06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Smith & Nephew Surgical Pty Ltd
SM180	Peri-Loc	Proximal Femur Plates	< 6 holes	$1,470.00
SN972	Peri-Loc	Distal Femur Plates	 ≤6 holes	$2,214.00
	Synthes Australia Pty Ltd
SY711	AO/ASIF Plates	Anatomic Locking Femur Plates	≤6 holes	$1,470.00
	Zimmer Pty Ltd
ZI844	Zimmer Periarticular Locking Plates	5.5mm Periarticular Locking Plates - 	2 - 6 holes Left & Right	$1,470.00
	Femur
	VAL
	Synthes Australia Pty Ltd
SY712	AO/ASIF Plates	Antomic Locking Femur Plates	≤6 holes	$1,800.00
	Zimmer Pty Ltd
ZI746	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	5 holes Left & Right	$1,800.00
	Femur - Ti Alloy
	06.03.03.33 - Periarticular anatomic - Femur ≥ 7 to ≤ 15 holes
	Device Technologies Australia Pty Ltd
DE078	Osteotomy Plates	Osteotomy, Femoral - Stainless Steel	7.5mm - 17.5 mm	$1,200.00
	Stryker Australia Pty Ltd
HW307	Dall Miles Cable Grip System - 	Stainless Steel Plate:9 hole -  	10 inches	$1,200.00
	Stainless Steel	Stainless Steel
HW308	Dall Miles Cable Grip System - 	Stainless Steel Plate:11 hole -  	12 inches	$1,200.00
	Stainless Steel	Stainless Steel
SK557	Stryker Plating System	Femur Anatomical Locking Plates	12-14 hole	$1,200.00
	Synthes Australia Pty Ltd
SY671	AO/ASIF Plates	Distal Femoral	7-15 holes	$1,854.00
	Zimmer Pty Ltd
ZI821	Periarticular Plates	Periarticular Femoral Condylar Plates 	7 - 15 holes	$1,200.00
	- Stainless Steel
Prostheses List by Category, Groups and Sponsor	Page 361 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Smith & Nephew Surgical Pty Ltd
SM181	Peri-Loc	Proximal Femur Plates	>7 - <15 holes	$1,470.00
SN973	Peri-Loc	Distal Femur Plates	≥7 to  ≤15 holes	$1,470.00
	Synthes Australia Pty Ltd
SY709	AO/ASIF Plates	Anatomic Locking Femur Plates	7-15 holes	$1,470.00
	Zimmer Pty Ltd
ZI749	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	9 holes - 13 holes Left & 	$1,470.00
	Femur - Ti Alloy	Right
ZI845	Zimmer Periarticular Locking Plates	5.5mm Periarticular Plates - Femur	7 - 15 Holes Left & Right	$1,470.00
ZI846	Zimmer Periarticular Locking Plates	5.5mm Periarticular Locking Plates - 	18 - 20 holes Left & Right	$1,470.00
	Femur
	VAL
	Biomet Australia Pty Ltd
BH311	Polyax Plating System	Distal Femoral Locking Plate, Titanium	7-15 holes	$1,800.00
	Synthes Australia Pty Ltd
SY710	AO/ASIF Plates	Anatomic Locking Femur Plates	7-15 Holes	$1,800.00
	Zimmer Pty Ltd
ZI747	NCB Polyaxial Locking Plate System	NCB Periprosthetic Variable Angle 	7 holes - 15 holes Left & 	$1,800.00
	Locking Plate - Femur - Ti Alloy	Right
	06.03.03.34 - Periarticular anatomic - Femur ≥ 16 holes
	Synthes Australia Pty Ltd
SY672	AO/ASIF Plates	Anatomic Non Locking Femur Plates	≥ 16 Holes	$1,854.00
	Zimmer Pty Ltd
ZI822	Periarticular Plates	Periarticular Femoral Condylar Plates 	Over 16 holes Left and Right	$1,854.00
	- Stainless Steel
	LK
	Smith & Nephew Surgical Pty Ltd
SM182	Peri-Loc	Proximal Femur Plates	>16 holes	$2,124.00
SN974	Peri-Loc	Distal Femur Plates	≥ 16 holes	$2,124.00
Prostheses List by Category, Groups and Sponsor	Page 362 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK558	Stryker Plating System	Femur Anatomical Locking Plates	16-24 hole	$2,124.00
	Synthes Australia Pty Ltd
SY768	AO/ASIF Plates	Anatomic Locking Femur Plates	≥16 Holes	$2,124.00
	VAL
	Biomet Australia Pty Ltd
BH312	Polyax Plating System	Distal Femoral Locking Plate, Titanium	16-25 holes	$2,454.00
	Synthes Australia Pty Ltd
SY769	AO/ASIF Plates	Anatomic Locking Femur Plates	≥16 Holes	$2,454.00
	Zimmer Pty Ltd
ZI748	NCB Polyaxial Locking Plate System	NCB Periprosthetic Variable Angle 	Over 16 holes Left & Right	$2,454.00
	Locking Plate - Femur - Ti Alloy
	06.03.03.35 - Periarticular anatomic - Fibula ≤ 6 holes
	LMT Surgical Pty Ltd
LM135	TriMed Hook Plate	TriMed Hook Plate	4 and 6 hole	$1,130.00
	Zimmer Pty Ltd
ZI762	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Fibula	2 - 6 holes Left & Right	$1,130.00
	LK
	Synthes Australia Pty Ltd
SY686	AO/ASIF Plates	Anatomic Locking Fibula	≤ 6 holes	$1,400.00
	Zimmer Pty Ltd
ZI847	Zimmer Periarticular Locking Plates	2.7mm Periarticular Locking Plates - 	2 - 6 Holes Left & Right	$1,400.00
	Fibula
	VAL
	Stryker Australia Pty Ltd
SK580	Stryker Locked Plate system	Periarticular variable angle locking 	5-6 Holes	$1,730.00
	plate - fibula
	Wright Medical Australia
WR240	Ortholoc Fracture System - Plates	Syndesmosis	4 Holes, Right and Left	$1,730.00
Prostheses List by Category, Groups and Sponsor	Page 363 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.36 - Periarticular anatomic - Fibula ≥ 7 to ≤ 15 holes
	LMT Surgical Pty Ltd
LM136	TriMed Hook Plate	TriMed Hook Plate	8 hole	$1,130.00
	Zimmer Pty Ltd
ZI763	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Fibula	7 - 15 holes Left & Right	$1,130.00
	LK
	Device Technologies Australia Pty Ltd
DE421	Locking distal Fibula plate	Locking Distal Fibula Plate For 	4-6 Holes ( Left and Right 	$1,400.00
	Fracture Fixation	Specific)
DE422	Locking Distal Fibula Plate	Locking Distal Fibula Plate for 	8 Hole ( Left and Right 	$1,400.00
	Fracture Fixation	Specific)
	LMT Surgical Pty Ltd
LM054	Argo Malleolar Plate 	Titanium	7-10 Hole	$1,400.00
	Synthes Australia Pty Ltd
SY760	AO/ASIF Plates	LCP Distal Fibula; lateral, 	7 to 15 Holes	$1,400.00
	Posterolateral
	Tornier Pty Ltd
TO101	MaxLock Extreme System - Distal 	Distal Fibula variable angle locking 	Long, Medium, Short, Right	$1,400.00
	Fibula Plate	plate, Titanium	 and Left
	Zimmer Pty Ltd
ZI848	Zimmer Periarticular Locking Plates	2.7 mm Periarticular Locking Plates - 	8 - 14 Holes Left & Right	$1,400.00
	Fibula
	VAL
	Stryker Australia Pty Ltd
SK581	Stryker Locked Plate System	Periartiicular variable angle locking 	7-15 holes	$1,730.00
	plate - fibula
	Synthes Australia Pty Ltd
SY761	AO/ASIF Plates	LCP Lateral Distal Fibula	7 to 15 Holes	$1,730.00
	Wright Medical Australia
WR239	Ortholoc Fracture System - Plates	Lateral Fibula, Posterior Fibula	8-15 Holes, Right and Left	$1,730.00
Prostheses List by Category, Groups and Sponsor	Page 364 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.37 - Periarticular anatomic - Fibula ≥ 16 holes
	Zimmer Pty Ltd
ZI764	Zimmer Periarticular Plates	3.5mm Periarticular Plates - Fibula	16 - 18 holes	$1,130.00
	06.03.03.38 - Periarticular anatomic - Tibia ≤ 6 holes
	Advanced Surgical Design & Manufacture Ltd
AE036	Opening Wedge Tibial Ostectomy 	Titanium	6mm - 20mm	$1,219.00
	Plate
	Biomet Australia Pty Ltd
BH197	Periarticular Plating System	Meta Plate - Titanium	Sm - Lge  3 to 6 Holes	$1,219.00
	Lifehealthcare Pty Ltd
LH445	Hinge Pediatric Plating System - 	Articulated growth-correction 	12mm, 16mm, 20mm 	$1,219.00
	Hinge Plate	fixation plate	(distance between 
	anchoring points)
LH458	I.T.S. Pilon Plate	Locking Pilon Plates	4.6 and 8-holes (Screw 	$1,219.00
	diameter: Cancellous 
	4.2mm; Cortical 4.5mm)
	Smith & Nephew Surgical Pty Ltd
SN570	TC 100 Plate	Cloverleaf Plate	3-4 hole	$1,219.00
SN581	TC-100	Tibia Plates, L:/E 6 Holes	≤ 6 holes	$1,219.00
	Stryker Australia Pty Ltd
SK530	Stryker Plating System.	T-Plate, pre-shaped	5-6 hole	$1,219.00
	Synthes Australia Pty Ltd
SY729	AO/ASIF Plates	Anatomic Tibial Plates	≤ 6 holes	$1,219.00
	Zimmer Pty Ltd
ZI398	High Tibia Osteotomy	High Tibia Osteotomy - Ti alloy	L shaped steel alloy plate;  	$1,219.00
	Standard & Long
ZI765	Zimmer Periarticular Plates	3.5 & 4.5mm Periarticular Plates - 	2 - 6 holes Left & Right	$1,219.00
ZI823	Periarticular Plates	Periarticular Tibial Plateau Plates - 	2 holes - 6 holes Left and 	$1,219.00
	Stainless Steel	Right
Prostheses List by Category, Groups and Sponsor	Page 365 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Synthes Australia Pty Ltd
SY732	AO/ASIF Plates	Anatomic Locking Tibial Plates	≤ 6 Holes	$1,489.00
	Zimmer Pty Ltd
ZI850	Zimmer Periarticular Locking Plates	3.5mm Periarticular Locking Plates - 	2 - 6 holes Left & Right	$1,489.00
	Tibia
	VAL
	Smith & Nephew Surgical Pty Ltd
SN975	Peri-Loc	Tibia Plates	  ≤6 holes	$1,819.00
	Wright Medical Australia
WR233	Ortholoc Ankle Plating	Anterior, Posterior, Lateral or Medial	4-6 holes, Right ad Left, 93-	$1,819.00
	155mm Length
	Zimmer Pty Ltd
ZI750	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	5 holes Left & Right	$1,819.00
	Tibia - Ti Alloy
	06.03.03.39 - Periarticular anatomic - Tibia ≥ 7 to ≤ 15 holes
	Smith & Nephew Surgical Pty Ltd
SN582	TC-100	Tibia Plates	7 to ≤ 15 holes	$974.00
	Stryker Australia Pty Ltd
SK531	Stryker Plating System	T-Plate, pre-shaped	7-13 hole	$974.00
	Synthes Australia Pty Ltd
SY730	AO/ASIF Plates	Anatomic Tibial Plates	7 - 15 Holes	$974.00
	Zimmer Pty Ltd
ZI766	Zimmer Periarticular Plates	3.5 & 4.5mm Periarticular Plates - 	7 - 15 holes Left & Right	$974.00
ZI824	Periarticular Plates	Periarticular Tibial Plateau Plates - 	7 holes - 15 holes, Left and 	$974.00
	Stainless Steel	Right
	LK
	Smith & Nephew Surgical Pty Ltd
SN985	Peri-Loc	Tibia Plates	>7 to <15 holes	$1,244.00
	Stryker Australia Pty Ltd
SK559	Stryker Plating System	Distal Tibia Anatomical Locking 	10-15 hole	$1,244.00
Prostheses List by Category, Groups and Sponsor	Page 366 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SK561	Stryker Plating System	Tibial Anatomical Locking Plates	10-14 hole	$1,244.00
	Synthes Australia Pty Ltd
SY758	AO/ASIF Plates	Anatomic Locking Tibial Plates	7 to 15 Holes	$1,224.00
	Tornier Pty Ltd
TO100	MaxLock Extreme System - Medial 	Medial distal tibia variable angle 	Short, Medium, Long, Left 	$1,244.00
	Distal Tibia Plate	locking plate, Titanium	and Right
	Zimmer Pty Ltd
ZI851	Zimmer Periarticular Locking Plates	3.5mm Periarticular Locking Plates - 	8 - 14 holes Left & Right	$1,244.00
	Tibia
	VAL
	Biomet Australia Pty Ltd
BH287	ALPS Anatomic Locked plating 	Distal and Proximal Tibial Plates, 	7 to 15 holes	$1,574.00
	system	Titanium
BH309	Polyax Plating System	Proximal Tibial Locking Plate, 	7 to 15 holes	$1,574.00
	Titanium
	Smith & Nephew Surgical Pty Ltd
SN986	Peri-Loc	Tibia Plates	>7 to <15 holes	$1,574.00
	Synthes Australia Pty Ltd
SY759	AO/ASIF Plates	Anatomic Variable Angle Locking 	7 to 15 Holes	$1,574.00
	Tibial Plates
SY770	AO/ASIF Plates	Anatomic Variable Angle Locking 	7 - 15 holes	$1,574.00
	Tibial Plates
	Wright Medical Australia
WR234	Ortholoc Fracture System - Plates	Anterolateral Tibia, Medial Tibia 	9, 12 or 13 holes, Right and 	$1,574.00
	Plates or 1/3 Tubular	Left
	Zimmer Pty Ltd
ZI751	NCB Polyaxial Locking Plate System	NCB Variable Angle Locking Plate - 	9 holes - 13 holes Left & 	$1,574.00
	Tibia - Ti Alloy	Right
	06.03.03.40 - Periarticular anatomic - Tibia ≥ 16 holes
	Synthes Australia Pty Ltd
SY731	AO/ASIF Plates	Anatomic Tibial Plates	≥16 holes	$1,219.00
Prostheses List by Category, Groups and Sponsor	Page 367 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI767	Zimmer Periarticular Plates	3.5 & 4.5mm Periarticular Plates - 	16 - 20 holes	$1,219.00
ZI825	Periarticular Plates	Periarticular Tibial Plateau Plates - 	Over 16 holes Left and Right	$1,219.00
	Stainless Steel
	LK
	Smith & Nephew Surgical Pty Ltd
SN976	Peri-Loc	Tibia Plates	 ≥ 16 Holes	$1,489.00
	Stryker Australia Pty Ltd
SK562	Stryker Plating System	Tibial Anatomical Locking Plates	16-30 hole	$1,489.00
	Synthes Australia Pty Ltd
SY756	AO/ASIF Plates	Anatomic Locking Tibial Plates	≥16 Holes	$1,489.00
	VAL
	Biomet Australia Pty Ltd
BH288	ALPS-Anatomic Locked Plating 	Distal and Proximal Tibial Plates, 	16 - 25 holes	$1,819.00
	system	Titanium
BH310	Polyax Plating System	Proximal Tibial Locking Plate, 	16 to 20 holes	$1,819.00
	Titanium
	Stryker Australia Pty Ltd
SK560	Stryker Plating System	Distal Tibia Anatomical Locking 	16-23 hole	$1,819.00
	Synthes Australia Pty Ltd
SY757	AO/ASIF Plates	Anatomic Variable Locking Tibial 	≥16 Holes	$1,819.00
	Plates
SY771	AO/ASIF	Anatomic Variable Angle Locking 	> 16 holes	$1,819.00
	Tibial Plates
	06.03.03.41 - Periarticular anatomic - Calcaneal ≤ 6 holes
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO405	Acumed Locking Calcaneal Plates	Locking Calcaneal Plates	<6 Hole LK	$1,209.00
	06.03.03.42 - Periarticular anatomic - Calcaneal ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BH194	Periarticular Plating System	Plate Calcaneal  - Titanium	Small - Large	$939.00
Prostheses List by Category, Groups and Sponsor	Page 368 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Integra Neurosciences Pty Ltd
IG097	Calcenea Fracture Plate	14 hole titanium plate	Small, Medium, Large	$939.00
	Lima Orthopaedics Australia Pty Ltd
LC110	MTP Calcaneal Plate	MTP Calcaneal Plpate 12 Hole	12 Hole - S/M/L - Left & 	$939.00
	Right
	Smith & Nephew Surgical Pty Ltd
SN569	TC-100 	Calcaneal Plates 	 ≥ 7 to ≤ 15 holes	$939.00
	Stryker Australia Pty Ltd
SK094	Stryker Plating System Small 	Calcaneal Plate	70-80mm	$939.00
	Fragment Set
	Synthes Australia Pty Ltd
SY017	AO/ASIF Plates	Calcaneal Plates	7 - 15 holes	$939.00
	Zimmer Pty Ltd
ZI857	Zimmer Periarticular Plating System	3.5mm Periarticular Plate - Calcaneal	7 holes	$939.00
	 VAL
	Wright Medical Australia
WR231	Calcaneus Plate	Titanium locking plate, Tab & 	14 holes	$1,539.00
	Perimeter
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO404	Acumed Locking Calcaneal Plates	Locking Calcaneal Plates	>7 to >15 holes LK	$1,209.00
	Ortho Solutions Pty Ltd
OU017	Ti Calaneal Locking Plate	Ti Calaneal Locking Plate 3.5	Ti Calaneal Locking Plate 	$1,209.00
	3.5, large
	Ti Calaneal Locking Plate 
	3.5, medium
	Ti Calaneal Locking Plate 
	3.5, small
	Smith & Nephew Surgical Pty Ltd
SN983	Peri-Loc	Calcaneal Plates	>7 to <15 holes	$1,209.00
	Synthes Australia Pty Ltd
SY188	AO/ASIF Plates	Calcaneal, Locking	7 - 15 holes	$1,209.00
Prostheses List by Category, Groups and Sponsor	Page 369 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO096	MaxLock Extreme System - 	Calcaneal variable angle locking 	Standard, Large, Extra 	$1,209.00
	CalcLock Extreme Plate	plate, Titanium	Large, Right and Left
TO148	WAVE Calcaneal Fracture System 	The WAVE Calcaneal Fracture System	Plates:	$1,209.00
	PLATE	 is a low profile, anatomical plate and 	Large Plates (Left or Right):
	screw system designed for the 	 Length = 71mm Width = 
	minimally invasive fixation of 	10-11mm
	calcaneal fractures. The plate and 	Medium Plates (Left or 
	associated locking and non-locking 	Right): Length =  67mm 
	screws facilitate the reconstruction of 	Width = 10-11mm
	the height and width of the calcaneus, 	Small Plates: (Left or 
	and the remodelling of the lateral 	Right): Length = 63mm 
	calcaneal wall. The WAVE calcaneal 	Width = 10-11mm
	Fracture System Plate has 7 screw 
	holes (6 are threaded) and the plates 
	are 2 - 3mm thick and are available in 
	3 sizes. The WAVE Calcaneal Fracture
	 System Plate also has two bending 
	zones for a customised anatomical fit
	VAL
	Biomet Australia Pty Ltd
BH243	ALPS Foot System	Calcaneal foot plate	small to large	$1,539.00
	Medartis
EO056	Aptus Foot	Calcaneus Plates	Left and right plates, small, 	$1,539.00
	medium and large
	Smith & Nephew Surgical Pty Ltd
SN984	Peri-Loc	Calcaneal Plates	>7 to <15 holes	$1,539.00
	Stryker Australia Pty Ltd
SR092	Stryker Locking Plate System	Calcaneus Locking Plates	12 Hole	$1,539.00
	06.03.03.43 - Periarticular anatomic - Calcaneal ≥ 16 holes
	VAL
	Stryker Australia Pty Ltd
SR093	Stryker Locking Plate System	Calcaneus Locking Plates	16 Hole	$1,539.00
	Wright Medical Australia
WR232	Calcaneus Plate	Titanium locking plate, Tab & 	16 & 17 holes	$1,539.00
	Perimeter
Prostheses List by Category, Groups and Sponsor	Page 370 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.44 - Periarticular anatomic - Foot
	Integra Neurosciences Pty Ltd
IG081	Hallu-Fix Plates	Hallu-C and Hallu-S titanium plates 	Length: 40 - 55mm 3 sizes: 	$450.00
	for first MTP arthrodesis 	1, 2, 3 for left or right 
	Medical & Optical Instruments Australia Pty Ltd
MO379	Acumed Congruent Plate System	Foot and Ankle Plate itianium	≤ 6 hole	$450.00
	LK
	Medical & Optical Instruments Australia Pty Ltd
MO380	Acumed Congruent Plate System	Foot and Ankle Plate Titanium	≤ 6 hole	$730.00
MO381	Acumed Congruent Plate system	Foort and Ankle Plate titanium	 ≥7 to ≤15 hole	$730.00
	Wright Medical Australia
WR052	Charlotte MTP Fusion System	MTP plate, stainless steel, SLIM 	Left & right	$730.00
WR065	Rearfoot Plate - RPS	Unique extended plate geometry for 	6 hole - 37mm, 8 hole - 	$730.00
	plating complex rearfoot 	50mm, 14 hole - 66mm
	reconstructions, uses 3.5mm locked 
	screws for optimal bone purchase.
	VAL
	Stryker Australia Pty Ltd
HW459	Memometal Anchorage Bone Plates	Osteosynthesis Bone Plate System	Length 41mm, 51.5mm, 	$1,060.00
	53mm Thickness 1.3mm, 
	1.5mm
	Synthes Australia Pty Ltd
SY715	AO/ASIF Plates	Anatomic Variable Angle Locking 	2-20 Holes	$1,060.00
	Foot Plate
	Wright Medical Australia
WR082	Orloloc Fracture System - Plates	Akin, MTP Plates	Akin - 3 Hole, 17mm; MTP -	$1,060.00
	 4 Hole, 23mm
WR244	Charlotte Claw Locking Plate	Straight, U, T Plates - 2, 3, & 4 Hole	15, 20, 25, 30mm, Sm, Med, 	$1,060.00
	Lge
Prostheses List by Category, Groups and Sponsor	Page 371 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.45 - Periarticular anatomic - Cable plate (hook/grip) ≤ 6 holes
	Biomet Australia Pty Ltd
BI258	BMP Cable System	Dynamic Compression Plate, 3 hole, 	One size only	$670.00
	Stainless Steel
BI259	BMP Cable System	Dynamic Compression Plate, 5 hole, 	One size only	$670.00
	Stainless Steel
	Synthes Australia Pty Ltd
SY378	Trochanteric Reattachment Device	Titanium alloy reattachment device 	Standard and Long	$670.00
	with cables
	Zimmer Pty Ltd
ZI167	Zimmer Internal Fixation Systems: 	Cable-Ready 6 Hole Plate - Stainless 	187mm long	$670.00
	Cable System	Steel
	06.03.03.46 - Periarticular anatomic - Cable plate (hook/grip) ≥ 7 to ≤ 15 holes
	Biomet Australia Pty Ltd
BI260	BMP Cable System	Dynamic Compression Plate, 7 hole, 	One size only	$790.00
	stainless steel
BI261	BMP Cable System	Dynamic Compression Plate, 9 hole, 	One size only	$790.00
	Stainless Steel
	Zimmer Pty Ltd
ZI169	Zimmer Internal Fixation Systems: 	Cable-Ready 10 Hole Plate - Stainless	305mm long	$790.00
	Cable System	 Steel
	06.03.03.48 - Periarticular anatomic - Cable plate with integrated cables - 2 or less, ≤ 6 holes
	Stryker Australia Pty Ltd
SK403	Trochanteric Grip	Trochanteric Grip Plate with 2 cables	Large, 110 - 210mm, 2 -6 	$1,736.00
	holes
	Tornier Pty Ltd
TO099	MaxLock Extreme System - Medial 	Medial malleolous variable angle 	5 holes	$1,736.00
	Malleolous Plate	locking plate, Titanium
	Zimmer Pty Ltd
ZI290	Cable Ready Cable Grip System	Titanium - comes with two cables (Co 	23 x 53mm, 1.8 x 635mm	$1,736.00
	Cr), Integral Crimps
Prostheses List by Category, Groups and Sponsor	Page 372 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.03.49 - Periarticular anatomic - Cable plate with integrated cables - > 2, ≤ 6 holes
	Smith & Nephew Surgical Pty Ltd
SN730	Accord	Orthopaedic Cable System, Titanium 	150-250mm	$2,600.00
	Plate
	Stryker Australia Pty Ltd
HW306	Dall Miles Cable Grip System - 	Stainless Steel Plate:7 hole -  	8 inches	$2,600.00
	Stainless Steel	Stainless Steel
SK402	Trochanteric Grip	Trochanteric Grip Plate with 2 cables	Medium 100 - 200mm, 2 -6 	$2,600.00
	Holes
	Zimmer Pty Ltd
ZI297	Cable Ready Cable Grip System	Titanium	5 hole GTR with 4 cables	$2,600.00
ZI298	Cable Ready Cable Grip System	Titanium	2 hole GTR with 4 cables	$2,600.00
ZI299	Cable Ready Cable Grip System	Titanium	4 hole GTR with 4 cables	$2,600.00
	LK
	Global Orthopaedic Technology
GO197	SuperCable Trochanteric Grips and 	Trochanteric Grips - Titanium	Short 50mm, 2 Hole Plate 	$2,870.00
	Cable Plate System	135mm, 4 Hole Plate 
	190mm, 6 Hole Plate 
	Straight, Right, Left 245mm
06.03.04 - Screws
	06.03.04.01 - Standard ( ≥4.5mm)
	Austofix
AX051	Tectona Hip Plate - Cortical Screw	Cortical Screw, self tapping	4.5mm, lengths 28-46mm	$72.00
AX052	Tectona Hip Plate - Compression 	Comprssion screw, sterile packed	Length 36mm. For 	$72.00
	Screw	compression with Tectona 
	Lag Screw
	B Braun Australia Pty Ltd
BB052	BRAUN AUST Intramedullary 	Compression Screw	4.5mmx64mm-4.5mmx102mm	$72.00
BB056	BRAUN AUST Intramedullary 	Fixation Screws	Dia 4.5mm-6mm,Length 	$72.00
	20mm-96mm
Prostheses List by Category, Groups and Sponsor	Page 373 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB057	BRAUN AUST Intramedullary 	Closure Screws	Length 8mm-10mm	$72.00
BB059	BRAUN AUST Intramedullary 	Huckstep Fine Thread Screw	4.5mmx19mm-4.5mmx57mm	$72.00
BB271	Aesculap Schanz Screw	Stainless steel	All sizes	$72.00
	Biomet Australia Pty Ltd
BH167	Comprehensive Shoulder Screws	Screw, Non-Locking	(4.75 or 6.5)mm x 15-50mm	$72.00
BH200	Small / Large Fragment Set 	Bone Screw	4.5-6.5mm diameter	$72.00
BH271	Polyax Plating System	Non-Locking Screw, Titanium	40-100mm	$72.00
BH283	ALPS Plating System	Non-locking bone screws	4.5 - 6.5mm diameter	$72.00
BH317	Affixus Hip Fracture Nail System	Distal screw	20-80mm	$72.00
BH331	Small / Large  Fragment Set	Bone Screw Titanium	4.5 to 6.5mm diameter	$72.00
BH348	Comprehensive Segmental Revision 	Comprehensive SRS Non-Locking 	One size	$72.00
	System (SRS)	Screw
BI220	Bio-Modular Shoulder System	Glenoid Screw	5mm x (15-40mm)	$72.00
BI262	EBI XFIX Dynafix System	Bone Screw, Cortical, tapered, 	2.4mm to 6.00mm diameter	$110.00
	Cancellous, Stainless Steel
BI829	EBI XFIX Vision System	Screw, Transfixing, Stainless steel	4 - 6mm diameter	$72.00
BI834	EBI XFIX DynaFix System	Screw, VS Osteotomy System, Ti	6mm x (30mm-110mm)	$72.00
	Device Technologies Australia Pty Ltd
DE367	Cancellous Bone Screws	Cancellous Bone Screws	25-50mm x 6.5mm	$72.00
DE423	PEEKPower HTO Plate	Medial High Tibial Osteotomy 	4.5mm Titanium 	$72.00
	Implant Device System	compression Screws
	DJO Australasia Pty Ltd
DD054	Replacement retaining screw for 	Replacement retaining screw for 	6.5mm x 30mm	$72.00
	glenoid head	glenoid head
	Emergo Asia Pacific Pty Ltd
ER097	DeRoyal Internal Fixation Systems -	Screws, Stainless Steel 316L, 	Standard size >=4.5mm	$72.00
	 Bone Screws	manufactured in USA
	Euros Orthopaedics Australia Pty Ltd
EU027	SCULTRA II Reverse Glenoid base 	Shoulder titanium glenoid base screw	Diameters: 4.5 and 6.5 mm; 	$72.00
	screw	Lengths: 15, 20, 25, 30, 35, 
	40 and 45 mm
Prostheses List by Category, Groups and Sponsor	Page 374 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX046	Equinoxe Compression Screw	The compression screw compresses 	4.5x18mm white, 4.5x22mm 	$72.00
	the glenoid plate to the bone while 	black, 4.5x26mm orange, 
	providing 30 degrees of angular 	4.5x30mm blue, 4.5x34mm 
	variability	red, 4.5x38mm green, 
	4.5x42mm yellow, 
	4.5x46mm purple
EX063	Equinoxe Reverse Shoulder, fracture	Locking screw for tray adapter.	One size.	$72.00
	 humeral adapter tray locking screw.
