt 	opening pressure 15 
	Assistant (the gravitational unit) 	cmH2O.
	proGAV offers protection against 	FV420T: gravitational unit, 
	overdrainage.	opening pressure 20 
	cmH2O.
	FV421T: gravitational unit, 
	opening pressure 25 
	cmH2O.
	FV422T: gravitational unit, 
BB338	Miethke proGAV with pre-attached 	Shunt system containing an 	Adjustable valve: diameter 	$3,055.00
	reservoir	adjustable valve with a gravitational 	18mm, opening pressure 0-
	unit and a reservoir. There are different	20 cmH20, height 4.5mm.
	 types of reservoirs available: Sprung 	Gravitational unit: length 
	/ Control / Flushing or Burrhole 	14.9mm, height 4.6mm.
	reservoir. The shunt system is used for	Distal catheter: length 
	 the treatment of pediatric and adult 	1200mm, inside diameter 
	hydrocephalus. The adjustable valve, 	1.2mm, outside diameter 
	the gravitational unit and the 	2.5mm.
	reservoir are made of titanium. The 	Sprung reservoir: diameter 
	catheter is made of silicone. The shunt 	20 or 14mm.
	system is MR safe up to 3 tesla.
BB339	Miethke proSA with differential 	proSA is an adjustable gravitational 	Adjustable gravitational 	$3,055.00
	pressure unit (miniNAV) and distal 	unit for the treatment of 	unit: height 4.5mm, diameter
	catheter	hydracephalus. The proSA valve can 	 18mm, opening pressure 0-
	be combined with any differential 	40 cmH2O.
	pressure valve. miniNAV is a very 	Differential pressure unit 
	small differential pressure unit, which 	(miniNAV): length 14.7mm, 
	is often used with proSA. The valves 	diameter 2.8mm.
	are made from titanium and are MR safe	Distal catheter: length 
	 up to 3 tesla. The distal catheter is 	1200mm, inside diameter 
	made of silicone.	1.2mm, outside diameter 
	2.5mm.
Prostheses List by Category, Groups and Sponsor	Page 171 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MI086	Strata Shunt Assembly	Assembly: Strata Shunt, Strata Burr 	90-120cm, 35-50mm	$3,055.00
	Hole Shunt, Strata Snap Shunt. 
	Adjustable CSF Valve with five 
	symmetric performance level steps, 
	includes integral (distal) peritoneal 
	catheter.
	Antisyphon function, Reservoir/Priming function
	B Braun Australia Pty Ltd
BB332	Miethke proGAV	proGAV is an adjustable valve with 	Adjustable valve: Diameter 	$2,870.00
	an integrated gravitational unit for the	18mm, Opening pressure 0-
	 treatment of pediatric and adult 	20 cmH2O, Height 4.5mm.
	hydrocephalus. The valve is made from	Gravitational unit: Length 
	 titanium and is MR safe up to 3 tesla. 	14.9mm, Height 4.6mm.
	In combination with its integrated, 	FV410T: gravitational unit, 
	well established Miethke Shunt 	opening pressure - .
	Assistant (the gravitational unit) 	FV411T: gravitational unit, 
	proGAV offers protection against 	opening pressure 10 
	overdrainage.	cmH2O.
	FV412T: gravitational unit, 
	opening pressure 15 
	cmH2O.
	FV413T: gravitational unit, 
	opening pressure 20 
	cmH2O.
	FV414T: gravitational unit, 
	opening pressure 25 
	cmH2O.
	FV415T: gravitational unit, 
BB340	Miethke proSA with differential 	proSA is an adjustable gravitational 	Adjustable gravitational 	$2,870.00
	pressure unit (miniNAV)	unit for the treatment of 	unit: height 4.5mm, diameter
	hydrocephalus. The proSA valve can 	 18mm, opening pressure 0-
	be combined with any differential 	40 cmH2O.
	pressure valve. miniNAV is a very 	Differential pressure unit 
	small differential pressure unit, which 	(miniNAV): length 14.7mm, 
	is often used with proSA. The valves 	diameter 2.8mm.
	are made from titanium and are MR safe
	 up to 3 tesla.
	Johnson & Johnson Medical Pty Ltd
MN109	Codman Certas Programmable Valve 	Programmable valve with Reservoir 	30-210mmH2O	$2,870.00
	- with Reservoir and Siphonguard	and Siphonguard
Prostheses List by Category, Groups and Sponsor	Page 172 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MI087	Strata Valve	Strata Valve, Strata Burr Hole Valve,. 	13-20mm x 35-50mm	$2,870.00
	Adjustable CSF Valve with five 
	symmetric performance level steps.
	Antisyphon, Distal catheter, Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
MN110	Codman Certas Programmable Valve 	Programmable valve with reservoir, 	30-210mmH2O	$3,055.00
	- with Reservoir, Siphonguard and 	siphonguard and catheters
	catheter
	Distal catheterProximal catheterReservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ159	Hakim Programmable Valve System	Standard system. Silicone casing with	Peritoneal Catheter length 	$2,700.00
	 catheter; stainless steel ruby ball in 	80 cm, Ventricular catheter 
	cone mechanism with variable 	length 14 cm
	Medtronic Australasia Pty Ltd
MC645	Strata Valve Unitised NSC (non 	Adjustable CSF valve with five 	8-120cm	$2,700.00
	siphon control) PSM range	symmetric performance level steps. 
	Includes a strata valve, pre-attached 
	ventricular catheter, and a pre-
	attached peritoneal catheter. Right 
	Angle Clip. Disposable Quick 
	Release Ventricular Catheter 
	National Surgical Pty Ltd
NK029	Sterile Hydrocephalic Shunts	Plastic/magnetic. Programmable 	3, 8 settings	$2,700.00
	valve. Programmer kit and shunts kit.
	Distal catheterReservoir/Priming function
	Medtronic Australasia Pty Ltd
MC963	Strata NSC Burr Hole Shunt 	Adjustable cerebrospinal fluid (CSF) 	One size only	$2,555.00
	Assembly	flow valve. Polypropylene and acetal 
	plastic base. Silicone elastomer dome. 
	With integral catheter.
	Distal catheter, Lumboperitoneal, Proximal catheter, 
	Medtronic Australasia Pty Ltd
MI080	Strata NSC LP Shunt Kit	Strata NSC LP Shunt Kit with 	One size only	$3,030.00
	Lumbar Catheter and Peritoneal 
	Catheter, Small Lumen
Prostheses List by Category, Groups and Sponsor	Page 173 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Distal catheter, Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
MN108	Codman Certas Programmable Valve 	Programmable valve with reservoir 	30-210mmH2O	$2,555.00
	- with reservoir and catheter	and catheters
	Medtronic Australasia Pty Ltd
MC646	Strata Valve Assembly NSC (non 	Adjustable CSF valve with five 	One size	$2,555.00
	siphon control) PSM range	symmetrical performance level steps. 
	Includes a strata valve, an integral 
	distal peritoneal catheter and catheter 
	passer, and a female leur adaptor and 
	prefill tubing.
	Lumboperitoneal, Reservoir/Priming function
	Medtronic Australasia Pty Ltd
MC928	Strata NSC L-P Shunt	Lumboperitoneal Shunt	44mm x 23mm x 12mm	$2,700.00
	Reservoir
	Johnson & Johnson Medical Pty Ltd
MN111	Codman Certas Programmable Valve 	Programmable valve with reservoir	30-210mmH2O	$2,370.00
	- with reservoir
	Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ436	Codman Hakim Programmable Valves	Programmable valve with reservoir	One Size Only	$2,370.00
	Medtronic Australasia Pty Ltd
MI082	Strata Valve NSC PSM Range	Strata NSC, Strata NSC Burr Hole 	13-20mm x 23-35mm	$2,370.00
	Valve. Adjustable cerebrospinal fluid 
	(CSF) flow valve. Polypropylene and 
	acetal plastic base. Silicone elastomer 
	dome.
Prostheses List by Category, Groups and Sponsor	Page 174 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	04.03.01.02 - Valve, Non-externally adjustable
	B Braun Australia Pty Ltd
BB325	Aesculap-Miethke DualSwitch 	Non-adjustable valve with preset 	28mm diameter, 5.7mm 	$1,110.00
	values for treatment of patients 	profile, 510-50cmH2O 
	susceptible to complication due to 	pressure setting
	tumour cells or high protein levels. 
	Treats patients in both supine and 
	upright position. Titanium 
	construction MRI compatible to 3 tesla
	Integra Neurosciences Pty Ltd
IG019	Precision Flow-OSV II Valve 	Ventricular/Peritoneal OSV11-  	Drainage Cath 110 cm, F7. 	$1,110.00
	Ventricular/Peritoneal 	Ventricular Catheters 7,9,13
	Hydrocephalus Shunt	 & 15 cm
IG026	Contour-Flex Valves	Silicone encased CSF Valve	Small (24mm Length) or 	$1,110.00
	Regular (28mm Length), 
	low medium or high 
IG027	Contour Flex Valve Shunt 	Shunt Assembly: silicone encased 	Small (24mm Length) or 	$1,110.00
	valve, silicone ventricular and 	regular (28mm Length); 
	peritoneal catheters	low, low/medium and 
	medium pressure; various 
	catheter and valve 
IG032	Burr Hole Valve Shunt Assemblies	Shunt Assembly: silicone encased 	16mm or 12mm base; low, 	$1,110.00
	valve, silicone ventricular and 	medium or high pressure, 
	peritoneal catheters	various kit configurations
	Antibiotics, Antisyphon function, Distal catheter, Proximal 
	Johnson & Johnson Medical Pty Ltd
JJ861	Codman Hakim Precision Fixed 	Fixed Pressure Valve with Bactiseal 	Standard and Micro	$2,180.00
	Pressure Valve	ventricular and peritoneal catheters, 
	reservoir and siphonguard: Opening 
	pressures: 10-130mmH2O
	Antibiotics, Distal catheter, Proximal catheter
	Johnson & Johnson Medical Pty Ltd
JJ863	Codman Hakim Precision Fixed 	Fixed Pressure Valve with Bactiseal 	Standard and Micro	$1,740.00
	Pressure Valve	ventricular and peritoneal catheters 
	and reservoir: Opening pressures: 10-
	130mmH2O
Prostheses List by Category, Groups and Sponsor	Page 175 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Antibiotics, Distal catheter, Proximal catheter, 
	Johnson & Johnson Medical Pty Ltd
JJ862	Codman Hakim Precision Fixed 	Fixed Pressure Valve with Bactiseal 	Standard and Micro	$2,090.00
	Pressure Valve	ventricular and peritoneal catheters 
	and reservoir: Opening pressures: 10-
	130mmH2O
	Antisyphon function, Coating, Distal catheter, Proximal 
	Medtronic Australasia Pty Ltd
MC648	Delta Valve Unitised with Bioglide 	CSF Flow Valves. Polypropylene and 	8-13.5cm x 90-120cm (0.5-	$1,990.00
	PSM range	acetal plastic base. Silicone elastomer 	2.0)
	dome. Unitised system includes the 
	valve, integral ventricular and 
	peritoneal catheter (all components 
	connected). Surface of valve bonded 
	with hydrogel (Bioglide surface 
	modificat
	Antisyphon function, Coating, Distal catheter, 
	Medtronic Australasia Pty Ltd
MC651	Delta Valve Assembly with 	CSF Flow Valves. Polypropylene and 	90-120cm (0.5, 1.0, 1.5, 2.0)	$1,845.00
	Bioglide PSM range	acetal plastic base. Silicone elastomer 
	dome. Assembly system includes the 
	valve, integral peritoneal catheter, 
	female luer adapter and prefill tubing. 
	Surface of the valve bonded with 
	hydrogel (Bioglide surface modifica
	Antisyphon function, Coating, Reservoir/Priming function
	Medtronic Australasia Pty Ltd
MC647	Delta Valve with Bioglide PSM 	CSF Flow Valve. Polypropylene and 	36-40mm x 9-20mm (0.5-2.0)	$1,660.00
	acetal plastic base. Silicone elastomer 
	dome. Surface of valve bonded with 
	hydrogel (Bioglide surface 
	modification).
	Antisyphon function, Distal catheter, Proximal catheter, 
	Johnson & Johnson Medical Pty Ltd
JJ220	Hakim Precision Valve System	Fixed pressure valve with reservoir, 	Very low to very high 	$1,880.00
	siphonguard, ventricular and 	including micro
	peritoneal catheters
Prostheses List by Category, Groups and Sponsor	Page 176 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC649	Delta Shunt Unitised	Delta valve is a fixed pressure CSF 	Delta Unitised Shunt small 	$1,880.00
	valve, available in four performance 	(Distal 65cm-90cm, 
	levels. Delta Unitised shunt includes 	ventricular 11cm) - 0.5, 1.0, 
	a delta valve, pre-attached ventricular 	1.5 and 2.0. Delta Unitised 
	catheter, and a pre-attached peritoneal 	Shunt regular (Distal 90cm, 
	catheter. Right Angle Clip. 	ventricular catheter 13cm) - 
	Disposable Quick Release Ventricular	0.5, 1.0, 1.5 and 2.0
	Antisyphon function, Distal catheter, Reservoir/Priming function
	Medtronic Australasia Pty Ltd
MC650	Delta Shunt Assembly	Delta valve is a fixed CSF pressure 	90-120cm (0.5 - 2.0)	$1,735.00
	valve, available in four performance 
	levels. Includes an Integral (distal) 
	Peritoneal Catheter, Disposable 
	Peritoneal Catheter Passer, Female 
	Luer Adapter and Prefill Tubing.
	Antisyphon function, Lumboperitoneal
	Integra Neurosciences Pty Ltd
IG001	Horizontal-Vertical (H-V) Lumbar 	The H-V Lumbar Valve adjusts to 	903-325A  85-125   205-	$1,530.00
	valve system	changes in posture to maintain 	285  small children, 903-
	pressure appropriate levels in both 	335A  85-125  265-365  tall
	standing and recumbent positions.  	 children, adults,  903-345A
	Has a unique anti-gravity mechanism 	  85-125  325-445 tall 
	automatically increasing flow 	adults,  903-320A  50-80  
	resistance when the patient resumes a 	170-240  small children, 
	standing or sitting position.	903-330A  50-80  230-320 
	tall children, adults, 903-
	340A  50-80,  290-400 tall
	Antisyphon function, Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ858	Codman Hakim Precision Valves	Valves with Siphonguard and 	10-130mm H2O including 	$1,550.00
	micro
	Medtronic Australasia Pty Ltd
MC532	Hydrocephalus Shunt	With Hydrostatic Valve, Delta 	12mm-90cm	$1,550.00
	Valves/Shunts/BioGlide, Vent 
Prostheses List by Category, Groups and Sponsor	Page 177 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Distal catheterProximal catheterReservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ221	Hakim Precision Valve System	Fixed pressure hydrocephalus shunt, 	One size only	$1,790.00
	packaged sterile, stainless steel and 
	ruby valve mechanism, silicone rubber
	 ventricular and peritoneal catheters.  
	In line or right angled with reservoir.  
	Opening pressure  H20; Very high 
	130mm, high 100mm, medium 70mm
	Distal catheter, Lumboperitoneal
	Integra Neurosciences Pty Ltd
IG017	Precision Flow-OSV II Valve 	Lumbar peritoneal OSV11-	Lumber Catheter 80cm, F5  	$1,625.00
	Lumboperitoneal System 	Peritoneal Catheter 110cm, 
	Hydrocephalus Shunt	F7
	Distal catheter, Proximal catheter
	Integra Neurosciences Pty Ltd
IG015	Cordis Omnishunt System, Hakim 	Hakim Valve System	Drainage Cath 110 cm, F7. 	$1,440.00
	Valve Series	Vent. Cath 15cm, F8.
IG018	Precision Flow-OSV II Valve 	Ventricular/Atrial OSV11-Ventricular	Drainage Cath 110 cm, F7. 	$1,440.00
	 /Atrial Hydrocephalus Shunt	Ventricular Catheters 7,9,13
	 & 15 cm
	Distal catheter, Proximal catheter, Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ157	Hakim Precision Valve System	Precision valve standard with 	Very low to very high 	$1,790.00
	reservoir, peritoneal and ventricular 	including micro
	Distal catheter, Reservoir/Priming function
	Medtronic Australasia Pty Ltd
MC531	Hydrocephalus Shunt	Ventricular/Peritoneal. CSF Flow 	12mm-90cm	$1,645.00
	Control Valves, BioGlide Contoured, 
	Ventriculostomy Kit-E, Neonatal 
	Delta Snap Shunt
Prostheses List by Category, Groups and Sponsor	Page 178 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lumboperitoneal
	Integra Neurosciences Pty Ltd
IG004	Spetzler Lumbar-Peritoneal Shunt 	Shunt, CSF Reservoir, In-line valve	Catheter length 80 - 105cm, 	$1,440.00
	System	Reservoir small & large, 
	Valve pressure range low - 
	high
	Reservoir/Priming function
	Johnson & Johnson Medical Pty Ltd
JJ156	Hakim Precision Valve System	Precision valve standard with 	Very low to very high 	$1,460.00
	including micro
JJ440	Codman Hakim Precision Valve, 	features 5 operating pressures	10, 40, 70, 100, and 	$1,460.00
	Right Angle Reservoir	130mmH2O
	Medtronic Australasia Pty Ltd
MC530	Hydrocephalus Shunt	Ventricular/Atrial, CSF Flow Control 	38cm-90cm	$1,460.00
	Shunts, Cont Small Valve
	with Antisyphon function
	B Braun Australia Pty Ltd
BB324	Aesculap-Miethke GAV/paediGAV 	Single valve, anti-siphon 	24mm and 27mm long, 	$1,200.00
	gravitational shunt	gravitational shunt, titanium 	4.0mm and 4.6mm diameter, 
	construction (MRI safe to 3 tesla)	4cmH2O and 5cmH2O-
	40cmH2O
04.03.02 - Unitised shunt assembly, with proximal/distal catheter
	Integra Neurosciences Pty Ltd
IG023	Cordis Omnishunt System	Silicone and Synthetic ruby	Very low to very high 	$450.00
	pressures
	Johnson & Johnson Medical Pty Ltd
JJ855	Codman-Medos Non-programmable 	Lumbar/peritoneal catheter, James and 	25-80cm	$450.00
	Valve System	Holter designs
	Medtronic Australasia Pty Ltd
MC529	Hydrocephalus Shunt	Lumbar peritoneal	84cm	$450.00
Prostheses List by Category, Groups and Sponsor	Page 179 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Antisyphon function
	B Braun Australia Pty Ltd
BB322	Aesculap-Miethke PaediGAV/GAV	Single valve, (anti-siphon) 	23mm long , 4.6mm diameter,	$1,650.00
	 gravitational shunt (with catheter)	gravitational shunt, titanium 	 5cmH2O - 40cmH2O, 
	construction (MRI safe to 3 tesla), 	Catheter - di=1.2mm, 
	with incorporated distal catheter, 	do=2.5cm, 1200mm long
04.03.03 - Catheter
	Antibiotics
	Johnson & Johnson Medical Pty Ltd
JJ883	Hakim Ventricular Catheter Set with	Silicone ventricular catheter, 	15cm	$469.00
	 Bactiseal	antibiotic impregnated
JJ884	Hakim Peritoneal Catheter Set with 	Silicone peritoneal catheter, 	80cm	$469.00
	Bactiseal	antibiotic impregnated
	Distal
	B Braun Australia Pty Ltd
BB329	Miethke Peritoneal Catheter	Peritoneal catheter, barium 	d 1.2mm od =2.5mm; 	$185.00
	impregnated, radio-opaque silicon	600,900 1200mm long
	2) Peritoneal catheter with integrated 
	barium strip
	Integra Neurosciences Pty Ltd
IG010	Shunt	Components - catheter: Atrial	55cm - 60cm, Low - High 	$185.00
	pressure range
IG011	Shunt	Peritoneal	90 - 120cm	$185.00
IG020	Atrial Catheter 	Components - catheter: Atrial Atrial 	Length: 46cm, F7.  OD: 	$185.00
	Catheters  Hydrocephalux Valve 	2.1mm; ID:1.1mm
	Accessories
IG021	Peritoneal Catheter	Peritoneal Catheters	Length: 91cm, F7.  OD: 	$185.00
	2.1mm; ID:1.1mm
IG030	Cardiac/Peritoneal Catheters	SiliconDistal Catheter, ID 1.3mm, OD 	90cm, barium impregnated 	$185.00
	2.5mm	silicone catheter, closed or 
	open ended, with or 
	without slits
Prostheses List by Category, Groups and Sponsor	Page 180 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ229	Codman Medos Peritoneal Catheter	85cm, packaged sterile, silicone rubber	85cm	$185.00
JJ261	ACCU-FLO Intracranial Pressure 	ACCU-FLO catheter, packaged 	91cm in length	$185.00
	shunt	sterile, silicone rubber
JJ857	HOLTER Intracranial Pressure 	HOLTER distal peritoneal 	90cm	$185.00
	catheter/Salmon, packaged sterile, 
	silicone
	Medtronic Australasia Pty Ltd
MC584	CSF - Distal Catheters	Non metallic and latex free, Models 	Distal cardiac/peritoneal 	$185.00
	43418,43103,43111,43209,43522,43	catheters ID 1.3mm OD 
	551,27211	2.5mm Length 90cm, 96cm, 
	110cm, 120cm, ID 1.2mm, 
	OD 2.1mm, Length 90cm, 
	75cm, 58cm
MC857	Small Lumen Peritoneal Catheter	CSF Distal Catheter	ID - 0.7mm OD - 2.5mm 	$185.00
	Length - 120cm
	DistalCoating
	Medtronic Australasia Pty Ltd
MC638	Peritoneal Catheter PSM range with	Translucent silicone elastomer with 	60-90cm	$255.00
	 Bioglide	Barium impregnated stripe.  Catheter 
	surface bonded with Hydrogel.
	Distal, Proximal, Antibiotics
	Johnson & Johnson Medical Pty Ltd
JJ160	Hakim Catheter Kit with Bactiseal 	Silicone antibiotic impregnated 	Kit	$675.00
	Silicone	catheter kit
Prostheses List by Category, Groups and Sponsor	Page 181 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Proximal
	B Braun Australia Pty Ltd
BB331	Miethke Ventricular catheter with 	Ventricular catheters (with deflector) 	Ventricular catheter with 	$185.00
	deflector	are used to drain CSF out of the 	deflector:
	ventricle. All catheters are made of 	Inside diameter 1.2mm, 
	radiopaque silicone. The deflectors 	Outside diameter 2.5mm.
	allow 90 degree deflection of the 	FV075P: Ventricular 
	ventricular catheter in the burrhole 	catheter 180mm, graduated.
	without kinking the catheter. All 	
	deflectors are made of titanium. The 	Deflector: Large.
	deflectors are adjustable on the 	FV078P: Ventricular 
	catheter, have suture fixation holes 	catheter 250mm, graduated.
	and are radiopaque.	
	Deflector: Large.
	Ventricular catheter with 
	deflector (for pediatric 
	application):
	Inside diameter 1.2mm, 
	Outside diameter 2.5mm.
	FV076P: Ventricular 
	catheter 180mm, graduated.
BB336	Miethke Ventricular Catheter with 	Ventricluar catheters (with stylet) are 	Inside diameter 1.2mm, 	$185.00
	stylet	used to drain CSF out of the ventricle. 	Outside diameter 2.5mm.
	All catheters are made of radiopaque 	FV074P: 180mm, graduated.
	silicone.	
	Integra Neurosciences Pty Ltd
IG009	Heyer-Schulte Pudenz Ventricular 	-	small, standard, right-	$185.00
	Catheter
IG012	Shunt	Ventricular	14.5cm - 23cm	$185.00
IG014	Heyer Schulte Portnoy Flanged 	Composition - silicone with tantalum 	Length 18cm, outer diameter	$185.00
	Ventricular Catheter	markings	 8mm
IG025	Right Angle Ventricular Catheter	Silicone, integral right angle	3-11cm	$185.00
IG031	Ventricular Catheters	Silicon Ventricular Catheter	15cm - 25cm, optional 	$185.00
	flanges or right angle or 
	endoscopic tip. ID 1.3mm, 
	OD 2.5mm
	Johnson & Johnson Medical Pty Ltd
JJ218	HOLTER Intracranial Pressure 	HOLTER Ventricular Catheter, 	3 - 7cm and 15cm	$185.00
	packaged sterile, silicone rubber
Prostheses List by Category, Groups and Sponsor	Page 182 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ227	Codman Medos Straight Ventricular 	14cm, packaged sterile, silicone rubber	14cm	$185.00
	Catheter
JJ263	ACCU-FLO Intracranial Pressure 	ACCU-FLO barium ventricular 	One size only	$185.00
	shunt	catheter, packaged sterile, silicone 
	rubber
	Medtronic Australasia Pty Ltd
MC735	Rivulet	Ventricular Catheter	4cm - 23cm	$185.00
MI122	CSF Ventricular Catheter PSM range	Ventricular catheter, non metallic latex	1.3 - 35cm	$185.00
	 free. Barium impregnated, include 
	stainless steel stylet.
	ProximalCoating
	Medtronic Australasia Pty Ltd
MC639	Ventricular Catheter PSM range 	Translucent silicone elastomer with 	15-23cm	$249.00
	with Bioglide	Barium impregnated stripe. Catheter 
	surface bonded with Hydrogel.
04.03.04 - Antisyphon Device
	B Braun Australia Pty Ltd
BB323	Aesculap-Miethke 	Single valve, anti-siphon 	19.5mm long and 23.7mm 	$880.00
	SHUNTASSISTANT/PAEDI - 	gravitational unit to treat standing 	long , 4.0mm diameter and 
	SHUNTASSISTANTgravitational 	pressure over drainage in conjunction	4.6mm diameter , 10cmH2O 
	 with existing shunts in children and 	and 15-35cmH2O
	adults, titanium construction (MRI 
	Integra Neurosciences Pty Ltd
IG024	Gravity Compensating Accessory	Silicone/Stainless steel	low, medium & high 	$880.00
	pressures
	Johnson & Johnson Medical Pty Ltd
JJ164	Siphonguard CSF Control Device	PET shell anti-siphon device for shunt	One size only	$880.00
Prostheses List by Category, Groups and Sponsor	Page 183 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.03.05 - Reservoir/Priming Device
	B Braun Australia Pty Ltd
BB326	Aesculap-Miethke Shunt inline 	Titanium, (MRI safe 3 tesla), radio- 	Radio-opaque titanium. 	$375.00
	Flushing reservoir	opaque with low overall height for 	14mm 
	easy and safe positioning of 	diameter,4.8mmheight; 
	ventricular catheter. Allows CSF 	20mm diameter, 5.65mm 
	extraction and drug injection by 	height. For catheters - id = 
	syringe through silicone dome. Solid 	1.2mm,od = 2.5mm
	Titanium base ensures syringes will 
BB327	Aesculap-Miethke Shunt Burr hole 	Titanium, (MRI safe 3 tesla), radio-	Radio- opaque titanium. 	$375.00
	port	opaque with low overall height for 	14mm diameter, 4.8mm 
	easy and safe positioning of 	height; 20/9.5mm diameter, 
	ventricular catheter. Allows CSF 	5.65mm height. For 
	extraction and drug injection by 	catheters - id =1.2mm, od 
	syringe through silicone dome. Solid 	=2.5mm
	Titanium base ensures syringes will 
	not penetrate, supplied sterile.
Prostheses List by Category, Groups and Sponsor	Page 184 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB333	Miethke Port / Reservoir	The ports / reservoirs are all made of 	Burrhole port:	$375.00
	titanium and are radiopaque. They 	FV030T: Diameter 20mm, 
	have a low overall height for easy and 	Height 5.65mm.
	safe positioning and fixation of the 	FV040T: Diameter 14mm, 
	ventricular catheter. They allow CSF 	Height 4.8mm (for pediatric 
	extraction and drug injection by 	application).
	inserting a syringe through the 	CSF port:
	silicone dome. The solid titanium base	FV060T: Diameter 20mm, 
	 prevents penetration with a syringe 	Height 5.65mm.
	needle. There are 6 different types: 	Burrhole reservoir:
	Burrhole port, CSF port, Burrhole 	FV028T: Diameter 20mm, 
	reservoir, Sprung reservoir, Flushing 	Height 5.65mm.
	reservoir, Control reservoir.	FV029T: Diameter 20mm, 
	Height 5.65mm with 
	adjustable connector.
	FV039T: Diameter 14mm, 
	Height 4.8mm (for pediatric 
	application).
	Sprung reservoir:
	FV043T: Diameter 20mm, 
	Height 5.65mm.
	Flushing reservoir:
	FV033T: Diameter 20mm, 
	Height 5.65mm.
	FV035T: Diameter 14mm, 
	Height 4.8mm (for pediatric 
	application).
	Control reservoir:
	FV047T: Diameter 20mm, 
	Height 5.65mm.
	Integra Neurosciences Pty Ltd
IG006	Heyer-Schulte Spetzler Lumbar-	-	Small, large	$375.00
	Peritoneal Low Pressure Flushing 
	Reservoir
IG008	Heyer-Schulte Ommaya CSF 	Standard, side-inlet, convertible, mini	1.5 - 2.5cm and mini	$375.00
	Reservoir
IG013	Shunt	Reservoir	Standard, Large	$375.00
IG033	Reservoirs	Shunt component	9mm to 25mm, with or 	$375.00
	without convertible outlet 
	port, burr hole or flat bottom
	 style
Prostheses List by Category, Groups and Sponsor	Page 185 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ856	Burr Hole Button Reservoirs	Various ventriculostomy reservoirs	Standard, dome, flat profile 	$375.00
	and large
	Medtronic Australasia Pty Ltd
MC534	Pressure valve (anti-siphon device 	Neonatal Reservior, CSF Lumbo 	2 - 90cm	$375.00
	or  flushing valve or flush pump)	Peritoneal
MI018	Reservoir	CSF Reservoir, Port, Neonatal, Snap 	Various	$375.00
	assembly
	Integrated catheter
	B Braun Australia Pty Ltd
BB330	Miethke Reservoir with integrated 	The reservoirs are all made of titanium 	Burrhole reservoir: 	$500.00
	catheter	and are radiopaque. They have a low 	FV027T - Diameter 20mm, 
	overall height for easy and safe 	Height 5.65mm, with 
	positioning and fixation of the 	integrated catheter 600mm. 
	ventricular catheter. They allow CSF 	
	extraction and drug injection by 	FV054T - Diameter 14mm, 
	inserting a syringe through the 	Height 4.8mm, with 
	silicone dome. The solid titanium base	integrated catheter 200mm 
	 prevents penetration with a syringe 	(pediatric).
	needle.	Sprung reservoir: 
	The reservoirs come with integrated 	FV044T - Diameter 20mm, 
	catheters. There are 4 different types of 	Height 5.65mm, with 
	reservoirs with integrated catheters: 	integrated catheter 600mm.
	Burrhole reservoir, sprung reservoir, 	
	flushing reservoir and control 	Flushing reservoir: 
	FV034T - Diameter 20mm, 
	Height 5.65mm, with 
	integrated 600mm.
	FV081T - Diameter 14mm, 
	Height 4.8mm, with 
	integrated catheter 600mm 
	(pediatric).
	Control reservoir: 
	FV048T - Diameter 20mm, 
	Height 5.65mm, with 
Prostheses List by Category, Groups and Sponsor	Page 186 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.03.06 - Shunt Attachment
	04.03.06.01 - Connector
	B Braun Australia Pty Ltd
BB328	Miethke Titanium connectors & 	Titanium, (MRI safe 3 tesla), deflector 	Radio-opaque titanium, 	$200.00
	deflectors	allows 90 degree deflection of the 	connector diameter: 1,9mm 
	ventricular catheter in the burr hole 	for use with catheters of id =
	without kinking, adjustable on 	 1.2mm; of id 1.2mm; od = 
	length of catheter, suture fixture hole	2.5mm
	Integra Neurosciences Pty Ltd
IG007	Heyer-Schulte Connectors for 	Pudenz straight, Pudenz right angled,	Each in one size	$38.00
	Neurosurgical Use	 Pudenz three-way (Y) Threaded 
	straight, Threaded right angled, 
	Double threaded straight
IG022	Connectors	Silicone and Stainless Steel	Straight, right angle, Y, T	$38.00
	Johnson & Johnson Medical Pty Ltd
JJ934	Codman Hydrocephalus Connectors	Metal and plastic connectors	8mm to 20mm length	$38.00
	Medtronic Australasia Pty Ltd
MI022	Shunt Component Connector	Connectors, fixation tabs	Various	$38.00
Prostheses List by Category, Groups and Sponsor	Page 187 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	04.03.06.02 - Right Angled Guide
	B Braun Australia Pty Ltd
BB334	Miethke Titanium connectors - right	In general, titanium connectors are 	Titanium connector: 	$200.00
	 angled / shaped	preferably used with catheters of 	Connector diameter, 1.9mm.
	internal diameter 1.2m and external 	
	diameter 2.5mm.	L-shape:
	Step-down connectors are designed 	FV051T: 1pc
	for connecting standard catheters to 	Y-shape:
	lumbar catheters.	FV015T: 1 pc, FV016T: 5 
	L-P connectors are designed for 	pcs, FV017T: 10 pcs.
	connecting two lumbar catheters to 	T-shape:
	each other.	FV018T: 1 pc, FV019T: 5 
	pcs, FV020T: 10 pcs.
	X-shape:
	FV021T: 1 pc, FV022T: 5 
	pcs, FV023T: 10 pcs.
	Y-shape:
	FV056T: 1 pc.
	U-shape:
	FV057T: 1 pc.
	F-shape:
	FV058T: 1 pc.
	L-shape:
	FV059T: 1 pc.
	Titanium connector, step-
	down: Connector diameters:
	 1.9mm to 1.4mm:
	L-shape: 
	FV052T: 1 pc.
	Titanium connector, L-P 
	drainage: Connector 
	diameters 1.4mm to 1.4mm:
	L-shape: 
	FV053T: 1 pc.
	Integra Neurosciences Pty Ltd
IG052	Electa right angle guide	Silicone	One Size Only	$200.00
Prostheses List by Category, Groups and Sponsor	Page 188 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.04.01 - Implantable Pulse Generator
	04.04.01.01 - Primary Cell Pulse Generator (non-rechargeable)
	Medtronic Australasia Pty Ltd
MC228	Soletra Model 7426 	Sterility - Ethylene Oxide.  	One size only	$9,050.00
	Neurostimualtor comprised of 
	electronic circuitry and a battery, 
	which are hermatically sealed in a 
	titanium case
MI031	Medtronic Activa SC 	Single channel neurostimulator for 	New or Old Header choice	$9,050.00
	Neurostimulator for Deep Brain 	Deep Brain stimulation
	Stimulation
	St Jude Medical Australia Pty Ltd
SJ197	Libra Deep Brain Stimulation 	Implantable pulse generator for deep 	50mm x 54mm x 14mm	$9,050.00
	System - Libra IPG - 6608	brain stimulation - 8 channel
	Dual channel
	Medtronic Australasia Pty Ltd
MC001	Kinetra Dual Channel Implantable 	Titanium, polyurethane	One size only	$15,060.00
	Pulse Generator Model 7428
MC838	Medtronic ACTIVA PC 	ACTIVA PC Dual channel primary 	One size only	$15,060.00
	Neurostimulator for Deep Brain 	cell neuro stimulator for Deep Brain 
	Stimulation	Stimulation (37601)
	St Jude Medical Australia Pty Ltd
SJ171	ANS Spinal Cord Stimulation 	Implantable Pulse Generator - 	One size only	$15,060.00
	System (SCS) GENESIS	Genesis Model 3608
SJ206	Libra XP DBS IPG 6644	Implantable pulse generation for deep 	76mm x 58mm x 14mm	$15,060.00
	brain stimulation - Dual 4 Channel
	04.04.01.02 - Rechargeable Pulse Generator
	Dual channel
	Medtronic Australasia Pty Ltd
MC946	Medtronic ACTIVA RC 	ACTIVA RC Dual channel 	One size only	$19,150.00
	Neurostimulator for Deep  Brain 	rechargeable neurostimulator for Deep
	Stimulation	 Brain Stimulation (37612)
Prostheses List by Category, Groups and Sponsor	Page 189 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	St Jude Medical Australia Pty Ltd
SJ202	Brio DBS Implantable Pulse 	Dual Channel 16 Contact 	29g, 17cc	$19,150.00
	Generator 6788	rechargeable IPG
	Zero Volt Rechargeable
	Boston Scientific Australia Pty Ltd
BS237	Vercise IPG Kit	Dual Channel, 16 Contact, Zero Volt 	One size only	$22,000.00
	Rechargeable Deep Brain Stimulation 
	IPG
04.04.02 - External Components
	04.04.02.01 - Patient Programmer
	Boston Scientific Australia Pty Ltd
BS243	Vercise Remote Control	Remote patient control for DBS	One size only	$1,400.00
	Medtronic Australasia Pty Ltd
MC249	Access Therapy Controller	Handheld device used with the 	One size only	$1,400.00
	Kinetra and Soletra Implantable Pulse
	 Generators
MC837	Medtronic Activa Patient 	Medtronic Activa Patient Programmer	One size only	$1,400.00
	 (Model 37642)
	St Jude Medical Australia Pty Ltd
SJ204	Brio DBS Patient Controller 6856	Patient Controller for DBS	One size only	$1,400.00
	04.04.02.02 - Recharger
	Boston Scientific Australia Pty Ltd
BS245	Vercise Charging System	Recharging system for DBS	N/A	$1,975.00
	Medtronic Australasia Pty Ltd
MC945	Medtronic ACTIVA Recharging 	Recharging System for Deep Brain 	One size only	$1,975.00
	System for Deep Brain Stimulation	Stimulation
Prostheses List by Category, Groups and Sponsor	Page 190 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.04.03 - Leads
	04.04.03.01 - Permanent Lead
	Boston Scientific Australia Pty Ltd
BS238	Boston Scientific DBS Lead Kit	Deep brain stimulation lead with 8 in-	30cm - 45cm	$4,150.00
	line contact electrodes. Independent 
	19-filar platinum-core.
	Medtronic Australasia Pty Ltd
MC244	Medtronic Australasia DBS Lead 	Deep brain stimulation lead with four 	28 - 40cm	$4,150.00
	Model 3389,  Medtronic 	platinum iridium electrodes Models 
	quadripolar Itrel II- 7424DBS, 	3387 and 3389.  Electrode spacing is 
	Active Implantable Stimulator & 	1.5mm apart for Model 3387 and 
	Ancillary Equipment	0.5mm apart for Model 3389.  PTFE, 
	polyurethane, platinum/iridium, 
	nickel alloy, tungsten
	St Jude Medical Australia Pty Ltd
SJ148	Libra Deep Brain Stimulation 	DBS Leads 6142-6145 1.5mm 	25-40cm	$4,150.00
	System  - Leads 6142 - 6149	electrode and space 1.5mm; 6146-
	6149 1.5mm electrode and 0.5mm 
	04.04.03.02 - Lead Extension
	Boston Scientific Australia Pty Ltd
BS239	Boston Scientific DBS Extension Kit	Deep brain stimulation extension kit	55cm	$2,100.00
	Medtronic Australasia Pty Ltd
MC305	Low Profile Impedance Extension 	Silicone Rubber	25, 40, 51, 66, 95cm	$2,100.00
	Kit for DBS Model 7482
MC852	Medtronic Extension for Deep Brain	Medtronic ACTIVA Stretch Coil 	40cm, 60cm, 95cm	$2,100.00
	 Stimulation	Extension for use with ACTIVA RC 
	and PC
MC940	Pocket Adaptors for Deep Brain 	Pocket Adaptors for Deep Brain 	25.5cm and 27.4cm	$2,100.00
	Stimulation	Stimulation (Single and Dual 
MI032	Medtronic Extension for Deep Brain	Extension for Deep Brain Stimulation	40cm, 60cm, 95cm	$2,100.00
	 Stimulation
Prostheses List by Category, Groups and Sponsor	Page 191 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	St Jude Medical Australia Pty Ltd
SJ149	Libra Deep Brain Stimulation 	4 Channel DBS Lead Extension	50-60cm	$2,100.00
	System - Lead Extensions 6345 and 
	6346
SJ234	Pocket Adaptor	IS-1 Pocket Adaptor	25cm and 50cm	$2,100.00
SJ273	Deep Brain Stimulation extensions -	Stretch coil extension for use with all 	50cm, 60cm, 90cm	$2,100.00
	 eXtend Technology	Neuro SJM Implantable pulse 
	generators
04.04.04 - Microtargetting Electrodes
	Medtronic Australasia Pty Ltd
MI073	Medtronic MicroTargeting 	Microelectrodes used for intra-	Various	$1,500.00
	operative recording of neuronal 
	activity for DBS
	St Jude Medical Australia Pty Ltd
SJ198	MicroTargeting Electrodes	Microtargeting mono- and bipolar- 	100-300mm	$1,500.00
	electrodes
04.04.05 - Accessories
	04.04.05.01 - Burr Hole Cover
	Boston Scientific Australia Pty Ltd
BS244	SureTek Burr Hole Cover	Burr hole cover	14mm compatability	$550.00
	Medtronic Australasia Pty Ltd
MC767	Stimloc	Burr Hole Cover	14mm	$550.00
	St Jude Medical Australia Pty Ltd
SJ199	Guardian Burr Hole Cover System	Cranial Burr Hole Cover	14 - 17mm outer diameter	$550.00
	04.04.05.02 - Connectors and cables
	Boston Scientific Australia Pty Ltd
BS242	Boston Scientific DBS OR Cable & 	OR cable and extension for DBS	One size only	$200.00
	Extension
Prostheses List by Category, Groups and Sponsor	Page 192 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC764	Microelectrode Cable	Cable used for intracranial recording 	One size	$200.00
	of neural activity prior to DBS
MC770	Snap Lid Connector	Connector for implanted lead to 	2.5" x 5.0"	$200.00
	external Implantable Pulse Generator
MC842	Medtronic Screening Cable (Twist 	Screening Cable with Twist Lock for 	One size only	$200.00
	Lock)	Intraoperative testing
MC843	Medtronic Screening Cable 	Screening Cable with Alligator Clip 	One size only	$200.00
	(Alligator Clip)	for Intraoperative testing
	04.04.05.03 - Intraoperative accessories
	Boston Scientific Australia Pty Ltd
BS240	Vercise Physician's Spare Kit	Boots accessory kit for DBS	N/A	$175.00
BS241	Boston Scientific DBS Tunneling 	Tunneling tool for DBS - straw, long	N/A	$175.00
	Tool
	Medtronic Australasia Pty Ltd
MC826	Medtronic Accessory Kit for Deep 	Boots accessory kit for DBS (3550-25)	N/A	$175.00
	Brain Stimulation
MI003	Medtronic DBS Tunneling Tool 	DBS Tunneling Tool Accessory Kit	One size only	$175.00
	Accessory Kit
MI119	Electrode Insertion Tube set	Electrode Insertion Tube Set for DBS	One size only	$175.00
04.05.01 - Pulse Generators
	04.05.01.01 - Primary Cell Pulse Generator (non-rechargeable)
	Medtronic Australasia Pty Ltd
MC137	Medtronic A/Asia, Synergy Dual 	DCI - Pulse Generator: Synergy Dual 	One size only	$19,150.00
	Channel Implantable Pulse 	Channel Implantable Pulse Generator 
	Generator Model 7427, Active 	Model 7427. Materials - Titanium 
	Implantable Stimulators.
MC742	Prime Advanced	Implantable Neurostimulator	Dimensions: 65 x 49 x 	$19,150.00
MI135	PrimeAdvanced Surescan MRI 	16 electrode non-rechargeable 	One size only	$19,150.00
	Neurostimulator	implantable neurostimulator for pain 
	management with Surescan MRI 
	technology Model 97702
Prostheses List by Category, Groups and Sponsor	Page 193 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Spinal Modulation
OD015	Axium Neurostimulator System - 	Spinal modulation implantable 	1 size; 31cc (1 presentation)	$19,150.00
	Implantable Neurostimulator	neurostimulator.
	St Jude Medical Australia Pty Ltd
SJ182	Eon Neurostimulation System	Eon Neurostimulation Implantable 	Height = 59mm	$19,150.00
	Pulse Generator #3716
	04.05.01.02 - Rechargeable Pulse Generator
	Emergo Asia Pacific Pty Ltd
ER005	Nevro Spinal Cord Stimulation 	The Implantable Pulse Generator 	N/A	$19,150.00
	System (SCSS) - IPG Kit	(IPG) is a rechargeable implantable 
	device. It is capable of stimulating the 
	spinal cord  nerves through the 
	electrodes of the leads connected to 
	any combination of the output 
	terminals, using one programmable 
	Medtronic Australasia Pty Ltd
MC746	Restore Advanced INS	Implantable Neurostimulator	Dimensions: 65 x 49 x 	$19,150.00
MC929	Medtronic RestoreULTRA 	16 Electrode Rechargeable 	22cc	$19,150.00
	Neurostimulator	implantable Neurostimulator for pain 
	management (37712)
MI133	RestoreUltra Surescan MRI 	16 Electrode rechargeable implantable	One size only	$19,150.00
	Neurostimulator	 neurostimulator for pain management 
	with Surescan MRI technology Model
	 97712
MI134	RestoreAdvanced Surescan MRI 	16 electrode rechargeable implantable 	One size only	$19,150.00
	Neurostimulator	neurostimulator for pain management 
	with Surescan MRI technology Model
	 97713
	St Jude Medical Australia Pty Ltd
SJ133	Eon Mini Neurostimulation System 	Eon Mini Neurostimulation System - 	18cc, 29g	$19,150.00
	- Implantable Pulse Generator 3788	Implantable Pulse Generator 3788
SJ210	Eon C IPG 3688	16 channel non-rechargeable multi-	49cc	$19,150.00
	program implantable pulse generator
Prostheses List by Category, Groups and Sponsor	Page 194 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Adaptive Stimulation
	Medtronic Australasia Pty Ltd
MI004	Medtronic RestoreSensor 	16 Electrode Rechargeable 	22cm3	$24,000.00
	Implantable Neurostimulator	implantable neurostimulator for pain 
	management with AdaptiveStim
MI132	RestoreSensor Surescan MRI 	16 electrode rechargeable implantable 	One size only	$24,000.00
	Neurostimulator	neurostimulator for pain management 
	with AdaptiveStim and Surescan MRI 
	technology
	Adaptive Stimulation, Zero Volt Rechargeable, 32 Electrode IPG
	Boston Scientific Australia Pty Ltd
BS254	Precision Spectra IPG	32-output, multi-channel, zero-volt 	One Size Only	$26,000.00
	rechargeable neurostimulation system 
	IPG with 3D alogrythmic programming
	Zero Volt Rechargeable
	Boston Scientific Australia Pty Ltd
BS104	Precision SCS Implantable Pulse 	Rechargeable Neurostimulation 	One Size Only	$22,000.00
	Generator	System Implantable Pulse Generator.
04.05.02 - External Components
	04.05.02.01 - Patient Programmer
	Boston Scientific Australia Pty Ltd
BS106	Precision SCS External Patients 	Hand held remote control External 	One Size Only	$1,500.00
	Remote Programmer	Patient Programmer
BS253	Precision Spectra Patient Remote 	Hand held remote control External 	One size only	$1,500.00
	Programmer	Patient Programmer
	Medtronic Australasia Pty Ltd
MC247	Patient Activators	Hand held device Models 7434 & 	One size only	$1,500.00
	7435 to be used with Itrel III and 
	Synergy Implantable Pulse 
MC943	Medtronic myStim Patient 	Patient programmer for Restore and 	One size only	$1,500.00
	Programmer	Prime Neurostimulation systems 
	(Model 37743)
MI005	Medtronic myStim Patient 	Patient programmer for implantable 	One size only	$1,500.00
	Programmer (Model 37744)	neurostimulator
Prostheses List by Category, Groups and Sponsor	Page 195 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI138	Surescan MRI Patient programmer	Patient controller for Surescan MRI 	One size only	$1,500.00
	Neurostimulators
	Spinal Modulation
OD017	Axium Neurostimulator System - 	Programmer - patient	1 size (1 presentation)	$1,500.00
	Programmer - Patient
	St Jude Medical Australia Pty Ltd
SJ172	ANS Spinal Cord Stimulation 	Patient Programmer Model 3850	One size only	$1,500.00
	System (SCS) GENESIS
SJ177	ANS Spinal Cord Stimulation 	QuikLink Patient Programmer Model 	One Size Only	$1,500.00
	System (SCS) GENESIS	3860
SJ183	Eon Neurostimulation System	Eon Programmer #3851	.	$1,500.00
	04.05.02.02 - Patient Programmer Antenna
	Medtronic Australasia Pty Ltd
MC694	Restore Rechargeable 	External Patient Programmer Antenna 	One size only	$178.00
	Neurostimulation System	Model 37092
	04.05.02.03 - On/Off switching device
	Emergo Asia Pacific Pty Ltd
ER009	Nevro Spinal Cord Stimulation 	The patient remote control is a 	N/A	$1,400.00
	System (SCSS) - Patient Remote Kit	handheld, battery operated unit able 
	to communicate via radiofrequency 
	(RF) with the Implantable Pulse 
	Generator and trial stimulator
	St Jude Medical Australia Pty Ltd
SJ173	ANS Spinal Cord Stimulation 	Communication Magnet Model 1210	One type only	$1,400.00
	System (SCS) GENESIS
	04.05.02.04 - Recharger
	Boston Scientific Australia Pty Ltd
BS105	Precision SCS External Patient 	External Patient Recharging System: 	One Size Only	$1,346.00
	Recharger	Base Station, charger, Cradle power 
	supply, charger base station
Prostheses List by Category, Groups and Sponsor	Page 196 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS143	Precision SCS External Patient 	External Patient Recharging System: 	One size only	$1,346.00
	Recharger System	Base Station, Charger, Cradle power 
	supply, charger base station.
	Emergo Asia Pacific Pty Ltd
ER008	Nevro Spinal Cord Stimulation 	The Charger is a battery powered 	N/A	$1,346.00
	System (SCSS) - Charger Kit	rechargeable device intended to 
	recharge the Implantable Pulse 
	Generator (IPG) battery 
	transcutaneously
	Hospira Pty Limited
HO004	Gemstar rechargeable system	Rechargeable battery, docking 	One size	$1,346.00
	station, AC adaptor and carry case for 
	use with the Gemstar infusion system.
	Medtronic Australasia Pty Ltd
MC692	Restore Rechargeable 	External Patient Recharger System 	one size only	$1,346.00
	Neurostimulation System	Model 37752
MI006	Medtronic External Patient 	Patient recharger system for 	One size only	$1,346.00
	Recharger System Model 37754	implantable neurostimulator
MI139	Medtronic Patient Recharger System	Recharging system for Surescan MRI 	One size only	$1,346.00
	Neurostimulators Model 97754
	St Jude Medical Australia Pty Ltd
SJ203	Brio DBS Charging System 6721	Charging System Model 6721	One size only	$1,346.00
SJ209	Eon Mini Neurostimulation System 	Charging System Model 3721	One size only	$1,346.00
	- Charging System Model 3721
SJ211	Eon Neurostimulation System - 	Mobile Charging System	One size	$1,346.00
	Mobile Charging System 3711
04.05.03 - Leads
	04.05.03.01 - Permanent Lead
	>8 electrodes
	Boston Scientific Australia Pty Ltd
BS110	Precision SCS 16 Point Leads	16 contact point leads with 	50cm - 70cm	$7,640.00
	independent current controlled.
	Medtronic Australasia Pty Ltd
MC776	Specify 5-6-5 Surgical Lead	Triple Array 16 Electrode Surgical 	30, 65cm	$7,640.00
	Lead with Duraloc Technology
Prostheses List by Category, Groups and Sponsor	Page 197 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC942	Specify 2x8 Surgical Lead	Surgical Lead	30cm and 65cm	$7,640.00
	St Jude Medical Australia Pty Ltd
SJ138	Lamitrode Lead - Tripole 16C	Tripole 16C - 3214, 3128, 3219, 	30-110cm	$7,640.00
	3220, 3221
SJ169	ANS Spinal Cord Stimulation 	Lamitrode Dual 8 Plate Electrode Lead	One size only	$7,640.00
	System (SCS)
SJ191	Lamitrode C Series Leads	Lamitrode C Series, 16 Channel, 	Length = 60cm	$7,640.00
	Model # 3289
SJ231	Penta Leads	Paddle leads (Penta Leads have a 	2-3mm, 30cm-110cm	$7,640.00
	curved paddle instead of a 
	conventional flat paddle)
	≥32 electrodes
	Boston Scientific Australia Pty Ltd
BS255	CoverEdge 32 Contact Surgical 	CoverEdge 32 has 4x8 tightly-spaced 	Up to 70cm in length	$12,200.00
	electrodes and CoverEdge 32 X has 
	4x8 widely-spaced electrodes.
	4 electrodes
	Medtronic Australasia Pty Ltd
MC827	Medtronic Pisces Quad Leads	Pisces Quad Lead (3487A), Pisces 	Various	$3,400.00
	Quad Compact Lead (3887), Pisces 
	Quad Plus Lead (3888)
MC828	Medtronic Resume Surgical Leads	Surgical Leads - Resume II (3587A), 	25cm	$3,400.00
	Resume TL (3986A)
MC829	Medtronic On Point Lead	On point peripheral nerve lead kit 	25cm	$3,400.00
	(3987A)
	Spinal Modulation
OD021	Axium Neurostimulator System - 	Implant lead kit.	Package containing either 	$3,400.00
	Implant Lead Kit	50cm or 90cm lead
	St Jude Medical Australia Pty Ltd
SJ162	ANS Spinal Cord Stimulation 	Quattrode Lead. 4 Electrode.	30cm, 60cm, 90cm 110cm	$3,400.00
	System (SCS)
SJ186	Lamitrode S Series Leads	Lamitrode S Series, 4 Channel, Model 	Length = 30cm	$3,400.00
	# 3243
SJ187	Lamitrode S Series Leads	Lamitrode S Series, 4 Channel, Model 	Length = 60cm, 90cm, 	$3,400.00
	# 3246
Prostheses List by Category, Groups and Sponsor	Page 198 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	8 electrodes
	Boston Scientific Australia Pty Ltd
BS109	Precision SCS Eight Contact Leads	Eight contact percutaneous leads.	30cm to 70cm	$4,230.00
	Emergo Asia Pacific Pty Ltd
ER006	Nevro Spinal Cord Stimulation 	The percutaneous lead is intended to 	Spacing: 1-9mm spacing, 1-	$4,230.00
	System (SCSS) - Lead Kit	be single use and interfaces with the 	9mm in 1mm increments; 
	Implantable Pulse Generator, lead 	Length: 30-90cm in 5cm 
	extender OR cable, and lead 	increments
	accessories.
	Medtronic Australasia Pty Ltd
MC135	Medtronic Specify Lead	8 electrode surgical lead kit	One size only	$4,230.00
MC361	2X4 Hinged Surgical Lead model 	Materials: silicone rubber, platinum-	30, 45 & 60cm	$4,230.00
	3999	iridium, polyurethane
MC690	Neurostimulation System - Octad 	Octad Standard Lead Kit without 	45, 60 & 75cm	$4,230.00
	Leads	Percutaneous Extension Model 3777,
MC710	Neurostimulation System - Octad 	Octad Standard Lead Kit with 	45, 60 & 75cm	$4,230.00
	Leads	Percutaneous extension model 3877
MC711	Neurostimulation System - Octad 	Octad Compact Lead Kit without 	45, 60 & 75cm	$4,230.00
	Leads	Percutaneous Extension Model 3778
MC712	Neurostimulation System - Octad 	Octad Compact Lead Kit with 	45, 60 & 75cm	$4,230.00
	Leads	Percutaneous Extension Model 3878
MC740	SCS Sub Compact Lead	Octad Sub Compact Lead Kit without 	45, 60 and 75cm	$4,230.00
	Percutaneous Extension Model 3776
MC759	SCS Sub Compact Lead	Ocatd Sub Compact Lead Kit with 	45, 60 and 75cm	$4,230.00
	Percutaneous Extension Model 3876
MI136	Vectris Surescan MRI 	Octad Compact Lead Kit Model 	60cm, 75cm, 90cm	$4,230.00
	Neurostimulation Leads	977A2, Subcompact lead Kit Model 
	977A1
	St Jude Medical Australia Pty Ltd
SJ161	ANS Spinal Cord Stimulation 	Octrode Lead. 8 Electrode (thoracic or	30cm, 60cm, 90cm 110cm	$4,230.00
	System (SCS)	 cervical placement).
SJ168	ANS Spinal Cord Stimulation 	Lamitrode Plate Electrode	60cm, 90cm, 110cm	$4,230.00
	System (SCS)
SJ184	Lamitrode S Series Leads	Lamitrode S Series, 8 Channel, Model 	Length = 30cm	$4,230.00
	# 3283
Prostheses List by Category, Groups and Sponsor	Page 199 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SJ185	Lamitrode S Series	Lamitrode S Series, 8 Channel, Model 	Length = 60cm, 90cm, 	$4,230.00
	# 3286
SJ188	Lamitrode C Series Leads	Lamitrode C Series, 8 Channel, Model 	Length = 60cm, 90cm, 	$4,230.00
	# 3245	110cmm
	04.05.03.02 - Trial Lead 
	Boston Scientific Australia Pty Ltd
BS118	Precision SCS Lead Blanks	Lead Blank	One Size Only	$485.00
BS119	Precision SCS Trial Leads	Trial Leads	30cm - 70cm	$485.00
	Medtronic Australasia Pty Ltd
MI137	Medtronic Vectris Neurostimulation	Octad Compact Trial lead Kit Model 	60cm	$485.00
	 Trial Lead	977D2 and Subcompact Model 
	Spinal Modulation
OD023	Axium Neurostimulator System - 	The Leads are designed for 	1 package containing the 	$485.00
	Trial Lead Kit	percutaneous introduction into the 	50cm lead - MN20350-
	body using special needle and a set of 	50AU
	custom delivery tools provided in 	1 package containing the 
	their respective kits. Each lead has 4 
	cylindrical electrodes spaced at equal 
	intervals, intended to provide 
	stimulation at the target dorsal root 
	ganglion.
04.05.04 - Lead Extension
	Boston Scientific Australia Pty Ltd
BS111	Precision SCS Lead Extensions	Lead Extensions	25cm to 55cm	$1,510.00
BS158	Precision Connector M1	Lead extension for Precision SCS 	35. 55. 70 cm length	$1,510.00
	System
BS169	Precision SCS Splitter	Lead extension for connection of 	Multiple Configurations	$1,510.00
	multiple leads
Prostheses List by Category, Groups and Sponsor	Page 200 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER007	Nevro Spinal Cord Stimulation 	The lead extender is intended to be 	Length: 15cm-60cm, in 	$1,510.00
	System (SCSS) - Lead Extension Kit	used when the implant site for the 	increments of 5cm
	Implantable Pulse Generator is too far 
	from the stimulation site to directly 
	connect the stimulation lead.
ER102	Nevro Spinal Cord Stimulation 	The Pocket Adaptor is intended to be 	Length of 10cm to 60cm, in 	$1,510.00
	System (SCSS) - Pocket Adaptor Kit	used when replacing a previously 	increments of 1cm.
	 - S8	implanted Pulse Generator with the 
	Nevro Implantable Pulse Generator. 
	The Pocket Adaptor interfaces the 
	Nevro Implantable Pulse Generator to
	 another manufacturer's previously 
	implanted compatible lead or lead 
	extension.
ER130	Nevro Spinal Cord Stimulation 	The Pocket Adaptor is intended to be 	Length of 10cm to 60cm, in 	$1,510.00
	System (SCSS) - Pocket Adaptor Kit	used when replacing a previously 	increments of 1cm
	 - M8	implanted Pulse Generator with the 
	Nevro Implantable Pulse Generator. 
	The Pocket Adaptor interfaces the 
	Nevro Implantable Pulse Generator to
	 another manufacturer's previously 
	implanted compatible lead or lead 
	extension
	Medtronic Australasia Pty Ltd
MC315	Low Profile Impedance Extension 	Silicone rubber	10, 25, 40, 51, 66cm	$1,510.00
	Kit for SCS Model 7489
MC688	Neurostimulation System - 	1 x 8 Synergy Extension Kit Model 	20, 40 & 60cm	$1,510.00
	7472; 1 x 8 Extension Kit Model 
MC733	Quadripolar Stretch-Coil 	Model 37083 Single, Silver and 	20cm - 60cm	$1,510.00
	Silicone Rubber
MC734	Quadripolar Stretch-Coil 	Model 37082 Bifurcated, Silver and 	20cm - 60cm	$1,510.00
	Silicone Rubber
MC941	Pocket Adaptors for Spinal Cord 	Pocket Adaptors for Spinal Cord 	25.5cm and 27.4cm	$1,510.00
	Stimulation	Stimulation (Single and Dual 
	Spinal Modulation
OD020	Axium Neurostimulator System - 	Lead extension kit.	1 size (1 presentation)	$1,510.00
	Lead Extension Kit
Prostheses List by Category, Groups and Sponsor	Page 201 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	St Jude Medical Australia Pty Ltd
SJ160	ANS Spinal Cord Stimulation 	Lead Extensions - in addition to 	60cm length	$1,510.00
	System (SCS)	3341, 3342, 3343, 3382 and 3383, 
	additional model 3346 - Dual Quad 
	Extension and 3386 - single octrode 
SJ178	A127 Lead Extension	A127 Lead Extension	15cm, 40cm, 60cm, 90cm	$1,510.00
04.05.05 - Accessories
	04.05.05.01 - Revision Kits
	Boston Scientific Australia Pty Ltd
BS120	Precision SCS Revision Pack	Lead Revision Pack; Hex Wrench, 	One Size Only	$545.00
	Tunnelling Tool, Clik Anchor, 
	Insertion Needles in four(4) sizes
	Medtronic Australasia Pty Ltd
MC094	Stimulator Accessory Kit - Pisces 	Model 3550-10 revision kit. 1 x boot, 	One size only	$545.00
	Quad; Pisces Z Lead Revision Kit; 	1 x twistlock anchor, 2 x silicone 
	Pisces Quad Revision Kit; Octad 	anchors, 1 x hex wrench, 1 x epidural 
	Revision Kit	needle 15 gauge, 1 x percutaneous 
	extension (inline) with set screws, 1 x 
	ball-tipped (bent) 28cm stylet for 
	Pisces-Quad lead, 1 x ball-tipped (
MC689	Lead Revision Kits	Sterile Revision Kit for Octad leads 	30 & 45cm; 60 & 75cm	$545.00
	45cm (3550-26), Sterile Revision Kit 
	for Octad leads 60-75cm (3550-27)
MI140	Revision kit Surescan MRI leads	Sterile Revision Kit for Surescan MRI 	60cm, 75cm, 90cm	$545.00
	leads
	Spinal Modulation
OD018	Axium Neurostimulator System - 	Lead accessories kit.	1 size (1 presentation)	$545.00
	Lead accessories kit
	04.05.05.02 - Plug
	Boston Scientific Australia Pty Ltd
BS121	Precision SCS IPG Port	IPG Port Plug	One Size Only	$168.00
Prostheses List by Category, Groups and Sponsor	Page 202 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER042	Nevro Spinal Cord Stimulation 	The Implantable Pulse Generator 	N/A	$168.00
	System (SCSS) - IPG Port Plug Kit	(IPG) Port Plug is provided to seal 
	the port of the IPG that is not is use.
	Medtronic Australasia Pty Ltd
MC687	Neurostimulation System - 	Lead Accessory Plug and Closed 	.	$168.00
	Accessory Kits	Boot Kit Model 3550-29
MC825	Medtronic Percutaneous Quad 	Percutaneous extension (in line 	One size only	$168.00
	extension	connector for quadripolar leads only)
MI050	Synergy IPG Connector Plug	Synergy IPG Connector Plug	Various	$168.00
	St Jude Medical Australia Pty Ltd
SJ290	Port Plug	Port Plug	One size only	$168.00
SJ291	Port Plug, Eon IPG	Port Plug, Eon IPG	One size only	$168.00
	04.05.05.03 - Intraoperative Accessories
	Boston Scientific Australia Pty Ltd
BS246	Introducer Kit	Introducer intended for the 	Length: 13cm; 23cm.	$168.00
	percutaneous introduction and 
	placement of leads.
BS247	Stylet Kit	Stylet Kit with steering cap and stiffer	Stiffer stylet length: Up to 	$168.00
	 stylet	70cm
BS249	Medical Adhesive	Medical adhesive is used to assist in 	One size	$168.00
	fixing the lead to the suture sleeve.
BS256	Tunnelling Tools	Aid in placement of leads.	Various	$168.00
BS257	Wrenches	Used to secure leads and anchors.	One size only	$168.00
BS258	Insertion Needles	Aid in placement of leads.	Various	$168.00
BS259	Passing Elevators and Paddle 	Aid in placement of leads, helps verify	Various	$168.00
	 that the epidural space is cleared.
Prostheses List by Category, Groups and Sponsor	Page 203 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER036	Nevro Spinal Cord Stimulation 	The Coiled Lead Blank made out of 	N/A	$168.00
	System (SCSS) - Coiled Lead Blank 	stainless steel is optionally used 
	Kit	during surgery to clear a path for the 
	introduction of the SCS Lead into the 
	epidural space. The coiled lead blank 
	is a tool used to help clear 
	obstructions within the cannula of the
	 insertion needle and may be used by 
	the physician to verify access to the 
	epidural space.
ER037	Nevro Spinal Cord Stimulation 	The Insertion Needle is used during 	Length: 5-15cm, in 	$168.00
	System (SCSS) - Insertion Needle Kit	implant surgery to introduce the Lead 	increments of 1cm
	between the vetebra into the epidural 
	space. The insertion needle is a two 
	part needle that contains a cannula 
	and stylet to facilitate access to the 
	spinal canal for lead placement
ER038	Nevro Spinal Cord Stimulation 	The Tunneling Tool creates a 	Length: 20-50cm, in 	$168.00
	System (SCSS) - Tunneling Tool Kit	subcutaneous tunnel from the 	increments of 1cm
	Implantable Pulse Generator (IPG) 
	site to the midline incision. The 
	tunneling tool is passed 
	subcutanously to deliver the leads 
	from needle insertion site to the IPG 
ER039	Nevro Spinal Cord Stimulation 	The cables are used during the Lead 	N/A	$168.00
	System (SCSS) - Cable Kit	implant procedure and patient trial to 
	make electrical and mechanical 
	connections between the Trial 
	Stimulator and the Lead or Lead 
	extension. There is a separate adaptor 
	cable that allows the use of the 
	Medtronic lead with the Nevro Senza 
	System
Prostheses List by Category, Groups and Sponsor	Page 204 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ER040	Nevro Spinal Cord Stimulation 	The Lead Anchors are used to anchor 	N/A	$168.00
	System (SCSS) - Lead Anchor Kit	the lead to the fascia or supraspinous 
	ligament. Lead Anchors are designed 
	to slide freely over the lead length to 
	the required fixation position and 
	sutures are then tied around the 
	anchor clamping the sleeve in place 
	on the lead.
ER041	Nevro Spinal Cord Stimulation 	The Torque Wrench is used to tighten 	N/A	$168.00
	System (SCSS) - Torque Wrench Kit	the set screws that lock the lead into 
	the Implantable Pulse Generator or to 
	lock the lead into a lead extension
ER043	Nevro Spinal Cord Stimulation 	The Implantable Pulse Generator 	N/A	$168.00
	System (SCSS) - IPG Template Kit	(IPG) Template is an aid for the 
	physician to assist in the proper 
	sizing of the IPG pocket.
ER044	Nevro Spinal Cord Stimulation 	The Stylets are used to push and 	Offered in Straight, Curved 	$168.00
	System (SCSS) - Stylet Kit	"steer" the stimulation Lead into 	or Tapered versions.
	place. These are standard 	Diameter: 0.3mm or 0.35, 
	configurations offered across industry 	Length:30-90cm in 5cm 
	offering the implanter the flexibility to	increments, 
	 maneuver the leads through the 	Angle: 15-30 degrees in 5 
	epidural space to the desired implant 	degree increments
	Medtronic Australasia Pty Ltd
MC731	Titan Anchor	Silicone with titanium insert	One size only	$168.00
MC930	3550-P4 Passing Elevator 	Kit Contents: 4 Passing Elevators 	One size	$168.00
	Accessory Kit	compatible with various leads
MC931	3550-63 Percutaneous Lead 	Percutaneous Lead Introducer 	One size only	$168.00
	Introducer Accessory Kit	Accessory Kit
MC951	Multi-Lead Trialing Cable	Connector for implanted lead to 	One size only	$168.00
	External Neurostimulator
MI038	Medtronic Neurostimulation 	Accessories for implant of 	One size only	$168.00
	Accessories (Wrenches and screws)	neurostimulation lead
MI039	Medtronic Neurostimulation 	Accessories for implant of 	Various	$168.00
	Accessories (Needles)	neurostimulation lead
MI051	Medtronic Neurostimulation 	Tunnelling Tools	Various	$168.00
	Tunnelling Tools
Prostheses List by Category, Groups and Sponsor	Page 205 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI052	Medtronic Neurostimulation 	EZ Anchor, Boot and Anchor Kit	Various	$168.00
	Accessory Kits
MI055	Medtronic Pocket Sizer	Implant accessory designed to aid in 	One size only	$168.00
	the creation of a pocket for Medtronic 
	implantable neurostimulators.
MI067	Injex Anchor Kit	Neurostimulation Anchor Kit	One Size	$168.00
	Spinal Modulation
OD019	Axium Neurostimulator System - 	Connector cable kit.	1 size (1 presentation)	$168.00
	Connector Cable Kit
OD022	Axium Neurostimulator System - 	Tunneling tool.	30cm or 51cm	$168.00
	Tunneling Tool
	St Jude Medical Australia Pty Ltd
SJ285	Strain Relief	Strain Relief	One size only	$168.00
SJ286	Anchor (Swift Lock)	Swift Lock Anchor	One size only	$168.00
SJ287	Anchor (Cinch)	Cinch Anchor	One size only	$168.00
SJ288	Anchor (Butterfly)	Lead Anchor (Butterfly)	One size only	$168.00
SJ289	Anchor (long)	Lead Anchor (Long)	One size only	$168.00
SJ302	Epidural Needle	A tool used to introduce a lead 	14-15 Gauge, 4-6 inch	$168.00
	percutaneously.
SJ303	Dual Quad Trial Adaptor	A tool used to connect two four-	One size	$168.00
	contact leads to a single port of a non-
	sterile external power source.
SJ304	Introde-AK Lead Introducer	A flexible tool passed over a partially-	4" and 9"	$168.00
	implanted lead or guide wire in order 
	to establish the appropriate pathway 
	for a lead to follow in the epidural 
	space despite obstructions.
SJ305	Tunneling Tool	A tool used to creat a subcutaneous 	12", 20"	$168.00
	passage to pass the lead from the lead 
	implant site to the IPG pocket site.
SJ306	Guide Wire for Percutaneous Leads	A tool used to establish and/or access	One size	$168.00
	 the appropriate pathway in the 
	epidural space before implanting the 
SJ307	Straight and Curved Stylet	A tool used to aid in positioning and 	30cm - 90cm	$168.00
	repositioning the lead intra-
	operatively to ensure accurate 
Prostheses List by Category, Groups and Sponsor	Page 206 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SJ308	Torque Wrench	A tool to set or release the IPG 	One size	$168.00
	setscrew that connects an implanted 
	lead to the IPG header.
SJ315	Standard Trial Cable Octrode and 	Connector which connects implanted 	One size	$168.00
	Quattrode	lead to external stimulator
	04.05.05.04 - Lead Delivery System
	Spinal Modulation
OD016	Axium Neurostimulator System - 	22cm delivery sheath kit - small curve 	2 sizes (2 presentations)	$730.00
	22cm Delivery Sheath Kit - small 	and big curve.	1 x Big Curve -
	curve and big curve	MN23950AU
	1 x Small Curve - 
	St Jude Medical Australia Pty Ltd
SJ283	Epiducer - Lead Delivery System	Lead Delivery System	13cm, 19cm	$730.00
	04.05.05.05 - Connectors and Cables
	Boston Scientific Australia Pty Ltd
BS248	OR Cable	OR Cable	Lengths up to 65cm	$200.00
	Medtronic Australasia Pty Ltd
MI049	Medtronic Neurostimulation 	Screening Cable	One size only	$200.00
	Screening Cable
04.06.01 - Implantable Infusion Pump 
	Variable Flow Rate
	Johnson & Johnson Medical Pty Ltd
JJ838	MedStream - Programmable Infusion 	Programmable infusion pump - variable	20-40ml	$16,250.00
	Pump
	Medtronic Australasia Pty Ltd
MC313	Synchro Med II Pump	Model No's 8637-20 & 8637-40, 	20 ml & 40 ml	$16,250.00
	Composition - Titanium
Prostheses List by Category, Groups and Sponsor	Page 207 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.06.02 - Patient Programmer
	Medtronic Australasia Pty Ltd
MC944	8835 Personal Therapy Manager for 	Personal Therapy Manager for 	One size only	$1,500.00
	Synchromed Pumps	SynchroMed II implantable infusion 
	pumps
04.06.03 - Intrathecal Catheter
	04.06.03.02 - Two piece
	Johnson & Johnson Medical Pty Ltd
JJ840	MedStream - Spinal 2 piece Catheter 	Surestream and Codman Intraspinal 	100-105cm	$1,100.00
	Kit	two piece catheter kit. Includes 
	catheter, guide wire, connectors, 
	anchors, tuohy needle, wing clip hub, 
	flushing adapter, ruler and data 
	Medtronic Australasia Pty Ltd
MC741	Indura Intrathecal Catheter	Sutureless pump connector, Silicone, 	One size only	$1,100.00
	Titanium and Nylon
	Reinforced
	Medtronic Australasia Pty Ltd
MI027	Medtronic Ascenda Intrathecal 	Intrathecal Catheter	114cm, 140cm	$1,100.00
	Catheter
Prostheses List by Category, Groups and Sponsor	Page 208 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
04.06.04 - Accessories 
	Medtronic Australasia Pty Ltd
MI028	Medtronic Ascenda Component 	Accessories for implantable drug 	One size	$163.00
	Accessory Kits	pumps
	