	Global Manufacturing Technology Pty Ltd
GM050	Contile Fin II	Bone Screw	20 to 50mm	$72.00
	Global Orthopaedic Technology
GO199	SuperCable Trochanteric Grips and 	Compression Screws Titanium	4.5mm Diameter 10mm to 50 	$72.00
	Cable Plate System	mm length
	Integra Neurosciences Pty Ltd
IG113	Bone Screws	Titanium screws (2) for use with the 	4.5mm x (15, 20, 25, 30, 	$72.00
	Universal2 Total Wrist System only	35mm)
	KH NXGEN (AUS) Pty Limited
KH013	NeoGen Locking Screw	Locking Screw	4.5 to 5.0mm diamter, 25 to 	$72.00
	110mm length
	Lifehealthcare Pty Ltd
LH444	Hinge Pediatric Plating System - 	2 screws for articulated growth-	4.5 x 35mm, 4.5 x 30mm, 4.5 	$72.00
	Screws	correction fixation plate	x 25mm
	Lima Orthopaedics Australia Pty Ltd
LC106	Supernail / Uninail - Self Tapping 	Supernail / Uninail - Self Tapping 	Diameter 4.5 / 6mm x Length	$72.00
	Bone Screw	Bone Screw	 24 - 100mm
LC128	MCD Non Locking Bone Screw - 	MCD Non Locking Bone Screw - 	4.5 / 6.5mm Dia x 20 -	$72.00
	Standard	Standard	120mm Length Full thread
	Mathys Orthopaedics Pty Ltd
MA539	Affinis Inverse Lag Screw	Metaglene Lag screw	18x4.5mm to 38 x 4.5 mm	$72.00
	Medical & Optical Instruments Australia Pty Ltd
MO005	HBS Bone screw	Compression - standard, high	Length 10 - 30mm	$72.00
MO413	Acumed Screws	Screws	>4.5mm	$72.00
Prostheses List by Category, Groups and Sponsor	Page 375 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO136	MUTARS Cancellous Screws	MUTARS Cancellous Screws	20-40mm	$72.00
	Ortho Solutions Pty Ltd
OU027	Cortical Screw (Ti6AI4V)	Cortical Screw	5.0mm x 20mm up to 5.0mm x	$72.00
	 40mm
OU037	Self Tapping Cortical Screw	Self Tapping Cortical Screw	4.5mm self tapping cortical 	$72.00
	screw 14mm to 95mm
	4.5mm cortical screw 14mm 
	to 140mm
	4.5mm malleloar screw 
	25mm to 70mm
	6.5 cancellous screw 16mm 
	thread 30mm to 150mm
	6.5mm cancellous screw 
	fully threaded 20mm to 
	110mm
	Smith & Nephew Surgical Pty Ltd
SL013	TC-100	Cortical & Cancellous Screws	 ≥4.5mm	$72.00
SL014	Peri-Loc & Peri-Loc VLP	Cortical & Osteopenia Screws	 ≥4.5mm	$72.00
	Stryker Australia Pty Ltd
HW337	Stryker Plating System	Screws Ti or StST	4.5-6.5mm, L12-140mm	$72.00
ST004	Stryker Plating System Screws - 	Titanium or Stainless Steel	10-20mm	$72.00
	Cortical 4.5mm
ST005	Stryker Plating System Screws - 	6.5mm Stainless Steel or Titanium	20-50mm	$72.00
	Cancellous
Prostheses List by Category, Groups and Sponsor	Page 376 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ084	PediNail - Captured Locking 	4.5x16 Cort Screw	4.5mm Cort screws: 4.5mm x 	$72.00
	screws - standard	4.5x18 Cort Screw	16-50mm, in 2mm 
	4.5x20 Cort Screw	increments 4.5mmx50mm-
	4.5x22 Cort Screw	85mm, in 5mm increments
	4.5x24 Cort Screw	4.5mm Cort Recon Screws: 
	4.5x26 Cort Screw	4.5mmx45-100mm, in 5mm 
	4.5x28 Cort Screw	increments
	4.5x30 Cort Screw
	4.5x32 Cort Screw
	4.5x34 Cort Screw
	4.5x36 Cort Screw
	4.5x38 Cort Screw
	4.5x40 Cort Screw
	4.5x42 Cort Screw
	4.5x44 Cort Screw
	4.5x46 Cort Screw
	4.5x48 Cort Screw
	4.5x50 Cort Screw
	4.5x55 Cort Screw
	4.5x60 Cort Screw
	4.5x65 Cort Screw
	4.5x70 Cort Screw
	4.5x75 Cort Screw
	4.5x80 Cort Screw
	4.5x85 Cort Screw
	4.5x45 Cort Recon Screw
	4.5x50 Cort Recon Screw
	4.5x55 Cort Recon Screw
	4.5x60 Cort Recon Screw
	4.5x65 Cort Recon Screw
	4.5x70 Cort Recon Screw
	4.5x75 Cort Recon Screw
	4.5x80 Cort Recon Screw
	4.5x85 Cort Recon Screw
	4.5x90 Cort Recon Screw
	4.5x95 Cort Recon Screw
	4.5x100 Cort Recon Screw
SQ088	PediLoc - 4.5mm Self Tapping 		10mm-60mm, in 2 mm 	$72.00
	Cortical Screws	4.5 mm non locking full thread screw	increments
	60mm-90mm, in 5mm 
	increments
Prostheses List by Category, Groups and Sponsor	Page 377 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY596	AO/ASIF Screws	Cortex,Cancellous, Compression 	≥ 4.5mm	$72.00
	Screws
	Tornier Pty Ltd
TO047	Fixation Screw for Articular Implant	Titanium	D. 4.5mm, L 18 to 45mm	$72.00
	Wright Medical Australia
WR036	Charlotte Carolina Jones Fracture 	Low profile, solid-core, surgical grade	4.5mm, 4.5mm, 6.5mm, 	$72.00
	System	 stainless steel screw, partially 	40mm-70mm overall screw 
	threatded with thread length varying 	lengths
	anthropometrically relative to overall 
	screw length, utilising specialised 
	instruments for IM placement in the 
	5th metatarsal
WR209	Non-Locking Screws	Titanium or Stailess Steel Alloy Non-	20-100mm, 4.5-5.5mm 	$72.00
	Locking Screws	Diameter
	Zimmer Pty Ltd
ZI133	NexGen Knee High Tibial 	Screw - Ti	4.5 - 10 - 80 mm, 6.5 - 10 - 	$72.00
	Osteotomy System	80 mm
ZI149	Periarticular Plates	Periarticular 6.5mm Cancellous 	16mm Thread - 35-90mm 	$72.00
	Screws - Stainless Steel	Long, 32mm Thread - 45-
	90mm Long, Fully Threaded
	 - 25-90mm Long
ZI151	Periarticular Plates	Periarticular 4.5mm Self Tapping 	26 - 90mm	$72.00
	Screws - Stainless Steel
ZI204	Zimmer ECT Screws	4.5mm Cortical Screws	14 - 120mm	$72.00
ZI205	Zimmer ECT Screws	4.5mm Self tapping Cortical Screws	14 - 70mm	$72.00
ZI206	Zimmer ECT Screws	4.5 Malleo Screw	25 - 70mm	$72.00
ZI207	Zimmer ECT Screws	6.5mm Cancellous Screws	25 - 110mm	$72.00
ZI400	Cortical Screws	Screws- Cortical - Ti alloy	4.5/30 to 60mm	$72.00
ZI596	NCB System	NCB Screw Self Tapping	5.00mm x 14-85; 4.00mm x 	$72.00
	14-48,
ZI598	NCB System	NCB Cancellous Screws	4.5mm x 30-65, 5.0mm x 32-	$72.00
	90, 4.5mm x 30-65 C/FT
ZI600	NCB System	NCB Cannulated Screws	14mm to 65mm	$72.00
ZI601	NCBSystem	NCB Cannulated Cancellous Screws	4.5mm x 30-90mm	$72.00
Prostheses List by Category, Groups and Sponsor	Page 378 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI831	NCB Polyaxial Locking System	Variable Angle Locking Screw Cap - 	8mm	$72.00
	Ti Alloy
ZI834	NCB Polyaxial Locking System	NCB Variable Angle Locking Spacer 	1 - 3mm	$72.00
	Pegs
ZI891	NCB System	NCB Screws	14- 100mm	$72.00
	CN
	Biomet Australia Pty Ltd
BH139	Peanut Growth Control Plating 	Cannulated growth contol screws, 	4.5mm Diameter, Length 16, 	$212.00
	System - Screws	titanium alloy	24, 30 and 40mm
BH184	Small / Large  Fragment Set	Cannulated Bone Screw Titanium	4.5 - 8mm	$212.00
BH333	Small / Large Fragment Set	Cannulated Bone Screw	4.5 to 8.0mm diameter	$212.00
	Device Technologies Australia Pty Ltd
DE371	Cannulated Titanium Low Profile 	Cannulated titanium Low Profile 	4.5-6.7mm	$212.00
	Screws, Large	Screws, Large
	Emergo Asia Pacific Pty Ltd
ER085	DeRoyal Internal Fixation System - 	Cannulated Screws Stainless Steel 	Standard size >=4.5mm	$212.00
	Cannulated Bone Screws	316L manufactured in USA
	Johnson & Johnson Medical Pty Ltd
JJ557	DELTA Xtend	Non Locking Canulated Metaglene 	4.5mm	$212.00
	Screw 
	KH NXGEN (AUS) Pty Limited
KH016	KCS Cannulated Screw	Cannulated Screw	4.5 to 7.3mm diameter, 20 to 	$212.00
	120mm length
	Lima Orthopaedics Australia Pty Ltd
LC071	TNP® Cannulated Self drilling 	TNP® Cannulated Self drilling Screw 	Diameter 4.5, 6mm x 20-	$212.00
	Screw with Ultra Flathead	with Ultra Flathead	120mm Length
LC120	Superscrew - Standard	Cannulated Cortical / Cancellous Lag 	Dia. 4.5 / 5.0 / 6.5 / 7.2 mm x	$212.00
	Screw Partial or Full Thread	 25-140mm Length
LC131	MCD Cannulated Bone Screw - 	MCD Cannulated Bone Screw Full or 	4.5 to 6.5mm Dia x 16 - 	$212.00
	Standard	Partial Threaded - Standard	120mm Length
	LMT Surgical Pty Ltd
LM151	Fyxis plate screw	Foot Plate Screw	9-55 mm	$212.00
Prostheses List by Category, Groups and Sponsor	Page 379 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
OU034	Cannulated Screw	Cannulated Screw	cannulated screw 7.0 length	$212.00
	 45, thread length 32mm up 
	to cannulated screw 7.0 
	length 130, thread length 
	32mm and cannulated screw 
	7.0 length 35, thread length 
	16mm up to cannulated 
	screw 7.0 length 130, thread
	 length 16mm
	5.0mm x 30mm up to 100mm 
	titanium cannulated 
	cancellous lag screw
	6.5mm x 20mm ( up to 
	120mm) titanium cann.18mm
	 thread
	8.0mm x 20mm titanuium 
	cann (up to 120mm)18mm 
	thread
	8.0mm x 20mm titanuium 
	cann (up to 120mm)30mm 
	thread
	8.0mm x 45mm titanuium 
	cann (up to 120mm)45mm 
	thread
	Smith & Nephew Surgical Pty Ltd
SL008	Cannulated Screw	Partially & Fully Threaded Titanium	≥4.5mm	$212.00
SL009	Cannulated screws	Partially & Fully Threaded Stainless 	≥4.5mm	$212.00
	Steel
SN631	Cannulated Hip Pins	Rush Nails, Round Bevil Point Hook 	20.3mm - 254mm	$212.00
	Pins
	Stryker Australia Pty Ltd
SK529	Stryker Cannulated Screw System	Asnis III Cannulated screws	5.0-8.0mm	$212.00
	Surgical Specialties
SQ058	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	4.5 x 90mm	$212.00
	copolymer
SQ089	PediPlates - Cannulated Screws	4.5 mm Cannulated Screw	4.5mm x 16-36mm, in 4mm 	$212.00
	increments
Prostheses List by Category, Groups and Sponsor	Page 380 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SQ090	Cannulated Screw System - Large: 	7 mm partially threaded/fully threaded	Fully Threaded: 30mm-	$212.00
	7.0mm Stainless Steel	 cannulated screw	120mm, in 5 mm increments
	
	32mm Threaded: 50-120 in 
	5mm increments
	16mm Threaded: 30mm-
	Surgiplas Medical
SP029	OsteoMed Plating & Fixation System	Plates - Fracture; Screws - Cannulated	6 Hole Fracture Plate 47 - 	$212.00
	 Lag	52mm; 2 x 2 Hole Angled 
	Fracture Plate; 3 x 3 Hole 
	Angled Fracture Plate; 
	6.5mm x (30 -150)mm; 
	7.3mm x (30 - 150)mm
	Synthes Australia Pty Ltd
SY630	AO/ASIF Screws	Cannulated Full, Partial Thread screw	≥4.50mm	$212.00
	Tornier Pty Ltd
TO114	MaxTorque Cannulated Screw 	Bone screws, Titanium, Cannulated, 	Ø5.5mm Short Thread, 	$212.00
	System - Standard screws	Short or Long Thread	Length 26-70mm
	Ø5.5mm Long Thread, 
	Length 45-70mm
	Ø7.0mm Short thread, 
	Length 40-130mm
	Ø7.0mm long Thread, 
	Length 45-130mm
	Wright Medical Australia
WR248	Darco Headed Compression Screw 	Cannulated titanium compression 	4.5mm x 8-60mm; 6.5mm x 	$212.00
	System 4.5, 6.5, 7.5	screws	35-120mm; 7.5mm x 35-
	120mm
	Zimmer Pty Ltd
ZI176	Zimmer Internal Fixation Systems: 	Magna-FX - Stainless Steel	16 mm Thread - 30-30 mm; 	$212.00
	Cannulated Screw	32 mm Thread - 40-120 mm; 
	Fully Threaded - 30-130 mm
	 Long
ZI448	Cannulated Screw	Ti alloy	One size only	$212.00
ZI836	NCB Polyaxial Locking System	4.5mm Cannulated Variable Angle 	14 - 100mm	$212.00
	Locking Screws - Ti Alloy
Prostheses List by Category, Groups and Sponsor	Page 381 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI872	Zimmer Cannulated Screw System	7.0mm Cannulated Screw 32mm 	7.0mm Cannulated Screw 	$212.00
	Thread	32mm Thread. L=140
	7.0mm Cannulated Screw 
	Full Thread. L=140
	7.0mm Cannulated Screw 
	32mm Thread. L=145
	7.0mm Cannulated Screw 
	Full Thread. L=145
	7.0mm Cannulated Screw 
	32mm Thread. L=150
	7.0mm Cannulated Screw 
	Full Thread. L=150
	7.0mm Cannulated Screw 
	32mm Thread. L=155
	7.0mm Cannulated Screw 
	Full Thread. L=155
	7.0mm Cannulated Screw 
	32mm Thread. L=160
	7.0mm Cannulated Screw 
	Full Thread. L=160
	7.0mm Cannulated Screw 
	32mm Thread. L=165
	7.0mm Cannulated Screw 
	Full Thread. L=165
	7.0mm Cannulated Screw 
	32mm Thread. L=170
	7.0mm Cannulated Screw 
	Full Thread. L=170
	7.0mm Cannulated Screw 
	32mm Thread. L=175
	7.0mm Cannulated Screw 
	Full Thread. L=175
	7.0mm Cannulated Screw 
	32mm Thread. L=180
	7.0mm Cannulated Screw 
	Full Thread. L=180
	CN, DT
	Lima Orthopaedics Australia Pty Ltd
LC068	DTS - DOUBLE THREADED 	DTS - DOUBLE THREADED - SELF	Diameter 4.5 and 6.5mm x 	$402.00
	CANNULATED SCREW	 TAPPING OR SELF DRILLING 	Length 30 to 100mm
	CANNULATED SCREW
Prostheses List by Category, Groups and Sponsor	Page 382 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LC122	Versa Screw	Self Drilling self tapping Cannulated 	6.5 to 8mm Dia x 40 to 	$402.00
	Compression Screw	120mm length
	LMT Surgical Pty Ltd
LM142	Extremity Medical Compression 	Compression Screws	6.5mm	$402.00
	Screw System
LM152	Unima Screw	Foot Screw 7.2	7.2 x 50 - 120mm	$402.00
LM153	Unima Screw	Foot Screw 4.5	4.5 x 30 - 50mm	$402.00
	Medical & Optical Instruments Australia Pty Ltd
MO357	Acutrak 2	Headless compression screw	>4.5mm	$402.00
MO383	Acumed Headless Compression Screw	Acutrak 6/7 screw, Acutrak Plus	>4.5mm	$402.00
	Synthes Australia Pty Ltd
SY645	AO/ASIF Screws	HCS Countersinkable Compression 	4.5mm-6.5mm	$402.00
	Screw
	Tornier Pty Ltd
TO123	NexFix 4.5MM Compression Screw	The NexFix Compression Screw is a 	4.5mm diameter x 14-40mm 	$402.00
	stainless steel, cannulated, self 	in 2mm increments, 40-
	tapping, and self drilling fixation 	65mm in 5mm increments, 
	device for osteotomies, fusions and 	with short and long thread 
	fracture fixation of small bones	options
TO126	NexFix 6.5mm Compression Screw	The NexFix Compression Screw is a 	6.5mm diameter x 40-120mm 	$402.00
	stainless steel, cannulated, self 	in 5mm increments with 
	tapping, and self drilling fixation 	short and long thread 
	device for osteotomies, fusions and 	options
	fracture fixation of small bones
	Wright Medical Australia
WR033	Cannulated Screw	Multi use compression screw, 	6.5mm& 7.0mm dia, 40-	$402.00
	cannulated, stainless steel or titanium	110mm lengths in 5mm 
	increments
	Zimmer Pty Ltd
ZI180	Zimmer Large Herbert Bone Screw	4.5mm Cannulated Double Threaded 	30 - 70mm	$402.00
	Compression Bone Screw - Ti Alloy
ZI181	Zimmer Large Herbert Bone Screw	6.5mm Cannulated Double Threaded 	25 mm - 100mm	$402.00
	Compression Bone Screw - Ti Alloy
Prostheses List by Category, Groups and Sponsor	Page 383 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	CN, LK
	Advanced Surgical Design & Manufacture Ltd
AE208	 Total Wrist Implant System	Carpal Screws	15, 18, 22, 26, 30mm	$282.00
	Johnson & Johnson Medical Pty Ltd
JJ558	DELTA Xtend	Locking Metaglene Screw Dia 4.5	4.5mm; 24, 30, 36, 42, 48	$282.00
	Smith & Nephew Surgical Pty Ltd
SN769	Peri-Loc	Locking Cannulated Screws	≥4.5mm	$282.00
	Stryker Australia Pty Ltd
SK564	Stryker Plating System	SPS Locking Plate System	Locking Screws - 5mm	$282.00
	Tornier Pty Ltd
TO051	Aequalis Humeral Nail Screws	Screws for Aequalis Humeral Head. 	Proximal Screws length: 	$282.00
	Cannulated Proximal screws: 5mm 	From 36 to 60 every 4mm 
	Diameter cannulated Ti, PE insert 	Distal Screws length: From 
	with thread inside. Distal screws 	20 to 32 every 2mm
	4.5mm Diameter, Ti.
	CN, LK, DT
	Synthes Australia Pty Ltd
SY632	AO/ASIF Screws	Cannulated Screws	≥4.50mm	$472.00
	CN,DT
	Orthopaedic Solutions Pty Ltd
OE046	Merete - Cannulated HCS (headless 	Bone screws, Titanium, Cannulated 	Diameter + 6.5mm, length 	$402.00
	Compression Screws) 6.5mm	Compression	40-120mm (in 5mm 
	increments)
	CN,LK
	Biomet Australia Pty Ltd
BH269	Polyax Plating system	Cannulated Locking Screw, Titanium	4.5 to 8.0mm diameter	$282.00
	Synthes Australia Pty Ltd
SY631	AO/ASIF Screws	Cannulated Locking Screws	≥4.50mm	$282.00
	DT
	Biomet Australia Pty Ltd
BH246	Rockwood Clavical Pin	Clavical Pin with dual thread	4.5mm	$262.00
Prostheses List by Category, Groups and Sponsor	Page 384 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lima Orthopaedics Australia Pty Ltd
LC075	F.T.S. BIOCOMPONENT 	F.T.S. BIOCOMPONENT 	Screw Dia 4.5 / 6mm x L 30-	$262.00
	Compression Screw and Washer	Compression Screw and/or Washer	120mm / Washer Dia 13-
	19mm
	Tornier Pty Ltd
TO143	611 Ankle Fusion Nail -Component	The 611 ankle arthrodesis nail, self 	5mm x100mm, 5mmx95mm, 	$262.00
	 : LOCKING SCREWS	locking screws are made out of 	5mmx90mm, 5mmx85mm, 
	titanium alloy (Ti6AI4V) and 	5mmx80mm, 5mmx75mm, 
	incorporate a unique anti-backout 	5mmx70mm, 5mmx65mm, 
	design feature to ensure optimal 	5mmx60mm, 5mmx55mm, 
	5mmx50mm, 5mmx45mm, 
	5mmx40mm, 5mmx35mm, 
	5mmx32mm, 5mmx29mm, 
	5mmx26mm, 5mmx23mm, 
	5mmx20mm
	DT, CN
	Advanced Surgical Design & Manufacture Ltd
AE250	FusiFIX™	Triple thread, compression, 	6mm	$402.00
	cannulated screw system
	Synthes Australia Pty Ltd
SY691	Midfoot Fusion Bolt	Solid intramedullary arthodesis 	6.5mm diameter; 50-160mm 	$402.00
	Length
	DT, LK
	Johnson & Johnson Medical Pty Ltd
DY572	Delta Shoulder system	Metaglene Screw Stainless Steel	4.5mm	$332.00
	LK
	Austofix
AX053	Tectona Hip Plate - Locking Screw	Locking screw, self tapping	5.0mm, lengths 28-46mm	$142.00
	B Braun Australia Pty Ltd
BB303	Position HTO Implant System - 	Titanium cancellous and cortical 	30mm-78mm x 4.5mm & 	$142.00
	Locking Screws	screw, locking head for solid plate 	6.0mm diameter.
	Biomet Australia Pty Ltd
BH166	Comprehensive Shoulder Screws	Screw, Locking, Ti	4.75 dia x (15-30)mm	$142.00
BH268	Polyax Plating System	Titanium Locking Screw	4.5-5.5mm	$142.00
BH284	ALPS Plating System	Locking screws	4.5 to 6.5mm diameter	$142.00
Prostheses List by Category, Groups and Sponsor	Page 385 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BH347	Comprehensive Segmental Revision 	Comprehensive SRS Locking Screw	One size	$142.00
	System (SRS)
	Device Technologies Australia Pty Ltd
DE343	PEEKPower HTO Plate	Medial High Tibial Osteotomy 	5.0mm	$142.00
	Implant Device System
DE344	iBalance HTO System	PEEK Screws for iBalance HTO 	4.5mm Cortical and 6.5mm 	$142.00
	Implant	Cancellous
DE369	Titanium Locking Cortical and 	Titanium Locking Cortical and 	4.5-6.5mm	$142.00
	Cancellous Screws, Large	Cancellous Screws, Large
	DJO Australasia Pty Ltd
DD056	Glenoid Baseplate Locking Bone 	Glenoid Baseplate Locking Bone 	5.0mm diameter, length 14-	$142.00
	Screws	Screws	38mm in 4mm increments
	Emergo Asia Pacific Pty Ltd
ER096	DeRoyal Implants-Internal Fixation 	Stainless Steel 316L locking screws 	Standard size >=4.5mm	$142.00
	-  Screws	manufactured in USA
	Exactech Australia
EX047	Equinoxe Glenosphere Locking 	The Locking Screw locks 	one size	$142.00
	compression screws to the glenoid 
	plate at a variable angle
	Global Orthopaedic Technology
GO198	SuperCable Trochanteric Grips and 	Locking Screw Titanium	5.0mm diameter 10mm to 	$142.00
	Cable Plate System	50mm length
	KH NXGEN (AUS) Pty Limited
KH015	MonoLoc Locking Screw	Locking Screw	3.5mm diameter, 10 to 80mm 	$142.00
	length
	Mathys Orthopaedics Pty Ltd
MA530	Affinis Inverse locking screw	Locking Metaglene screw	24x4.0mm to 48x4.0mm	$142.00
	Medical & Optical Instruments Australia Pty Ltd
MO414	Acumed Screws	Locking Screws	>4.5mm	$142.00
	PurePlay Orthopaedics
PJ003	FlexiSystem, Flexit Cortical and 	Cortical and Cancellous locking Duel	30,35,40,45,50,55,60,6,70,7	$142.00
	Cancellous locking screws and duel	 threaded screws	5mm
	 threaded screws
Prostheses List by Category, Groups and Sponsor	Page 386 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN768	Peri-Loc	Fixation Device, Internal, Locking, 	4.5mm -5.0mm	$142.00
	Stainless Steel, Cortical & Cancellous
	 Screw
SN890	PROMOS Reverse Modular 	Glenoid Bone Screw	6/20mm 6/25mm, 6/30mm,  	$142.00
	Shoulder System	6/35mm,  6/40mm
	Stryker Australia Pty Ltd
HW531	Stryker Plating System	Locking Screw	5.0mm	$142.00
	Surgical Specialties
SQ091	PediLoc - 4.5 Self-tapping, Locking	4.5 mm locking full thread screw	10mm-60mm, in 2mm 	$142.00
	 Cortical Screws	increments
	60mm-90m, in 5mm 
	increments
	Synthes Australia Pty Ltd
SY653	AO/ASIF Screws	Locking Screws	≥ 4.5mm	$142.00
SY693	Dynamic Locking Screw	Pin-sleeve locking screw	5.0mm	$142.00
	Tornier Pty Ltd
TO046	Aequalis Reversed Shoulder - 	Titanium	D45mm, L20 to 50mm	$142.00
	Fixation Screw for Articular Implant
	Wright Medical Australia
WR074	Locking Screws	Stainless Steel or Titanium Locking 	4.5-5.5mm diameter, 8 - 	$142.00
	Screws	100m length
	Zimmer Pty Ltd
ZI534	Zimmer Trabecular Metal Reverse 	Inverse/Reverse Screw 4.5mm	18mm, 24mm, 27mm, 30mm, 	$142.00
	Shoulder System	33mm, 36mm, 42mm, 48mm
ZI548	Zimmer Universal Locking System	2.7mm Universal Locking Screw	Length:8mm; 10mm; 12mm; 	$142.00
	14mm; 16mm; 18mm; 20mm; 
	22mm; 24mm; 26mm; 28mm; 
	30mm; 32mm; 34mm; 36mm; 
	38mm; 40mm; 42mm; 44mm; 
	46mm; 48mm; 50mm; 55mm; 
	60mm
Prostheses List by Category, Groups and Sponsor	Page 387 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK, DT, CN
	LMT Surgical Pty Ltd
LM134	TriMed Compression Screws	Compression Screws	4.5-7.5mm	$472.00
	06.03.04.02 - Small (2.71mm – 4.49mm)
	Advanced Surgical Design & Manufacture Ltd
AE154	ASDM Clavicle Plating System - 	Fixation Device, Internal, Non-	3.5mm Low-profile Cortex 	$91.00
	Screws	locking, Stainless Steel, Cortical 	Screws, 10-30mm (2mm 
	Screw Size: 3.5mm & Cancellous 	increments)
	Screw sizes 4.0mm	4.0mm Low-profile Cortex 
	Screws, 10-30mm (2mm 
	increments)
AE235	Stability Sigmoid Notch Total 	The Sigmoid Notch Radial Screw is a 	The Sigmoid Notch screw is	$91.00
	DRUJ System / Sigmoid Notch 	low profile self tapping cortical screw 	 available in 2mm 
	made of implantable CoCr.  It is 	increments from 18mm - 
	designed to be placed bi cortical in 	32mm and has a diameter of 
	the radius and is introduced into the 
	Radial stem thru a hole.  It is placed 
	into the stem and tightened down
AE247	Sbi Non-Locking Screws	Titanium Cortical Non-Locking Self 	2.7mm Cortical, Non 	$91.00
	tapping screws	Locking, Self-tapping 10 -
	30mm
	2.7mm Lag, Non Locking, 
	self tapping 10 -30mm
	3.5mm Cortical, Non 
	Locking,Self tapping 8 -
	20mm
	Austofix
AX042	VRP Distal Radius Fixation System,	3.5mm Cortical Screw, Titanium	3.5mm diameter, 10mm-	$91.00
	 3.5mm Cortical Screw, Titanium	20mm lengths
AX087	Austofix Proximal Humeral Plating 	Cortical Screw, Titanium	3.5mm, 20-40mm	$91.00
	System - Austofix Cortical Screw
AX090	Austofix Proximal Humeral Plating 	Cancellous Screw, Titanium	4mm 20-40mm	$91.00
	System - Austofix PHP Cancellous 
	Screw
	Biomet Australia Pty Ltd
BH142	OptiLock Upper Extremity Plating 	Non-Locking Screws, Stainless Steel	3.5mm diameter, 10-60mm 	$91.00
	System - Non-Locking Screws	length (2mm increments)
Prostheses List by Category, Groups and Sponsor	Page 388 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BH185	Small / Large  Fragment Set	Bone Screw, Titanium	3.5 - 4.0mm diameter	$91.00
BH257	Distal Radius Fracture Repair 	Non-locking bone screw	3.5mm diameter	$91.00
BH260	HI S3 Shoulder Fixation System	Peg, Standard Stainless Steel	4mm	$91.00
BH262	HI S3 Shoulder Fixation System	Bone screw	3.8 to 4.0mm	$91.00
BH275	ALPS Plating System	Non locking Bone Screws	3.0-4.0mm	$91.00
	Device Technologies Australia Pty Ltd
DE366	Low Profile Cancellous Bone Screws	Low Profile Cancellous Bone Screws	4mm	$91.00
DE407	Non-Locking Cortical and 	Non-Locking Cortical and 	3-3.5mm	$91.00
	Cancellous Screws, Small	Cancellous Screws, Small
	DJO Australasia Pty Ltd
DD055	Glenoid Baseplate Non Locking 	Glenoid Baseplate Non Locking 	3.5mm diameter, length 14-	$91.00
	Bone Screw	Bone Screw	34mm in 2mm increments
	Emergo Asia Pacific Pty Ltd
ER098	DeRoyal Internal Fixation System - 	Screws, Stainless Steel 316L, 	Small(2.71 - 4.49mm)	$91.00
	screws	manufactured in USA
	Global Manufacturing Technology Pty Ltd
GM109	OsteoBridge	OsteoBridge Interlocking Screw	18m to 56mm	$91.00
	Integra Neurosciences Pty Ltd
IG063	Tibiaxys Distal tibia system	Titanium screw for use with Tibiaxys 	4mm diameter with 6mm 	$91.00
	distal tibia system	head; 40mm - 100mm length
IG066	Integra Total Wrist Fusion System	Cortical Screw for use with the Integra	3.5mm diameter: 10-32mm 	$91.00
	 Total Wrist Fusion Plates	length
IG080	Hintegra Total Ankle Prosthesis	Cortical fixation screw, Composition -	Length 12 - 42mm	$91.00
	 Stainless Steel
IG099	Calcanea Variable Angle Screw	Cortical Screw, Titanium	Diameter 3.5mm, Length 	$91.00
	20mm to 45mm
IG124	VIPER with VALT - cortical screws	Cortical screw for fixation	Diameter 3.5mm, length 10-	$91.00
	18mm
IG130	Spider Limited Wrist Fusion System	Stainless steel screws for Spider Plate	Diameter 2.8mm, length 10-	$91.00
	 - 2.8mm bone screws	18mm
	Lifehealthcare Pty Ltd
LH323	ITS Cancellous Screws	Cancellous Screws	D=3.5mm & 4.2mm,  Length 	$91.00
	= 14mm - 60mm (with 
	incremental of 2)
Prostheses List by Category, Groups and Sponsor	Page 389 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LH324	ITS Cortical Screws	Cortical Screws	D=3.5mm & 4.2, 4.5mm, 	$91.00
	Length =14mm - 60 mm 
	(with incremental of 2)
	Lima Orthopaedics Australia Pty Ltd
LC052	Bone Screw	Bone Screw self tapping cortical	Diameter 3.5mm length 20-	$91.00
	100mm
LC091	Diphos Plate - Spherical Head 	Spherical Head Screw - Small	Diameter 3.5mm x 8-26mm 	$91.00
	Screw - Small	length
LC101	Osteosynthesis Bone Screws 	Osteosynthesis Bone Screws 	Dia 3.5mm x 10-120mm 	$91.00
	Cancellous - Small	Cancellous - Mini	length
LC102	Osteosynthesis Bone Screw 	Osteosynthesis Bone Screw Cortical -	Dia 3.5mm x 10-120mm 	$91.00
	Cortical - Small	 Small	length
LC127	MCD non Locking Bone screw - 	MCD NON Locking Bone Screw 	3 to 4mm Dia x 08 - 60mm 	$91.00
	Small	Length partial or Full 
	LMT Surgical Pty Ltd
LM075	Surgicraft Bone Screws	Surgicraft Bone Screws	2-4mm diameter/10-40mm 	$91.00
	length
LM116	Newclip Bone Screws	NewClip Non - Locking Bone screws	2.8 - 4.5mm diameter to 10-	$91.00
	60mm in length
LM146	TriMed Bone Screws	Non-Locking Cortical Bone Screw	3.2/3.8/4.0 x 10-60mm	$91.00
LM170	Screws - Standard	Standard Screws	10 - 70mm	$91.00
	Medartis
EO077	APTUS Screws	Cortical Screws	2.8mm - 3.5mm Diameter	$91.00
	Medical & Optical Instruments Australia Pty Ltd
MO321	Acumed Hexalobe Non Locking 	Acumed Hexalobe Non Locking 	Small (2.71mm-4.49mm)	$91.00
	Screws
MO378	Acu-Loc Distal Radius Plate 	Cortical Screw Locking	3.5mm	$91.00
	Ortho Solutions Pty Ltd
OU028	fps non-LOCKING SCREW	FPS 2.7mm non locking screw	8-30mm (FPS 2.7mm non 	$91.00
	FPS GENII 2.7mm non-locking screw	locking)
		10-50mm (FPS 3.5mm non-
	FPS 3.5mm non-locking screw	locking)
Prostheses List by Category, Groups and Sponsor	Page 390 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OU032	CORTICAL SCREW	CORTICAL SCREW	3.5MM CORTICAL 	$91.00
	SELF TAPPING CORTICAL 	SCREW 8MM
	3.5MM CORTICAL 
	SCREW 10MM
	3.5MM CORTICAL 
	SCREW 12MM
	3.5MM CORTICAL 
	SCREW 14MM
	3.5MM CORTICAL 
	SCREW 16MM
	3.5MM CORTICAL 
	SCREW 18MM
	3.5MM CORTICAL 
	SCREW 20MM
	3.5MM CORTICAL 
	SCREW 22MM
	3.5MM CORTICAL 
	SCREW 24MM
	3.5MM CORTICAL 
	SCREW 26MM
	3.5MM CORTICAL 
	SCREW 28MM
	3.5MM CORTICAL 
	SCREW 30MM
	3.5MM CORTICAL 
	SCREW 32MM
	3.5MM CORTICAL 
	SCREW 34MM
	3.5MM CORTICAL 
	SCREW 36MM
	3.5MM CORTICAL 
	SCREW 38MM
	3.5MM CORTICAL 
	SCREW 40MM
	3.5MM CORTICAL 
	SCREW 42MM
	3.5MM CORTICAL 
	SCREW 44MM
	3.5MM CORTICAL 
	SCREW 45MM
	3.5MM CORTICAL 
	SCREW 50MM
	3.5MM CORTICAL 
	SCREW 55MM
	3.5MM CORTICAL 
	SCREW 60mm
Prostheses List by Category, Groups and Sponsor	Page 391 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SCREW	3.5MM CORTICAL 
	SCREW 65mm
	3.5MM CORTICAL 
	SCREW 70mm
	3.5MM CORTICAL 
	SCREW 75mm
	3.5MM CORTICAL 
	SCREW 80mm
	3.5MM CORTICAL 
	SCREW 85mm
	3.5MM CORTICAL 
	SCREW 90mm
	3.5MM CORTICAL 
	SCREW 95mm
	3.5MM CORTICAL 
	SCREW 100mm
	3.5MM CORTICAL 
	SCREW 105mm
	3.5MM CORTICAL 
	SCREW 110mm
	3.5MM SELF TAPPING 
	CORTICAL SCREW 10MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 12MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 14MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 16MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 18MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 20MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 22MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 24MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 26MM
Prostheses List by Category, Groups and Sponsor	Page 392 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 28MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 30MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 32MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 34MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 36MM
	
	3.5MM SELF TAPPING 
	CORTICAL SCREW 38MM
	
OU036	Cancellous Screw	Cancellous Screw	4.0mm cancellous screw 	$91.00
	fully threaded 10mm to 
	60mm
	4.0mm cancellous screw 
	partially threaded 10mm to 
	60mm
	Orthotech Pty Ltd
OH454	OsteoMed FPS	Bone screws	3.5/4mm x 10-60mm	$91.00
	Smith & Nephew Surgical Pty Ltd
SL011	TC-100	Cortical and Cancellous Screws	2.71mm-4.49mm	$91.00
SL012	Peri-Loc and Peri-Loc VLP	Cortical and Osteopenia Screws	2.71mm-4.49mm	$91.00
	Stryker Australia Pty Ltd
HW461	Memometal Anchorage Bone Screws	Anchorage Locking Bone Screws	3.0 - 3.5mm diameter to 10 - 	$91.00
	40mm in length
SK229	Omega Plus Compression Hip 	Cephalic Implants	Hansson Twin Hook 	$91.00
	Screw System	Compression Screw 25mm
SK452	Stryker Plating System	Cortical  Screws	2.7mm - 4.5mm Diameter	$91.00
	8mm - 150mm Length
ST006	Stryker Plating System	Cancelleous screws	2.7-4.0mm	$91.00
Prostheses List by Category, Groups and Sponsor	Page 393 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ085	PediNail-Captured locking screws-	4.0 x 15 Cort Screw (7mm Distal 	4mmx15mm-60mm in 5 mm 	$91.00
	small	Lock)	increments
	4.0 x 20 Cort Screw (7mm Distal 
	Lock)
	4.0 x 25 Cort Screw (7mm Distal 
	Lock)
	4.0 x 55 Cort Screw (7mm Distal 
	Lock)
	4.0 x 60 Cort Screw (7mm Distal 
	Lock)
	4.0 x 30Cort Screw (7mm Distal Lock)
SQ092	PediLoc Small Screws	3.5-4.0mm non-locking screws	10-70mm	$91.00
	Surgiplas Medical
SP032	OsteoMed Plating & Fixation System	Lag Screws - Maxi, MMF, 3.0mm	2.4mm x (8 - 42)mm; 2.4 x 	$91.00
	(12 - 18)mm; 3.0mm x (12 - 
	36)mm;
	Synthes Australia Pty Ltd
SY068	AO/ASIF Screws	Cortex, Conical, Cancellous, 	5mm - 160mm	$91.00
	Compression Screws
	Tornier Pty Ltd
TO108	MaxLock Extreme System - 3.5/4mm 	Bone screws, Titanium, non locking	Ø 3.5mm, length 8-50mm	$91.00
	Non Locking Screws	Ø 4mm, length 8-60mm
TO145	WAVE Calcaneal Fracture System - 	The WAVE Calcaneal Fracture System	Screws Diameter = 4.0mm; 	$91.00
	Fully Threaded Screw	 is a low profile, anatomical plate and 	Length = 26-50mm in 2mm 
	screws system designed for the 	increments & 55-90mm in 
	fixation of calcaneal fractures. The 	5mm
	plate and associated locking and non-
	 locking screws facilitate the 
	reconstrution of the height and width 
	of the calcaneus, and possible 
	remodelling of the lateral calcaneal 
	wall. The WAVE calcaneal Fracture 
	System is provided non-sterile. The 
	Fully Threaded Screw is used with the
	 WAVE Calcaneal Plate
	Wright Medical Australia
WR219	Evolve Ortholoc EPS System 3.5 	Stainless Steel, Cortical & Cancellous	3.5mm diameter 10-60mm	$91.00
	NL Screws	 Screws
WR241	Stainless Steel Screw	Stainless steel plate screw, non 	2.7 & 3.2 dia. 8-50mm 	$91.00
	length in 2mm increments
Prostheses List by Category, Groups and Sponsor	Page 394 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI150	Periarticular Plates	Periarticular 4.0mm Cancellous 	Part thread - 30-60 mm, Full 	$91.00
	Screws - Stainless Steel	thread 30-110 mm
ZI152	Periarticular Plates	Periarticular 3.5mm Self Tapping 	10 - 80mm	$91.00
	Screws - Stainless Steel
ZI202	Zimmer ECT Screws	3.5mm Cortical Screws	10 - 130 mm	$91.00
ZI203	Zimmer ECT Screws	4.0mm Cancellous Screws	10 - 60 mm	$91.00
ZI892	NCB System	NCB Screws	4mm x 14-90mm	$91.00
	Break off
	Device Technologies Australia Pty Ltd
DE365	QuickFix Screw, Small	Titanium Snapp-off Small Bone Screw, 	3.0mm Diameter x 13-19mm 	$336.00
	small	Lengths
	Breakoff
	Integra Neurosciences Pty Ltd
IG134	Snap-Off screws	Titanium break-off barrel screws for 	Diameter 3.0mm, Length 10 	$336.00
	Hallu-Fix	- 18mm
	Stryker Australia Pty Ltd
HW450	Fixos Screws, Snap-off, 2.7mm	Bone Fixation Screws, Snap-off, 2.7mm	2.7mm diameter, 14 to 22mm 	$336.00
	(each 2mm)
	Breakoff, DT
	Perios Pty Ltd
PF002	BePOD	Self-Compressive Screw	Lengths 10mm - 34mm	$526.00
PF008	Forefoot Snap off Screws	Titanium Alloy Screws with Snap-off 	Arthrodesis large diameter 	$526.00
	Grip / Cannulated	L28 - L40
	CD, DT
	Lima Orthopaedics Australia Pty Ltd
LC132	MCD Cannulated Double Threaded 	MCD Cannulated Double Threaded 	3.0/4.0mm Dia x 14 to 34mm	$421.00
	Bone Scre - Small	Bone Screw - Small	 Length
	CN
	Biomet Australia Pty Ltd
BH186	Small / Large  Fragment Set	Cannulated Titanium Bone Screw	3.0mm - 4.0mm	$231.00
BH277	ALPS Plating System	Cannulated  Bone Screws	3.0 to 4.0mm diameter	$231.00
Prostheses List by Category, Groups and Sponsor	Page 395 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE370	Cannulated Low Profile Screws, 	Cannulated Low Profile Screws, Small	3-4mm	$231.00
	Small
	Emergo Asia Pacific Pty Ltd
ER088	DeRoyal Internal Fixation Systems -	Cannulated Screws, Stainless Steel 	Small (2.71 - 4.49mm)	$231.00
	 cannulated screws	316L, manufactured in USA
	KH NXGEN (AUS) Pty Limited
KH017	KCS Cannulated Screws	Cannulated Screw	4.0mm diameter, 25 to 70mm 	$231.00
	length
	Lima Orthopaedics Australia Pty Ltd
LC119	Superscrew - small	Cannulated Cotical / Cancellous Lag 	Dia. 3.5 / 4.0 mm x 10-70mm 	$231.00
	Screw Partial or Full Thread	length
LC130	MCD Cannulated Bone Screw - Small	MCD Canulated Bone Screw - Partial 	3.0 to 4.0 mm Dia x 08-	$231.00
	or Full Thread - Small	60mm Length
	LMT Surgical Pty Ltd
LM154	EOS Footset-Antares	Footscrew	12-34mm	$231.00
	Ortho Solutions Pty Ltd
OU030	Cannulated Screw Self Drill/Tap	bone screws and washers are 	3.5mm x 22mm, 3.5mm x 	$231.00
	indicated for use in fixation of various 	24mm, 3.5mm x 26mm, 3.5mm
	fractured bones. Mini plates and 	 x 28mm, 3.5mm x 30mm, 
	screws 3.5mm or smaller are intended 	3.5mm x 32mm, 3.5mm x 
	fro use in small bones in the hand or 	34mm, 3.5mm x  36mm, 
	foot and include metacarpal, metatarsal	3.5mm x 40mm, 3.5mm x 
	 and phalange bones. Small and large 	42mm, 3.5mm x 44mm, 3.5mm
	plates and screws 4.0mm and larger are	 x 45mm, 3.5mm x 46mm, 
	 intended for use in large and long 	3.5mm x 48mm, 3.5mm x 
	bones which can include the clavicle, 	50mm, 3.5mm x 55mm, 3.5mm
	scaplua, pelvis, calcaneus, talus ans 	 x 60mm
	long bones (humerus, ulna, radius, 
	femur, tibia and fibula)
OU033	Titianium Cannulated Cancellous 	Titianium Cannulated Cancellous lag 	4.0mm x 10mm Titianium 	$231.00
	lag Screw	Screw	Cannulated Cancellous lag 
	Screw up to (4.0mm x 28mm)
	Smith & Nephew Surgical Pty Ltd
SN971	Cannulated Screw	Stainless Steel	2.71mm - 4.49mm	$231.00
	Stryker Australia Pty Ltd
SK528	'Stryker Cannulated Screw System	Asnis III Cannulated screws	4.0mm	$231.00
Prostheses List by Category, Groups and Sponsor	Page 396 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SR094	Stryker Cannulated Screw System	Asnis Micro Cannulated screw	2.71mm-3.0mm, Diameters, 	$231.00
	8mm-40mm lengths
	Surgiplas Medical
SP037	OsteoMed Plating & Fixation System	Screws - Cannulated Lag	3.0mm x (10 x 28)mm; 4.0mm	$231.00
	 x (12 - 30)mm
SP038	OsteoMed Plating & Fixation System	Screws - Cannulated Lag	3.0mm x (30 x 40)mm; 4.0mm	$231.00
	 x (32 - 52)mm
	Synthes Australia Pty Ltd
SY071	AO/ASIF Screws	Cannulated screws	>2.7mm-4.49mm	$231.00
	Tornier Pty Ltd
TO113	MaxTorque Cannulated Screw 	Bone screws, Titanium, Cannulated, 	Ø3.2mm Short Thread, 	$231.00
	System - Small Screws	Short or Long Thread	Length 12-30mm
	Ø3.2mm Long Thread, 
	Length 12-38mm
	Ø3.8mm Short 
	Thread,Length 16-50mm
	Ø4.0mm Long Thread, 
	Length 14-50mm
	Ø4.0mm Long Thread, 
	Length 24-50mm
TO121	CoverLoc Screws	CoverLoc Screws, stainless steel, (lag 	2.7mm & 3.3mm x 10mm-	$231.00
	& cortical) & Pegs (threaded & 	26mm in 2mm increments
	unthreaded)
TO146	WAVE Calcaneal Fracture System - 	The WAVE Calcaneal Fracture System	Screws: Diameter: 4mm; 	$231.00
	Cannulated Lag Screw	 is a low profile, anatomical plate and 	Length = 26mm - 90mm (for 
	screws system designed for the 	lag screws) in 2mm 
	fixation of calcaneal fractures. The 	increments up to 50mm and 
	plate and associated locking and non-	5mm increments up to 90mm
	locking screws facilitate the 
	reconstruction of the height and 
	width of the calcaneus, and possible 
	remodelling of the lateral calcaneal 
	wall. The WAVE Calcaneal Fracture 
	System is provided non-sterile. The 
	Cannulated Lag Screw is used with 
	the WAVE Calcaneal Fracture Plate or
	 with the washer for optional off plate 
	use.
Prostheses List by Category, Groups and Sponsor	Page 397 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR068	Cannulated Screw	Titanium cannulated screw intended 	3.5mm diameter x 34, 36 & 	$231.00
	for use in conjunction with a plate for 	38mm
	fixation of midfoot fusion
WR247	Darco Headed Compression Screw 	Cannulated titanium compression 	3.0-4.0mm x 16-50mm	$231.00
	System	screws
	Zimmer Pty Ltd
ZI177	Zimmer Internal Fixation Systems: 	Mini Magna-FX - Stainless Steel	4 & 5mm diameters	$231.00
	Cannulated Screw
ZI835	NCB Polyaxial Locking System	4.0mm Cannulated Variable Angle 	14 - 65mm	$231.00
	Locking Screws - Ti Alloy
	CN, DT
	Biomet Australia Pty Ltd
BH190	Barouk Screw System	Metatarsal screw	3.0mm	$421.00
	Integra Neurosciences Pty Ltd
IG057	Kompressor	Titanium compression screw	10-34mm	$421.00
IG069	Bold Compression Screw	Cannulated titanium	3mm diam 10-34mm length	$421.00
IG070	ICOS Screw: Ideal Compression 	Cannulated titanium	4.0mm diam 26-60mm 	$421.00
	Screw	length, 6.5mm diam 40-
	150mm length
IG109	Qwix Screw	Self drilling, self tapping, cannulated, 	Diameter 3.0mm-7.5mm, 	$421.00
	titanium screws.	length 10mm-120mm
	Lima Orthopaedics Australia Pty Ltd
LC067	DTS - Double threaded cannulated 	DTS - Double threaded cannulated 	Diameter 3, 3.5, x Length 12	$421.00
	screw with guidewire	screw with guidewire	 to 40mm
LC109	WG - Mica Forefoot Surgey - Bone 	self-threading, double threaded 	3mm Dia x 10-40mm Length	$421.00
	Screw - Small	cannulated 3mm screws
LC124	TwinLock Screw - Small	TwinLock Screw - Small	3.5/3.6mm to 4.0/4.1mm Dia 	$421.00
	x 16 to 34 mm length
LC125	Twinlock Screw - Standard	Twinlock Screw - Standard	5.2/5.5mm to 6.0/7.0mm Dia 	$421.00
	x 25 to 120 mm Length
	LMT Surgical Pty Ltd
LM052	Ascension Compression Screw	Titanium Compression Screw	2-5mm diameter ; 12 - 40mm 	$421.00
	length
Prostheses List by Category, Groups and Sponsor	Page 398 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LM143	Extremity Medical Compression 	Compression Screws	3.0-4.5mm	$421.00
	Screw System
LM179	Compression Screw - Small	3.9mm diameter cannulated 	Length: 14 - 22mm	$421.00
	compression screw
LM186	Foot Motion - self-drilling 	Self-drilling auto-compressive 	3.0mm diameter, length 	$421.00
	cannulated compression screws	cannulated screw	8mm-40mm
	Medical & Optical Instruments Australia Pty Ltd
MO355	Acutrak 2	Headless compression screw	2.71mm - 4.49mm	$421.00
MO368	Acumed Fixation Screw	Acutrak Compression Screw Titanium	2.71mm - 4.49mm	$421.00
MO382	Acutrak Headless Compression Screw	Acutrak 4/5 screw	2.71mm - 4.49mm	$421.00
Prostheses List by Category, Groups and Sponsor	Page 399 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
Prostheses List by Category, Groups and Sponsor	Page 400 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OU031	Compression Screw	Compression Screw	3.0MM META SCREW - 	$421.00
	LONG THREAD 10MM
	3.0MM META SCREW - 
	LONG THREAD 12MM
	3.0MM META SCREW - 
	LONG THREAD 14MM
	3.0MM META SCREW - 
	LONG THREAD 16MM
	3.0MM META SCREW - 
	LONG THREAD 18MM
	3.0MM META SCREW - 
	LONG THREAD 20MM
	3.0MM META SCREW - 
	LONG THREAD 22MM
	3.0MM META SCREW - 
	LONG THREAD 24MM
	3.0MM META SCREW - 
	LONG THREAD 26MM
	3.0MM META SCREW - 
	LONG THREAD 28MM
	3.0MM META SCREW - 
	LONG THREAD 30MM
	3.0MM META SCREW - 
	LONG THREAD 32MM
	3.0MM META SCREW - 
	LONG THREAD 34MM
	3.0MM META SCREW - 
	SHORT THREAD 12MM
	3.0MM META SCREW - 
	SHORT THREAD 14MM
	3.0MM META SCREW - 
	SHORT THREAD 16MM
	3.0MM META SCREW - 
	SHORT THREAD 18MM
	3.0MM META SCREW - 
	SHORT THREAD 20MM
	3.0MM META SCREW - 
	SHORT THREAD 22MM
	3.0MM META SCREW - 
	SHORT THREAD 24MM
	3.0MM META SCREW - 
	SHORT THREAD 26MM
	3.0MM META SCREW - 
	SHORT THREAD 28MM
	3.0MM META SCREW - 
	SHORT THREAD 30MM
Prostheses List by Category, Groups and Sponsor	Page 401 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	3.0MM META SCREW - 
	SHORT THREAD 32MM
	3.0MM META SCREW - 
	SHORT THREAD 34MM
	3.0MM META SCREW - 
	SHORT THREAD 36MM
	3.0MM META SCREW - 
	SHORT THREAD 40MM
	3.0MM META SCREW - 
	SHORT THREAD 44MM
	COMPRESSION SCREW 
	10MM
	COMPRESSION SCREW 
	12MM
	COMPRESSION SCREW 
	14MM
	COMPRESSION SCREW 
	16MM
	COMPRESSION SCREW 
	18MM
	COMPRESSION SCREW 
	20MM
	COMPRESSION SCREW 
	22MM
	COMPRESSION SCREW 
	24MM
	COMPRESSION SCREW 
	26MM
	COMPRESSION SCREW 
	28MM
	COMPRESSION SCREW 
	30MM
	COMPRESSION SCREW 
	32MM
	COMPRESSION SCREW 
	34MM
	SCARF SCREW 10MM
	SCARF SCREW 12MM
	SCARF SCREW 14MM
	SCARF SCREW 16MM
	SCARF SCREW 16MM
	SCARF SCREW 18MM
	SCARF SCREW 20MM
	SCARF SCREW 22MM
	SCARF SCREW 24MM
	SCARF SCREW 26MM
Prostheses List by Category, Groups and Sponsor	Page 402 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SCARF SCREW 28MM
	SCARF SCREW 30MM
	SCARF SCREW 32MM
	SCARF SCREW 34MM
	Orthotech Pty Ltd
OH446	ExtremiFix Screws	Headless Cannulated Compression 	Diameter 3.0mm, 4.0mm. 	$421.00
	Screw	Length 10mm to 52mm; 
	Diameter 2.71mm - 4.49mm.
	Smith & Nephew Surgical Pty Ltd
SM173	Peri-Loc	Headless Cannulated Screw	2.71mm-4.49mm Headless 	$421.00
	Cannulated Screw 8mm - 
	40mm
	Stryker Australia Pty Ltd
HW451	Fixos Screws, Snap-off,AO fitting 	Bone Fixation Screws, Snap-off, AO 	3.0mm diameter, 10 to 22mm 	$421.00
	3.0mm	fitting 3.0mm	(each 2mm)
HW452	Fixos Screws	Bone Fixation Srews, Cannulated, 	3.0mm-4.0mm diamter, 10 to 	$421.00
	Double Threaded	60mm (each 2mm)
SK256	TwinFix Cannulated Compression 	0	Diameter 3.2mm, lengths 14-	$421.00
	Screw System	34mm
	Surgiplas Medical
SP122	ExtremiFix Screws	Headless Cannulated Compression 	Diameter 3.0mm, 4.0mm. 	$421.00
	Screw	Length 10mm to 52mm; 
	Diameter 2.71mm - 4.49mm.
	Synthes Australia Pty Ltd
SY644	AO/ASIF Screws	HCS Countersinkable Compression 	3.0	$421.00
	Screw
	Tornier Pty Ltd
TO124	NexFix 3.0mm Compression Screw	The NexFix Compression Screw is a 	3.0mm diameter x 10 - 34mm 	$421.00
	stainless steel, cannulated, self 	length in 2mm increments
	tapping, and self drilling fixation 
	device for osteotomies, fusions and 
	fracture fixation of small bones
Prostheses List by Category, Groups and Sponsor	Page 403 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR034	Charlotte Foot & Ankle System	Multi use compression screw, 	3.0 & 4.3mm dia. 10-60mm 	$421.00
	cannulated, stainless steel	in 2mm increments
	CN, LK
	Integra Neurosciences Pty Ltd
IG093	Newdeal Screws/Lock Screws	Screws - Cancellous, Cancellous 	Cancellous/Cancellous 	$301.00
	cannulated, cortical, cortical 	cannulated - Diameter 
	cannulated plus Lock screws	6.5mm, Length 20mm - 
	100mm + Lock Screw, 
	Cortical - Diameter 5.0mm, 
	Length 25mm - 45mm + 
	Lock Screw, Cortical - 
	Diameter 4.5mm, Length 
	14mm - 65mm + Lock Screw,
	 Cortical - Diameter 3.5mm, 
	Length 14mm - 32mm + Lo
IG108	Newdeal Surfix Style Screws	Titanium bone screw +locking screw 	Diameter 3.5mm, Length 10-	$301.00
	for the fixation of specific Newdeal 	50mm; Diameter 4.5mm, 
	bone plates	length 14-65mm; Diameter 
	6.5, length 20-100mm
	Johnson & Johnson Medical Pty Ltd
MN040	Bristow-Latarjet Instability 	Cannulated titanium locking screw	28mm to 48mm	$301.00
	Shoulder Set - Screw
	CN,DT
	Device Technologies Australia Pty Ltd
DE427	Headless Compression Screw	Headless Compression Screw for bone	3mm x 10-32mm	$421.00
	 fixation
	Orthopaedic Solutions Pty Ltd
OE048	Merete - Cannulated HCS 	Bone Screws, Titanium, Cannulated 	Diameter = 3.0mm, Length = 	$421.00
	(Compression Screws 3.0mm x 	Compression	12-32mm in2mm increments 
	4.3mm)	& 35mm, 40mm
	Diameter = 4.3mm, Length 
	=20-40mm in 2mm increments
	Orthotech Pty Ltd
OH474	DynafitSystem	Self-compressive screws	3.2 x 12-26mm	$421.00
Prostheses List by Category, Groups and Sponsor	Page 404 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OH477	DynafitSystem	Self-compressive screws	3.2 x 12-26mm	$421.00
OH480	HBS 2 midi	Self-compressive screws	3.0mm x 10-40mm	$421.00
	Perios Pty Ltd
PF001	BePOD	Canulated Self-Compressive Screws	lengths 10mm to 34mm	$421.00
	Wright Medical Australia
WR264	MICA Compression Screw	Compression Screw for Minimally 	Sizes 3mm 32mm - 44mm	$421.00
	Invasive Surgery
	CN,LK
	Synthes Australia Pty Ltd
SY797	AO/ASIF Screws	Philos Cannulated locking screw	3.5mm	$301.00
	Zimmer Pty Ltd
ZI853	Zimmer Periarticular Plating System	5.5mm Cannulated Periarticular 	30 - 150mm	$301.00
	Locking Screws
ZI855	Zimmer Periarticular Locking 	3.5mm Cannulated Periarticular 	30 - 90mm	$301.00
	Locking Screws
	DT
	Biomet Australia Pty Ltd
BH247	Rockwood Clavical Pin	Clavical Pin with dual thread	3.0-3.8mm	$281.00
	Device Technologies Australia Pty Ltd
DE272	Bio-Compression Screw System	Fixation Device	16mm, 18mm, 20mm, 22mm, 	$281.00
	24mm, 26mm
	LMT Surgical Pty Ltd
LM182	Chevron Screw	Non-Cannulated Self Tapping Screws	Diameter: 2.8mm	$281.00
	Length: 16- 28mm
	Medical & Optical Instruments Australia Pty Ltd
MO374	Acutrak Fusion Screws	Fusion Screws Titanium	2.71mm - 4.49mm	$281.00
	DT CN
	Wright Medical Australia
WR062	Headless Compression screws	Compression screw cannulated, 	2.5-3.2mm diameter x 10-	$421.00
	titanium, self tapping, self drilling.	32mm
Prostheses List by Category, Groups and Sponsor	Page 405 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	DT, CN
	Advanced Surgical Design & Manufacture Ltd
AE249	FusiFIX™	Triple thread, cannulated, 	4mm	$421.00
	compression screw system
	Integra Neurosciences Pty Ltd
IG107	Bold Compression Screw	Cannulated Titanium	Diameter 3.0-3.70mm, 	$421.00
	length 10-34mm
	LMT Surgical Pty Ltd
LM109	NewClip Compression Screws	Compression Screw	3.5mm x 10-18mm	$421.00
	Medartis
EO058	Aptus 3.0 Cannulated Headless 	Aptus 3.0 Cannulated Headless 	3.0 diameter.  Short and 	$421.00
	Compression Screw	Compression Screw	long threaded 10mm to 
	RQSolutions Medical Devices Distribution Support
RQ003	Orthomed Metallic Compression 	The compression screw is indicated 	10 sizes	$421.00
	Screw	for fixation of bone fragments for 	Head diameter: 3.8mm
	forefoot surgery.	Proximal diameter: 3mm
	The compression screws are self-	Internal diameter: 1.10mm
	tapping cannulated screws, which 	Different length from 10mm 
	present two types of thread diameter 	to 34mm by pitch of 2mm 
	(one on the screw head and a body 	between each reference
	part of the screw). They are 
	particularly intended to repair the 1st 
	metatarsal in the foot. 
	The pitch difference between the 
	proximal and the distal part allows 
	creating a compression are between 
	the upper and lower bone fragment of 
	1st metatarsal improving the healing 
	process.
	DT, LK
	Medartis
EO074	APTUS Screws	Aptus Locking Screws	2.8mm - 3.5mm Diameter	$351.00
	DT,LK
	Johnson & Johnson Medical Pty Ltd
DY573	Delta Shoulder System	Metaglene Screw Stainless Steel	3.5mm	$351.00
Prostheses List by Category, Groups and Sponsor	Page 406 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Advanced Surgical Design & Manufacture Ltd
AE155	ASDM Clavicle Plating System - 	Fixation Device, Internal, Locking, 	3.5mm Locking Screws, 10-	$161.00
	Screws	Stainless Steel, Cortical Screw Size: 	30mm (2mm increments)
	3.5mm
AE246	SBi Locking Screws	Titanium Cortical Locking Self-	2.7mm Cortical Locking, 	$161.00
	tapping screws	Self-tapping 10 - 30mm
	3.5mm Cortical, Locking, 
	Self tapping 8 -20mm
	Austofix
AX003	Austofix Intramedullary Screws	Humeral Head Screw, stainless steel	4.3mm	$161.00
AX086	Austofix Proximal Humeral Plating 	Locking Screw Titanium	3.5mm, 20-100mm	$161.00
	System - Austofix PHP Locking 
	Screw
AX089	Austofix Proximal Humeral Plating 	Variable Angle Locking Screw, 	3.5mm 20-100mm	$161.00
	System - Austofix VA Locking 	Cobalt Chrome
	Biomet Australia Pty Ltd
BH141	OptiLock Upper Extremity Plating 	Locking Screws, Stainless Steel	3.5mm Diameter, 10-60mm 	$161.00
	System - Locking Screws	length (2mm increments)
BH261	HI S3 Shoulder Fixation System	Locking Peg	4mm diameter	$161.00
BH272	Polyax Plating System	Locking Bone screws	4.0mm diameter	$161.00
BH276	ALPS Plating System	Cancellous titanium Locking Bone 	10-100mm	$161.00
	Screws
BH289	ALPS System	Polyaxial locking screws	3-4.0mm diameter	$161.00
	Device Technologies Australia Pty Ltd
DE368	Locking Cortical land Cancellous 	Locking Cortical and Cancellous 	3-3.5mm	$161.00
	Screws, Small	Screws, Small
	Emergo Asia Pacific Pty Ltd
ER086	DeRoyal Internal Fixation Systems -	Locking Screws, Stainless Steel 	Small (2.71-4.49mm)	$161.00
	 Locking Screws	316L, manufactured in USA
	Integra Neurosciences Pty Ltd
IG067	Surfix screw plus Surfix Lock-Screw	Locking screws with an independent 	2.7mm: 10-32mm	$161.00
	lock-screw head
Prostheses List by Category, Groups and Sponsor	Page 407 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
IG068	Surfix Screw plus Surfix Lock-Screw	Locking screws with an independent 	3.5mm: 10-28mm	$161.00
	lock-screw head that screw into 
	fixation plates. This combination 
	effects dynamic compression.
IG092	Newdeal Lock Screws	For use with Newdeal bone screws 	Diameter 2.7mm - 6.5mm	$161.00
	and plates
IG098	Calcanea Locking Screw	Cortical Screw, Titanium	Diameter 3.5mm, Length 	$161.00
	20mm to 45mm
IG120	Surfix Locking Screws	Locking screws with an independent 	3mm; 10-24mm length	$161.00
	lock-screw head
	Lima Orthopaedics Australia Pty Ltd
LC053	Threaded Head Bone Screw	Threaded Head Bone Screw Cancellous	Diameter 3.5, 4mm, length 	$161.00
	10-60mm
LC095	Diphos Plate - Threaded Head 	Threaded Head Screw - Small	Diameter 3.5mm x Length 8-	$161.00
	Screw - Small	40mm
LC113	MCD Locking Bone Screw - smal	MCD Locking Bone Screw Small	3.5/40 mm Dia x 08-60mm 	$161.00
	Length Parital or Full Thread
	LMT Surgical Pty Ltd
LM069	Normed Foot screws	Titanium locking bone screws	2.7-4.0mm	$161.00
LM115	Newclip Bone Screws	Newclip Locking Bone Screws	2.8 - 4.5mm diameter to 10-	$161.00
	60mm in length.
LM145	TriMed Bone Screw	Locking Cortical Bone Screw	3.2mm x 10-40mm	$161.00
LM147	TriMed Bone Screw	Locking Compression Bone Screw	4mm x 35-60mm	$161.00
LM171	Screws -Locking	Locking Screw	10 - 70mm	$161.00
	Medical & Optical Instruments Australia Pty Ltd
MO322	Acumed Hexalobe Locking Screws	Acumed Hexalobe Locking Screws	Small (2.71mm-4.49mm)	$161.00
MO370	Acumed Tap-Loc	Tap screws, Tap-Loc Screws	3.6mm -60 mm Length	$161.00
MO377	Acu-Loc Distal Radius Plate 	Cortical Screw	3.5mm	$161.00
MO415	Acumed Screws	Screws	2.71mm - 4.49mm	$161.00
	Ortho Solutions Pty Ltd
OU024	Locking screw	FPS 3.5mm locking screw	FPS 3.5mm x 14mm locking 	$161.00
	FPS GENII 3.5mm locking screw	screw up to 35mm
	FPS 2.7mm locking screw
	FPS GENII 2.7mm locking screw
Prostheses List by Category, Groups and Sponsor	Page 408 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthopaedic Solutions Pty Ltd
OE047	Merete - MetaFix LS - Locking  	Bone screws, Titanium, Locking	Diameter = 3.0, length = 12-	$161.00
	Screws 3.0 & 3.5mm	28mm in 2mm increments 
	Diameter = 3.5mm, length 
	12-48mm in 2mm increments
	Orthotech Pty Ltd
OH455	OsteoMed FPS	Bone screws	3.5/4mm x 10-60mm	$161.00
	Smith & Nephew Surgical Pty Ltd
SN944	Peri-Loc	Locking Screws	2.71mm - 4.49mm	$161.00
	Stryker Australia Pty Ltd
HW460	Memometal Anchorage Bone Screws	Anchorage Bone Screws	3.0-3.5mm diameter to 10 - 	$161.00
	40mm in length
SK563	Stryker Plating System	SPS Locking Plate System	Locking screws 3-4mm	$161.00
SR073	Stryker Locking Plate System	Locking Screws	Diameter 2.7 to 3.5mm, 	$161.00
	Length 10mm to 70mm
	Surgical Specialties
SQ093	PediLoc - 3.5mm self-tapping, 	3.5 mm self tapping/locking cortical 	Self tapping cortical screw 	$161.00
	Locking Cortical Screws	screw (threaded/T15 hexalobe)	with T 15 Hexalobe: 10mm-
	60mm, in 2mm increments 
	60-70mm, in 5mm 
	increments
	Locking cortical full thread:
	 10mm-60mm, in 2mm 
	increments, 60mm-70mm, in 
	5mm increments
	Locking CorticalScrew 
	with T15 Hexalobe:
	10mm-56mm, in 2mm 
	increments
	Synthes Australia Pty Ltd
SY652	AO/ASIF Screws	Locking Head Screws	>2.7mm - <4.5mm	$161.00
SY692	Dynamic Locking Screw	Pin-sleeve locking screw	3.7mm	$161.00
Prostheses List by Category, Groups and Sponsor	Page 409 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO032	Aequalis Humeral Plate Screws	Proximal humeral plate screws 	Proximal locking screws: 	$161.00
	(Cancellous self-tapping locking 	4mm, cortical self tapping 
	screws, Cortical self-tapping locking 	locking screws: 20 to 60mm
	screws or Cortical Self-tapping 	 length; proxmial inferior 
	compression screws)	locking screws: 3.5mm, 
	cortical self tapping locking
	 screws: 10 to 40mm length;
	 distal compression screws: 
	3.5mm, cortical self-tapping 
	compression
TO109	MaxLock Extreme System - 3.5mm 	Bone screws, titanium, fixed or 	Ø 3.5mm Fixed angle, 	$161.00
	locking screws	variable angle locking	Length 8-45mm
	Ø 3.5mm Variable angle, 
	Length 10-50mm
TO118	Nexfix MTP Fusion System	Unique low profile stainless steel 	3.2mm x 12mm, 14mm, 16mm,	$161.00
	locking screw for use with NexFix 	 18mm, 20mm
	MTP Fusion plates,  indicated for use 
	in osteoporotic bone
TO147	WAVE Calcaneal Fracture System - 	The WAVE Calcaneal Fracture System	Screws: Diameter = 4.0mm, 	$161.00
	Locking Screw	 is a low profile, anatomical plate and 	Length - 14-44 in 2mm 
	screw system designed for the 	increments
	minimally invasive fixation of the 
	calcaneal fractures. The plate and 
	associated locking and non-locking 
	screws facilitate the reconstruction of 
	the height and width of the calcaneus, 
	and remodelling of the lateral 
	calcaneal wall. The WAVE calcaneal 
	System is provided non-sterile. The 
	Locking Screw is used with the 
	WAVE Calcaneal Fracture Plate
	Wright Medical Australia
WR072	Ortholoc Fracture System Screws	Titanium, variable angle locking 	3.5 & 4.0mm diameter, 8-	$161.00
	100mm length
WR078	Charlotte Lisfranc Recontruction 	Solid core stainless steel screw.	3.7mm diameter, 8-100mm 	$161.00
	System - Screw.	length.
WR218	Evolve Ortholoc EPS System 3.5 	Stainless Steel, Variable Angle 	3.5mm Diameter, 10-60mm	$161.00
	locking	Locking, Cortical & Cancellous 
Prostheses List by Category, Groups and Sponsor	Page 410 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR228	Titanium Screw	Locking, non-locking or cannulated, 	8-40mm, 3.5mm	$161.00
	for use only with Darco titanium 
	plates, self-tapping
WR242	Stainless Steel Screw	Stainless steel plate screw, locking	2.7 & 3.2 dia. 8-50mm 	$161.00
	length in 2mm increments
WR245	Charlotte Claw Locking Screws	3.5mm stainless steel locking screws 	3.5mm: 12-40mm	$161.00
	for use with Claw Plate
	Zimmer Pty Ltd
ZI852	Zimmer Periarticular Plating System	4.5mm Periarticular Locking Screws	12 - 110mm	$161.00
ZI854	Zimmer Universal Locking System	3.5mm Universal Locking Screws	12 - 90mm	$161.00
ZI856	Zimmer Universal Locking System	3.5mm Universal Locking Screws - Ti 	12 - 60mm	$161.00
	Alloy
	LK, CN, DT
	LMT Surgical Pty Ltd
LM133	TriMed Compression Screws	'Compression Screws	3.0-4.5mm	$491.00
	06.03.04.03 - Mini (2.01 – 2.7 mm)
	Advanced Surgical Design & Manufacture Ltd
AE080	Carpal Fusion System Screw	316L Stainless Steel, Low Profile 	2 - 7 mm Diameter 12 - 24mm	$93.00
	Custom Thread Screw	 Length
AE149	ASDM Clavicle Plating System - 	Fixation Device, Internal, Non-	2.7mm Low-profile cortex 	$93.00
	Screws	locking, Stainless Steel, Cortical 	screws, 10-30mm (2mm 
	Screw Size: 2.7mm	increments)
AE214	Carpal Screw	Titanium	2.5mm diameter in sizes 	$93.00
	12mm - 20mm length
AE234	Percufix	Titanium	Diameter: 2-2.5mm, Length 	$93.00
	22-40mm
	Biomet Australia Pty Ltd
BH278	ALPS Plating System	Non-locking bone screw	2.5 to 2.7mm	$93.00
BH302	ALPS Hand Fracture System	Bone screws	2.5mm	$93.00
BI768	Mandibular Fracture System	Screw, IMF 2./2.4 Mandibular 	2.0 x(5 - 13)mm	$93.00
	Fracture, Titanium
	Device Technologies Australia Pty Ltd
DE214	Cortical Screw	Titanium	10-24mm x 2.3mm	$93.00
Prostheses List by Category, Groups and Sponsor	Page 411 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER089	DeRoyal Internal Fixation Systems -	Screws, Stainless Steel 316L, 	Mini (2.01 - 2.7mm)	$93.00
	 screws	Manufactured in USA
	Integra Neurosciences Pty Ltd
IG065	 Integra Total Wrist Fusion System -	Cortical screw for use with the integra	2.7mm diameter: 10-32mm 	$93.00
	 Cortical Screw	 Total Wrist Fusion Plates	length
IG129	Spider Limited Wrist Fusion System	Stainless steel screws for Spider plate	Diameter 2.4mm, length 8-	$93.00
	 - 2.4mm bone screws	14mm
	Lima Orthopaedics Australia Pty Ltd
LC100	Osteosynthesis Bone Screws - Mini	Osteosynthesis Bone Screws - Mini	Dia 2.7mm x 6-40mm length	$93.00
LC134	MCD Bone Screw - Mini	MCD Non Locking bone Screw - 	2.3 / 2.7 Dia x 06-30mm 	$93.00
	Length
	LMT Surgical Pty Ltd
LM111	Ascension Radial Head Plate 	Ascension radial Head Plate Non-	2.7mm x 10-26mm	$93.00
	Locking Screws
LM144	TriMed Bone Screw	Non-Locking Cortical Bone Screws	2.3mm x 32mm, 2.7 x 10 - 	$93.00
	24mm
LM174	Screws - Standard - Mini	2.7mm diameter standard screw	8 - 30mm	$93.00
	Medartis
EO076	APTUS Screws	Cortical Screws	2.3mm - 2.5mm Diameter	$93.00
	Medical & Optical Instruments Australia Pty Ltd
MO323	Acumed Hexalobe Non Locking 	Acumed Hexalobe Non Locking 	Mini (2.01mm-2.7mm)	$93.00
	Screws
MO375	Acu-Loc Distal Radius Plate 	Threaded, non-threaded,locking, non-	2.3 mm	$93.00
	locking screw peg, titanium
MO394	RibLoc rib fracture plating system 	RibLoc Screws	Mini 2.01-2.7mm	$93.00
	screws
Prostheses List by Category, Groups and Sponsor	Page 412 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
OU026	Cortex screws	Cortex screws	2.4mm x 10mm up to 28mm	$93.00
	2.0mm x 8mm up to 26mm
	2.0mm cortical screw 6mm 
	up to 38mm
	2.0mm self tapping S/S 
	cortical screw 8mm up to 
	24mm
	2.7mm cortical screw 6mm 
	up to 38mm
	Orthotech Pty Ltd
OH452	OsteoMed FPS	Bone screw - std	2/2.7mm x 8-22mm	$93.00
OH464	OsteoMed HPS	Bone screws - threaded/lag	2.4mm x 4-36mm	$93.00
OH469	IXOS Radius Plating System	Std Screw	2.5 x 8-30mm	$93.00
	Smith & Nephew Surgical Pty Ltd
SN082	TC 100 	Cortical Screws	2.01mm - 2.7mm	$93.00
SN833	Peri-Loc & Peri-Loc VLP	Cortical Screws	2.01-2.7mm	$93.00
	Stryker Australia Pty Ltd
SK103	Stryker Plating System	Cortical bone screws	2.7mm diameter, 22 - 80mm  	$93.00
	lengths
	Synthes Australia Pty Ltd
SY352	A/ASIF Screw	Cortex, Cancellous, Compression 	5mm - 60mm	$93.00
	Screws
	Tornier Pty Ltd
TO107	MaxLock Extreme System - 	Bone screws, Titanium, Non locking	Ø 2.4/2.7mm, length 6-	$93.00
	2.4/2.7mm Non locking screws
TO120	Nexfix MTP Fusion System	Unique low profile stainless steel 	2.7mm x 12mm, 14mm, 16mm,	$93.00
	locking screw for use with NexFix 	 18mm, 20mm, 24mm, 28mm
	MTP Fusion plates, indicated for use 
	in normal bone
Prostheses List by Category, Groups and Sponsor	Page 413 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
TO130	Activa Screw	The Activa Screw is a bioresorbable 	2.7mm x 10, 12 , 14 , 16, 20 	$93.00
	device that maintains accurate 	& 24mm
	alignment of bone fractures, 
	osteotomies, arthrodeses, bone grafts 
	and osteochondral fractures after 
	surgical procedure. The Activa Screw 
	possess' rigidity similar to bone 
	which decreases 
	Wright Medical Australia
WR031	Micronail intramedullary radial 	2.7mm Titanium Screw	10mm - 20mm	$93.00
	fixation
WR255	Evolve EPS System Non-Locking	Stainless Steel Cortical Screws	2.5 - 2.7mm Diameter, 10-	$93.00
	50mm
	Zimmer Pty Ltd
ZI201	Zimmer ECT Screws	2.7mm Cortical Screws	6 - 50mm	$93.00
ZI551	Zimmer Universal Locking System	2.7 mm Locking T & L Plate Sterile 	2 hole head 3 hole shaft 	$93.00
	and Non-Sterile	39mm length; 2 hole head 5 
	hole shaft 62mm length; 3 
	hole shaft left 39mm; 3 hole 
	shaft right 39mm; 3 hole 
	shaft oblique left 42mm; 3 
	hole shaft oblique right 
	42mm; 5 hole shaft left 
	62mm; 5 hole shaft right 
	62mm; 5 hole shaft obl
	Breakoff
	Integra Neurosciences Pty Ltd
IG105	Hallu Break-off screw	Titanium with break-off barrel	Diameter 2.7mm, Length 11-	$338.00
	14mm
IG133	Snap-Off screws	Titanium break-off barrel screws for 	Diameter 2.7mm; length 10-	$338.00
	Hallu-Fix	34mm
	Lima Orthopaedics Australia Pty Ltd
LC056	Self Breaking Screw - Mini	Self Breaking Screw Mini	Diameter 2.7 mm x length 	$338.00
	11-22 mm
	LMT Surgical Pty Ltd
LM155	EOS Footset - Entos	Footscrew	11-14mm	$338.00
Prostheses List by Category, Groups and Sponsor	Page 414 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
OU029	TWIST-OFF SCREW	11 mm TWIST-OFF SCREW2.5MM 	10-18mm (1.5mm shank) 10-	$338.00
	Cancellous thread	18mm, 11-17mm (cancellous
	12 mm TWIST-OFF SCREW2.5MM 	 thread)
	Cancellous thread
	13 mm TWIST-OFF SCREW2.5MM 
	Cancellous thread
	14 mm TWIST-OFF SCREW2.5MM 
	Cancellous thread
	15 mm TWIST-OFF SCREW2.5MM 
	Cancellous thread
	17 mm TWIST-OFF SCREW2.5MM 
	Cancellous thread
	SCREW-OFF screw10mm (1.5mm 
	Shank)
	SCREW-OFF screw11mm (1.5mm 
	Shank)
	SCREW-OFF screw12mm (1.5mm 
	Shank)
	SCREW-OFF screw13mm (1.5mm 
	Shank)
	SCREW-OFF screw14mm (1.5mm 
	Shank)
	SCREW-OFF screw15mm (1.5mm 
	Shank)
	SCREW-OFF screw16mm (1.5mm 
	Shank)
	SCREW-OFF screw17mm (1.5mm 
	Shank)
	SCREW-OFF screw18mm (1.5mm 
	Shank)
	SCREW-OFF screw10mm 
	SCREW-OFF screw11mm
	SCREW-OFF screw12mm
	SCREW-OFF screw13mm
	SCREW-OFF screw14mm
	SCREW-OFF screw15mm
	SCREW-OFF screw16mm
	SCREW-OFF screw17mm
	SCREW-OFF screw18mm
Prostheses List by Category, Groups and Sponsor	Page 415 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Perios Pty Ltd
PF007	Forefoot Snap off Screws	Titanium Alloy Screws with Snap-off 	Weil self tapping L9 - L15	$338.00
	Grip
	Stryker Australia Pty Ltd
HW453	Fixos Screws	Bone Fixation Screws, Double 	2.2mm diameter, 11 to 16mm 	$338.00
	Threaded	(each 1mm)
	Tornier Pty Ltd
TO133	NexFix Snap-Off Screw	The NexFix Snap-Off Screw System is 	2.0mm x 11mm, 2.0mm x 	$338.00
	a self-drilling and self-tapping screw 	12mm, 2.0mm x 13mm, 2.7mm
	system for fixation of fractures, fusions 	 x 13mm, 2.7mm x 15mm, 
	and osteotomies. The design allows 	2.7mm x 17 mm
	the holding device to break off once 
	the screw head is in contact with the 
	distal cortex.
	Wright Medical Australia
WR035	Charlotte Foot & Ankle System	Snap-off screws, titanium alloy	2.0 dia 11, 12, 14mm. 2.7 dia	$338.00
	 13, 15, 17mm
WR230	Twist-off Screw	Unique feature of two thread diameters	2.5mm diameter x 11-15mm	$338.00
	 to suit variable bone quality, 
	specifically designed for Weil-
	osteotomy, titanium, self drilling and 
	self tapping, twist-off connector.