	The Ascenda Kit consists of single-
	use aids integral for implanting the 
	Intrathecal Catheter (App 028), which
	 are only suitable for use with the 
	patient in whom the intrathecal 
	catheter is implanted.
	
	Kit includes:
	- Anchor with anchor dispenser
	- Anchor removal tool
	- Catheter connector with 2 attached 
	coils.
	
	The Ascenda provides better 
	stabilization and reduced catheter 
	dislodgement due to a newly 
	designed anchor and dispensing tool.
MI047	Intrathecal catheter accessory	Synchromed connector (40 degree)	One size only	$163.00
MI048	Intrathecal catheter accessory	Tunnelling rods - Stainless steel	38-60cm	$163.00
	04.06.04.01 - Revision Kit
	Johnson & Johnson Medical Pty Ltd
JJ839	MedStream - Replacement Connector	Replacement connector with strain 	One size only	$600.00
	relief sleeve
	Medtronic Australasia Pty Ltd
MC774	8578 Sutureless Pump Connector	Sutureless Pump Connector: Material 	One size only	$600.00
	radiopaque silicon titanium, nylon
MC817	Medtronic Intrathecal Catheter 	Revision kit to repair proximal end of 	66cm	$600.00
	Revision Kit (Proximal)	intrathecal catheter (8596SC)
MC818	Medtronic Intrathecal Catheter 	Revision kit to repair distal end of 	38.1cm	$600.00
	Revision Kit (Distal)	intrathecal catheter (8598A)
Prostheses List by Category, Groups and Sponsor	Page 209 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI029	Medtronic Ascenda Spinal Segment 	Intrathecal Catheter Spinal Segment 	One Size	$600.00
	Revision Kit	Revision Kit
MI030	Medtronic Ascenda Pump Segment 	Intrathecal Catheter Pump Segment 	One Size	$600.00
	Revision Kit	Revision Kit
	04.06.04.02 - Refill/Catheter Access Kits
	Medtronic Australasia Pty Ltd
MI040	Medtronic Infusion Pump 	Accessories for refill/catheter access of	Various	$40.00
	 infusion pumps
04.07.01 - Vagal nerve stimulators
	04.07.01.01 - Implantable pulse generator
	Aurora BioScience Pty Ltd
RA001	VNS Therapy Pulse/Pulse Duo	Model 102/102R Generator	One size only	$12,670.00
	04.07.01.02 - Lead
	Aurora BioScience Pty Ltd
RA002	VNS Therapy Lead	Model 302	One size only	$3,400.00
04.08.01 - Stent
	Covidien Pty Ltd
AS196	Solitaire	Solitaire Neurovascular Remodelling 	Diameter: 3-6mm	$7,500.00
	Device is a self-expanding, fully 	Length: 15-40mm
	retrievable device which can be 
	delivered and deployed by a single 
	operator.
	Culpan Medical Pty
CB012	LVIS Intraluminal Support Device	Self-expanding intracranial vascular 	Diameters: 2.5, 3.0, 4.0, 	$7,500.00
	stent	5.5mm
	Lengths: 15, 16, 17, 24, 25, 
	35, 41, 49mm
Prostheses List by Category, Groups and Sponsor	Page 210 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ650	Cordis Enterprise Vascular 	Closed Cell Design Nitinol 	4.5 mm in diameter and 4 	$7,500.00
	Reconstruction Device and 	Neurovascular	different lengths:  14mm, 
	Delivery System	22mm, 28mm and 37mm
MN149	Pharos Neurovascular Stent	Balloon expandable stent for treatment	Diameter 2.0mm-5.0mm, 	$7,500.00
	 of intracranial artery stenosis and 	length 8mm-40mm
	aneurysm
	N Stenning & Co Pty Ltd
NG053	Leo+	Leo+ Stent	D 2.0mm L 8mm, 12mm, 	$7,500.00
	15mm, 25mm.
	D 2.5mm L 12mm, 18mm, 
	25mm.
	D 3.5mm L 12mm, 18mm, 
	25mm, 35mm.
	D 4.5mm L 15mm, 20mm, 
	25mm, 30mm, 40mm, 50mm.
	
	D 5.5mm L 25mm, 30mm, 
	35mm, 50mm, 75mm.
	Stryker Australia Pty Ltd
HW464	Neuroform Microdelivery Stent 	Nitinol Self-Expanding Stent, 3fr 	Diameter 2.5 - 4.5 mm	$7,500.00
	System	delivery catheter, peelable sheath, 2fr 	Length 10 - 30 mm
	stabilising catheter, rotating 
	haemostasis valve (x2)
HW469	Neuroform EZ Stent System	Self expanding Nitinol stent with 	2.5-4.5mm	$7,500.00
	delivery system
HW470	Wingspan Stent System	Wingspan Self Expanding Nitonol 	Stent diameters: 2.5mm to 	$7,500.00
	Stent and delivery catheter	4.5mm; Stent lengths: 
	9.0mm to 20.0mm
04.08.02 - Coils
	Cook Medical Australia Pty Ltd
WC061	Detachable Coil System	Microembolisation Coils - Platinum	011/018 2-20mm diameter, 2	$1,505.00
	 - 50cm length
Prostheses List by Category, Groups and Sponsor	Page 211 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Covidien Pty Ltd
AS193	Axium Detachable Coil System	Platinum alloy coils (including coils 	Diameter:  1.5 - 25mm; 	$1,505.00
	enlaced with PGLA filaments and 	Length:  1 - 50cm
	Nylon Fibers)  attached to a 
	composite implant delivery pusher 
	with a radiopaque positioning marker.
	  The proximal end of the pusher is 
	loaded into the Actuator which 
	detaches the coil.
	Culpan Medical Pty
CB010	Hydrocoils	Framing and filling coils with 	Diam: 1-24mm	$1,505.00
	Length: 1-50cm
CB011	Microplex Coils	Framing and filling coils	Diam: 1-24mm	$1,505.00
	Length: 1-68cm
	ev3 Australia Pty Ltd
EE034	Concerto Detachable Coil System	Platinum alloy coils (including coils 	Diameter:  1.5 - 25mm; 	$1,505.00
	enlaced with PGLA filaments and 	Length:  1 - 50cm
	Nylon Fibers)  attached to a 
	composite implant delivery pusher 
	with a radiopaque positioning marker.
	  The proximal end of the pusher is 
	loaded into the Actuator which 
	detaches the coil.
	Johnson & Johnson Medical Pty Ltd
JJ859	Trufill DCS Orbit Detachable Coil 	Helical, Standard and Complex	1.5 to 30cm	$1,505.00
	System
MN137	Ultipaq Microcoil System	Platinum Coil	2 to 4mm loop diameter	$1,505.00
MN139	Helipaq Microcoil System	Platinum Coil	2 to 20mm coil diameter	$1,505.00
MN140	Micrusphere Microcoil System	Platinum Coil	2 to 18mm loop diameter	$1,505.00
MN142	Helipaq Microcoil System	Cerecyte coils	2 to 20mm loop diameter	$1,505.00
MN143	Ultipaq Microcoil System	Cerecyte coils	2 to 4mm loop diameter	$1,505.00
MN144	Micrusphere Microcoil System	Cerecyte coils	2 to 18mm loop diameter	$1,505.00
MN145	Presidio Microcoil System	Cerecyte coils	4 to 20mm loop diameter	$1,505.00
MN146	Cashmere Microcoil System	Platinum and Cerecyte coils	2 to 12mm loop diameter	$1,505.00
MN165	Delta Coiling Systems	Triangular (Delta) wind endovascular 	1.5 to 24mm diameter	$1,505.00
	coils
Prostheses List by Category, Groups and Sponsor	Page 212 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Penumbra Neuro Australia Pty Ltd
PN003	Penumbra Coil System / Penumbra 	Frame configuration coil, three-	Diameters: 3-24mm	$1,505.00
	Complex Standard Coil 400	dimensional complex shape, stiffest 	Lengths: 6-57cm
	coil within the system, first coil to be 
	placed, frames area of embolisation and
	 holds subsequent coils within this 
PN004	Penumbra Coil System / Penumbra 	Fill configuration coil is used to fill 	Diameters: 3-24mm	$1,505.00
	Complex Soft Coil 400	empty space within the frame coil. The 	Lengths: 6-57cm
	stiffness allows for a traumatic 
	interaction with the aneurysm wall 
	and primary packing of the occlusion 
	site (aneurysm).
PN005	Penumbra Coil System / Penumbra J 	Finish Coil Implant (J Soft) fills small 	Lengths: 1-15cm	$1,505.00
	Soft Coil 400	empty pockets remaining within the 
	occlusion site. The J shaped tip and 
	stiffness allows the coils to 
	manoeuvre and fill the remaining 
	pockets after use of the primary Fill 
PN006	Penumbra Coil System / Penumbra 	The Soft Finish Coil Implant (Curve 	Diameters: 2-4mm	$1,505.00
	Curve Extra Soft 400	Extra Soft) is used for final packing of 	Lengths: 1-20cm
	the aneurysm. The serpentine shape 
	and the lowest stiffness allow the 
	coils to manoeuvre and fill any 
	remaining pockets after use of the 
PN009	Penumbra Complex Extra Soft Coil 	The Soft Finish Coil Implants 	Secondary diameters: 2-	$1,505.00
	400	(Complex Extra Soft) are used for final 	4mm; Lengths: 2-10mm
	packing of the aneurysm. The coil 
	combines the shape of the complex 
	standard coil, with the lowest 
	stiffness of the Curve Extra Soft coil. 
	The Soft Finish Coil Implants are 
	available in varying diameters and 
	lengths to accommodate physician 
	need.
	Stryker Australia Pty Ltd
HW465	GDC 360 Shaped Detachable Coil	Stretch-Resistant Bare Platinum Coil, 	Length: 5cm to 40cm; 	$1,505.00
	360 Shape	Diameter: 2mm to 24mm
HW467	Target Detachable Coils	Detachable GDC coils	2mm-15mm diameter  1cm to 	$1,505.00
	40cm length
HW471	Guglielmi Detachable Coil (GDC)	Stretch-Resistant Bare Platinum Coil	2-20mm x 4-30cm	$1,505.00
Prostheses List by Category, Groups and Sponsor	Page 213 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW472	Matrix Detachable Coils	PGLA-Coated, Stretch-Resistant, 	Length: 2cm to 40cm, 	$1,505.00
	Platinum Coils	Diameter: 2mm to 24mm
04.08.03 - Assist Devices
	04.08.03.01 - Catheters
	Covidien Pty Ltd
AS198	ev3 Occlusion Balloon Catheters	Single lumen balloon catheter to 	3-7mm diameter; 7-30mm 	$700.00
	temporarily occlude the central lumen 	length
	allowing inflation of the balloon 
	during neurosurgical and vascular 
AS201	Marksman Microcatheters	The MARKSMAN Microcatheter is a 	Outer Diameter: 2.8F  Inner 	$700.00
	variable stiffness, single lumen 	Diameter: 0.027"  Length: 
	catheter designed to access small, 	105-150cm
	tortuous vascular areas.  The outer 
	surface of the catheter's distal segment 
	is coated with a hydrophilic material 
	to provide lubricity during use. The 
	catheter also incorporates a PTFE 
	liner to facilitate movement of delivery
	 devices passed through its lumen and
	 has a radiopaque marker at the distal 
	tip to facilitate fluoroscopic 
	visualization. The distal tip of the 
	catheter is shapeable.
AS202	Micro Catheters	For the delivery of therapeutic agents 	Length: 135 - 170cm; 	$700.00
	such as embolisation coils and liquid 	Diameter: 3.0 - 1.3 Fr
	embolics; and diagnostic agenst such 
	as contrast media.
	Culpan Medical Pty
CB013	Scepter Occlusion Balloon Catheter	Intravascular occlusion balloon 	Balloon diameter: 4mm	$700.00
	Balloon lengths: 10 - 20mm
CB014	Headway Microcatheter	Single lumen microcatheter	Internal diameter: 0.42mm - 	$700.00
	0.69mm
	Outside diameter - distal: 
	1.6 - 2.6 Fr
	Outside diameter - proximal 
	2.1 -3.1 Fr
	Length: 150cm to 167cm
Prostheses List by Category, Groups and Sponsor	Page 214 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ488	Prowler Infusion Catheters	Braid/coil catheter	Size:  50cm - 170cm.	$700.00
MN136	Envoy Guiding Catheters	Guiding Catheters	90 to 105cm length	$700.00
MN166	Transit Microcatheter System	Transit and Rapidtransit 	75 to 175cm	$700.00
MN167	Ascent Balloon Catheter System	Coaxial dual lumen balloon catheter	4-6mm diameter	$700.00
	Lifehealthcare Pty Ltd
LH499	Sequent VIA Microcatheter	A sterile single lumen device with 	Lengths: 133-161cm	$700.00
	one distal tip marker	Diameters: 0.685-0.838mm; 
	1.07-1.27mm; 0.991-1.14mm
	N Stenning & Co Pty Ltd
NG056	SONIC Microcatheter	Micro catheter DMSO compatible	Dia: 1.2fr or 1.5fr	$700.00
	Length: 165cm or 190cm
Prostheses List by Category, Groups and Sponsor	Page 215 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NG057	Balt Remodelling Balloon	Remodelling Balloon Kit, includes a 	SCOPERNIC10: 10mm 	$700.00
	200cm tapered Hybrid Guidewire.	balloon length, max fill 
	volume 0.30ml;
	SCOPERNIC15: 15mm 
	balloon length, max fill 
	volume 0.35ml;
	SCOPERNIC20: 20mm 
	balloon length, max fill 
	volume 0.40ml;
	SCOPERNIC30: 30mm 
	balloon length, max fill 
	volume 0.50ml;
	SECLIPSE7: Balloon 
	length 7mm, balloon dia 4 
	to 6mm, max fill vol 0.20ml;
	
	SECLIPSE9: Balloon 
	length 9mm, balloon dia 4 
	to 6mm, max fill vol 0.25ml;
	
	SECLIPSE12: Balloon 
	length 12mm, balloon dia 4 
	to 6mm, max fill vol 0.30ml;
	
	SECLIPSE15: Balloon 
	length 15mm, balloon dia 4 
	to 6mm, max fill vol 0.40ml;
	
	SECLIPSE20 Balloon 
	length 20mm, balloon dia 4 
	to 6mm, max fill vol 0.50ml.
	
	Packaging includes one 
Prostheses List by Category, Groups and Sponsor	Page 216 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NG066	VASCO+	A progressive step braided micro-	VASCO+10MHD, 	$700.00
	catheter with radio-opaque markers on	Length:155cm, Distal Outer
	 the distal tip used to assist in the 	 Diameter: 1.9F, VASCO+10
	treatment of aneurysms and other 	 (D,MP,COB), Length: 
	neurological disorders.	155cm, Distal Outer 
	Diameter: 1.9F, Proximal 
	Outer Diameter: 2.4F, 
	VASCO+18 (D,MP,COB), 
	Length: 155cm, Distal 
	Outer Diameter: 
	2.1F,Proximal Outer 
	Diameter: 2.8F, VASCO+21 
	( D,MP,COB), Length: 
	155cm, Distal Outer 
	Diameter: 2.4F, Proximal 
	Outer Diameter: 3.1F,  
	VASCO+25 (D,MP,COB), 
	Length: 155cm, Distal 
	Outer Diameter: 3.0F, 
	Proximal outer Diameter: 
	3.3F, VASCO+28 
	(D,MP,COB), Length: 
	155cm, Distal Outer 
	Diameter: 3.3F, Proximal 
	Outer Diameter: 3.4F, 
	VASCO+35 (D,MP,COB), 
	Length: 135cm, Distal 
	Outer Diameter: 3.8F, 
	Proximal Outer Diameter: 
	4.0F, VASCO+ASPI 
	(D,MP), Length: 140cm, 
	Distal Outer Diameter: 5.0F,
	Penumbra Neuro Australia Pty Ltd
PN007	Penumbra Coil System / Penumbra 	A variable stiffness catheter reinforced	Length: 150cm	$700.00
	PX 400 Microcatheter	 with nitinol provides access to target
	 site, reinforcing conduit for other 
	intravascular devices. Includes 
	rotating hemeostasis valve, tip 
	shaping mandrel, introducer sheath.
Prostheses List by Category, Groups and Sponsor	Page 217 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
PN010	Penumbra Coil System / Penumbra 	The PX SLIM Microcatheter is a 	PXSLIMSTR: Tip – 	$700.00
	PX Slim Microcatheter	variable stiffness catheter with a 	straight; Inner Diameter – 
	maximum distal outer diameter of 	0.025in; Length – 150cm
	0.034in, 2.6 F and a maximum proximal	PXSLIM045: Tip – 45°; 
	 outer diameter of 0.0387in, 2.95 F.  	Inner Diameter – 0.025in; 
	The catheter shaft is reinforced with a 	Length – 150cm
	nitinol coil, and has a two radiopaque	PXSLIM090: Tip – 90°; 
	 markerbands on the distal end.  It is 	Inner Diameter – 0.025in; 
	available with an inner diameter of 	Length – 150cm
	0.025in.  The microcatheter has a 	PXSLIM130: Tip – 130°; 
	PTFE-lined lumen, which is coil re-	Inner Diameter – 0.025in; 
	enforced, flexible, and hydrophilically	Length – 150cm
	 coated. 
	It is inserted through a guide catheter 
	or vascular sheath, provides access to 
	the target site and once in place, 
	provides a reinforcing conduit for 
	other intravascular devices.  The 
	device is provided sterile and 
	includes a rotating hemostasis valve, 
	a tip shaping mandrel and an 
	introducer sheath. Available in 
	various tip configurations including 
	straight, 45º, 90º and 130º.
PN011	Penumbra Neuron Delivery Catheter	Neuron Intracranial Access System is 	Neuron 053 System - 	$700.00
	 053 & 070 System	a two-catheter system comprising of 	Proximal OD: 6F (0.079in - 
	the Neuron Delivery Catheter. The 	0.084in), Proximal ID: 
	Neuron Delivery Catheter can be used	0.053in Max, Useable 
	 individually with a 0.038in guide 	Length: 105cm-115cm, 
	wire to access the desired anatomy. 	Distal OD: 5F (0.065in - 
	The Catheter is a single lumen, coil-	0.072in), Distal ID: 0.053in
	reinforced, variable stiffness catheter 	 Max, Tip Shape: Straight or 
	with a radiopaque marker band on the 	Shaped, Distal Flexible 
	distal end and a Luer hub on the 	Length: 6cm-12cm.
	proximal end. The Catheter 	Neuron 070 System - 
	dimensions are included on the 	Proximal OD: 6F (0.081 in -
	individual device label. The Neuron 	 0.084 in), Proximal ID: 
	Delivery Catheter is compatible with 	0.070 in Max, Useable 
	introducer sheaths having an inner 	Length: 95cm-105cm, 
	diameter of 6F or greater.	Distal OD: 6F (0.081 in -
	0.084 in), Distal ID: 0.070 
	in Max, Tip Shape: Straight 
	or Curved, Distal Flexible 
	Length: 6cm-8cm.
Prostheses List by Category, Groups and Sponsor	Page 218 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW468	Neuro Renegade Hi-Flo 	Microcatheter for deployment of 	2.5-4.5mm	$700.00
	neuroform stent system
HW488	Excelsior SL-10 & Excelsior 1018	Excelsior SL-10 & the Excelsior 1018	Length: 150cm	$700.00
	 Microcatheter is indicated to assist in	Outer Diameter: 2.4F - 2.6F
	 the delivery of diagnostic agents, 	
	such as contrast media, and 	Inner Diameter: 0.165" - 
	therapeutic agents, such as occlusion 
	coils, into the peripheral, coronary 
	and neurovasculature.
HW530	Excelsior XT27	Stryker Neurovascular Excelsior XT-	Length: 150cm / 135cm	$700.00
	27 Microcatheter is intended to assist 	Distal Lengths: 6cm / 18cm
	in the delivery of diagnostic agents, 	
	such as contrast media, therapeutic 	Outer Diameter: 2.7F - 2.9F
	agents and interventional devices, 
	into the neurovasculature
	04.08.03.02 - Coil detachment device
	Covidien Pty Ltd
AS197	LRS Actuator	LRS Actuator is a sterile, hand held 	Length 5.75", Diameter 1", 	$350.00
	mechanical unit with a thumb slide 	Weight 28 grams
	that detaches the coil. When the slider
	 is retracted while the pusher is 
	loaded, it releases the coil into the 
	targeted vaculature. Coils cannot be 
	deployed without the use of the 
	Culpan Medical Pty
CB015	V-Grip Detachment Controller	A battery powered device used to 	One size only	$350.00
	control detachment of an implantable 
	embolisation coil from a delivery 
	pusher.
	Johnson & Johnson Medical Pty Ltd
DY533	Trufill Coil system - Trufill DCS 	Trufill syringe barrel with a pressure 	One sterile unit.	$350.00
	Syringe	gauge, a threaded plunger assembly.
MN168	EnPOWER Detachment Control 	Sterile Field Coil Detachment Control	Single unit	$350.00
	System
Prostheses List by Category, Groups and Sponsor	Page 219 of 1059

04 - NEUROSURGICAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Penumbra Neuro Australia Pty Ltd
PN008	Penumbra Coil System / Penumbra 	A single detachment handle which is 	One size only	$350.00
	Coil Detachment Handle	compatible with all Penumbra Coil 
	configurations and can be used to 
	detach all coils needed for a single 
	patient.
	Stryker Australia Pty Ltd
HW466	InZone Detachment System	InZone Detachment System is 	One size	$350.00
	specifically designed for use with the 
	Target Detachable Coils
04.09.01 - Transducer
	Catheter
	Johnson & Johnson Medical Pty Ltd
JJ906	MicroSensor Monitoring System	Ventricular catheter with transducer	Catheter length 38cm	$1,300.00
	Skull Bolt
	Johnson & Johnson Medical Pty Ltd
MN158	MicroSensor Monitoring System	Skull bolt with ICP transducer	0.7mm sensor lead diameter	$1,050.00
04.10.01 - External Ventricular Drain
	Johnson & Johnson Medical Pty Ltd
JJ907	Codman External Ventricular Drain 	External Ventricular Drain	1.5mm & 1.9mm diameter	$185.00
	(EVD) Catheter
	Medtronic Australasia Pty Ltd
MI123	EDM Ventricular Catheter	External drainage ventricular catheter,	35cm	$185.00
	 non metallic latex free. Barium 
	impregnated, includes stainless steel 
	stylet.
	Antibiotics
	Johnson & Johnson Medical Pty Ltd
JJ908	Codman Bactiseal External 	Antibiotic impregated External 	1.5mm & 1.9mm lumen 	$469.00
	Ventricular Drain (EVD) Catheter	Ventricular Drain	diameter
Prostheses List by Category, Groups and Sponsor	Page 220 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
05.01.01 - Inflatable
	05.01.01.01 - Pump
	American Medical Systems Pty Ltd
AM029	AMS 800 Artificial Urinary 	Control Pump	One size	$4,947.00
	Sphincter Pump
	A
	American Medical Systems Pty Ltd
AM050	Urinary Control System Pump	Pump with InhiboZone Antibiotic 	One size only.	$5,343.00
	Surface Treatment
	05.01.01.02 - Occlusive cuff
	American Medical Systems Pty Ltd
AM001	AMS 800 Artificial Urinary 	Occlusive Cuff	13 Cuff sizes from 3.5 to 	$2,614.00
	Sphincter Cuff	11.0 cm: Size: 3.5, 4, 4.5, 5, 
	5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 
	11cm
AM021	AMS 800 Artificial Urinary 	Silicone cuff for artificial urinary 	13 Cuff sizes from 3.5 to 	$2,614.00
	Sphincter Cuff	sphincter. For the implantation of the 	11.0 cm: Size: 3.5, 4, 4.5, 5, 
	second cuff for the AMS 800	5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 
	11cm
	A
	American Medical Systems Pty Ltd
AM051	AMS 800 Urinary Control System 	Occlusive Cuff with InhibiZone 	13 Cuff sizes from 3.5 to 	$2,850.00
	with InhibiZone - cuff	Antibiotic Surface Treatment	11.0 cm
	05.01.01.03 - Regulating Balloon
	American Medical Systems Pty Ltd
AM028	AMS 800 Artificial urinary 	Pressure Regulating Balloon	51 - 60cm, 61 -70cm, 71 - 	$2,057.00
	sphincter Pressure Regulating 	80cm
Prostheses List by Category, Groups and Sponsor	Page 221 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.01.01.04 - Constrictor
	Device Technologies Australia Pty Ltd
DE313	Inflatable Periurethral Constrictor	Consists of a membrane, filler product 	One size only	$1,225.00
	and silicone tube
	05.01.01.05 - Accessory kit
	American Medical Systems Pty Ltd
AM030	AMS 800 Artificial Urinary 	Accessory Kit	One Size	$689.00
	Sphincter Accessory Kit
	05.01.01.06 - System
	Endotherapeutics Pty Ltd
ET057	Flow Secure Artificial Urinary 	Artificial Urinary Sphincter with 	One Size	$10,000.00
	Sphincter	conditional occlusion, inflatable 
	hydraulic device
05.01.02 - Permanently Adjustable
	05.01.02.01 - Single
	MD Solutions Pty Ltd
MB003	Adjustable Continence Therapy for 	ACT Device: Prosthesis designed for 	6 - 14cm	$4,145.00
	Women	the treatment of female SUI comprising
	 of a single silicone balloon attached 
	via a conduit to titanium and rubber 
	ports allowing for post operative 
MB006	Adjustable Continence Therapy for 	ProACT Device: Prosthesis designed 	6 - 14cm	$4,145.00
	Men	for the treatment of male SUI 
	comprising of a single silicone 
	balloon attached via a conduit to 
	titanium and rubber ports allowing for
	 post operative adjustment.
Prostheses List by Category, Groups and Sponsor	Page 222 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.01.02.02 - Double
	Endotherapeutics Pty Ltd
ET074	ATOMS System	The ATOMS System is a long term, 	1 size only - ATS 5011 	$8,290.00
	adjustable prostheses that substitutes	(Length of Implant 560mm, 
	 urinary sphincter function in 	width of tape 12mm, 
	incontinent males. It is a hydraulic 	dimensions of cushion 
	system comprising of a suburethral 	40x45mm, max. filling 
	sphincter cushion/cuff which can be 	volume of cushion 25mL). 
	adjusted hydraulically intra-	Titanium port-reservoir 
	operatively or post-operatively 	with hydraulic tubing, one 
	through an implanted titanium port. 	size.
	Fixation arms and attachment sutures 
	hold the implant in situ.
ET075	AMI ATOMS Infusion Port	Hydraulic Infusion port for use with 	22mm Diameter, 9.8mm High	$1,000.00
	AMI ATOMS System - seperate
	MD Solutions Pty Ltd
MB004	Adjustable Continence Therapy 	ACT Device: prosthesis designed for 	6 - 14cm	$8,290.00
	device for women	the treatment of female SUI comprising
	 of silicone balloons x 2 attached via a
	 conduit to titanium and rubber ports 
	allowing for post operative 
MB005	Adjustable Continence Therapy for 	ProACT Device: prosthesis designed 	6 - 14cm	$8,290.00
	Men	for the treatment of male SUI 
	comprising of silicone balloons x2 
	attached via a conduit to titanium and 
	rubber ports allowing for post 
	operative adjustment.
05.01.03 - Sling
	05.01.03.01 - Male
	American Medical Systems Pty Ltd
AM017	InVance Male Sling System	Kit includes inserter with shaft, 6 	One Size	$5,718.00
	bone screws with suture and silicone-
	coated sling surgical mesh
Prostheses List by Category, Groups and Sponsor	Page 223 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AM048	AMS AdVance XP Male Sling System	Sub-urethral sling implant for 	Arm width: 1.2cm, Centre 	$5,718.00
	treatment of male stress urinary 	width: 3.55cm, Total 
	incontinence. Made from 	Length: 35.5cm, 43.5cm
	polypropylene monofilament mesh
	Coloplast Pty Ltd
CT015	Virtue Male Sling System	Male sling system with quadratic 	One Size	$5,718.00
	fixation
	Endotherapeutics Pty Ltd
ET050	ARGUS	Adjustable Male Sling made of 	One size only	$5,718.00
	silicone adjustable self fixating 
	columns and urethral cushion
	Gytech Pty Ltd
GP006	Contrasure Remeex Male	Adjustable male SUI sling	Varitnesor is 1 x 1 x 2.5cm, 	$5,718.00
	the sling is 22mm x 33mm.
	Medical Specialties Australia Pty Ltd
MS055	TiLOOP Male	Tension-free mesh made out of 	65 g/m2 (strong)	$5,718.00
	titanized polypropylene for 
	restoration of male urinary continence.
	05.01.03.02 - Female
	American Medical Systems Pty Ltd
AM014	Sparc Sling System	Polypropylene mesh sling, two 	One size only	$865.00
	needles with rotating handles, two 
	cystoscopy aids
AM019	MONARC Sling System	Product includes - mesh and two 	One Size Only	$865.00
	needles with handles attached
AM049	MiniArcTM Single-Incision Sling 	The MiniArcTM Single Incision Sling	8.5cm	$865.00
	System	 System is intended for the placement 
	of a suburethral sling for the treatment 
	of female stress urinary incontinence 
	(SUI) resulting from urethral 
	hypermobility and/or intrinsic 
	sphincter deficiency.
Prostheses List by Category, Groups and Sponsor	Page 224 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AM055	MiniArc Precise Single-Incision 	The MiniArc Precise and MiniArc Pro	Short Centre-Length Sling	$865.00
	Sling System	 Single-Incision Sling System 	
	(MiniArc System) is intended for the 	Total: 8.5cm
	placement of a suburethral sling for 	Centre (mid section): 2.0cm
	the treatment of female stress urinary 	
	incontinence (SUI) resulting from 	Long Centre-Length Sling
	urethral hypermobility and/or 
	intrinsic sphincter deficiency
AM056	RetroArc™ Retropubic Sling 	Female sling system for SUI	1.1 cm x 50 cm	$865.00
	Boston Scientific Australia Pty Ltd
BS078	Advantage Transvaginal Mid-	Polypropylene mesh sling	One size only	$865.00
	Urethral Sling System
BS096	Lynx Suprapubic Mid-Urethral 	Polypropylene mesh Sling	One size only	$865.00
	Sling System
BS097	Obtryx Transoburator Mid-Urethral 	Polypropylene mesh sling	One size only	$865.00
	Sling System
BS140	Advantage Fit Transvaginal Mid-	Polypropylene mesh sling	One size only	$865.00
	Urethral Sling System
BS154	Solyx SIS System	Polypropylene mesh sling	One size only	$865.00
BS226	Obtryx II Transobturator Mid-	Polypropylene mesh sling	One size only	$865.00
	Urethral Sling System
	Coloplast Pty Ltd
CT013	Aris Transobturator Sling System	Sling System for female stress urinary 	One Size	$865.00
	incontinence
CT018	Altis Single Incision Sling System	Single Incision Sling System for 	One size	$865.00
	female SUI
	Covidien Pty Ltd
AS120	IVS Tunneller-Intravaginal 	IVS Tunneller System Trans 	50 cm (mesh)	$865.00
	Tunneller System	Obuturator with two stylets and 
	polypropylene mesh
	Endotherapeutics Pty Ltd
ET043	Safyre Autofixation System	Urinary incontenence sling made of 	One size only	$865.00
	polydimethysiloxane and 
ET059	TOA/TVA SLING, 	SLING FOR THE TREATMENT OF 	ONE SIZE	$865.00
	TRANSVAGINAL TRANS-	FEMALE STRESS URINARY 
	OBTURATOR APPROACH	INCONTINENCE WITH INTRA 
	AND POST-OPERATIV 
Prostheses List by Category, Groups and Sponsor	Page 225 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ET060	Ophira Minisling System	Mini sling system made from 	One size.	$865.00
	monofilament mesh, held between self 
	anchoring polypropylene columns in 
	a fishbone design.  Supplied with a 
	retractable insertion guide for sling 
	placement.  Ophira sling has a blue 
	loosening suture inserted in the base 
	of one 
	Gytech Pty Ltd
GP005	Contrasure Needleless	Female SUI sling	11.4 x 1.2cm with two 	$865.00
	pockets 2.2cm wide
	Johnson & Johnson Medical Pty Ltd
JJ070	TVT (Tension-Free Vaginal Tape) 	Undyed Prolene (polypropylene) 	11 x 450mm	$865.00
	Single use device	nonabsorbable tape
JJ442	Gynecare TVT-O	Items included are: Gynecare TVT 	1.1x45 cm	$865.00
	Obturator device, Two Gynecare TVT 
	Helical Passers and a Gynecare TVT 
	Atraumatic Winged Guide.  The 
	device component of the system 
	consists of undyed or blue Prolene 
	Polypropylene Mesh
MN039	Gynecare TVT ABBREVO™ 	Implant assembly consisting of mesh 	1.1cm x 12cm	$865.00
	Continence System	sling and sterile, single-patient use 
	helical passer sheaths.
	Medical Specialties Australia Pty Ltd
MS060	TiLOOP Tape	Tension-free non-absorbable titanised	light / extralight	$865.00
	 tape
	TFS Manufacturing Pty Ltd
TF001	TFS Tissue Fixation System	TFS Tissue Fixation System	One Size Only	$865.00
	adjustable
	Gytech Pty Ltd
GP007	Contrasure Remeex Female	Adjustable female SUI sling	Varitnesor is 1 x 1 x 2.5cm, 	$1,730.00
	the sling is 15mm x 32mm.
Prostheses List by Category, Groups and Sponsor	Page 226 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
05.01.04 - Injectable, Synthetic
	05.01.04.01 - 1 ml
	Lifehealthcare Pty Ltd
LH376	Durasphere SUI	Injectable Bulking agent for Stress 	1ml	$531.00
	Urinary Incontinence
	NEOGENIX PTY LTD
GN001	Opsys Injectable SUI	Opsys is a manually injectable, non-	Opsys Kit contains 5 x 1ml 	$531.00
	absorbable, permanent, synthetic 	syringes.
	tissue bulking agent used in the 
	endoscopic treatment of female Stress 
	Urinary Incontinence.
GN002	Opsys Injectable SUI	Opsys is a manually injectable, non-	1 x 1ml syringe.	$531.00
	absorbable, permanent, synthetic 
	tissue bulking agent used in the 
	endoscopic treatment of female Stress 
	Urinary Incontinence.
	05.01.04.02 - 1.3 ml
	Endotherapeutics Pty Ltd
ET011	Macroplastique	Sterile, textured, highly cross linked 	1.3 ml	$690.00
	polydimethylsiloxane elastomer 
	implants suspended in a bio-
	excretable carrier gel.
	05.01.04.03 - 2 ml
	Johnson & Johnson Medical Pty Ltd
JJ802	BULKAMID Urethral Bulking 	Transparent polyacrylamide gel for 	2 x 1ml syringes, 2 x 	$1,062.00
	System	female urinary incontinence. Kit 	BULKAMID 23G needles, 
	comprises 2 syringe, 2 needles, 1 	1 x disposable sheath
	applicator
Prostheses List by Category, Groups and Sponsor	Page 227 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.01.04.04 - 2.5 ml
	Endotherapeutics Pty Ltd
ET053	Macroplastique	Sterile, textured, highly cross linked 	2.5ml Implants	$1,328.00
	polydimethylsiloxane elastomer 
	implants suspended in a bio-
	excretable carrier gel.
	05.01.04.05 - 3 ml
	Lifehealthcare Pty Ltd
LH379	Durasphere SUI	Injectable Bulking agent for Stress 	3ml	$1,593.00
	Urinary Incontinence
05.01.05 - Injectable, Biological
	Bard Australia Pty Ltd
BA041	Contigen Cross Linked Collagen 	Contigen Bard Collagen Implant for 	2.5cc per syringe	$674.00
	Stress Urinary Incontinence
05.02.01 - Fixed length
	05.02.01.01 - Polyurethane
	Applied Medical Australia Pty Ltd
MH010	Silhouette Ureteral Stent	The Silhouette Ureteric Stent is 	Multiple French Sizes & 	$140.00
	manufactured with a soft material that 	Lengths
	provides superior comfort.  It has 
	superior column strength through a 
	coil-reinforced body providing 
	effortless placement.  The tight coils 
	prevent migration.  The smaller 
	Cook Medical Australia Pty Ltd
WC027	Polyurethane Double Pigtail Stent 	Polyurethane Double Pigtail Stent Set	Multiple French Sizes and 	$140.00
	Lengths
Prostheses List by Category, Groups and Sponsor	Page 228 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC281	Universa Soft Ureteral Stent Set	Universa Soft Ureteral Stent Set, with 	5, 6, 7 and 8FR in fixed 	$140.00
	or without the TFE WireGuide, fixed 	lengths (18 - 30CM)
	length
	Promis Medical (Australia) Pty ltd
PP001	White Star Double-J Ureteral Stent 	The stent consists of a stable tube, the 	Fr 04 - 08, length - 10 - 	$140.00
	Set, Yellow Star Double-J Ureteral 	ends of which are formed into loops. 
	Stent Set, Green Star Double-J 	These serve to stabilise the position 
	Ureteral Stent Set, White Star 	of the ureteral sent. The purpose of the 
	Intraoperative Double-J Ureteral 	endoprosthesis is to restore or 
	Stent Set, White Star ESWL 	improve the drainage from the kidney 
	Double-J Ureteral Stent Set, White 	to the bladder, to ensure ureteral 
	Star Stenosis Stent Set	drainage over and endangered 
	segment of the ureter, to prevent 
	development of a urine fistula into the 
	retroperitoneum, to serve as a growth 
	stent for the uroepithelium if there is a 
	defect, and to prevent a stricture. 
	When implanted, one loop is located 
	in the renal pelvis and the other in the
	 bladder to prevent migration.
Prostheses List by Category, Groups and Sponsor	Page 229 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
PP002	Yellow Star Tumor-Stent Double J 	The stent consists of a stable tube, the 	Fr 06 -08, length -22 - 32cm	$140.00
	Ureteral Stent Set PC-Coated	ends of which are formed into loops. 
	These serve to stabilise the position 
	of the ureteral stent. The 
	phosphorylcholie coating of the 
	tumor stent reduces the risk of 
	infections and encrustations, which 
	results in a prolongation of 
	indwelling time. Phosphorylcholine 
	is a biocompatible and durable 
	material for sealing implant surfaces 
	that prevents biofilm formation and 
	subsequent encrustation. The purpose
	 of the endoprosthesis is to restore or 
	improve the drainage from the kidney 
	to the bladder to ensure ureteral 
	drainage over an endangered segment 
	of the ureter, to prevent development 
	of a urine fistula into the 
	retroperitoneum, to serve as a growth 
	stent for the uroepithelium if there is a 
	defect, and to prevent a stricture. 
	When implanted, one loop is located 
	in the renal pelvis and the other in the
PP003	White Star Mono Mono-J Ureteral 	The stent consists of a stable tube, one	Fr 04 - 12, length - 70cm	$140.00
	Stent Set, Green Star Mono Mono-J 	 end of the endoprosthesis is to 
	Ureteral Stent Set	restore or improve the drainage from 
	the kidney to the bladder, to ensure 
	ureteral drainage over an endangered 
	segment of the ureter, to prevent 
	development of a urine fistula into the 
	retroperitoneum, to serve as a growth 
	stent for the uroepithelium if there is a 
	defect, and to prevent a stricture. 
	When implanted, one loop is located 
	in the renal pelvis to prevent 
	migration.
	Pyramed Pty Limited
PY011	Optimed Opti-J Stents	Dual Use directional Double J stent 	5, 6, 7, 8Fr; 22-34cm	$140.00
	and delivery system. Can also be used 
	as urinary diversion stent.
Prostheses List by Category, Groups and Sponsor	Page 230 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	P
	Cook Medical Australia Pty Ltd
WC022	C-Flex Double Pigtail Ureteric 	Set includes: Stent, Wire, Positioner	Multiple French Sizes, 	$180.00
	Stent Set	Multi-length
	SP
	Cook Medical Australia Pty Ltd
WC018	C-Flex Endoureteratomy Stent Set	C-Flex Endoureteratomy Stent Set	6.0/10.0 Fr, & 7.0/14.0 Fr, 	$241.00
	Multiple Length
WC236	Paterson-Forrester Subcutaneous 	Subcutaneous Urinary Diversion 	Stent 8.5 French, 65cm long	$241.00
	Urinary Diversion Stent
	T
	Cook Medical Australia Pty Ltd
WC214	Cook Ureteral Stents	Amplatz Ureteral Stent Set, Ultrathane	8.5Fr - 12,20,22,24,26,28cm	$197.00
	 RB Design Radioplaque Band and 	 and 10.2Fr - 22,24,26,28cm
	AQ Hydrophilic Coating Set includes
	 one stent positioner with flexible 
	stent introducer catheter
	N Stenning & Co Pty Ltd
NG030	Paediatric Ureteric Valve Stent Set	Open end with introducer and 	12 - 22cm	$197.00
	guidewire, Polyurethane
NG031	Paediatric Ureteric Integral Stent 	Open end with introducer and guide 	12 - 22cm Per pack of 5	$197.00
	wire, Polyurethane
NG032	DD Ureteric Stent Set	Open end with introducer and guide 	22 - 30cm Per pack of 2	$197.00
	wire
NG046	Paediatric Ureteric Valve Stent Set	Fixed length wirthan stent	12 - 22cm	$197.00
	Pyramed Pty Limited
PY012	Ex-Stent Tumour Ureteral Stent Set	Open end stent with guide wire and 	6-8Fr., length 26-32cm	$197.00
	pusher
Prostheses List by Category, Groups and Sponsor	Page 231 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.02.01.02 - Other synthetic
	Applied Medical Australia Pty Ltd
MH012	Silhouette System Ureteral Stent Set	Coil reinforced body.  SL-6 	Mulitple French Sizes & 	$198.00
	hydrophilic coating.  UroWire 0.035" 	Lengths
	3-in-1 guidewire with kink resistant 
	nitinol core.  Design divided into 3 
	sections: silver section (front end) 
	floppy SL - 6 hydrophilic coating; 
	Blue section (mid) super stiff PTFE 
	(not hydrophicaly coated); and Green 
	section (back) flexible
	Cook Medical Australia Pty Ltd
WC273	Ureteric Stent Set	Set includes soft Aqueous Coated 	Multiple French Sizes and 	$198.00
	(AQ) ureteric stent, positioner, with 	Lengths
	or without wire guide
	N Stenning & Co Pty Ltd
NG028	DD Ureteric Tumor Stent Set	Open/Closed end with introducer and	20 - 28cm	$198.00
	 guide wire, Polyurethane
NG029	DD Ureteric Valve Stent Set	Open end with introducer and guide 	22 - 30cm	$198.00
	wire, Polyurethane
	Olympus Australia
OL078	Ureteral Stents 	Diversion Stent, silicone	7 - 8.5 F x 90cm	$198.00
	P
	Applied Medical Australia Pty Ltd
MH013	Paediatric Silhouette System Set	Coil reinforced body.  SL-6 	4F, 8 - 12cm	$245.00
	hydrophilic coating.  UroWire 0.035" 
	3-in-1 guidewire with kink resistant 
	nitinol core.  Design divided into 3 
	sections: silver section (front end) 
	floppy SL - 6 hydrophilic coating; 
	Blue section (mid) super stiff PTFE 
	(not hydrophilicaly coated); and 
	Green section (back) flexible
Prostheses List by Category, Groups and Sponsor	Page 232 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SP
	Cook Medical Australia Pty Ltd
WC024	Ultrathane Endoureteratomy Stent 	Ultrathane Endoureteratomy Stent Set	6/9.5 Fr & 7/14.0Fr , 	$234.00
	Multiple Length
	Pyramed Pty Limited
PY001	Optimed Ureteral Stents	Soft-Polyurethane. Ureteral. 	Ureteral 4.5 x 28,30,32 cm; 	$234.00
	Paediatric Ureteral. Renal 	6 x 26,28,30,32 cm; 7 x 
	Transplantation. Urinary Diversion.	26,28,30,32 cm. Paediatric 
	Ureteral 8 x 28,30,32 cm. 
	Renal Transplantation 4 x 
	10,12,14,16 cm; 6 x 
	12,14,16 cm; 7 x 12,14,16 
	cm. Urinary Diversion 8 x 
	12,14,16 cm.
	Therm
	Boston Scientific Australia Pty Ltd
BS086	Polaris Ultra Ureteral Stent	Dual durometer ureteral stent with 	Diameters up to 14Fr & 	$214.00
	attached suture	lengths up to 40cm
BS091	Percuflex; Percuflex Plus; Percuflex 	Ureteral stent with attached suture	Diameters up to 14Fr & 	$214.00
	Tail; Percuflex Tail Plus Ureteral 	lengths up to 40cm
	Stents; Ureteral Stent System Kit
BS092	Contour Ureteral Stent	Ureteral stent with attached suture	Diameters up to 14Fr & 	$214.00
	lengths up to 40cm
BS093	Retromax Plus Ureteral Stent	Ureteral stent	Diameters up to 14Fr & 	$214.00
	lengths up to 40cm
BS116	Polaris Loop Ureteral Stent	Dual durometer ureteral stent with 	Diameters up to 14Fr & 	$214.00
	attached suture	lengths up to 40cm
BS192	Percuflex® Helical	Ureteral Stent with Hydro Plus™ 	6fr to 8fr and 10cm to 30cm	$214.00
	Coating
	Cook Medical Australia Pty Ltd
WC130	Ureteric Stent Set	Set includes Aqueous Coated (AQ) 	Multiple French Sizes, and 	$214.00
	firm fixed length ureteric stent, 	Lengths
	positioner, with or without wire 
WC131	Endo-sof double pigtail stent Set 	Endo-sof double pigtail stent Set 	Multiple French Sizes and 	$214.00
	with AQ Hydrophilic Coating and 	with AQ Hydrophilic Coating and 	Lengths
	Sideholes
Prostheses List by Category, Groups and Sponsor	Page 233 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC170	Universa Firm	Universa Firm Double Pigtail Stent 	Multiple French Sizes and 	$214.00
	and Positioner only	Lengths
WC172	Universa Firm	Universa Firm Double Pigtail Stent 	Multiple French Sizes and 	$214.00
	Lengths
	05.02.01.03 - Metal
	T
	Cook Medical Australia Pty Ltd
WC226	RESONANCE Metallic Ureteral 	Metallic Double Pigtail Stent	 6 Fr, lengths 12-30cm	$1,720.00
	Stent Set
	Therm
	Endotherapeutics Pty Ltd
ET055	Memokath Ureteric Stent	Memokath Model 051CW.	30mm - 200mm	$3,778.00
	MD Solutions Pty Ltd
MB016	Allium Ureteral Stent	Round Nitinol stent with copolymer 	8mm x 100mm, 8mm x 	$3,778.00
	covering and supplied premounted on	120mm, 10mm x 100mm, 
	 a delivery tool. Intended to be 	10mm x 120mm
	inserted into the lower ureter to allow
	 free flow of urine from the kidney to 
	Pyramed Pty Limited
PY030	Taewoong ePTFE covered dual 	Taewoong ePTFE covered dual 	Diameter: 7 - 9mm; Length: 	$3,778.00
	nitinol ureteric stent	nitinol ureteric stent	6 - 20cm; Delivery Device: 
	9 Fr; Length 70cm
05.02.02 - Multi-length
	05.02.02.01 - Polyurethane
	Bard Australia Pty Ltd
BA044	Ureteral Stent	Bard Inlay Hydrophilic coated Pigtail	(Inlay) 4.7Fr 14, 20, 22, 24, 	$199.00
	 Ureteric stent without guidewire; 	26, 28cm.  6Fr- 14, 20, 22, 
	Bard Flouro 4 Silicone Multilength 	24, 26, 28cm  7Fr 14, 20, 22,
	ureteric stent with guidewire; Urinary	 24, 26, 28cm  8Fr- 14, 20, 
	 Diversion Stent All Silicone	22, 24, 26, 28cm. (Flouro) 
	Multilength  4,6,7,and 8fr. 
	(Diversion)  7Fr x  90cm  &  
	8Fr  x 90cm.
Prostheses List by Category, Groups and Sponsor	Page 234 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	CK Surgitech Pty Ltd
AK006	Ureteric stents	Ureteric stents, hydrophilic coated, 	3 french – 16 french, 	$90.00
	tapered ends both open, single loop, 	multiple lengths
	one end multi loop, both ends multi 
	loop, with sutures, pusher and guide 
	wire
	Cook Medical Australia Pty Ltd
WC020	Towers Peripheral Ureteral Stent Set	Towers Peripheral Ureteral Stent Set	Multiple French Sizes 	$199.00
	Multi-length
WC282	Universa Soft Ureteral Stent Set	Universa Soft Ureteral Stent Set, with 	5, 6, 7 and 8FR in multi-	$199.00
	or without the TFE WireGuide, multi-	length (21-31CM)
	length
	Promis Medical (Australia) Pty ltd
PP004	White Star Double-J Ureteral Stent 	The stent consists of a stable tube, the 	Fr 4.7 - 08, length - 22-30cm	$199.00
	Sets Flexible length, Yellow star 	ends of which are formed into loops. 
	Double-J Ureteral Stent set flexible 	These serve to stabilise the position 
	length, Green Start Double-J 	of the ureteral stent. The length can be 
	Ureteral Stent Set Flexible length	adjusted to the desired length. The 
	purpose of the endoprosthesis is to 
	restore or improve the drainage from 
	the kidney to the bladder, to ensure 
	ureteral drainage over an endangered 
	segment of the ureter, to prevent 
	development of a urine fistula into the 
	retroperitoneum, to serve as a growth 
	stent for the uroepithelium if there is a 
	defect, and to prevent a stricture. 
	When implanted, one loop is located 
	in the renal pelvis and the other in the
	 bladder to prevent migration.
	P
	Cook Medical Australia Pty Ltd
WC218	C-Flex Multilength Ureteric Stent 	Set includes: Paediatric Stent, Wire, 	3.7 Fr, Multiple Lengths	$254.00
	Positioner
WC219	C-Flex Double Pigtail Ureteric 	Set includes: Paediatric Stent, Wire 	3.7 Fr, Multilple Lengths	$254.00
	Stent Set	and Positioner
Prostheses List by Category, Groups and Sponsor	Page 235 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SP
	Cook Medical Australia Pty Ltd
WC237	Radiance Ureteric Stent Set	Synthetic Thermosensitive Ureteral 	Multiple French Sizes and 	$261.00
	Stent Set with Heparin Coating	Lengths
	05.02.02.02 - Other synthetic
	Cook Medical Australia Pty Ltd
WC002	Sof-Flex Multi-length Ureteric Stent	Set includes Stent, Wire, Positioner	Multiple French Sizes, 	$198.00
	 Set	Multi-length
WC003	Sof-Flex Multi-length Ureteric Stent	Stent and Positioner only	Multiple French Sizes, 	$198.00
	 Set	Multi-length
WC104	Cook Ureteral Stent - Sof-Flex 	Radiopaque Sof-Flex Stent, Stainless 	Multiple French Sizes and 	$198.00
	Double Pigtail Stent Set - Special	Steel Wire Guide, Radiopaque 	Lengths
	Polyurethane Catheter and 
	Radiolucent Vinyl Positioner
WC140	Filiform Multi-Length Silicone 	Stent, Wire, Positioner	Multiple French Sizes and 	$198.00
	Stent Set	Lengths
WC147	Kwart Retro-Inject Stent Set	Stent, Wire, Inserter, Release Sleeve	Multiple French Sizes and 	$198.00
	Lengths
WC149	Sof-Flex Double Pigtail Ureteric 	Stent and Positioner only	Multiple French Sizes and 	$198.00
	Stent Set	Lengths
WC150	Sof-Flex Double Pigtail Ureteric 	Set includes: Stent, Wire, Positioner	Multiple French Sizes and 	$198.00
	Stent Set	Lengths
WC272	Ureteric Stent Set	Set includes soft Aqueous Coated 	Multiple French Sizes, 	$198.00
	(AQ) ureteric stent, positioner, with 	multi-length
	or without wire guide
	Olympus Australia
OL076	Ureteral Stents 	Single J Ureteric Stent, silicone	7 - 8.5 F x 90cm	$198.00
OL077	Ureteral Stents	Double J Ureteric Stent, silicone	6-8.5 F, 12 - 24 cm	$198.00
OL080	Quadra-Coil Multi Length Ureteral 	Tecoflex polymer, hydrophilic 	4.5F-8.5F x length 22 - 	$198.00
	Stent	coating/PTFE coating
	P
	Cook Medical Australia Pty Ltd
WC217	Sof-Flex Multilength Ureteric Stent 	Set includes: Paediatric Stent, Wire, 	3 Fr, Multiple Lengths	$259.00
	Set	Positioner
Prostheses List by Category, Groups and Sponsor	Page 236 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC220	Sof-Flex Double Pigtail Ureteric 	Set includes: Paediatric Stent, Wire, 	3 Fr, Multiple Lengths	$259.00
	Stent Set	Positioner
	SP
	Cook Medical Australia Pty Ltd
WC023	Greene Renal Transplant Stent Set	Transplant stent set	Multiple French Sizes, 	$243.00
	Multi-length
	T
	Cook Medical Australia Pty Ltd
WC138	Filiform Double Pugtail Silicone 	Stent, Wire, Positioner	Multiple French Sizes and 	$265.00
	Stent Set	Lengths
	Therm
	Boston Scientific Australia Pty Ltd
BS094	Contour VL; Stretch VL Flexima; 	Ureteral stent with attached suture	Diameters up to 14Fr & 	$212.00
	Ureteral Stents	lengths up to 40cm
	Cook Medical Australia Pty Ltd
WC035	Ureteric Stent Set	Set includes Aqueous Coated (AQ) 	Multiple French Sizes, 	$212.00
	firm multilength ureteric stent, 	Multi-Length
	positioner, with or without wire 
WC169	Universa Firm	Universa Firm Multi-length stent set	Multiple French Sizes and 	$212.00
	Lengths
WC171	Universa Firm	Universa Firm Multi-length Stent and 	Multiple French Sizes and 	$212.00
	Positioner only	Lengths
05.02.03 - Urinary diversion
	Boston Scientific Australia Pty Ltd
BS095	Urinary Diversion Stents	Percuflex urinary diversion stent	Diameters up to 14Fr & 	$132.00
	lengths up to 95cm
	Cook Medical Australia Pty Ltd
WC031	Bander Ureteral Diversion Stent Set	Left or right stent	Multiple French Sizes and 	$132.00
	Lengths
Prostheses List by Category, Groups and Sponsor	Page 237 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	D
	Cook Medical Australia Pty Ltd
WC128	Bander Ureteral Diversion Stent Set	Left and Right Stents	Multiple French Sizes and 	$212.00
	Lengths
05.03.01 - Urethral Stents
	05.03.01.01 - Metal
	American Medical Systems Pty Ltd
AM003	Urolume Plus TM Endo Urethral 	Endourethral wall stent for urethral 	Range: 1.5 - 4.0cm	$2,475.00
	prostheses                                                 	strictures, DESD and BPH

	Bard Australia Pty Ltd
BA042	Memotherm Prostatic Stents	Memotherm Prostatic Urethral wall 	36Fr, 20mm to 60mm in 5mm	$2,475.00
	Stent	 increments; 42Fr, 20mm to 
	60mm in 5mm increments
	Endotherapeutics Pty Ltd
ET054	Memokath Prostatic - Urethral Stents	Memokath Models: 028S, 028SW, 	 5mm - 90mm	$2,475.00
	028T, 028TW, 044T, 044TW, 045T, 
	045TW, 045TTW
	MD Solutions Pty Ltd
MB013	Allium Bulbar Urethral Stent	Round Nitinol stent with co-polymer 	Body Lengths 50, 55, 60mm	$2,475.00
	covering and supplied premounted on	
	 a delivery tool. For longer term 	All with a Main Body 
	temporary treatment of bladder outlet 
	obstruction caused by bulbar 
	strictures of the male urethra.
MB014	Allium Round Posterior Urethral 	Round Nitinol stent with copolymer 	The RPS has a body length 	$2,475.00
	covering and supplied premounted on	of 40mm and a main body 
	 a delivery tool. For longer term 	calibre of 45Fr
	temporary treatment of bladder outlet 
	obstruction caused by  male stenotic 
	posterior urethra or  stenotic bladder-
	neck.
Prostheses List by Category, Groups and Sponsor	Page 238 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MB015	Allium Triangle Prostatic Urethral 	Round Nitinol stent with copolymer 	Body lengths 30, 40, 50, 60,	$2,475.00
	Stent	covering and supplied premounted on	 65mm
	 a delivery tool. For longer term 	main body calibre 45Fr
	temporary treatment of bladder outlet 
	obstruction caused by enlarged 
	05.03.01.02 - Paediatric
	Cook Medical Australia Pty Ltd
WC126	Firlit-Kluge Uretheral Stent	Firlit-Kluge uretheral stent	Multiple French Sizes, 	$58.00
	Length 30cm
WC136	Kaontz Urethral Stent	Kaontz Urethral Stent	Multiple French Sizes, 	$58.00
	Length 12cm
WC137	Pediatric Urethral C-Stent	Pediatric Urethral C-Stent	Multiple French Sizes, 	$58.00
	Length 15cm
WC162	Tarkington Urethral Stent Set	Stent, Wire	8 Fr	$58.00
05.03.02 - Prostatic Retractor
	Neotract Australia Pty Ltd
NZ001	UroLift® System	Prostatic urethral tissue-retaining 	One size.	$620.00
	retractor with adjustable retraction.
05.03.03 - Assisted Bladder Drainage
	05.03.03.01 - In Flow Device
	MD Solutions Pty Ltd
MB012	In-Flow	The In-Flow is a urethral prosthesis 	3.0cm to 7.0cm in .5cm 	$141.00
	designed to enable normal bladder 	increments
	drainage and toilet habits in women 
	with chronic voiding dysfunction. 
	The In-Flow system consists of an 
	implantable silicone catheter 
	containing a miniature valve-pump 
	and a remote controlled magnet or 
	"Activator" which causes a spinning 
	mechanism to "draw" urine from the 
	bladder.
Prostheses List by Category, Groups and Sponsor	Page 239 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.03.03.02 - Activator
	MD Solutions Pty Ltd
MB020	In-Flow - Activator	Activator (Remote Control)	One size only	$118.00
	05.03.03.03 - Sizing Catheter
	MD Solutions Pty Ltd
MB021	In-Flow - Sizing Catheter	Sizing Catheter	One size only	$71.00
05.04.01 - Synthetic
	05.04.01.01 - <500 sq cm
	Boston Scientific Australia Pty Ltd
BS127	Polyform Synthetic Mesh	Synthetic Polypropylene mesh	Width Up to 15cm & 	$310.00
	lengths up to 20cm
	Coloplast Pty Ltd
CT014	NovaSilk Polypropylene Mesh	knitted monofilament polypropylene 	15cm x 15cm - One Size	$310.00
	mesh
CT016	Restorelle M Smartmesh	Smartmesh, Type 1, macroporous, soft, 	15cm x 10cm	$310.00	The provision of the prosthesis is 
	knitted, monofilament polypropylene 	only to be funded when used in 
	mesh.	conjunction with MBS Item No. 
	35597.
	
	See rule 5B for effect of Condition.
CT019	Restorelle L Smartmesh	Smartmesh, Type 1, macroprous, soft, 	24cm x 8cm	$310.00
	knitted, monofilament polypropylene 
	mesh
	Johnson & Johnson Medical Pty Ltd
JJ790	GYNECARE GYNEMESH PS	Pelvic floor reconstructive material, 	10 x 15 cm	$310.00
	lightweight mesh
	ap
	American Medical Systems Pty Ltd
AM023	IntePro Large Pore Polypropylene 	Large pore polypropylene mesh	One size	$677.00
	Y-Sling
Prostheses List by Category, Groups and Sponsor	Page 240 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Boston Scientific Australia Pty Ltd
BS252	Upsylon Y-Mesh Kit	Y-Mesh with single use instrument 	Graft Dimensions: 24 x 4 cm	$677.00
	for mesh placement
	Coloplast Pty Ltd
CT017	Restorelle Y Smartmesh	Smartmesh for vaginal vault prolapse 	24cm x 4cm and 27cm x 4cm.	$677.00
	repair for abdominal, laproscopic or 
	robotic sacrocolpopexy.
	Johnson & Johnson Medical Pty Ltd
JJ905	ARTISYN™	Pelvic floor reconstructive material, 	27 x 5 cm	$677.00
	lightweight, Y shaped mesh
	ap, k
	Boston Scientific Australia Pty Ltd
BS131	Pinnacle PFR Kit	Synthetic Polypropylene mesh 	One configuration	$2,540.00
	assembly and fixation device
BS157	Pinnacle Duet PFR Kit	Synthetic polypropylene mesh 	Two configurations	$2,540.00
	assemblies and fixation device
BS193	PFR Kit - Pinnacle™ LITE 	Synthetic polypropone mesh 	One configeration	$2,540.00
	Anterior/Apical	assemblies and fixation device
	Johnson & Johnson Medical Pty Ltd
JJ476	Gynecare Prolift Pelvic Floor 	Pre-cut gynemesh PS and single use 	one size only	$2,540.00
	Repair System	instruments for mesh placement
JJ745	GYNECARE PROSIMA Combined 	Pre-cut gynemesh PS and single use 	2 x Pieces of GYNECARE 	$2,540.00
	Pelvic Floor Repair System	instruments for mesh placement	GYNEMESH PS* Mesh 
	(approximately 80mm x 
	60mm).  1 x Vaginal Support
	 Device, 1 x Syringe, 1 x 
	Anterior Inserter, 1 x 
	Posterior Inserter
JJ747	GYNECARE PROLIFT+M 	Pre-cut GYNECARE GYNEMESH 	One Size Only	$2,540.00
	combined Pelvic Floor Repair System	M* Partially Absorbable mesh and 
	single use instuments for mesh 
	placement
Prostheses List by Category, Groups and Sponsor	Page 241 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	k
	American Medical Systems Pty Ltd
AM026	Perigee Transobturator Anterior 	4 helical shaped needles with 	One size	$1,322.00
	Prolapse Repair System	handles, 4 synthetic graft arms 
	enclosed in plastic with a centre 
AM027	Apogee Vault Suspension System	2 stainless steel curved needles with 	One size	$1,322.00
	handles, a large pore polypropylene 
	mesh attached in the centre of a 
	polypropylene mesh enclosed in 
	plastic sheaths and two dilating 
AM052	Elevate Anterior & Apical Prolapse 	IntePro Lite Mesh and single use 	One size only.	$1,322.00
	Repair System	instuments for mesh placement.
AM053	Elevate Apical & Posterior 	IntePro Lite mesh and single use 	one size only	$1,322.00
	Prolapse Repair System	instruments for mesh placement
	Boston Scientific Australia Pty Ltd
BS155	Uphold Vaginal Support System	Synthetic polypropylene mesh 	One configuration	$1,322.00
	assembly and fixation device
BS156	Pinnacle PFR Kit Posterior	Synthetic polypropylene mesh 	One configuration	$1,322.00
	assembly and fixation device
BS194	Pinnacle™ Lite - PFR Kit Posterior	Synthetic polypropylene mesh 	One configuration	$1,322.00
	assemblies and fixation device
BS198	Uphold™ LITE Vaginal Support 	Synthetic polypropylene mesh 	One configuration	$1,322.00
	System	assemblies and fixation device
	Johnson & Johnson Medical Pty Ltd
JJ477	Gynecare Prolift Pelvic Floor 	Pre-cut gynemesh PS and single use 	one size only	$1,322.00
	Repair System	instruments for mesh placement
JJ478	Gynecare Prolift Pelvic Floor 	Pre-cut gynemesh PS and single use 	one size only	$1,322.00
	Repair System	instruments for mesh placement
JJ676	GYNECARE PROSIMA  Anterior 	Precut gynaemesh PS and single use 	1 x Pieces of GYNECARE 	$1,322.00
	Pelvic Floor Repair System	instruments for mesh placement. 	GYNEMESH PS* Mesh 
	Includes vaginal support device	(approximately 80mm x 
	60mm).  1 x Vaginal Support
	 Device, 1 x Syringe, 1 x 
	Posterior  Inserter
Prostheses List by Category, Groups and Sponsor	Page 242 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ679	GYNECARE PROLIFT + M 	Pre-cut GYNECARE GYNEMESH 	One size only	$1,322.00
	Anterior Pelvic Floor Repair System	M* Partially Absorbable mesh and 
	single use instruments for mesh 
	placements
JJ746	GYNECARE PROSIMA Posterior 	Pre - Cut gynemesh PS and single use 	1 x Pieces of GYNECARE 	$1,322.00
	Pelvic Floor Repair System	instruments for mesh placement	GYNEMESH PS* Mesh 
	(approximately 80mm x 
	60mm).  1 x Vaginal Support
	 Device, 1 x Syringe, 1 x 
	Posterior  Inserter
JJ748	GYNECARE PROLIFT+M 	Pre-cut GYNECARE GYNEMESH 	Once Size Only	$1,322.00
	Posterior Pelvic Floor Repair 	M* Partially Absorbable mes and 
	single use instruments for mesh 
	placement
	Medical Specialties Australia Pty Ltd
MS061	TiLOOP Two Kit	Tension-free non-absorbable titanised	light, extralight, small, 	$1,322.00
	 polypropylene mesh for posterior 	medium
	pelvic floor repairs with instruments
MS062	TiLOOP Four Kit	Tension-free non-absorbable titanised	light, extralight, small, 	$1,322.00
	 polypropylene mesh for anterior 	medium
	pelvic floor repairs with instruments
	05.04.01.02 - ≥500 sq cm
	Coloplast Pty Ltd
CT020	Restorelle XL Smartmesh	Smartmesh, Type 1, macroporous, soft, 	30cm x 30cm	$677.00
	knitted, monofilament polypropylene 
	mesh
	Johnson & Johnson Medical Pty Ltd
JJ789	GYNECARE GYNEMESH	Pelvic floor reconstructive material, 	25 x 25 cm	$677.00
	lightweight mesh
05.04.02 - Biological
	05.04.02.01 - <70 sq cm
	Boston Scientific Australia Pty Ltd
BS185	Xenform Soft Tissue Repair Matrix 	Graft derived from fetal dermal bovine 	2x7cm	$786.00
	2x7cm	tissues
Prostheses List by Category, Groups and Sponsor	Page 243 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS186	Xenform Soft Tissue Repair Matrix 	Graft derived from fetal dermal bovine 	4x7cm	$786.00
	4x7cm	tissues
BS187	Xenform Soft Tissue Repair Matrix 	Graft derived from fetal dermal bovine 	6x10cm	$786.00
	6x10cm	tissues
	05.04.02.02 - ≥70 sq cm
	Boston Scientific Australia Pty Ltd
BS188	Xenform Soft Tissue Repair Matrix 	Graft derived from fetal dermal bovine 	8x12cm	$1,200.00
	8x12cm	tissues
	Cook Medical Australia Pty Ltd
WC253	Surgisis Biodesign 4-layer Tissue 	Surgisis Biodesign Posterior Pelvic 	14cm x 16cm Site Specific 	$1,200.00
	Graft	Floor Graft	Shape
WC254	Surgisis Biodesign 4-layer Tissue 	Surgisis Biodesign Anterior Pelvic 	14cm x 14cm / 7cm x 10 cm 	$1,200.00
	Graft	Floor Graft	(shaped) 9cm x 12cm 
	(Trapezoide)
05.04.03 - Bone and ligament fixation
	American Medical Systems Pty Ltd
AM010	Influence Bone Screw	Bone screw with pre-attached 	5.5 x 1.7 mm	$700.00
	polypropylene monofilament suture. 
	For incinsionless tranvaginal sling 
	procedure. Loop Screw Bone Screw
Prostheses List by Category, Groups and Sponsor	Page 244 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
05.05.01 - Malleable
	American Medical Systems Pty Ltd
AM054	AMS Spectra Concealable Penile 	AMS Spectra Concealable Penile 	9.5 mm x 12cm AMS Spectra	$817.00
	Prosthesis	Prosthesis	
	9.5 mm x 16cm AMS Spectra
	