	Breakoff, CN
	Stryker Australia Pty Ltd
HW457	Fixos Screws	Bone Fixation Screws	2mm diam. X11mm lenth to 	$478.00
	2mm x 16mm
	CN
	Emergo Asia Pacific Pty Ltd
ER092	DeRoyal Internal Fixation Systems -	DeRoyal Internal Fixation Systems - 	Mini (2.01 - 2.7mm)	$233.00
	 cannulated screws	cannualted screws Stainless Steel 
	316L Manufactured in USA
	Lima Orthopaedics Australia Pty Ltd
LC118	Superscrew - Mini	Cannulated Cortical Partial or Full 	Dia. 2.7mm x 10-30mm length	$233.00
	Thread
LC129	MCD Cannulated Bone Screw - 	MCD Cannulated Bone Screw - Mini	2.0 to 2.3mm Dia x 08 - 	$233.00
	24mm Length
Prostheses List by Category, Groups and Sponsor	Page 416 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM156	EOS Footset-Pyxis	Footscrew	11-28mm	$233.00
LM180	Compression Screw - Mini	2.7mm diameter cannulated 	Length:14 - 24mm	$233.00
	compression screw
	Smith & Nephew Surgical Pty Ltd
SN970	Cannulated Screw	Stainless Steel	2.01mm - 2.1mm	$233.00
	Stryker Australia Pty Ltd
SR095	Stryker Cannulated Screw System	Asnis Micro Cannulated Screw	2.01mm-2.7mm, Diameters, 	$233.00
	8mm-40mm lengths
	Surgiplas Medical
SP035	OsteoMed Plating & Fixation System	Screws - Cannulated Lag	2.0mm x (6 - 16)mm; 2.4mm x	$233.00
	 (6 - 20)mm
SP036	OsteoMed Plating & Fixation System	Screws - Cannulated Lag	2.0mm x (18 - 42)mm; 2.4mm 	$233.00
	x (22 - 50)mm
	Synthes Australia Pty Ltd
SY321	AO/ASIF Screw	Cannulated screw	2.4mm	$233.00
	Tornier Pty Ltd
TO112	MaxTorque Cannulated Screw 	Bone screws, Titanium, Cannulated, 	Ø2.5mm Short Thread, 	$233.00
	System - Mini Cannulated Screws	Short or Long Thread	Length 18-30mm
	Ø2.5mm Long Thread, 
	Length 10-30mm
	Wright Medical Australia
WR246	Headed Compression Screw System	Cannulated compression screws - 	2.0-2.7mm x 10-50mm	$233.00
	titanium or stainless steel
	CN, DT
	Advanced Surgical Design & Manufacture Ltd
AE236	AutoFIX	The SBi AutoFIX Twin Pitch 	2.0mm and 2.5mm 	$423.00
	Cannulated Compression Screw 	Cannulated Compression 
	System implants are indicated in the 	Screw
	treatment of fractures, nonunions, 
	pseudarthrosis and degenerative 
	changes, as well as corrective 
	osteotomies geared towards a 
	functionally stable osteosynthesis
Prostheses List by Category, Groups and Sponsor	Page 417 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lima Orthopaedics Australia Pty Ltd
LC062	HVS BONE SCREW	Self drilling, self threading double 	Length 10-34mm	$423.00
	threaded cannulated screw
LC123	TwinLock Screw - Mini	TwinLock Screw - Mini	2.5/2.8mm Dia x 8 to 20 mm 	$423.00
	length
	Orthotech Pty Ltd
OH447	ExtremiFix Screws	Headless Cannulated Compression 	Diameter 2.0mm, 2.4mm. 	$423.00
	Screw	Length 10mm to 52mm; 
	Diameter 2.01mm - 2.7mm
	Stryker Australia Pty Ltd
HW454	Fixos Screws, Cannulated, Double 	Done Fixation Screws, Cannulated 	2.5mm  diameter, 10 to 30 	$423.00
	Threaded, 2.5mm	Threaded, 2.5mm	(each 2mm)
	Surgiplas Medical
SP121	ExtremiFix Screws	Headless Cannulated Compression 	Diameter 2.0mm, 2.4mm. 	$423.00
	Screw	Length 10mm to 52mm; 
	Diameter 2.01mm - 2.7mm
	Synthes Australia Pty Ltd
SY646	AO/ASIF Screws	HCS Countersinkable Compression 	2.4	$423.00
	Screw
	Tornier Pty Ltd
TO125	NexFix 2.5mm Compression Screw	The NexFix Compression Screw is a 	2.5mm diameter x 10 - 34mm 	$423.00
	stainless steel, cannulated, self 	length in 2mm increments
	tapping, and self drilling fixation 
	device for osteotomies, fusions and 
	fracture fixation of small bones
	CN,DT
	LMT Surgical Pty Ltd
LM181	Cannulated Self Tapping 	Cannulated Self Tapping Compression	Diameter 2.25 -2.6mm, 	$423.00
	Compression Screws	 Screws	Length: 10 -34mm
	Medical & Optical Instruments Australia Pty Ltd
MO356	Acutrak 2	Headless compression screw	2.5mm	$423.00
	Orthotech Pty Ltd
OH462	OsteoMed HPS	Bone screws - cannulated headless	2.4mm x 10-36mm	$423.00
OH475	DynafitSystem	Self-compressive screws	12-26mm	$423.00
OH481	HBS 2 mini	Self-compressive screws	2.5mm x10-40mm	$423.00
Prostheses List by Category, Groups and Sponsor	Page 418 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	DT
	Biomet Australia Pty Ltd
BH245	Rockwood Clavicle Pin	Clavicle Pin with dual thread	2.5mm	$257.00
	Lima Orthopaedics Australia Pty Ltd
LC137	MCD Double Threaded Bone Screw 	MCD Double Threaded Bone Screw - 	2.3/3.0 mm Dia x 08 - 26mm 	$283.00
	- Mini	Mini	Length
	Medical & Optical Instruments Australia Pty Ltd
MO373	Acutrak fusion Screws	Fusion Screws Titanium	2.01mm - 2.7mm	$283.00
	Orthotech Pty Ltd
OH476	DynafitSystem	Self-compressive screws	2/2.6 x 12-26mm	$283.00
	Zimmer Pty Ltd
ZI178	Zimmer Herbert Bone Screw	Double Threaded Compression Bone 	Scaphoid - 12 - 30mm 	$283.00
	Screw
ZI179	Zimmer Herbert/Whipple Bone 	Cannulated Double Threaded 	12 mm - 30 mm	$283.00
	Compression Bone Screw
	DT CN
	Ortho Solutions Pty Ltd
OU025	2.5 mm Meta Screw	Meta Screw	2.5mm length 10 up to 	$423.00
	2.5mm length 26mm
	DT, CN
	Biomet Australia Pty Ltd
BH241	Hand and Foot Fracture Systems	FRS Screw	10mm to 34mm L x 2.5mm 	$423.00
	Diameter
	Integra Neurosciences Pty Ltd
IG121	BOLD 2.5mm Compression Screw	Cannulated, double threaded 	Diameter 2.5mm, length 10-	$423.00
	compression screw	30mm
	Medartis
EO057	Aptus 2.2 Cannulated Headless 	APTUS® Cannulated Compression 	2.2 diameter.  Short and 	$423.00
	Compression Screws	Screws	long threaded 10mm to 
	DT, LK
	Medartis
EO073	APTUS Screws	Aptus Locking Screws	2.5mm Diameter	$423.00
Prostheses List by Category, Groups and Sponsor	Page 419 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK
	Austofix
AX043	VRP Distal Radius Fixation System,	Threaded, non-threaded, partially 	2.0, 2.5, 2.6mm diameter, 	$163.00
	 Threaded, mpm-threaded, partially 	threaded locking, non-locking screw, 	14mm-30mm lengths
	threaded locking, non-locking 	peg, titanium
	screw, peg, Titanium
AX083	VRP Distal Radius Fixation System 	Variable Angle Locking Screw, 	2.5mm, 10-30mm	$163.00
	- VRP VA locking Screw	Cobalt Chrome
	Biomet Australia Pty Ltd
BH294	Distal Radius Fracture Repair 	Locking titanium bone screws	2-2.5mm	$163.00
BH295	Distal Radius Fracture Repair 	'Multidirectional locking bone 	2-2.5mm	$163.00
BH296	Distal Radius Fracture Repair 	Locking titanium bone screws with 	2.0 - 2.5mm	$163.00
	dual thread
BH301	ALPS Hand Fracture System	Multidirectional locking bone screws	2.5mm	$163.00
BH303	ALPS Hand Fracture System	Locking Bone Screws	2.5mm	$163.00
BI929	Sternalock	Screws Ti	2.4-2.7mm x 8-12mm	$163.00
	Device Technologies Australia Pty Ltd
DE412	Low Profile Locking Screws	Locking screws for Arthrex Fracture 	2.7mm x (8-30mm)	$163.00
	Plate Fixation
	Emergo Asia Pacific Pty Ltd
ER087	DeRoyal Internal Fixation Systems -	Locking Screw, Stainless Steel 316L, 	Mini (2.01 - 2.7mm)	$163.00
	 Locking screws	manufactured in USA
	Integra Neurosciences Pty Ltd
IG123	VIPER with VALT - variable angle 	Variable angle locking screws	Diameter 12.7mm, length 	$163.00
	locking screws	10-30mm
IG126	Surfix Locking Screws	Locking screws with an independent 	2.7mm, 10 - 24mm length	$163.00
	lock-screw head
	Lima Orthopaedics Australia Pty Ltd
LC092	Diphos Plate - Threaded Head 	Threaded Head Screw - Mini	Diameter 2.3/2.7mm x 	$163.00
	Screw - Mini	Length 10-40mm
LC093	Diphos Plate - Threaded Pin with 	threaded Pin with Screw head	Diameter 2.3mm x Length 	$163.00
	Screw Head	30-40mm
LC136	MCD Locking Bone Screw - Mini	MCD Locking Bone Screw - Mini	2.3 / 2.7mm Dia x 06 - 30mm 	$163.00
	Length
Prostheses List by Category, Groups and Sponsor	Page 420 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM061	Xpode Screws	Xpode screws	2.4mm 	$163.00
LM112	Ascension Radial Head Plate 	Ascension Radial Head Plate 	2.7mm x 10mm - 40mm	$163.00
	Locking Screws
LM175	Screws -Locking -mini	2.7mm diameter locking screw	8 - 30mm	$163.00
LM185	Trimed Locking Cortical Screws	Locking cortical screw	2.7mm x 10 -20mm	$163.00
	Medical & Optical Instruments Australia Pty Ltd
MO320	Acumed Hexalobe Locking Screws	Acumed Hexalobe Locking Screws	Mini (2.01mm-2.7mm)	$163.00
MO369	Acumed Tap-Loc	Tap screws, Tap-Loc Screws	2.7mm 36mm-60mm length	$163.00
MO376	Acu-Loc Distal Radius Plate 	Locking screws	2.01-2.7mm	$163.00
	Orthotech Pty Ltd
OH453	OsteoMed FPS	Bone Screws - Locking	2/2.7m x 8-22mm	$163.00
OH463	OsteoMed HPS	Bone screws - angled locking	2.4mm x 6-36mm	$163.00
OH468	IXOS Radius Plpating System	Locking Screw	2.5 x 8-30mm	$163.00
	Smith & Nephew Surgical Pty Ltd
SL028	D-RAD SMART PACK	Cortical screws	2.01 mm - 2.7 mm	$163.00
SL030	D-RAD SMART PACK	VAL Locking screws 2.01mm - 2.7mm	2.01mm - 2.7mm	$163.00
SN968	Peri-Loc	Locking screws	2.01mm - 2.7mm	$163.00
SN969	Peri-Loc VLP	VAL Locking Screws 2.01mm - 2.7mm	2.01mm - 2.7mm	$163.00
	Stryker Australia Pty Ltd
SK527	Stryker Locking Plate System	Locking Screws	2.3-2.7mm	$163.00
	Synthes Australia Pty Ltd
SY651	AO/ASIF Cortex Screws	Locking Head Screws	2.4mm-2.7mm	$163.00
	Tornier Pty Ltd
TO104	Mini MaxLock Extreme System - 	Bone screws, Titanium, fixed or 	Ø2.4/2.7mm Fixed angle 	$163.00
	2.4/2.7mm Locking Screws	variable angle locking	locking, Length 6-40mm
	Ø2.4mm Variable angle 
	locking, Length 6-30mm
	Wright Medical Australia
WR032	Micronail Intramedullary Radial 	2.5mm titanium buttress screw	16 - 28mm	$163.00
	Fixation
Prostheses List by Category, Groups and Sponsor	Page 421 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR081	Ortholoc Fracture System	Titanium, variable angle locking 	2.4, 2.7mm diameter, 8-	$163.00
	100mm length
WR227	Titanium Screw	Locking, non-locking or cannulated, 	8-40mm, 2.7mm	$163.00
	for use only with Darco titanium 
	plates, self-tapping
WR243	Charlotte Claw Locking Screws	2.7mm stainless steel locking screws 	2.7mm, 12-36mm	$163.00
	for use with Claw Plate
WR257	Evolve EPS System 2.7 Locking	Stainless Steel Variable Angle 	2.7mm Diameter, 10-50mm	$163.00
	Locking Screws
	Zimmer Pty Ltd
ZI858	Zimmer Periarticular Locking 	2.4 & 2.7mm Periarticular Locking 	8-40mm	$163.00
	Screws
	LK, DT, CN
	LMT Surgical Pty Ltd
LM132	TriMed Compression Screws	Compression Screws	2.0mm – 2.5mm	$493.00
	06.03.04.04 - Micro (≤ 2.0mm)
	Biomet Australia Pty Ltd
BH299	ALPS Hand Fracture System	Bone Screws	1.0 - 2.0mm	$67.00
	Emergo Asia Pacific Pty Ltd
ER090	DeRoyal Internal Fixation Systems -	Screws, Stainless steel 316L, 	Micro (<=2.0mm)	$67.00
	 screws	manufactured in the USA
	Lima Orthopaedics Australia Pty Ltd
LC099	Osteosynthesis Bone Screws - 	Osteosynthesis Bone Screws - Micro	Dia 1.5/1.8/2.0mm x 4-40mm	$67.00
	 length
LC133	MCD Non Locking Bone Screw - 	MCD Non Locking Bone Screw - 	2.0mm Dia x 06-26mm Length	$67.00
	Micro	Micro
	LMT Surgical Pty Ltd
LM173	Screws - Standard - Micro	2mm diameter standard screw	5 - 19mm	$67.00
	Medartis
EO075	APTUS Screws	Cortical Screws	1.5mm - 2.0mm Diameter	$67.00
	Orthotech Pty Ltd
OH459	OsteoMed HPS	Bone Screws - threaded/lag	1.2/1.6/2.0mm x 4-36mm	$67.00
Prostheses List by Category, Groups and Sponsor	Page 422 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SL006	TC-100	Cortical Screws	≤2.0mm	$67.00
	Synthes Australia Pty Ltd
SY065	AO/ASIF Screws	Cortex Screw	≤2.0mm	$67.00
	Wright Medical Australia
WR256	Evolve EPS System Non-Locking	Stainless Steel Cortical Screws	1.5 - 2.0mm Diameter, 10-	$67.00
	40mm
	Zimmer Pty Ltd
ZI742	Zimmer ECT Screws	1.5mm Cortical Screws	6 - 18mm	$67.00
	Break off
	Device Technologies Australia Pty Ltd
DE364	QuickFix Screw Micro	Titanium Snap-off Small Bone Screw	2.0mm Diameter x 10-14mm 	$312.00
	lengths
	RQSolutions Medical Devices Distribution Support
RQ001	Orthomed Metallic Snap-off screw	The Snap-off screw is indicated for 	Thread diameter: 	$312.00
	fixation of bone fragments. Snap off 	2mm/cortical thread
	screws are breakable self tapping 	Core diameter: 1mm
	screws, which present a breakable 	Overall length: depending 
	cartridge necessary to the screw 	on reference
	setting. They are particularly intended	Threaded length: depending
	 to repair the 2nd, 3rd, 4th and 5th 	 on reference
	metatarsal of the foot.	2 opposite slots at the tip 
	(self drilling and self 
	tappering profile)
	4 slots in the screw head for 
	screwdriver grip
	Breakoff
	Biomet Australia Pty Ltd
BH193	Twistoff Screw	TwistOff Screw Titanium	11-14mm Long	$312.00
	Integra Neurosciences Pty Ltd
IG135	Spin screw: Snap-off screws	Titanium break-off barrel screws	Diameter 2.0 mm, Length 11 	$312.00
	-14mm
	Lima Orthopaedics Australia Pty Ltd
LC077	Self Breaking Screw - Micro	Self Breaking Screw - Micro	Dia 2.0 mm x Length 7-24 mm	$312.00
Prostheses List by Category, Groups and Sponsor	Page 423 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM172	Peri-Loc	2.0mm Twist-Off Screw	2.0mm Twist-Off Screw 8mm,	$312.00
	 2.0mm Twist-Off Screw 
	10mm, 2.0mm Twist-Off 
	Screw 12mm, 2.0mm Twist-
	Off Screw 14mm, 2.0mm 
	Twist-Off Screw 16mm, 
	2.0mm Twist-Off Screw 
	18mm
	Wright Medical Australia
WR229	Twist-off Screw	Unique feature of two thread diameters	2.0mm diameter x 11-15mm	$312.00
	 to suit variable bone quality, 
	specifically designed for Weil-
	osteotomy, titanium, self drilling and 
	self tapping, twist-off connector.
	CN, DT
	LMT Surgical Pty Ltd
LM187	Foot Motion - weil screws	Weil screw is a titanium self tapping, 	2.0mm diameter, length 8mm 	$397.00
	self-cutting screw	- 15mm
	Synthes Australia Pty Ltd
SY647	AO/ASIF Screws	HCS Countersinkable Compression 	1.5	$397.00
	Screw
	CN,DT
	Orthotech Pty Ltd
OH461	OsteoMed HPS	Bone screws - cannulated headless	2.0mm x 10-36mm	$397.00
	DT
	Tornier Pty Ltd
TO128	NexFix Compression Pin	The NexFix Compression Pin is a 	2.0mm x 10mm, 2.0mm x 	$257.00
	tapered stainless steel compression 	12mm, 2.0mm x 14mm, 2.0mm
	pin for use in maintaining alignment 	 x 16mm, 2.7mm x 20mm, 
	and providing interfragmentary 	2.7mm x 24mm, 3.5mm x 
	compression of small bones in 	25mm, 3.5mm x 30mm
	osteotomies, fusions and fractures 
	until a stable bony union occurs. It is 
	self drilling 
Prostheses List by Category, Groups and Sponsor	Page 424 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	DT, Break off
	Medical & Optical Instruments Australia Pty Ltd
MO367	Acumed Fixation Screw	Acutrak Compression Screw Titanium	≤2mm	$502.00
	DT, LK
	Medartis
EO072	APTUS Screws	Aptus Locking Screws	1.5mm - 2.0mm Diameter	$297.00
	LK
	Biomet Australia Pty Ltd
BH300	ALPS Hand Fracture System	Locking Bone Screws	1.0 - 2.0mm	$137.00
	Emergo Asia Pacific Pty Ltd
ER100	DeRoyal Internal Fixation Systems -	Locking Screws, Stainless Steel 	Micro (<= 2.0mm)	$137.00
	 Locking Screws	316L, manufactured
	Lima Orthopaedics Australia Pty Ltd
LC135	MCD Locking Bone Screw - Micro	MCD Locking Bone Screw - Mini	2mm Dia x 08 - 26mm 	$137.00
	Length
	LMT Surgical Pty Ltd
LM110	NewClip Distal Radius Screws	Cortical Bone Screw	2.0mm x 14-28mm	$137.00
	Orthotech Pty Ltd
OH460	OsteoMed HPS	Bone screws - angled locking	1.6/2mm x 6-36mm	$137.00
	Stryker Australia Pty Ltd
SK526	Stryker Locking Plate System	Locking Screws	1.2-2.0mm diameter	$137.00
	Synthes Australia Pty Ltd
SY650	AO/ASIF Cortex Screws	Locking head screws	1.5-2.0mm	$137.00
	Wright Medical Australia
WR030	Evolve Locking Cancellous Bone 	The Evolve stainless steel locking 	2.0mm x 14 - 28mm	$137.00
	Screws
WR073	Ortholoc Fracture System	Titanium, variable angle locking 	2.0mm diameter, 8 - 100mm 	$137.00
	length
WR258	Evolve EPS System 2.0 Locking	Stainless Steel Variable Angle 	2.0mm Diameter, 10-50mm	$137.00
	Locking Screws
Prostheses List by Category, Groups and Sponsor	Page 425 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LK, DT, CN
	LMT Surgical Pty Ltd
LM131	TriMed Compression Screws	Compression screws	1.7mm	$467.00
	06.03.04.05 - Dynamic
	Advanced Surgical Design & Manufacture Ltd
AE068	ASDM Clavicle Compression 	Clavicle Compression PinTitanium 	3.2 & 4.0 mm x 50mm - 130mm	$247.00
	Screw, Double Threaded
	Austofix
AX054	Tectona Hip Plate - Standard Lag 	Hip Lag Screw, sterile packed	12.5mm, 14.5mm	$247.00
	Screw
AX055	Tectona Hip Plate - Lag Screw HA 	Hip Lag Screw HA coated, sterile 	12.5mm - lengths 50-145mm	$247.00
	coated	packed
	Ortho Solutions Pty Ltd
OU035	CHS/SCS Lag Screw	Lag Screrw	CHS/SCS Lag Screw 50mm 	$247.00
	to145mm
	Smith & Nephew Surgical Pty Ltd
SN489	Intermediate Osteotomy System	Lag	35 mm - 85mm, 1 1/2" - 3-3/4"	$247.00
SN492	Paediatric Osteotomy System	Lag Screw	22mm- 40mm	$247.00
	Stryker Australia Pty Ltd
HW333	Omega Plus Compression Hip 	Lag Screw - Standard -  Stainless Steel	50-130mm length 	$247.00
	Screw System
HW334	Omega Plus Compression Hip 	Lag Screw - Super -  Stainless Steel	50-130mm length 	$247.00
	Screw System
SK228	Omega Plus Compression Hip 	Cephalic Implants	Hansson Twin Hook 50-	$274.00
	Screw System	140mm
	Synthes Australia Pty Ltd
SY054	AO/ASIF Screws	DHS/DCS lag screw	50-145mm L	$247.00
SY690	MultiLoc Screw	Conical, Locking "Screw-in-Screw"	4.5mm; 20mm - 60mm 	$247.00
	Length
	Zimmer Pty Ltd
ZI158	Zimmer Internal Fixation Systems: 	Freelock/Versa-fx lag screw - Stainless	50 mm - 150 mm long	$247.00
	Compression Hip Screw	 Steel
Prostheses List by Category, Groups and Sponsor	Page 426 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.04.06 - Screw Washers
	Austofix
AX027	Austofix Femoral & Tibial Nailing 	Washer for screws; s-s	Dia 11mm & 13mm	$103.00
	System
	Biomet Australia Pty Ltd
BH169	Washerloc Tibial Fixation Device	Interference Anchor Plate	(4.75 or 6.5)mm dia x 15-	$103.00
	50mm
BH189	Small / Large Fragment Set S/S	Washer Spiked, Standard, Cancellous,	One size only	$103.00
	 Cortical & Fastening Wire
BH280	ALPS SFS	Flat and cupped Titanium washers	Flat and cupped	$103.00
BH286	ALPS LFS	Flat and cupped Titanium washers	4.5-6.5mm	$103.00
BH332	Small / Large  Fragment Set	Washer Titanium - 	One size only	$103.00
	Flat/Cup/Countersink
	Device Technologies Australia Pty Ltd
DE071	Washer	Screw Washer	7 - 15mm	$103.00
DE163	Bio-Post & Washers	PLLA composition	Implant 35mm - 50mm, 	$103.00
	Washers 16mm
	Emergo Asia Pacific Pty Ltd
ER093	DeRoyal Internal Fixation Systems -	Washers, threaded and unthreaded, 	3.0mm - 13.0mm	$103.00
	 Washers	Stainless Steel 316L, manufactured in 
	USA
	Johnson & Johnson Medical Pty Ltd
JJ824	Bristow-Latarjet Instability 	Cannulated titanium top hat screw	One size only	$103.00
	Shoulder Set - Top Hat Screw
	Lima Orthopaedics Australia Pty Ltd
LC087	TNP® Bone Washer Ti	TNP® Bone Washer Ti	13mm to 19mm	$103.00
LC121	Versa Screw Washer	Versa Screw Washer	One Size	$103.00
	LMT Surgical Pty Ltd
LM081	Surgicraft Washers	Fixation Washers	0.5-3mm	$103.00
	Medical & Optical Instruments Australia Pty Ltd
MO158	Polarus Humeral Rod System	Polarus Washer	3.5mm	$103.00
Prostheses List by Category, Groups and Sponsor	Page 427 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH458	OsteoMed FPS	Screw Washers	2/2.7/3.5/4.0mm	$103.00
	Smith & Nephew Surgical Pty Ltd
SL007	Universal Washers	Screw Washers	All sizes	$103.00
SN424	ACL/PCL Reconstructions	Acufex Spiked Washer	One size only	$103.00
	Stryker Australia Pty Ltd
HW298	Asnis Guided Screw System	Washer, Stainless Steel	One size only	$103.00
HW299	Asnis Guided Screw System	Washer -  Titanium	4, 5, 6.5,8mm	$103.00
SK201	Stryker Trauma Locking Nail 	Proximal Humeral Nail	Proximal Humerous Washer 	$103.00
	round/square
SK565	Stryker Plating System	Washers	7-13mm	$103.00
	Synthes Australia Pty Ltd
SY092	AO/ASIF Washers	Washers	1.0mm - 16mm D	$103.00
	Tornier Pty Ltd
TO115	MaxTorque Cannulated Screw 	Screw washer, Titanium, Contoured or	Ø4.0 to 7.0mm	$103.00
	System- Washers	 Flat
TO127	NexFix Washer	The NexFix Washer is a threaded 	9mm, 11mm, 13mm	$103.00
	circular piece of stainless steel 
	through which is inserted a NexFix 
	Compression Screw. The Compression
	 Screw is locked to the washer to form 
	a headed screw that will increase bone
	 coverage and prevent the screw from 
	sinking
	Wright Medical Australia
WR060	Ring washer	Screw Washers	2.7/3.7/4.0/4.5	$103.00
	Zimmer Pty Ltd
ZI210	Zimmer Large-Frag System	Washer/Spiked washer	Small & Large	$103.00
	Ti
	Smith & Nephew Surgical Pty Ltd
SN982	Double-spiked plate	Low-profile washer for tibial fixation 	10-25mm	$85.00
	system
Prostheses List by Category, Groups and Sponsor	Page 428 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.04.07 - Screw post/peg
	ConMed Linvatec Australia Pty Ltd
LV022	EndoPearl Bio-Absorbable Implant 	ACL Fixation - PLLA	7mm - 9mm	$140.00
	- ACL Fixation
	LMT Surgical Pty Ltd
LM041	Trimed Bearing Plate, Fixation Pegs	Bearing plate fixation pegs	2.3mm	$140.00
	Medartis
EO088	Aptus Shoulder (Spiral Blades )	Spiral Blades Proximal Humerus	3.5mm System	$140.00
	Smith & Nephew Surgical Pty Ltd
SL029	D-RAD SMART PACK	Variable angle locking screw or peg	1.0 - 2.0mm	$140.00
SN422	Fixation Post	Tibial fixation device	25 -55mm	$140.00
	Stryker Australia Pty Ltd
SK154	Stryker Cross-Screw	HA/PLLA screw for ligament/tendon 	Dia 6mm: Length 40-60mm	$140.00
	fixation
SK155	Wedge Interference screw	Threaded PLLA screw with cross pin 	Dia 7-12mm, Length 20-	$140.00
	for ligament/tendon fixation	40mm; pin length standard
	Synthes Australia Pty Ltd
SY110	AO/ASIF Screws	Buttress Pin	Various lengths	$140.00
SY435	Epoca Custom Offset Shoulder 	Epoca Glenoid Screw	8-30mm	$140.00
	Prosthesis
SY649	AO/ASIF Screws	Self Drilling, self tapping, conical 	≥ 3.5mm	$140.00
	screws
	Tornier Pty Ltd
TO098	MaxLock Extreme System - DRLock 	Locking Peg, Titanium	Ø2.0mm, Length 10-30mm	$140.00
	Extreme Locking Peg
	06.03.04.08 - Screw Accessories - Nuts
	Stryker Australia Pty Ltd
SK566	Stryker Plating System	Nuts	4.5-5.0mm	$40.00
	Zimmer Pty Ltd
ZI209	Zimmer Large-Frag System	Cortical Nut for 4.5mm screw	Small & Large	$40.00
Prostheses List by Category, Groups and Sponsor	Page 429 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.04.09 - Screw Accessories - Locking Nuts
	Stryker Australia Pty Ltd
HW274	Stryker Plating System	Locking Insert/Plug Assembly	5mm	$280.00
	Zimmer Pty Ltd
ZI859	Zimmer Periarticualr Locking 	1.8mm Periaticular Locking Pegs	18-30mm	$280.00
	06.03.04.10 - Screw Accessories - Caps
	Smith & Nephew Surgical Pty Ltd
SN945	Peri-Loc	Screw Accessories, Hole Filler	4.5mm	$130.00
	Stryker Australia Pty Ltd
HW335	Omega Plus Compression Hip 	Compression Screw -  Stainless Steel	25mm length	$130.00
	Screw System
	Synthes Australia Pty Ltd
SY195	Orthopaedic External Fixator 	Protective caps for rods, protection 	One size only	$10.00
	Tornier Pty Ltd
TO110	MaxLock Extreme System  - PEEK 	Locking Ring, PEEK,Pre - assembled 	Ø 2.4/3.5mm	$130.00
	ring	on inserter
	Zimmer Pty Ltd
ZI597	NCB Plating System	NCB Spacers & Screw Caps	1, 2 and 3	$130.00
06.03.05 - Surgical Accessories
	06.03.05.01 - Wires
	Advanced Surgical Design & Manufacture Ltd
AE052	ASDM K-wire	Stainless steel - sterile	Dia 0.7 - 2.5mm, length 100 	$12.00
	- 230mm
	Biomet Australia Pty Ltd
BH201	Ace External Fixator	Olive wire bayonet point - stainless 	1.5 or 1.8mm	$12.00
	steel, packet of 3
BH202	Ace External Fixator	Wire bayonet point - stainless steel	1.8mm	$12.00
BH335	Small / Large Fragment Set S/S	K/Wire Stainless Steel 	0.8 to 3.0 mm x 6-9" or 150-	$12.00
	500mm
Prostheses List by Category, Groups and Sponsor	Page 430 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER054	Nile CoCr Wire System	CoCr wire	1.0mm	$12.00
	Johnson & Johnson Medical Pty Ltd
DP045	Isola System (Stainless Steel)	Double Wire	One size only	$12.00
	Lima Orthopaedics Australia Pty Ltd
LC088	Clavical Fracture Wire	Threaded Clavical Fracture Wire	Diameter 2 - 2.5 - 3 - 3.5 - 4 -	$12.00
	 4.5 - 5mm x Length 280mm
	Link Orthopaedics  Australia
LO147	Bone Cerclage Wire	Cerclage Wire	Length 470mm, Diameter 	$12.00
	sizes of 0.4mm, 0.5mm, 
	0.6mm, 0.7mm, 0.8mm. 
	Packet size of 10
	Medtronic Australasia Pty Ltd
MC506	Orfil	Double Pearl-Tipped Wires	1 - 350mm	$12.00
	Orthotech Pty Ltd
OH260	Hartshill	Wire (packet 10) stainless steel	1.2mm diam & 0.9mm dia	$12.00
	Smith & Nephew Surgical Pty Ltd
SN440	Ilizarov	Wires	300-370 length x 1-1.8mm 	$12.00
	diameter
SN459	Wire	Suture	18Ga - 28Ga	$12.00
SN460	Wire	Cerclage	0.6mmx175mm - 	$12.00
	0.8mmx200mm
	Wright Medical Australia
WR063	K Wire	Titanium or stainless steel, single or 	0.9 - 2.0mm	$12.00
	double trocar
	Zimmer Pty Ltd
ZI293	Zimmer Wires	Stainless Steel	Length 23cm, Thickness 	$12.00
	2mm, 0-4mm, 8mm
ZI294	Zimmer Wires	Stainless Steel	Length 7, 6cm - 23cm, 	$12.00
	Thickness 0mm, 7mm - 2mm, 
	0mm
Prostheses List by Category, Groups and Sponsor	Page 431 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	OL
	Johnson & Johnson Medical Pty Ltd
DY528	Expedium Spinal System - Cobalt 	CoCr wire single with/without 	1.0mm	$166.00
	Chrome Single Wire
	Ortho Solutions Pty Ltd
OU002	RFS OLIVE WIRE	RFS OLIVE WIRE	1.8MM X 400MM	$166.00
	1.5MM X 300MM
	Smith & Nephew Surgical Pty Ltd
SN441	Ilizarov	Wires with stopper	300-370 length x 1-1.8mm 	$166.00
	diameter
	06.03.05.02 - Pins
	Advanced Surgical Design & Manufacture Ltd
AE070	ASDM Steinmann Pin	Steinmann Pin	2.8-5.0mm diameter	$30.00
AE238	SBi K-Wire	K-Wire	1.6mm	$30.00
	Biomet Australia Pty Ltd
BI232	Moore Pins	Scan Pin, Stainless Steel	16mm x 51-152mm	$30.00
BI271	EBI XFIX Dynafix System	Wire Straight or Olive with Washer, 	160 or 200mm x (1.6 or 	$30.00
	Chrome Cobalt	2.0mm)
BI304	Rush Intramedullary Pins	Stainless Steel	3.2mm x (100-250mm)	$30.00
BI306	Rush Intramedullary Pins	Stainless Steel	(6 - 6.4mm) x (280 - 440mm)	$30.00
BI857	Kirschner Wires	Stainless Steel wire	(1-3.2mm) diameter x (100 to	$30.00
	 310mm) length
	CK Surgitech Pty Ltd
AK004	Kirschner Wires	Kirschner Wire	0.6mm to 3.0mm diameter / 	$10.00
	various lengths
	Emergo Asia Pacific Pty Ltd
ER147	DeRoyal Internal Fixation  Systems 	Wires, threaded and unthreaded, 	1.0mm - 2.8mm Threaded and	$30.00
	- Wires	Stainless Steel 316L, manufactured in 	 Unthreaded
	USA
	Integra Neurosciences Pty Ltd
IG073	K-Wire (Kirschner)	Stainless steel	70mm, 100mm, 200mm 	$30.00
	length
Prostheses List by Category, Groups and Sponsor	Page 432 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
IG074	Tac-Pin (Threaded)	Compression pin-titanium	1.7mm diam 15-25mm length	$30.00
	Johnson & Johnson Medical Pty Ltd
DP809	Small / Large Fragment Set S/S	K-wire standard	0.2-3.5mm	$30.00
	Lima Orthopaedics Australia Pty Ltd
LC076	Steinmann Pin	Steinmann	Diameter 2 - 5mm x Length 	$30.00
	150 - 250mm
LC089	Kirschner Wire	Kirschner Wire - Various	Diameter 1 to 3mm x 80 to 	$30.00
	310mm Length
LC145	MCD K-Wire Threaded	Threaded Stainless Steel (<2mm)	0.6 to 2.0mm Dia x 150 to 	$30.00
	200mm Length
LC146	MCD K Wire Non-Threaded	Non-Threaded Stainless Steel (>2mm)	2.8mm Dia x 200 to 450mm 	$30.00
	Length
LC147	MCD K Wire Non-Threaded	Non-Threaded Stainless Steel K Wire 	0.6 to 2.0mm Dia x 150 to 	$30.00
	(<2mm)	200mm Length
LC148	MCD K Wire Threaded	Threaded Stainless Steel (>2mm)	208mm Dia x 200 to 450mm 	$30.00
	Length
	LMT Surgical Pty Ltd
LM014	Trimed Marked K-Wire	Stainless Steel	Diameter 0.9 - 1.1mm	$30.00
	Medartis
EO089	Aptus K-wires	K-wires	0.8mm-1.8mm Diameter, 	$30.00
	100mm - 150mm in length
	Medical & Optical Instruments Australia Pty Ltd
MO177	Acutrak Fixation Screw	Wire Kirschner Stainless Steel	0.70mm to 1.6mm diameter, 4	$30.00
	 to 9in (10.16 to 22.86mm) 
	length
MO209	Acumed Congruent Plate System	Threaded K-Wire - Titanium	WT-1606STT: Length 15cm	$30.00
	 x Diameter 0.62"; WT-
	0906STT: Length 15cm x 
	Diameter 0.35"; WS-
	2408STT length 20.32cm x 
	Diameter 0.24cm
Prostheses List by Category, Groups and Sponsor	Page 433 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
OU001	RFS STRAIGHT WIRE	RFS STRAIGHT WIRE	RFS STRAIGHT WIRE 	$11.00
	1.8MM X 370MM
	RFS DT STRAIGHT WIRE 
	1.8MM X 370MM
	RFS STRAIGHT WIRE 
	1.5MM X 300MM
	RFS TITANIUM 
	STRAIGHT WIRE 1.8MM 
	X 370MM
OU003	K-WIRE DOUBLE TROCAR	K-WIRE DOUBLE TROCAR	1.1mm x 150mm	$30.00
	1.6mm x 125mm
	2.0mm x 150mm
	Smith & Nephew Surgical Pty Ltd
SN451	Wire	Kirschner	Various 1.3 - 304.8mm	$30.00
	Stryker Australia Pty Ltd
HW368	Osteo Kirschner Wire	K wire -  Stainless Steel	Diameter 1.0 - 2.0mm	$30.00
SK213	Hoffmann II External Fixation 	Hoffmann II Micro	K-wire	$30.00
ST007	Stryker Plating System - K Wires	Stainless Steel or Titanium	150mm length in 1.25, 1.6, 	$30.00
	2.0mm diameter
ST890	Steinmann Pins	Stainless Steel	7,9"	$30.00
	Surgical Specialties
SQ076	K wires	k wire threaded	1.6mm	$30.00
	Synthes Australia Pty Ltd
SY249	AO/ASIF K Wires, Pins 	Hybrid Pins - Spade point 	1.5, 3.2mm Diameter	$30.00
	wires/reduction wires
SY787	AO/ASIF K-Wires	K-Wires	0.25 - 400mm	$30.00
	Trewavis Surgical Instruments Pty Ltd
TS001	Trewavis Surgical Kirschner Wires	Composition: Stainless Steel, Model 	Dia 0.7-2.8mm, Length 100-	$30.00
	No: 200-000-A to 200-930-K	230mm
TS002	Trewavis Surgical Steinmann Pins	Composition:  Stainless Steel, Model 	Dia 3.0 - 5.0mm	$30.00
	Nos: 200 - 950-L to 200-970-Q
	Zimmer Pty Ltd
ZI323	Zimmer Wires	Stainless Steel Rushpins	Diameter 2.4 - 6.4mm; 	$30.00
	Length 2.5 - 52.7cm
Prostheses List by Category, Groups and Sponsor	Page 434 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	AB
	B Braun Australia Pty Ltd
BB060	BRAUN AUST Intramedullary 	Isosorb Resorbable Fixation Pin	2mmx60mm-3.5mmx80mm	$294.00
	Biomet Australia Pty Ltd
BH319	Orthosorb Absorbable Pin	Orthosorb - Polydiaxanone Fixation 	40 x 1.3mm	$294.00
	Pins 3 pins per pkt
BH320	Orthosorb Absorbable Pin	Orthosorb - Polydiaxanone 3 pins per	40mm x 2mm	$294.00
	 pkt
BH321	Orthosorb Absorbable Pin	Orthosorb Pkt 1 - Polydiaxanone	1mm x 40mm x 1.3mm	$294.00
BH322	Orthosorb Absorbable Pin	Orthosorb Pkt 1 - Polydiaxanone	40 x 2.0mm	$294.00
BH324	Orthosorb Absorbable Pin	Orthosorb -Polydiameterxanone	50 x 1.3mm	$294.00
BH325	Orthosorb Absorbable Pin	Orthosorb - Polydiaxanone 2 pins per	40mm x 2.0mm	$294.00
	 pkt
BH326	Orthosorb Absorbable Pin	Orthosorb Arthroscopic Fix-Set - 	40 x 1.3mm	$294.00
	Polydiaxanone 5 pins per pkt
	ConMed Linvatec Australia Pty Ltd
LV050	Bionx Implants - Rods 	PGA, PLA or PLLA	1.5mm x 10-70mm	$294.00
LV051	Bionx Implants - Rods 	PGA, PLA or PLLA	2.0mm	$294.00
LV063	SmartNail	Self-Reinforced 96L/4D PLA Bone 	1.5mm O.D x 16, 20 & 25mm	$294.00
	Fixation Nail	 L
LV084	SmartNail	Self-reinforced 96L / 4D PLA Bone 	2.4mm O.D x 16, 25, 35 & 	$294.00
	Fixation Nail	45mm L
LV088	SmartPin Resorbable Bone Fixation 	Self-Reinforced PLLA	10, 20, 30 & 40mm	$294.00
	Pin, 1.1mm
	Device Technologies Australia Pty Ltd
DE273	Trim-IT Spin Pin	Trim-IT  Pin Fixation	1.5 - 2.0mm x 100mm	$294.00
	Surgical Specialties
SQ063	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Pin 1.5 & 2 mm dia x 20-50 	$294.00
	copolymer	mm long
Prostheses List by Category, Groups and Sponsor	Page 435 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO129	Activa Pin	The Activa pin is a bioreabsorbable 	1.5mm x 50mm, 2.0mm x 50mm	$294.00
	grooved pin device for fixation of 
	bone fractures, osteotomies, 
	arthrodeses, and osteochondral 
	fractures. They are designed to 
	maintain structural function for up to 
	8 weeks and to completely resorb 
	within 2 years, eliminating the need 
	for implant removal.
	COM
	Stryker Australia Pty Ltd
SK230	Hansson Pin	Cephalic Implants	Hansson Pin 70-140mm	$358.00
	OL
	Johnson & Johnson Medical Pty Ltd
DP480	DePuy Spinal Wire	Wire with Button or Beaded Wire	18 - 24 gauge wire	$134.00
DY527	Expedium Spinal System - Cobalt 	CoCr wire double with/without button	1.0mm	$134.00
	Chrome Double Wire
	Medical & Optical Instruments Australia Pty Ltd
MO162	Tension Band Pin	Stainless Steel	50 to 90mm	$134.00
	Stryker Australia Pty Ltd
SK117	Stryker Kirschner Wires	Olive Wires	1.0- 2.0mm Diameter	$134.00
	TH
	Advanced Surgical Design & Manufacture Ltd
AE069	Threaded wires & pins	Threaded wires & pins	1.0-5.0mm diameters	$30.00
	various threaded lengths
	06.03.05.03 - Cables
	Biomet Australia Pty Ltd
BI253	BMP Cable System	Cable Chrome Cobalt	1.6mm or 2.0mm	$379.00
BI256	BMP Cable System	Cable, Stainless Steel	1.6mm or 2.0mm	$379.00
	Medical & Optical Instruments Australia Pty Ltd
MO166	Osteo Clage Cable System	CoCr, Stainless Steel Cable	850mm	$379.00
Prostheses List by Category, Groups and Sponsor	Page 436 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Perios Pty Ltd
PF014	TLS- Tendon 	Suspension tape for anchoring tendon	One size - 6mm	$379.00
	Anchoring/Suspension Tape	 for ACL/PCL reconstruction
	Stryker Australia Pty Ltd
HW309	Dall Miles Cable Grip System - 	Vitallium: Cable -  Vitallium	1.6 and 2mm	$379.00
	Vitallium
	Synthes Australia Pty Ltd
SY276	Spine Cable System	Single Lead	One size only	$379.00
	Zimmer Pty Ltd
ZI161	Zimmer Internal Fixation Systems: 	Cable-Ready Stainless Steel	1.3 mm	$379.00
	Cable System
ZI163	Zimmer Internal Fixation Systems: 	Cable-Ready Plate Cable Stainless 	610 mm long	$379.00
	Cable System
	06.03.05.04 - Cables - with in-built locking device
	Advanced Surgical Design & Manufacture Ltd
AE171	Blackstone - Posterior Cervical 	Double  Loop Cable w/Four Crimps - 	One size only	$539.00
	System	Titanium
AE172	Blackstone - Posterior Cervical 	Single Loop Cable w/Two Crimps - 	One size only	$539.00
	System	Titanium
	Global Orthopaedic Technology
GO092	C-Fix Cable Fixation System	Titanium Leader Cable Assembly	1-1.3mm	$539.00
GO168	Iso-Elastic™ Cerclage System	Iso-Elastic™ Cerclage Cable 	One Size Only	$539.00
	Johnson & Johnson Medical Pty Ltd
DP364	Control Cable with Sleeve	Control Cable with sleeve 	One size only	$539.00
	Lifehealthcare Pty Ltd
LH496	Jazz Posterior Fixation System - 	A multi-purpose Ti alloy connector 	3.5mm to 6.0mm, all sizes in 	$539.00
	Multipurpose Connector	which is clipped onto 5.5 diameter 	between.