	9.5 mm x 20cm AMS Spectra
	
	12 mm x 12cm AMS Spectra
	
	12 mm x 16cm AMS Spectra
	
	12 mm x 20cm AMS Spectra
	Device Technologies Australia Pty Ltd
DE314	Malleable Penile Implant	Consists of a membrane, filler product 	14-23cm	$817.00
	and silicone tube
	A
	Coloplast Pty Ltd
CT007	Genesis Penile Prosthesis (Resist 	Malleable Penile Prosthesis (Resist 	Dia 9mm (14 - 23cm 	$900.00
	Coated)	Coated)	lengths), Dia: 11mm (16 - 
	25cm lengths), Dia: 13mm 
	(18 - 27cm lengths)
05.05.02 - Inflatable - Two component
	A
	American Medical Systems Pty Ltd
AM041	AMS Ambicor	AMS Ambicor Inflatable Penile 	AMS Ambicor Inflatable 	$10,414.00
	Prostheses	Penile Prostheses 12.5mm 
	in 14, 16 & 18cm length, 
	14mm in 16, 18 & 20cm 
	length, 15.5mm in 18, 20 & 
	22cm length
Prostheses List by Category, Groups and Sponsor	Page 245 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Coloplast Pty Ltd
CT001	Excel Inflatable Penile Prosthesis 	Two-piece inflatable penile prosthesis	Cylinder lengths 	$10,414.00
	(Resist Coated)	 (Resist Coated)	10,12,14,16,18,20,22cm & 
	six rear-tip extenders (two 
	each 1, 2 & 3cm)
	A
	MD Solutions Pty Ltd
MB022	Zephyr Hydraulic  Penile Implant	This hydraulic  penile implant is made	All sizes contained in one 	$10,414.00
	 from silicone elastomer and comprises	system pack. (13, 16, 19 cm)
	 of two inflatable cylinders. a reservoir
	 and a pump.
05.05.03 - Inflatable - Three component
	05.05.03.01 - Cylinder
	American Medical Systems Pty Ltd
AM022	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	12, 14, 15, 16, 18, 21cm	$3,520.00
	Prostheses Cylinders
	A
	American Medical Systems Pty Ltd
AM004	AMS 700 Series Inflatable Penile 	700 Series with InhibiZone	12, 14, 15, 16, 18, 21cm	$3,830.00
	Prostheses with Inhibizone 
	Coloplast Pty Ltd
CT008	Titan Inflatable Penile Prosthesis 	Cylinders for three component penile 	10, 12, 14,  16, 18, 20, 22cm	$3,830.00
	(Resist Coated) - Cylinders	prosthesis (Resist Coated)
	05.05.03.02 - Reservoir
	American Medical Systems Pty Ltd
AM044	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	 50, 65, 100ml	$1,795.00
	Prostheses Reservoir non Inhibizone
	A
	American Medical Systems Pty Ltd
AM038	AMS 700 Series Inflatable Penile 	700 Series InhibiZone	50, 65, 100ml	$1,980.00
	Prostheses InhibiZone Reservoir
Prostheses List by Category, Groups and Sponsor	Page 246 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Coloplast Pty Ltd
CT010	Titan Inflatable Penile Prosthesis 	Reservoir for three component penile 	60, 75, 100ml	$1,980.00
	(Resist Coated) - Lock-out Valve 	prosthesis (Resist Coated)
	Reservoir
	05.05.03.03 - Pump
	American Medical Systems Pty Ltd
AM042	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	One Size	$4,290.00
	Prostheses Pump
	A
	American Medical Systems Pty Ltd
AM036	AMS 700 Series Inflatable Penile 	700 Series with InhibiZone	One Size	$4,665.00
	Prostheses with InhibiZone Pump
	Coloplast Pty Ltd
CT011	Titan Inflatable Penile Prosthesis 	Pump for three component penile 	One Size	$4,665.00
	(Resist Coated) - Pump	prosthesis (Resist Coated)
	05.05.03.04 - Deactivation set
	American Medical Systems Pty Ltd
AM040	AMS 700 Series Inflatable Penile 	700 Series with InhibiZone	One Size	$135.00
	Prostheses with InhibiZone 
	Deactivation Package
AM046	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	One Size	$135.00
	Prostheses Deactivation Package
	Coloplast Pty Ltd
CT012	Titan Inflatable Penile Prosthesis 	True Lock Plug for deactivation of 	One Size	$135.00
	(Resist Coated) - True-lock Plug	three component penile prosthesis 
	(Resist Coated)
	05.05.03.05 - Accessory kit
	American Medical Systems Pty Ltd
AM045	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	One Size	$689.00
	Prostheses Accessory Kit
Prostheses List by Category, Groups and Sponsor	Page 247 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	A
	Coloplast Pty Ltd
CT005	Titan Inflatable Penile Prosthesis 	Assembly kit for three component 	Standard & Narrow -base	$689.00
	(Resist Coated) - Assembly Kit	penile prosthesis (Resist Coated)
	05.05.03.06 - Pump and cylinder
	American Medical Systems Pty Ltd
AM043	AMS 700 Series Inflatable Penile 	700 Series (Non InhibiZone)	12, 14, 15, 16, 18, 21cm	$7,810.00
	Prostheses Pump & Cylinders 
	Preconnected
	A
	American Medical Systems Pty Ltd
AM037	AMS 700 Series Inflatable Penile 	700 Series with InhibiZone	12, 14, 15, 16, 18, 21cm	$8,495.00
	Prostheses with InhibiZone Pump 
	& Cylinders Preconnected
	Coloplast Pty Ltd
CT009	Titan Inflatable Penile Prosthesis 	Preconnected Cylinders & pump for 	10, 12, 14, 16, 18, 20, 22cm 	$8,495.00
	(Resist Coated) - Cylinders & Pump 	three component penile prosthesis 	(in both infrapubic & 
	Preconnected	(Resist Coated)	scrotal models)
05.06.01 - Testicular prostheses
	American Medical Systems Pty Ltd
AM015	AMS Testicular Prostheses	Solid silicone elastomer with suture 	Small, Medium, Large	$653.00
	hole
	Coloplast Pty Ltd
CT003	Saline Filled Testicular Prosthesis	 Testicular Prosthesis	Extra Small, Small, Medium, 	$653.00
	Large
CT004	Soft Solid Testicular Prosthesis	Gel filled Testicular Prosthesis	Small, Medium, Large & 	$653.00
	Extra Large
	Device Technologies Australia Pty Ltd
DE324	Testicular Implant	Silicone with holes for fixation 3230	5-38cc	$653.00
Prostheses List by Category, Groups and Sponsor	Page 248 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Endotherapeutics Pty Ltd
ET028	Promedon Testicular Prosthesis	Silicone Elastomer	Small - 31 x 23 mm,  Medium	$653.00
	 - 37 x 28 mm,  Large - 42 x 
	32 mm,  Xlarge
	Surgiplas Medical
SP002	Testicular Implant	Silicone Elastomer	Small / Medium / Large	$653.00
05.07.01 - Primary Cell Pulse Generator (non-rechargeable)
	Medtronic Australasia Pty Ltd
MC719	InterStim Neurostimulator Model 	Titanium	42g	$9,550.00
	3023
MC755	InterStim II Neurostimulator	Titanium	Weight 22g	$9,550.00
05.07.02 - External Components
	05.07.02.01 - Programmer
	Medtronic Australasia Pty Ltd
MC756	InterStim iCON Patient Programmer	Hand held device Model 3037 to be 	One size only	$1,400.00
	used with implantable 
	neurostimulation devices
	05.07.02.02 - External Neurostimulator
	Medtronic Australasia Pty Ltd
MI126	Verify External Neurostimulator	External Neurostimulator	One size only	$1,200.00
MI128	Medtronic Controller	Patient programmer	One size only	$1,200.00
05.07.03 - Lead
	05.07.03.01 - Permanent
	tined
	Medtronic Australasia Pty Ltd
MI074	Sacral Nerve Stimulation Lead	4 Electrode tined lead	28 - 41cm	$4,420.00
Prostheses List by Category, Groups and Sponsor	Page 249 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	05.07.03.02 - Trial
	Medtronic Australasia Pty Ltd
MC185	Sacral Nerve Stimulation Unilateral	Interstim Temporary test stimulation 	Various	$393.00
	lead
	05.07.03.03 - Extension
	Medtronic Australasia Pty Ltd
MC777	Interstim Extension Lead	Quadripolar Extension Kit	10, 25, 51cm	$1,510.00
05.07.04 - Accessories
	05.07.04.01 - Implant/Revision Kits
	Medtronic Australasia Pty Ltd
MC775	Interstim Lead Introducer Kit	Lead Introducer Kit for Sacral Nerve 	One size only	$541.00
	Stimulation
	05.07.04.02 - Other Accessories
	Medtronic Australasia Pty Ltd
MC186	Sacral Nerve Stimulation Accessories	Model 041827-002 Auxiliary 	One size only;  9-12.5cm	$130.00
	screener cable kit. Polypropylene. OR
	 Model 041828-002 and model 
	041829 Foramen Needle (box of 6). 
	Sterile individual units. Stainless 
	05.07.04.03 - Connectors and Cables
	Medtronic Australasia Pty Ltd
MI127	Medtronic Cables	Stimulation Cables for Intraoperative 	Various	$200.00
	testing
Prostheses List by Category, Groups and Sponsor	Page 250 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
05.08.01 - Extraluminal
	05.08.01.01 - Clip
	Femcare Australia Pty Ltd
FE001	Filshie Clip	Titanium	One size only	$155.00
	with applicator
	Femcare Australia Pty Ltd
FE003	Filshie Clips - Sterishot	With Disposable Applicator	One Size	$410.00
	05.08.01.02 - Band
	Olympus Australia
OL079	Falope-Ring Bands	Fallopian Tube Clip (each)	5mm - 12mm	$39.00
05.08.02 - Intraluminal
	Gytech Pty Ltd
GP004	Essure System (ESS305)	Stainless steel, polyester fibre	One size only, 2 per pack	$1,196.00
05.09.01 - Nephrostomy Catheters
	Boston Scientific Australia Pty Ltd
BS228	Flexima Nephrostomy Catheter	Urinary drainage catheters for internal	Length up to 25cm	$120.00
	 and external drainage of the urinary 
	tract.
	Cook Medical Australia Pty Ltd
WC291	Dawson-Mueller Drainage Catheter	A drainage catheter intended for use 	5-14 Fr, Length: 15-25cm	$120.00
	for Nephrostomy applications either 
	by direct stick or modified seldinger 
	technique.
Prostheses List by Category, Groups and Sponsor	Page 251 of 1059

05 - UROGENITAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	N Stenning & Co Pty Ltd
NG058	NEPHRO-CATH Nephrostomy 	Nephrostomy Drainage Catheter	Diameters: 8fr to 14fr sizes; 	$120.00
	Drainage Catheter	Lengths 27cm through to 
	29cm
	Pyramed Pty Limited
PY013	Optimed nephrostomy catheter set	Soft polyurethane drainage sets	7-14Fr., length 25cm - 30cm	$120.00
PY014	Optimed nephrostomy catheter	Soft polyurethane drainage catheter	7-14Fr., length 25cm - 30cm	$120.00
	Bard Australia Pty Ltd
BA250	Navarre Drainage Catheter	A drainage catheter intended for use 	6-12 French, Length: 15-	$120.00
	for Nephrostomy applications either 	40cm
	by direct stick or modified seldinger 
	technique.
05.10.01 - Vesicoureteral Reflux Prostheses
	Galderma Australia Pty Ltd
GD001	Deflux	Deflux is a sterile, highly viscous gel 	1ml in syringe	$1,000.00
	of dextranomer microspheres and non-
	animal stabilised hyaluronic acid 
	constituting a biocompatible and 
	biodegradable implant for the 
	treatment of vesicoureteral reflux.  The 
	stabilised hyaluronic acid acts mainly
GD002	Deflux and Metal needle kit	Deflux is a sterile, highly viscous gel 	1 ml syringe and needle size	$1,000.00
	of dextranomer microspheres and non-	 3.7FR x 23G x 350mm
	animal stabilised hyaluronic acid 
	constituting a biocompatible and 
	biodegradable implant for the 
	treatment of vesicoureteral reflux. The 
	stabilised hyaluronic acid acts mainly
	NEOGENIX PTY LTD
GN003	Vantris	Bulking agent for the treatment of 	1ml Syringe	$1,000.00
	Vesicoureteric Reflux
Prostheses List by Category, Groups and Sponsor	Page 252 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.01.01 - Ankle joint component
	06.01.01.01 - Liner - fixed bearing
	Johnson & Johnson Medical Pty Ltd
DY083	Agility LP Ankle System	Agility Ankle Tibial Insert 	Size 1-6	$660.00
	Tornier Pty Ltd
TO094	Salto Talaris Ankle Prosthesis - 	Tibial insert, fixed, UHMWPE	Sizes 00, 0, 1, 2, 3, Left and 	$660.00
	Tibial insert	Right, each size avaliable in
	 the following thickness: 
	8mm, 9mm, 10mm, 11mm
	06.01.01.02 - Liner - mobile bearing
	Advanced Surgical Design & Manufacture Ltd
AE242	LINK STAR Ankle Prosthesis	UHMWPE Sliding Core	6- 14mm	$622.00
	Integra Neurosciences Pty Ltd
IG079	Hintegra Total Ankle Prosthesis - 	Sliding insert	Size 0 - 6, thickness 5 - 9mm	$622.00
	PE Inlay
	Johnson & Johnson Medical Pty Ltd
DY408	Mobility Ankle	Mobile Bearing	1-6 from 3-11mm	$622.00
	MatOrtho
MJ016	Box Ankle	Meniscal Insert, UHMWPE	Small 5-8mm, Medium 5-	$622.00
	8mm and Large 5-8mm
	Tornier Pty Ltd
TO073	Cheville Salto Ankle Prostheses	Mobile insert UHMWPE	Sizes 0,1,2,3. Each size has 	$622.00
	thickness 4,5,6 & 7mm
	Wright Medical Australia
WR260	CCI Evolution	CCI Evolution Bearing Component	Std/Std+/Large, 4-10mm	$622.00
Prostheses List by Category, Groups and Sponsor	Page 253 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.01.02 - Sinus Tarsi Implant
	06.01.02.01 - Metal
	Device Technologies Australia Pty Ltd
DE293	Prostop	Arthroereisis Subtalar implant	7x12mm 8x12mm 9x14mm 	$1,390.00
	10x14mm 11x16mm 12x16mm
	Integra Neurosciences Pty Ltd
IG053	MBA Titanium Subtalar Implant	Implant for subtalar joint arthroereisis	6, 8, 9, 10, 12mm and guide 	$1,390.00
	pin 2mm
	Lifehealthcare Pty Ltd
LH454	Horizon Subtalar Implant	Subtalar Screw	6mm, 8mm, 10mm, 11mm, 	$1,390.00
	12mm
	Lima Orthopaedics Australia Pty Ltd
LC063	Calcaneo stop screw	Cannulated self-drilling & self 	Diameter 7mm Length 28mm	$1,390.00
	threading eccentric screw for 
	calcaneous stop
LC126	R2 Subtalar Implant	R2 Subtalar Implant	Size 7/13mm to 12/18mm	$1,390.00
	LMT Surgical Pty Ltd
LM100	Hyprocure	Sinus Tarsi Implant	5-9mm	$1,390.00
LM101	Instratek Sub-Talar Lok	Arthroereisis Implant System	7-11mm	$1,390.00
	Tornier Pty Ltd
TO116	Futura Conical Subtalar Implant	The Conical Subtalar Implant (CSI) is 	7 - 12	$1,390.00
	designed to treat hyperpronated foot 
	and to stabilize the subtalar joint. It is
	 intended to block forward, downward
	 and medial displacement of the talus, 
	allowing for normal subtalar joint 
	motion while simultaneously 
	Wright Medical Australia
WR001	BioArch Subtalar Arthroereisis 	Conical, tapered, titanium implant 	8, 9, 10, 11, 12mm	$1,390.00
	Implant	with blunt thread design.
Prostheses List by Category, Groups and Sponsor	Page 254 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.01.02.02 - Metal Poly
	Integra Neurosciences Pty Ltd
IG072	Kalix 	Flat foot implant titanium/UHMWP	9 - 17mm diameter	$1,165.00
06.01.03 - Ankle joint
	06.01.03.01 - Talar component
	Advanced Surgical Design & Manufacture Ltd
AE240	LINK STAR Ankle Prosthesis	Talar Component, cemented	xx-Small - x- large	$2,300.00
AE243	LINK STAR Ankle Prosthesis	Talar Component, cementless	xx- small - x-large	$2,300.00
	Integra Neurosciences Pty Ltd
IG094	Hintegra Total Ankle Prosthesis	Talar Implant - Flat talar resection	Left - Size 1-5, Right - Size 	$2,300.00
	1-5
	Johnson & Johnson Medical Pty Ltd
DP871	Agility Ankle System	Agility Ankle Talar	Size 1 - 6	$2,300.00
DY409	Agility LP Ankle System	Wide Ankle Talus	Size 1-6	$2,300.00
DY419	Mobile Ankle 	Uncemented Porocoat Talar 	Size 1-6	$2,300.00
	MatOrtho
MJ017	Box Ankle	Talar Component CoChr. Cementless	Small, Medium and Large	$2,300.00
	Tornier Pty Ltd
TO072	Salto Ankle Prostheses	Talar component mobile bearing CoCr,	Sizes 0,1,2,3 left and right	$2,300.00
	 Ti, HA
TO092	Salto Talaris Ankle Prosthesis - 	Talar compoment, CrCo + Ti	Sizes 0, 1, 2, 3, Left and 	$2,300.00
	Talar component	Right
	Wright Medical Australia
WR259	CCI Evolution	CCI Evolution Talar Component	Std/Std+/Large	$2,300.00
	CS
	Integra Neurosciences Pty Ltd
IG078	Hintegra Total Ankle Prosthesis - 	Talar implant for primary surgery	Right and left, sizes 0 to 6	$3,100.00
	Talar component with Pegs
Prostheses List by Category, Groups and Sponsor	Page 255 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.01.03.02 - Tibial component
	Advanced Surgical Design & Manufacture Ltd
AE241	LINK STAR Ankle Prosthesis	Tibial Component, cemented	xx-small - x-large	$2,000.00
AE244	LINK STAR Ankle Prosthesis	Tibial Component, cementless	xx-small - x-large	$2,000.00
AE245	LINK STAR Ankle Prosthesis	Revision Tibial Component, 	Extra small - Extra large	$2,000.00
	Integra Neurosciences Pty Ltd
IG077	Hintegra Total Ankle Prosthesis	Tibial implant	Right and left, sizes 1 - 6	$2,000.00
IG095	Hintegra Total Ankle Prosthesis 	Tibial Implant	Right & Left, Sizes 1 - 6, 	$2,000.00
	Flat Cut	Thickness 8mm or 12mm
	Johnson & Johnson Medical Pty Ltd
DY418	Mobile Ankle 	Uncemented Porocoat Tibial 	Size 1-6	$2,000.00
	MatOrtho
MJ018	Box Ankle	Tibial Component CoChr. Cementless	Small, Medium and Large	$2,000.00
	Tornier Pty Ltd
TO071	Cheville Salto Ankle Prostheses	Tibial component mobile bearing 	Sizes 0,1,2,3 left and right	$2,000.00
	CoCr, Ti, HA
	Wright Medical Australia
WR261	CCI Evolution	CCI Evolution Tibial Component	Std/Std+/Lge/Lge+	$2,000.00
	06.01.03.03 - Tibial component, cemented/uncemented, fixed bearing
	Johnson & Johnson Medical Pty Ltd
DY082	Agility LP Ankle System	Agility Ankle Tibial Shell Right and 	Size 1-6	$1,724.00
	Left
	Tornier Pty Ltd
TO093	Salto Talaris Ankle Prosthesis - 	Tibial component, fixed bearing, CrCo 	Sizes 0, 1,2,3	$1,724.00
	Tibial component	+ Ti
Prostheses List by Category, Groups and Sponsor	Page 256 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.01.04 - Replacement of other joints of the foot including articulations
	06.01.04.01 - Great toe, MTP, total, metatarsal component 
	Integra Neurosciences Pty Ltd
IG056	Kinetik Great Toe Implant	Metatarsal Component  made of 	1, 2, 3 Right & Left	$800.00
	chrome cobalt 01-2002, 01-2004, 01-
	2006, 01-2003, 01-2005, 01-2007
	Orthotech Pty Ltd
OH443	Reflexion 1st MPJ Implant System	Reflexion metatarsal stems, 3 part 1st 	Small, medium, large	$800.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
OH449	Bio-Action Great Toe System	Bio-Action Metatarsal Implant Cobalt	Small neutral / small left/ 	$800.00
	 Chrome	small right/ large neutral
	Smith & Nephew Surgical Pty Ltd
SM008	Toefit - Plus	Titanium alloy	Metatarsal Component XS-L	$800.00
SM047	Toefit - Plus	Modular cobalt chrome meta-tarsal 	Proximal Insert 6, 7, 8	$800.00
	head insert for proximal component of 
	total Metatarsophalangeal arthroplasty
	Surgiplas Medical
SP057	Bio-Action Great Toe System	Bio-Action Metatarsal Implant Cobalt	Small neutral / small left/ 	$800.00
	 Chrome	small right/ large neutral
SP061	Reflexion 1st MPJ Implant System	Reflexion metatarsal stems, 3 part 1st 	Small, medium, large	$800.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
	06.01.04.02 - Great toe, MTP, total, phalangeal component 
	Integra Neurosciences Pty Ltd
IG055	Kinetik Great Toe Implant	Phalangeal Component made of 	0,1,2,3	$790.00
	titanium alloy 01-2010, 01-2012, 01-
	2014, 01-2016
Prostheses List by Category, Groups and Sponsor	Page 257 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH445	Reflexion 1st MPJ Implant System	ReflexionPhalangeal Bases, 3 part 1st 	Small, medium, large	$790.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
OH448	Bio-Action Great Toe Implant	Bio-Action Phalangeal Implant, 	Small neutral/ small 	$790.00
	Titanium Alloy and UHMWPE.	modified/ large modified.
	Smith & Nephew Surgical Pty Ltd
SM009	Toefit - Plus	Titanium Alloy	Phalangeal Component XS-	$790.00
	Surgiplas Medical
SP056	Bio-Action Great Toe Implant	Bio-Action Phalangeal Implant, 	Small neutral/ small 	$790.00
	Titanium Alloy and UHMWPE.	modified/ large modified.
SP063	Reflexion 1st MPJ Implant System	ReflexionPhalangeal Bases, 3 part 1st 	Small, medium, large	$790.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
	06.01.04.03 - Great toe, MTP, total, articular insert or liner
	Orthotech Pty Ltd
OH444	Reflexion 1st MPJ Implant System	Reflexion metatarsal heads, 3 part 1st 	Standard, long, extra-long	$530.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
	Smith & Nephew Surgical Pty Ltd
SM046	Toefit - Plus	Polyethylene	Polyethylene Distal Insert 	$530.00
	11 - 15mm
	Surgiplas Medical
SP062	Reflexion 1st MPJ Implant System	Reflexion metatarsal heads, 3 part 1st 	Standard, long, extra-long	$530.00
	MPJ reconstruction system, 2 part 
	composition - titanium/cobalt chrome,
	 1 part composition - 
	titanium/UHMWPE,
Prostheses List by Category, Groups and Sponsor	Page 258 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.01.04.04 - Great toe, resurfacing hemi articulation, metatarsal
	Advanced Surgical Design & Manufacture Ltd
AE138	Hemi CAP Articular Resurfacing 	Articular Component	12mm (1-2mm x 1.5-3mm 	$740.00
	Great Toe System	offset), 15mm (1.5-2.5mm x 
	2.5-4.5mm offset)
AE139	Hemi CAP Articular Resurfacing 	Fixation Component	8mm x 16mm, 9.5mm x 18mm	$740.00
	Great Toe System
	Smith & Nephew Surgical Pty Ltd
SM045	Toefit - Plus	Chromium Cobalt	Distal Insert 13 - 17mm	$740.00
	06.01.04.05 - Great toe, resurfacing hemi articulation, phalangeal
	Device Technologies Australia Pty Ltd
DE289	AnaToemic	AnaToemic Phalangial Prosthesis	17mm, 20mm, 21.5mm, 23mm	$1,205.00
	Integra Neurosciences Pty Ltd
IG058	K2 Hemi Toe Implant System	Surface replacement for base of hallux 	1-4	$1,205.00
	with titanium plasma coated stem for 
	fixation and suture hole for FHL 
	tendon transfer
	Lifehealthcare Pty Ltd
LH232	Toe Joint	Metallic Hemiarthroplasty resurfacing	8mm - 23 mm	$1,205.00
	 prosthesis for the 
	Metatarsophalangeal Joint
	Orthotech Pty Ltd
OH442	Hemi-Great Toe Implant	Great Toe implant, Cobalt Chromium	XS, S, M, L	$1,205.00
	Surgiplas Medical
SP055	Hemi-Great Toe Implant	Great Toe implant, Cobalt Chromium	XS, S, M, L	$1,205.00
	Wright Medical Australia
WR045	Wright Titanium Great Toe	Great toe titanium	0,1, 2, 3, 4	$1,205.00
WR047	LPT Great Toe Implant	Titanium LPT Metatarsal Component 	Sizes 1, 2 & 3 Regular Great	$1,205.00
	available in Regular and Angled Toe	 Toe Implants. Sizes 1 & 2 
	Angled Great Toe Implants
Prostheses List by Category, Groups and Sponsor	Page 259 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.01.04.06 - Great toe, non articulating articulation (for silastic implant replacement)
	Tornier Pty Ltd
TO117	Stayfuse	Titanium inter-digital fusion device	Prox 2.8mm Blue; Mid 	$577.00
	3.8mm x 6mm Blue; Mid 
	4.3mm x 6mm Blue; Prox 
	3.3mm Grey; Prox 3.8mm 
	Grey; Mid 3.8 x 6mm Grey; 
	Mid 4.3 x 6mm Grey; Mid 
	5.0 x 5mm Grey; Mid 5.0 x 
	6mm Grey; Prox 6.5mm 
	Gold; Distal 5.5 x 10mm 
	Gold; Distal 6.5 x 10mm 
	Gold
	Wright Medical Australia
WR044	WMT Orthopaedics Implants Hinge 	Silastic flexible hinge toe 	0, 1, 2, 3, 4, 5, 6, 7	$577.00
	Toe and Hammertoe Implant	with/without grommets
06.02.01 - Wrist
	06.02.01.01 - Carpal component
	Advanced Surgical Design & Manufacture Ltd
AE210	Total Wrist Implant System	Carpal Component	Small, Medium, Large	$1,800.00
AE248	Artelon	Co-polymer biomaterial built on well 	Standard & Large	$1,800.00
	known chemical components (PUUR) 
	- Polycaprolactone & Urethrane Urea
	Integra Neurosciences Pty Ltd
IG110	Universal2 Carpal Component	Carpal plate (titanium) with fixed 	xs, small, med, large	$1,800.00
	central peg and porous coating
	06.02.01.02 - Radial component
	Advanced Surgical Design & Manufacture Ltd
AE207	Total Wrist Implant System	Left and Right Radial Components	Small, Medium, Large	$3,275.00
Prostheses List by Category, Groups and Sponsor	Page 260 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AE239	Stability Sigmoid Notch Total 	Radial stem is made of Cobalt 	Small & Large	$3,275.00
	DRUJ system / Stability Sigmoid 	chromium with a CPTi plasma spray 
	Notch Radial Stem and Insert.  Total 	on the back for bone ongrowth.  
	Wrist Implant System	Radial Insert is made of UHMWP 
	Polyethyelene
	Integra Neurosciences Pty Ltd
IG112	Universal2 Radial Component	Radial Implant (cobalt chrome) with 	x-small - left & right, small - 	$3,275.00
	integral stem and porous coating	left & right, medium - left & 
	right, large - left & right
	06.02.01.03 - Carpal spacer
	Advanced Surgical Design & Manufacture Ltd
AE209	Total Wrist Implant System	Carpal Ball	Small, Medium, Large	$2,150.00
	Integra Neurosciences Pty Ltd
IG111	Universal2 Carpal Poly Component	Polyethylene carpal component to 	xs-standard, xs +1, xs+2, 	$2,150.00
	restore proper carpal height in 	small - standard, small +1, 
	Universal2 total wrist implant	small +2, Med-standard, 
	med+1, med+2; large-
	standard, large+1, large+2
	Tornier Pty Ltd
TO134	BioProfile Pyrocarbon Total Wrist 	Low Temperature Isotropic Pyrolytic 	Medium, Large	$2,150.00
	Replacement (Capitate Resurfacing)	Carbon Implants for capitate 
	resurfacing (reverse total wrist 
	arthroplasty)
TO135	BioProfile Pyrocarbon Carpal 	Low temperature Isotropic Pyrolytic 	Small, Medium, Large & 	$2,150.00
	Implants	Carbon Implants for carpal 	Extra Large
	replacement/interposition, includes 
	Proximal Scaphoid, 
	Scapho/Trapezio/Trapezoid & 
	Trapezium
	Wright Medical Australia
WR041	Orthosphere	The Orthosphere is a spherical 	9mm - 14mm	$2,150.00
	interpositional implant that may be 
	used in both the carpometacarpal joint
	 and tarsometatarsal joint as a 
	spherical interpositional device.  It is 
	used to replace the sympotmatic joint 
	- either between the trapezium and firs
Prostheses List by Category, Groups and Sponsor	Page 261 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.02.01.04 - Distal ulnar stem
	Advanced Surgical Design & Manufacture Ltd
AE220	Ulnar Head Implants	UlnarHead CoCr	1,2,3,4	$1,120.00
	LMT Surgical Pty Ltd
LM148	Ascension DRUJ Ulna Head, 	Cobalt chromium stem with 	0, 1, 2, 3, 4	$1,120.00
	Implant System	PyroCarbon or Cobalt Chromium 
	Articular Surface
	Medical & Optical Instruments Australia Pty Ltd
MO145	Martin Ulna Head prosthesis	Ulnar Stem Titanium	Small, medium and 	$1,120.00
	large,2mm,4mm and 17mm 
	collar
	Tornier Pty Ltd
TO137	Eclypse Modular Pyrocarbon Ulnar 	A modular titanium stem for ulnar 	6, 7.5, 9mm	$1,120.00
	Head	head prostheses
	Wright Medical Australia
WR027	E-Centrix Ulnar Head Replacement	Ulnar Stem	5.5 STD, 6.5 STD, 7.5 STD, 	$1,120.00
	8.5 STD
WR028	E-Centrix Ulnar Head Replacement	Ulnar Stem Extender	20mm	$1,120.00
	06.02.01.05 - Distal ulnar head
	Advanced Surgical Design & Manufacture Ltd
AE221	Ulnar Head Implants	Ulnar Stem CoCr	1,2,3,4	$1,120.00
	LMT Surgical Pty Ltd
LM149	Ascension DRUJ Ulna Head, 	Cobalt chromium stem with 	0, 1, 2, 3, 4	$1,120.00
	Implant System	PyroCarbon or Cobalt Chromium 
	Articular Surface
	Medical & Optical Instruments Australia Pty Ltd
MO324	Martin Ulna Head prosthesis	UHP Ceramic Head	Small, medium and large	$1,120.00
MO325	Martin Ulna Head prosthesis	UHP Cobalt Chrome Head	Small, medium and large	$1,120.00
	Tornier Pty Ltd
TO136	Eclypse Modular Pyrocarbon Ulnar 	A modular pyrocarbon ulnar head 	14, 16, 18mm	$1,120.00
	Head	prosthesis
Prostheses List by Category, Groups and Sponsor	Page 262 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR026	E-Centrix Ulnar Head Replacement	Ulnar Head	16 x 1.5mm Offset, 16 x 	$1,120.00
	3.0mm Offset, 18 x 1.5mm 
	Offset, 20 x 1.5Offset, 20 x 
	3.0mm Offset
	06.02.01.06 - Tendon Spacer
	Wright Medical Australia
WR053	WMT Orthopaedic Implants Hand	Silastic tendon spacer	24in long, 3, 4, 5, 6mm wide	$310.00
06.02.02 - Finger Joint Articulations
	06.02.02.01 - Thumb, carpometacarpal
	Advanced Surgical Design & Manufacture Ltd
AE215	Elektra Stem	Cobalt Chromium/Hydroxyapatite 	6-8mm	$884.00
	coated
AE216	Elektra Neck	Cobalt Chromium	Extra Short, Short, Medium, 	$884.00
	Long
AE217	Trapezio Metacarpal Prosthesis 	Cup, Polyethylene	One size only	$884.00
AE219	Elektra Cup	Cobalt Chromium and Hydroxyapatite	One size only	$884.00
	 coating
	LMT Surgical Pty Ltd
LM028	Ascension pyrocarbon carpal 	Pyrocarbon carpal prostheses	Multiple sizes	$884.00
	Orthopaedic Solutions Pty Ltd
OE029	BIOProfile Pyrocarbon 	Low Temperature Isotropic Pyrolytic 	Small, Medium, Large & 	$884.00
	Carpometacarpal Implants	Carbon Implants for carpometacarpal 	Extra Large
	resurfacing (arthroplasty)
	Wright Medical Australia
WR042	WMT Orthopaedic Implants Hand	The Swanson Trapezium Implant is a 	1, 2, 3, 4, 5	$884.00
	flexible, one-piece intramedullary-
	stemmed implant developed to restore 
	function to thumbs disabled by 
	degenerative arthritis or post-
	traumatic arthritis.
Prostheses List by Category, Groups and Sponsor	Page 263 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR043	Wright Swanson Titanium Carpal 	The Swanson Basal Thumb implant is 	1 to 5 - length 19.3 to 	$884.00
	Scaphoid, Carpal Lunate, Basal 	a one-piece intramedullary-stemmed 	26.3mm, width 9.5 to 
	Thumb Implant	implant designed to be used as an 	13.6mm
	adjunct to resection arthroplasty of 
	the trapeziometacarpal joint.  It acts as
	 a spacer to preserve joint relationship
	 and allow appropriate capsulolig
	06.02.02.02 - Thumb, interphalangeal
	Advanced Surgical Design & Manufacture Ltd
AE211	MCP Finger Prosthesis "Ariadna"	Distal part, Stainless Steel	1,2 or3	$585.00
AE213	MCP Finger Prosthesis "Ariadna"	Proximal part, Stainless Steel	1,2,or 3	$585.00
	Orthotech Pty Ltd
OH202	Daphne	Metacarpophalangeal Joint Prosthesis	3, 4, 5, 6	$585.00
	Stryker Australia Pty Ltd
HW458	Memometal Ivory Trapezo - 	A cement less Trapezo- Metacarpal 	Cup sizes 9-11 mm, Head 	$585.00
	metacarpal cement less prosthesis	prosthesis.	Short medium and long, 
	Stem size 1,2,3,4.
	Wright Medical Australia
WR046	WMT Orthopaedic Implants 	Silastic finger joint with/without Ti 	00, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9	$585.00
	Finger/Thumb	grommets 470 series
	06.02.02.03 - Other fingers, metacarpophalangeal
	Advanced Surgical Design & Manufacture Ltd
AE204	Sbi Silicone MCP Implant System	Silicon finger joint	Various	$1,400.00
AE226	SR Hand Implant System	SR Hand MCP Distal or proximal, 	XS/S/M/L/XL	$1,400.00
	CoCr - Titanium Alloy, UHMWPE
	Johnson & Johnson Medical Pty Ltd
DP573	Neuflex Finger   	Neuflex MCP implant - Anasil Silicone	Size 0-60	$1,400.00
	LMT Surgical Pty Ltd
LM011	Ascension Finger Joint Replacement	Pyrocarbon, distal or proximal	05D/05P/10D/10P 	$1,400.00
	20D/20P, 30D/30P, 
LM053	Osteotec Silicone PIP Joint 	2 component hinged joint replacement	5 - 50	$1,400.00
	Replacement	 for the proximal interphalangeal joint
Prostheses List by Category, Groups and Sponsor	Page 264 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LM102	Ascension Silicone Finger joint 	MCP moulded silicone finger joint	Various	$1,400.00
	replacement
	MatOrtho
MJ019	PIPR Finger Joint	Proximal Interphalangeal Replacement	Sizes 7 through to 11	$1,400.00
	 Joint
	06.02.02.04 - Other fingers, interphalangeal
	Advanced Surgical Design & Manufacture Ltd
AE203	Sbi PIP Silicone Implant System	Silicone finger joint	Various	$1,600.00
AE212	PIP Finger Prosthesis	Proximal part PIP joint	0-5	$1,600.00
AE218	PIP Finger Prosthesis	Distal part PIP joint	0-5	$1,600.00
AE225	SR Hand Implant System	SR Hand PIP Distal or proximal 	1,2,3,4,5	$1,600.00
	CoCr- Titanium Alloy, UHMWPE
	Johnson & Johnson Medical Pty Ltd
DY400	Neuflex Finger	Neuflex PIP	1 to 20	$1,600.00
	LMT Surgical Pty Ltd
LM103	Ascension Silicone Finger joint 	PIP moulded silicone finger joint	00-05	$1,600.00
	replacement
	Mathys Orthopaedics Pty Ltd
MA520	RM Finger	Interphalangeal thumb, titanium 	L24.5, diam 6-7	$1,600.00
	coated PEEK Optima, includes 
	expansion screw
MA521	RM Finger	Interphalangeal-distal proximal, small,	L18 D4.0 - L26 D6.0	$1,600.00
	 standard, large titanium coated 
	PEEK, Optima, Semi-constrained
06.02.03 - Elbow
	06.02.03.01 - Distal humeral component/s
	Biomet Australia Pty Ltd
BH060	Discovery Elbow System	Humeral Component, Hydroxy 	(305)mm diam x (75-150)mm	$4,618.00
	Apatite + porous coated or cemented	 length
BH338	Comprehensive Segmental Revision 	Comprehensive SRS Distal Humeral 	50mm to 70mm	$4,618.00
	System (SRS)	Body
Prostheses List by Category, Groups and Sponsor	Page 265 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY137	Acclaim Elbow	Humeral Stem, Std/Lge	100-200mm	$4,618.00
	Stryker Australia Pty Ltd
HW377	Souter Strathclyde Elbow	Humeral - Long stem, left and right	Medium, Large	$4,618.00
HW379	Souter Strathclyde Elbow	Revision Humeral  - Custom, Long 	A, B, C, D	$4,618.00
	Stem
ST818	Osteonics Solar Elbow System - 	Titanium alloy with polyethylene 	Standard, large	$4,618.00
	humeral assembly	bushing
ST819	Osteonics Solar Elbow System - 	Titanium alloy with polyethylene 	Standard, large	$4,618.00
	long humeral assembly	bushing
	Tornier Pty Ltd
TO068	Latitude Elbow Prosthesis	Latitude Humeral Stem component, 	Small, Medium, Large for 	$4,618.00
	CoCr	both left and right
TO070	Latitude Elbow Prosthesis	Latitude Ulnar Stem CoCr + UMHWPE	Small , Medium, Large	$4,618.00
	Left and Right specific for 
	both  long and short stem 
	option
	Zimmer Pty Ltd
ZI004	Coonrad-Morrey Elbow	Humerus - Titanium	4, 6, 8 inch, Left & Right	$4,618.00
	06.02.03.02 - Proximal radial stem
	Advanced Surgical Design & Manufacture Ltd
AE223	Radial Head Implants	Radial Stem	2,3,4,4N	$1,325.00
	Biomet Australia Pty Ltd
BH059	Explor Radial Head	Stem	(5-10)mm x (22-32)mm	$1,325.00
	LMT Surgical Pty Ltd
LM104	Ascension Radial Head	Proximal Radial Stem	01/02/03/04, standard & 	$1,325.00
	Medical & Optical Instruments Australia Pty Ltd
MO271	Acumed Total Radial Head	Stem	6-10mm diameter, 0-8mm 	$1,325.00
	neck height
Prostheses List by Category, Groups and Sponsor	Page 266 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO074	RHS Radial Head System, Radial Stem	RHS Elbow prosthesis, Proximal 	Press-Fit Short Stems: 6 to 	$1,325.00
	Radial Stem, Press-fit Short Stems or 	10mm , neck 13mm or 16mm. 
	Long Cemented Stems, Ti Co	Cementeed Long Stems: 6.5 
	or 8mm, neck 19 or 22mm
TO077	Latitude Elbow Prosthesis	Latitude Radial Stem component	Diam 6.5mm or 5mm	$1,325.00
TO139	MoPyC-Modular Pyrocarbon 	A modular titanium stem for radial 	7mm, 8mm, 9mm, 10mm	$1,325.00
	Radial head Prosthesis	head prosthesis
	Wright Medical Australia
WR022	Evolve Modular Radial Head	Cobalt chromium alloy, standard and 	Stem 4.5 - 9.5mm Standard, 	$1,325.00
	plus stems	+2 & +4mm
	06.02.03.03 - Proximal radial head/neck
	Advanced Surgical Design & Manufacture Ltd
AE222	Radial Head Implants	Radial Head	2,3,4,4N	$1,334.00
	Biomet Australia Pty Ltd
BH058	Explor Radial Head	Head	(10-20)mm x (20-24)mm	$1,334.00
	LMT Surgical Pty Ltd
LM105	Ascension Radial head	Proximal Radial Head	20/22/24mm	$1,334.00
	Medical & Optical Instruments Australia Pty Ltd
MO270	Acumed Total Radial Head	Head	20-28mm	$1,334.00
	Stryker Australia Pty Ltd
HW381	Radial Head Prostheses	Radial Head - Small, Medium, Large	8 - 15mm	$1,334.00
	Tornier Pty Ltd
TO075	RHS Radial Head System, Radial 	RHS Elbow prosthesis, Radial Head, 	18mm to 24mm	$1,334.00
	Head	Ti Co
TO076	Latitude Elbow Prosthesis	Latitude Radial Head component	Small, Medium, Large, Large	$1,334.00
	 +
TO138	MoPyC-Modular Pyrocarbon 	A modular pyrocarbon radial head / 	18mm, 20mm, 22mm	$1,334.00
	Radial head Prosthesis	neck prosthesis
	Wright Medical Australia
WR023	WMT Orthopaedic Implants 	Radial head implant HP silastic	1, 1.5, 2, 2.5, 3	$1,334.00
	Radial/Ulna Head
Prostheses List by Category, Groups and Sponsor	Page 267 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR024	WMT Orthopaedic Implants 	Radial head titanium	1, 1.5, 2, 2.5, 3	$1,334.00
	Radial/Ulna Head
WR025	Evolve Modular Radial Head	Cobalt chromium alloy head	Head 18-28mm Std, +2 and 	$1,334.00
	+4mm
	06.02.03.04 - Proximal ulnar component
	Biomet Australia Pty Ltd
BH061	Discovery Elbow System	Ulnar Component; Hydroxy apatite + 	(3-5)mm dia x (75-115)mm 	$3,577.00
	porous coated or cemented	length
	Johnson & Johnson Medical Pty Ltd
DY138	Acclaim Elbow	Ulnar Stem, Std/Lge-Left/Right	60-85mm	$3,577.00
	Oceania Orthopaedics
OO132	MUTARS Proximal ulna	MUTARS Proximal ulna	60mm	$3,577.00
	Stryker Australia Pty Ltd
HW378	Souter Strathclyde Elbow	Ulnar - Retentive, non retentive	50 - 90mm (Non), 70 - 90mm	$3,577.00
	 (Retentive)
HW380	Souter Strathclyde Elbow	Revision Ulnar - Custom, Long stem	Small, Medium	$3,577.00
	Tornier Pty Ltd
TO013	Tornier Latitude Total Elbow 	Ulnar component, CoCr + UHMWPE	Small, Medium, Large	$3,577.00
	Prosthesis
	Zimmer Pty Ltd
ZI003	Coonrad-Morrey Elbow	Ulna - Titanium	Petite, Left, Right	$3,577.00
	06.02.03.06 - Elbow pin
	Stryker Australia Pty Ltd
HW224	Howmedica Modular Resection 	Humeral Axis -  Vitallium	One size only	$829.00
	System
	06.02.03.07 - Accessories - bushing / insert / spool
	Biomet Australia Pty Ltd
BH062	Discovery Elbow System	2 x Condyle Bearings, 2 x screws, 	Std, Revision	$1,440.00
	Poly articulation bearings
Prostheses List by Category, Groups and Sponsor	Page 268 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY140	Acclaim Elbow	Linked Ulnar Metal Bearing or 	One size only	$1,440.00
	Polyethylene Yoke
	Tornier Pty Ltd
TO069	Latitude Elbow Prosthesis	Latitude Humeral Spool component, 	Standard spool: Small, 	$1,440.00
	standard or anatomic, CoCr + PEEK	Medium, Large, Large +, 
	anterior, posterior or 
	centered, 
	Anatomic Spool: Small, 
	Medium, Large, Large +, 
	Left and Right, Anterior 
	Centred and Posterior Offset
	Zimmer Pty Ltd
ZI005	Coonrad-Morrey Elbow	Bushing -  Polyethylene, Titanium	1 & 2	$1,440.00
	06.02.03.08 - Accessories - circlips
	Stryker Australia Pty Ltd
HW199	Howmedica Modular Resection 	Circlip -  Vitallium	One size only	$74.00
	System
	06.02.03.10 - Accessories - cement restrictor
	Stryker Australia Pty Ltd
HW223	Howmedica Modular Resection 	Ulna Joint -  Vitallium	One size only	$3,783.00
	System
06.02.04 - Shoulder - Humeral
	06.02.04.01 - Humeral component and head – monoblock, cemented
	Smith & Nephew Surgical Pty Ltd
SN138	Neer 3 Total Shoulder System	Humeral stems	Head size 15 - 26, stem diam	$2,740.00
	 8 - 12mm
	06.02.04.02 - Humeral component - cemented
	Biomet Australia Pty Ltd
BI884	Comprehensive Fracture Stem	Fracture Stem Cobalt Chrome, 	4,6,8,10,12,14mm	$3,969.00
Prostheses List by Category, Groups and Sponsor	Page 269 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	DJO Australasia Pty Ltd
DD005	Turon Shoulder System - Humeral 	Turon Humeral Stem, Primary and 	6-16mm x 115mm and 6-	$3,969.00
	Stems	Revision	16mm x 200mm
	Euros Orthopaedics Australia Pty Ltd
EU019	SCULTRA II Reverse Humeral 	Humeral cemented stem	Length: short (124 mm) or 	$3,969.00
	cemented stem	long (188 mm); Diameters: 
	6.5, 9, 12 mm
	Johnson & Johnson Medical Pty Ltd
DP966	Global FX Shoulder	Global FX Stem Chrome	6-12mm and STD and 	$3,969.00
	revision 160-220mm length
DY273	Global FX Porocoat	FX PC Stem Standard / Long	6-12mm	$3,969.00
	Lima Orthopaedics Australia Pty Ltd
LC044	SMR Large Resection Stem	Resection Stem Large Ti6AI4V	7-10mm Dia x 50-80 Height	$3,969.00
	Mathys Orthopaedics Pty Ltd
MA523	Affinis Shoulder System	Stem Cemented - adjustable cone	6, 9, 12 and 15mm	$3,969.00
	Smith & Nephew Surgical Pty Ltd
SM169	PROMOS Modular Shoulder 	PROMOS Modular Shoulder System 	8x80mm, 8x120mm, 	$3,969.00
	Cemented Humeral Stem	10x80mm, 10x120mm, 
	12x80mm, 12x120mm, 
	14x80mm, 8x160mm, 
	10x160mm, 12x160mm
SN395	Modular Neer 3	Humeral stem component	Stem diameter 8-14mm, stem 	$3,969.00
	length 125-175mm
SN404	Modular Cofield	Humeral Stem	6mmx115mm - 16mmx245mm	$3,969.00
	Tornier Pty Ltd
TO056	Affinity Shoulder - Revision 	Fixed angle humeral stem with low-	Long Humeral Stems: 4 	$3,969.00
	Humeral Stem	profile lateral borders, Ti alloy, 	diameters - 8, 10, 12, 14mm.
	cemented or uncemented. Long stem.
TO081	Ascend Shoulder, Humeral Stem	Anatomic monolithic humeral stem Ti	27 sizes, 9 length from 	$3,969.00
	66mm to 98mm, 3 angles per 
	length from 125 to 140 deg
	Zimmer Pty Ltd
ZI579	Anatomical shoulder	Anatomical cemented Humeral Stem	7 x 100mm; 9 x 110mm; 12 x 	$3,969.00
	110mm; 7 x 200mm; 9 x 
	210mm; 14 x 210mm
Prostheses List by Category, Groups and Sponsor	Page 270 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Reverse
	Johnson & Johnson Medical Pty Ltd
JJ548	DELTA Xtend	Monobloc Humeral Cemented 	8 to 14 mm	$6,800.00
	Epiphysis Standard
JJ549	DELTA Xtend	Monobloc Humeral Cemented 	8 to 14mm	$6,800.00
	Epiphysis Revision
	Mathys Orthopaedics Pty Ltd
MA526	Affinis Inverse Stem, cemented	Humeral component - cemented. 	6,9,12,15mm	$6,800.00
	Monoblock primary stem for reverse 
	inlay
MA528	Affinis Inverse revision stem, 	Monoblock Revision Humeral Stem	6x180 to 12x230mm	$6,800.00
	cemented
	Tornier Pty Ltd
TO048	Aequalis Reversed fracture-standard	Monobloc Humeral Stem CoCr 	Length 130mm Dia 7 9 11 	$6,800.00
	cemented	13 15
	06.02.04.03 - Humeral component - uncemented 
	Biomet Australia Pty Ltd
BH047	Comprehensive Shoulder System	Humeral Stems, standard, mini, micro 	4mm to 20mm Diameter	$3,500.00
	and revision, porous coated, Ti
	Device Technologies Australia Pty Ltd
DE168	Univers 3D Shoulder Prostheses	Stem	6-12mm	$3,500.00
DE173	Univers Fracture Prostheses	Shaft	8-13mm	$3,500.00
	DJO Australasia Pty Ltd
DD029	Foundation Shoulder System	Humeral Stem, Ti	6mm to 16mm	$3,500.00
DD032	Reverse Shoulder System	Humeral Stem, Ti	6mm to 12mm	$3,500.00
	Euros Orthopaedics Australia Pty Ltd
EU020	SCULTRA II Reverse Humeral 	Humeral uncemented stem	Length: short (124 mm); 	$3,500.00
	uncemented stem	Diameters: 6.5, 9, 10.5, 12 mm
	Johnson & Johnson Medical Pty Ltd
DP029	Global Advantage Shoulder	Revision Stem Titanium alloy	8mm x 200mm - 14mm x 	$3,500.00
	220mm
DP030	Global Advantage Shoulder	Stem Standard, Titanium alloy	6mm - 16mm	$3,500.00
Prostheses List by Category, Groups and Sponsor	Page 271 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DP077	Global Advantage Shoulder	Global Advantage Stem	Size 8 to 14 or Length 6-	$3,500.00
	16mm
JJ610	Global AP Shoulder	Humeral Stem	Humeral Stem 6mm, 8mm, 	$3,500.00
	10mm, 12mm, 14mm, 16mm
JJ611	Global AP Shoulder	Humeral Stem Long	Humeral Stem Long - 8mm, 	$3,500.00
	10mm, 12mm, 14mm
JJ612	Global  Shoulder System	Porocoat Humeral Stem	6-16mm	$3,500.00
	Mathys Orthopaedics Pty Ltd
MA522	Affinis Shoulder System	Stem Cementless - Titanium, 	6, 7.5, 9, 10.5, 12, 13.5 and 	$3,500.00
	adjustable cone	15mm
	Smith & Nephew Surgical Pty Ltd
SM110	Promos Shoulder Replacement	Humeral Stem	01 - 4	$3,500.00
	Stryker Australia Pty Ltd
ST674	Osteonics Solar Shoulder 	Humeral stem polyethylene	3,5,7,9,11	$3,500.00
	Synthes Australia Pty Ltd
SY431	Epoca Custom Offset Shoulder 	Epoca ZF Cementless Stem	6 - 14mm, Length: 115 - 	$3,500.00
	Prosthesis	135mm
	Tornier Pty Ltd
TO002	Aequalis Primary Shoulder 	Aequalis Primary stem, Ti Ta	6.5-15mm - 1mm increm 	$3,500.00
	wide, 66-167mm long
TO029	Aequalis Fracture Shoulder HA 	Fracture shoulder humeral stem Cobalt	Diam 6.5mm - 130mm and 	$3,500.00
	Coated	 Chrome, HA coated	170mm lengths, Diam 9mm - 
	130mm, 180mm and 210mm 
	lengths. Diam 12mm - 
	130mm, 180mm and 210mm 
	lengths
TO049	Aequalis Reversed Fracture 	Monobloc Humeral Stem CoCr and 	Length 170, 180 or 210mm 	$3,500.00
	Shoulder - Revision	HA coated proximally	Dia 7 9 11 13mm
TO057	Affinity Shoulder - Standard 	Fixed angle humeral stem with low-	Standard Humeral Stems: 7 	$3,500.00
	Humeral Stem	profile lateral borders, Ti alloy, 	diameters - 6, 8, 10, 12, 14, 
	cemented or uncemented.	16, 18mm.
	Zimmer Pty Ltd
ZI289	Bigliani Shoulder System	Cobalt Chrome	Lengths 130 - 200mm, 	$3,500.00
	Thickness 6 - 16mm
Prostheses List by Category, Groups and Sponsor	Page 272 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI326	Bigliani/Flatow Trabecular Metal 	Porous Tantulum Humeral Stem	6mm-19mm diameter	$3,500.00
	Humeral Shoulder
ZI582	Anatomical Shoulder	Anatomical Press-fit Humeral Stem	7 x 100mm, 9 x 110mm, 10.5 	$3,500.00
	x 110mm, 12 x 110mm, 14 x 
	110mm
	Reverse
	Mathys Orthopaedics Pty Ltd
MA527	Affinis Inverse Stem, uncemented	Monoblock Humeral Stem	6 to 15 mm	$6,330.00
MA529	Affinis Inverse Revision stem, 	Monoblock Revision Humeral Stem	6 to 12 x180 to 230mm	$6,330.00
	uncemented
	Zimmer Pty Ltd
ZI528	Zimmer Trabecular Metal Reverse 	Trabecular Metal Humeral Stem 	8mm-18mm x 130mm-170mm	$6,330.00
	Shoulder System	Titanium Alloy and Tantalum
	06.02.04.04 - Modular humeral component - metaphyseal, cemented
	Biomet Australia Pty Ltd
BH339	Comprehensive Segmental Revision 	Comprepehnsive SRS Proximal Body	42mm to 62mm	$2,436.00
	System (SRS)
BH340	Comprehensive Segmental Revision 	Comprehensive SRS Tumour Body	51mm to 71mm	$2,436.00
	System (SRS)
	DJO Australasia Pty Ltd
DD036	Reverse Shoulder System	Humeral Socket Shell - Ti	Neutral, +4mm, +8mm offset	$2,436.00
	Exactech Australia
EX051	Equinoxe Humeral Long Stem	The long/revision stem is intended for	8x175mm, 8x215mm, 	$2,436.00
	 cemented fixation only. The 	10x200mm, 12x200mm
	long/revision stem is advised when 
	the distal bone quality is insufficient 
	to adequately anchor the primary 
	stems (typically as a result of mid-
	humeral fractures)
EX055	Equinoxe Humeral Stem, Fracture	The fracture stem is intended for 	Fracture: left: 7mm - 12mm, 	$2,436.00
	cemented fixation only and is advised 	right 7mm- 12mm Long stem
	for 3 & 4 part fractures of the proximal 	 fracture: left 7mm, 200mm 
	humerus	right 7mm,200mm
Prostheses List by Category, Groups and Sponsor	Page 273 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
EX059	Equinoxe Humeral Stem, primary 	The cemented primary humeral stem is 	1.5mm o/s, 4.5mm o/s  & 	$2,436.00
	including replicator plate	intended for cemented fixation only. 	6mm - 17mm
	The press-fit are intended for press-fit 
	applications but may be used with 
	bone cement if deemed appropriate by 
	the surgeon
EX064	Equinoxe Reverse Shoulder, 	Reverse, fracture humeral adapter tray.	+0mm.	$2,436.00
	Fracture Humeral Adapter Tray.
	Johnson & Johnson Medical Pty Ltd
JJ833	Delta Shoulder System	Modular metaphyseal cemented 	1-4 in 26-42mm	$2,436.00
	component
	06.02.04.05 - Modular humeral component - metaphyseal, uncemented
	Biomet Australia Pty Ltd
BI880	Mosaic Humeral Replacement 	Mosaic System - CoCr, Ti	Proximal Body - Std to +20	$2,580.00
	Device Technologies Australia Pty Ltd
DE256	Eclipse Humeral Head Prosthesis	Eclipse Humeral Head Prosthesis 	41 - 53mm	$2,580.00
	Trunnion
	DJO Australasia Pty Ltd
DD035	Reverse Shoulder System	Humeral Socket Insert - UHMWPE	32mm to 40mm	$2,580.00
	Johnson & Johnson Medical Pty Ltd
JJ551	DELTA Xtend	Modular Epiphysis HA coated	1 + 2	$2,580.00
JJ834	Delta Shoulder System	Modular metaphyseal component HA 	1-4 in 26-42mm	$2,580.00
	coated
	Lima Orthopaedics Australia Pty Ltd
LC041	SMR Shoulder	Humeral Body - Finned - Trauma - 	Short/Medium/Long	$2,580.00
	Reverse
	Mathys Orthopaedics Pty Ltd
MA481	Affinis Shoulder System	Affinis Fracture Stem - metaphyseal, 	15.5, Part 2- 18	$2,580.00
	uncemented
	Smith & Nephew Surgical Pty Ltd
SM111	Promos Shoulder Replacement	Body	30 - 35 - 40mm	$2,580.00
SN893	Promos Reverse Modular Shoulder 	Body	36/mm, 36/10mm, 36/15mm, 	$2,580.00
	System	42/5, 42/10mm, 42/15mm
Prostheses List by Category, Groups and Sponsor	Page 274 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO043	Aequalis Reversed Shoulder -	Cemented: CoCr and UMWHPE, 	D.36mm & 42mm	$2,580.00
	Metaphysis (Cemented or 	Cementless: CoCr, HA Coated and 
	UMWHPE
	06.02.04.06 - Modular humeral component - diaphyseal, cemented, Long (>220mm)
	Lima Orthopaedics Australia Pty Ltd
LC048	Randelli/SMR Total Shoulder	Randelli/SMR shoulder revision 	200, 240, 280mm	$3,000.00
	cemented stem
	06.02.04.07 - Modular humeral component - diaphyseal, uncemented, long (>220mm)
	Johnson & Johnson Medical Pty Ltd
DP965	Delta Shoulder system	Revision Cementless Diaphysis 	Size 1-4	$3,818.00
	INOX / ST. Steel + Aluminia+HAC
	Stryker Australia Pty Ltd
SK427	Solar Reunion Humeral Fracture 	Solar Reunion Humeral Fracture System	Short & Long	$3,818.00
	System
	06.02.04.08 - Modular Humeral component - diaphyseal, cemented, short (≤220mm)
	Biomet Australia Pty Ltd
BH337	Comprehensive Segmental Revision 	Comprehensive SRS Modular Stem	(6 to 20) mm dia x (50 to 	$4,000.00
	System	200)mm length
BI882	Mosaic Humeral Replacement 	Mosaic Distal Stem	(6.5 to 14.5) mm dia x (50 to 	$4,000.00
	200)mm length
	Johnson & Johnson Medical Pty Ltd
JJ550	DELTA Xtend	Modular Humeral Diaphysis	10, 12, 14, 16mm	$4,000.00
MN135	Delta Xtend Shoulder System	Porocoat Global Unite Distal Stem	size 6-16	$4,000.00
	Lima Orthopaedics Australia Pty Ltd
LC042	SMR Shoulder System	Short and Revision Cemented Stem	Dia 12-20mm x length 80-	$4,000.00
	210mm
	Mathys Orthopaedics Pty Ltd
MA479	Affinis Shoulder System	Affinis Fracture Stem - diaphyseal, 	6/125, 9/125, 12/125, 	$4,000.00
	cemented, short	12/125, 9/200, 12/200
Prostheses List by Category, Groups and Sponsor	Page 275 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY571	Epoca Custom Offset Shoulder 	Epoca Stem - Cemented	6-14mm, Length: 115-215mm	$4,000.00
	Prosthesis
	Tornier Pty Ltd
TO078	Aequalis Reversed Shoulder, 	Aequalis Reversed Shoulder 	Diam 6.5mm to 15mm, 	$4,000.00
	Cemented Stem	prosthesis, Cemented Stem, CoCr	Length 100 to 210mm
	06.02.04.09 - Modular Humeral component - diaphyseal, uncemented, short (≤220mm)
	Biomet Australia Pty Ltd
BI216	Bio-Modular Shoulder System	Humeral Stem, titanium	6-15mm	$2,800.00
	Device Technologies Australia Pty Ltd
DE258	Eclipse Humeral Head Prosthesis	Eclipse Humeral Head Prosthesis 	Small - X-Large	$2,800.00
	Cage Screw
	Johnson & Johnson Medical Pty Ltd
DP956	Delta Shoulder system	Modular diaphyseal stem HA coated	Size 1-4	$2,800.00
	Lima Orthopaedics Australia Pty Ltd
LC178	SMR Mini - Finned & Revision 	Mini - Finned Humeral Stem Ti6AI4V	Dia 11-24mm x Length 60 - 	$2,800.00
	Humeral Stem	80mm
LC179	SMR Resurfacing Humeral Stem	Resurfacing Humeral Stem Ti6AI4V - 	Dia 11-13mm x length 32-	$2,800.00
	Uncemented	36mm
	Synthes Australia Pty Ltd
SY572	Epoca Custom Offset Shoulder 	Epoca Stem - Uncemented	6-14mm, Length: 115-215mm	$2,800.00
	Prosthesis
	Tornier Pty Ltd
TO079	Aequalis Reversed Shoulder, 	Aequalis Reversed Shoulder 	Diam 6.5mm to 154mm, 	$2,800.00
	Cementless Stem	prosthetis, Cementless stem Ti, HA 	Length 100mm to 210mm
	Zimmer Pty Ltd
ZI575	Anatomical Shoulder	Anatomical Fracture Stem	7-14mm x 130mm; 7mm x 	$2,800.00
	170mm; 9, 11, 13mm x 
	200mm.
Prostheses List by Category, Groups and Sponsor	Page 276 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.02.04.10 - Bipolar humeral head
	Biomet Australia Pty Ltd
BI209	Bi-Angular Shoulder System	Bi Polar Head, Chrome Cobalt	Std to +4mm	$1,400.00
	Stryker Australia Pty Ltd
ST676	Osteonics Solar Shoulder Prostheses	Solar bipolar humeral inner head, 	22mm with 0, +2 and +4mm 	$1,400.00
	cobalt chromium	neck lengths
	Zimmer Pty Ltd
ZI444	BiPolar Head	Humeral Head used with Select 	26/42 to 26/60	$1,400.00
	Shoulder Humeral Stem - CoCr alloy/ 
	PE
	06.02.04.11 - Bipolar humeral shell
	Biomet Australia Pty Ltd
BI208	Bi-Angular Shoulder System	Bi Polar Shell, Titanium/ 	Size 40-60mm	$1,660.00
	UHMWPE/Chrome Cobalt
BI214	Bio-Modular Shoulder System	Bi-Polar shell/ Titanium, chrome 	40-60mm	$1,660.00
	Stryker Australia Pty Ltd
ST877	Osteonics Solar Shoulder Prostheses	Solar bipolar humeral  outer head, 	22mm with 0, +2 and +4mm 	$1,660.00
	cobalt chromium	neck lengths
	06.02.04.12 - Standard humeral head
	Biomet Australia Pty Ltd
BH126	Versadial Humeral Head	Humeral Head	(38 -58)mm x (19 -37)mm x 	$1,327.00
	(39-61)mm
BH349	Comprehensive Segmental Revision 	Comprehensive SRS Super EAS Head	Short, Long	$1,327.00
	System (SRS)
BI215	Bio-Modular Shoulder System	Humeral Head, Chrome Cobalt	40-54mm	$1,327.00
BI218	Bio-Modular Shoulder System	Modular Head, Chrome Cobalt	Std, +2, +4mm	$1,327.00
BI222	Bio-Modular Shoulder System	Shoulder Offset Head, Chrome Cobalt	40-54mm	$1,327.00
BI835	Bio-Modular Shoulder System	Extended Articular Surface Humeral 	40 - 54mm	$1,327.00
	Head, CrCo
Prostheses List by Category, Groups and Sponsor	Page 277 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE171	Univers 3D Shoulder Prostheses	Metal Head	40/14 - 54/23	$1,327.00
DE174	Univers Fracture Prostheses	Metal head	43/15 - 51/22	$1,327.00
DE257	Eclipse Humeral Head Prosthesis	Eclipse Humeral Head Prosthesis Head	41/16 - 53/20	$1,327.00
	DJO Australasia Pty Ltd
DD003	Turon Shoulder System - Humeral 	Turon Standard Humeral Head, 	38-54mm x 14-26mm	$1,327.00
	Head	Standard and Offset
DD030	Foundation Shoulder System	Humeral Head, CrCo	38mm to 54mm	$1,327.00
	Exactech Australia
EX058	Equinoxe Humeral Head	The humeral head is used in hemi-	38mm - 53mm	$1,327.00
	shoulder and total-shoulder joint 
	replacement procedures and for use in 
	fractures of the proximal humerus and 
	for use in total-shoulder joint 
	replacement procedures in 
	conjunction with an irreparable or 
	nonfunctional rotat
	Johnson & Johnson Medical Pty Ltd
DP020	Global Advantage Shoulder	Eccentric Head, Cobalt chrome alloy	44- 56mm x 18, 21mm	$1,327.00
DP962	Delta Shoulder system	DELTA Humeral Head INOX / 	36 - 42 mm in +0-+4	$1,327.00
	ST.Steel / Nichtrostender St.
JJ614	Global AP Shoulder	Humeral Head-Eccentric	40 – 56mm	$1,327.00
JJ828	Global Shoulder System	Standard humeral head	40-56mm	$1,327.00
	Lima Orthopaedics Australia Pty Ltd
LC180	SMR Humeral Head	Humeral Head CoCrMo	40-54mm Standard / 	$1,327.00
	Flattened
	Mathys Orthopaedics Pty Ltd
MA448	Affinis Total Shoulder	Humeral Head - CoCr	Diameter 39, 41, 43, 45, 47, 	$1,327.00
	49, 51, 53mm
	Smith & Nephew Surgical Pty Ltd
SM113	Promos Shoulder Replacement	Ball head anatomic	R19/H14-R26/H21	$1,327.00
SN403	Modular Cofield	Humeral Head	14x36mm - 36x58mm	$1,327.00
Prostheses List by Category, Groups and Sponsor	Page 278 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW214	Howmedica Modular Resection 	Humeral Head Fixed -  Vitallium	One size only	$1,327.00
	System
ST027	Solar Total Shoulder System	Dual Offset Humeral Heads	40-50mm diameter, 15-21mm	$1,327.00
	 thickness
ST672	Osteonics Solar Shoulder 	Humeral head polyethylene	40-55mm by 12-34mm	$1,327.00
ST673	Osteonics Solar Shoulder Prostheses	Dual offset humeral head polyethylene	40,45,50mm Diameter by 15,	$1,327.00
	 18, 21mm Thickness
	Synthes Australia Pty Ltd
SY432	Epoca Custom Offset Shoulder 	Epoca Head	40 - 54mm, Height: 15 - 	$1,327.00
	Prosthesis	20.25mm
	Tornier Pty Ltd
TO003	Aequalis Primary Shoulder 	Aequalis Primary Eccentric Humeral 	Diameter: 	$1,327.00
	Head, CoCr	37,39,41,43,46,48,50,52mm
TO055	Affinity Shoulder - Standard 	High integrity Morse taper and 	40 x 15, 40 x 18, 40 x 21, 44 	$1,327.00
	Humeral Head.	highly polished CoCr	x 15, 44 x 18, 44 x 21, 48 x 
	15, 48 x 18, 48 x 1, 52 x 15, 
	52 x 18, 52 x 21, 56 x 15, 56 
	x 18, 56 x 21.
TO058	Affinity Shoulder - Eccentric 	Infinitely dialable eccentric heads, 	40 x 18, 40 x 21, 44 x 18, 44 	$1,327.00
	Humeral Head.	multiple head hight per diam, high 	x 21, 48 x 18, 48 x 21, 52 x 
	integrity morse taper, highly polished	18, 52 x 21, 56 x 18, 56 x 21.
	 CoCr.
TO080	Ascend Shoulder, Humeral 	Anatomic humeral heads, low and 	Low offset: 9 diameters from 	$1,327.00
	Component	high offset, CoCr	38mm to 54mm, 8 
	thicknesses from 15mm to 
	21mm, offset 1.5mm
	