	Medtronic Australasia Pty Ltd
MI146	Atlas Cable System	Single	One size only	$539.00
	Smith & Nephew Surgical Pty Ltd
SN732	Accord	Orthopaedic Cable System, SS Cable 	2.0mm	$539.00
	w/clamp
Prostheses List by Category, Groups and Sponsor	Page 437 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW524	Dall Miles Cable Grip System	Cable and sleeve	1.6mm and 2.0mm	$539.00
	Synthes Australia Pty Ltd
SY377	Orthopaedic Cable System	Cable with Crimp	1.0mm - 1.7mm, 750mm	$539.00
	Zimmer Pty Ltd
ZI164	Zimmer Internal Fixation Systems: 	Cable-Ready GTR Distal end Cable - 	635 mm long	$539.00
	Cable System	Cobalt Chrome
ZI170	Zimmer Internal Fixation Systems: 	Cable-Ready Pin - Stainless Steel	35, 40, 45, 65mm long	$539.00
	Cable System
ZI173	Zimmer Internal Fixation Systems: 	Cable-Ready GTR Cable - Proximal 	635mm long	$539.00
	Cable System
ZI174	Zimmer Internal Fixation Systems: 	Cable-Ready Stainless Steel Cable	1.8mm	$539.00
	Cable System
	06.03.05.05 - Cables - with >1 locking device
	Johnson & Johnson Medical Pty Ltd
JJ923	Songer Cable System	Double loop Cable with 2 crimps	One size only	$539.00
	Lima Orthopaedics Australia Pty Ltd
LC049	DCD Cerclage Cable	The DCD cerclage cable is used to 	Single size only.	$539.00
	treat femoral fractures, humeral and 
	tibial fractures, diaphyseal 
	reconstruction in revision hip 
	arthroplasty and diaphyseal 
	reconstruction in revision shoulder 
	arthroplasty. The spacers minimise 
	contact with the periostium to reduce 
	the potential of interruption to the 
	periosteal blood supply to facilitate 
	bone healing.
	Medigroup Australia
MZ007	Pioneer Cable System	Pioneer Titanium Sternal Orthopaedic	One diameter size (1.10mm) 	$470.00
	 Cable and Crimp - Single	Reverse cutting needle
MZ008	Pioneer Cable System	Pioneer Stainless Steel Sternal 	One diameter size (1.10mm) 	$470.00
	Orthopaedic cable and crimp - Single	There are 4 needle types on 
	the cables. Cutting Edge, 
	Blunt Tip, Tapered Tip, 
	Reverse Cutting.
Prostheses List by Category, Groups and Sponsor	Page 438 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MZ009	Pioneer Cable System	Pioneer Stainless Steel Sternal 	One diameter size (1.10mm)	$470.00
	Orthopeadic Cable and Crimp - 4 Pack	
	There are four needle types 
	on the cables. Cutting edge, 
	Blunt Tip, Tapered Tip, 
MZ012	Tritium SCP (Sternal Cable Plate)	Periarticular Titanium Sternal Double 	One Size	$539.00
	Double Cable Plate (6 Holes, 2 	Cable Plate, 6 Holes, 2 Integrated 
	Integrated Cables)	Cables, Locking Plate
MZ013	Tritium SCP (Sternal Cable Plate)	BOX Plate (4 Holes, 1 Integrated 	One Size	$539.00
	Cable)
MZ014	Tritium SCP (Sternal Cable Plate)	Periarticular Titanium Sternal X Plate,	One Size	$539.00
	 8 holes, 1 Integrated Cable, Locking 
	Screws
MZ015	Tritum SCP (Sternal Cable Plate), 	Cannullous Locking Rescue Screw for	Diameter: 3.0mm	$539.00
	Rescue Screw	 use with Pioneer Tritium SCP 	Lengths: 8mm, 10mm, 12mm,
	(Sternal Cable Plate), 3.0mm	 14mm, 16mm,18mm,20mm
MZ016	Tritium SCP (Sternal Cable Plate)	V Shaped Titanium Sternal Plate, 4 	one size	$539.00
	Holes, Locking Screw/Plate, Complex
	 Shape
MZ017	Tritium SCP (Sternao Cable Plate), 	Cannullous Locking Screw for use 	"Diamter: 2.7mm	$539.00
	Standard Screw	with Pioneer Tritium SCP (Sternal 	Lengths: 8mm, 10mm, 12mm,
	Cable Plate), 2.7mm	 14mm, 16mm, 18mm, 20mm"
	Medtronic Australasia Pty Ltd
MI147	Atlas Cable System	Double w/2 crimps	One size only	$539.00
	Orthotech Pty Ltd
OH258	Songer cable system	Double loop titanium spinal cable 	One size only	$539.00
	plus crimps
	Stryker Australia Pty Ltd
SK401	Trochanteric Grip	Dall-Miles Trochanteric Grip with 2 	Small, Medium and Large	$539.00
	Chrome Cobalt Cables
	06.03.05.06 - Wire forms (including washers/screws) - all sizes
	LMT Surgical Pty Ltd
LM001	TriMed Wrist Fixation System	Washer	.	$123.00
Prostheses List by Category, Groups and Sponsor	Page 439 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY257	A/O/ASIF K-wires	Cerclage Wire - coils with and 	0.4-2.5mm	$123.00
	without eye
	06.03.05.07 - Cerclage bands
	Lifehealthcare Pty Ltd
LH497	Jazz Posterior Fixation System - 	Polyester braid with buckle and 	4mm width	$497.00
	Open Braid	stainless steel tip
	LMT Surgical Pty Ltd
LM005	TriMed Fixation Systems	Multiple stainless steel wire forms	various sizes	$497.00
	Mathys Orthopaedics Pty Ltd
MA540	Reconstruction Cerclage Band	Cerlage Band,Titanium	260x6x0.5 mm	$497.00
	Oceania Orthopaedics
OO044	IC Cerclage System	IC Bone Cerclage System, pure titanium	8mm wide	$497.00
	Smith & Nephew Surgical Pty Ltd
SM010	PLUS Endoprothetik Cerclage 	CCG Band - Pure Titanium	Length 27cm	$497.00
	Systems
SM011	PLUS Endoprothetik Cerclage 	CCG-GF Band with fixation spikes - 	Length 27cm	$497.00
	Systems	Pure Titanium
SM033	PLUS Endoprothetik Cerclage 	CCG Stabilizer with Band	XS - L	$497.00
	06.03.05.08 - Locking device for wires/cables
	Advanced Surgical Design & Manufacture Ltd
AE170	Blackstone - Posterior Cervical 	Crimp Two Pack - Titanium	One size only	$116.00
	System
	Biomet Australia Pty Ltd
BI254	BMP Cable System	Cable Sleeve, Chrome Cobalt, 	One Size only	$116.00
	Stainless Steel
	Johnson & Johnson Medical Pty Ltd
DP363	Control Cable	Control Cable sleeve 	One size only	$116.00
JJ924	Songer Cable System	Flanged crimp/flat bar or 2 hole bar	One size only	$116.00
JJ925	Songer Cable System	Cable and Crimp	One size only	$116.00
Prostheses List by Category, Groups and Sponsor	Page 440 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH498	Jazz Posterior Fixation System - 	Connector/Grip Titanium Alloy	5.5mm	$116.00
	Connector
	Medical & Optical Instruments Australia Pty Ltd
MO165	Osteo Clage Cable System	CoCr, Stainless Steel Cable Sleeve	2mm	$116.00
	Medtronic Australasia Pty Ltd
MI148	Atlas Cable System	Crimp	One size only	$116.00
	Orthotech Pty Ltd
OH259	Songer Cable System - 2 Crimps	Titanium	One size only	$116.00
	Smith & Nephew Surgical Pty Ltd
SN733	Accord	Orthopaedic Cable System, SS Button 	One Size Only	$116.00
	Plate Adapter
	Stryker Australia Pty Ltd
HW310	Dall Miles Cable Grip System - 	Vitallium: Sleeve -  Vitallium	1.6 and 2mm	$116.00
	Vitallium
	Synthes Australia Pty Ltd
SY057	AO/ASIF K-Wires, Pins, Washers 	Wire mount & spacer	2mm - 6mm	$116.00
	06.03.05.09 - Hook/Grip for wires/cables
	Biomet Australia Pty Ltd
BI255	BMP Cable System	Trochanteric Grip, Chrome Cobalt	1.6mm or 2.0mm	$582.00
	Stryker Australia Pty Ltd
HW302	Dall Miles Cable Grip System - 	Stainless Steel: Trochanter Grip -  	Small, Medium, Large	$582.00
	Stainless Steel	Stainless Steel
HW311	Dall Miles Cable Grip System - 	Vitallium: Trochanter Grip -  	Small, Medium and Large	$582.00
	Vitallium
SR072	Dall miles Trochanteric grip with 	stainless steel dall miles trochanteric 	small, medium, large  43-	$582.00
	divergent hooks	grip with diverging proximal hooks	53mm
Prostheses List by Category, Groups and Sponsor	Page 441 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.05.10 - Grooved Button for wires/cables
	Advanced Surgical Design & Manufacture Ltd
AE202	Parcus MiTi Suture Anchor	The Parcus MiTi Suture Anchor is a 	2.0mm, 2.5mm & 3.5mm 	$240.00
	threaded, tapered fastener for use in 	diameter
	attachment of soft tissue to bone. The 
	device is made from a Titanium alloy, 
	Ti-6A1-4V. MiTi Suture Anchors are 
	presented as sterile items.
	Stryker Australia Pty Ltd
HW313	Dall Miles Cable Grip System - 	Vitallium: Grooved Button -  	One size only	$195.00
	Vitallium
	Zimmer Pty Ltd
ZI234	Cable System 	Cable Ready, Cable Button	2,5mm - 5,0mm	$195.00
	06.03.05.11 - Wedges
	Device Technologies Australia Pty Ltd
DE345	iBalance HTO System	Medial High Tibial Osteotomy 	Small (6mm, 7mm, 8mm, 9mm,	$1,681.00
	Implant Device System	 10mm, 11mm, 12mm, 13mm, 
	14mm, 15mm)
	Medium (5mm, 6mm, 7mm, 
	8mm, 9mm, 10mm, 11mm, 
	12mm, 13mm, 14mm, 15mm)
	
	Large (5mm, 6mm, 7mm, 
	8mm, 9mm, 10mm, 11mm, 
	12mm, 13mm, 14mm, 15mm)
Prostheses List by Category, Groups and Sponsor	Page 442 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.03.06 - Staples
	06.03.06.01 - Staples
	Advanced Surgical Design & Manufacture Ltd
AE237	StaFIX	The StaFIX Staples are retained 	6x6, 6x12,8x8, 8x16, 10x10, 	$134.00
	implants and removable used 	10x20, 12x24
	primarily for the following 
	applications: Synthesis of fractures; 
	Synthesis of osteotomies; 
	Arthrodesis; Reattachment of 
	ligaments ot tendons.  The aim of the 
	StaFIX staple is to provide a effective 
	fixation of the bone fragments during 
	healing.
	Biomet Australia Pty Ltd
BH191	Barouk System Staples	Varisation Staple  Stainless Steel	26-90Deg x 8-10mm	$134.00
BH327	Barouk System Staples	TIFLEX Staple  / Pin -  Titanium	1.6 - 2.5 Dia 7-24mm width 	$134.00
	13/15-36/50mm Length
	ConMed Linvatec Australia Pty Ltd
LV025	Staplizer Bone Staple Cartridge	5 Titanium staples per cartridge	7 x 7mm, 7 x 10mm, 10 x 	$134.00
	7mm, 10 x 10mm, 10 x 15mm,
	 13 x 7mm, 13 x 10mm, 13 x 
	15mm, 13 x 20mm, 16 x 
	10mm, 16 x 15mm, 16 x 
	20mm, 16 x 25mm
	Corin Australia Pty Ltd
CR118	LARS Ligament Staple	CoCr synthetic ligament anchor	Width 8mm & length 20mm	$134.00
	Device Technologies Australia Pty Ltd
DE062	Ligament Staples	Cobalt Chromium Molybdenium 	6mm - 16mm	$134.00
DE292	QuickFix Staple System	Compression Staple for Fusion	8mm 10mm	$134.00
	Integra Neurosciences Pty Ltd
IG075	Solustaple Standard Staple	Stainless steel 90 deg & 26 degree	8 & 10mm length	$134.00
Prostheses List by Category, Groups and Sponsor	Page 443 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
IG076	Uni-Clip Compression Staple	Stainless steel	Width 11mm - 20mm, 	$134.00
	Length 13mm - 32mm; 
	Notched - Width 11mm - 
	20mm, Length 13mm - 
	32mm;
IG103	Uni-Clip Compression Staple 	Stainless Steel, Notched and Non-	Width 11-30mm, Length 	$134.00
	Notched	13-32mm
	Lima Orthopaedics Australia Pty Ltd
LC072	Ligament Fixation Staple - Small	Ligament Fixation Staple - Small	6 - 11 mm width	$134.00
LC073	Straight Staples - Small	Straight Staples - Small	7.5 to 10 mm width	$134.00
LC074	Osteotomy Offset Staple - Small	Osteotomy Offset Staple - Small	5 - 11 mm	$134.00
LC083	Ligament Fixation Staple - Medium	Ligament Fixation Staple - Medium	11 - 16 mm width	$134.00
LC084	Straight Staples - Medium	Straight Staples - Medium	12.5 mm	$134.00
LC085	Osteotomy Offset Staple - Medium	Osteotomy Offset Staple - Medium	11 - 20 mm	$134.00
LC086	Osteotomy Offset Staple - Large	Osteotomy Offset Staple - Large	26 - 36 mm	$134.00
	LMT Surgical Pty Ltd
LM157	EOS Footset - Varisation staple	Foot staple	8-10mm	$134.00
LM158	Pareous staple	Foot staple	1.5mm 6-14 and 2.5mm 14-	$134.00
	30
	Ortho Solutions Pty Ltd
OU005	VARISATION STAPLE	VARISATION STAPLE 90° 10MM	VARISATION STAPLE 	$134.00
	VARISATION STAPLE 26° 10MM	90° 10MM WIDE
	VARISATION STAPLE 90° 8MM	VARISATION STAPLE 
	VARISATION STAPLE 26° 8MM	26° 10MM WIDE
	VARISATION STAPLE 
	90° 8MM WIDE
	VARISATION STAPLE 
	26° 8MM WIDE
	RQSolutions Medical Devices Distribution Support
RQ012	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	10*8, 10*10	$134.00
	Staples	cobalt non-absorbable. Stainless Steel
	 non-absorbable.
RQ014	Orthomed Osteotomy & Ligament 	Ligament Staple.  Cast Chromium-	6.6*20, 6.6*15	$134.00
	Staples	cobalt staples, non-absorbable.
RQ016	Orthomed Osteotomy & Ligament 	Ligament Staple.  Cast Chromium-	10*25, 5*25	$134.00
	Staples	cobalt staples, non-absorbable.
Prostheses List by Category, Groups and Sponsor	Page 444 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
RQ017	Orthomed Osteotomy & Ligament 	Ligament Staple.  Cast Chromium-	16*12.5	$134.00
	Staples	cobalt staples, non-absorbable
RQ062	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	20*25, 26*25, 36*25, 	$134.00
	Staples	cobalt non-absorbable. Stainless Steel	26*34, 34*34, 24*36, 
	 non-absorbable. Non-sterile 57-73
RQ063	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	20*25	$134.00
	Staple	cobalt staples, non-absorbable
RQ064	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	26*25, 36*25, 26*34, 	$134.00
	Staple	cobalt non-absorbable.	34*34, 24*36,24*40,24*44
RQ065	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	16*25, 18*25, 20*25, 	$134.00
	Staples	cobalt non-absorbable. Stainless Steel	22*25, 26*25, 32*25, 36*25
	 non-absorbable.  Non-sterile 57-75
RQ066	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	16*25, 18*25, 20*25	$134.00
	Staple	cobalt non-absorbable.
RQ067	Orthomed Osteotomy & Ligament 	Osteotomy Staple.  Cast Chromium-	22*25, 26*25, 32*25, 36*25	$134.00
	Staple	cobalt non-absorbable.
RQ068	Orthomed Osteotomy & Ligament 	Ligament Staple.  Cast Chromium-	6*15, 6*20, 8*15, 8*20	$134.00
	Staples	cobalt staples, non-absorbable
RQ069	Orthomed Osteotomy & Ligament 	Ligament Staple.  Cast Chromium-	11*15, 11*20, 16*20, 16*15	$134.00
	Staples	cobalt staples, non-absorbable.
	Smith & Nephew Surgical Pty Ltd
SN463	Bone Staple	Fixation - Osteotomy	Fixation Staple 5mm- 14mm. 	$134.00
	 McConnel HTO PF 15mm 
	0-S
SN464	Bone Staple	Fixation - Short Leg	Xsmall - large	$134.00
SN465	Bone Staple	Fixation - Table	Small -Medium  13mm - 	$134.00
	16mm. 
SN466	Bone Staple	Krackow HTO	12,14,16mm	$134.00
	Stryker Australia Pty Ltd
HW317	Rutherford Staple	Ellison Arched Staple, Vitallium	9,12,15mm x 23mm	$134.00
HW318	Rutherford Staple	Ellison Flat Staple, Vitallium	8,11,14 x 23mm	$134.00
HW319	Rutherford Staple	Ellison Soft Tissue Retainer,  	8,11,14mm 	$134.00
Prostheses List by Category, Groups and Sponsor	Page 445 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ071	Mini Staple	For fixation of osteotomies of first 	0° and 63°, 8-10mm x 10mm	$134.00
	phalanx (e.g. Akin), 1mm diameter, 
	straight & angled design
	Tornier Pty Ltd
TO131	NexFix Compression Staples	The NexFix Compression Staple is 	10 mm in width, leg length 	$134.00
	made of stailess steel and is used for 	varies 13 mm - 20 mm
	internal fixation of fractures, fusions, 
	bone grafts and osteotomies in the 
	bones of the hand and foot. It is 
	designed so the surgeon can control 
	the amount of compression depending 
	on the type of osteotomy and on the 
	patient’s bone quality
TO132	NexFix Closing Wedge Osteotomy 	The NexFix Closing wedge osteotomy	8mm x 90 deg, 8mm x 64 deg	$134.00
	Staples	 staples are made of stainless steel and 
	are intended to be used for internal 
	fixation of fusions, bone grafts and 
	osteotomies in the bones of the hand 
	and foot following alignment 
	Wright Medical Australia
WR037	Charlotte Foot & Ankle System	Compression Staple, Stainless Steel	13, 15, 20, 25mm interaxis, 	$134.00
	leg lengths 11, 13, 15, 17, 
	20 & 25mm, 10 Sizes in Total
WR038	Charlotte Foot & Ankle System	Quick Staple, Stainless Steel	One Size Only	$134.00
	COMP
	Device Technologies Australia Pty Ltd
DE295	Compression Staple	Compression staple for fusion	10x10mm 10x15mm 	$417.00
	15x10mm 15x15mm 20x20mm
	MM
	Advanced Surgical Design & Manufacture Ltd
AE230	M-Fix	Nitinol	10-19mm	$534.00
	Biomet Australia Pty Ltd
BH192	Barouk System Staples	Memory Staple - Titanium Alloy	12-20mm Long	$534.00
Prostheses List by Category, Groups and Sponsor	Page 446 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lima Orthopaedics Australia Pty Ltd
LC064	Hot Memory Staple 4 leg - Medium	Hot Memory Staple 4 leg - Medium	Width 11-20 mm	$534.00
LC065	ADS INTERPHALANX COLD 	INTERPHALANX Cold Memory 	0-35 Degree	$534.00
	MEMORY STAPLE	Staple
LC079	Mono-Cortical Hot Memory Staple -	Mono-Cortical Hot Memory Staple - 2	Width 20-30 mm	$534.00
	 2 leg large	 leg large
LC080	Mono-cortical Hot Memory Staple - 	Mono-cortical Hot Memory Staple - 2 	Width 11-20 mm	$534.00
	2 leg Medium	leg Medium
LC081	Mono-cortical Hot Memory Staple - 	Mono-cortical Hot Memory Staple - 2 	Width 8-11 mm	$534.00
	2 leg Small	leg Small
LC082	Asymmetric Hot Memory Staple - 	Asymmetric Hot Memory Staple - 2 	Width 11-12mm	$534.00
	Medium	leg - Medium
	LMT Surgical Pty Ltd
LM159	Eleos staple	Foot staple	4-34/38mm	$534.00
Prostheses List by Category, Groups and Sponsor	Page 447 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
Prostheses List by Category, Groups and Sponsor	Page 448 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OU004	MEMO STAPLE	12mm memo staple /16mm memo 	12MM MEMO STAPLE 	$534.00
	staple/ 20mm memo staple	(13MM)
	12MM MEMO STAPLE 
	(14MM)
	12MM MEMO STAPLE 
	(15MM)
	12MM MEMO STAPLE 
	(16MM)
	12MM MEMO STAPLE 
	(17MM)
	12MM MEMO STAPLE 
	(13MM X 15MM)
	12MM MEMO STAPLE 
	(14MM X 16MM)
	12MM MEMO STAPLE 
	(15MM X 17MM)
	12MM MEMO STAPLE 
	(16MM X 18MM)
	12MM MEMO STAPLE 
	(17MM X 19MM)
	20MM MEMO STAPLE 
	(13MM)
	20MM MEMO STAPLE 
	(15MM)
	20MM MEMO STAPLE 
	(17MM)
	20MM MEMO STAPLE 
	(19MM)
	20MM MEMO STAPLE 
	(21MM)
	20MM MEMO STAPLE 
	(23MM)
	20MM MEMO STAPLE 
	(25MM)
	20MM MEMO STAPLE 
	(12MM X 15MM)
	20MM MEMO STAPLE 
	(14MM X 17MM)
	20MM MEMO STAPLE 
	(16MM X 19MM)
	20MM MEMO STAPLE 
	(18MM X 21MM)
	20MM MEMO STAPLE 
	(20MM X 23MM)
	12mm Memo Staple (13mm)
	
Prostheses List by Category, Groups and Sponsor	Page 449 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	12mm Memo Staple (14mm)
	
	12mm Memo Staple (15mm)
	
	12mm Memo Staple (16mm)
	
	12mm Memo Staple (17mm)
	
	16mm Memo staple (14mm x 
	16mm)
	16mm Memo staple (16mm x 
	18mm)
	16mm Memo staple (18mm x 
	20mm)
	Stryker Australia Pty Ltd
HW462	Memometal Memory Staples	Memory Metal Implants	10 mm to 25 mm	$534.00
	Surgical Specialties
SQ044	BME Nitininol Osteosynthesis 	Dynamic Compression Implants OSS 	Large wire 2.0-3.0 - Sizes 	$534.00
	Staple - Biocompatible Nitonol	20x20x20, 22x25x22, 
	30x30x30, 12x15x12
SQ045	BME Nitinol Osteosynthesis staple	Dynamic Compression Implants OSS 	Small Wires	$534.00
	Staple - Biocompatible Nitono
SQ046	OSSStaple Osteosynthesis Staple	Dynamic Compression Implants OSS 	Asymmetric - 11x15x13, 	$534.00
	Staple - Asymmetric Staples - 	11x17x15, 11x17x19 &
	Biocompatible Nitonol Construction	18x18x15
SQ048	Step/Barb OSStaple	Dynamic Compression Implant, 	2mm, 4mm, 6mm 9mm & 	$534.00
	Calcaneal Step OSStaple, Nitinol 	12mm offsets
	Memory Alloy
SQ068	Hammerlock	Nitinol Intramedullary Fixation 	16, 19 and 22mm	$534.00
	System - Straight and Angled
	06.03.06.04 - Plate staple
	Surgical Specialties
SQ047	BME Nitinol Osteosynthesis Staple	Dynamic Compression Implants OSS 	Plate Staple - 15x6, 15x8, 	$577.00
	Plate Staple - Biocompatible Nitonol 	15x10
	Construction
Prostheses List by Category, Groups and Sponsor	Page 450 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.03.07 - Soft Tissue Fixation Devices
	06.03.07.01 - No suture (including arrows)
	ConMed Linvatec Australia Pty Ltd
LV028	Pre-loaded BioStinger Bio-	Violet, PLLA	10, 13, 16mm	$246.00
	Absorbable Meniscal Repair 
LV071	Contour Meniscus Arrow	80L/20D, LPLA & PLLA	1.1mm x 10, 13,16mm	$246.00
	Smith & Nephew Surgical Pty Ltd
SN413	Shoulder Reconstruction	3.7mm TAG & Wedge Suture Wedge	3.7mm	$246.00
SN414	Shoulder Reconstruction	Suretac Absorbable Staple	6-8 x 16mm	$246.00
SN415	Shoulder Reconstruction	TAG Bioabsorbable Anchor Wedge	3.7mm	$246.00
	Stryker Australia Pty Ltd
HW374	Howmedica Mainstay Soft Tissue 	Without suture - Titanium	4.5, 3.5 and 2.7 anchor	$246.00
	Anchor
HW375	Howmedica Mainstay Soft Tissue 	Zip anchor - Titanium	Sip 4.5 anchor with #5 	$246.00
	Anchor	suture and #2 suture 2 
	strands, zip 3.5 anchor with 
	#2 suture and #0 suture 2 
	strands, zip 2.7 anchor with 
	#0 suture
SK048	Stryker Cuff Anchor	Titanium anchor kit for soft tissue 	Length 5-8mm	$246.00
	reattachment
	Tornier Pty Ltd
TO095	ArthroTunneler TunnelPro System	Lateral button, PEEK	10mm	$246.00
	Zimmer Pty Ltd
ZI182	Zimmer Internal Fixation Systems: 	Statak/Mini-Statak - Suture, Stainless 	2, 5 mm - 5, 0mm	$246.00
	Soft Tissue Re-attachment Device	Steel
	AB
	Device Technologies Australia Pty Ltd
DE059	Arthrex Meniscal Dart	PLA	10mm - 14mm	$309.00
DE126	Chondral Dart	Polylactide Compositition	Length 18mm	$309.00
Prostheses List by Category, Groups and Sponsor	Page 451 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.07.02 - Suture, Small anchors (≤2.3mm)
	Arthrocare Australasia Pty Ltd
AF039	Q-Fix All Suture Anchor	Soft suture anchor	1.8mm	$310.00
	Biomet Australia Pty Ltd
BH171	JuggerKnot Soft Anchor	Suture Anchor , Polyester, PE	1.0mm, 1.4mm, 1.5mm	$310.00
BI969	MaxFire	Meniscal Repair Device	one size	$310.00
BI979	Hitch suture anchor	Suture anchor with maxbraid sutures, 	2.4mm	$310.00
	PEEK
	ConMed Linvatec Australia Pty Ltd
LV005	Ultrafix MiniMite StitchPak Suture 	Soft Tissue Re-attachment - Stainless 	2.3mm predeployed diameter	$310.00
	Anchor	Steel
LV024	Ultrafix MicroMite Small Joint 	Suture Anchoring Device - Titanium	1.5mm predeployed diameter	$310.00
	Anchor
LV119	Y-Knot Suture Anchor	Y-Knot Suture Anchor 1.3mm and 	1.3mm and 1.8mm	$310.00
	1.8mm
LV124	PressFT PEEK Suture Anchor 	The ConMed Linvatec PressFT Suture	2.1mm	$335.00
	 Anchors are manufactured from PEEK
	 and are provided, preloaded on a 
	single use driver and pre-threaded 
	with either one or two Hi-Fi Sutures.
	Danex Medical Pty Ltd
XD016	Nanotack Suture Anchor	1.4mm High Strength PEEK suture 	1.4mm	$310.00
	anchor pre-loaded with suture and 
	inserter for arthrosopic hip labral 
	reattachment
	Device Technologies Australia Pty Ltd
DE430	Corkscrew Suture Anchor	Titanium alloy with Fibrewire suture	2.2mm	$310.00
	Johnson & Johnson Medical Pty Ltd
JJ087	Mitek Tacit Quick Anchor 	Titanium Suture Anchor	2.0 x 3.6mm	$310.00
JJ091	Mini Quick Anchor with Suture	Anchor with Suture	Anchor with Suture and 	$310.00
	Multiple size needles
JJ100	Micro Quick Anchor 	Titanium Suture Anchor	1.3 x 3.7mm	$310.00
Prostheses List by Category, Groups and Sponsor	Page 452 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM160	AIM-TEC AVRE SF Anchor System 	Titanium screw type anchor system	Diameter : 1.7 and 22mm	$335.00
	- Small
	RQSolutions Medical Devices Distribution Support
RQ010	Orthomed Metallic Suture Screwed 	Metallic screwed anchors are made of a	A total of 1 size	$310.00
	Anchors	 titanium, with one or two sutures of 	2mm
	braided ultra-high molecular weight 
	polyethylene (UHMWPE) with or 
	without needles. This anchor is 
	placed on a single use insertion 
	device.
	The ORTHOMED single-use 
	insertion device is composed of a 
	stainless steel axis and a polymer 
	Smith & Nephew Surgical Pty Ltd
SL025	Suturefix Ultra	All suture anchor	1.7-2.3	$310.00
SM162	SPYROMITE	A non-absorbable polymer (PEEK) 	2mm in diameter	$310.00
	anchor for use in ligament/tendon 
	reconstruction in small joint 
	applications
SM163	DYNOMITE	A non-absorbable polymer (PEEK) 	2mm in diameter	$310.00
	anchor for use in ligament/tendon 
	reconstruction in small joint 
	applications
SN417	T-Bar Suture Retention System	T-Fix RCG 	1.8mm	$310.00
SN418	T-Bar Suture Retention System	T-Fix Single & Double	T-Fix Suture Bar, Straight 	$310.00
	Needle, Double Suture
SN442	Mini TAG	Suture Anchor 2.0mm	2.0mm	$310.00
	Stryker Australia Pty Ltd
HW526	Memometal Anchor Fixation System	Anchors	1-2mm	$310.00
	Synthes Australia Pty Ltd
SY417	Titanium Wire, Barb and Needle	Titanium wire surture and needle with	One size only	$310.00
	 titanium alloy barb fixation
	Wright Medical Australia
WR212	G Force Anchorlok Soft Tissue 	Titanium suture anchor	1.9mm	$310.00
	Anchors
Prostheses List by Category, Groups and Sponsor	Page 453 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	AB
	ConMed Linvatec Australia Pty Ltd
LV125	GENESYS PressFT Suture Anchor 	The ConMed Linvatec GENESYS 	2.1mm	$529.00
	2.1mm	PressFT (biocomposite) Suture 
	Anchors are manufactured from 
	polylactide copolymer (96L/4D PLA 
	co-polymer) and beta-tricalcium 
	phosphate (B-TCp), and are provided 
	sterile, preloaded on a single-use 
	driver and pre-threaded with either 
	one or two Hi-Fi Sutures
	Johnson & Johnson Medical Pty Ltd
JJ421	MicroFix Anchor with Suture	Anchor with suture	Anchor with Suture and 	$529.00
	Multiple size needles
JJ926	MiniLok Anchor System	Suture Anchor	2.3mm	$529.00
	MI
	ConMed Linvatec Australia Pty Ltd
LV115	Sequent Meniscal Repair Device	The Sequent Meniscal Repair Device 	7 (5.1mm x 1.3mm Implants)	$795.00
	is pre-loaded with 
	polyetheretherketone (PEEK) 
	implants threaded onto one size #0 
	(3.5 metric) HiFi® suture.  The device 
	sequentially deplos the implants and 
	suture that are tightened down to 
	create multiple stitches to create 
	fixation points along a soft tissue tear
Prostheses List by Category, Groups and Sponsor	Page 454 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.07.03 - Suture, Medium anchors (2.4 – 3.9mm)
	Advanced Surgical Design & Manufacture Ltd
AE150	Parcus Series 3 Peek CF Suture 	10323T, 3.5mm w/Suture Push-In 	3.5mm diameter	$465.00
	Anchor	Anchor w/two #2 Parcus Braid TM 
	Sutures (green, white/green).
	10313, 3.5mm Knotless Push-In 
	Anchor provided with a Suture Passer
	 (MUST BE USED IN 
	CONJUNCTION WITH #10344 
	Sterile Driver).
	10344, 3.5mm Sterile Driver for 35 
	Knotless Anchor (used with 35 
	knotless anchor #10313)
	Arthrocare Australasia Pty Ltd
AF005	ArthRoCare Anchor System	Anchor fixating soft tissue to bone	2.8 - 3.4mm	$465.00
AF036	Speedfix PEEK Suture Implant	Soft tissue to bone suture anchor	3.4mm x 12.5mm	$465.00
AF037	Speedlock HIP Knotless Fixation 	PEEK knotless suture anchor implant	3.4mm	$465.00
	Implant	 for fixation of soft tissue to bone in 
	the hip
AF038	Magnum M Suture Implant	Anchor fixating soft tissue to bone	2.8mm	$465.00
AF040	Q-Fix All Suture Anchor	Soft suture anchor	2.8mm	$465.00
	Biomet Australia Pty Ltd
BI320	Arthrotek Harpoon System	Suture Anchor, Stainless Steel, Ti	1 to 5	$465.00
BI968	ToggleLoc	Femoral Fixation Device	15mm-60mm	$465.00
	ConMed Linvatec Australia Pty Ltd
LV010	Mini-Revo Screw	Soft Tissue Re-attachment - Titanium	2.7mm diameter	$465.00
LV027	Pre-Loaded Ultrafix RC Anchor	Surgical Grade Stainless Steel, 	Dia 2.9mm, length 6.5mm	$465.00
	preloaded with 2 #2 sutures
LV108	Bio Mini-Revo Suture Anchor	Bioabsorbable Suture Anchor with 	3.1mm O.D	$465.00
	Two #2 Hi-Fi Sutures
LV123	Press FT PEEK Suture Anchor	Press FT PEEK Suture Anchor - 	2.6mm	$465.00
	preloaded on a single driver
Prostheses List by Category, Groups and Sponsor	Page 455 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Danex Medical Pty Ltd
XD020	Pivot Anatomic Labrum Restoration	High Strength PEEK anchor pre-	12mm x 2.4-2.8mm, 1.4-	$465.00
	 Anchors	laoded with suture and inserter for 	2.0mm, 2.8-3.5mm
	arthroscopic hip labral reattachment
	Device Technologies Australia Pty Ltd
DE198	Fastak Suture Anchor (Small Bone)	With Fibrewire Suture	Dia. 2.4mm x Length 7.5mm	$465.00
DE225	Fastak Anchor	Titanium with fibrewire suture	2.8mm x 11.7mm	$465.00
DE428	Corkscrew Suture Anchor	Titanium alloy with Fibrewire suture	3.5mm	$465.00
DE433	Pushlock Suture Anchor	Knotless Suture Anchor	2.5 - 3.5mm	$465.00
DE461	SutureTak Suture Anchor	Suture Anchor with Fiberwire	2.4mm - 3mm	$465.00
	Johnson & Johnson Medical Pty Ltd
DY576	Healix Anchor System	Titanium anchor with suture	2.9 - 3.9mm	$465.00
JJ076	Mitek Ethibond Knotless Suture 	Titanium anchor	2.7 x 10.8 mm	$465.00
	Anchor
JJ089	Mitek GII QuickAnchor Plus 	Titanium Anchor, with various 	2.4 x 8.8mm	$465.00
JJ093	Mitek Rotator Cuff Quick Anchor 	Titanium  Anchor, with various 	2.8 x 11mm	$465.00
	Plus 
JJ095	Mitek Super Quick Anchor Plus 	Titanium  Anchor, with various 	2.8 x 11.4mm	$465.00
JJ946	GRYPHON PEEK Instability 	Suture Anchor	2.4-3.0mm	$465.00
JJ948	Healix Anchor System	PEEK anchor with Orthocord suture	2.9 - 3.9mm anchor diameter	$465.00
	LMT Surgical Pty Ltd
LM161	AIM-TEC AVRE SF Anchor System 	Titanium screw type anchor system	Diameter : 3mm	$400.00
	- Medium
LM163	AIM-TEC AVRP SF (PEEK) 	PEEK screw type anchor system	Diameter: 3mm	$465.00
	Anchor System -Medium
	RQSolutions Medical Devices Distribution Support
RQ009	Orthomed Metallic Suture Screwed 	Metallic screwed anchors are made of a	A total of 1 size	$465.00
	Anchors	 titanium, with one or two sutures of 	3mm
	braided ultra-high molecular weight 
	polyethylene (UHMWPE) with or 
	without needles. This anchor is 
	placed on a single use insertion 
	device.
	The ORTHOMED single-use 
	insertion device is composed of a 
	stainless steel axis and a polymer 
Prostheses List by Category, Groups and Sponsor	Page 456 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM146	Bioraptor 2.3 PK	PEEK optima suture anchor	2.3mm	$465.00
SM177	RAPTORMITE 3.0 PK	An non-absorbable polymer (PEEK) 	3mm	$465.00
	suture anchor for use in 
	ligament/tendon reconstruction
SN141	T-Bar Suture Retention System	Fastfix	One size only	$465.00
SN846	KINSA	Suture Anchor, Polmer With 	2.9mm	$465.00
	Polyester Suture Material
SN854	Fast-Fix Ultra	Meniscal suture anchor	One Size	$465.00
SN902	FAST-FIX 360	This is a double anchor, self tying 	One size	$465.00
	device for all-inside meniscal repair
SN903	Minitac	This is a titanium suture anchor with 	2.0mm	$465.00
	needles for repair and reattachment of 
	the ligaments in small joint 
SN907	TWINFIX Ti	This is a titanium suture anchor for 	2.8mm	$465.00
	repair and reattachment of ligaments to
	 bone in joint arthroscopy
SN909	BIORAPTOR Knotless	This is a knotless suture anchor for 	2.9mm.	$465.00
	repair and reattachment of the labrum 
	in shoulder and hip arthroscopy.