	High offset: 9 diameters from
	 38mm to 54mm, 8 
	thicknesses from 15mm to 
	21mm, offset 3.5mm to 4mm
	Zimmer Pty Ltd
ZI300	Bigliani Shoulder System	Bigliani-Flatow Shoulder - Heads 	40, 46, 52, 52mm diameters	$1,327.00
	(Cobalt chrome)
ZI441	Select Shoulder	Humeral Head Eccentric - CoCr alloy	44/19 to 56/32 	$1,327.00
Prostheses List by Category, Groups and Sponsor	Page 279 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI562	Anatomical Shoulder	Anatomical removable head 	D40 H14; D42 H15; D44 	$1,327.00
	H16; D46 H16; D48 H17; 
	D50 H18; D52 H19; D48 
	H20; D50 H21; D52 H23.
ZI565	Anatomical Shoulder	Anatomical Fracture Humeral Head	40mm Left & Right; 44mm 	$1,327.00
	Left & Right; 48mm Left and
	 Right.
	Cer
	Mathys Orthopaedics Pty Ltd
MA480	Affinis Humeral Head	Affinis Humeral Head - Ceramic	39 to 53	$1,525.00
	EL
	Johnson & Johnson Medical Pty Ltd
DY129	Global Advantage CTA Head	Extended Lip Rotator Cuff Humeral 	44 x 18 - 56 x 23	$5,495.00
	Head component
JJ554	DELTA Xtend	Delta Xtend CTA Head Extended Lip	48 + 52; 21, 26mm	$5,495.00
JJ788	Global AP CTA Humeral Head	CTA Humeral Head	Sizes 44-56mm	$5,495.00
	Lima Orthopaedics Australia Pty Ltd
LC181	SMR CTA Humeral Head	CTA Humeral Head CoCRMo	42 - 54mm	$5,495.00
	06.02.04.13 - Resurfacing humeral head 
	Biomet Australia Pty Ltd
BI343	Copeland Shoulder System	Humeral Resurfacing head, macrobond	small, med large, xlarge 1-8	$3,200.00
	 coated
BI345	Copeland Shoulder System	Humeral Component, Chrome Cobalt	Small, Std, Large (no 	$3,200.00
	specific size)
	Johnson & Johnson Medical Pty Ltd
JJ787	Global CAP Resurfacing Humeral 	Global CAP Conservative 	40-56mm Diameter	$3,200.00
	Head Implant	Anatomical Prosthesis (Shoulder 
	Humeral Head Surface Replacement)
	Lima Orthopaedics Australia Pty Ltd
LC182	SMR Resurfacing Humeral Head	Resurfacing Humeral Head CoCrMo + 	42 - 54mm	$3,200.00
	Poro+Ti+HA coated
Prostheses List by Category, Groups and Sponsor	Page 280 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM078	Ascension HRA - Humeral 	A anatomic semi constrained, 	40mm x 16mm to 56mm x21mm	$3,200.00
	Resurfacing Arthroplasty	monobody device intended for 
	resurfacing of the humeral head.
	Smith & Nephew Surgical Pty Ltd
SM170	PROMOS Modular Shoulder 	PROMOS Modular Shoulder System 	38-54mm	$3,200.00
	Resurfacing Humeral Head
	Synthes Australia Pty Ltd
SY438	Epoca Resurfacing Head	Humeral head surface replacement, HA	Diameter 40 - 54mm	$3,200.00
	 coating
	Tornier Pty Ltd
TO031	Aequalis Resurfacing Shoulder	Resurfacing humeral head	12 head sizes from 37mm x 	$3,200.00
	13.5mm to 54mm x 27mm, 3 
	stem lengths: 30, 35 and 
	40mm
	EL
	Johnson & Johnson Medical Pty Ltd
JJ805	Global CAP CTA	Global CAP CTA Head	40 - 56 x 15 - 21mm	$5,495.00
	Lima Orthopaedics Australia Pty Ltd
LC183	SMR Resurfacing CTA Humeral 	CTA Resurfacing Humeral Head 	42 - 54mm	$5,495.00
	CoCrMo +Poro+Ti+Ha Coated
	06.02.04.14 - Humeral cup
	Biomet Australia Pty Ltd
BH055	Comprehensive shoulder - reverse 	Reverse shoulder humeral bearing, 	(Standard or Retentive) x 	$815.00
	humeral cup	highly cross linked UHMWPE	(std, +3) x (31 to 41)mm
	Euros Orthopaedics Australia Pty Ltd
EU021	SCULTRA II Reverse Neutral Insert	Shoulder Reverse polyethylene Insert	Height: 0, +3 mm, +6 mm	$815.00
EU022	SCULTRA II Reverse Retentive 	Shoulder Reverse polyethylene Insert	Height: 0, +3 mm, +6 mm	$815.00
Prostheses List by Category, Groups and Sponsor	Page 281 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX048	Equinoxe Humeral Liner including 	The Equinoxe Reverse Shoulder 	Liner: 38mm+0, 38mm+2.5, 	$815.00
	Humeral Adapter Tray	System includes a reverse semi-	42mm+0, 42mm+2.5 
	constrained prosthesis for use in 	Constrained Humeral Liner:
	total-shoulder joint replacement 	 38mm+0, 38mm+2.5, 
	procedures in cases with an 	42mm+0, 42mm+2.5 Tray: 
	irreparable or nonfunctional rotator 	+0, +5, +10
	Smith & Nephew Surgical Pty Ltd
SN888	PROMOS Reverse Modular 	Polyethylene insert for reverse total 	36/6mm, 36/9mm, 36/12mm, 	$815.00
	Shoulder System	shoulder joint arthroplasty	42/6mm, 42/9mm, 42/12mm
	Tornier Pty Ltd
TO040	Aequalis Reversed Shoulder 	Eccentric Humeral Insert (High 	36mm and 42mm, 2mm 	$815.00
	Eccentric humeral Insert (High 	Mobility Cup) for Aequalis Reversed 	eccentric +6mm and +9mm, 
	Mobility Cup)	Shoulder	4mm eccentric +9mm and 
	+12mm
	Zimmer Pty Ltd
ZI580	Anatomical shoulder	Anatomical Inverse/Reverse Humeral 	Zero degree Retro; Zero 	$815.00
	Cup	degree Retro +6; +10 degree
	 Retro; –10 degree Retro; 
	+20 degree Retro; -20 
	degree Retro;9mm 0 degree 
	Retro; 9mm 0 degree Retro 
	Reverse
	Johnson & Johnson Medical Pty Ltd
JJ552	DELTA Xtend	Modular Eccentric Epiphysis HA 	1 + 2 Left + Right	$2,482.00
	Coated
MN170	Delta Shoulder System	Humeral cup	36 to 42	$2,482.00
	Lima Orthopaedics Australia Pty Ltd
LC175	SMR Reverse Modular Humeral 	Reverse Modular Mumeral Body 	+9mm	$2,482.00
	Body Extension	Extension Ti6AI4V
LC176	SMR Reverse Liner (Cup) 	Reverse Liner UHMWPE X-Lima	36mm x +3/+6mm Standard 	$2,482.00
	UHMWPE X-Lima	& Retentive
LC177	SMR Reverse Liner (Cup) CoCrMo	Reverse Liner Standard & Excentric 	Dia 40 - 44mm x Short to 	$2,482.00
	CoCrMo	Long
	Mathys Orthopaedics Pty Ltd
MA532	Affinis Inverse inlay	Humeral Cup	36+0 to 42+6mm	$2,482.00
Prostheses List by Category, Groups and Sponsor	Page 282 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.02.04.15 - Focal defect resurfacing - cap
	Advanced Surgical Design & Manufacture Ltd
AE131	HemiCAP Contoured Articular 	Articular Component  - Chrome 	Articular Component 25mm 	$4,035.00
	Resurfacing Shoulder System	- 2.5mm x 2.5mm to 5.0mm x 
	5.0mm offset;  Articular 
	Component 30mm - 4.5mm x 
	4.5mm to 7.0mm x 7.0mm 
	offset; Articular Component 
	35mm - 6.0mm x 6.0mm to 
	9.5mm x 9.5mm; Articular 
	Component 40mm - 8.0mm x 
	8.0mm to 12.0mm x 12.0mm
	06.02.04.16 - Focal defect resurfacing - screw
	Advanced Surgical Design & Manufacture Ltd
AE132	HemiCAP Contoured Articular 	Fixation Screw - Titanium	10.5mm, 12.5mm, 13.7mm, 	$1,545.00
	Resurfacing Shoulder System	15.6mm,
	06.02.04.18 - Special purpose/tumour prosthesis - tumour section
	Biomet Australia Pty Ltd
BH341	Comprehensive Segmental Revision 	Comprehensive SRS Intercalary 	30-120mm	$12,480.00
	System (SRS)	Segment
BH342	Comprehensive Segmental Revision 	Comprehensive SRS Humeral Coupler	100mm	$12,480.00
	System (SRS)
BH343	Comprehensive Segmental Revision 	Comprehensive SRS Anti Rotation 	30mm	$12,480.00
	System (SRS)	Intercalary Segment
	06.02.04.19 - Special purpose/tumour prosthesis - limb salvage system
	Oceania Orthopaedics
OO134	MUTARS ulna anchorage	MUTARS ulna anchorage	100mm, left/right	$67,600.00
Prostheses List by Category, Groups and Sponsor	Page 283 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR159	Limb Salvage System for the 	Repiphysis non invasive expandable 	Custom Made	$67,600.00
	Skeletally Immature - Repiphysis	custom designed prosthesis for the 
	upper limb (all components delivered 
	as one unit)
	06.02.04.21 - Necks/collar (modular) 
	DJO Australasia Pty Ltd
DD002	Turon Shoulder System - Humeral 	Turon - Humeral Neck	Neutral and 7.5 Degree	$1,050.00
	Neck
	Johnson & Johnson Medical Pty Ltd
JJ616	Global AP Shoulder	Ball Taper Adjustable Neck Assembly	N/A	$1,050.00
	6.2.4.19 - Special purpose/tumour prosthesis
	Corin Australia Pty Ltd
CR166	METS Humeral Collar Round Smooth	Titanium, smooth uncoated collar for a	20mm, 22mm, 24mm	$2,316.00
	 secure fit in the humeral canal
CR167	METS Humeral Component for use 	Titanium humeral component	Small and standard	$7,042.00
	with Hemi Head
CR168	METS Humeral Head Fixation Screw	Titanium screw which fixes the 	Small and standard	$565.00
	humeral component and the humeral 
	head together
CR169	METS Humeral Component with 	Titanium component with HA coated 	Mono-size, left and right	$8,990.00
	Liner and re-attachment	rails for tissue reattachment, 
	HYMWPE liner with encased metal 
	ring for use with contrained glenoid
CR170	METS Humeral Collar Round 	Titanium colar with HAP coated 	20mm, 22mm, 24mm	$4,122.00
	stipples
CR171	METS Humeal Stem	Straight titanium stems, 7-11mm 	Diameters 7-11mm,  Lengths	$2,723.00
	diameters	 70-90mm
CR172	METS Humeral Shaft	Titanium shafts in 15mm increments, 	Lengths 38-143mm	$3,243.00
	reconstructs the humeral shaft where 
	there is diseased or deficient bone
Prostheses List by Category, Groups and Sponsor	Page 284 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
CR173	METS Humeral Integral Shaft & 	Titanium, combined shaft, stem & 	20mm shaft plateau with 	$7,945.00
	Stem Coated	collar with HA coated stipples	8mm diameter stem, 24mm 
	shaft plateau with 10mm 
	diameter stem
	7945
CR174	METS Humeral Integral Shaft & 	Titanium, combined shaft, stem & 	20mm shaft plateau with 	$4,480.00
	Stem Uncoated	8mm diameter stem, 24mm 
	shaft plateau with 10mm 
	diameter stem
CR175	METS Humeral Component with 	Titanium component, UHMWPE liner	Mono-size, left and right	$7,083.00
	Liner	 with encased metal ring for use with 
	constrained glenoid
CR176	METS Humeral Component with 	Titanium humeral component with HA	Small and standard	$9,342.00
	Reattachment for use with Hemi 	 coated rails for tissue reattachment
CR177	METS Bayley Walker Glenoid 	Titanium HAP coated tapered screw 	Extra small, small and 	$7,485.00
	Component	with 22.2mm CoCr-Molybdenum 	standard
	head, for Glenoid fixation
CR178	METS Humeral Hemi-head	Titanium humeral hemi-head forming 	Diameters 43mm, 46mm, 	$3,388.00
	part of a modular system to replace 	52mm, 55mm, 58mm
	diseased or damaged bone
06.02.05 - Shoulder - Glenoid
	06.02.05.01 - Glenoid component, All poly
	Biomet Australia Pty Ltd
BH050	Comprehensive Shoulder - Glenoid 	Glenoid Post, Ti Regenerx or 	1 size	$1,995.00
	Stem	Polyethylene
	Device Technologies Australia Pty Ltd
DE172	Univers 3D Shoulder Prostheses	Cemented glenoid	Small, Medium, Large	$1,995.00
	DJO Australasia Pty Ltd
DD004	Turon Shoulder System - All-Poly 	Turon - All-Poly Glenoid, Keeled and	38mm, 42mm, 46mm, 50mm, 	$1,995.00
	Glenoid	 Pegged	54mm
DD031	Foundation Shoulder System	Pegged & Keeled Glenoid, 	38mm to 54mm	$1,995.00
	compression moulded UHMWPE
Prostheses List by Category, Groups and Sponsor	Page 285 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX060	Equinoxe Glenoid, keeled	UHMWPE component used to replace	small, medium, large	$1,995.00
	 the Glenoid during total shoulder 
	arthroplasty. This component is to be 
	used with the Equinoxe total 
	shoulder replacement
EX061	Equinoxe Glenoid, pegged	UHMWPE component used to replace	small, medium, large	$1,995.00
	 the Glenoid during total shoulder 
	arthroplasty. This component is to be 
	used with the Equinoxe total 
	shoulder replacement
	Johnson & Johnson Medical Pty Ltd
DP086	Global Shoulder 	Global FIN/ Peg  Glenoid	Size 40-56	$1,995.00
DY360	Global Advantage Shoulder	Anchor Peg Glenoid	40 to 56 mm	$1,995.00
JJ637	Global Advantage Shoulder – Cross	Cross Linked Polyethylene Glenoid 	40 to 56mm including XL	$1,995.00
	 Linked Anchor Peg Glenoid	Implant
	Lima Orthopaedics Australia Pty Ltd
LC172	SMR Cemented Glenoid	All Poly Glenoid Cemented 	Small - Large	$1,995.00
LC173	SMR - Glenoid 3 Peg UHMWPE	Glenoid 3 Peg UHMWPE X-Lima	Small, Standard	$1,995.00
	Mathys Orthopaedics Pty Ltd
MA450	Affinis Total Shoulder	Glenoid - UHMWPE	Size 1 to 4	$1,995.00
	Smith & Nephew Surgical Pty Ltd
SM114	Promos Shoulder Replacement	Glenoid	1-23: - 4-29	$1,995.00
SN397	Cofield 	Glenoid All Polyethylene component	Small, Standard	$1,995.00
	Stryker Australia Pty Ltd
ST675	Osteonics Solar Shoulder 	Glenoid component polyethylene	5,7,9,11	$1,995.00
	Synthes Australia Pty Ltd
SY434	Epoca Custom Offset Shoulder 	Epoca Glenoid	40mm - 54mm	$1,995.00
	Prosthesis
	Tornier Pty Ltd
TO004	Aequalis Primary Shoulder 	UHMWPE Keeled Glenoid 	31mm,35mm,39mm dia 	$1,995.00
	(small, medium & large)
TO015	Aequalis Pegged Glenoid USA	Pegged Glenoid Polyethylene 	Small, Medium, Large, Extra 	$1,995.00
	(UHMWPE)	Large
Prostheses List by Category, Groups and Sponsor	Page 286 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
TO059	Affinity Shoulder - Pegged Glenoid.	Minimally cemented Pegged Glenoid 	5 diameters: 44, 44, 48, 52, 	$1,995.00
	UHMWP with finned press-fit central 	56.
	peg.
	Zimmer Pty Ltd
ZI304	Bigliani Shoulder System	Bigliani-Flatow shoulder - Glenoid 	40, 46 and 52mm diameters	$1,995.00
	(UHMWPE)
ZI440	Anatomical	Glenoid - PE	S, M, L	$1,995.00
ZI581	Anatomical Shoulder	Anatomical Pegged Glenoid	Small, Medium and Large	$1,995.00
	06.02.05.02 - Glenoid component, Metal backed
	Biomet Australia Pty Ltd
BH049	Comprehensive shoulder - glenoid	Modular hybrid glenoid base 	small, medium, large	$2,220.00
	UHMWPE; Titanium
BI217	Bio-Modular Shoulder System	Glenoid Component, Cemented, 	Small, Medium, Large x 4 or 	$2,220.00
	Titanium/UHMWPE	7mm
	Device Technologies Australia Pty Ltd
DE169	Univers 3D Shoulder Prostheses	Glenoid Metal Back	Small, Medium, Large	$2,220.00
	Johnson & Johnson Medical Pty Ltd
DP899	S-Fit Metal Glenoid	S-FIT M/B Glenoid 	Size 40-52	$2,220.00
	Lima Orthopaedics Australia Pty Ltd
LC038	SMR Shoulder System	Metal Back Glenoid	 Small, Small R, Standard, 	$2,220.00
	Large
	Smith & Nephew Surgical Pty Ltd
SN398	Cofield 	Glenoid Component Metal backed	Standard Base. Base Insert.  	$2,220.00
	Glenoid Comp Sm, Stan, St 
	W/off
	Synthes Australia Pty Ltd
SY436	Epoca Custom Offset Shoulder 	Epoca Reco Glenoid	42 - 52mm	$2,220.00
	Prosthesis
	06.02.05.03 - Glenoid component & insert
	Biomet Australia Pty Ltd
BI221	Bio-Modular Shoulder System	Glenoid Shell, Titanium	Low Profile	$4,088.00
Prostheses List by Category, Groups and Sponsor	Page 287 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI319	Bigliani Flatow Total Shoulder 	Trabecular Metal Backed Glenoid 	Diameter 40 - 52mm	$4,088.00
	System - Glenoids	(uncemented)  
	06.02.05.04 - Glenoid insert
	Biomet Australia Pty Ltd
BI219	Bio-Modular Shoulder System	Glenoid Liner Noncemented, 	Low Profile	$1,960.00
	UHMWPE
	Device Technologies Australia Pty Ltd
DE170	Univers 3D Shoulder Prostheses	Glenoid PE-Inlay	Small, Medium, Large	$1,960.00
	Johnson & Johnson Medical Pty Ltd
DP898	S-Fit Metal Glenoid	S-FIT Glenoid Bearing 	Size 40-52	$1,960.00
	Lima Orthopaedics Australia Pty Ltd
LC174	SMR - Glenoid Component 	Glenoid - MB Liner - UHMWPE	3 to 6mm thick x small-R to 	$1,960.00
	UHMWPE	Large
	Synthes Australia Pty Ltd
SY437	Epoca Custom Offset Shoulder 	Epoca Glenoid Insert	42 - 54mm	$1,960.00
	Prosthesis
	Zimmer Pty Ltd
ZI529	Zimmer Trabecular Metal Reverse 	Polyethylene Liner	Standard 7 Deg. & 	$1,960.00
	Shoulder System	Retentive 65 Deg; 36mm - 
	Neutral, Plus 3mm, Plus 
	6mm; 40mm - Neutral, Plus 
	3mm, Plus 6mm
ZI577	Anatomical Shoulder	Anatomical Inverse/Reverse Humeral 	36mm x 0, 3 & 6mm; 40mm x 	$1,960.00
	Poly inlay	0, 3 & 6mm.
	06.02.05.05 - Reverse glenoid component, Base plate, uncemented
	Biomet Australia Pty Ltd
BH052	Comprehensive Shoulder - Reverse 	Reverse glenoid baseplate, Ti, Porous 	28mm, 25mm	$2,096.00
	Glenoid Baseplate	coating
	DJO Australasia Pty Ltd
DD053	Reverse Shoulder - Glenoid 	Reverse Glenoid Component, 	Baseplate - Small to Large, 	$2,096.00
	Baseplate & Head	Baseplate & Head	Head - 32mm to 40mm
Prostheses List by Category, Groups and Sponsor	Page 288 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Euros Orthopaedics Australia Pty Ltd
EU024	SCULTRA II Reverse Glenoid base	Shoulder Glenoid base in titanium	One-size	$2,096.00
	Exactech Australia
EX049	Equinoxe Glenoid Plate	The glenoid plate provides multiple 	one size	$2,096.00
	options for screw insertion
	Johnson & Johnson Medical Pty Ltd
DP950	Delta Shoulder system	Standard Metaglene  INOX/ ST. Steel 	One size only	$2,096.00
	+ Aluminia+HAC
DP951	Delta Shoulder system	Revision Metaglene INOX/ ST. Steel 	One size only	$2,096.00
	+ Aluminia+HAC
JJ562	DELTA Xtend	Metaglene	.	$2,096.00
JJ563	DELTA Xtend	Revision Metaglene	.	$2,096.00
	Lima Orthopaedics Australia Pty Ltd
LC186	SMR Reverse Glenoid Base Plate	Reverse Glenoid Base Plate	Small-R or Small/Standard	$2,096.00
	Mathys Orthopaedics Pty Ltd
MA534	Affinis Inverse Metaglene	Metaglene, uncemented. Ti plasma 	one size only	$2,096.00
	plus CaP coating
MA535	Affinis Inverse revision metaglene	Revision Metaglene, Ti plasma plus 	one size only	$2,096.00
	CaP Coating
MA536	Affinis Fracture Inverse	Metaphyseal body with Ti plama 	6 to 15 mm	$2,096.00
	spray plus CaPcoating- includes 
	humeralcup with CoCr bearing surface
	Smith & Nephew Surgical Pty Ltd
SN892	Promos Reverse Modular Shoulder 	Glenoid Base Plate	5-20mm  1-5  Small Medium 	$2,096.00
	System	Large
	Tornier Pty Ltd
TO066	Aequalis Reversed Shoulder, 	Glenoid Base Plate (Metaglene) with 	Standard or Revision (Long	$2,096.00
	Glenoid Base Plate	Long Post option for revision	 Post)
	dia 25mm and dia 29mm
	Zimmer Pty Ltd
ZI533	Zimmer Trabecular Metal Reverse 	Trabecular Metal Reverse Base Plate - 	One Size Only	$2,096.00
	Shoulder System	Ti Alloy & Tantalum
ZI578	Anatomical Shoulder	Anatomical Inverse/Reverse Glenoid 	One size only.	$2,096.00
	Fixation
Prostheses List by Category, Groups and Sponsor	Page 289 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.02.05.06 - Glenosphere
	Biomet Australia Pty Ltd
BH051	Comprehensive Shoulder - Reverse 	Reverse glenosphere	(31mm to 41)mm x (standard,	$2,290.00
	Glenosphere	 +3, +6)
	Euros Orthopaedics Australia Pty Ltd
EU025	SCULTRA II Reverse centered 	Shoulder glenoid sphere	One size: centered (standard)	$2,290.00
	(standard) Glenoid sphere
EU026	SCULTRA II Reverse Offset 	Shoulder glenoid sphere	One size: offset (eccentric)	$2,290.00
	(eccentric) Glenoid sphere
	Exactech Australia
EX050	Equinoxe Glenosphere	The glenosphere aids in glenosphere 	38mm, 42mm	$2,290.00
	insertion and protects any remaining 
	intact soft tissues.
	Johnson & Johnson Medical Pty Ltd
DP952	Delta Shoulder system	Centror Glenoid INOX / ST.Steel / 	Size 36-40 /42	$2,290.00
	Nichtrostender St.
JJ555	DELTA Xtend	Eccentric Glenosphere	38 + 42	$2,290.00
JJ556	DELTA Xtend	Standard Glenosphere	38 + 42	$2,290.00
	Lima Orthopaedics Australia Pty Ltd
LC184	SMR Reverse Poly Gleonsphere	Reverse Glenophere UHMWPE X-	40 - 44 Standard & 	$2,290.00
	Lima Ti6AI4V
LC185	SMR Reverse Glenosphere	Reverse Glenosphere CoCrMo	36mm Standard and Eccentric	$2,290.00
	Mathys Orthopaedics Pty Ltd
MA533	Affinis Inverse glenosphere	Glenosphere	36 to 42mm	$2,290.00
	Smith & Nephew Surgical Pty Ltd
SN891	Promos Reverse Modular Shoulder 	Glenosphere	centric 36mm, centric 42mm, 	$2,290.00
	System	eccentric 36/+5mm, 
	eccentric 42/+5mm
	Tornier Pty Ltd
TO067	Aequalis Reversed Shoulder, 	Glenoid Sphere, standard, eccentric or	Diam 36 and 42mm	$2,290.00
	Glenoid Sphere	 wear compensation	Centre, or Eccentricity 
	+2mm, or Wear 
	Compensations 10deg
Prostheses List by Category, Groups and Sponsor	Page 290 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI532	Zimmer Trabecular Metal Reverse 	Glenosphere - CoCr - Mo Alloy	36mm, 40mm	$2,290.00
	Shoulder System
ZI564	Anatomical Shoulder	Anatomical Inverse/Reverse Glenoid 	36mm; 40mm	$2,290.00
	Head
06.02.06 - Shoulder - Accessories
	06.02.06.01 - Humeral sleeve
	Biomet Australia Pty Ltd
BH129	Mosaic Humeral Replacement 	Soft Tissue Attachment Segment 	short, long	$950.00
	Overlseeve
BH344	Comprehensive Segmental Revision 	Comprehensive SRS Modular 	Small, Large	$950.00
	System (SRS)	Regenerex Augment
BH345	Comprehensive Segmental Revision 	Comprehensive SRS PPS Augment	Small, Large	$950.00
	System (SRS)
	Lima Orthopaedics Australia Pty Ltd
LC040	Randelli/SMR Total Shoulder	Randelli/SMR Neutral Taper	0 - 6mm	$950.00
	06.02.06.02 - Humeral spacer
	Biomet Australia Pty Ltd
BH128	Mosaic Humeral Replacement 	Humeral Stem Extension Segment	80, 110, 140mm	$1,000.00
	Euros Orthopaedics Australia Pty Ltd
EU023	SCULTRA II Reverse raising block	Shoulder Reverse titanium humeral 	Height: +9mm	$1,000.00
	spacer (provided with its locking 
	Johnson & Johnson Medical Pty Ltd
DP964	Delta Shoulder system	Humeral Spacer INOX / ST.Steel / 	Dia 36/42 + 9	$1,000.00
	Nichtrostender St.
JJ561	DELTA Xtend	Humeral Spacer	9mm	$1,000.00
	Lima Orthopaedics Australia Pty Ltd
LC036	SMR Shoulder - Modular Augment	Modular Augment Ti6AI4V	20 - 50mm	$1,000.00
	Tornier Pty Ltd
TO011	Aequalis Shoulder Prostheses 	CoCr Reverse Humeral Neck	diameter 36 & 42mm wide x 	$1,000.00
	9mm high
Prostheses List by Category, Groups and Sponsor	Page 291 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI530	Zimmer Trabecular Metal Reverse 	Spacer	9mm, 12mm Taper Insert	$1,000.00
	Shoulder System
ZI531	Zimmer Trabecular Metal Reverse 	Dual Taper Insert	One Size Only	$1,000.00
	Shoulder System
	06.02.06.03 - Articular insert
	Smith & Nephew Surgical Pty Ltd
SN409	Modular Cofield	Standard Articular Insert	Small, Standard	$470.00
	06.02.06.04 - Taper assembly
	Johnson & Johnson Medical Pty Ltd
JJ615	Global AP Shoulder	Fixed 135 Degree Taper Assembly	135 Degree Angle	$1,118.00
	Lima Orthopaedics Australia Pty Ltd
LC117	SMR Shoulder Accessories	SMR Connector and Screw	Small R / Small STD	$1,118.00
	06.02.06.05 - Eccentrical adaptor
	Biomet Australia Pty Ltd
BH127	Versadial Humeral Head	Eccentric adaptor, taper insert	Std, reverse	$1,220.00
	Lima Orthopaedics Australia Pty Ltd
LC037	SMR Adaptor	Adaptor Eccentric / Neutral / CTA	Standard & long 0 to +8mm	$1,220.00
	Mathys Orthopaedics Pty Ltd
MA537	Affinis Inverse head adaptor	Adaptor for conversion tohemi 	One size only	$1,220.00
	prostheses, includes fixation screw
MA538	Affinis Inverse inlay spacer	Humeral offset spacer. Supplied with 	+9mm	$1,220.00
	screw
	Smith & Nephew Surgical Pty Ltd
SM112	Promos Shoulder Replacement	Inclination set allowing 12 degrees of	20 - 22 - 24 - 26mm	$1,220.00
	 inclination in any direction, 
	allowing surgeon to match the 
	optimal position of the head with the 
	anatomy of the patient for anatomic 
	shoulder joint arthroplasty
Prostheses List by Category, Groups and Sponsor	Page 292 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY433	Epoca Custom Offset Shoulder 	Modular press-fit component for 	One size only	$1,220.00
	Prosthesis	independent adjustments of the head 
	or shaft; both medial and posterior 
	06.02.06.06 - Definition screw / Locking Screw
	Mathys Orthopaedics Pty Ltd
MA531	Affinis Fixation Screw	Fixation Screw Long	one size only	$1,220.00
	06.02.06.07 - Reverse humeral tray
	Biomet Australia Pty Ltd
BH054	Comprehensive Shoulder - reverse 	Modular Reverse Humeral tray, to 	Std, +5, +10	$873.00
	humeral tray	mount onto Comprehensive stem
	Tornier Pty Ltd
TO045	Aequalis Reversed Shoulder - 	The humeral cup is made of 	D. 36mm +6mm, D.36mm 	$873.00
	Lateralized Insert	UHMWPE. It comes in two diameters 	+9mm, D.36mm +12mm, 
	(36 + 42mm) to correspond with the 	D.42mm +6mm, D. 42mm 
	humeral metaphyseal components & 	+9mm, D.42mm +12mm
	three heights 6, 9 & 12mm.
	6.2.6.6 - Definition screw
	Exactech Australia
EX062	Equinoxe Reverse Torque 	Reverse Torque Definition Screw with	One size only	$1,220.00
	Definition Screw Kit	 Drive
EX065	Equinoxe Torque Definition Screw 	Torque Definition Screw with Drive.	One size only.	$1,220.00
	Kit.
06.03.01 - Intramedullary Nails
	06.03.01.01 - Femoral, Proximal short (<220mm)
	Austofix
AX026	Austofix Femoral & Tibial Nailing 	F2 Hip Nail 4.8/6.5; high nitrogen s-s	Dia 11mm, Length 170mm - 	$1,063.00
	System	240mm
Prostheses List by Category, Groups and Sponsor	Page 293 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	B Braun Australia Pty Ltd
BB051	BRAUN AUST Intramedullary 	Compression Nail	100mmx10.5mm-	$1,063.00
	610mmx12.5mm
	Biomet Australia Pty Ltd
BH313	Affixus Hip Fracture Nail System	Short Hip fracture nails	9-13mm diameter, 180mm 	$1,063.00
	length
	KH NXGEN (AUS) Pty Limited
KH006	NeoGen Nail System Fermoral Nail	Intramedullary Nail for Femoral	9-11mm Diameter, 170-	$1,063.00
	200mm Length
	Lima Orthopaedics Australia Pty Ltd
LC096	Uninail Intrameduallry Nail	Uninail Intrameduallry Nail	Distal Diameter 11mm	$995.00
	Proximal Diameter 16.5mm x
	 Length 180-205mm x 125-
	130 Degrees
LC103	Supernail Intramedullary	Supernail Intramedullary	Diameter 9 - 14mm x Length 	$1,063.00
	205mm x 125 or 130 Deg
	Smith & Nephew Surgical Pty Ltd
SN763	IMHS CP	Intramedullary Hip Nail, stainless 	10 - 16mm x 19.5cm left and 	$1,063.00
	right
SN838	Trigen InterTAN Nail	Nail, Titanium	diameter 10-13mmlength 	$1,063.00
	18-46cmAngle 125°-135°
	Stryker Australia Pty Ltd
SK246	Gamma LN	Standard - Titanium	120, 125, 130 Deg; 	$1,063.00
	Diameter 10-12mm; Length 
	170-200mm
	Synthes Australia Pty Ltd
SY790	AO/ASIF Intramedullary Nails	Femoral Nail	9-15mm D <220mm length	$1,063.00
	Zimmer Pty Ltd
ZI723	Zimmer Natural Nail System	Cephalomedullary, Short Nails, 	10mm to 14.5mm (in 1.5mm 	$1,063.00
	Titanium	increments) x 21.5cm 125 to 
	135 CCD (in 5 CCD 
	increments) Left and Right.
Prostheses List by Category, Groups and Sponsor	Page 294 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.01.02 - Femoral, Proximal long (≥220mm)
	Austofix
AX024	Austofix Femoral & Tibial Nailing 	F2 Femoral Nail 4.8/6.2; s-s	Dia 9 - 12mm; Lengths 320 	$1,442.00
	System	- 460mm
	Biomet Australia Pty Ltd
BH266	VersaNail IM Nailing Platform	Troch Entry and Universal Femoral 	9-13mm x 28-48CM	$1,442.00
	Nails, Titanium, Locking, cannulated.
BH314	Affixus Hip Fracture Nail System	Long Hip fracture nails	9-15mm diameter, 260-	$1,442.00
	460mm length
BI921	EBI Paediatric Locking Nail System	Femoral Locking Nail - titanium;	28 -42cm x 5.5 - 6.5mm	$1,442.00
	KH NXGEN (AUS) Pty Limited
KH008	NeoGen Nail System Femoral Nail	Intramedullary Nail for Femoral	9-13mm Diamter, 240-	$1,442.00
	440mm Length
	Lima Orthopaedics Australia Pty Ltd
LC104	Supernail Intramedullary Nail - 	Supernail Intramedullary Nail - Long	Distal Diameter 11mm x 	$1,442.00
	Proximal Diameter 16.5mm x
	 Length 280 - 400mm x 125 
	or 130 Deg
	Smith & Nephew Surgical Pty Ltd
SN521	TriGen 	Nail: TAN & FAN, titanium	10, 11.5 &13mm diameter	$1,442.00
SN764	IMHS CP	Intramedullary Hip Nail, stainless 	10 - 14mm x 32 - 44cm left 	$1,442.00
	and right
	Stryker Australia Pty Ltd
SK214	Stryker Trauma Locking Nail 	Reconstruction Nail	Recon Nail 	$1,442.00
	Left/RightDiameter 9-15mm,
	 Length 260-480mm
SK244	Stryker Intramedullary Nailing 	Gamma Long	120, 125, 130 Deg; 	$1,442.00
	Diameter 10-15mm; Length 
	280-480mm
Prostheses List by Category, Groups and Sponsor	Page 295 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ086	Pedinail - Cannulated, 	IM Femoral Nail (Right/Left)	Right:7mm x 20cm-30cm, 	$1,350.00
	intramedullary nail, left and right	8mm x 24cm-36cm, 9mm x 
	28cm-38cm in 2cm 
	increments
	Left: 7mm x 20cm-30cm, 
	8mm x 24cm-36cm, 9mm 
	x28cm-38cm in 2cm 
	increments
	Synthes Australia Pty Ltd
SY791	AO/ASIF Intramedullary Nails	Femoral Nail	9-15mm D ≥ 220mm length	$1,442.00
	Zimmer Pty Ltd
ZI715	Zimmer Natural Nail System	Cephalomedullary, Femoral Long 	10mm to 14.5mm (in 1.5mm 	$1,442.00
	Nails, Titanium	increments) x 30 to 48cm (in
	 2cm increments) x 125 & 
	130 CCD Left and Right.
ZI722	Zimmer Natural Nail System	Antegrade Femoral Nails, Greater 	8 to 14mm x 24 to 48cm (in 	$1,442.00
	Trochanter, Titanium	2cm increments) Left and 
	Right
	06.03.01.03 - Femoral, Distal
	Austofix
AX020	S2 Nail System	Cannulated supracondylar nail, 	11/13mm x 160-380mm	$1,121.00
	stainless steel
	Smith & Nephew Surgical Pty Ltd
SN522	TriGen 	Knee Nail	8.8, 10, 11.5 & 13mm 	$1,121.00
	diameters, 26-50cm lengths
	Stryker Australia Pty Ltd
SK202	Stryker Trauma Locking Nail 	SCN	Diameter 11m - 14mm, 	$1,121.00
	Length 170mm - 240mm
SK465	Stryker Intermedullay Nailing System	T2 	7-15mmDiameter, 140 to 	$1,121.00
	Retrograde/Antegrade/Compression 	480mm lengths
	Synthes Australia Pty Ltd
SY264	AO/ASIF Intramedullary Nails	Distal Femoral Nail - DFN	9-15mm / 160-420mm Length	$1,121.00
Prostheses List by Category, Groups and Sponsor	Page 296 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI721	Zimmer Natural Nail System	Retrograde Femoral Nail - Titanium	10mm to 13mm (in 1.5mm 	$1,121.00
	increments) x 20, 24, 28, 30, 
	32, 34, 36, 38, 40, 42, 44cm 
	Universal.
	06.03.01.04 - Tibial/Fibular
	Austofix
AX022	Austofix Femoral & Tibial Nailing 	Tibial Nail 4.0/4.8; s-s	Dia 8 - 11mm, Lengths 260 -	$1,335.00
	System	 420mm
	Biomet Australia Pty Ltd
BH267	VersaNail IM Nailing Platform	Tibial Nails, Titanium, Locking, 	8-13mm x 25 - 50cm	$1,335.00
	cannulated.
	KH NXGEN (AUS) Pty Limited
KH007	NeoGen Nail System Tibial Nail	Intramedullary Nail for Tibia	8-9mm Diameter, 260-	$1,335.00
	420mm Length
	Medical & Optical Instruments Australia Pty Ltd
MO280	Acumed Fibula Rod System	Intramedullary Nail, fibula lower limb 	3.00mm & 3.6mm diameter 	$1,335.00
	specific	left and right specific rods 
	with lengths of 110mm, 
	145mm, 180mm
	Smith & Nephew Surgical Pty Ltd
SN841	Trigen META	Metaphyseal Nail, Titanium	8.5-13mm15x50cm	$1,335.00
	Synthes Australia Pty Ltd
SY788	AO/ASIF Intermedullary Nails	Tibial Nail	7-19; 200-600mm	$1,335.00
	Zimmer Pty Ltd
ZI719	Zimmer Natural Nail System	Tibial Nails - Titanium	8.3mm; 9.3mm; 10mm; 	$1,335.00
	11mm; 12mm; 14mm x 24 to 
	44cm in 2cm increments
	06.03.01.05 - Humeral
	Austofix
AX013	Proximal Humeral Nail	Stainless Steel	Diameter 8 mm, Length 170 	$924.00
	mm
Prostheses List by Category, Groups and Sponsor	Page 297 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	B Braun Australia Pty Ltd
BB107	BRAUN AUST Intramedullary 	Nail for small bones	Dia 3mm-8mm	$924.00
	Lima Orthopaedics Australia Pty Ltd
LC047	Lima Humeral Nail	Stainless steel	Dia 7 - 8mm, length 200 - 	$924.00
	300mm
	Medical & Optical Instruments Australia Pty Ltd
MO154	Polarus Proximal Humeral Fixation 	Polarus Proximal Humeral Rod 	150 - 300mm length	$924.00
	System	Standard/Plus Titanium
	Smith & Nephew Surgical Pty Ltd
SN740	Trigen	Humeral Nail	7-11cm x 16-30cm	$924.00
	Stryker Australia Pty Ltd
SK006	Stryker Trauma Locking Nail 	Titanium - Humeral Nail	Dia 7,8,9mm length 140 - 	$924.00
	320mm
SK199	Stryker Trauma Locking Nail 	Proximal Humeral Nail	Nail Left/Right	$924.00
	Synthes Australia Pty Ltd
SY129	AO/ASIF Intramedullary Nails	Humeral Nail	6.0 - 12.0 mm length 100 - 	$924.00
	400mm
SY416	AO/ASIF Intramedullary Nails ASLS	Intramedullary Angular Stable 	4-6mm	$924.00
	Locking System
SY689	MultiLoc Humeral Nail	Humeral Nail	7.0mm-9.5mm D, 160mm-	$1,075.00
	315mm L
	Tornier Pty Ltd
TO050	Aequalis Humeral Nail	Intermedullary Humeral Nail, straight,	Right/Left	$924.00
	 cannulated, Ti
	Zimmer Pty Ltd
ZI716	Zimmer Natural Nail System	Antegrade Humeral Nail - Titanium	7, 8, 9 & 10mm x 15, 18, 	$924.00
	19.5, 21, 22.5, 24, 25.5, 27, 
	28.5 & 30cm. Left & Right.
Prostheses List by Category, Groups and Sponsor	Page 298 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Gth
	Lifehealthcare Pty Ltd
LH367	Fassier-Duval Telescopic IM System	The Fassier-Dual Telescopic IM 	The syste is composed fo a 	$3,524.00
	 Component: Male	System is an endomedular nail 	total of 108 rods in 9 
	designed for patients suffering from 	different diameters per type.  
	Osteogenesis Impecfecta (OI), Skeletal	The nail is manufactured in 
	 Displasia, Congenital Tibial 	both Ti alloy (Ti6A14V 
	Pseudoarthosis, Limb lengthening 	ASTM-136) and medical 
	over nail, Segmental Tumor removal 	grade Stainless Steel (315L,
	and other bone deform	 ASTM 138).  It is available 
	in five diameters: 3.2, 
	4,4.8,5.6 and 6.4 mm
LH368	Fassier-Duval Telescopic IM System	The Fassier-Duval Telescopic IM 	The system is composed of a 	$3,524.00
	 Component: Female	System is an endomedular nail 	total of 108 rods in 9 
	designed for patients suffering from 	different diameters per type.  
	Osteogenesis Imperfecta (OI), Skeletal	The nail is manufactured in 
	 Displasia, Congenital Tibial 	both Ti alloy (Ti6A14V 
	Pseudoarthrosis, Limb lengthening 	ASTM-136) and medical 
	over nail, Segmental Tumor removal 	grade stainless steel (316L, 
	and other bone defo	ASTM 138).  It is available 
	in five diameters: 
	3.2,4.4,8,5.6 and 6.4mm;
	06.03.01.06 - Arthrodesis knee
	Biomet Australia Pty Ltd
BH350	OSS Modular Arthrodesis Nail	OSS Modular Arthrodesis Nail Collar	0-7 Degree	$4,699.00
	 Assembly
	Link Orthopaedics  Australia
LO100	LINK Arthrodesis Pin	Cobalt Chromium	90mm	$4,699.00
LO101	LINK Arthrodesis Pin	Tilastan	90mm	$4,699.00
	Smith & Nephew Surgical Pty Ltd
SN497	Intramedullary Nailing System	Knee Fussion Nail, Stainless Steel	11x 65-75 & 12 x 65-85cm	$4,699.00
	Stryker Australia Pty Ltd
SK337	Stryker Trauma Locking Nail 	Arthrodesis Nail - Knee	Arthrodesis Nail 	$4,699.00
	Left/Right; 11.5mm and 13mm
Prostheses List by Category, Groups and Sponsor	Page 299 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.01.07 - Arthrodesis ankle
	Biomet Australia Pty Ltd
BH044	Biomet Phoenix Nail Arthrodesis 	Ankle Arthrodesis Locking Nail, 	9 - 12mm diameter x 150 - 	$4,730.00
	Nailing System - Nail	Titanium Alloy	420mm length
BH239	Versa Nail	TTC Fusion Nail	10mm x 15cm up to 12mm x 	$4,730.00
	30cm
	Integra Neurosciences Pty Ltd
IG100	Panta Arthrodesis Nail	Ankle Nail, Titanium	Diameter 10 -13 mm 	$4,730.00
	Length - 150-240 mm
	Ortho Solutions Pty Ltd
OU008	OXFORD ANKLE FUSION NAIL	OXFORD ANKLE FUSION NAIL 	AFN NAIL 11MM X 	$4,730.00
	(Ti6AI4V)	150MM (Ti6AI4V)
	AFN NAIL 11MM X 
	180MM (Ti6AI4V)
	AFN NAIL 10MM X 
	150MM (Ti6AI4V)
	AFN NAIL 10MM X 
	180MM (Ti6AI4V)
	AFN NAIL 12MM X 
	150MM (Ti6AI4V)
	AFN NAIL 12MM X 
	180MM (Ti6AI4V)
	Smith & Nephew Surgical Pty Ltd
SN772	Trigen	Hindfoot Fusion Nail, Titanium	10 - 11.5mm Diameter	$4,730.00
	Stryker Australia Pty Ltd
SK450	T2 Ankle Arthrodesis Nail	T2 Ankle Arthrodesis Type II 	10, 11, 12mm Diameters & 	$4,730.00
	Anodized Titanium Alloy (Ti6A14V)	150,200 & 300mm Lengths
	Synthes Australia Pty Ltd
SY130	AO/ASIF Arthrodesis system	Arthrodesis	26 - 240mm	$4,730.00
Prostheses List by Category, Groups and Sponsor	Page 300 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO142	611 Ankle Fusion Nail	The 611 ankle arthrodesis nail is made	10mm x 180mm, 6 deg left, 	$4,730.00
	 out of titanium alloy (Ti6AI4V) and 	10mm x 180mm, 6 deg right
	is associated with self locking screws,	
	 a plug and an internal screw. The nail 	12mm x 180mm, 6 deg left, 
	is delivered sterile. The self locking 	12mm x 180mm, 6 deg right
	screws, plug and internal locking 	
	screw are delivered non-sterile with 	10mm x 180mm, 11 deg left, 
	the instrumentation	10mm x 180mm, 11 deg right
	
	Wright Medical Australia
WR208	Valor Hindfoot Fusion System	Valor Hindfoot Fusion Nail, Titanium 	10 & 11.5mm diameter, 150, 	$4,730.00
	Alloy	200 & 250mm length, left 
	and right
	06.03.01.08 - Flexible/paediatric
	Advanced Surgical Design & Manufacture Ltd
AE227	Metaflex	Low compression screw	Diameter: 1.2, 1.4, 1.6, 2.0 - 	$235.00
	2.5mm, Length: 10mm - 30mm
	Biomet Australia Pty Ltd
BH179	Nancy Nail System	Pediatric Flexible Nail	2.5 or 3.0 mm x 190 -290mm	$235.00
BH180	Nancy Nail System	Pediatric Flexible Nail	3.5 mm x  270-350mm	$235.00
BH181	Nancy Nail System	Pediatric Flexible Nail	4.0 mm x  330-450mm	$235.00
BH183	Nancy Nail System 	Pediatric Flexible Nail	2.0 - 4.0  mm x 130 - 450mm	$235.00
BH265	Small Bone Fixation System - Small 	Intramedullary Nail Fixation System 	1.6mm and 1.1mm	$235.00
	Bone Fixation System Kit
	Stryker Australia Pty Ltd
SK506	T2 Kids Paediatric Nail	Paediatric Flexible Nail	1.5-4mm, 300-450mm	$235.00
	Surgical Specialties
SQ094	PediFlex - Flexible nails	Flex Nail- Ti ; SS; cap	2.0mm-4.5mm, in 0.5mm 	$235.00
	increments
	1.5mm-4.5mm, in 0.5 
	increments
	1.5-4.0mm, in 0.5mm 
	increments
Prostheses List by Category, Groups and Sponsor	Page 301 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY064	Titanium Elastic Nail	1.5mm - 4.0mm	$235.00
	06.03.01.09 - Radial/Ulnar
	Medical & Optical Instruments Australia Pty Ltd
MO159	Polarus Humeral Rod System	Polarus Ulna Rod Titanium	210 to 270mm length	$1,559.00
MO161	Polarus Humeral Rod System	Polarus Radius Rod Titanium	190 to 230mm length	$1,559.00
	Smith & Nephew Surgical Pty Ltd
SN496	Intramedullary Nailing System	Foresight Nail	4-5mm Diameter 20-26cm 	$1,559.00
	Length
	Synthes Australia Pty Ltd
SY781	AO/ASIF Intramedullary Nails	Olecranon Osteotomy Nail	63mm	$1,559.00
	Wright Medical Australia
WR029	Micronail intramedullary radial 	Titanium, Distal radial nail	1, 2, 3, 4 and XL	$1,559.00
	fixation
	06.03.01.10 - Dynamic distraction - electronic
	Akva Surgical Pty Ltd
VK015	ISKD Internal Limb Lengthening 	Titanium Alloy	Diameter 12.5 - 14.5mm	$17,622.00
	System
	Orthotech Pty Ltd
OH393	Wittenstein FITBONE - Active limb	Active intramedullary nail	one size	$17,622.00
	 lengthening nail
OH473	Precice Limb Lengthening	Limb Lengthening system	8.5/10.7/12.5	$17,622.00
	06.03.01.11 - Arthrodesis Other
	Danex Medical Pty Ltd
XD015	Nextra hammertoe Correction 	Interdigital Fusion Implant	3.5mm MPI / 3.2mm PI	$577.00
	Prosthesis	4.5mm MPI / 3.2mm PI
	5.5mm MPI / 3.2mm PI
	4.5mm MPI / 4.5mm PI
	5.5mm MPI / 4.5mm PI
Prostheses List by Category, Groups and Sponsor	Page 302 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR252	Pro-toe VO	Hammertoe Fixation System	Small, Large, Straight & 	$577.00
	Angled
06.03.02 - Intramedullary Nail Accessories
	06.03.02.01 - Intramedullary nail lag screw
	Austofix
AX025	Austofix Femoral & Tibial Nailing 	6.2/6.5mm Hip Screw; high nitrogen 	Dia 6.2 & 6.5mm; Lengths 	$209.00
	System	70 - 120mm
	Biomet Australia Pty Ltd
BH315	Affixus Hip Fracture Nail System	Lag Screw	70-130mm	$209.00
BI922	EBI Paediatric Locking Nail System	Screw Pilot Double Thread - titanium;	20 - 68mm x 4.0mm	$209.00
	Integra Neurosciences Pty Ltd
IG137	Panta Arthrodesis Nail	Partially threaded lag Screw, Titanium	Diameter 5 mmLength - 20	$209.00
	 - 110 mm
	KH NXGEN (AUS) Pty Limited
KH009	NeoGen Nail System Lag Screw	Lag Screw for Intramedullary Nail	10.5mm diamter, 75 to 120 	$196.00
	length
KH012	NeoGen Nail System Lag Screw	Blade for Intrameduallary Nail	10.3mm diamter, 70 to 	$209.00
	120mm Length
	Smith & Nephew Surgical Pty Ltd
SL026	Compresion Hip Screw	Lag Screws	55-140mm	$209.00
SM155	InterTAN CHS-Integrated 	Integrated Interlocking Screws	11mm x 7.0mm diameter, 	$209.00
	Interlocking Screws	65mm Lag Screw/60mm 
	Compression Screw (65/60),
	 70/65, 75/70, 80/75, 85/80,
	 90/85, 100/95, 105/100, 
	110/105, 115/110, 
	120/115, 125/120, 
	130/125, 135/130, 
	140/135.
SN761	IMHS CP	Subtrochanteric lag screw	12.7mm x 70mm to 12.7mm x 	$209.00
	140mm
SN839	Trigen InterTAN Nail	Lag/Compression Screw, Titanium	30-120	$209.00
Prostheses List by Category, Groups and Sponsor	Page 303 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY126	AO/ASIF Intramedullary Nails	Spiral blade	Length 20 - 150mm	$209.00
	Zimmer Pty Ltd
ZI713	Zimmer Natural Nail System	Lag Screws, Titanium	10.5mm x 70 to 130mm in 	$209.00
	5mm increments
	COM
	Stryker Australia Pty Ltd
SK243	Gamma LN	Lag Screw - Titanium	10.5mmx70mm - 	$497.00
	10.5mmx130mm
SK490	U-Blade	U-Blade Lag Screw Set	All Gamma 3 U-Blade's are 	$497.00
	10.5mm in diameter, ranging
	 from 70-130mm in 5mm 
	increments
	Synthes Australia Pty Ltd
SY285	AO/ASIF Intramedullary nails	Helical blade	50-150mm length	$497.00
	COMP
	Smith & Nephew Surgical Pty Ltd
SN774	IMHS CP	Captured Compression Screw, 	19mm	$256.00
	Stainless Steel
	Stryker Australia Pty Ltd
ST035	Stryker Trauma Locking Nail 	Titanium	One size only	$256.00
	System: Compression Screw
	06.03.02.02 - Reconstruction screw
	Austofix
AX021	S2 Nail System	6.2mm condylar screws	6.5mm x 60-85mm	$234.00
	Biomet Australia Pty Ltd
BH336	Small / Large Fragment Set S/S	CHS Lag Screw Stainless Steel 	Length 50-145mm	$234.00
	Integra Neurosciences Pty Ltd
IG138	Panta Arthrodesis Nail	Fully threaded lag Screw, Titanium	Diameter 5 mmLength - 20	$234.00
	 - 110 mm
Prostheses List by Category, Groups and Sponsor	Page 304 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN519	TriGen	Capture Reconstruction Screws 	6.4mm diameter 65-125mm 	$234.00
	Titanium	length
	Synthes Australia Pty Ltd
SY263	AO/ASIF Intramedullary Nails	Reconstruction Screw	26-200mm Length	$234.00
	Zimmer Pty Ltd
ZI717	Zimmer Natural Nail System	Cancellous Screws Titanium - 	6.0mm x 50 to 145mm at 	$234.00
	Partially Threaded & Fixed Angle	5mm increments
	CN
	KH NXGEN (AUS) Pty Limited
KH010	NeoGen Reconstruction Screw	Reconstruction screw	6.4mm diameter, 65 to 	$278.00
	125mm length
	Stryker Australia Pty Ltd
SK203	Stryker Trauma Locking Nail 	SCN	Condyle Screws 5mm x 	$278.00
	(40mm-120mm)
SK215	Stryker Trauma Locking Nail 	Reconstruction Nail	Recon Lag Screw	$278.00
	06.03.02.03 - Set screw/Locking bolt
	Austofix
AX023	Austofix Femoral & Tibial Nailing 	4.0/4.8 Screws; Locking; dual thd; 	Dia 4.0 - 4.8mm; Lengths 	$150.00
	System	high nitrogen s-s	20-80mm
	Biomet Australia Pty Ltd
BH046	Biomet Phoenix Ankle Nailing 	Double lead screw - Ti-6Al-4V 	5mm Dia x (20 to 110)mm 	$150.00
	System - 5mm Double-lead thread 	Standard or osseotite finish	length
	screw
BH263	HI S3 Shoulder Fixation System	Set Screw, 90 Deg Locking 	One size	$150.00
	Lima Orthopaedics Australia Pty Ltd
LC105	Supernail / Uninail Cephalic Screw	Supernail / Uninail Cephalic Screw	Diameter 12mm x Length 70 	$150.00
	- 120mm
LC187	SMR Revision Modular Locking 	Modular Locking Collar (Ring) 	One Size	$150.00
	Ti6AI4V
	Oceania Orthopaedics
OO081	MUTARS - Interlocking Screw	Arthrodesis interlocking screw	10mm x 25mm - 245mm	$124.00
Prostheses List by Category, Groups and Sponsor	Page 305 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH394	Wittenstein FITBONE - Internal 	Locking screw long/short thread	20-85mm	$150.00
	limb lengthening locking screw
	RQSolutions Medical Devices Distribution Support
RQ050	Dual Cone Locking Extension (as a 	Orthodynamics The Integral Leg 	6 sizes	$124.00
	component of the Orthodynamics 	Prosthesis-Dual Cone Locking 
	The Integral Leg Prosthesis	Extension
RQ052	Offset Antirotational Locking 	Orthodynamics The Integral Leg 	3 sizes	$124.00
	Busing (as a component of the 	Prosthesis -Offset Antirotational 
	Orthodynamics The Integral Leg 	Locking Bushing
	Prosthesis)
RQ053	Orthodynamics The Integral Leg 	Orthodynamics The Integral Leg 	1 size	$150.00
	Prosthesis - Permanent 	Prosthesis -Permanent Unidirectional
	Unidirectional Locking Fixture (as 	 Locking Fixture
	a component of tehOrthodynamics 
	The Integral Leg Prosthesis
	Smith & Nephew Surgical Pty Ltd
SN467	Compressing Screw	For Intramedullary and compression 	19mm & 28.5mm	$150.00
	Hip Screw Systems
SN739	Trigen	Self Tapping Cortical Screw	20mm - 60mm	$150.00
SN762	IMHS CP	Captured locking screw	4.5mm x 22mm to 4.5mm x 	$150.00
	64mm
SN775	IMHS CP	Set Screw, Stainless Steel	Standard	$150.00
	Stryker Australia Pty Ltd
SK216	Stryker Trauma Locking Nail 	Reconstruction Nail	Blocking Screw	$150.00
SK245	Gamma LN	Locking Screw - Titanium	5x25mm - 5x95mm	$150.00
SK247	Gamma LN	Set Screw - Titanium	8x17.5mm	$150.00
ST043	Stryker Trauma Locking Nail 	Titanium	20-120mm	$150.00
	System: Locking Screw with & 
	Synthes Australia Pty Ltd
SY789	AO/ASIF intramedullary Nails	Locking Screws/Bolts	3.0mm-6.0mm D 10mm- 	$150.00
	150mm L
Prostheses List by Category, Groups and Sponsor	Page 306 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI714	Zimmer Natural Nail System	Cortical Screws (Partially Threaded) 	4.0mm & 530mm x 20mm to 	$150.00
	Titanium	60mm (2.5mm increments); 
	4.0mm & 5.0mm x 65 to 100 
	mm (5mm increments)
ZI718	Zimmer Natural Nail System	Cortical Screws - Fixed Angle (Fully 	4.0mm & 5.0mm x 20 to 	$150.00
	Threaded) Titanium	60mm (2.5mm increments); 
	4.0mm & 5.0mm x 65 to 
	100mm (5mm increments)
	06.03.02.04 - End caps and extension caps
	Austofix
AX029	Austofix Femoral & Tibial Nailing 	End Cap; I.M. Nails; s-s	8 - 13mm	$101.00
	System
	Biomet Australia Pty Ltd
BH045	Biomet Phoenix Arthrodesis 	Offset end cap, Titanium	0mm - 20mm	$101.00
	Nailing System - End Cap
BH316	Affixus Hip Fracture Nail System	End Caps	5mm, flush or impinging	$101.00
BH328	Versa Nail	TTC Nail Cap Unsterile Impinging 	One Size	$101.00
	and Non Impinging
BH329	Versa Nail	TTC Nail Cap Sterile Impinging and 	One Size	$101.00
	Non Impinging
BH330	VersaNail IM Nailing Platform	End caps for VersaNail IM Nail 	Flush, impinging & 5-15mm	$101.00
	Platform
BH334	Small / Large Fragment Set S/S	CHS Compression Screw - Stainless 	Neutral to +2	$101.00
	Steel
BI923	EBI Paediatric Locking Nail System	Nail end cap, titanium	5.5mm - 6.5mm	$101.00
	Integra Neurosciences Pty Ltd
IG102	Panta Arthrodesis Nail	End Cap, Titanium	One Size	$101.00
	KH NXGEN (AUS) Pty Limited
KH011	NeoGen Nail System End Cap	End Cap for Intramedullary Nail	10.3mm to 15.5mm diameter	$101.00
	Lima Orthopaedics Australia Pty Ltd
LC107	Supernail / Ininail Bone Plug - 	Supernail / Ininail Bone Plug - 	Standard / Long	$101.00
	Blocking Screw	Blocking Screw
Prostheses List by Category, Groups and Sponsor	Page 307 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical & Optical Instruments Australia Pty Ltd
MO200	Polarus Proximal Humeral Fixation 	End cap, titanium	Only size only	$101.00
	System
	Ortho Solutions Pty Ltd
OU007	FIXATION NAIL END CAP	OXFORD AFN ENDCAP LOCKING	OXFORD AFN END CAP	$95.00
		