	Stryker Australia Pty Ltd
HW527	Memometal Anchor Fixation System	Anchors	3.6mm	$465.00
SK177	Stryker Cuff Anchor	Glenoid Titanium anchor kit for soft 	Dia 2 - 3mm	$465.00
	tissue reattachment
SK451	XCEL Anchor	Bio-absorbable Suture Anchor	2mm-10mm	$465.00
	Tornier Pty Ltd
TO052	Piton Knotless Fixation Implant 	System includes Piton Knotless 	Anchor: one size. Suture: 	$465.00
	System	anchors (single) NiTi and two Force 	size 2 in the system, 
	Fiber sutures size #2 UHMWPE	options: blue/white or 
	Wright Medical Australia
WR210	G Force Anchorlok Soft Tissue 	Peek suture anchor	3.5mm	$465.00
	Anchors
WR214	G Force Anchorlok Soft Tissue 	Titanium Suture Anchor	2.5 & 3.5mm	$465.00
	Anchors
Prostheses List by Category, Groups and Sponsor	Page 457 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	AB
	ConMed Linvatec Australia Pty Ltd
LV126	GENESYS PressFT Suture Anchor 	The ConMed Linvatec GENESYS 	2.6mm	$527.00
	2.6mm	PressFT (biocomposite) Suture 
	Anchors are manufactured from 
	polylactide copolymer (96L/4D PLA 
	co-polymer) and beta-tricalcium 
	phosphate (B-TCp), and are provided 
	sterile, preloaded on a single-use 
	driver and pre-threaded with either 
	one or two Hi-Fi Sutures
	Device Technologies Australia Pty Ltd
DE197	Bio - Fastak	with Fibrewire suture	3mm x 11mm	$527.00
DE304	BioComposite SutureTak Suture 	Absorbable suture anchor with a 	3mm	$527.00
	Anchor	molded-in suture eyelet. The unique 
	suture eyelet maintains its strength 
	throughtout most of the degradation 
	cycle and eliminates suture abrasion 
	during knot tying. The flexible eyelet 
	eliminates the need to orientate the 
	eyelet during insertion to optimize 
	suture sliding
DE431	Corkscrew FT	Suture Anchor with Fiberwire	2.4mm - 3.9mm	$527.00
DE435	BioComposite PushLock	BioComposite Pushlock Knotless 	2.4 - 3.5 mm	$527.00
	Suture Anchor
DE460	Bio Suturetak Suture Anchor	Absorbable Suture Anchor with 	2.4mm - 3mm	$527.00
	Fiberwire
	Johnson & Johnson Medical Pty Ltd
JJ927	Panalok RC Anchor System	Suture Anchor	2.9mm	$527.00
JJ928	Bioknotless Anchor System	Suture Anchor	3.9mm	$527.00
JJ945	GRYPHON BR Instability Anchor	Suture Anchor	2.4-3.0mm	$527.00
JJ950	HEALIX BR Anchor	Biocryl Rapide anchor with suture	3.4 to 3.9mm	$527.00
MN171	Lupine Anchor System	Suture Anchor	3.9mm	$527.00
	Smith & Nephew Surgical Pty Ltd
SM178	RAPTORMITE 3.7	This is a absorbable suture anchor for 	3.7mm	$527.00
	repair and reattachment of ligaments in
	 arthroscopic surgery
Prostheses List by Category, Groups and Sponsor	Page 458 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN906	OSTEORAPTOR	This is an hydroxyapatite 	2.9mm	$527.00
	incorporated absorbable suture 
	anchor for repair and reattachment of 
	the labrum in shoulder and hip 
SN908	OSTEORAPTOR	This is an hydroxyapatite 	2.9mm	$527.00
	incorporated absorbable suture 
	anchor for repair and reattachment of 
	the labrum in shoulder and hip 
	06.03.07.04 - Suture, Large anchors (≥4mm)
	Advanced Surgical Design & Manufacture Ltd
AE128	V-Lox PEEK CF Suture Anchors	Titanium Fully Threaded Suture 	4.5mm; 5.5mm; 6.5mm, 	$465.00
	double loaded and triple 
	loaded suture anchors
AE129	V-Lox PEEK CF Suture Anchors	PEEK CF Fully Threaded Suture 	4.5m; 5.5mm; 6.5mm,	$465.00
	Anchor
	Arthrocare Australasia Pty Ltd
AF004	ArthroCare Anchor System	Anchor fixating soft tissue to bone	4.5,5.5mm & 6.5mm	$465.00
AF034	Titan Ti Suture Anchor System	Tendon to bone Anchor	5.5mm and 6.55mm x 16.5mm	$465.00
AF035	Spartan PEEK Suture Implant	Spartan PEEK Suture Implant	5.5mm, 6.5mm	$465.00
	Biomet Australia Pty Ltd
BH056	Lactosorb Suture Anchor	Threaded with 1 suture, PGA/PLA, 	(3.5, 5.5, 6.8)mm dia anchor	$465.00
	polyethylene
BH057	Lactosorb Suture Anchor	Threaded with 2 suture, PGA/PLA, 	(3.5, 5.5, 6.8)mm dia anchor	$465.00
	polyethylene
BH117	Allthread Knotless Suture Anchor	Knotless peek suture anchor, polymer	4.5, 5.5 & 6.8mm	$465.00
BH118	Allthread Titanium Suture Anchor	Suture anchor, titanium with 	5.0 & 6.5mm	$465.00
	Maxbraid suture with and without 
BH119	Allthread Peek Suture Anchor	Suture anchor, peek polymer, with 	5.5 &6.8mm	$465.00
	maxbraid suture and without needles
	ConMed Linvatec Australia Pty Ltd
LV009	Revo Cancellous Screw	Soft Tissue Re-attachment - Titanium	4mm diameter	$465.00
LV090	Super Revo Suture Anchor with Hi-	Titanium Suture Anchor	5.0mm O.D x 14.2mm L	$465.00
	Fi Suture
Prostheses List by Category, Groups and Sponsor	Page 459 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LV091	ThRevo Suture Anchor	Titanium screw-in suture anchor	5.0mm OD x 14.2mm L	$465.00
LV112	CrossFT Suture Anchor	PEEK Optima Suture Anchor with 	4.5mm, 5.5mm & 6.5mm 	$465.00
	multiple sutures with or without 	diameters
LV113	PopLok Suture Anchor	PEEK Optima Suture Anchor with or 	2.8mm, 3.3mm, 3.5mm & 	$465.00
	without sutures	4.5mm diameters
LV114	Super Revo-FT,ThRevo-FT	Fully Threaded Suture Anchor pre-	5mm	$465.00
	threaded with two or three sutures 
	with or without needles
LV116	Sequent Meniscal Repair Device	The Sequent Meniscal Repair Device 	4 (5.1mm  x 1.3mm Implants	$465.00
	is pre-loaded with 
	polyetheretherketone (PEEK) 
	implants threaded onto one size #0 
	(3.5 metric) HiFi® suture.  The device 
	sequentially deplos the implants and 
	suture that are tightened down to 
	create multiple stitches to create 
	fixation points along a soft tissue tear
LV117	CrossFT Suture Anchor Polyester	PEEK Optima Suture Anchor with 	4.5mm, 5.5mm and 6.5mm	$465.00
	Multiple Polyester Sutures
LV122	Sequent Meniscal Repair Device - 3 	The Sequential Meniscal Repair 	5.1mm x 1.3mm	$465.00
	Implant	Device is pre-loaded with 
	polyetheretheketone (PEEK) 
	implants threaded onto one size #0 
	Danex Medical Pty Ltd
XD017	Quattro Link Knotless Anchor	Knotless Anchor manufactured from 	2.9mm,4.5mm and 5.5mm	$465.00
	PEEK-OPTIMA polymer pre-
	assembled to stainless steel inserter. 
	Provided as a single-use sterile 
XD018	Quattro X Suture Anchor	Suture Anchor with sutures, 	5.5mm and 6.5mm	$465.00
	manufactured from PEEK-OPTIMA 
	polymer pre assembled to stainless 
	stell inserter. Provided as a single-use
	 sterile device.
	Device Technologies Australia Pty Ltd
DE298	Tightrope Syndesmosis Buttress 	For Syndesmosis and Fracture Repair	Universal one size only	$465.00
DE429	Corkscrew Suture Anchor	Titanium alloy with Fibrewire suture	4.5mm - 6.5mm	$465.00
DE434	Pushlock Suture Anchor	Knotless Suture Anchor	4.5mm	$465.00
DE458	Swivelock	Twist-in knotless suture anchor	≥4mm	$465.00
Prostheses List by Category, Groups and Sponsor	Page 460 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY577	Healix Anchor System	Titanium anchor with suture	4.5 - 6.5mm	$465.00
JJ096	Mitek Fastin Anchor 	Titanium Suture Anchor	3 x 8.4mm, 4 x 9.7mm, 5.2 x 	$465.00
	11.5mm
JJ097	Fastin Anchor System	Suture Anchor	4 & 6.5mm	$465.00
JJ678	Versalok Bone Anchor System	Suture anchor	4.9-6.3mm	$465.00
JJ909	OmniSpan	Peek backstops with suture	0 to 27 degrees	$465.00
JJ947	Healix  Anchor System	PEEK anchor system	4.5 - 6.5mm anchor diameter	$465.00
MN101	OmniSpan Meniscal Repair System	Pre-loaded Peek backstops and 	0 to 27 degrees	$465.00
	ORTHOCORD suture
	LMT Surgical Pty Ltd
LM162	AIM-TEC AVRE SF Anchor System 	Titanium screw type anchor system	Diameter : 5 and 6mm	$400.00
	- Large
LM164	AIM-TEC AVRP SF (PEEK) 	PEEK screw type anchor system	Diameter: 5 and 6.5mm	$465.00
	Anchor System - Large
	Medical & Optical Instruments Australia Pty Ltd
MO408	Acu-Sinch Repair System	This is a suture-and-anchor soft tissue	Titanium Anchor: D=5.5mm,	$465.00
	 repair system designed to complement	 L=12mm
	 the Acumed Clavicle Plating system 	Titanium Suture Retainer: 
	by treating coracoclavicular ligament 	L=5.3mm, W=4mm
	repair injuries associated with 
	clavicle fractures and is used in 
	conjuction midshaft or distal clavicle 
	plate. All Acu-Sinch kits come in a 
	sterile procedure pack.
	RQSolutions Medical Devices Distribution Support
RQ004	Orthomed Metallic Suture Screwed 	Metallic screwed anchors are made of a	A total of 4 sizes	$465.00
	Anchors	 titanium, with one or two sutures of 	4mm
	braided ultra-high molecular weight 	5mm
	polyethylene (UHMWPE) with or 	5.5mm with needles
	without needles. This anchor is 	5.5mm without needles
	placed on a single use insertion 
	device.
	The ORTHOMED single-use 
	insertion device is composed of a 
	stainless steel axis and a polymer 
Prostheses List by Category, Groups and Sponsor	Page 461 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
RQ008	Orthomed Absorbable Screwed 	Absorbable screwed anchors are made 	Two sizes:	$465.00
	Anchors - two sutures	of a lactic-acid copolymer: poly (L,DL	5.5mm absorbable screwed 
	 - lactide) anchor, with two non 	anchor with 2 sutures #2 
	absorbable sutures of braided ultra-	with needles
	high molecular weight polyethylene 	5.5mm absorbable screwed 
	(UHMWPE) with and without 	anchor with 2 sutures #2 
	needles. This anchor is placed on a 	without needles
	single use insertion device.
	Signature Orthopaedics
SF003	Signature ST Shoulder Anchor	PEEK fully threaded suture anchor	4.5mm, 5.5mm &6.5mm	$465.00
	Smith & Nephew Surgical Pty Ltd
SL015	Healicoil	suture anchor	4.5mm and 5.5mm	$465.00
SM147	Twinfix PK	PEEK Optima fully threaded suture 	4.5mm 5.5mm and 6.5mm	$465.00
	anchor
SM148	Footprint	Non-knot tying suture anchor	4.5mm, 5.5mm, 6.5mm	$465.00
SM179	TWINFIX Ti	This is a titanium suture anchor for 	4.5mm, 5.5mm, 6.5mm	$465.00
	repair and reattachment of ligaments to
	 bone in joint arthroscopy
SN008	Rotorloc Absorbable PLA Suture 	-	One size only	$465.00
	Anchor System
SN416	Shoulder Reconstruction 	Fastentor Suture Anchor	One size only	$465.00
SN651	OBL Anchor System	Preloaded Soft Tissue Anchor System 	Anchor sizes - Titanium: 	$465.00
	Material: Titanium Alloy or 	2.8, 3.5, 4.0 5.0, 6.5mm 
	Polyacetal Polymer. Comes with 	Anchor size - Polymer: 5.0mm
	Insertion device and 2 Braided 
SN652	OBL Anchor System 	Soft Tissue Anchor System Non-	4.0 and 6.5mm	$465.00
	preloaded Material:  Titanium Alloy
SN714	TwinFix	Quick-T	2.8 - 6.5mm	$465.00
	Stryker Australia Pty Ltd
HW373	Howmedica Mainstay Soft Tissue 	With suture - Titanium	4.5 anchor with #2 and #5 	$465.00
	Anchor	suture, 2.7 anchor with #0 
	suture
SK176	Stryker Cuff Anchor	Bio Zip PLLA anchor for soft tissue 	Dia 3 - 8mm	$465.00
	ligament/tendon fixation
Prostheses List by Category, Groups and Sponsor	Page 462 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO090	Insite FT anchors	Bone anchors Ti or PEEK, preloaded 	4.5mm, 5.5mm or 6.5mm	$465.00
	with suture
	Wright Medical Australia
WR211	G Force Ancholok Soft Tissue 	Peek suture anchor	5.0mm	$465.00
	Anchors
WR213	G Force Anchorlok Soft Tissue 	Titanium suture anchor	5.0mm	$465.00
	Anchors
	AB
	Arthrocare Australasia Pty Ltd
AF033	Doubleplay Suture Implant	Doubleplay Implant (TCP/PLLA) - 	5.0mm and 6.5mm	$527.00
	Tricalcium phosphate and poly-L-
	lactide
	ConMed Linvatec Australia Pty Ltd
LV118	Genesys CrossFT	Micro TCP Soft Tissue Suture Anchor 	4.5mm, 5.5mm, 6.5mm 	$527.00
	with multiple sutures with or without	diameters
	 needles
	Device Technologies Australia Pty Ltd
DE302	BioComposite Corkscrew Suture 	The threaded design over the entire 	4.5mm - 5.5mm	$527.00
	Anchor	length of the suture anchor provides 
	substantially higher pull-out strength
	 than comparable anchors in poor 
	quality bone. The fully threaded 
	design also prevents anchor "pull-
	back" that may occur with 
	countersunk anchors. The internal 
	drive mechanism substantially 
	increases resistance to stripping 
	during insertion into hard bone. The 
	recessed FiberWire suture eyelet is 
	self-aligning and minimizes suture 
	abrasion during knot tying.
DE306	BioComposite SwiveLock	The SwiveLock is a 4.75 or 5.5mm 	4.75mm - 5.5mm	$527.00
	twist-in knotless anchor. This anchor 
	functions very similar to the 
	PushLock but with a twist-in design. 
	This anchor is available with a b-TCP 
	and PLLA anchor body and PEEK 
DE432	Corkscrew FT	Suture Anchor with Fiberwire	4mm - 6.5mm	$527.00
Prostheses List by Category, Groups and Sponsor	Page 463 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE436	BioComposite PushLock	Knotless Suture Anchor	4.5mm	$527.00
DE459	Bio Swivelock	Twist-in knotless suture anchor	≥4mm	$527.00
	Johnson & Johnson Medical Pty Ltd
JJ099	Panalok Anchor System	Polylactic acid absorbable anchor 	4.1 x 6.0mm	$527.00
	with absorbable and non-absorbable 
JJ929	BioKnotless RC Anchor System	Suture Anchor	One size only	$527.00
JJ930	RapidLoc Anchor System	Suture top Hat	Straight 12 degree and 27 	$527.00
	degree
JJ931	Spiralok Anchor System	Suture Anchor	5-6.5mm	$527.00
JJ949	HEALIX Anchor System	Biocryl Rapide anchor with suture	4.5-6.5mm	$527.00
	Smith & Nephew Surgical Pty Ltd
SN703	Absorbable Suture Anchor	Preloaded PLLA Suture Anchor	5.0mm & 6.5mm	$527.00
	06.03.07.05 - Button/thread/tape or Button/thread/button
	Advanced Surgical Design & Manufacture Ltd
AE130	Parcus - GFS	Parcus - GFS Fixation for knee 	GFS Standard with 10mm, 	$394.00
	ligament reconstruction	15mm, 20mm & 25mm Suture
	 Loops; and
	GFS Large with 15mm to 
	45mm Suture Loops (in 2mm
	 increments)
	Biomet Australia Pty Ltd
BH111	Ziptight Fixation System	Ankle syndesmosis device, stainless 	One Size	$394.00
	steel, titanium, PE suture with or 
	without disposable instruments
BI005	Re-Unite Orthopaedic System	Rotator Cuff Butress, Lactosorb; 	One size only	$394.00
	PGA/PLA
BI920	EZLoc Femoral fixation Device	Ligament Anchor, Ti, PE	7-8; 9-10mm x Short, std or 	$394.00
	long.
	ConMed Linvatec Australia Pty Ltd
LV109	XO Button with Continuous Loop	Titanium suspensor, fixation device 	4.5mm x 13.5mm with 	$394.00
	for femoral fixation in ACT and PCL 	Continuous Loop lengths 
	repairs	15-60mm
Prostheses List by Category, Groups and Sponsor	Page 464 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE252	Tightrope Syndesmosis Repair Kit	Titanium or stainless steel, with non 	One size only	$394.00
	absorbable Fiberwire suture material
DE271	RetroButton	Femoral Fixation Device	12mm Button with 15-60mm	$394.00
	 loops, 15mm Button with 
	15-60mm loops
DE299	Meniscal Cinch	Meniscal Repair Device	Universal One size only	$394.00
	Emergo Asia Pacific Pty Ltd
ER129	BOTAO - ACL Button with 	BOTAO Titanium button with 	15mm - 40mm loop length	$394.00
	Continuous Loop - ligament 	polyester Continuous Loop and 
	fixation device	Polyester Traction Threads
	Johnson & Johnson Medical Pty Ltd
JJ951	RigidLoop	Cortical Fixation Loop	15-60mm, Xlarge, adjustable	$394.00
	RQSolutions Medical Devices Distribution Support
RQ005	Orthomed ACF Femoral Cortical 	The ACF Femoral Cortical Anchor is 	10 sizes:	$394.00
	Anchors	used for ACL reconstruction, in 	15mm to 60mm in 5mm 
	accordance with the hamstring tendon	increments
	 method to fasten the graft on the 
	femoral cortex.
	Smith & Nephew Surgical Pty Ltd
SL016	Endobutton Twinbridge	A button/thread/button device for 	6mm	$394.00
	ligament reconstruction
SN429	ACL/PCL Reconstructions	EndoButton Tape	One size only	$394.00
SN853	Endobutton	Fixation for ACL/PCL reconstruction	5-9mm, 15-60mm	$394.00
	06.03.07.06 - Button
	Device Technologies Australia Pty Ltd
DE301	Suture Button	Multiple hole button for fixation of 	2.6mm - 7.5mm	$394.00
	bone to bone or soft tissue to bone, 
	and are intended as fixation posts, a 
	distribution bridge, or for 
	distributing suture tension over areas 
	of ligament or tendon repair
	Smith & Nephew Surgical Pty Ltd
SN426	ACL/PCL Reconstructions	EndoButton	4 x 12mm, 4mm x 18mm	$394.00
Prostheses List by Category, Groups and Sponsor	Page 465 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN427	ACL/PCL Reconstructions	Fixation Button	12-17mm	$394.00
SN428	ACL/PCL Reconstructions	EndoButton CL	20-50mm	$394.00
	06.03.07.07 - Interference Screw (± sleeve)
	Advanced Surgical Design & Manufacture Ltd
AE094	ACL Fixation Screws Tapered	Flat Head, Tappered, Titanium	9 - 11mm Diameter 30mm 	$190.00
	Length
AE095	ASDM Standard ACL Fixation 	Standard Flat Head Screw	7 - 11mm Diameter 20mm - 	$190.00
	50mm Length
AE127	Parcus PEEK CF Interface Screw	PEEK CF Interface Screw	7,8,9mm x 20-35mm 	$190.00
	10,11,12mm x 25-35mm
	Biomet Australia Pty Ltd
BH145	TunneLoc	Tibial Fixation Device with 	7 to 10mm diameter	$190.00
	Tensioner, PEEK
BH168	Washerloc Tibial Fixation Device	Screw - Ti	24 - 60mm x 5.8mm diameter	$190.00
BI239	Arthrotek Ligament Fixation System	Interference Screw, Titanium	15-30mm	$190.00
BI241	Gentle Threads Ligament Fixation 	Screw, Graft Interference, PGA/PLA	7mm, 8mm, 9mm, 10mm	$190.00
	Screws
	ConMed Linvatec Australia Pty Ltd
LV016	Propel Interference Screws	ACL Fixation - Titanium	Diameter 7.0 - 9.0mm, 	$190.00
	Length 20 - 30mm
LV017	Guardsman Femoral Interference 	ACL Fixation - Titanium	Diameter 7.0 - 9.0mm, 	$190.00
	Screws	Length 20 - 30mm
LV018	Cannulated Interference Screws	ACL Fixation - Titanium	Diameter 7.0 - 9.0mm, 	$190.00
	Length 20 - 40mm
	Corin Australia Pty Ltd
CR031	LARS Interference Screw	Titanium Interference screw	5.2 - 10mm diameter, 15 - 	$190.00
	30mm
	Device Technologies Australia Pty Ltd
DE374	GraftBolt	Interference Screw and Sheath	7mm, 8mm, 9mm and 10mm	$190.00
DE439	Peek Delta Screws	Interference screw for soft tissue 	6-12mm Diameter x (23mm-	$190.00
	Fixation	35m) Length
DE440	Interference Screws	Interference screw for Soft Tissue 	7-10mm x (15-35mm)	$190.00
	Fixation
Prostheses List by Category, Groups and Sponsor	Page 466 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ588	Femoral Intrafix System	Screw and Sheath Fixation System for 	7 to 10mm	$190.00
	the Femur in ACL repairs
JJ912	Intrafix Interference System	Non absorbable screw/sheath	6 to 10mm	$190.00
JJ922	Kuroska Fixation Screw System	Interference screw	7 to 9mm	$190.00
	Perios Pty Ltd
PF015	TLS - Tendon Anchoring System - 	Titanium screw for suspensory 	10 x 20mm, 10 x 25mm, 12 x 	$190.00
	Titanium	fixation of tendon	20mm
PF016	TLS - Tendon Anchoring Screw - 	PEEK screw for suspensory fixation 	10 x 20mm 10 x 25mm	$190.00
	PEEK	of tendon
	RQSolutions Medical Devices Distribution Support
RQ002	Orthomed Interference Screws with 	The screws are intended to fix an 	9 sizes	$190.00
	Atraumatic Thread	autogenous transplant (hamstring 	Diameter: 7,8 and 9mm
	tendons) or a synthetic graft in the 	Length: 18, 23 and 28mm
	femur and tibia during an Anterior 
	Cruciate Ligament (ACL) 
	reconstruction.
Prostheses List by Category, Groups and Sponsor	Page 467 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
RQ006	Orthomed MISBIO Bioresorbable 	The Orthomed Misbio Bioresorbable 	Diameter 6-10mm, length 	$190.00
	Interference Screws	interference screws are intended to set 	23mm
	an autogenous transplant (hamstring 	Diameter 7-10mm, length 
	tendons or patellar tendon) in the 	30mm
	femur and tibia during an Anterior 	Diameter 9-11mm, length 
	Cruciate Ligament (ACL) 	35mm
	Details:
	MISBIO 6.23: 6mm 
	diameter, 23mm length
	MISBIO 7.23: 7mm 
	diameter, 23mm length
	MISBIO 8.23: 8mm 
	diameter, 23mm length
	MISBIO 9.23: 9mm 
	diameter, 23mm length
	MISBIO 10.23: 10mm 
	diameter, 23mm length
	MISBIO 7.30: 7mm 
	diameter, 30mm length
	MISBIO 8.30: 8mm 
	diameter, 30mm length
	MISBIO 9.30: 9mm 
	diameter, 30mm length
	MISBIO 10.30: 10mm 
	diameter, 30mm length
	MISBIO 9.35: 9 mm 
	diameter, 35mm length
	MISBIO 10.35: 10mm 
	diameter, 35mm length
	MISBIO 11.35: 11mm 
	diameter, 35mm length
RQ007	Orthomed Interference Screw Bone 	The screws are intended to set an 	9 sizes:	$190.00
	to Bone	autogenous transplant (hamstring 	Diameter: 7, 8 & 9mm
	tendons or patellar tendons) in femur 	Lengths: 18, 23 & 28mm
	and tibia during an Anterior Cruciate
	Signature Orthopaedics
SF001	Tissue Loc Tenodesis Screw	Cannulated Interference Screw - 	4x10mm, 5x10mm, 4x15mm, 	$190.00
	5x15mm, 6x15mm, 6x20mm, 
	7x25mm, 8x25mm, 8x30mm, 
	9x25mm, 9x30mm
SF035	Signature ST Shoulder Anchor	PEEK fully threaded suture anchor	2.3mm	$190.00
Prostheses List by Category, Groups and Sponsor	Page 468 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SL017	Biosure Healicoil	interference screw	6-10mm diameter	$190.00
SL024	RCI PK	Interference screw	5x22, 5x22L, 6x22, 6x22L, 	$190.00
	6x27, 6x27L, 7x22,  7x22L, 
	7x27, 7x27L, 7x32, 7x32L, 
	8x22, 8x22L, 8x27, 8x27L, 
	8x32, 9x27, 9x27L, 9x32, 
	9x37, 10x32, 10x37, 11x32 
	11x37, 12x32, 12x37
SM164	BIOSURE	A non-absorbable polymer (PEEK) 	6-12mm in diameter	$190.00
	interference screw for use in 
	ligament/tendon reconstruction
SN420	ACL/PCL Reconstruction	RCI Screws Titanium	7-11mm diameter, 25-40mm 	$190.00
	length
SN423	ACL/PCL Reconstructions	Acufex Tibial Fixation Anchor	One size only	$190.00
SN425	ACL/PCL Reconstructions	Cannuflex Silk & Soft Silk Interference	5.5 x 20mm - 9x30mm	$190.00
	 Screw
SN432	ACL/PCL Reconstructions	Tibial Post Screw	Small, Standard	$190.00
SN981	BIOSURE SYNC	Soft tissue intra-tunnel tibial fixation 	6-12mm	$190.00
	device which includes Interference 
	screw and sheath
	Stryker Australia Pty Ltd
SK023	ACL Wedge Interference Screw	Threaded titanium screw for 	Dia 7 - 12mm, length 20 - 	$190.00
	ligament/tendon fixation	40mm
SK047	Stryker Wedge Interference Screw	Threaded biosteon screw for 	Dia 7 - 12mm, length 20 - 	$190.00
	ligment/tendon fixation	40mm
ST830	Stryker Wedge Interference Screw	Small threaded titanium screw for 	Diameter 7 - 9mm, Length 	$190.00
	ligament/tendon fixation	20 - 25mm
	Synthes Australia Pty Ltd
SY292	Facet Interference Screw	Cannulated Screw	7.5mm	$190.00
	Wright Medical Australia
WR080	G-Force Tenodesis System	Cannulated Interference Screw - 	4-8mm diameter, 10-25mm 	$190.00
	PEEK Optima	width
Prostheses List by Category, Groups and Sponsor	Page 469 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	AB
	ConMed Linvatec Australia Pty Ltd
LV019	BioScrew Bioabsorbable 	ACL Fixation - PLLA	Diameter 7.0 - 9.0mm, 	$481.00
	Interference Screw	Length 20 - 30mm
LV077	BioScrew XtraLok Tibial Fixation 	ACL Fixation - PLLA	Diameter 8, 9, 10, 11mm; 	$481.00
	Device	Length 35 & 40mm
LV103	Matryx Interference Screw	Matryx (SR-96L/4D PLA with ß-	7.3 x 20mm; 7.3 x 25mm; 7.3 	$481.00
	TCP) Inteference Screw	x 30mm; 8 x 20mm; 8 x 
	25mm; 8 x 30mm; 9 x 20mm; 
	9 x 25mm; 9 x 30mm; 9 x 
	38mm; 10 x 25mm; 10 x 
	33mm; 10 x 38mm; 11 x 
	25mm; 11 x 33mm; 11 x 38mm
LV120	GENESYS Matryx Interference 	GENESYS Matryx Interference Screw 	7.0x20mm,7.0x25mm,7.0x30	$481.00
	Screw, diameter 7 - 11mm	 - cannulated bioabsorbable	mm,8.0x20mm,8.0x25mm,8.0
	x30mm,8.0x35mm,9.0x20mm,
	9.025mm,9.0x30mm,9.0x35m
	m,10x20mm,10x25mm,10x30
	mm,10x35mm,11x20mm,11x
	25mm,11x25mm,11x25mm,1
	1x25mm,11x30mm,11x35mm
	,11x40mm
LV121	GENESYS Matrix Interference 	GENESYS Matrix Interference Screw -	5.0mm diameter 	$481.00
	Screw, diameter 5-6.5mm.	 Cannulated,bioabsorbable	x15,20,25,30mm lengths
	5.5mm diameter 
	x15,20,25,30mm lengths
	6.0mm diameter 
	x15,20,25,30mm lengths
	6.5mm diameter 
	x15,20,25,30mm lengths
	Device Technologies Australia Pty Ltd
DE068	Interference Screws	ARTHREX Non-sheathed	7 x 28mm - 12 x 28mm	$481.00
DE069	Interference Screws	Bio-Cortical - PLA	8 x 17 - 11 x 17mm and 8 x 	$481.00
	20 - 10 x 20mm
DE072	Bio-Interference Screw	PLA	7mm - 9mm	$481.00
DE166	Bio-Tenodesis Screw	Composition PLLA	Dia 5.5-9mm	$481.00
Prostheses List by Category, Groups and Sponsor	Page 470 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE167	Bio-Interference Screw	Composition - PLLA, delta tapered	Dia6.5 - 10.5mm to 8 - 12mm	$481.00
	 x 28 - 35mm length
DE224	Retro Screw	Composition PLLA	8-10mm x 20mm	$481.00
	Johnson & Johnson Medical Pty Ltd
JJ127	Absolute Absorbable Interference 	Polylactic acid screw	7 to11mm x (23 to 30mm)	$481.00
	Screw 
	Smith & Nephew Surgical Pty Ltd
SN004	Bioabsorbable screw	BioRCI-HA Screw, Medial, Portal, 	7 x 20mm - 12 x 35mm	$481.00
	Reverse thread, Tibial specific, Trans-
	tibial
SN421	ACL/PCL Reconstructions	Absorbable PLLA Screw	7-12mm diameter, 25-35mm 	$481.00
	length
SN430	ACL/PCL Reconstructions	EndoFix Bioabsorbable Screw	7 x 20mm - 9mm x30mm	$481.00
	Surgical Specialties
SQ067	CPS Screw Hexalon Biodegradable 	Biodegradable ACL/PCL Recon 	6 x 20, 6 x 25, 6 x 30, 7 x 20, 	$481.00
	ACL/PCL Reconstruction	Screw PLLA/PGA/TMC	7 x 25, 7 x 30, 8 x 20, 8 x 25, 
	8 x 30, 9 x 20, 9 x 25, 9 x 30, 
	10 x 30
	AB, HA
	Device Technologies Australia Pty Ltd
DE297	BioComposite Interference Screw	Soft Tissue Fixation Device	7mm - 35mm	$481.00
	Johnson & Johnson Medical Pty Ltd
DY477	BioIntrafix Tibial Soft Tissue 	Compostion - Tricalcium Phosphate &	30mm	$481.00
	Fastener (Sheath)	 Polylactic Acid
JJ337	Biocryl - TCP/PLA Interference Screw	Composition - Tricalcium Phosphate 	7x23mm; 7x30mm; 8x23mm; 	$481.00
	& Polylactic Acid	8x30mm, 9x23mm; 9x30mm; 
	10x23mm; 10x30mm; 
	11x30mm
JJ473	BioIntrafix Tibial Soft Tissue 	Compostion - Tricalcium Phosphate &	6 to 10mm	$481.00
	 Polylactic Acid
JJ484	MILAGRO Interference Screw	TCP/PLGA Interference ACL Screw 	5-12mm	$481.00
	System
Prostheses List by Category, Groups and Sponsor	Page 471 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Signature Orthopaedics
SF057	Bio-Composite Interference Screw	HA infused Ploymer Interference 	5-12mm	$481.00
	Screws
	Smith & Nephew Surgical Pty Ltd
SM176	Biosure HA	An absorbable polymer interference 	6-12mm	$481.00
	screw for use in ligament/tendon 
	reconstruction
	06.03.07.08 - Screw/Pin/Post
	Advanced Surgical Design & Manufacture Ltd
AE097	Tibial Post Screw	Titanium	5 - 6mm	$475.00
	Biomet Australia Pty Ltd
BI246	Arthrotek Ligament Fixation System	Bone Mulch Screws, Titanium	10.5mm x (20-35mm)	$475.00
	Device Technologies Australia Pty Ltd
DE070	TransFix Implant Screw System - 	Titanium alloy	40mm & 50 mm	$475.00
	Arthrex
	Stryker Australia Pty Ltd
SK024	Stryker Cross-screw	Threaded titanium screw for 	8mm x 40-60mm	$475.00
	ligament/tendon fixation
	AB
	Device Technologies Australia Pty Ltd
DE127	Bio-Transfix	Composition Poly (L-lactide)	Diameter 5mm, length 50mm	$486.00
	Johnson & Johnson Medical Pty Ltd
JJ078	Rigidfix ACL Cross Pin	Polylactic acid pin	2.7 & 3.3mm x 42mm	$486.00
JJ815	RIGIDFIX BIOCRYL Cross Pin	Cross pin composed of Biocryl 	2.7mm & 3.3mm	$486.00
	(bioabsorbable TCP/PLA)
06.03.08 - Soft Tissue Substitute
	06.03.08.01 - Biological (human or animal tissue derived)
	Johnson & Johnson Medical Pty Ltd
DY136	Restore Orthobiologic Soft Tissue 	Restore Patch	One size only	$6,339.00
	Implant
Prostheses List by Category, Groups and Sponsor	Page 472 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.08.02 - Non-biological
	Corin Australia Pty Ltd
CR032	Lars Ligamanet Augmentation 	Woven polyester prosthetic ligaments	60,80,100,120,160 & Y 	$4,439.00
	reconstruction system	shaped fibres
CR201	Ligament Augmentation & 	Woven polyester prosthesic ligament	30 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) 	 only be funded for intra-articular 
	AC30RA	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR202	Ligament Augmentation & 	Woven polyester prosthetic ligament	20 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) 	 only be funded for intra-articular 
	LAC 20	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR203	Ligament Augmentation & 	Woven polyester prosthetic ligament	30 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) 	 only be funded for intra-articular 
	LAC 30	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR204	Ligament Augmentation & 	Woven polyester prosthetic ligament	32 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) 	 only be funded for intra-articular 
	MCL 32	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR205	Ligament Augmentation & 	Woven polyester prosthetic ligament	40 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) - 	 only be funded for intra-articular 
	Rotator Cuff CR 25	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR206	Ligament Augmentation & 	Woven polyester prosthetic ligament	48 fibres	$4,439.00	That an Artificial Ligament should
	Reconstruction System (LARS) - 	 only be funded for intra-articular 
	Rotary Cuff CR 30	cases where no non-synthetic graft
	 sources (allografts and autografts)
	 are available.
CR214	LARS Reinforcer Ligament	Woven polyester prosthetic ligaments	8 fibres	$4,439.00
Prostheses List by Category, Groups and Sponsor	Page 473 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM070	Surgicraft Ligament Augmentation 	Woven Polyester Prosthetic 	Various	$4,439.00
	Reconstruction System
	NeoSurgical Pty Ltd
NY001	Poly-Tape	Open weave high strength polyester 	Width 3mm-50mm	$4,439.00
	tape	Length 400-800mm
Prostheses List by Category, Groups and Sponsor	Page 474 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	RQSolutions Medical Devices Distribution Support
RQ070	LIGASTIC reinforcement ligament	The LIGASTIC reinforcement artificial	7 sizes:	$4,439.00	That an Artificial Ligament should
	 ligament is to constitute a 	LCA60NEF: 30 threads, 	 only be funded for intra-articular 
	reinforcement or support during 	length 300mm, diameter 	cases where no non-synthetic graft
	healing & repair of the Patellar 	6mm	 sources (allografts and autografts)
	tendon, achilles tendon, antero lateral 	LT60:30 threads, length 	 are available.
	laxity of ankle, medial collateral 	290mm, width 6 or 8.8mm
	ligament and posterior cruciate 	RTF22: 11 threads, length 
	ligament.	360mm, width 8mm
	There are different products for the 	RTF18: 9 threads, length 
	reinforcement of the collateral 	360mm, width 7mm
	ligaments, anterior cruciate ligament, 	LCP88NE: 22 threads, 
	achilles tendon, shoulder, patella 	length 550mm, width 5.5mm
	tendon, popliteal tendon, ankle 	
	anterior-lateral laxity and acromial-	LLI30: 15 threads, length 
	clavicular dislocation.	350mm, width 22.5mm
	The product consists of warp-knitted  	L30: 15 threads, length 
	fibres of PET. It is knitted in bands of 	360mm, diameter 4.5mm
	8, 15, 18, 22, 36 or 72 warp threads. 	LT60: 30 threads, length 
	The basic structure of LIGASTIC is 
	always identical. However, the 
	presentation varies depending on the 
	actual joint affected. The ligaments 
	presented are:
	- cylindrical string, with variable 
	length & diameter. Diameter varies 
	according to fiber content & required 
	resistance. Both ends of the ligament 
	are soft, formed as a reinforced loop, 
	allowing an easy passage through the 
	bone tunnels. These ends have a 
	temporary function & are able to be 
	cut off after the tunnel passage.
	- band, for reinforcement of a flat 
	anatomical structure such as the 
	medial collateral ligament in the knee
	
	- reinforcement ligament (uncoated 
	LIGASTIC) - for support and healing 
	of intra-articular or extra-articular 
	natural ligaments
Prostheses List by Category, Groups and Sponsor	Page 475 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
06.03.09 - 6.3.9 - Soft Tissue Fixation Devices
	06.03.09.05 - Button/thread/tape or Button/thread/button
	Signature Orthopaedics
SF019	EZ Flip ACL/PCL Fixation system	Fixation for ACL/PCL fixation	15-60mm length	$369.00
06.03.11 - External Fixateurs
	06.03.11.01 - Halo-thoracic device
	Australian Orthotic Technologies
ZT001	Ossur Halo Thoracic Orthosis	Spinal, Halo thoracic orthosis; 	Small, medium (standard) 	$3,035.00
	inclusive of crown, skull pins and vest	and large.