	ANKLE ARTHRODESIS NAIL END	AFN END CAP DIA 
	10MM X 5MM LONG
	AFN END CAP DIA 
	10MM X 10MM LONG
	AFN END CAP DIA 
	11MM X 5MM LONG
	AFN END CAP DIA 
	11MM X 10MM LONG
	AFN END CAP DIA 
	12MM X 5MM LONG
	AFN END CAP DIA 
	12MM X 10MM LONG
	OXFORD AFN END CAP 
	LOCKING
	RQSolutions Medical Devices Distribution Support
RQ047	Orthodynamics The Integral Leg 	Orthodynamics The Integral Leg 	1 size	$101.00
	Prostheses-Central Screw (as a 	Prosthesis-Central Screw
	component of the Orthodynamics 
	The Integral Leg Prosthesis
	Smith & Nephew Surgical Pty Ltd
SN498	Intramedullary Nailing System	Nail Cap	One size only	$101.00
	Stryker Australia Pty Ltd
SK248	Gamma LN	Proximal/Extension Plug - Titanium	0mm, +5mm, +10mm	$101.00
SK491	U-Blade End Cap	U-Blade Lag Screw End Cap	One size 9mm x 10.5mm 	$101.00
	(diameter)
ST045	Stryker Trauma Locking Nail 	Titanium	Standard, +5, +10, +15	$101.00
	System: End Cap
	Surgical Specialties
SQ087	PediNail End Caps	Nail End Cap	0-20mm, in 5mm increments	$101.00
	Surgien Pty Ltd
BR007	OPRA System - Graft Screw	Graft Screw	One size only	$101.00
Prostheses List by Category, Groups and Sponsor	Page 308 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY125	AO/ASIF Intramedullary Nails	End cap	0 - 40mm	$101.00
	Tornier Pty Ltd
TO144	611 Ankle Fusion Nail - 	The 611 ankle arthrodesis nail, 2mm &	2mm plug, 7mm plug	$95.00
	Component: PLUGS	 7mm plugs are made out of titanium 
	alloy (Ti6AI4V). They are delivered 
	non-sterile
	Wright Medical Australia
WR207	Valor Hindfoot Fusion System - 	Valor Endcap	n/a	$101.00
	Endcap
	Zimmer Pty Ltd
ZI709	Zimmer Natural Nail System	Cortical Nuts and Washers	Cortical Nut for the 6mm 	$101.00
	Cancellous Screw
ZI710	Zimmer Natural Nail System	Cephalomedullary Nail Caps - 	Height: 0mm, 5mm, 10mm & 	$101.00
	Titanium (Neutral, Sliding & Locking)	15mm
ZI711	Zimmer Natural Nail System	Femoral Nail Caps (Titanium)	Height: 0mm, 5mm, 10mm & 	$101.00
	15mm
ZI712	Zimmer Natural Nail System	Humeral Nail Caps (Titanium) 	Height: 0mm, 5mm, 10mm & 	$101.00
	Antegrade & Retrograde	15mm (Antegrade), 0mm, 
	5mm, 10mm (Retrograde)
ZI720	Zimmer Natural Nail System	Tibial Nail Caps (Titanium)	Height: 0mm, 5mm, 10mm & 	$101.00
	15mm
	6.3.2.6 - Compression screw used with lag, long 4.5-7.5mm
	CN
	Biomet Australia Pty Ltd
BH318	Affixus Hip Fracture Nail System	Anti- rotational screw	5mm diameter	$98.00
06.03.03 - Plates
	06.03.03.01 - Standard (screw size ≥4.5mm)(including blade) ≤ 6 holes
	Biomet Australia Pty Ltd
BH138	Peanut Growth Control Plating 	Guided growth control plate, titanium	12 and 16mm, 2 holes	$570.00
	System - Plates	 alloy, stepped and arched
BH188	Small / Large  Fragment Set	3.5mm Titanium plates	2 to 6 holes	$570.00
BH195	Periarticular Plating System	Fibula Composite Plate - Titanium  	5 Hole	$570.00
Prostheses List by Category, Groups and Sponsor	Page 309 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER073	DeRoyal Implants - complex Plate	DeRoyal Implants - Plates and Screws	Standard (screw size 	$570.00
	 - Stainless Steel 316L - manufactured 	≥4.5mm)(including blade) ≤ 
	in USA	6 holes
ER075	DeRoyal Implants - Plate	DeRoyal Implants - Plates and Screws	Standard (screw size ≥ 	$570.00
	 - Stainless Steel 316L - Manufactured	4.5mm)(including blade) ≤ 6
	 in USA	 holes
	Integra Neurosciences Pty Ltd
IG086	Newdeal Distal Humeral Plates	Composition - 316L Stainless Steel.  	4 holes	$570.00
	To be used only with Newdeal 
	screws/lock screws
	LMT Surgical Pty Ltd
LM066	TriMed Olecranon Sled	Washer	one size	$570.00
	Smith & Nephew Surgical Pty Ltd
SN071	TC 100 	4.5mm Straight Plates	< 6 holes	$570.00
SN942	Peri-Loc	4.5 Straight Non Locking Plates	≤6 holes	$570.00
	Stryker Australia Pty Ltd
ST039	Stryker Plating System	L-Plates	4-6hole	$570.00
	Surgical Specialties
SQ074	PediPlates: O Plates	O-plate 12mm - Center Hole	12mm, 16mm, 20mm, 24mm	$570.00
	O-plate 16mm - Center Hole
	O-plate 20mm - Center Hole
	O-plate 24mm - Center Hole
	Synthes Australia Pty Ltd
SY603	AO/ASIF Plates	Non Locking Fragment plates	≤ 6 holes	$570.00
	Zimmer Pty Ltd
ZI776	ZPS-Zimmer Plate and Screw System	4.5mm ZPS Semi-tubular Narrow Plate	2-6 holes	$570.00
ZI777	ZPS-Zimmer Plate and Screw System	4.5mm ZPS Semi-tubular Narrow Plate	7 holes - 15 holes	$570.00
ZI792	ZPS-Zimmer Plate and Screw System	4.5mm Straight Recon Plate	4-6 holes	$570.00
ZI794	ZPS-Zimmer Plate and Screw System	4.5mm Broad Compression Plate	2-6 holes	$570.00
ZI804	ZPS-Zimmer plate and Screw System	4.5mm Dual Compression Plate	2-6 holes	$570.00
Prostheses List by Category, Groups and Sponsor	Page 310 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	COM
	Biomet Australia Pty Ltd
BI843	EBI XFIX DynaFix System	Plate, VS Osteotomy  Ti	4 hole, 6 hole	$970.00
	Device Technologies Australia Pty Ltd
DE055	Stainless Steel Square Wedge Tibial	Steel Square Wedge Tibial Osteotomy	3mm - 17.5mm	$970.00
	 Osteotomy Plate	 Plate with 4 non locking holes 
DE094	 Anterior Posterior Sloped Stainless	Anterior Posterior Sloped Stainless 	5 - 15mm length	$970.00
	 Steel Tibial Osteotomy Plate	Steel Tibial Osteotomy Plate with 4 
	non locking holes
	Global Orthopaedic Technology
GO245	Iso-Elastic SuperCable Trochanteric	Cable Paltes Titanium	6 Hole 185mm	$970.00
	 Grips and Cable-Plates System
	Integra Neurosciences Pty Ltd
IG087	Newdeal Femoral Osteosynthesis 	Composition - 316L Stainless Steel.  	8/9/10 hole, left and right	$970.00
	Plates	To be used only with Newdeal 
	screws/lock screws
IG088	Newdeal Distal Femoral Varus 	Stainless steel periarticular 	1 Size 	$970.00
	Osteotomy Plate	anatomically shaped plate fixed with 3
	 locking screws into femoral condyle 
IG089	Newdeal Femoral Varus and De-	Stainless steel periarticular anatomic 	Newdeal Femoral Varus and 	$970.00
	rotation Osteotomy Plates	plate fixed with locking screws into 	De-rotation Osteotomy 
	proximal femur 	Plates - 3 holes, Newdeal 
	Femoral Varus and De-
	rotation Osteotomy Plates - 
	4 holes, Newdeal 
	Reinforced Femoral 
	Newdeal and De-rotation 
	Osteotomy Plates - left and 
	right
	Smith & Nephew Surgical Pty Ltd
SN022	TC-100       	Osteotomy Blade Plates  	< 6 holes	$970.00
SN143	TC 100 	4.5mm Reconstruction Plate         	< 6 holes	$970.00
	Stryker Australia Pty Ltd
SK075	Stryker Plating System Basic 	4.5mm Reconstruction Plate	3-9 Holes	$970.00
	Fragment Set
Prostheses List by Category, Groups and Sponsor	Page 311 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ075	PediPlates: I Plates	I-Plate 16mm - Center Hole 	16mm	$970.00
	I-Plate 22mm - Center Hole 	22mm
	I-Plate 32mm - Center Hole	32mm
	Synthes Australia Pty Ltd
SY622	AO/ASIF Plates	Non Locking Specialty Plates	≤ 6 Holes	$970.00
	Zimmer Pty Ltd
ZI132	NexGen Knee High Tibial 	Plate - Ti	1 - 6 Holes	$632.00
	Osteotomy System
ZI217	ZPS Plate System	4.5mm T Buttress Plates	4 - 6 Hole	$970.00
	COM, LK
	B Braun Australia Pty Ltd
BB311	Position HTO Implant System - 	Titanium Osteotomy Plate, internal 	One size	$1,240.00
	HTO Plate	fixation plate used in proximal tibial 
	repositioning osteotomy.
	Device Technologies Australia Pty Ltd
DE348	Calcaneal Step Plate	Calcaneal Step Plate	5mm, 7.5mm, 10mm	$1,240.00
	Integra Neurosciences Pty Ltd
IG090	Newdeal Proximal Humeral Plate	Composition - 316L Stainless Steel. 	6  holes	$1,240.00
	To be used only with Newdeal 
	screws/lock screws
IG091	Newdeal HTO Plates	Stainless steel anatomically shaped 	Opening wedge HTO 	$1,240.00
	plates for high tibial osteotomy;4 or 5	plates, left and right. 
	 holes 	Closing wedge HTO plates, 
	left and right. Reinforced 
	closing wedge HTO plates, 
	Surgical Specialties
SQ077	PediLoc - Periarticular Locking 	4.5 Locking Plate	3-6 Hole	$1,240.00
	Plating System Femur<6 holes
	Wright Medical Australia
WR067	Displacement Plate - DPS	Unique steep plate design allows for 	6, 8 & 10mm step, 4 hole	$1,240.00
	controlled fixation of displacement 
	calcaneal osteotomies. 3 step 
	variations allows for accurate 
	corrections. 3.5mm Titanium locking 
Prostheses List by Category, Groups and Sponsor	Page 312 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	COM, VAL
	Device Technologies Australia Pty Ltd
DE216	Titanium Anterior Posterior Sloped 	Titanium Anterior Posterior Sloped 	0-17.5mm	$1,550.00
	Tibial Osteotomy Plate	Tibial Osteotomy Plate with 4 
	variable angle locking holes and 6 
	variable angle locking holes 
DE217	Titanium Femoral Osteotomy Plate 	Titanium Femoral Osteotomy Plate 	5mm - 17.5mm	$1,550.00
	with 7 Variable Angle Locking Holes
	LMT Surgical Pty Ltd
LM074	Elix (plate)	PEEK HTO plate                	4 Hole, right and left plate.	$1,550.00
	LK
	B Braun Australia Pty Ltd
BB312	Position HTO Implant System - 	Osteotomy Spacer Block, solid 	5mm - 16mm	$840.00
	Spacer Block with Fixation Screw	titanium. Consists of block and 
	fixation screw.
	Emergo Asia Pacific Pty Ltd
ER072	DeRoyal Implants - Locking 	DeRoyal Implants - Plates and Screws	Standard (screwsize ≥ 	$840.00
	Complet Plate	 - Stainless Stell 316L - Manufactured 	4.5mm)(inluding blade) ≤6 
	in USA	holes
ER074	DeRoyal Implants - Locking Plate	DeRoyal Implants - Plates and Screws	Standard (screw size 	$840.00
	 - Stainless Steel 316L - Manufactured	≥4.5mm)(including blade) ≤ 
	 in USA	6 holes
	Integra Neurosciences Pty Ltd
IG083	Newdeal Reinforced Bendable 	Stainless Steel 2 - 4 Holes 	2 holes, 4 holes/77mm, 4 	$840.00
	Osteosynthesis Plates	holes/112mm
IG084	Newdeal Bendable Osteosynthesis 	Composition - 316L Stainless Steel.  	3-6 holes 	$840.00
	Plates	To be used only with Newdeal 
	screws/lock screws.
	PurePlay Orthopaedics
PJ001	Flexit System, Flexit HTO Opening 	Anatomic Locking Tibial Plates	51mm,63mm,2.8mm thick 4-	$840.00
	Wedge Tibial Plate	6 holes
	Stryker Australia Pty Ltd
SK532	Stryker Plating System	Locking Compression Anatomical 	2-6 hole	$840.00
	Shape
SK535	Stryker Plating System	Locking Reconstruction Plates	5.0mm, 4-6 hole	$840.00
Prostheses List by Category, Groups and Sponsor	Page 313 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY116	AO/ASIF Plates	LCP Large Fragement Plates	≤ 6 holes	$840.00
	VAL
	Biomet Australia Pty Ltd
BH281	ALPS LFS	4.5mm titanium plates	1-6 holes	$1,170.00
	VAL, COM
	Biomet Australia Pty Ltd
BH285	ALPS LFS	4.5mm Titanium Spider plates	Single hole plate with hooks	$1,550.00
	06.03.03.02 - Standard (screw size ≥4.5mm)(including blade) ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH198	Periarticular Plating System	Fibula Composite Plate - Titanium  	9 Hole 	$710.00
	Device Technologies Australia Pty Ltd
DE342	PEEKPower HTO Plate	Medial High Tibial Osteotomy 	One Universal Size	$710.00
	Implant Device System
	Emergo Asia Pacific Pty Ltd
ER069	DeRoyal Implants - Plate	DeRoyal Implants - Plpates and 	Standard (screw size 	$710.00
	Screws - Stainless Steel 316L - 	≥4.5mm)(including blade) 
	Manufacturing in USA	≥7 to ≤15 holes
ER071	DeRoyal Implants - Plate - Complex	DeRoyal - Plates and Screws - 	Standard (screw 	$710.00
	Stainless Steel 316L - Manufactured 	size≥4.5mm)(including 
	in USA	blade)≥7 to ≤ 15holes
	Smith & Nephew Surgical Pty Ltd
SN098	TC-100 	4.5mm Reconstruction Plate 	> 7 to < 15 holes	$710.00
SN133	TC-100       	4.5mm Straight Plates 	 > 7 to < 15 holes	$710.00
SN943	Peri-Loc	4.5 Straight Non Locking Plates	≥7 to ≤15 holes	$710.00
	Stryker Australia Pty Ltd
SK544	Stryker Plating System Basic 	4.5mm Reconstruction Plate	7-15 hole	$710.00
	Fragment Set
	Synthes Australia Pty Ltd
SY605	AO/ASIF Plates	Non Locking Fragment Plates	7 - 15 holes	$710.00
Prostheses List by Category, Groups and Sponsor	Page 314 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI168	Zimmer Internal Fixation Systems: 	Cable-Ready 8 Hole Plate - Stainless 	246mm long	$710.00
	Cable System	Steel
ZI793	ZPS-Zimmer Plate and Screw System	4.5mm Straight Reconstruction Plate	7-15 holes	$710.00
ZI795	ZPS-Zimmer Plate and Screw System	4.5mm Broad Compression Plate	7-15 holes	$710.00
ZI805	ZPS-Zimmer Plate and Screw System	4.5mm Dual Compression Plate	7-15 holes	$710.00
	Com
	Biomet Australia Pty Ltd
BH199	Periarticular Plating System	Tibial Plate - Titanium	7 - 15 Holes	$1,110.00
	Global Orthopaedic Technology
GO246	Oso-elastic SuperCable 	Cable Plates Titanium	6 Hole 185mm	$1,110.00
	Trochanteric Grips and Cable-Plates
	Surgical Specialties
SQ078	PediLoc System ≥7 to ≤15 holes, 	4.5mm Bowed locking compression 	4.5mm bowed 10, 12, 14 	$1,110.00
	scfew size ≥4.5mm	femur 10, 12, 14 hole plates	hole
	4.5mm contour locking compression 	4.5mm contour 8,10,12,14 
	femur 8, 10, 12, 14 hole plates left and 	hole right
	right	4.5mm contour 8, 10, 12, 14 
	Zimmer Pty Ltd
ZI788	ZPS-Zimmer Plate and Screw System	4.5mm T-Plates	7-15 holes	$1,110.00
	COM, LK
	LMT Surgical Pty Ltd
LM168	Ankle Fix - Plate ≥ 7 to ≤ 15 holes	Ankle Fusion plate	Standard and Large	$1,380.00
	LK
	Biomet Australia Pty Ltd
BH065	Sternalock	Plate, locking, >6 hole, Various 	8-12 hole	$980.00
	Emergo Asia Pacific Pty Ltd
ER068	DeRoyal Implants - Plate - Complex 	DeRoyal Implants - Plates and Screws	Standard (screw size 	$980.00
	Locking	 - Stainless Steel 316L - Manufactured	≥4.5mm)(including blade) 
	 in USA	≥7 to ≤15 holes
ER070	DeRoyal Implants - Plate - Locking	DeRoyal Implants - Plates and Screws	Standard (screw 	$980.00
	 - Stainless steel 316L - Manufactured 	size≥4.5mm)(including 
	in USA	blade) ≥7 to ≤15 holes
Prostheses List by Category, Groups and Sponsor	Page 315 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Integra Neurosciences Pty Ltd
IG085	Newdeal Bendable Osteosynthesis 	Stainless steel bendable plates 7 - 9 	7-9 holes     	$980.00
	Plates	holes 
	PurePlay Orthopaedics
PJ002	FlexiSystem, Flexit HTO Opening 	Anatomic Locking Tibial Plates	80mm, 7-15 holes	$980.00
	wedge Tibial Plate
	Stryker Australia Pty Ltd
SK533	Stryker Plating System	Locking Compression Anatomical 	7-15 hole	$980.00
	Shape
SK536	Stryker Plating System	Locking Reconstruction Plates	5.0mm, 8-14 hole	$980.00
	Synthes Australia Pty Ltd
SY636	AO/ASIF Plates	LC-LCP Fragment Plates	7-15 Holes	$980.00
	VAL
	Biomet Australia Pty Ltd
BH282	ALPS LFS	 4.5mm titanium plates,	7-15 holes	$1,310.00
	06.03.03.03 - Standard (screw size ≥4.5mm)(including blade) ≥ 16 holes
	Smith & Nephew Surgical Pty Ltd
SN078	TC-100 	4.5mm Straight Plates	> 16 holes	$780.00
SN784	Peri-Loc	Plates, Stainless Steel, Non-Locking, 	4.5mm. 18-22 hole	$780.00
	Broad, Left & Rights
	Stryker Australia Pty Ltd
SK545	Stryker Plating System Basic 	4.5mm Reconstruction Plate	16-22 hole	$780.00
	Fragment Set
	Synthes Australia Pty Ltd
SY661	AO/ASIF Plates	Non Locking Large Fragment Plates	≥ 16 Holes	$780.00
	COM
	Smith & Nephew Surgical Pty Ltd
SN075	TC 100	 4.5mm Reconstruction Plates 	≥ 16 Holes	$1,180.00
Prostheses List by Category, Groups and Sponsor	Page 316 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ079	PediLoc - Periarticular Locking 	4.5mm Bowed locking compression 	4.5mm Bowed, 16 hole	$1,180.00
	Plating System Femur- > 16 holes, 	femur 16 hole plate	4.5mm Bowed, 18 hole
	screw size ≥4.5mm	4.5mm Bowed locking compression 	4.5mm contour,16 hole, 
	femur 18 hole plate	right
	4.5mm contour locking compression 	4.5mm contour,18 hole, 
	femur 16 hole plate right	right
	4.5mm contour locking compression 	4.5mm contour,20 hole, 
	femur 18 hole plate right	right
	4.5mm contour locking compression 	4.5mm contour,16 hole, left
	femur 20 hole plate right
	4.5mm contour locking compression 
	femur 16 hole plate left
	4.5mm contour locking compression 
	femur 18 hole plate left
	4.5mm contour locking compression 
	femur 20 hole plate left
	Synthes Australia Pty Ltd
SY716	AO/ASIF Plates	Non Locking specialty Plates	≥16 Holes	$1,180.00
	COM LK
	LMT Surgical Pty Ltd
LM169	Ankle Fix -Plate ≥ 16 holes	Ankle fusion plate	One size only	$1,450.00
	LK
	Emergo Asia Pacific Pty Ltd
ER101	DeRoyal Implants - Plate-Locking	DeRoyal Implants - Plates and Screws	standard (screw 	$1,050.00
	 - Stainless steel 316L- Manufactured 	size≥4mm)(including blade)
	in USA	 ≥16 holes
	Stryker Australia Pty Ltd
SK534	Stryker Plating System	Locking Compression Anatomical 	16-22 hole	$1,050.00
	Shape
SK537	Stryker Plating System	Locking Reconstruction Plates	5.0mm, 16-22 hole	$1,050.00
	Synthes Australia Pty Ltd
SY637	AO/ASIF Plates	LC-LCP Plates	≥ 16 Holes	$1,050.00
Prostheses List by Category, Groups and Sponsor	Page 317 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.04 - Small (screw size 2.71mm – 4.49mm)(including blade) ≤ 6 holes
	Akva Surgical Pty Ltd
VK016	Orthofix eight-Plate	Guided growth plate for correction of 	12mm, 16mm	$225.00
	angular deformities over an open 
	growth plate. Titanium, two screw 
	holes, wire guided.
	Emergo Asia Pacific Pty Ltd
ER078	DeRoyal Implants - Plate	DeRoyal Implamts - Plates and Screws	Small (screw size 2.71mm - 	$225.00
	 - Stainless Steel 316L - Manufactured	4.49mm)(including blade)≤ 
	 in USA	6 HOLES
	Integra Neurosciences Pty Ltd
IG096	Basal Osteotomy Plate	Titanium	5 Deg, Left and Right, 	$460.00
	10Deg, Left and Right
	Lima Orthopaedics Australia Pty Ltd
LC098	Osteosynthesis Bone Plate - Small	Osteosynthesis Bone Plate - Small	Length 45 - 79mm x 3 - 6 	$225.00
	hole
LC142	Fibula Compression Plate 	≤ 6 hole	Fibula Compression Foot Plate ≤6 	3-6 hole Fibula Plate 1.5mm	$225.00
	 thick x 2mm Compression 
	path
	LMT Surgical Pty Ltd
LM121	'TriMed Wire Plates	Wire Fixation plate	3 & 5 hole	$225.00
LM122	TriMed Peri-articular plate	TriMed straight plates	5 hole	$225.00
	Ortho Solutions Pty Ltd
OU018	T-Plate	3.5mm T-plate	T-Plate 3.5mm right angled 	$225.00
	3,4,5,6 hole
	T-Plate 3.5mm oblique 
	angled 3,4,5 hole
OU021	1/3 Tubular Plate with Collar	1/3 Tubular Plate with Collar	1/3 Tubular Plate with 	$225.00
	Collar 2,3,4,5,6 hole
	Smith & Nephew Surgical Pty Ltd
SN012	TC-100 & Peri-Loc	1/3 Tubular Plates	 ≤ 6 holes.	$225.00
SN044	TC-100 & Peri-Loc	 3.5mm Straight Plates	 ≤ 6 holes	$225.00
SN109	TC100	3.5mm Reconstruction Plates	≤ 6 holes	$225.00
SN136	TC-100 	Small right angle & T plates 	≤ 6 holes	$225.00
Prostheses List by Category, Groups and Sponsor	Page 318 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK548	Stryker Plating System Small 	3.5mm Reconstruction Plate	4-6 hole	$225.00
	Fragment Set
ST037	Stryker Plating System Small 	One Third Tubular Plate with Collar	2-6 Holes	$225.00
	Fragment Set 
ST730	Leibinger Titanium Implant System	Hand system, fixation plate, L-shape, 	1.7mm, 6 holes	$225.00
	right/left
	Synthes Australia Pty Ltd
SY702	AO/ASIF Plates	DCS DHS Plate, Angled blade, 	≤6 holes	$225.00
	Osteotomy
SY726	AO/ASIF Plates	Non-Locking Fragment Plates	≤6 Holes	$225.00
	Zimmer Pty Ltd
ZI778	ZPS-Zimmer Plate and Screw System	3.5mm Straight Compression Plate	2-6 holes	$225.00
ZI781	ZPS-Zimmer Plate and Screw System	3.5mm ZPS One Third Tubular Plates	2-6 holes left and right	$225.00
ZI785	ZPS-Zimmer Plate and Screw System	3.5mm T-Plates	4-6 holes, left and right	$225.00
ZI789	ZPS-Zimmer Plate and Screw System	3.5mm Straight Reconstruction Plates	3-6 holes	$225.00
ZI796	ZPS-Zimmer Plate and Screw System	4.5mm Broad Compression Plate	2-6 holes	$225.00
ZI806	ZPS-Zimmer Plate and Screw System	4.5mm Dual Compression Plate	2-6 holes	$225.00
ZI817	Zimmer Universal Locking System	2.7mm Locking Dual Compression 	2 holes - 6 holes	$225.00
	Plate Sterile and Non Sterile
	COM
	Integra Neurosciences Pty Ltd
IG106	B-BOP Plantar Basal Osteotomy 	Titanium, 4 hole plate for fixation of 	Moderate Correction(5°) 	$625.00
	Plate (Sterile)	osteotomy of the base of the first 	Left, Right. Severe 
	metatarsal	Correction (10°) Left, Right
IG128	Spider Limited Wrist Fusion System	Recessed, circular stainless steel plate	6 hole	$625.00
	LMT Surgical Pty Ltd
LM125	TriMed Sidewinder	Ankle Fixation Plate	6 hole sidewinder plate	$625.00
	Smith & Nephew Surgical Pty Ltd
SN800	Peri-Loc	3.5mm Recon Plate 	 ≤ 6 holes  	$625.00
SN801	Peri-Loc 	3.5mm Recon Plates   	> 7 to < 15 holes	$625.00
	Stryker Australia Pty Ltd
SK546	Stryker Plating System	T-Plates, pre-shaped	2-6 holes	$625.00
Prostheses List by Category, Groups and Sponsor	Page 319 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ST738	Leibinger Titanium Implant System	Leibinger profyle hand & small  	1.7mm system, 2x2 holes	$625.00
	fragment system, fixation, 3D plate, 
	titanium
	Synthes Australia Pty Ltd
SY704	AO/ASIF Plates	Cloverleaf Plates	≤ 6 holes	$625.00
	Wright Medical Australia
WR050	Charlotte MTP Fusion System	MTP plate, stainless steel	Left & Right extended,9 	$625.00
	holes
	Zimmer Pty Ltd
ZI220	ZPS Plate System	3.5mm Cloverleaf Plates	88 - 104mm	$625.00
ZI786	ZPS-Zimmer Plate and Screw System	3.5mm T-Plates	2 holes - 6 holes	$625.00
ZI787	ZPS-Zimmer Plate and Screw System	4.5mm T-Plates	2-6 holes	$625.00
ZI797	ZPS-Zimmer Plate and Screw System	3.5mm Calcaneal Plates	2-6 holes	$625.00
	COM LK
	Device Technologies Australia Pty Ltd
DE290	Titanium Plate with or without 	Titanium Plate with or without wedge	Flat Plates - left large, right 	$895.00
	 with 4 and non locking holes. Left 	large, left medium, right 
	and right side specific.	medium, left small, right 
	small
	Wedge Plates - 10mm 
	wedge left, 10mm wedge 
	right, 8mm wedge left, 8mm 
	wedge right, 6mm wedge 
	left, 6mm wedge right
DE417	Locking Medial Hook Plate	Locking Medial Hook Plate for 	3-5 holes	$895.00
	Fixation of medial malleolus fractures
DE419	Locking Lateral Hook Plate	Locking Lateral Hook Plate for 	3-5 Holes	$895.00
	Fracture Fixation of the Lateral 
	Malleolus
	Ortho Solutions Pty Ltd
OU014	Tarsal Fusion Plate	Tarsal Fusion Plate	Tarsal Fusion Plate 12mm 	$895.00
	(TFP)
	Tarsal Fusion Plate 14mm 
	(TFP)
	Tarsal Fusion Plate 16mm 
	(TFP)
Prostheses List by Category, Groups and Sponsor	Page 320 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OU015	Rearfoot Recon Plate	Rearfoot Recon Plate	Rearfoot Recon. Plate 6 hole	$895.00
	 (RRP)
	Rearfoot Recon. Plate 8 hole
	 (RRP)
	Rearfoot Recon. Plate 14 
	hole (RRP)
OU016	Arthrodesis Wedge Plate	Arthrodesis Wedge Plate	Arthrodesis Wedge Plate 	$895.00
	0mm - 8mm (AWP)
	3.5mm Universal Locking 
	Plate 12mm - 30mm 
	(3.5ULP)
	COM, LK
	Biomet Australia Pty Ltd
BI930	Sternalock	Plate, locking, <5 hole, Various 	4-5 hole	$895.00
	Integra Neurosciences Pty Ltd
IG117	UNI-CP Compression plating 	2 or 4 hole stainless steel 	2 or 4 hole, 4 interaxis 	$895.00
	compression plate, with 3 plate 	sizes: 17, 20, 25 and 30mm
	configurations (2 or 4 hole 'straight' 
IG136	Uni-CP Compression plating 	4 hole U design	4 hole, 3 interaxis sizes: 	$895.00
	17,19,21mm
	LMT Surgical Pty Ltd
LM128	Normed fracture fixation plates	Titanium locking foot plates	4/6 hole and 3.5mm screws	$895.00
	Ortho Solutions Pty Ltd
OU010	Calcaneal Step plate	Calcaneal Step plate	Calcaneal Step plate 6mm 	$895.00
	(CSP)
	Calcaneal Step plate 8mm 
	(CSP)
	Calcaneal Step plate 10mm 
	(CSP)
OU011	Lapidus Plate	Lapidus Plate	Lapidus plate flat ( LP), 	$895.00
	Lapidus plate 1mm step 
	(LP) up to
	Lapidus plate flat ( LP), 
	Lapidus plate 6mm step 
Prostheses List by Category, Groups and Sponsor	Page 321 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthopaedic Solutions Pty Ltd
OE044	Merete MetaCun/ DuoMetaCun/ 	Small Plates, Titanium, < 6 holes	Plates, < 6 holes:	$895.00
	MetaFix Plantar BG10 - Fusion 	MetaCun - 21mm, 23mm 
	25mm 27mm
	DuoMetaCun - small 23, 
	medium 23; Small 25, 
	Medium 25
	MetaFix Plantar BG10 - 
	37mm, 40mm (Left & Right)
	Surgical Specialties
SQ080	PediLoc-Plating System   ≥ 6 holes, 	3.5 Locking Plate	3-6 Hole	$895.00
	screw size 2.71 – 4.49mm
	Tornier Pty Ltd
TO105	MaxLock Extreme System - Small 	Small variable angle locking plates, 	≤ 6 holes	$895.00
	Plates ≤ 6 holes	titanium, ≤ 6 holes
TO140	'Nexfix MTP Fusion System	A bendable stainless steel bone plate 	6 hole	$895.00
	and screw system with unique low 
	profile locking screw option.  
	Indicated for use in primary and 
	revision MTP fusion
	Wright Medical Australia
WR049	Charlotte MTP Fusion System	MTP plate, stainless steel	Left & Right small & 	$895.00
	standard, 6 holes
WR057	Lapidus Plate	Titanium locking plate with unique 	 3.5mm: neutral, 1-6mm step	$895.00
	stepped displacement in 1mm 
	increments permits accurate 
	plantarisation and lateralisation in 
	midfoot fusions.
WR066	Arthrodesis Flat Plate - AFP	Flat plate intended for use in isolated 	12, 14 & 16mm length - 4 	$895.00
	tarsal fusions, titanium locking plate, 	hole
	2mm thickness
WR069	TOM Plate	Designed for base osteotomies and 	- L & R: neutral, 1-5mm 	$895.00
	fusions of MT1 with correction 	step, 4 hole
	achieved through one cut. It is a 
	titanium locking plate, anatomically 
	designed with a smaller radius to fit 
	the contour of the first metatarsal and 
	5 step variation in 1mm increments for 
Prostheses List by Category, Groups and Sponsor	Page 322 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI543	Zimmer Universal Locking System	3.5mm Locking T plate	3 hole head 5 hole shaft 	$895.00
	73mm length; 4 hole head 6 
	hole shaft 85mm length; 3 
	hole head 3 hole shaft left 
	51mm length; 3 hole head 4 
	hole shaft left 63mm length; 
	3 hole head 3 hole shaft 
	right 51mm length; 3 hole 
	head 4 hole shaft right 
	63mm length.
	COM, VAL
	Biomet Australia Pty Ltd
BH242	ALPS Foot System	Complex periarticular foot plates	small to large	$1,225.00
BH279	ALPS - Anatomic Locked Plating 	3.5mm titanium locking spider plates	Small - large and offset	$1,225.00
	System
	Integra Neurosciences Pty Ltd
IG132	TIBIAXYS Distal Tibia System - 	Titanium medial anterior plate with 6 	3mm thick, 77mm long	$1,225.00
	Ankle Arthrodesis - Medial anterior	holes; left or right
	 plate
	Medartis
EO080	APTUS Foot	TriLock Plates	2.8	$1,225.00
	Orthotech Pty Ltd
OH450	OsteoMed FPS	Titanium locking footplates	3.5mm and 4mm	$1,225.00
	Wright Medical Australia
WR056	Locking Plate	Titanium locking plates anatomically 	2.7mm & 3.5mm, neutral, 	$1,225.00
	contoured for forefoot and midfoot 	1mm, 2mm, 3mm, 4mm, 5mm, 
	osteotomies.	6mm, 7mm 4-6 holes
WR064	MPJ Fusion Plate	Titanium locking plate with built-in 	Small, Medium & Revision, 	$1,225.00
	1- degree valgus angle for anatomic 	Left & Right, 0, 5 & 10 
	fixation of 1st MTP joint	degree
	COM,LK
	Synthes Australia Pty Ltd
SY703	AO/ASIF Plates	LC-LCP Plates	≤ 6 holes	$895.00
Prostheses List by Category, Groups and Sponsor	Page 323 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Device Technologies Australia Pty Ltd
DE285	 Titanium Lapidus Arthrodesis 	Titanium Lapidus Arthrodesis Plate 	Small, Large	$495.00
	with locking holes and compresion 
DE413	Locking Reconstruction Plate	Reconstruction Plate for communited 	4-6 Holes	$495.00
	Fibula Shaft Fractures
DE416	Locking Third Tubular Plate	Plate for fracture fixation of the Fibula	4-6 holes	$495.00
DE453	X Plate	Plate for fusion	Medium, Large	$495.00
DE455	Low Profile T-Plate	Plate for fusion	3-4 Holes	$495.00
DE457	Low Profile Straight Plate	Plate for fusion	2-5 Holes	$495.00
	Emergo Asia Pacific Pty Ltd
ER067	DeRoyal Implants - Plate-Complex-	DeRoyal Implates - Plates and Screws 	Small (screw size 2.71mm - 	$495.00
	Locking	- Stainless Steel 316L - Manufactured 	4.49mm)(including blade) 
	in USA	≤6 holes
	Smith & Nephew Surgical Pty Ltd
SN796	Peri-Loc	Locking 1/3 Tubular & 3.5mm 	≤ 6 holes	$495.00
	Straight Plates 
	Stryker Australia Pty Ltd
SK538	Stryker Plating System	Locking Compression Anatomical 	2-6 hole	$495.00
	Shape
SK540	Stryker Plating System	Locking Reconstruction Plates	4.0mm, 4-6 hole	$495.00
SK542	Stryker Plating System	Locking One Third Tubular Plates	3.0mm, 2-6 hole	$495.00
	Synthes Australia Pty Ltd
SY723	AO/ASIF Plates	LCP Plates	≤6 Holes	$495.00
	Zimmer Pty Ltd
ZI774	Zimmer Universal Locking System	3.5mm One-Third Tubular Locking 	5-6 holes	$495.00
	Plate
ZI783	Zimmer Universal Locking System	3.5mm Universal Locking System 	3-6 holes	$495.00
	Reconstruction Plates
ZI800	Zimmer Universal Locking System	3.5mm One Third Tubular Locking 	5-6 holes	$495.00
	Plate
ZI808	Zimmer Universal Locking System	3.5mm One Third Tubular Locking 	3-4 holes	$495.00
	Plate
Prostheses List by Category, Groups and Sponsor	Page 324 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI810	Zimmer Universal Locking System	3.5mm Dual Compression Locking 	4 - 6 holes	$495.00
	Plates
	VAL
	Biomet Australia Pty Ltd
BH273	ALPS - Anatomic Locked Plating 	3.5mm titanium plate	2-6 holes	$825.00
	System
	Integra Neurosciences Pty Ltd
IG116	TIBIAXYS Distal Tibial Osteotomy 	Titanium 4 or 6 hole fibula plate	4 hole plate - 48.7mm 	$825.00
	System - Fibula plate	length; 6 hole plate - 
	68.5mm length
	Smith & Nephew Surgical Pty Ltd
SN938	Peri-Loc VLP	VAL/LK 3.5 1/3 Tubular	≤6 holes	$825.00
SN979	Peri-Loc	Fibula Plates	 ≤ 6 holes	$825.00
	Wright Medical Australia
WR237	Ortholoc Fracture System - Plates	Universal	6 Hole	$825.00
	06.03.03.05 - Small (screw size 2.71mm – 4.49mm)(including blade) ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH187	Small / Large  Fragment Set	3.5mm Titanium plate	7-14 holes	$294.00
	Emergo Asia Pacific Pty Ltd
ER082	DeRoyal Implants - Plate-Complex	DeRoyal Implants - Plates and Scews 	Small (scrwe size 2.71mm-	$294.00
	- Stainless Steel 316L - Manufactured 	4.49mm)(including blade) ≤ 
	in USA	6holes
ER083	DeRoyal Implants - Complex Plate	DeRoyal Implants - Plates and Screws	Small (screw size 2.71mm-	$294.00
	 - Stainless Steel 316L - Manufactured	4.49mm)(including blade) 
	 in USA	≥7 to ≤15 holes
ER095	DeRoyal Implants - Plate	DeRoyal Implants - Plates and Screws	Small (screw size 2.71mm - 	$294.00
	 - Stainless Steel 613L - Manufactured	4.49mm)(including blade) 
	 in USA	≥7 to ≤15 holes
	Lima Orthopaedics Australia Pty Ltd
LC143	Fibula Compression Plate ≥	 7 to ≤ 	Fibula Compression foot Plate ≥	 7 to 	7-8 Hole Plate 1.5mm thick 	$294.00
	15 hole	≤ 15 hole	x 2mm Compression
	LMT Surgical Pty Ltd
LM123	'TriMed Peri-articular plate	TriMed straight plates	7-15 hole	$294.00
Prostheses List by Category, Groups and Sponsor	Page 325 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
OU009	3.5mm A.C.P Plate	A.C.P Plate	3.5mm, 7 hole plate to 	$294.00
	3.5mm 12 hole plate
	3.5mm straight 7 hole 
	reconstruction plate to 
	3.5mm straight 14 hole 
	reconstruction plate
OU013	1/3 Tubular Plate with Collar	1/3 Tubular Plate with Collar	1/3 Tubular Plate with 	$294.00
	Collar, 8-12hole
OU020	Reconstructive Plate	3.5mm Reconstructive Plate	3.5mm Reconstructive Plate 	$294.00
	3.5mm A.C.P Plate	5-6 hole
	3.5mm A.C.P Plate 2,3,4,5,6 
	hole
	Smith & Nephew Surgical Pty Ltd
SN118	TC-100 & Peri-Loc 	3.5mm Straight Plates 	 ≥ 7 to ≤ 15 holes 	$294.00
SN130	TC-100 & Peri-Loc 	 3.5mm Straight Plates	≥ 7 to ≤ 15 holes	$294.00
	Stryker Australia Pty Ltd
SK099	Stryker Plating System Small 	One Third Tubular Plate with Collar	9-14 Holes	$294.00
	Fragment Set
SK549	Stryker Plating System Small 	3.5mm Reconstruction Plate	7-14 hole	$294.00
	Fragment Set
	Synthes Australia Pty Ltd
SY721	AO/ASIF Plates	Non-Locking Fragment Plates	7-15 Holes	$294.00
	Zimmer Pty Ltd
ZI772	Zimmer Universal Locking System	3.5mm Reconstruction Locking Plate	13-15 holes	$294.00
ZI779	ZPS-Zimmer Plate and Screw System	3.5mm Straight Compression Plate	7-15 holes	$294.00
ZI782	ZPS-Zimmer Plate and Screw System	3.5mm ZPS One Third Tubular Plates	7 holes - 15 holes left and 	$294.00
	right
ZI790	ZPS-Zimmer Plate and Screw System	3.5mm Straight Reconstruction Plates	7-15 holes	$294.00
ZI807	ZPS-Zimmer Plate and Screw System	Standard DC Plate	7-15 holes	$294.00
ZI818	Zimmer Universal Locking System	2.7mm Locking Dual Compression 	7 holes - 15 holes	$294.00
	Plate Sterile and Non Sterile
Prostheses List by Category, Groups and Sponsor	Page 326 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	COM
	Integra Neurosciences Pty Ltd
IG127	Spider Limited Wrist Fusion System	Recessed, circular stainless steel plate	8 holes	$694.00
	 - Spider Plate
	LMT Surgical Pty Ltd
LM126	TriMed Sidewinder	Ankle Fixation Plate	7 hole sidewinder plate	$694.00
	Medical & Optical Instruments Australia Pty Ltd
MO208	Acumed Bone Plate	Wrist Fusion Plate - Titanium	Standard/Mini 7-9 holes.      	$694.00
	Smith & Nephew Surgical Pty Ltd
SN069	 TC-100 	3.5mm Reconstruction Plates 	 ≥ 7 to ≤ 15 holes 	$694.00
SN936	TC-100	3.5mm Curved Reconstruction Plate	≥7 to ≤15 holes	$694.00
	Stryker Australia Pty Ltd
SK547	Stryker Plating System	T-Plates, pre-shaped	7-13 hole	$694.00
ST051	Stryker Plating System Small 	Cloverleaf Plate	3-5 Holes	$694.00
	Fragment Set
	Synthes Australia Pty Ltd
SY037	AO/ASIF Plates	Wrist fusion plate	2-28 hole	$694.00
	COM LK
	Device Technologies Australia Pty Ltd
DE418	Locking Medial Hook Plate	Locking Medial Hook Plate for 	7 Holes	$964.00
	fixation of Medial malleolus fractures
DE420	Locking Lateral Hook Plate	Locking Lateral Hook Plate for 	7 Holes	$964.00
	Fixation of Lateral Malleolus
	COM, LK
	Integra Neurosciences Pty Ltd
IG064	Integra Total Wrist Fusion System - 	Straight (bendable), Standard bend, 	1 size only of each type of 	$964.00
	Plates	Short Bend	plate:
	Straight: 105.5mm length
	Standard and short bend: 
	110mm length
	LMT Surgical Pty Ltd
LM064	TriMed Ulnar Osteotomy System	Ulna Osteotomy Plate 	7 Holes 	$964.00
Prostheses List by Category, Groups and Sponsor	Page 327 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LM130	Normed fracture fixation plates	Titanium locking foot plates	8/10/12 holes and 3.5mm 	$964.00
	screw
LM183	Trimed Radiocarpal Fusion Plate	Radiocarpal fusion plate	Short bend, standard bend, 	$964.00
	straight
	Orthopaedic Solutions Pty Ltd
OE045	Merete MetaFix MTP >6 holes	Small Plates, Titanium, >6 holes	39mm & 52mm (Left & Right)	$964.00
	Tornier Pty Ltd
TO141	'Nexfix MTP Fusion System	A bendable stainless steel bone plate 	9 hole	$964.00
	and screw system with unique low 
	profile locking screw option.  
	Indicated for use in primary and 
	revision MTP fusion
	COM, VAL
	Biomet Australia Pty Ltd
BH244	ALPS foot system	periarticular foot, metatarsal and tarsal	small to large	$1,294.00
	 plates
	Integra Neurosciences Pty Ltd
IG119	HALLU-Lock MTP Arthrodesis 	Titanium contoured Hallu-Lock S 	7 holes, sizes 0 to 3, length 	$1,294.00
	System - HALLU-Lock S Plate	plate for revision of Keller osteotomy, 	40 to 55mm
	failed arthroplasty, failed fusion
IG131	TIBIAXYS Distal Tibia System - 	Titanium lateral anterior plate with 8 	3mm thick, 92mm long	$1,294.00
	Ankle Arthrodesis - Lateral anterior	holes; left or right
	 plate
	LMT Surgical Pty Ltd
LM060	BioTech Xpode 4	PEEK curved and round plate	14mm-22mm	$1,294.00
	COM,VAL
	Medartis
EO081	APTUS Foot	TriLock Plates	2.8	$1,294.00
	LK
	Device Technologies Australia Pty Ltd
DE414	Locking Reconstruction Plates	Reconstruction Plate for communited 	7-12 holes	$564.00
	Fibula Shaft Fractures
DE415	Locking Third Tubular Plates	Plate for fracture of the Fibula	7-12 Holes	$564.00
Prostheses List by Category, Groups and Sponsor	Page 328 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE441	Medial Column Plate	Plate for fusion	Small, Medium, Large (Left 	$564.00
	and Right)
	Emergo Asia Pacific Pty Ltd
ER079	DeRoyal Implants - Locking - 	DeRoyal Implants - Plates and Screws	Small (screw size 2.71mm - 	$564.00
	Complex	 - Stainless Steel 316L - Manufactured	4,49mm)(including 
	 in USA	blade)≥7 to ≤ 15holes
ER080	DeRoyal Implants - Locking	DeRoyal Implants - Plates and Screws	Small ( screw size 2.71mm - 	$564.00
	 - Stainless Steel 316L - manufactured 	4.49mm) (including blade)< 
	in USA	6 holes
ER081	DeRoyal Implants	DeRoyal Implants - Plate and screws -	Mini (screw size <2.7mm) 	$564.00
	 Stainless steel 316L - Manufactured 	(Including blade) >7 to <15 
	in USA	holes
ER094	DeRoyal Implants - Locking	DeRoyal Implants - Plates and Screws	Small (screw size 2.71mm - 	$564.00
	 - Stainless Steel 3165L - 	4.49mm)(including 
	Manufactured in USA	blade)>7 to <15 holes LK
	Smith & Nephew Surgical Pty Ltd
SN797	Peri-Loc	Locking 1/3 Tubular & 3.5mm 	≥ 7 to ≤ 15 holes 	$564.00
	Straight Plates
	Stryker Australia Pty Ltd
SK539	Stryker Plating System	Locking Compression Anatomical 	7-14 hole	$564.00
	Shape
SK541	Stryker Plating System	Locking Reconstruction Plates	4.0mm, 7-14 hole	$564.00
SK543	Stryker Plating System	Locking One Third Tubular Plates	3.0mm, 7-14 hole	$564.00
	Surgical Specialties
SQ081	PediLoc-Periarticular Locking 	3.5mm Contour or Bowed Locking 	3.5mm Bowed, 14 hole	$564.00
	Plating System Femur - >7 to >15 	Compression, 8-14 Hole Plate, Left-	3.5mm contour, 8 - 14 Hole 
	holes, screw size 2.71 - 4.49mm	Right	Left-Right
	Synthes Australia Pty Ltd
SY722	AO/ASIF Plates	LCP Plates	7-15 holes	$564.00
	Tornier Pty Ltd
TO106	MaxLock Extreme System - Small 	Small variable angle locking plates, 	> 6 holes	$564.00
	Plates > 6 holes	Titanium, > 6 holes
	Zimmer Pty Ltd
ZI775	Zimmer Universal Locking System	3.5mm One-Third Tubular Locking 	7-10 holes	$564.00
	Plate
Prostheses List by Category, Groups and Sponsor	Page 329 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI784	Zimmer Universal Locking System	3.5mm Universal Locking System 	7 holes - 15 holes	$564.00
	Reconstruction Plates
ZI801	Zimmer Universal Locking System	3.5mm One Third Tubular Locking 	7-15 holes	$564.00
	Plate
ZI809	Zimmer Universal Locking System	3.5mm One Third Tubular Locking 	12-14 holes	$564.00
	Plate
ZI811	Zimmer Universal Locking System	3.5mm Dual Compression Locking 	7 - 14 holes	$564.00
	Plates
	VAL
	Biomet Australia Pty Ltd
BH274	ALPS - Anatomic Locked Plating 	3.5mm Titanium  plates	7 to 15 holes	$894.00
	System
	Integra Neurosciences Pty Ltd
IG115	TIBIAXYS Distal Tibial Osteotomy 	Inverted T-shape medial osteotomy 	8 hole; 70mm	$894.00
	System - Medial osteotomy plate	plate to fit medial malleolus
	Orthotech Pty Ltd
OH451	OsteoMed FPS	Titanium Locking footplates	3.5mm and 4mm	$894.00
	Smith & Nephew Surgical Pty Ltd
SN939	Peri-Loc VLP	VAL/LK 3.5mm 1/3 Tubular Plates	≥7 to ≤15 holes	$894.00
SN980	Peri-Loc	Fibula Plates	≥ 7 to   ≤15 Holes	$894.00
	Wright Medical Australia
WR238	Ortholoc Fracture System - Plates	Universal	8 Hole	$894.00
	VAL, COM
	Integra Neurosciences Pty Ltd
IG114	TIBIAXYS Distal Tibial Osteotomy 	Titanium contoured right and left 	8 hole; Lateral plates 	$1,294.00
	System: Medial right/lateral left 	design plates for wedge osteotomy of 	75.2mm length
	osteotomy plate: lateral right/medial	distal tibia
	 left osteotomy plate
	06.03.03.06 - Small (screw size 2.71mm – 4.49mm)(including blade) ≥ 16 holes
	Emergo Asia Pacific Pty Ltd
ER091	DeRoyal Implants	DeRoyal implants - Plates and Screws	Small ( screw size 2.71mm - 	$801.00
	 - Stainless Steel 316L - Manufactured	4.49 mm) Including blade) 
	 in USA	>16 holes
Prostheses List by Category, Groups and Sponsor	Page 330 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM124	'TriMed Peri-articular plate	TriMed straight plates	16-20 hole	$801.00
	Smith & Nephew Surgical Pty Ltd
SN011	TC-100 &Peri-Loc 	Sterile, 14 - 26 hole	 ≥ 16 holes 	$801.00
	Stryker Australia Pty Ltd
SK550	Stryker Plating System Small 	3.5mm Reconstruction Plate	16-22 hole	$801.00
	Fragment Set
	Synthes Australia Pty Ltd
SY724	AO/ASIF Plates	Non-Locking Fragment Plates	≥16 Holes	$801.00
	Zimmer Pty Ltd
ZI780	ZPS-Zimmer Plate and Screw System	3.5mm Straight Compression Plate	16-18 holes	$801.00
ZI791	ZPS-Zimmer Plate and Screw System	3.5mm Straight Recon Plates	16-22 holes	$801.00
ZI819	Zimmer Universal Locking System	2.7mm Locking Dual Compression 	16 holes	$801.00
	Plate Sterile and Non Sterile
	COM
	Smith & Nephew Surgical Pty Ltd
SN134	TC-100	3.5mm Reconstruction Plates	 ≥ 16 holes 	$1,201.00
SN937	TC-100	3.5mm Curved Reconstruction Plate	≥16 holes	$1,201.00
	Surgical Specialties
SQ082	PediLoc-Plating System   ≥ 16 	3.5mm bowed locking compression 	3.5mm Bowed, 16,18 hole	$1,201.00
	holes, screw size 2.71 – 4.49mm	femur 16,18 hole plate	3.5mm contour 16,18 hole 
	3.5mm contour locking compression 	right
	femur 16,18 hole plate right	3.5mm contour 16,18 hole 
	3.5mm contour locking compression 	left
	femur 16,18 hole plate left
	Synthes Australia Pty Ltd
SY717	AO/ASIF Plates	Non Locking Specialty Plates	≥16 Holes	$1,201.00
	COM, LK
	LMT Surgical Pty Ltd
LM129	Normed fracture fixation plates	Titanium locking foot plates	16 hole	$1,471.00
	Synthes Australia Pty Ltd
SY718	AO/ASIF Plates	Locking Specialty Plate	≥16 Holes	$1,470.00
Prostheses List by Category, Groups and Sponsor	Page 331 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Emergo Asia Pacific Pty Ltd
ER076	DeRoyal Implants - Plate - Locking	DeRoyal Implants - Plates and Screws	Small (screw size 2.71mm - 	$1,070.00
	 - Stianless Steel 316L - Manufactured	4.49mm)(including blade) ≥ 
	 in USA	16 holes
	Smith & Nephew Surgical Pty Ltd
SN798	Peri-Loc	Plates, Stainless Steel, Locking, 	3.5mm, 20 - 22 holes	$1,070.00
	Compression, Lefts and Rights
	Surgical Specialties
SQ083	PediLoc - Anterolateral and Medial 	3.5 mm distal tibial locking 	3.5mm anterolateral left 	$1,070.00
	Distal Tibial Paediatric Locking 	compression plate (narrow/wide; 2-5 	(2,3,4,5, holes)
	holes)	3.5mm anterolateral right 
	(2,3,4,5 holes)
	3.5mm Narrow Left (2,3,4,5, 
	holes)
	3.5mm narrow right (2,3,4,5 
	holes)
	3.5mm wide left (2,3,4,5 
	holes)
	3.5mm wide right (2,3,4,5 
	holes)
	Zimmer Pty Ltd
ZI773	Zimmer Universal Locking System	3.5mm Reconstruction Locking Plate	16-20 holes	$1,070.00
	VAL
	Biomet Australia Pty Ltd
BH307	ALPS Fibula Plating System	Anatomic Fibular Plating System	7 to 15 holes	$1,401.00
	06.03.03.07 - Mini (screw size ≤2.7mm)(including blade) ≤ 6 holes
	Lima Orthopaedics Australia Pty Ltd
LC097	Osteosynthesis Bone Plate - Mini	Osteosynthesis Bone Plate - Mini < 6 	Length 12 - 57 mm x 2 - 6 	$660.00
	hole	hole
LC140	Compression Plate ≤ 6 hole - Mini	Compression Plate ≤ 6 hole - Mini	3-6 Hole Straight Plate x 	$660.00
	1.2mm Thick x Compression 
	1-2mm
	Medartis
EO084	APTUS Hand	Fixation Plates	1.2 - 2.3	$660.00
Prostheses List by Category, Groups and Sponsor	Page 332 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical & Optical Instruments Australia Pty Ltd
MO202	Acumed Bone Plate	MCP Fusion Plate - Titanium	 4 Hole	$660.00
	Smith & Nephew Surgical Pty Ltd
SN073	TC-100 	Mini L Plates & T Plates	 ≤ 6 holes	$660.00
SN083	TC-100	2.0mm T Plates 	≤ 6 holes	$660.00
SN088	TC-100	Semitubular Plates	≤ 6 holes	$660.00
SN116	TC-100  	2.7mm T Plates	≤ 6 holes	$660.00
SN928	TC-100	Quarter Tubular Plates, L/E 6 holes	≤6 holes	$660.00
SN932	TC-100	2.0mm Straight Plates	≤6 holes	$660.00
	Stryker Australia Pty Ltd
ST788	Leibinger Titanium Implant System	Leibinger System, anatomical shap, 	1 - 4 holes	$660.00
	Titanium
	Synthes Australia Pty Ltd
SY736	AO/ASIF Plates	Non-Locking Plates	≤ 6 holes	$660.00
	Zimmer Pty Ltd