	Standard
	Johnson & Johnson Medical Pty Ltd
DY294	Bremer Halo Crown System	Aluminium Crown & Vest	Standard & 3D	$3,035.00
	06.03.11.02 - Frame Complete - Monoplanar & Modular Frames
	Mini
	Advanced Surgical Design & Manufacture Ltd
AE228	MiniFix	Finger Mini Fixator System	One size	$2,055.00
AE233	MicroFix	Finger Mini Fixator System	one size	$2,055.00
	Akva Surgical Pty Ltd
VK006	Orthopaedic External Fixation 	Complete System Sterile	One size only	$2,055.00
	System - Radiolucent Wrist Fixator
VK010	Orthopaedic External Fixation 	Articulated Ankle Fixator	One size only	$2,055.00
	System - Xcaliber External Fixator
	Biomet Australia Pty Ltd
BH240	Hoffman Wrist Kit	Hoffman Sterile Wrist Kit	One size only	$2,055.00
BI775	EBI XFIX DynaFix System	Distal radius fixator, wristfix, sterile, 	One size only	$2,055.00
	complete
BI777	EBI XFIX DynaFix System	Mini fixator/lengthener with 	Small, Medium, Long, 	$2,055.00
	100mm, 150mm
Prostheses List by Category, Groups and Sponsor	Page 476 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR205	Sidekick Rearfoot Fixator	Pre-assembled external fixator for 	n/a	$2,055.00
	specific indications of triple 
	arthrodesis, subtalar arthrodesis and 
	ankle arthrodesis
	Small
	Advanced Surgical Design & Manufacture Ltd
AE229	RadioFix	Radio Fixator System	One size	$2,150.00
AE231	Poing Fix	Wrist Fixator System	One size	$2,150.00
AE232	Wrist Fixator PFII	Wrist Fixator System	One size	$2,150.00
	Akva Surgical Pty Ltd
VK002	Orthofix External Fixation System 	Anodised aluminium and stainless 	One size only	$2,150.00
	Pennig Wrist Fixator
VK013	Orthofix External Fixation Systems	MiniRail System	Short, Standard, Long and 	$2,150.00
	Articulated Horizontal and 
	Vertical Axis
	Biomet Australia Pty Ltd
BH154	EBI XFIX Dynafix System	Fixator Complete, small	Small, Extra small	$2,150.00
BH158	EBI XFIX Dynafix System	Distal Radius Fixator, Wristfix, 	One Size Only	$2,150.00
	Stainless Steel, Aluminium
	Smith & Nephew Surgical Pty Ltd
SN965	Smith & Nephew External Fixation 	Complete Frame, 3 Dimensional & 	Small	$2,150.00
	(Llizarov, Taylor Spatial Frame, Jet-	Compression/Distraction Device
	X, Compass)
	Stryker Australia Pty Ltd
SK396	Hoffmann II Compact Wrist Sterile 	Bridging & Non-bridging	Sterile Wrist Kit	$2,150.00
	Pre-Packs, RL
	Small, CDD
	Stryker Australia Pty Ltd
ST945	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	15mm	$2,900.00
	assembly yellow
Prostheses List by Category, Groups and Sponsor	Page 477 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Standard
	Akva Surgical Pty Ltd
VK001	Orthofix External Fixation System 	Anodised aluminium and stainless 	One size only	$6,500.00
	Ankle Fixator
VK009	Orthopaedic External Fixation 	Metadiaphyseal Fixator	One size	$6,500.00
	System - Xcaliber External Fixator
VK012	Orthofix Limb Reconstruction System	Orthofix Limb Reconstruction System	Adult and paediatric - 	$6,500.00
	Short, Standard and Long
	Biomet Australia Pty Ltd
BH150	EBI XFIX Dynafix System	Standard Straight Fixator Complete	Stndard 5 or 8 cm arms	$6,500.00
BI850	EBI XFIX DynaFix System	Hip Distractor Aluminium, Stainless 	One Size Only	$6,500.00
	Steel, Titanium
	Smith & Nephew Surgical Pty Ltd
SN946	Smith & Nephew External Fixation 	Complete Frames, 3 Dimensional & 	Standard	$6,500.00
	(Llizarov,Taylor Spatial Frame, Jet-	Compression/Distraction
	X, Compass
	Stryker Australia Pty Ltd
SK365	Hoffman II External Fixation System	Hoffmann II Ankle Sterile Pre-Pack 	Standard Large Ankle Kit  	$6,500.00
	kit, RL
	Standard, CDD
	Biomet Australia Pty Ltd
BH353	TEMPFIX External Fixation System 	Sterile pack for external fixation of 	Sterile transfixing pin lower	$9,925.00
	-transfixing pin sterile kit	lower extremity periarticular fractures	 leg frame kits
BH354	TEMPFIX External Fixation System 	Sterile pack for external fixation of 	Sterile half pin lower leg 	$9,925.00
	- half pin sterile kit	lower extremity periarticular fractures	frame kits
	Stryker Australia Pty Ltd
SK364	Hoffman II External Fixation System	Hoffman II Sterile Pre-pack kit, RL	Standard Tibia	$9,925.00
SK378	Hoffman II External Fixation System	Hoffman Pre-pack Pelvic kit	Sterile Pelvic Kit	$9,925.00
ST946	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	20mm	$9,925.00
	assembly blue
ST947	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	25mm	$9,925.00
	assembly rod
Prostheses List by Category, Groups and Sponsor	Page 478 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.11.03 - Frame Component - Monoplanar, Clamp
	3D
	Stryker Australia Pty Ltd
HW517	HOFFMANN3 EXTERNAL 	MULTIPLANAR CLAMP 	STANDARD	$1,662.00
	FIXATION SYSTEM	PIN/ROD-ROD
	Mini
	Synthes Australia Pty Ltd
SY664	Orthopaedic External Fixator 	Mini Frame Holding Clamp	3.0-4.0mm	$328.00
SY727	Orthopaedic External Fixator 	External fixator clamps, connecting 	1-3mm	$328.00
	clamp
	Small
	Akva Surgical Pty Ltd
VK014	Orthofix External Fixation Systems	Pennig Minifixator	Short, Standard, Long	$4,800.00
	Biomet Australia Pty Ltd
BH155	EBI XFIX Dynafix System	Clamp straight body, Tee, or ankle	Small or extra small	$4,800.00
BH163	EBI XFIX Dynafix System	Clamp: straight body, Tee or ankle	Small, Extra Small	$4,800.00
	Smith & Nephew Surgical Pty Ltd
SN966	Smith & Nephew External Fixation 	Monoplanar Clamp, 3 Dimensional	Small	$4,800.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Synthes Australia Pty Ltd
SY728	Orthopaedic External Fixator 	External fixator clamps, connecting 	2.0 - 4.9mm	$4,800.00
	clamp
	Standard
	Biomet Australia Pty Ltd
BH159	EBI XFIX Dynafix System	Clamp: straight body, Tee or ankle	5 - 8 cm	$1,662.00
BI851	EBI XFIX Dynafix System	Rail Clamp (Rotational Serrated T-	Ex Small, Small, Adult, 4-6mm	$1,662.00
	clamp, Swivel, Translational, 
	Uniplaner Adjustable)
	Synthes Australia Pty Ltd
SY199	Orthopaedic External Fixator 	External fixator clamps, double clamp	8.0 - 11mm	$1,662.00
SY203	Orthopaedic External Fixator 	External fixator clamps, tube to 	11mm Diameter	$1,662.00
	tube/universal clamp
Prostheses List by Category, Groups and Sponsor	Page 479 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY236	Orthopaedic External Fixator 	External fixator clamp components, 	1.25-6.0mm	$1,662.00
	halo with visor
SY247	Orthopaedic External Fixator 	External fixator clamp components, 	1.25-6.0mm	$1,662.00
	double joint
	Standard, 3D
	Smith & Nephew Surgical Pty Ltd
SN947	Smith & Nephew External Fixation 	Monoplanar Clamp	Standard	$1,662.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Stryker Australia Pty Ltd
ST968	TenXor External Fixation System	Anodized metal alloy, ring to 	One size only	$1,662.00
	monotube triax tube clamp
	Standard, 3D, CDD
	Biomet Australia Pty Ltd
BH149	EBI XFIX Dynafix System	Distraction mechanism	Male female	$2,300.00
	Standard, CDD
	Biomet Australia Pty Ltd
BH151	EBI XFIX Dynafix System	Clamp: Straight body, tee or ankle	5-8cm	$1,662.00
BH152	EBI XFIX Dynafix System	Compression / Distraction / 	5-8cm	$1,662.00
	dynamisation modules
	Smith & Nephew Surgical Pty Ltd
SL021	Modular Rail System	Monoplanar Clamp	50mm - 100mm	$1,662.00
	06.03.11.04 - Frame Component - Monoplanar, Body
	Small
	Biomet Australia Pty Ltd
BH164	EBI XFIX Dynafix System	Fixator Body	Small, Extra Small	$2,485.00
	Small CDD
	Biomet Australia Pty Ltd
BH157	EBI XFIX Dynafix System	CD Mechanism	Small, Extra Small fixator	$2,485.00
	Small, CDD
	Stryker Australia Pty Ltd
ST948	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	15mm	$2,485.00
	yellow
Prostheses List by Category, Groups and Sponsor	Page 480 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Standard
	Biomet Australia Pty Ltd
BH153	EBI XFIX Dynafix System	Body component	Std	$2,000.00
BH161	EBI XFIX Dynafix System	Body Component	Std	$2,000.00
BI856	EBI XFIX Dynafix System	Monoplanar Transport Rail, 	100-420mm	$2,000.00
	radiolucent (carbon fibre) 
	Smith & Nephew Surgical Pty Ltd
SL018	Modular Rail System	Rail	Standard; small; small short	$2,000.00
	standard CDD
	Stryker Australia Pty Ltd
SK568	Hoffmann II MRI System	Anodized metal alloy, dynamic tube, 	15/20mm	$2,650.00
	MRI
	Standard, CDD
	Biomet Australia Pty Ltd
BI819	EBI XFIX Dynafix System	Multi Axial Correction and 	4-8cm, Xsmall - Adult	$2,650.00
	Metaphyseal Arc Module complete 
	with T-clamp
	Smith & Nephew Surgical Pty Ltd
SN950	Smith & Nephew External Fixation 	Monoplanar Clamp, compression 	Standard	$2,650.00
	(Ilizarov, Taylor Spatial Frame, Jet-	distraction device
	X, Compass)
	Stryker Australia Pty Ltd
SK567	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	20mm	$2,650.00
	blue
	06.03.11.05 - Frame Component - Monoplanar, Adaptor
	standard
	Smith & Nephew Surgical Pty Ltd
SN948	Smith & Nephew External Fixation 	Monoplanar Clamp, 3 Dimensional	Standard	$2,000.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN949	Smith & Nephew External Fixation 	Monoplanar clamp, Compresion 	Standard	$2,000.00
	(Llizarov, Taylor Spatial Frame, Jet-	Distraction Device
	X, Compass)
Prostheses List by Category, Groups and Sponsor	Page 481 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
ST943	Hoffman II External Fixation System	Anodised metal alloy, adjustable 	Long, short	$2,000.00
	connecting rod
ST953	Monotube External Fixation System	Anodized metal alloy, T-Adapter 	15, 20, 25mm	$2,000.00
	yellow, blue, red
	06.03.11.06 - Frame Component - Full Circular Ring
	Stryker Australia Pty Ltd
HW476	HOFFMANN LRF - FULL 	FULL CURCULAR RING	DIAMETER - 80 - 270MM	$721.00
	CIRCULAR RING
	Standard
	Smith & Nephew Surgical Pty Ltd
SN952	Smith & Nephew External Fixation 	Full Circular Ring	standard	$721.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Synthes Australia Pty Ltd
SY425	Distraction Osteogenesis Ring 	Full Ring, MRI safe, Titanium	140mm-200mm Diameter	$721.00
SY665	Orthopaedic External Fixator 	Full Ring for Hybrid, RL MRI	115-205mm	$721.00
	06.03.11.07 - Frame Component - Partial Circular Ring
	Akva Surgical Pty Ltd
VK011	Orthopaedic External Fixation 	Hybrid Fixator	One size only	$1,105.00
	System - Xcaliber External Fixator
	Stryker Australia Pty Ltd
HW478	HOFFMANN LRF - PARTIAL 	PARTIAL CIRCULAR RING	DIAMETER - 100-240MM	$1,105.00
	CIRCULAR RING
	Standard
	Biomet Australia Pty Ltd
BH147	EBI XFIX Dynafix System	MAC Rings or Arcs, Rotational or 	100-220mm	$1,105.00
	Smith & Nephew Surgical Pty Ltd
SL019	Modular Rail System	Rail Arc	Various	$1,105.00
Prostheses List by Category, Groups and Sponsor	Page 482 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN953	Smith & Nephew External Fixation 	Partial Circular Ring	Standard	$1,105.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Stryker Australia Pty Ltd
ST965	TenXor External Fixation System	Anodized metal alloy, open ring	150, 180, 210, 250mm	$1,105.00
	Synthes Australia Pty Ltd
SY422	Distraction Osteogenesis Ring 	Partial Circular Ring, Arch Plate	80-240mm	$1,105.00
SY666	Orthopaedic External Fixator 	Partial Ring for Hybrid, RL MRI 1/4, 	115-205mm	$1,105.00
	3/4
	06.03.11.08 - Frame Component - Circular Coupling Device
	Stryker Australia Pty Ltd
HW474	HOFFMANN LRF	Coupling	SHORT , LONG	$360.00
	Standard
	Smith & Nephew Surgical Pty Ltd
SN951	Smith & Nephew External Fixation 	Monoplanar adaptor	standard	$360.00
	(Ilizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN954	Smith & Nephew External Fixation 	Circular Coupling device	standard	$360.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Stryker Australia Pty Ltd
HW482	HOFFMANN LRF - WIRE BOLT 	WIRE BOLT COUPLING	SHORT, MEDIUM, LONG	$360.00
	COUPLINGS
	Synthes Australia Pty Ltd
SY662	Orthopaedic External Fixator 	Hybrid Ring Clamps; Combination, 	11.0mm	$360.00
	Rod, Rod/Wire, Adjustable, 
	Tube/Tube RL MRI
	06.03.11.09 - Frame Component - Circular Frame Strut Device
	Stryker Australia Pty Ltd
HW481	HOFFMANN LRF - THREADED 	THREADED TELESCOPIC ROD	DIAMETER - 6MM 	$1,000.00
	TELESCOPIC ROD	LENGTHS  - 30-400MM
Prostheses List by Category, Groups and Sponsor	Page 483 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	3D
	Synthes Australia Pty Ltd
SY793	Distraction Osteogenesis Ring 	Circular Frame, 3 Dimensional 	Extra short - Long	$1,300.00
	Telescopic Struts
	Standard
	Biomet Australia Pty Ltd
BI828	EBI XFIX Vision System	Clamp/Rod, stainless steel/aluminium	4mm/6mm, 3-5 hole, 50-	$1,000.00
	150mm
	Smith & Nephew Surgical Pty Ltd
SN956	Smith & Nephew External Fixation 	Circular Frame Strut Device, 	standard	$1,000.00
	(Llizarov, Taylor Spatial Frame, Jet-	Compression Distraction Device
	X, Compass)
	Stryker Australia Pty Ltd
HW480	HOFFMANN LRF - STATIC 	STATIC STRUT	LENGTHS - 20 -60MM	$1,000.00
SR096	HOFFMANN LRF - TELESCOPIC 	TELESCOPIC STRUT	LENGTHS - 100-277MM	$1,000.00
	STRUT
	Standard, 3D
	Smith & Nephew Surgical Pty Ltd
SN955	Smith & Nephew External Fixation 	Circular Frame Strut Device, 3 	standard	$1,000.00
	(Llizarov, Taylor Spatial Frame, Jet-	Dimensional
	X, Compass)
	06.03.11.10 - Frame Component - Foot Plate
	Stryker Australia Pty Ltd
HW475	HOFFMAN LRF	FOOT RING PLATE/ARCH	DIAMETER - 100-210MM	$3,000.00
	Standard
	Smith & Nephew Surgical Pty Ltd
SN957	Smith & Nephew External Fixation 	Foot Plate	Standard	$3,000.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Synthes Australia Pty Ltd
SY427	Distraction Osteogenesis Ring 	Foot Plates, Carbon Fibre RL MRI	100mm-180mm	$3,000.00
Prostheses List by Category, Groups and Sponsor	Page 484 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.11.11 - Frame Component - Circular Frame, Nuts & Spacers
	Stryker Australia Pty Ltd
HW477	HOFFMANNLRF - NUTS, 	NUTS, WASHERS , SPACERS	SHORT, LONG, M6,M8,1-	$47.00
	WASHERS , SPACERS	7MM
	Standard
	Smith & Nephew Surgical Pty Ltd
SL023	Modular Rail System	Rail Accessories	Various	$47.00
SN958	Smith & Nephew External Fixation 	Circular Frame, Nuts & Spacer	standard	$47.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Synthes Australia Pty Ltd
SY228	Distraction Osteogenesis Ring 	Connecting Plate / Spacer	1 - 5 holes	$47.00
SY419	Distraction Osteogenesis Ring 	Nuts, Washers & Spacers	1mm-50mm	$47.00
	06.03.11.12 - Frame Component - Coupling Device
	Stryker Australia Pty Ltd
HW516	HOFFMANN3 EXTERNAL 	ROD COUPLER	0-120 DEGREES	$770.00
	FIXATION SYSTEM
	Synthes Australia Pty Ltd
SY091	AO/ASIF k-Wires, Pins, Washers etc	Pinless pins/clips	Asymetric small and large	$770.00
	Mini
	Lima Orthopaedics Australia Pty Ltd
LC058	S.E.M. II 400 External Fixator -	Clamp - Left / Right / Threaded / Non 	One size	$645.00
	Clamp	Threaded
	Stryker Australia Pty Ltd
SK206	Hoffmann II External Fixation 	Hoffmann II Micro - Couplings 	Couplings, Rod to rod, Pin 	$645.00
	to Rod and Multipin
	Small
	Stryker Australia Pty Ltd
ST935	Hoffman II External Fixation System	Anodised metal alloy, rod to rod 	8/8mm	$655.00
	coupling
Prostheses List by Category, Groups and Sponsor	Page 485 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ST936	Hoffman II External Fixation System	Anodised metal alloy, pin to rod 	8/4, 5mm	$655.00
	coupling
	Synthes Australia Pty Ltd
SY746	Orthopaedic External Fixator 	Frame Coupling Device	2.0mm - 4.9mm	$655.00
	Small, CCD
	Synthes Australia Pty Ltd
SY745	Orthopaedic External Fixator 	Distractors and lengthening 	1.0 - 2.5mm	$655.00
	Standard
	Biomet Australia Pty Ltd
BH148	EBI XFIX Dynafix System	MAC system couplig devices, Ring, 	Male Female	$770.00
	Angulating coupler, rotational adapter
BI827	EBI XFIX Vision System	Rod connectors, stainless 	Dia 9.5mm	$770.00
	steel/aluminium
BI831	EBI XFIX Vision System	Post, Bone Screw, Telescoping, 	One size only	$770.00
	stainless steel
BI854	EBI XFIX Dynafix System	Rail Accessory (Adaptor, CD 	Ex Small, Small, Adult, 4-6mm	$770.00
	Support, Dynamization, Bridge)
	Smith & Nephew Surgical Pty Ltd
SL020	Modular Rail System	Caps, clamps (upper, lower & stacked)	Various	$770.00
	 & hinges, clamp connectors
SL022	Modular Rail System	Angle Clamps	Various	$770.00
	Stryker Australia Pty Ltd
HW448	Hoffmann3 External Fixation system 	Hoffmann3 posts	straight, 30 deg, 90 deg	$770.00
	- Posts
HW449	Hoffmann3 External Fixation System	Rod & Pin-Rod couplings	Coupling, 5/8/11mm rods - 	$770.00
	4/5/6mm pins
SK375	Hoffman II External Fixation System	Hoffman II MRI Coupling	Pin to Rod, Rod to Rod, 	$770.00
	Tube to Rod, Pin Clamp 
	Assembly
SK485	Hoffmann Xpress - Universal Pin 	Hoffmann Xpress External Fixation 	One size to fit the Rod to Rod	$770.00
	Clamp	Device - Adapted to fit the needs of 
	medically trained staff of such 
	occupations as the Armed Forces
Prostheses List by Category, Groups and Sponsor	Page 486 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SK487	Hoffmann Xpress - 5 Pin Clamp Posts	Hoffmann Xpress External Fixation 	2 categories, a 1 post clamp 	$770.00
	Device - adapted to fit needs of 	and a 2 post clamp
	medically trained staff of such 
	occupations as the Armed Forces
ST952	Monotube External Fixation System	Anodized metal alloy, single pin 	15, 20, 25mm	$770.00
	clamp yellow, blue, red
ST954	Monotube External Fixation System	Anodized metal alloy, tube to tube 	15, 20, 25mm, 15/20mm, 	$770.00
	clamp yellow, blue, red, yellow/blue, 	20/25mm
	blue/red
ST966	TenXor External Fixation System	Anodized metal alloy, ring clamp	One size only	$770.00
ST967	TenXor External Fixation System	Anodized metal alloy, wire post, pin 	One size only	$770.00
	post
ST971	TenXor External Fixation System	Anodized metal alloy, with sliding 	One size only	$770.00
	clamp
ST972	TenXor External Fixation System	Anodized metal alloy,with sliding 	One size only	$770.00
	clamp and spacer
	Synthes Australia Pty Ltd
SY663	Orthopaedic External Fixator 	Medium Frame; Rod, Threaded, 	5-11.0mm	$770.00
	Adjustable Clamps RL MRI
SY744	Orthopaedic External Fixator 	Distractors and lengthening 	20mm - 30mm	$770.00
	Standard, 3D
	Smith & Nephew Surgical Pty Ltd
SN959	Smith & Nephew External Fixation 	Coupling device, 3 dimensional	Standard	$770.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN964	Smith & Nephew External Fixation 	Articulating Hinge, 3 Dimensional	Standard	$770.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN967	Smith & Nephew External Fixation 	Articulating Hinge, 3 Dimensional & 	Mini	$770.00
	(Llizarov, Taylor Spatial Frame, Jet-	Compression Distraction Device
	X, Compass)
	Stryker Australia Pty Ltd
ST951	Monotube External Fixation System	Anodized metal alloy, pin clamp 	15, 20, 25mm	$770.00
	yellow, blue, red
Prostheses List by Category, Groups and Sponsor	Page 487 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Standard, CCD
	Akva Surgical Pty Ltd
VK003	Orthofix External Fixation System 	Anodised aluminium and stainless 	One size only	$770.00
	Elbow Fixator
	Standard, CDD
	Akva Surgical Pty Ltd
VK004	Orthofix External Fixation System 	Anodised aluminium and stainless 	One size only	$770.00
	Hybrid Fixator
VK005	Orthofix External Fixation System 	Anodised aluminium and stainless 	One size only	$770.00
	Knee Fixator
	Biomet Australia Pty Ltd
BI853	EBI XFIX Dynafix System	CD Clicker	Ex Small, Small, Adult, 5-	$770.00
	20cm
	Stryker Australia Pty Ltd
SK390	Hoffman II External Fixation System	Hoffman II MRI	Compression/Dystraction 	$770.00
	Tube, Dynamisation Tube
ST950	Monotube External Fixation System	Anodized metal alloy, dynamic tube 	25mm	$770.00
	Synthes Australia Pty Ltd
SY237	Orthopaedic External Fixator 	3 degree, 6 degree, 11 degree. Medium,	8.0 - 11.0mm	$770.00
	 Large
	06.03.11.13 - Frame Component - Rods
	Mini
	Stryker Australia Pty Ltd
SK211	Hoffmann II External Fixation 	Hoffmann II Micro - Carbon Fibre 	3mm (30-150mm)	$52.00
	Rods, RL
SK212	Hoffmann II External Fixation 	Hoffman II Micro - Stainless Steel Rods	3mm x (30-180mm)	$52.00
	Small
	Stryker Australia Pty Ltd
ST962	Monotube External Fixation System	Carbon tube yellow 015, RL	15mm	$144.00
	Synthes Australia Pty Ltd
SY193	Orthopaedic External Fixator 	Rod / Bar	2.0mm - 15mm	$144.00
SY668	Orthopaedic External Fixator  	Curved and straight rod, RL, MRI 	4.0mm	$144.00
	Carbon Fibre
Prostheses List by Category, Groups and Sponsor	Page 488 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Standard
	Biomet Australia Pty Ltd
BH358	Ace External Fixator	Threaded Rod, titanium	1/4" x 20cm	$155.00
BI830	EBI XFIX Vision System	Ring Connector Assembly, stainless 	1 or 2 bolt model	$155.00
	steel/aluminium
BI832	EBI XFIX Vision System	Rods, Bars, stainless steel/aluminium/	Dia 9.5mm, 150-400mm 	$155.00
	 or carbon fibre (radiolucent)	length
	Smith & Nephew Surgical Pty Ltd
SN960	Smith & Nephew External Fixation 	Rods	Standard	$155.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN961	Smith & Nephew External Fixation 	Rods, telescopic	standard	$155.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Stryker Australia Pty Ltd
HW446	Hoffmann3 External Fixation system 	MRI curved and straight rod/coupler -	Diameter - 11mm, lengths 	$155.00
	- MRI Curved and straight 	 carbon fibre	100-650mm
	rod/coupler - carbon fibre
SK393	Hoffman II External Fixation System	Hoffmann II MRI Connecting Rods, 	8mm Connecting rod 	$155.00
	RL 	(100mm - 500mm), 5mm 
	Connecting rod (100mm - 
	500mm), Semi Circular 
	Curve Rod
SK486	Hoffmann Xpress External Fixation 	Hoffmann Xpress - Connnecting Tube, 	15 mm diameter / 150 to 440	$155.00
	Device	RL, MRI	 mm in length
ST963	Monotube External Fixation System	Carbon tube blue 015, RL	150, 200, 250, 300mm	$155.00
ST964	Monotube External Fixation System	Carbon tube red 015, RL	150, 200, 250, 300mm	$155.00
	Synthes Australia Pty Ltd
SY196	Orthopaedic External Fixator 	Rod/Bar	8 - 11 mm	$155.00
SY238	Orthopaedic External Fixator 	External fixator clamp components, 	1.25-6.0mm	$155.00
	connecting tube
SY421	Distraction Osteogenesis Ring 	Threaded Rod, MRI Safe	250mm-350mm	$155.00
SY667	Orthopaedic External Fixator 	Curved and straight rod, RL, MRI 	8.0-11.0mm	$155.00
	Carbon Fibre
Prostheses List by Category, Groups and Sponsor	Page 489 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.11.14 - Frame Component - Pins
	Akva Surgical Pty Ltd
VK007	Screw	Frame Component - Pins	Shaft Dia 3.0 - 6.0mm	$149.00
	Thread Dia 6.0 - 2.00mm
	Total Length 40 - 260mm
	Thread Length 15 - 100mm
VK008	Osteotite screw	HA coated screw used for fixation of 	Shaft Dia 3.0 - 6.0mm, 	$149.00
	an external frame	Thread Dia 6.0 - 2.0mm, 
	Total Length 40 - 260mm, 
	Thread Length 15 - 90mm
Prostheses List by Category, Groups and Sponsor	Page 490 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ortho Solutions Pty Ltd
Prostheses List by Category, Groups and Sponsor	Page 491 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OU006	TITANIUM EX. FIX. PIN	TITANIUM EX.FIX.PIN	TITANIUM EX. FIX. PIN 	$149.00
	4.0MM X 20MM, 
	TITANIUM EX. FIX. PIN 
	4.0MM X 25MM
	TITANIUM EX. FIX. PIN 
	4.0MM X 30MM, 
	TITANIUM EX. FIX. PIN 
	4.0MM X 35MM
	TITANIUM EX. FIX. PIN 
	4.0MM X 40MM, 
	TITANIUM EX. FIX. PIN 
	4.0MM X 45MM
	TITANIUM EX. FIX. PIN 
	4.0MM X 50MM, 
	TITANIUM EX. FIX. PIN 
	4.0MM X 60MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 20MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 25MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 30MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 35MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 40MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 45MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 50MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 55MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 60MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 65MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 70MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 75MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 80MM, 
	TITANIUM EX. FIX. PIN 
	5.0MM X 85MM
	TITANIUM EX. FIX. PIN 
	5.0MM X 90MM, 
Prostheses List by Category, Groups and Sponsor	Page 492 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	TITANIUM EX. FIX. PIN 
	6.0MM X 20MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 25MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 30MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 35MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 40MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 45MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 50MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 55MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 60MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 65MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 70MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 75MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 80MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 85MM
	TITANIUM EX. FIX. PIN 
	6.0MM X 90MM
	SST EX. FIX PIN 5MM X 
	35MM X 175MM, SELF 
	DRILL/TAP PIN 3.0MM 
	L=60/10, SELF 
	DRILL/TAP PIN 3.0MM 
	L=60/15 SELF 
	DRILL/TAP PIN 3.0MM 
	L=80/20 SELF 
	DRILL/TAP PIN 3.0MM 
	L=110/22, SELF 
	DRILL/TAP PIN 4.0MM 
	L=90/40
	SELF DRILL/TAP PIN 
	4.0MM L=120/45, 
	SELF DRILL/TAP PIN 
	4.0MM L=150/40, 
Prostheses List by Category, Groups and Sponsor	Page 493 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SELF DRILL/TAP PIN 
	4.0MM L=150/50,
	SELF DRILL/TAP PIN 
	4.0MM L=180/50,
	SELF DRILL/TAP PIN 
	4.0MM L=200/40,
	SELF DRILL/TAP PIN 
	4.0MM L=250/50, 
	SELF DRILL/TAP PIN 
	4.0MM L=250/70,
	SELF DRILL/TAP PIN 
	5.0MM L=120/35,
	SELF DRILL/TAP PIN 
	5.0MM L=150/40,SELF 
	DRILL/TAP PIN 5.0MM 
	L=150/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=180/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=200/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=150/40,SELF 
	DRILL/TAP PIN 5.0MM 
	L=150/50,
	SELF DRILL/TAP PIN 
	5.0MM L=180/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=200/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=200/60,SELF 
	DRILL/TAP PIN 5.0MM 
	L=250/50,SELF 
	DRILL/TAP PIN 5.0MM 
	L=250/70,
	Smith & Nephew Surgical Pty Ltd
SL010	Smith & Nephew Ex-Fix	Frame Component - pins	All sizes	$149.00
	Stryker Australia Pty Ltd
SK483	HA Apex Pins	HA coated bone screw	4-6mm diameters, various 	$274.00
	lengths.
ST884	Apex Pins	Stainless Steel Orthopaedic Pins	2 - 6mm	$149.00
Prostheses List by Category, Groups and Sponsor	Page 494 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY051	AO/ASIF Pins	Seldrill	3mm - 6mm	$149.00
	06.03.11.15 - Frame Component - Pin Clamp Assembly
	Small
	Stryker Australia Pty Ltd
ST892	Hoffmann II Compact External 	Pin clamp assembly with no post	One Size Only	$695.00
	Fixation System
	Synthes Australia Pty Ltd
SY224	Orthopaedic External Fixator 	External fixator clamp components, 	1.0 - 3.0mm	$695.00
	angled piece
	Standard
	Smith & Nephew Surgical Pty Ltd
SN962	Smith & Nephew External Fixation 	Pin Clamp Assembly	Standard	$1,077.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
SN963	Smith & Nephew External Fixation 	Pin Clamp Assembly, 3 Dimensional	Standard	$1,077.00
	(Llizarov, Taylor Spatial Frame, Jet-
	X, Compass)
	Stryker Australia Pty Ltd
HW447	Hoffmann3 External Fixation System	Pin clamp Assembly	5 hole with/without posts	$1,077.00
	 - Pin Clamp
SK373	Hoffman II External Fixation system	Hoffman II MRI, Pin Clamp Assembly, 	Pelvic Clamp	$1,077.00
	MRI
	Synthes Australia Pty Ltd
SY200	Orthopaedic External Fixator 	External fixator clamps, transverse 	1.25 - 6.0mm	$1,077.00
	clamp
SY239	Orthopaedic External Fixator 	External fixator clamp components, 	1.25-8.0mm	$1,077.00
	angled piece with nut
SY242	Orthopaedic External Fixator 	External fixator clamp components, bar	1.25-6.0mm	$1,077.00
	 for upper jaw
SY418	Distraction Osteogenesis Ring 	Bolt-connecting, clamp, eye, wire 	One size	$1,077.00
	offset, wire slotted, MRI safe.
Prostheses List by Category, Groups and Sponsor	Page 495 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Standard, 3D
	Biomet Australia Pty Ltd
BI852	EBI XFIX Dynafix System	Rail Clamp (Rotational Serrated T-	Ex Small, Small, Adult, 4-6mm	$3,348.00
	clamp, Swivel, Translational, 
	Uniplaner, Adjustable) 
	06.03.11.16 - Frame Component  - Pin Clamp Assembly Post
	Small
	Stryker Australia Pty Ltd
ST937	Hoffman II External Fixation System	Anodised metal alloy, 30 deg angled 	One size only	$99.00
	post, stainless steel
ST938	Hoffman II External Fixation System	Anodised metal alloy, straight post, 	One size only	$99.00
	stainless steel
	Standard
	Stryker Australia Pty Ltd
HW479	HOFFMANN LRF - POSTS	POSTS	LENGTHS - 44-88MM	$111.00
SK374	Hoffman II External Fixation System	Hoffman II MRI	Posts 8mm and 5mm	$111.00
	Synthes Australia Pty Ltd
SY420	Distraction Osteogenesis Ring 	Wire Post MRI Safe	Short, Long	$111.00
	06.03.11.17 - Articulating Hinge
	Australian Orthotic Technologies
ZT002	Ossur Halo Thoracic Orthosis	Spinal, Halo thoracic orthosis; skull 	2 1/4" or 3".	$451.00
	pin set
	Mini
	Wright Medical Australia
WR206	Sidekick Coretrak Articulating 	Sterile kit, includes tube fixator, 	Standard, long, articulating	$2,460.00
	articulating fixator, half pin and pin 
	covers, for external fixation of the foot 
	of hand, Radiolucent
	Standard
	Biomet Australia Pty Ltd
BI849	EBI XFIX DynaFix System	OptiROM Passive Distractor Module	One Size Only	$451.00
Prostheses List by Category, Groups and Sponsor	Page 496 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY295	Bremer Halo Crown System	Titanium Skull Pins	Standard & Hi-Fix	$451.00
	Synthes Australia Pty Ltd
SY428	Distraction Osteogenesis Ring 	Universal Hinge	One Size	$451.00
	System & Orthopaedic External 
	Fixator Systems
	Standard, CDD
	Biomet Australia Pty Ltd
BI776	EBI XFIX DynaFix System	OptiROM Articulating Fixator 	Small and Large	$4,070.00
	Complete
	Stryker Australia Pty Ltd
ST888	Howmedica Dynamic Joint 	Complete Y Body Frame - Stainless 	One size only	$4,070.00
	Steel
	06.03.11.18 - Upper body kit
	Stryker Australia Pty Ltd
HW489	HOFFMANN3 external fixation 	Sterile field kit	Standard kit A	$6,366.00
	system
	06.03.11.19 - Lower body kit
	Stryker Australia Pty Ltd
HW490	HOFFMANN3 external fixation 	Sterile field kit	Standard kit B	$5,681.00
	system
06.03.14 - Bone Cement
	06.03.14.01 - Cement only
	CareFusion Australia 316 Pty Ltd
ZQ001	Ava-Tex Radiopaque Bone Cement 	13.8g Barium-Polymer Powder & 6ml 	12mL	$174.00
	Kit	Liquid Monomer (part No. BCPM003
	Cook Medical Australia Pty Ltd
WC145	Osteo-Firm	Osteo Bone cement - Osteo Firm	One size only	$174.00
	Global Manufacturing Technology Pty Ltd
GM148	BonOs Inject	Injectable acrylic vertebroplasty 	40gm	$174.00
Prostheses List by Category, Groups and Sponsor	Page 497 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Heraeus Kulzer Australia Pty Ltd
HK005	Palacos or Palamed bone cement	Single mix PMMA	40g	$174.00
	Johnson & Johnson Medical Pty Ltd
DP107	CMW Bone Cement	CMW Bone Cement Various  without 	20, 40 grams	$174.00
	Antibiotic
DY097	Vetebrplastic Cement	Vetebrplastic cement	One size only	$174.00
JJ609	Vertebroplasty System	Vertobroplasty System	11cc	$174.00
JJ932	SmartSet	PMMA bone cement	20 to 40g	$174.00
	Medtronic Australasia Pty Ltd
MC984	CD HORIZON Fenestrated Screw 	Fenestrated screw cement - High 	20g powder, 9g vial	$174.00
	Cement	viscosity, radiopaque, PMMA bone 
	cement
	Orthotech Pty Ltd
OH126	Cemex bone cement	1 mix 	1 mix 40g powder and 13.3g	$174.00
	Methylmethacrylate/Polymethylmetha	 liquid
	crylate
OH166	Mendec Spine	Bone Cement	20g sterile powder / 9.4g 	$174.00
	sterile liquid
	Scient'x Australia
SX051	OsseoFix+ System	Radiopaque bone cement 	10gm, 11gm, 13gm	$174.00
	vertebroplasty system, including 
	mixing chamber, cement delivery gun, 
	extension tube, cement delivery 
	cannula and targeting needle.