ZI222	ZPS Mini Plate System	 1.5 & 2.7mm Epiphysys Plates	2 - 6 Hole	$660.00
ZI863	ZPS - Zimmer Plate & Screw System	2.0mm Straight & Epiphysis Plates	2- 6 holes LEFT AND 	$660.00
	RIGHT
ZI870	Zimmer Plates	Mini SCP Plate	1 - Holes	$660.00
	COM
	Device Technologies Australia Pty Ltd
DE215	Titanium Metatarsal Opening 	Titanium Metatarsal Opening Wedge 	2mm - 8mm	$1,060.00
	Wedge Osteotomy Plate 	Osteotomy Plate with 4 non locking 
	holes and square wedge 
	Lima Orthopaedics Australia Pty Ltd
LC138	Compression Plate Complex ≤ 6 	Compression Plate Complex ≤ 6 hole -	4-6Hole Compression Plate 	$1,060.00
	hole - Mini	 Mini	- 1 to 2 mm thick 
	with/without step
	LMT Surgical Pty Ltd
LM150	Fyxis plate	Foot plate	40-55mm	$1,060.00
	Smith & Nephew Surgical Pty Ltd
SN068	TC 100	Plate: Condylar	1.5mm, 2.0mm &2.7mm	$1,060.00
Prostheses List by Category, Groups and Sponsor	Page 333 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN081	TC 100 2.0mm H-plates	Sterile	One size only	$1,060.00
SN129	TC 100 1.5mm Mini Plates	Stainless steel, Sterile	H-Plates 4 holes	$1,060.00
	Stryker Australia Pty Ltd
SR086	Stryker Locking Plate System	Plates including Locking, Standard 	4-6 hole	$1,060.00
	and Compression
ST786	Leibinger Titanium Implant System	Leibinger Forefoot Reconstruction 	4 holes	$1,060.00
	System, straight plate, Titanium
ST787	Leibinger Titanium Implant System	Leibinger Forefoot Reconstruction 	6 holes	$1,060.00
	System, straight plate, Titanium
	Synthes Australia Pty Ltd
SY747	AO/ASIF Plates	Condylar plates	≤ 6 holes	$1,060.00
	COM LK
	Ortho Solutions Pty Ltd
OU012	MTP Plate	MTP Plate	2.7mm Univeral locking 	$1,330.00
	plate 18mm (2.7ULP), up to 
	24mm 
	Open wedge locking plate 
	4mm (OW) up to 7mm
	Open wedge locking plate 
	0mm
	Open wedge osteotomy 
	plate 4mm to 7.00mm
OU019	Universal - Wedge Locking plate	Universal - Wedge Locking plate	2.7mm universal locking 	$1,330.00
	plate 18,20,22,24mm
	Opening Wedge Locking 
	plate 0,3,4,5,6,7mm
	Openeing Wedge 
	Osteotomy plate 
	Com, LK
	Device Technologies Australia Pty Ltd
DE442	X Plate	Plate for fusion	Small	$1,330.00
	LMT Surgical Pty Ltd
LM127	Normed fracture fixation plates	Titanium locking foot plates	4/6 hole and 2.7mm screws	$1,330.00
	Medical & Optical Instruments Australia Pty Ltd
MO395	RibLoc Rib fracture plating System	RibLoc Plate	46mmL X 8-14mm W	$1,330.00
Prostheses List by Category, Groups and Sponsor	Page 334 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN930	Peri-Loc	2.7mm LK Reconstruction Plates	≤6 holes	$1,330.00
	Tornier Pty Ltd
TO102	Mini MaxLock Extreme System - 	Mini variable angle locking plates, 	≤ 6 holes	$1,330.00
	Mini Plates ≤ 6 holes	Titanium, ≤ 6 holes
	COM, VAL
	LMT Surgical Pty Ltd
LM050	Biotech Easy Lock Osteosystem	Titanium and PEEK	2-10 holes  straight	$1,660.00
LM051	Biotech Easy Lock System	Easy Lock Plating System	Various	$1,660.00
	Medartis
EO060	Aptus Wrist Arthrodesis	STT Fusion Plate	2.0 system	$1,660.00
	Synthes Australia Pty Ltd
SY713	AO/ASIF Plates	LCP, Condylar, Mini Fragment Plates 	≤6 holes	$1,660.00
	- Various
	Wright Medical Australia
WR235	Ortholoc Fracture System - Plates	Straight, T, L Plates	3, 4, and 6 hole	$1,660.00
	COM,LK
	Medical & Optical Instruments Australia Pty Ltd
MO392	RibLoc rib fracture plating system	RidLoc Plate	46-60mm L X 8-14mm W	$1,330.00
	COM,VAL
	Medartis
EO082	APTUS Hand and Foot	TriLock Plates	1.2 - 2.3	$1,660.00
	LK
	Device Technologies Australia Pty Ltd
DE443	Low Profile T-Plate	Plate for fusion	3-6 Holes	$930.00
DE444	Low Profile Straight Plate	Plate for Fusion	4-6 Holes	$930.00
	Emergo Asia Pacific Pty Ltd
ER099	DeRoyal Implants - Plate - Locking	DeRoyal Implants - Plates and Screw -	Mini (screw size 	$930.00
	 Stainless Steel 316L - Mnaufactured 	≤2.7mm)(including blade) ≤ 
	in USA	6 holes
	Synthes Australia Pty Ltd
SY737	AO/ASIF Plates	Locking Plates	≤6 Holes	$930.00
Prostheses List by Category, Groups and Sponsor	Page 335 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR077	Charlotte LisfrancReconstruction 	Stainless steel plate for stabilisation 	4, 6, 5 & 9 hole.	$930.00
	System - Bridge Plate.	of the tarsometatarsal joint.
	Zimmer Pty Ltd
ZI802	Zimmer Universal Locking System	2.7mm One Quarter Tubular Locking 	2-6 holes	$930.00
	Plate
ZI812	Zimmer Universal Locking System	2.7mm Universal Locking System 	2 holes - 6 holes	$930.00
	Reconstruction Plates, Straight - 
	Sterile & Non Sterile
ZI815	Zimmer Universal Locking System	2.7mm Locking One-Quarter Tubular 	2 holes - 6 holes	$930.00
	Plate-Sterile and Non-Sterile
	LK, COM
	Emergo Asia Pacific Pty Ltd
ER066	DeRoyal Implants - Plate - Locking 	DeRoyal Implants - Plates and Screws	Mini (screw 	$1,330.00
	Complex	 - Stainless Steel 316L - manufactured 	size≤2.7mm)(including 
	in USA	blade) ≤ 6 holes LK,COM
	VAL
	Biomet Australia Pty Ltd
BH308	ALPS Fibula Plating System	Anatomic Fibular Locking Plate	16 to 20 holes	$1,260.00
BH355	ALPS Fibula Plating System	Composite Locking Plate	6 holes	$1,260.00
	Integra Neurosciences Pty Ltd
IG118	HALLU-Lock MTP Arthrodesis 	Titanium contoured plate for 1st MTP 	4, 5 or 6 holes; sizes 0 to 3, 	$1,260.00
	System - HALLU-Lock C Plate	arthrodesis, fixation of fractures and 	length 35 to 50mm
	osteotomies
	LMT Surgical Pty Ltd
LM191	Newclip Olecranon Plates ≤6 holes	Plates for the fixation of fractures of 	≤6 holes	$1,260.00
	the elbow
	Orthotech Pty Ltd
OH457	OsteoMed FPS	Titanium locking footplates	2mm and 2.7mm	$1,260.00
OH470	IXOS Radius Plating System	Titanium Right and left plates	23-32mm x 60-95mm	$1,260.00
	Smith & Nephew Surgical Pty Ltd
SN940	Peri-Loc VLP	VAL/LK, 2.7mm Quarter Tubular 	≤6 holes	$1,260.00
	Plates
Prostheses List by Category, Groups and Sponsor	Page 336 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.08 - Mini (screw size ≤2.7mm)(including blade) ≥ 7 to ≤ 15 holes
	Lima Orthopaedics Australia Pty Ltd
LC108	Osteosynthesis Bone Plate - Mini	Osteosynthesis Bone Plate - Mini > 7 	Length 21 - 11mm x 7 - 15 	$402.00
	- 15 hole	hole plate
LC139	Compression Plate Complex ≥ 7 to 	Compression Plate Complex ≥ 7 to 	7-10 Hole Compression 	$402.00
	≤15 hole - Mini	≤15 hole - Mini	Plate from 1 to 2 mm thick 
	with/without step
LC141	Compression Plate ≥ 7 	≤15 Hole - 	Compression Plate ≥ 7 	≤15 Hole - 	8 Hole Straight Plate - a1-	$402.00
	Mini	2mm Thick x 1-2mm 
	Compression path
	Medartis
EO085	APTUS Hand	Fixation Plates	1.2 - 2.3	$402.00
	Smith & Nephew Surgical Pty Ltd
SN087	TC-100	Semi-tubular plates	 ≥ 7 to ≤ 15 holes	$402.00
SN929	TC-100	Quarter Tubular Plates, G/E 7 to L/E 	≥7 to ≤15 holes	$402.00
	15 holes
SN934	TC-100	1.5mm Mini Plates	≥7 to ≤15 holes	$402.00
	Synthes Australia Pty Ltd
SY735	AO/ASIF Plates	Non-Locking Plates	7-15 Holes	$402.00
	Zimmer Pty Ltd
ZI816	Zimmer Universal Locking System	2.7mm Locking One-Quarter Tubular 	7 holes - 15 holes	$402.00
	Plate-Sterile and Non-Sterile
ZI864	ZPS - Zimmer Plate & Screw System	2.0mm Straight & Epiphysis Plates	7 -15 holes	$402.00
ZI871	Zimmer Plates	Mini SCP Plate	7 - 15 Holes	$402.00
	COM
	Stryker Australia Pty Ltd
SR087	Stryker Locking Plate System	Plates including Locking, Standard 	7-13 hole	$802.00
	and Compression
	Synthes Australia Pty Ltd
SY748	AO/ASIF Plates	Condylar plates	≥ 7 to ≤ 15 holes	$802.00
Prostheses List by Category, Groups and Sponsor	Page 337 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	COM, LK
	Biomet Australia Pty Ltd
BH064	Sternalock	Ladder Plate	12 Hole (2 x 6)	$1,072.00
	Medical & Optical Instruments Australia Pty Ltd
MO393	RibLoc rib fracture plating system	RibLoc Plate	61mm-76mm L X8-14mm W	$1,402.00
	Smith & Nephew Surgical Pty Ltd
SN931	Peri-Loc	2.7mm LK Reconstruction Plates	≥7 to ≤15 holes	$1,072.00
	Synthes Australia Pty Ltd
SY253	AO/ASIF Plates	Foot & hand plates - steel - titanium 	1 - 4mm	$1,072.00
	multiple hole
SY620	AO/ASIF Plates	Pre-contoured locking plates	7-15 holes	$1,072.00
	Tornier Pty Ltd
TO103	Mini MaxLock Extreme System - 	Mini Variable angle locking plates, 	> 6 holes	$1,072.00
	Mini Plates > 6 holes	Titanium, > 6 holes
	Com, VAL
	Medartis
EO061	Aptus Wrist Arthrodesis	RSL Fusion Plate	7 to 15 holes	$1,402.00
EO083	APTUS Hand and Foot	TriLock Plates	1.2 - 2.3	$1,402.00
	Orthotech Pty Ltd
OH466	OsteoMed HPS	Low Profile hand plates	1.2/1.6/2.0/2.4mm 4-12 	$1,402.00
	hole; Complex
	Synthes Australia Pty Ltd
SY714	AO/ASIF Plates	LCP, Condylar, Mini Fragment Plates 	7-15 holes	$1,402.00
	- Various
	Wright Medical Australia
WR236	Ortholoc Fracture System - Plates	Straight, T, L Plates	Straight - 7 hole	$1,402.00
	COM,VAL
	Synthes Australia Pty Ltd
SY259	AO/ASIF Plates	Small & Mini Fragment Plates	7-15 Holes	$1,402.00
Prostheses List by Category, Groups and Sponsor	Page 338 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Device Technologies Australia Pty Ltd
DE372	Low Profile MTP Plate	Athrodesis Plate - 6 hole plates	Contoured small 	$672.00
	left,contoured small right, 
	contoured standard 
	right,contoured small 
	straight,
DE373	Low Profile MTP Plate	Arthodesis Plate - 8 Hole plate	8 Hole plate	$672.00
DE454	Low Profile T-Plate	 Plate for fusion	7-9 Holes	$672.00
DE456	Low Profile Straight Plate	Plate for fusion	7-8 Holes	$672.00
	Emergo Asia Pacific Pty Ltd
ER077	DeRoyal Implants - Plate - Locking	DeRoyal Implants - Plates and Screws	Mini (screw size 	$672.00
	 - Stainless Steel 316L - Manufactured	≤2.7mm)(including blade) 
	≥7 to ≤15 holes
	Synthes Australia Pty Ltd
SY624	AO/ASIF Plates	Reconstruction, J, Low Profile	7-14 Holes	$672.00
SY628	AO/ASIF Plates	LCP, Condylar , mini Fragment Plates 	7 - 15 holes	$672.00
	- Various
	Zimmer Pty Ltd
ZI803	Zimmer Universal Locking System	2.7mm Quarter Tubular Locking Plate	7-15 holes	$672.00
ZI813	Zimmer Universal Locking System	2.7mm Universal Locking System 	7 holes - 15 holes	$672.00
	Reconstruction Plates, Straight - 
	Sterile & Non Sterile
	VAL
	Biomet Australia Pty Ltd
BH297	ALPS Hand Fracture System - 	1.0 - 2.5mm titanium hand plates	7 to 25 holes	$1,002.00
	Locking Plate
BH356	ALPS Fibula Plating System	Composite Locking Plate	7 to 14 holes	$1,002.00
	LMT Surgical Pty Ltd
LM192	Newclip Olecranon Plates 7-15 	Plates for the fixation of fractrures of 	7 -15 holes	$1,002.00
	the elbox
LM193	Newclip Distal Humerus Plates 7 - 	Plates for the fixation of fractures of 	7 - 15 holes	$1,002.00
	15 holes	the elbow
Prostheses List by Category, Groups and Sponsor	Page 339 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH456	OsteoMed FPS	Titanium locking footplates	2mm and 2.7mm	$1,002.00
OH465	Osteomed HPS	Low Profile hand plates	1.2/1.6/2.0/2.4mm 4-12 	$1,002.00
	hole; straight, L, T
	Smith & Nephew Surgical Pty Ltd
SN941	Peri-Loc VLP	VAL/LK, 2.7mm Quarter Tubular 	≥7 to ≤15 holes	$1,002.00
	Plates
	Stryker Australia Pty Ltd
SR089	Stryker Locking Plate System	Periarticular Plates, Locking	4-6	$1,002.00
SR090	Stryker Locking Plates System	Locking Plates	7-13	$1,002.00
	06.03.03.09 - Mini (screw size ≤2.7mm)(including blade) ≥ 16 holes
	LMT Surgical Pty Ltd
LM118	TriMed Radial Column Plates	Radial Column Plate	7 hole	$670.00
	Medartis
EO086	APTUS Hand	Fixation Plates	1.2 - 2.3	$670.00
	Smith & Nephew Surgical Pty Ltd
SN933	TC-100	2.0mm Straight Plates	≥16 holes	$670.00
SN935	TC-100	1.5mm Mini Plates	≥16 holes	$670.00
	Synthes Australia Pty Ltd
SY629	'AO/ASIF Plates	Non-locking Plates	≥ 16 holes	$670.00
	Zimmer Pty Ltd
ZI865	ZPS - Zimmer Plate & Screw System	2.0mm Straight & Epiphysis Plates	Over 16 holes	$670.00
	COM, LK
	LMT Surgical Pty Ltd
LM172	NEUMANN Wrist Arthrodesis 	Wrist arthrodesis plate	small and large	$1,340.00
	System - Plate
	Synthes Australia Pty Ltd
SY621	AO/ASIF Plates	Pre-contoured Locking plate	≥ 16 holes	$1,340.00
Prostheses List by Category, Groups and Sponsor	Page 340 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Com, VAL
	Medartis
EO062	Aptus Wrist Arthrodesis	Total Wrist Fusion Plate, Straight, 	>16 holes	$1,670.00
	long bend and short bend
	Stryker Australia Pty Ltd
SR088	Stryker Locking Plate System	Plates including Locking, Standard, 	16 hole	$1,670.00
	and Compression
	LK
	Zimmer Pty Ltd
ZI814	Zimmer Universal Locking System	2.7mm Universal Locking System 	Over 16 holes	$940.00
	Reconstruction Plates, Straight - 
	Sterile & Non Sterile
	VAL
	LMT Surgical Pty Ltd
LM188	Newclip Distal Humerus Plates 16+	Plates for the fixation of fractures of 	16+ holes	$1,270.00
	 hole	the elbow
	Stryker Australia Pty Ltd
SR091	Stryker Locking Plate System	Locking Plates	16 hole	$1,270.00
	06.03.03.10 - Dynamic - Hip ≤ 6 holes
	Austofix
AX056	Tectona Hip Plate	Hip plate, locking with removable 	 135 degree, 3 hole	$328.00
	targeting jig, sterile packed
	Biomet Australia Pty Ltd
BH249	Compression Hip Screw System	Stainless Steel Trochanteric Support 	Small-Large	$328.00
	Plate
BH304	Compression Hip Screw System	Compression hip screw plate, 	2 to 6 holes	$328.00
	stainless steel
	Ortho Solutions Pty Ltd
OU022	CHS Plate	CHS Plate	130/135/140/145/150 	$328.00
	Degree CHS plate 2-6 hole
	Smith & Nephew Surgical Pty Ltd
SN468	Compression Hip Screw System	Ambi Standard Barrel Plates	60mm -80mm, 2-3 slot	$328.00
Prostheses List by Category, Groups and Sponsor	Page 341 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN471	Compression Hip Screw System	Ambi Short Barrel Plates	100mm, 4-5 slot	$328.00
SN473	Compression Hip Screw System	Classic Standard Barrel Plates	60-140mm, 2-3 slot	$328.00
SN476	Compression Hip Screw System	Classic Short Barrel Plates	≤ 6 holes	$328.00
SN488	Intermediate Osteotomy System	Compressing	One size only	$328.00
SN493	Paediatric Osteotomy System	 Paediatric Osteotomy System	 ≤ 6 holes	$328.00
SN912	Intermediate Osteotomy System	Plate (hip screw)	≤6 holes	$328.00
SN924	TC-100	95 Degree Condylar Plates, Small 	≤6 holes	$328.00
	stature
SN926	Compression Hip Screw System	Ambi Standard Barrel Plates	≤6 holes	$328.00
	Zimmer Pty Ltd
ZI768	Zimmer Internal Fixation System: 	Versa Fx II CHS Tube Plates	2-6 holes left and right	$328.00
	Compression Hip Screw
	COM
	Synthes Australia Pty Ltd
SY606	AO/ASIF Plates	DHS Plates	2-6 holes	$528.00
	COM, LK
	Stryker Australia Pty Ltd
SK551	Omega3 Compression Hip Screw 	Omega3 Locking Plate	2-6 hole	$528.00
	System
	Synthes Australia Pty Ltd
SY609	AO/ASIF Plates	DHS Plates	2-6 holes	$528.00
	06.03.03.11 - Dynamic - Hip ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH248	Compression Hip Screw System	Stainless Steel Trochanteric Support 	Small-Large	$695.00
	Plate
BH305	Compression Hip Screw System	Compression hip screw plate, 	7 to 15 holes	$695.00
	stainless steel
	Smith & Nephew Surgical Pty Ltd
SN470	Compression Hip Screw System	Ambi Standard Barrel Plates	260mm+, 12-14 slot	$695.00
SN475	Compression Hip Screw System	Classic Standard Barrel Plates	260mm+, 12-14 slot	$695.00
SN913	Intermediate Osteotomy System	Plate (hip screw)	≥7 to ≤15 holes	$695.00
Prostheses List by Category, Groups and Sponsor	Page 342 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN925	TC-100	95 Degree Condylar Plates, Small 	≥7 to ≤15 holes	$695.00
	stature
SN927	Compression Hip Screw System	Ambi Standard Barrel Plates	≥7 to ≤15 holes	$695.00
	Zimmer Pty Ltd
ZI769	Versa Fx II Compression Hip Screw	Versa Fx II CHS Tube Plates	7-15 holes left and right	$695.00
	COM
	Synthes Australia Pty Ltd
SY607	AO/ASIF Plates	DHS Plates	8-14 holes	$895.00
	COM, LK
	Synthes Australia Pty Ltd
SY610	AO/ASIF Plates	DHS Plates	8-14 holes	$895.00
	LK
	Ortho Solutions Pty Ltd
OU023	CHS Plate	CHS Plate	135 Degree CHS Plate 8 - 	$695.00
	14 hole
	150 Degree CHS Plate 8, 
	10, 12 hole
	Stryker Australia Pty Ltd
SK552	Omega3 Compression Hip Screw 	Omega3 Locking Plate	7-14 hole	$695.00
	System
	06.03.03.12 - Dynamic - Hip ≥ 16 holes
	Biomet Australia Pty Ltd
BH250	Compression Hip Screw System	Stainless Steel Trochanteric Support 	Small-Large	$695.00
	Plate
BH306	Compression Hip Screw System	Compression hip screw plate, 	16 holes	$695.00
	stainless steel
	COM
	Synthes Australia Pty Ltd
SY608	AO/ASIF Plates	DHS Plates	≥ 16 holes	$895.00
	COM, LK
	Synthes Australia Pty Ltd
SY611	AO/ASIF Plates	DHS Plates	≥ 16-20 holes	$895.00
Prostheses List by Category, Groups and Sponsor	Page 343 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.13 - Dynamic - supracondylar ≤ 6 holes
	Smith & Nephew Surgical Pty Ltd
SN922	Compression Hip Screw System	Classic Supracondylar Plate	≤6 holes	$695.00
	Synthes Australia Pty Ltd
SY641	AO/ASIF Plates	DCS DHS plate	≤ 6 holes	$695.00
	Zimmer Pty Ltd
ZI770	Versa Fx II Compression Hip Screw	Versa Fx II CHS Tube Plates	2-6 holes left and right	$695.00
	COM
	Synthes Australia Pty Ltd
SY738	AO/ASIF Plates	Osteotomy, Dynamic Supracondylar 	≤6 holes	$895.00
	Plates
	COM, LK
	Stryker Australia Pty Ltd
SK553	Stryker Compression Hip Screw 	Omega3 Supracondylar Plate	6 hole	$895.00
	System
	06.03.03.14 - Dynamic - supracondylar ≥ 7 to ≤ 15 holes
	Smith & Nephew Surgical Pty Ltd
SN923	Compression Hip Screw System	Classic Supracondylar Plate	≥7 to ≤15 holes	$695.00
	Synthes Australia Pty Ltd
SY642	AO/ASIF Plates	DCS DHS plate	7- 15 holes	$695.00
	Zimmer Pty Ltd
ZI771	Versa Fx II Compression Hip Screw	Versa Fx II CHS Tube Plates	7-15 holes left and right	$695.00
	COM
	Synthes Australia Pty Ltd
SY739	AO/ASIF Plates	Osteotomy, Dynamic Supracondylar 	≥ 7 to ≤ 15 holes	$895.00
	Plates
	COM, LK
	Stryker Australia Pty Ltd
SK554	Stryker Compression Hip Screw 	Omega3 Supracondylar Plate	8-14 hole	$895.00
	System
Prostheses List by Category, Groups and Sponsor	Page 344 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.15 - Dynamic - supracondylar ≥ 16 holes
	Synthes Australia Pty Ltd
SY643	AO/ASIF Plates	DCS DHS plate	≥ 16 Holes	$1,214.00
	COM
	Synthes Australia Pty Ltd
SY740	Ao/ASIF Plates	Osteotomy, Dynamic Supracondylar 	≥16 holes	$1,214.00
	Plates
	06.03.03.16 - Periarticular anatomic - Clavicle/clavicle hook plate ≤ 6 holes
	LK
	Advanced Surgical Design & Manufacture Ltd
AE148	ASDM Clavicle Plating System - 	Clavicle fracture plating system 	6 holes(L&R), 75-91mm 	$1,420.00
	Plates	consisting of anatomic pre-contoured 	long, 9mm wide
	stainless steel locking compression 
	plates and screws (cortical, cancellous
	 & locking)
	Medical & Optical Instruments Australia Pty Ltd
MO371	Acumed Locking Scapula Plate 	Locking Bone Plate, Scapula	≤6 hole	$1,420.00
	System
MO384	Acumed Locking Clavical Plating 	Locking Clavicle Plates Mid Shaft 	≥ 6 holes	$1,420.00
	System	Anterior and Distal
	Smith & Nephew Surgical Pty Ltd
SN914	Peri-Loc	Clavicle plates	≤6 holes	$1,420.00
	Synthes Australia Pty Ltd
SY616	AO/ASIF Plates	LCP Clavicle - superior, anterior, hook	1-6 holes	$1,420.00
SY617	AO/ASIF Plates	Pre-contoured, anatomic rib	1-6 Holes	$1,420.00
	VAL
	Stryker Australia Pty Ltd
HW455	Stryker locked Plating System	Periarticular variable angle locking 	1-6 holes	$1,750.00
	plate - clavicle
Prostheses List by Category, Groups and Sponsor	Page 345 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.17 - Periarticular anatomic - Clavicle/clavicle hook plate ≥ 7 to ≤ 15 holes
	LK
	Advanced Surgical Design & Manufacture Ltd
AE153	ADSM Clavicle Plating System - 	Clavicle fracture plating system 	8-10 holes (L & R), 109-	$1,770.00
	Plates	consisting of anatomic pre-contoured 	133mm long, 10mm wide
	stainless steel locking compression 
	plates and screws (cortical, cancellous
	 & locking)
	LMT Surgical Pty Ltd
LM139	NewClip Clavicle Plate	Locking medial & lateral Clavicle 	1 and 2	$1,770.00
LM184	Trimed Clavicle Fixation Plates	Plates for fixation of fractures of the 	7-15 holes	$1,770.00
	clavicle
	Medical & Optical Instruments Australia Pty Ltd
MO372	Acumed Locking Scapula plate 	Locking Bone Plate, Scapula	≥7 to ≤15 holes	$1,770.00
	System
MO385	Acumed Locking Clavical Plating 	Locking Clavicle Plates Mid Shaft, 	 ≥7 to  ≤15 holes	$1,770.00
	System	Anterior and Distal
	Smith & Nephew Surgical Pty Ltd
SN915	Peri-Loc	Clavicle plates	≥7 to ≤15 holes	$1,770.00
	Synthes Australia Pty Ltd
SY618	AO/ASIF Plates	LCP Clavicle - superior, anterior, hook	7-15 holes	$1,770.00
	VAL
	Stryker Australia Pty Ltd
HW456	Stryker Locked Plate System	Periarticular variable angle locking 	7-15 holes	$2,100.00
	palte - clavicle
	Synthes Australia Pty Ltd
SY619	AO/ASIF Plates	LCP Clavicle - Anterior	7-15 holes	$2,100.00
	Tornier Pty Ltd
TO111	MaxLock Extreme System - Clavicle 	Clavicle Variable angle locking 	9 to 13 holes	$2,100.00
	Plates	plates, Titanium
Prostheses List by Category, Groups and Sponsor	Page 346 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.18 - Periarticular anatomic - Clavicle/clavicle hook plate ≥ 16 holes
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO386	Acumed Locking Clavical Plating 	Lockinh Clavicle Plates Mid Shaft, 	 ≥ 16 holes	$1,420.00
	System	Anterior and Distal.
	06.03.03.19 - Periarticular anatomic - Humerus ≤ 6 holes
	Lifehealthcare Pty Ltd
LH443	I.T.S. Distal Humeral Locking 	Humeral Plates, Distal	4-7 holes, dorsolateral, left 	$1,130.00
	and right; 8-10 holes, 
	medial, left and right (Screw 
	diameter 3.5mm)
	Zimmer Pty Ltd
ZI755	Zimmer Periarticular Plates	3.5 & 4.5mm Periarticular Plates - 	2 - 6 holes Left & Right	$1,130.00
	Humerus
	LK
	Smith & Nephew Surgical Pty Ltd
SN916	Peri-Loc	Humerus Plates	≤6 holes	$1,400.00
	Synthes Australia Pty Ltd
SY680	AO/ASIF Plate	Locking Periarticular Anatomic 	≤ 6 holes	$1,400.00
	Humerus plate
	Zimmer Pty Ltd
ZI837	Zimmer Pty Ltd	3.5mm Pertiarticular Locking Plates - 	2-6 holes left & right	$1,400.00
	Humerus
	VAL
	Medical & Optical Instruments Australia Pty Ltd
MO352	Acumed Tap Loc Elbow plates	Variable angle locking plate system	≤6 holes lateral	$1,730.00
	Zimmer Pty Ltd
ZI743	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	80 - 93mm	$1,730.00
	Humerus - Ti Alloy
Prostheses List by Category, Groups and Sponsor	Page 347 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.20 - Periarticular anatomic - Humerus ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH251	Small/Large Fragment Set	Humeral Titanium Plate	7 to 15 holes	$1,130.00
	LMT Surgical Pty Ltd
LM189	Newclip Distal Humerus Plates - 	Plates for the fixation of fractures of 	7 - 15 holes	$1,130.00
	Periarticular 7-15 holes	the elbow
	Smith & Nephew Surgical Pty Ltd
SN107	TC 100 4.5mm Condylar Buttress 	Sterile,  right, 11 - 15 hole	221 - 285mm	$480.00
	plates
	Zimmer Pty Ltd
ZI756	Zimmer Periarticular Plates	3.5 & 4.5mm Periarticular Plates - 	7 - 15 holes Left & Right	$1,130.00
	Humerus
	LK
	Biomet Australia Pty Ltd
BH140	OptiLock Upper Extremity Plating 	Proximal Humeral Locking 	75mm to 123mm	$1,400.00
	System - Proximal Humeral Plates	Periarticular Plates, Stainless Steel
	KH NXGEN (AUS) Pty Limited
KH014	MonoLoc Humeral Plate	Periarticular Anatomic Humeral Plate	7-15 Hole	$1,400.00
	Lima Orthopaedics Australia Pty Ltd
LC050	DiPhos H Plate	Proximal Humeral 3 hole plate	3 hole	$1,400.00
LC051	DiPhos H Plate	Proximal Humeral 5 hole plate	5 hole	$1,400.00
	Medical & Optical Instruments Australia Pty Ltd
MO243	Polarus Proximal Humeral Plate	Titanium Humeral Plate	  ≥7 to ≤15 holes. 	$1,400.00
	Smith & Nephew Surgical Pty Ltd
SN917	Peri-Loc	Humerus Plates	≥7 to ≤15 holes	$1,400.00
	Stryker Australia Pty Ltd
SK555	Stryker Plating System	Proximal Humerus Anatomical 	11-13 hole	$1,400.00
	Locking Plates
	Synthes Australia Pty Ltd
SY762	AO/ASIF Plate	Locking Perarticular Anatomic 	≥ 7 - ≤ 15 holes	$1,400.00
	Humerus plate
Prostheses List by Category, Groups and Sponsor	Page 348 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI838	Zimmer Periarticular Locking Plates	3.5mm Periarticular locking plates - 	7 - 15 holes Left & Right	$1,400.00
	humerus
	VAL
	Austofix
AX088	Austofix Proximal Humeral Plating 	Anatomic Periarticular Humeral 	3-15 Hole	$1,730.00
	System - Austofix Proximal Humeral 	Variable Angle Locking Plate, 
	Plate
	Biomet Australia Pty Ltd
BH258	HI S3 Shoulder Fixation System	S3 Shoulder Plate	7 to 15 holes	$1,730.00
BH290	ALPS Elbow System	Humeral Titanium Plates	Small - Large, 7 to 15 holes	$1,730.00
	LMT Surgical Pty Ltd
LM138	Newclip Proximal Humerus Plate	Proximal Humerus Plate	1/2/3	$1,730.00
	Medartis
EO078	Aptus Elbow	Distal Humerus Plpates, 	2.8mm	$1,730.00
	Lateral,Middle and Posterolateral
	Medical & Optical Instruments Australia Pty Ltd
MO353	Acumed Tap Loc Elbow plates	Variable angle locking plate system	≥7 to ≤15 holes medial 	$1,730.00
	Stryker Australia Pty Ltd
SK569	Stryker Plating System	Stryker locked plating system	7-15 Holes	$1,730.00
	Synthes Australia Pty Ltd
SY763	AO/ASIF Plate	Locking Perarticular Anatomic 	≥ 7 - ≤ 15 holes	$1,730.00
	Humerus plate
	Tornier Pty Ltd
TO030	Aequalis Humeral Plate	Proximal Humeral Plate, Stainless 	90mm length with 3-holes 	$1,730.00
	Steel, 4 proximal holes, option of 3 or 	shaft and 120mm length 
	5 distal holes (short or long version)	with 5-hole shaft
	Wright Medical Australia
WR225	Evolve Ortholco EPS System - 	Stainless Steel, Polyaxial Locking 	Right & left, 2.7 & 3.5mm	$1,730.00
	Distal Humerus	Plate, Straight, Coronal, Medial, 
	Lateral, Posterolateral
	Zimmer Pty Ltd
ZI744	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	7 - 12 Holes	$1,730.00
	Humerus - Ti Alloy
Prostheses List by Category, Groups and Sponsor	Page 349 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.21 - Periarticular anatomic - Humerus ≥ 16 holes
	LMT Surgical Pty Ltd
LM190	Newclip Disal Humerus Plates - 	Plates for the fixation of fractures of 	7 - 15 holes	$1,130.00
	Perarticular 16+ holes	the elbow
	Zimmer Pty Ltd
ZI757	Zimmer Pty Ltd	3.5 & 4.5mm Periarticular Plates - 	Over 16 holes	$1,130.00
	Humerus
	LK
	Biomet Australia Pty Ltd
BH146	OptiLock Upper Extremity Plating 	Proximal Humeral Locking 	171mm	$1,400.00
	System - Proximal Humeral Plates	Periarticular Plates, Stainless Steel
	Stryker Australia Pty Ltd
SK556	Stryker Plating System	Proximal Humerus Anatomical 	16-27 hole	$1,400.00
	Locking Plates
	Synthes Australia Pty Ltd
SY754	AO/ASIF Plates	Anatomical Locking Humerus Plate	≥ 16 holes	$1,400.00
	Zimmer Pty Ltd
ZI839	Zimmer Periarticular Locking Plates	3.5mm Pericaticular Locking Plates - 	16 - 19 Holes Left & right	$1,400.00
	Humerus
	VAL
	Biomet Australia Pty Ltd
BH259	HI S3 Shoulder Fixation System	S3 Shoulder Plate	16-20 Hole, Left & Right	$1,730.00
	Medartis
EO079	Aptus Elbow	Distal Humerus Plates Posterolateral	2.8mm System	$1,730.00
EO087	Aptus Shoulder (Proximal Humerus 	Proximal Humerus Fixation plates	3.5mm System	$1,730.00
	Plates)
	Medical & Optical Instruments Australia Pty Ltd
MO354	Acumed Tap Loc Elbow plates	Variable angle locking plate system	≥16 holes	$1,730.00
	Stryker Australia Pty Ltd
SK570	Stryker Plating System	Stryker locked plating system	16-17 Hole	$1,730.00
	Synthes Australia Pty Ltd
SY755	AO/ASIF Plates	Anatomical Locking Humerus Plate	≥ 16 holes	$1,730.00
Prostheses List by Category, Groups and Sponsor	Page 350 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR226	Evolve Ortholco EPS System - 	Stainless Steel, Polyaxial Locking 	Right & left, 2.7 & 3.5mm	$1,730.00
	Distal Humerus	Plate, Straight, Coronal, Medial, 
	Lateral, Posterolateral
	Zimmer Pty Ltd
ZI745	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	17 Holes	$1,730.00
	Humerus - Ti Alloy
	06.03.03.22 - Periarticular anatomic - Radius ≤ 6 holes
	Advanced Surgical Design & Manufacture Ltd
AE205	SCS Distal Radius Plate System	Left and Right, Tined	Small and Large 3 hole	$915.00
AE224	rHead Plating System	Comprehensive plating system: four 	Neck Plate: neck width - 15	$915.00
	plate designs; locking & non-locking	 or 18mm, plate width - 6mm,
	 screw options	 length - 23 or 29mm. Rim 
	Plate: neck width 13.6 or 
	16.8mm, plate width 6mm, 
	length 29.75 or 35.75mm. 
	Bone Screws: diameter - 2.4 
	or 2.7mm; length - 8mm - 
	28mm.
	Device Technologies Australia Pty Ltd
DE437	PEEK Distal Radius Plate	Peek Plate for Fracture Fixation	3-5 Hole Plate (Left & right 	$915.00
	side specific)
	LMT Surgical Pty Ltd
LM033	Trimed Wrist Fixation System, Volar	Stainless Steel	Volar Peg Plate 3-hole, 	$915.00
	 Peg Plate	Right & Left, 4 and 5 Peg; 
	Volar Peg Plate 5-hole, 
	Right & Left, 4 and 5 Peg
LM117	TriMed Radial Column Plates	Radial Column Plate	3 & 5 hole	$915.00
	Tornier Pty Ltd
TO119	NexFix MTP Fusion System	A bendable stainless steel bone plate 	Left 2 + 3; Right 2 + 3	$915.00
	and screw system with unique low 
	profile locking screw option.  
	Indicated for use in primary MTP 
Prostheses List by Category, Groups and Sponsor	Page 351 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
TO122	CoverLoc Volar Plate	A stainless steel volar plate system 	'22mm x 3, 4 & 8 hole left & 	$915.00
	intended for fixation of fractures and 	right 25mm x 3 & 4 hole left 
	osteotomies involving the distal 	& right
	radius. The CoverLoc feature is 
	unique and allows both compression 
	and lagging with fixed angle screws.
	Zimmer Pty Ltd
ZI758	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Radius	2 - 6 holes Left & Right	$915.00
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO194	Acumed Congruent Plate System	Elbow plate  titanium, locking radial 	Locking radial head, 3 hole 	$1,185.00
	head	std curve 31mm, 5 hole std 
	curve 46mm, 3 hole curve 
	31mm, 5 hole curve 46mm
MO362	Anatomic Midshaft Forearm Plates	Internal Fixation Plate Anatomic 	≤6 holes	$1,185.00
	Forearm, Radius
MO366	Acu-Loc Distal Radius Plating 	Volar, Dorsal, Distal Ulna, Standard, 	Radius ≤6 holes`	$1,185.00
	Long, Extra long, wide, narrow, left, 
	right, extra-articular plates
	Smith & Nephew Surgical Pty Ltd
SN920	Peri-Loc	Radius Plates	≤6 holes	$1,185.00
	Synthes Australia Pty Ltd
SY675	AO/ASIF Plates	Locking Distal Radius; Ulna Column 	≤ 6 holes	$1,185.00
	Plate System
	Zimmer Pty Ltd
ZI840	Zimmer Periarticular Locking Plates	2.4mm Periarticular Locking Plates - 	2 - 6 holes ledft & Right	$1,185.00
	Radius
	VAL
	Biomet Australia Pty Ltd
BH291	ALPS Elbow System	Radial Titanium Plates	Small – Large, 3 to 6 holes	$1,515.00
	Lima Orthopaedics Australia Pty Ltd
LC094	DiPhos Radial Plate	Diphos 'R' Plate	3-5 Hole	$1,515.00
	LMT Surgical Pty Ltd
LM137	'NewClip Variable Angle Distal 	Distal Radius narrow and wide plates	4 and 6 hole	$1,515.00
	Radius Plate
Prostheses List by Category, Groups and Sponsor	Page 352 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LM140	TriMed Wrist Fixation System	TriMed Volar Bearing Plate	3 and 5 hole	$1,515.00
	Medartis
EO067	Aptus Wrist	2.5 TriLock Distal Radius Small 	2.5mm diameter system	$1,515.00
	Fragment Plates
	Orthotech Pty Ltd
OH472	IXOS Radius Plating System	Straight/L plate R&L	7.5-15mm x 43-52mm	$1,515.00
	Stryker Australia Pty Ltd
SK571	Universal Distal Radius System	SMARTLock Column Locking Plates	4-6 Hole	$1,515.00
	Synthes Australia Pty Ltd
SY676	AO/ASIF Plates	Locking Distal Radius Ulna Column 	5-6 holes	$1,515.00
	Plate System
	06.03.03.23 - Periarticular anatomic - Radius ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH252	Small/Large Fragment Set	Radial Titanium Plate	7 to 15 holes	$915.00
BH255	Distal Radius Fracture Repair 	DNP, titanium radius nail plates	7 to 15 holes	$915.00
BH351	EPAK	Sterile Distal Radius Fracture 	Narrow Mini, Mini, Narrow,	$915.00
	Procedure Pack	 Standard, Medium
	Device Technologies Australia Pty Ltd
DE438	PEEK Distal Radius Plate	Peek Plate for Fracture Fixation	7 Hole Plate (left & right 	$915.00
	side specific)
	Zimmer Pty Ltd
ZI759	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Radius	2 - 6 holes Left & Right	$915.00
	LK
	Austofix
AX041	VRP Distal Radius Fixation System 	Volar Distal Radius Plate - Standard	Standard, 3 and 4 hole, left 	$1,185.00
	Volar Distal Radius Plate - Standard	and right
	LMT Surgical Pty Ltd
LM178	PIDI-KIT System - Plate	Proximal radial head and neck fracture 	Small, medium and large	$1,185.00
	plate
	Medical & Optical Instruments Australia Pty Ltd
MO363	Anatomic Midshaft Forearm Plates	Internal Fixation Plate Anatomic 	≥7 to ≤15 holes	$1,185.00
	Forearm, Radius
Prostheses List by Category, Groups and Sponsor	Page 353 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MO406	Acu-Loc Distal Radius Plating 	Volar, Dorsal, Distal Ulna, Standard, 	>7 - >15	$1,185.00
	Long, Extra long, wide, narrow, left, 
	right, extra-articular plates
	Smith & Nephew Surgical Pty Ltd
SN921	Peri-Loc	Radius Plates	≥7 to ≤15 holes	$1,185.00
	Synthes Australia Pty Ltd
SY677	AO/ASIF Plates	Anatomical Locking Radial Plates	7-15 holes	$1,185.00
	Tornier Pty Ltd
TO097	MaxLock Extreme System - DRLock 	Distal radius variable angle locking 	Short, Short Narrow, 	$1,185.00
	Extreme Distal Radius Plate	plate, Titanium	Standard, Standard Narrow, 
	Right and Left
	Wright Medical Australia
WR048	Evolve Radial Head Plate	Evolve Radial Plate System Stainless 	32mm x 20-26mm in 2mm 	$1,185.00
	Steel	increments, 7 & 8 hole
	Zimmer Pty Ltd
ZI841	Zimmer Periarticular	2.4mm periarticular Locking Plates - 	7 - 15 holes Left and Right	$1,185.00
	Radius
	VAL
	Austofix
AX040	VRP Distal Radius Fixation System,	Volar Distal Radius Plate - Non-	Wide, narrow, long, short 	$1,515.00
	 Volar Distal Radius Plate - Non-	standard	sizes
	standard
	Biomet Australia Pty Ltd
BH253	Distal Radius Fracture Repair 	DVR titanium radius plates	7 to 15 holes	$1,515.00
BH256	Distal Radius Fracture Repair 	Fragment locking plate, titanium	Right, left, straight, Y	$1,515.00
BH352	DVR EPAK	Sterile Distal Radius Fracture 	Wide, Long, Extra Long, 	$1,515.00
	Procedure Pack	Extra Extra Long
Prostheses List by Category, Groups and Sponsor	Page 354 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Integra Neurosciences Pty Ltd
IG122	VIPER with VALT-plate	Distal palmar radius plate	Right & left; 10 or 12 hole 	$1,515.00
	(note that although the 
	description in the Surgical 
	technique is of a 4 or 6 
	holes - this refers only to 
	the proximal end of the 
	plate. The distal end has 6 
	holes - thus the plates have 
	either 6 + 4 = 10 holes or 6 
	+6 = 12 holes
	LMT Surgical Pty Ltd
LM057	Ascension Radial Head Locking 	Titanium pre-formed anatomical radial 	small and large	$1,515.00
	Plate and Screws	head plate
LM141	TriMed Wrist Fixation System	TriMed Volar Bearing Plate	7,9 and 11 Hole	$1,515.00
	Medartis
EO068	APTUS Wrist	2.5 TriLock Distal Radius Plates, 	2.5mm diameter system	$1,515.00
	Adaptive, Volar, Dorsal, Correction, 
	Extra-articular
	Medical & Optical Instruments Australia Pty Ltd
MO407	Acu-Loc Distal Radius Plating 	Volar, Dorsal, Distal Ulna, Standard, 	>7 ->15	$1,515.00
	Long, Extra long, wide, narrow, left, 
	right, extra articular plates
	Orthotech Pty Ltd
OH471	IXOS Radius Plating System	Titanium Right and left plates	23-27mm x 43-52mm	$1,515.00
	Smith & Nephew Surgical Pty Ltd
SL027	D-RAD SMART PACK	D-RAD SMART PACK Plate Kit	Standard, Wide	$1,515.00
	Stryker Australia Pty Ltd
SK572	Universal Distal Radius System	SMARTLock Column Locking Plates	7 hole	$1,515.00
SK573	Universal Distal Radius System	Universal SMARTLock Locking 	9-15 Hole	$1,515.00
SK575	VariAx Plate	Volar Plate, Polyaxial Locking	9-15 Hole	$1,515.00
	Synthes Australia Pty Ltd
SY678	AO/ASIF Plates	Anatomical Variable Angle Locking 	7-15 holes	$1,515.00
	Radial Plates
Prostheses List by Category, Groups and Sponsor	Page 355 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.24 - Periarticular anatomic - Radius ≥ 16 holes
	 LK
	Medical & Optical Instruments Australia Pty Ltd
MO364	Acumed Acu-Loc Radius Plating 	Volar, Dorsal, Distal Ulna, Standard, 	≥16 holes	$1,450.00
	system	Long, Extra long, wide, narrow, left, 
	right, extra-articular plates
	 VAL
	Stryker Australia Pty Ltd
SK576	VariAx Plate	Volar Plate, Polyaxial Locking	16-22 Hole	$1,780.00
	LK
	Synthes Australia Pty Ltd
SY679	AO/ASIF Plates	Anatomical Locking Radial Plates	≥ 16 Holes	$1,450.00
	VAL
	Biomet Australia Pty Ltd
BH254	Distal Radius Fracture Repair 	DVR-A, distal volar radius locking 	16 to 20 holes	$1,780.00
	plate, titanium
	Medartis
EO069	APTUS Wrist	2.5 TriLock Distal Radius Plates, 	2.5mm diameter system	$1,780.00
	Volar, Dorsal, Correction
	Stryker Australia Pty Ltd
SK574	Universal Distal Radius System	Universal SMARTLock Locking 	17 Hole	$1,780.00
	06.03.03.25 - Periarticular anatomic - Ulna ≤ 6 holes
	Lifehealthcare Pty Ltd
LH459	I.T.S. Olecranon Plate	Locking Olecranon Plates	6, 8, 10 and 12-holes (Screw	$915.00
	 diameter: Cancellous 
	4.2mm; Cortical 3.5mm)
	LMT Surgical Pty Ltd
LM119	TriMed Ulna Column Plates	Ulna Column Plate	3 & 5 hole	$915.00
	Medical & Optical Instruments Australia Pty Ltd
MO349	Acumed Tap Loc Elbow plates	Variable angle locking plates	≤6 holes Coronoid	$915.00
Prostheses List by Category, Groups and Sponsor	Page 356 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI760	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Ulna	2 - 6 holes Left & Right	$915.00
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO361	Anatomic Midshaft Forearm Plates	Internal Fixation Plate Anatomic 	≤6 holes	$1,185.00
	Forearm, Ulna
	Smith & Nephew Surgical Pty Ltd
SN918	Peri-Loc	Olecranon Plates	≤6 holes	$1,185.00
	Synthes Australia Pty Ltd
SY743	AO/ASIF Plates	Anatomic Locking Ulna Plates	≤6  Holes	$1,185.00
	Zimmer Pty Ltd
ZI842	Zimmer Periarticular Locking Plates	2.7mm Periarticular Locking Plates - 	2 - 6 Holes Left and Right	$1,185.00
	Ulna
	VAL
	Biomet Australia Pty Ltd
BH292	ALPS Elbow System	Ulna Titanium Plates	Small – Large, 3 to 6 holes	$1,515.00
	Medartis
EO059	Aptus Elbow	Olecranon Tension Plate	Ulna < 6 holes	$1,515.00
	06.03.03.26 - Periarticular anatomic - Ulna ≥ 7 to ≤ 15 holes
	LMT Surgical Pty Ltd
LM120	TriMed Ulna Column Plates	Ulna Column Plate	7 hole	$915.00
	Zimmer Pty Ltd
ZI761	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Ulna	7 - 15 holes Left & Right	$915.00
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO360	Anatomic Midshaft Forearm Plates	Internal Fixation Plate Anatomic 	≥7 to ≤15 holes	$1,185.00
	Forearm, Ulna
	Smith & Nephew Surgical Pty Ltd
SN919	Peri-Loc	Olecranon Plates	≥7 to ≤15 holes	$1,185.00
	Synthes Australia Pty Ltd
SY767	AO/ASIF Plates	Locking Periarticular Ulna Plates	≥7 to ≤15 holes	$1,185.00
Prostheses List by Category, Groups and Sponsor	Page 357 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR221	Evolve Ortholoc EPS System - 	Stainless Steel, Polyaxial Locking 	Right & Left, 2.7 & 3.5mm, 	$1,185.00
	Olecranon Plate	Plate, Olecranon, Right & Left	9-16 holes
	Zimmer Pty Ltd
ZI843	Zimmer Periarticular Locking Plates	2.7mm Periarticular Locking Plates - 	7 - 15 holes Left & Right	$1,185.00
	Ulna
	VAL
	Biomet Australia Pty Ltd
BH293	ALPS Elbow System	Ulna Titanium Plates	Small – Large, 7 to 15 holes	$1,515.00
	Medartis
EO063	Aptus Elbow	Olecranon Plates Right, Left, Straight 	> 7 to < 15 holes	$1,515.00
	and Tension
EO070	APTUS Wrist	2.5 TriLock Y Plate	2.5mm diameter system	$1,515.00
	Medical & Optical Instruments Australia Pty Ltd
MO350	Acumed Tap Loc Elbow plates	Variable angle locking plate system	≥7 to ≤15 holes Olecranon	$1,515.00
	Stryker Australia Pty Ltd
SK499	Stryker Locking Plate system	Variable angle locking plate for 	7-15 Hole	$1,515.00
	olecranon fractures
	Synthes Australia Pty Ltd
SY766	AO/ASIF Plates	Variable Angle Locking Perarticular 	≥7 to ≤15 holes	$1,515.00
	Ulna Plates
	06.03.03.27 - Periarticular anatomic - Ulna ≥ 16 holes
	LK
	Emergo Asia Pacific Pty Ltd
ER084	DeRoyal Implants - Distual Radius 	DeRoyal Implants - Plates and Screws	Periarticular anatomic - 	$1,220.00
	Plate	 - Stainless Steel 316L - Manufactured	Radius ≥7 to ≤15 holes LK
	 in USA
	Synthes Australia Pty Ltd
SY764	AO/ASIF Plates	Anatomic Locking Ulna Plates	≥16 holes	$1,220.00
	Zimmer Pty Ltd
ZI849	Zimmer Periarticular Locking Plates	2.7 mm Periarticular Locking Plates - 	16 holes  left & Right	$1,220.00
	Fibula
Prostheses List by Category, Groups and Sponsor	Page 358 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	VAL
	Medical & Optical Instruments Australia Pty Ltd
MO351	Acumed Tap Loc Elbow plates	Variable angle locking plate system	≥16 holes Olecranon	$1,550.00
	Synthes Australia Pty Ltd
SY765	AO/ASIF Plates	Anatomic Locking Ulna Plates	≥16 holes	$1,550.00
	06.03.03.28 - Periarticular anatomic - Hand-phalangeal
	Advanced Surgical Design & Manufacture Ltd
AE126	Carpal Fusion Compression Plate	316L Stainless Steel Compression 	2 Hole; and 3 Hole Plates	$2,092.00
	Plate, 2 hole and 3 hole
AE206	Diamond Plate/Carpal Button	Carpal Fusion Plate	Large, Small	$2,092.00
	 LK
	Synthes Australia Pty Ltd
SY626	AO/ASIF Plates	Anatomic Locking Hand Plates	2-12 holes	$2,092.00
	VAL
	Biomet Australia Pty Ltd
BH298	ALPS Hand Fracture System - 	1.0 - 2.5mm titanium hand plates	7 to 15 holes	$2,692.00
	Locking Plate
	Medartis
EO071	APTUS Wrist	2.0 Four Corner Fusion Plate	2.0mm diameter system	$2,692.00
	Stryker Australia Pty Ltd
SK038	Leibinger Titanium Implant system	Profyle hand and small fragment plate 	2.3mm system L, compr 10 	$2,692.00
	system	hole T bar
	06.03.03.29 - Periarticular anatomic - Pelvis ≤ 6 holes
	Stryker Australia Pty Ltd
SK577	Stryker Plating System	Matta Pelvic Plates	2-6 Holes	$800.00
	Synthes Australia Pty Ltd
SY725	AO/ASIF Plates	Non-Locking Anatomical Pelvic 	≤6 Holes	$800.00
	Zimmer Pty Ltd
ZI752	ZPS-Zimmer Plate & Screw System	3.5mm curved reconstruction plates	6 Hole	$800.00
Prostheses List by Category, Groups and Sponsor	Page 359 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Synthes Australia Pty Ltd
SY623	AO/ASIF Plates	Anatomical Pelvic Locking Plates	 ≤ 6 Holes	$1,550.00
	06.03.03.30 - Periarticular anatomic - Pelvis ≥ 7 to ≤ 15 holes
	Stryker Australia Pty Ltd
SK578	Stryker Plating System	Matta Pelvic Plates	7-15 Holes	$800.00
	Zimmer Pty Ltd
ZI753	ZPS-Zimmer Plate & Screw System	3.5mm Curved Reconstruction Plates	7 Holes - 15 holes	$800.00
	06.03.03.31 - Periarticular anatomic - Pelvis ≥ 16 holes
	Stryker Australia Pty Ltd
SK579	Stryker Plating System	ocking Compression Anatomical 	16-22 Hole	$800.00
	Synthes Australia Pty Ltd
SY719	AO/ASIF Plates	Anatomical Non Locking Pelvic 	≥16 Holes	$800.00
	Zimmer Pty Ltd
ZI754	ZPS - Zimmer Plate & Screw System	3.5 Curved Reconstruction Plates	Over 16 holes	$800.00
	LK
	Synthes Australia Pty Ltd
SY720	AO/ASIF Plates	Anatomical Locking Pelvic Plates	≥16 holes	$1,270.00
	06.03.03.32 - Periarticular anatomic - Femur ≤ 6 holes
	Stryker Australia Pty Ltd
HW305	Dall Miles Cable Grip System - 	Stainless Steel Plate:5 hole -  	6 inches	$1,200.00
	Stainless Steel	Stainless Steel
	Synthes Australia Pty Ltd
SY682	AO/ASIF Plates	Anatomic Non-Locking Femur Plates	≤ 6 holes	$1,200.00
	Zimmer Pty Ltd
ZI820	Periarticular Plates	Periarticular Femoral Condylar Plates 	2-6 Holes Left and Right	$1,854.00
	- Stainless Steel
Prostheses List by Category, Groups and Sponsor	Page 360 of 1059