	Smith & Nephew Surgical Pty Ltd
SN667	Versabond Bone Cement	Methyl Methacrylate Methyl Acrylate	40g	$174.00
	 Copolymer, Methylmethacrylate 
	Homopolymer, Supplied as Powder 
	(copolymer) and liquid (monomer) in 
	an ampule
	Stryker Australia Pty Ltd
HW322	Surgical Simplex P Radiopaque 	Polymethyl Methacrylate, Styrene 	40 grams	$174.00
	Bone Cement	Copolymer, Barium Sulfate
SK458	Simplex P Speed Set Bone Cement	PMMA Bone Cement	40g pack	$174.00
Prostheses List by Category, Groups and Sponsor	Page 498 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.14.02 - Cement with Antibiotic
	Biomet Australia Pty Ltd
BI243	Refobacin Plus Bone Cement	Bone Cement, Gentamicin, PMMA	40gm	$184.00
BI844	Refobacin Plus Bone Cement	Bone Cement, Methyl methacrylate, 	40 gm (2 x 20 gm)	$184.00
	Gentamicin
BI845	Refobacin Plus Bone Cement	Bone Cement, Methyl methacrylate, 	80 gm (2 x 40 gm)	$184.00
	Gentamicin
	Heraeus Kulzer Australia Pty Ltd
HK007	Palacos or Palamed Bone Cement 	Single Mix PMMA with Gentamicin	20 grams	$184.00
	with Gentamicin
HK008	Copal G+C	High-viscosity, radiopaque bone 	40g	$184.00
	cement with gentamicin and 
	clindamycin
HK009	Palacos or Palamed Bone Cement 	Single Mix PMMA with Gentamicin	40g	$184.00
	with Gentamicin
	Johnson & Johnson Medical Pty Ltd
DP108	CMW Antibiotic Bone Cement 	CMW Bone Cement Various with 	20, 40 grams	$184.00
	Antibiotic
JJ933	SmartSet	Bone cement with antibiotic	20 to 40g	$184.00
	Orthotech Pty Ltd
OH127	Cemex-genta bone cement	1 mix Methylmethacrylate/ 	1 mix 40g powder and 13.3g	$184.00
	Polymethylmethacrylate with 	 liquid
	gentamiacin
	Stryker Australia Pty Ltd
HW320	Antibiotic Simplex Bone Cement 	Polymethyl Methacrylate, Styrene 	40 grams	$184.00
	with Tobramycin	Copolymer, Barium Sulfate
	Zimmer Pty Ltd
ZI877	Cemex-genta bone cement	1 mix Methylmethacrylate/ 	1 mix 40g powder and 13.3g	$184.00
	Polymethylmethacrylate with 	 liquid
	gentamiacin
Prostheses List by Category, Groups and Sponsor	Page 499 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.14.03 - Cement with Complex Delivery System
	CareFusion Australia 316 Pty Ltd
ZQ002	AVAmax Plus	Radiopaque bone cement system	11G & 13G	$500.00
ZQ003	AVAmax	Radiopaque bone cement system	11G & 13G	$500.00
	Johnson & Johnson Medical Pty Ltd
DP446	CMW	Bone Cement with vaccum mixing 	40 to 100g	$500.00
	system
JJ582	SmartMix	Bone Cement with Vacuum Mixing 	40 to 100g	$500.00
	System
JJ736	Confidence Spinal cement system	Spinal Bone Cement PMMA and 	5-11cc	$500.00
	Percutaneous Administration Kit
	Synthes Australia Pty Ltd
SY429	Vertebral Augmentation	Vertecem, Traumacem Cement, and 	21gm	$500.00
	Viscosafe Mixing System
	CDS
	Orthotech Pty Ltd
OH171	Mendec Spine	Bone Cement	20g powder / 9.4g sterile 	$500.00
	liquid
	06.03.14.04 - Cement with Antibiotic and Complex Delivery System
	Biomet Australia Pty Ltd
BH112	Optipac	Refobacin Plus, Prefilled Vaccum 	40gm	$500.00
	Mixing System, Gentamicin Sulphate, 
	PMMA Cement
BH113	Optipac	Refobacin Plus, Prefilled Vacuum 	60-80gm	$500.00
	mixing system, Gentamicin Sulphate, 
	PMMA Cement
	Heraeus Kulzer Australia Pty Ltd
HK010	Palacos R+G Pro	Single Mix PMMA with Gentamicin 	55g, 75g	$500.00
	and Complex Delivery System
	Johnson & Johnson Medical Pty Ltd
DP445	CMW	Antibiotic Bone cement with vacuum 	40 to 100g	$500.00
	mixing system
Prostheses List by Category, Groups and Sponsor	Page 500 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ583	SmartMix	Antibiotic Bone Cement with Vacuum	40 to 100g	$500.00
	 Mixing System
	Zimmer Pty Ltd
ZI873	Cemex® System Genta	Bone Cement  with Gentamicin 	40, 60, 70 and 80 grams	$500.00
	packaged in a complex delivery 
	06.03.14.05 - Accessories - Restrictors
	Stryker Australia Pty Ltd
HW006	Stryker Cement Security System	PMMA Bone Plug	6 - 24mm	$268.00
	Tornier Pty Ltd
TO006	Bone Plug	UHMWPE - Cement Plug	24mm	$268.00
	Wright Medical Australia
WR117	Bone Plug	PMMA Cement	8, 10, 12, 14, 16mm	$268.00
	Zimmer Pty Ltd
ZI188	Zimmer Bone Cement Systems	Poly Medullary Plug - PMMA	8 - 23 mm	$268.00
ZI328	Coonrad/Morrey Elbow Cement 	PMMA/Plastic Cement Restrictor	Extra Small, Small, Regular	$268.00
	Restrictor
06.03.15 - Bone Graft Substitute
	06.03.15.01 - Ceramic, 0-5cc
	Austofix
AX066	Graftys BCP - Preformed 5cc	Biphasic Calcium Phosphate 	0-5cc	$760.00
AX073	Graftys Bone Cement - HBS Bone 	Macroporous Calcium Phosphate 	5cc	$760.00
	Cement	Cement
AX078	Graftys Bone Cement - Quickset 	Macroporous Calcium Phosphate 	5cc	$760.00
	Bone Cement	Cement
AX080	Graftys BCP - Granules 5cc	Biphasic Calcium Phosphate 	0.5-5cc	$760.00
	Austspine Pty Ltd
AJ005	Kasios TCP	TCP Bone graft substitute Granules	5cc	$760.00
AJ007	JectOS	Injectable synthetic bone graft 	5cc	$760.00
AJ010	KGBone	Synthetic bone substitute, custom-fit 	4mm-10mm	$760.00
	for KAGE cervical interbody cage
Prostheses List by Category, Groups and Sponsor	Page 501 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Baxter Healthcare Pty Ltd
BX296	ACTIFUSE SHAPE 1.6mL–BONE 	A silicate substituted synthetic bone 	1.6mL	$760.00
	MATRIX IMPLANT ARTIFICIAL	graft
BX297	ACTIFUSE SHAPE 2.6mL–BONE 	A silicate substituted synthetic bone 	2.6mL	$760.00
	MATRIX IMPLANT ARTIFICIAL	graft
BX305	ACTIFUSE 	A silicate substituted synthetic bone 	2.5mL	$760.00
	MICROGRANULES2.5mL–BONE 	graft
	MATRIX IMPLANT ARTIFICIAL
BX306	ACTIFUSE MICROGRANULES 	A silicate substituted synthetic bone 	5mL	$760.00
	5mL–BONE MATRIX IMPLANT 	graft
	ARTIFICIAL
	Biomimetic Therapeutics PTY Ltd
BM008	Augment Bone Graft - rhPDGF-BB 	rhPDGF-BB solution (0.3mg/ml)	1.5cc (0.45mg)	$760.00
	component
BM009	Augment Bone Graft - rhPDGF-BB 	rhPDGF solution (0.3mg/ml)	3cc (0.90mg)	$760.00
	component
BM010	Augment Bone Graft - β-TCP 	β-TCP granules	1.5 cc, 3cc	$760.00
	component
	Device Technologies Australia Pty Ltd
DE308	BonAlive Granules	Bone Graft Substitute - Bioactive 	13130 - 0.5-0.8mm small 	$760.00
	Glass Granules	granules, 5cc syringe
	13330 -1.0-2.0mm medium 
	granules, 5cc syringe
	13430 -2.0-3.15mm large 
	granules, 5cc syringe
DE310	SINTlife	Nanostructured Paste/putty in 	0-5 cc	$760.00
DE312	ENGlpore	Granules (size 1,0-2, 5 mm) 5 cc	Granules (size 1,0-2, 5 mm) 	$760.00
	Granules (size 2, 5-4, 0 mm) 5 cc	5 cc
	Granules (size 2, 5-4, 0 mm) 
	5 cc
Prostheses List by Category, Groups and Sponsor	Page 502 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE346	Engipore Pre-formed Bone 	Pre-formed Bone Substitute 0-5cc	Catalogue number: 	$760.00
	Substitute 0-5cc	PFS015005-30-00 Size: 
	4.7cc
	Catalogue number: 
	PFS015006-19-00 Size: 
	2.6cc
	Catalogue number: 
	PFS015006-20-00 Size: 
	3.6cc
	Catalogue number: 
	PFS015006-25-00 Size: 
	2.2cc
	Catalogue number: 
	PFS015005-21-00 Size: 
	1.2cc
	Emergo Asia Pacific Pty Ltd
ER002	Kryptonite	Radiopaque	5cc sterile kit with syringe 	$760.00
	with barium
ER004	Kryptonite	Osteoconductive Adhesive	5cc sterile kit with syringe	$760.00
ER104	GeneX	GeneX paste	5cc	$760.00
ER106	GeneX	GeneX putty	5cc	$760.00
ER107	GeneX	GeneX putty	2.5cc	$760.00
ER124	Stimulan Kit/Rapid Cure-5 cc	Calcium Sulphate synthetic rapid cure	5cc	$760.00
	 bone void filler kit.
ER127	Stimulan kit -5cc	Calcium Sulphate synthetic bone void	5cc	$760.00
	 filler kit
ER153	Kainos	Granules	1 x 2cm3	$760.00
ER154	Kainos	Granules	1 x 3cm3	$760.00
ER155	Kainos	Granules	1x5cm3	$760.00
ER161	Kainos	Blocks	4-8x13x14	$760.00
	Eupharma
EH001	OSIQ Nano HA Bone Paste - Bone 	OSIQ is a ready to use Nano Bone 	Pre loaded syringes 	$760.00
	matrix implant artificial	Graft Substitiute injectable bone 	0.5cc,1.0cc,2.0cc,3.0cc & 
	matrix paste.	5.0cc
EH002	ELIZ Bone Graft Substitute	Synthetic HA / TCP Bone Graft 	Granules (1.0 - 4.0mm) (0.8 -	$760.00
	Substitute	 1.5mm) (0.5 - 1.0mm)
	Volume / Vial (0.25cc to 
	5.0cc)
Prostheses List by Category, Groups and Sponsor	Page 503 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DP447	Biosel 2	BIOSEL II Dose 5G (Calcium 	5g	$760.00
	Phosphates)
DY362	Conduit	Conduit Cylinder	H8 - 20 x D10 - 20mm	$760.00
DY363	Conduit	Conduit Wedge	H6-18 x D15 x L15	$760.00
DY427	Conduit TCP	Bone matrix implant	5cc	$760.00
	LMT Surgical Pty Ltd
LM067	Crossbone	Bone substitute	Wedges:6-15mm height	$760.00
	Blocks: height 3 -10mm,
	Width 3-10mm, 
	length10-20mm
	Granules: Granule size 0.5 -
	 3.5mm, Volume 0.4 -5cc
	Medtronic Australasia Pty Ltd
MC415	BCP	Biphasic Calcium Phosphate 	1-3cc	$760.00
	Reabsorbable Graft Supplement
MC594	Mastergraft	Calcium Phosphate Ceramic Granules	5cc Vial	$760.00
MC669	BCP	Biphasic Calcium Phosphate 	5cc	$760.00
	Reabsorbable Graft Supplement
MC853	Nanostim	Synthetic Bone Paste	1cc	$760.00
MC854	Nanostim	Synthetic Bone Paste	2cc	$760.00
MC855	Nanostim	Synthetic Bone Paste	5cc	$760.00
	More Group Pty Ltd
MV001	BondBone	Biphasic Calcium Sulfate	0.5cc, 1cc	$760.00
MV003	4Bone Synthetic Bone Graft	HA/βTCP synthetic bone graft	0.5cc, 1cc, 2cc	$760.00
	Nuvasive Australia and NZ  Pty Ltd
NV075	AttraX bone graft substitute	1cc Cylinder (Putty)	1cc, 2cc 2.5cc, 5cc	$760.00
	2cc Cylinder (Putty)
	2.5cc Cylinder (Putty)
	5cc (2x2.5cc) Strip (Putty)
Prostheses List by Category, Groups and Sponsor	Page 504 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Prism Surgical Designs Pty Ltd
PZ004	In'Oss	Synthetic Bone Graft Putty 	0.5ml, 1ml, 2.5ml and 5ml 	$760.00
	Hydroxyapatite/Beta Calcium 	Putty
	Phosphate (HA/beta-TCP) and 
	Hydroxpropylmethylcellulose 
	hydrogel carrier (HPMC)
PZ005	ReproBone	TCP/HA Synthetic Bone Graft 	0.5-5cc	$760.00
PZ009	ReproBone novo	HA Synthetic Bone Graft Paste	0.5-5ml	$760.00
	Scient'x Australia
SX019	Bonex	Granules	2cc	$760.00
SX073	Samarys RF - 3D bone substitute	3D hydroxapatite and tricalcic 	4.5mm to 10 height (o.1cc to	$760.00
	phosphate implant	 1cc)
SX085	Bone'XTRUDABLE	Biphasic Calcium Phosphate, 	1ml, 2ml, 5ml	$760.00
	Hydrated Biphasic Calcium 
SX086	Alphatec Velossity	Biphasic Calcium Phosphate with 	1ml. 2.5ml, 5ml	$760.00
	absorbable hydrogel (putty)
	Signature Orthopaedics
SF005	Osteoflo	Biphasic Calcium Phosphate; 	1ml, 2ml, 5ml	$760.00
	Hydrated Biphasic Calcium 
SF060	Osteoflo G	Biphasic Calcium Phosphate	2cc, 5cc Granules	$760.00
	Signature Spine
SV014	Tripore HA Granuels 5cc	Biphasic Calcium Phosphate	2cc Granules, 5cc Granules	$760.00
	Stryker Australia Pty Ltd
SK184	VITOSS - Synthetic cancellous bone	Beta-tricalcium phosphate	1.2cc dowel	$760.00
	 void filler
SK191	VITOSS - Synthetic Cancellous 	Beta-tricalcium phosphate	5cc morsels	$760.00
	bone void filler
SK480	HydroSet Injectable Calcium 	Injectable, rapid set, calcium 	5cc	$760.00
	Phosphate Cement	phosphate bone substitute  kit
SR061	HydroSet Injectable Calcium 	Injectable, rapid set, calcium 	3cc	$760.00
	Phosphate Cement	phosphate bone substitute kit
	Synthes Australia Pty Ltd
SY003	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	5g	$760.00
	Graft Substitute
Prostheses List by Category, Groups and Sponsor	Page 505 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY004	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	1g	$760.00
	Graft Substitute
SY005	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	0.5g	$760.00
	Graft Substitute
SY331	Norian®	Fast Set Putty	5cc	$760.00
SY333	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	2.5cc	$760.00
	Graft Substitute
SY358	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	F1, 2, 3, 4, 5 & C1, 2, 3, 4, 5	$760.00
	Graft Substitute-Cervios Cylinder
	Wright Medical Australia
WR005	ProDense / Osteoset	Composite Bone Void Filler - Pellets	2cc, 5cc	$760.00
WR008	ProDense / Osteoset XR	Composite Bone Void Filler - Pellets, 	3.0mm, 1.25cc	$760.00
	Injector
WR009	ProDense / Osteoset XR	Composite Bone Void Filler - Pellets, 	4.8mm, 5cc	$760.00
	Injector
WR014	OSTEOSET - BVT KIT 	Mini Bead Kit	5cc Standard/Fast Cure	$760.00
	(STANDARD CURE, FAST CURE)
WR016	Osteoset Bone Void Filler	Calcium Sulphate	3mm & 4.8mm Pellets 5cc	$760.00
WR018	Osteoset Bone Void Filler	Calcium Sulphate	4.8mm Syringe 5cc	$760.00
WR224	Osteoset T	Calcium Sulphate with Tobroamycin	5cc vial	$760.00
	Zimmer Pty Ltd
ZI192	Bone Graft Substitute	Triosite Granules (0.5 - 1.0 mm grain 	1 g Tube	$760.00
	sizes)- HATCP
ZI193	Bone Graft Substitute	Triosite Granules (2 - 3mm grain size) 	5g Tube	$760.00
	- HATCP
ZI194	Bone Graft Substitute	Triosite Block 5 x 5 x 10mm Box of 4 - 	10mm	$760.00
	HATCP
ZI195	Bone Graft Substitute	Triosite Block 5 x 5 x 20mm Box of 4 - 	20mm	$760.00
	HATCP
ZI196	Bone Graft Substitute	Triosite Block 5 x 5 x 10mm Box of 2 - 	10mm	$760.00
	HATCP
ZI197	Bone Graft Substitute	Triosite Block 5 x 5 x 20mm Box of 2 - 	20mm	$760.00
	HATCP
ZI198	Bone Graft Substitute	Triosite Oesteotomy Wedges - 	6 - 12mm	$760.00
Prostheses List by Category, Groups and Sponsor	Page 506 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	CDS
	LMT Surgical Pty Ltd
LM091	FixEx Bone Cement	Calcium Phosphate Bone Cement	5cc	$1,250.00
	Medical & Optical Instruments Australia Pty Ltd
MO387	Callos Bone Void Filler	Calcium Phosphate Bone Void Fille	3CC, 5CC	$1,250.00
	Surgiplas Medical
SP064	Osteovation	Calcium Phosphate Bone substitute 	2-3cc	$1,250.00
	kit, quick set, EX/Impact/Inject
SP065	Osteovation	Calcium Phosphate Bone sbustitute 	5cc	$1,250.00
	kit; Quick Set; EX/Impact/Inject
	Synthes Australia Pty Ltd
SY189	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	8.5, 9.5, 10.5, 12.5 & 14cm	$1,250.00
	Graft Substitute-Cylinder
SY281	Norian®	Injectable Bone Cement	5cc	$1,250.00
SY450	chronOS ß-TCP	Porous  ß-Tricalcium Phosphate Bone	50 mm x25 mm x 3 mm	$1,250.00
	 Graft Substitute & Resorbable 
	Polymer - Strip
SY573	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	Small Syringe, 5x5x10mm	$1,250.00
	Graft Substitute-Block
SY575	chronOS™ β-TCP	Porous chron β-Tricalcium Phosphate	25x20x6-8mm	$1,250.00
	 Bone Graft Substitute-Wedge
	Wright Medical Australia
WR002	ProDense / Osteoset XR	Composite Injectable Bone Void 	4cc	$1,250.00
WR017	Osteoset Bone Void Filler	Calcium Sulphate	3mm Syringe 1.25cc	$1,250.00
WR019	Osteoset MIIG X3	Injectable Calcium Sulphate Bone 	5cc	$1,250.00
	Void Filler, Includes Syringe
	06.03.15.02 - Ceramic, >5cc - 10cc
	Austofix
AX069	Graftys Bone Cement - Quickset 	Macroporous Calcium Phosphate 	8cc	$1,200.00
	Bone Cement	Cement
AX071	Graftys Bone Cement - HBS Bone 	Macroporous Calcium Phosphate 	8cc	$1,200.00
	Cement	Cement
Prostheses List by Category, Groups and Sponsor	Page 507 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AX079	Graftys BCP - Granules 10cc	Biphasic Calcium Phosphate 	10cc	$1,200.00
	Austspine Pty Ltd
AJ006	Kasios TCP	TCP Bone graft substitute Granules	10cc	$1,200.00
AJ008	JectOS 10cc	Injectable synthetic bone graft 	10cc	$1,200.00
	Baxter Healthcare Pty Ltd
BX299	ACTIFUSE SHAPE 8.0mL –BONE 	A silicate substituted synthetic bone 	8.0mL	$1,200.00
	MATRIX IMPLANT ARTIFICIAL	graft
BX301	ACTIFUSE GRANULES 	A silicate substituted synthetic bone 	10mL	$1,200.00
	10mL–BONE MATRIX IMPLANT 	graft
	ARTIFICIAL
BX304	ACTIFUSE EASY PREP –BONE 	A silicate substituted synthetic bone 	10ml	$1,200.00
	MATRIX IMPLANT ARTIFICIAL	graft
BX307	ACTIFUSE MICROGRANULES 	A silicate substituted synthetic bone 	10mL	$1,200.00
	–BONE MATRIX IMPLANT 	graft
	ARTIFICIAL
	Biomet Australia Pty Ltd
BI946	Calcibon	Granules or paste, TCP	10cc	$1,200.00
	Danex Medical Pty Ltd
XD019	Comp06 Bone Reinforcement 	Bone Reinforced Comppsite 	10cc	$1,200.00
	Composite	consisting of Flowable, curable 
	polymeric matrix with bioceramic, 
	supplied in a sterile ready-to-use 
	double syringe cartridge with mixing 
	tip allowing mixing of the two 
	Device Technologies Australia Pty Ltd
DE307	BonAlive Granules	Bone Graft Substitute - Bioactive 	13140 - 0.5-0.8mm small 	$1,200.00
	Glass Granules	granules, 10cc syringe
	13340 - 1.0-2.0mm medium 
	granules, 10cc syringe
	13440 - 2.0-3.15mm large 
	granules, 10cc syringe
DE311	SINTlife	Nanostructured Paste/putty in 	10 cc	$1,200.00
	syringe - 10 cc
Prostheses List by Category, Groups and Sponsor	Page 508 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE347	Engipore Pre-formed Bone 	Pre-formed Bone Substitute 5-10cc	Catalogue No: PFS015005-	$1,200.00
	Substitute 5-10cc	31-00  Size: 6.4cc
	Catalogue No: PFS015005-
	32-00  Size: 8.2cc
	Catalogue No: PFS015005-
	23-00  Size: 7.2cc
	Catalogue No: PFS015005-
	24-00  Size: 9.6cc
	Catalogue No: PFS015008-
	02-00  Size: 6.8cc
	Catalogue No: PFS015008-
	03-00  Size: 9.9cc
	Emergo Asia Pacific Pty Ltd
ER001	Kryptonite	Osteoconductive Adhesive	10cc sterile kit with syringe	$1,200.00
ER003	Kryptonite	Radiopaque	10cc sterile kit with syringe	$1,200.00
	 with barium
ER103	GeneX	GeneX paste	10cc	$1,200.00
ER105	GeneX	GeneX putty	10cc	$1,200.00
ER125	Stimulan Kit/Rapid Cure-10cc	Calcium Sulphate synthetic rapid cure	10 cc	$1,200.00
	 bone void filler kit
ER128	Stimulan kit-10cc	Calcium Sulphate synthetic bone void	10cc	$1,200.00
	 filler kit
ER156	Kainos	Granules	1x6cm3	$1,200.00
ER157	Kainos	Granules	1x10cm3	$1,200.00
	Eupharma
EH003	ELIZ Bonr graft Substitute	Synthetic HA /TCP Bone Graft 	Granules (1.0 - 4.0mm) (0.8 -	$1,200.00
	Substitute	 1.5mm) (0.5 - 1.0mm)
	Volume / Vial 10.0cc
	Global Orthopaedic Technology
GO066	ApaPore	Actifuse. Sterile, hydroxyapatite-	 1-2ml to 10cc	$1,200.00
	based bone matrix
	Johnson & Johnson Medical Pty Ltd
DY353	Conduit TCP	Bone matrix implant	10cc	$1,200.00
Prostheses List by Category, Groups and Sponsor	Page 509 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM176	Cross Bone 5-10cc	Bone substitute	Blocks-Height:10mm, 	$1,200.00
	Width:14-20mm, 
	Length:30-40mm (Volume: 
	5.6-6.0cc)
	Granules - Granule size 0.5-
	Medtronic Australasia Pty Ltd
MC595	Mastergraft	Calcium Phosphate Ceramic Granules	10cc Vial	$1,200.00
MC670	BCP	Biphasic Calcium Phosphate 	10cc	$1,200.00
	Reabsorbable Graft Supplement
MC856	Nanostim	Synthetic Bone Paste	10cc	$1,200.00
	More Group Pty Ltd
MV002	4Bone Synthetic Bone Graft	HA/βTCP synthetic bone graft	6cc	$1,200.00
	Nuvasive Australia and NZ  Pty Ltd
NV076	AttraX bone graft substitute 	6cc (2x3cc) Blocks (Putty)	6cc, 10cc	$1,200.00
	(>5cc<=10cc)	10cc (2x5cc) Strip (Putty)
	Prism Surgical Designs Pty Ltd
PZ006	ReproBone	TCP/HA Synthetic Bone Graft 	6-10cc	$1,200.00
PZ010	ReproBone novo	HA Synthetic Bone Graft Paste	6-10ml	$1,200.00
	Scient'x Australia
SX018	Bonex	Granules	10cc	$1,200.00
SX087	Alphatec Velossity	Biphasic Calcium Phosphate with 	10ml	$1,200.00
	absorbable hydrogel (putty)
	Signature Orthopaedics
SF061	Osteoflo G	Biphasic Calcium Phosphate	6cc,10cc Granules	$1,200.00
	Signature Spine
SV015	Tripore HA Granuels 10cc	Biphasic Calcium Phosphate	10cc	$1,200.00
	Stryker Australia Pty Ltd
SK188	VITOSS - Synthetic cancellous bone	Beta-tricalcium phosphate	10cc morsels and 10cc 	$1,200.00
	 void filler	dowels
SR054	HydroSet Injectable Calcium 	Injectable, rapid set, calcium 	10cc	$1,200.00
	Phosphate	phosphate bone substitute kit
Prostheses List by Category, Groups and Sponsor	Page 510 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY002	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	10g	$1,200.00
	Graft Substitute
SY332	Norian®	Fast Set Putty	10cc	$1,200.00
	Wright Medical Australia
WR006	ProDense / Osteroset XR	Composite Bone Void Filler - Pellets	10cc	$1,200.00
WR012	Osteoset	Calcium Sulphate	4.8mm pellets 10cc	$1,200.00
WR021	Osteoset T Pellets	Calcium sulphate with tobramycin	10cc	$1,200.00
	CDS
	Biomet Australia Pty Ltd
BI936	GPS Bone Biologics	TCP Granules/GPS, TCP	10ml	$1,525.00
	Medical & Optical Instruments Australia Pty Ltd
MO388	Callos Bone Void Filler	Calcium Phosphate Bone Void Filler	10CC	$1,525.00
	Stryker Australia Pty Ltd
SK189	CORTOSS - Synthetic cortical bone 	-	10cc CORTOSS kit	$1,525.00
	void filler
	Surgiplas Medical
SP066	Osteovation	Calcium Phosphate Bone substitute 	10cc	$1,525.00
	kit; Quick Set; EX/Impact/Inject
	Synthes Australia Pty Ltd
SY282	Norian®	Injectable Bone Cement	10cc	$1,525.00
SY451	chronOS ß-TCP	Porous ß-Tricalcium Phosphate Bone 	50-100 mm x25 mm x 3-6 mm	$1,525.00
	Graft Substitute & Resorbable 
	Polymer - Strip
SY574	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	Large Syringe, 12.5 x 	$1,525.00
	Graft Substitute-Block	12.5x10mm
SY576	chronOS™ β-TCP	Porous β - Tricalcium Phosphate 	20x25x10-14mm; 25x35x7-	$1,525.00
	Bone Graft Substitute - Wedge	13mm
	Wright Medical Australia
WR003	ProDense / Osteoset XR	Composite Injectable Bone Void 	10cc	$1,525.00
WR039	Cellplex TCP Synthetic Cancellous 	Alpha & Beta Tricalcium Phosphate	7cc	$1,525.00
	Bone
Prostheses List by Category, Groups and Sponsor	Page 511 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.15.03 - Ceramic, >10cc - 20cc
	Austspine Pty Ltd
AJ034	Jectos 20cc	Injectible synthetic bone graft 	20cc	$1,500.00
	Baxter Healthcare Pty Ltd
BX298	ACTIFUSE GRANULES –BONE 	A silicate substituted synthetic bone 	20mL	$1,500.00
	MATRIX IMPLANT ARTIFICIAL	graft
BX300	ACTIFUSE SHAPE15.8mL –BONE	A silicate substituted synthetic bone 	15.8mL	$1,500.00
	 MATRIX IMPLANT ARTIFICIAL	graft
BX302	ACTIFUSE GRANULES –BONE 	A silicate substituted synthetic bone 	5mL	$1,500.00
	MATRIX IMPLANT ARTIFICIAL	graft
	Biomet Australia Pty Ltd
BI947	Calcibon	Granules or paste, TCP	20ml	$1,500.00
	Device Technologies Australia Pty Ltd
DE309	ENGlpore	Granules (size 1,0-2,5 mm) 15 cc	Granules (size 1,0-2,5 mm) 	$1,500.00
	Granules (size 2,5-4,0 mm) 15 cc	15 cc
	Granules (size 2,5-4,0 mm) 
	15 cc
	Emergo Asia Pacific Pty Ltd
ER126	Stimulan Kit/Rapid Cure-20cc	Calcium Sulphate synthetic rapid cure	20cc	$1,500.00
	 bone void filler kit.
ER158	Kainos	Granules	1x16cm3	$1,500.00
ER159	Kainos	Granules	1x20cm3	$1,500.00
	Eupharma
EH004	ELIZ Bone Graft Substitute	Synthetic HA / TCP Bone graft 	Granules (1.0 - 4.0 mm) (0.8 	$1,500.00
	Substitute	- 1.5mm) (0.5 - 1.0mm)
	Volume / Vial ( 15.0 cc to 
	20.0cc)
	Global Orthopaedic Technology
GO067	ApaPore	Actifuse. Sterile, hydroxyapatite-	20cc	$1,500.00
	based bone matrix
	Johnson & Johnson Medical Pty Ltd
DY354	Conduit TCP	Bone matrix implant	15cc	$1,500.00
Prostheses List by Category, Groups and Sponsor	Page 512 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	LMT Surgical Pty Ltd
LM177	Cross Bone 10-20cc	Bone Substitute	Blocks - Height: 15mm, 	$1,500.00
	Width: 30mm Length:35mm
	 (Volume:15.75cc)
	Granyles - Granule size 0.5-
	3.5mm; Volume 20cc
	Medtronic Australasia Pty Ltd
MC596	Mastergraft	Calcium Phosphate Ceramic Granules	15cc Vial	$1,500.00
MC671	BCP	Biphasic Calcium Phosphate 	20cc	$1,500.00
	Reabsorbable Graft Supplement
	Prism Surgical Designs Pty Ltd
PZ007	ReproBone	TCP/HA Synthetic Bone Graft 	11-20cc	$1,500.00
PZ011	ReproBone novo	HA Synthetic Bone Graft Paste	11-20ml	$1,500.00
	Signature Spine
SV016	Tripore HA Granuels 20cc	Biphasic Calcium Phosphate	12cc Granuels, 20cc 	$1,500.00
	Stryker Australia Pty Ltd
SK185	VITOSS - Synthetic cancellous bone	Beta-tricalcium phosphate	15cc morsels	$1,500.00
	 void filler
SK481	HydroSet injectable Calcium 	Injectable, rapid set, calcium 	15cc	$1,500.00
	Phosphate Cement	phosphate bone substitute kit
	Synthes Australia Pty Ltd
SY001	chronOS™ β-TCP	Porous β-Tricalcium Phosphate Bone 	20g	$1,500.00
	Graft Substitute
	Wright Medical Australia
WR007	ProDense / Osteoset XR	Composite Bone Void Filler - Pellets	20cc	$1,500.00
WR015	Osteoset Pellets - Bone Graft 	Calcium Sulphate	4.8mm Pellets 20cc	$1,500.00
	Substitute
	CDS
	Biomet Australia Pty Ltd
BI937	GPS Bone Biologics	TCP Granules/GPS, TCP	20ml	$2,150.00
	Synthes Australia Pty Ltd
SY452	chronOS ß-TCP	Porous ß-Tricalcium Phosphate Bone 	100 mm x25 mm x 6mm	$2,150.00
	Graft Substitute & Resorbable 
	Polymer - Strip
Prostheses List by Category, Groups and Sponsor	Page 513 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR004	ProDense/Osteoset XR	Composite Injectable Bone Void 	20cc	$2,150.00
WR020	Osteoset MIIG X3	Injectable Calcium Sulphate Bone 	15cc	$2,150.00
	Void Filler, Includes Syringe
WR040	Cellplex TCP Synthetic Cancellous 	Alpha & Beta Tricalcium Phosphate	15cc & 20cc	$2,150.00
	Bone
WR215	Pro-Dense core Decompression Kit	Composite Injectable Bone Void 	15cc	$2,150.00
	Filler plus instrumentation kit for core
	 decompression
	06.03.15.04 - Ceramic, >20cc
	Baxter Healthcare Pty Ltd
BX303	ACTIFUSE GRANULES 	A silicate substituted synthetic bone 	40mL	$1,560.00
	40mL–BONE MATRIX IMPLANT 	graft
	ARTIFICIAL
	Biomet Australia Pty Ltd
BI948	Calcibon	Granules or paste, TCP	50ml	$1,560.00
	Device Technologies Australia Pty Ltd
DE082	Hatric Bone Substitute	Ceramic	7mm - 15mm	$1,560.00
	Emergo Asia Pacific Pty Ltd
ER160	Kainos	Granules	1x30cm3	$1,560.00
	Eupharma
EH005	ELIZ Bone Graft Substitute	Synthetic HA / TCP Bone Graft	Granules (1.0 - 4.0mm) (0.8 -	$1,560.00
	 1.5mm)(0.5 - 1.0mm)
	Volume / Vial (25.0 cc to 
	30.0 cc)
	Health Care Surgical Pty Ltd
HC011	Squale Bone Substitute	Block	H: 4 -20mm	$1,560.00
	Johnson & Johnson Medical Pty Ltd
DY355	Conduit TCP	Bone matrix implant	30cc	$1,560.00
DY361	Conduit 	Conduit Blocks	10 x 10 x 10mm to 25 x 25 x 	$1,560.00
	30mm
	Medtronic Australasia Pty Ltd
MC597	Mastergraft	Calcium Phosphate Ceramic Granules	30cc Vial	$1,560.00
Prostheses List by Category, Groups and Sponsor	Page 514 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Prism Surgical Designs Pty Ltd
PZ008	ReproBone	TCP/HA Synthetic Bone Graft 	21-30cc	$1,560.00
	Scient'x Australia
SX017	Bonex	Block	L:5.5 - 50mm	$1,560.00
	Signature Orthopaedics
SF062	Osteoflo G	Biphasic Calcium Phosphate	30cc Granules	$1,560.00
	Stryker Australia Pty Ltd
SK187	VITOSS - Synthetic cancellous bone	Beta-tricalcium phosphate	30cc morsels and 30cc 	$1,560.00
	 void filler	dowels
ST021	Stryker Bone Substitute	Bonesave, Calcium Phosphate	40gms, sizes 2 - 4 and  4-6mm	$1,560.00
	Wright Medical Australia
WR011	Osteoset BVF Kit	Kit contains calcium sulfate, diluent, 	25cc only	$1,560.00
	mould, spatula and mixing bowl
WR013	Osteoset T Pellets	Calcium sulphate with tobramycin	20cc	$1,560.00
	06.03.15.05 - Demineralised Bone Matrix,< 2cc
	Henry Schein-Halas Pty Ltd
HD001	Bio-Oss Bone Natural Bone Mineral	Derived from bovine bone	0.25g, 0.5cc volume	$99.00
HD002	Bio-Oss Bone Natural Bone Mineral	Derived from bovine bone	0.5g, 1cc volume	$99.00
	06.03.15.06 - Demineralised Bone Matrix, 2 – 5cc
	Henry Schein-Halas Pty Ltd
HD003	Bio-Oss Bone Natural Bone Mineral	Derived from bovine bone	2.0gm	$529.00
HD009	Bio-Oss	This bone block consists of anorganic	approx 1.4-1.6g, 2cc	$529.00
	 bovine bone matrix sterilised by 
	gamma-irradiation.  Bio-Oss is a 
	natural bone mineral for filling of bone
	 defects in maxillofacial surgery, 
	implantology, and periodontology.
	Lifehealthcare Pty Ltd
LH476	Orthoss - Bone implant material	Orthoss Spongiosa Block. Bone 	1 x 1x 2 approx. 1.6g	$529.00
	Implant material, biological, animal 
	source.
Prostheses List by Category, Groups and Sponsor	Page 515 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MI096	Grafton Plus Demineralized Bone 	Grafton Plus Demineralized Bone 	1-5cc	$529.00
	Matrix	Matrix: Paste
MI098	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	5cc	$529.00
	Orthoblend
MI101	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	1.5cm x 1.5cm x 0.25cm	$529.00
	Flex
MI103	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	60mm diameter	$529.00
	A-Flex
	06.03.15.07 - Demineralised Bone Matrix, >5cc - 10cc
	Henry Schein-Halas Pty Ltd
HD017	Bio-Oss	Natural bone mineral derived from 	1 to 2mm; 2.0g (6cc)	$1,400.00
	bovine bone
	Lifehealthcare Pty Ltd
LH474	Orthoss - Bone implant material	Orthoss Granules Spongiosa.  Bone 	Granule Size 2-4mm, 3g 	$1,400.00
	implant material, biological, animal 	(approx. 8-10cc)
	source
LH475	Orthoss - Bone implant material	Orthoss Spongiosa Block. Bone 	2 x 2 x 1.3cm (approx. 3.6g)	$1,400.00
	Implant material, biological, animal 
	source.
	Medtronic Australasia Pty Ltd
MI097	Grafton Plus Demineralized Bone 	Grafton Plus Demineralized Bone 	10cc	$1,400.00
	Matrix	Matrix: Paste
MI099	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	10cc	$1,400.00
	Orthoblend
MI102	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	2.5cm x 10cm x 0.25cm	$1,400.00
	Flex
MI104	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	2.5cm x 5cm x 0.8cm (2)	$1,400.00
	Matrix PLF
MI106	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	1cm x 10cm x 0.8cm (2)	$1,400.00
	Matrix Strips
Prostheses List by Category, Groups and Sponsor	Page 516 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.15.08 - Demineralised Bone Matrix, >10cc
	Lifehealthcare Pty Ltd
LH473	Orthoss - Bone implant material	Orthoss Granules Spongiosa,  Bone 	Granule size 1-2mm, 5g-7g; 	$2,100.00
	implant material, biological, animal 	(approx.. 13-20cc)
	source
	Medtronic Australasia Pty Ltd
MI100	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	15cc	$1,800.00
	Orthoblend
MI105	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	2.5cm x 10cm x 0.8cm (2)	$1,800.00
	Matrix PLF
MI107	Grafton Demineralized Bone Matrix	Grafton Demineralized Bone Matrix: 	1cm x 20cm x 0.8cm (2)	$1,800.00
	Matrix Strips
	06.03.15.09 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), 0 - 5cc
	Henry Schein-Halas Pty Ltd
HD007	Bio-Oss Collagen	The product consists of Bio-Oss 	1 preformed block of 	$850.00
	granules, embedded in 10% porcine 	cancellous-bone granulate 
	collagen.  The collagen component is 	and collagen, block sizes 
	resorbed within a few weeks.  The 	500mg
	properties of the Bio-Oss granules 
	remain unchanged. Facilitates 
	handling. 
HD008	Bio-Oss Collagen	The product consists of Bio-Oss 	1 preformed block of 	$850.00
	granules, embedded in 10% porcine 	cancellous-bone granulate 
	collagen.  The collagen component is 	and collagen, block size 
	resorbed within a few weeks.  The 	250mg
	properties of the Bio-Oss granules 
	remain unchanged. Facilitates 
	handling. 
HD014	Bio-Oss Collagen	The product consists of Bio-Oss 	1 preformed block of 	$850.00
	granules, embedded in 10% porcine 	cancellous-bone granulate 
	collagen.  The collagen component is 	and collagen, block size 
	resorbed within a few weeks.  The 	100mg
	properties of the Bio-Oss granules 
	remain unchanged. Facilitates 
	handling. 
Prostheses List by Category, Groups and Sponsor	Page 517 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC660	Mastergraft	Matrix	5cc	$850.00
MI142	Mastergraft	Mastergraft Putty	>0cc-5cc	$850.00
	Stryker Australia Pty Ltd
SK466	VITOSS Foam - Compression 	Highly porous bone graft material 	5cc Foam strip (25x50x4)	$850.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Boane Void Filler	(β-TCP) and Type I bovine collagen.
SK476	VITOSS Foam - Compression 	Highly porous bone graft material 	1.2cc Foam Pack	$850.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler.	(β-TCP) and Type I bovine collagen
SK477	VITOSS Foam - Compression 	Highly porous bone graft material 	2.5cc Foam Pack	$850.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler.	(β-TCP) and Type I bovine collagen
SK478	VITOSS Foam - Compression 	Highly porous bone graft material 	5cc Foam Pack	$850.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler.	(β-TCP) and Type I bovine collagen.
	06.03.15.10 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >5cc - 10cc
	Medtronic Australasia Pty Ltd
MC663	Mastergraft	Matrix	10cc	$1,988.00
MI143	Mastergraft	Mastergraft Putty	>5cc-10cc	$1,988.00
	Stryker Australia Pty Ltd
SK467	VITOSS Foam - Compression 	Highly porous bone graft material 	10cc Foam strip (25x100x4)	$1,988.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler	(β-TCP) and Type I bovine collagen.
SK468	VITOSS Foam - Compression 	Highly porous bone graft material 	10cc Foam strip (25x50x8)	$1,988.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler	(β-TCP) and Type I bovine collagen.
SK470	VITOSS Foam - Compression 	Highly porous bone graft material 	Small Cup 52mm Diameter	$1,988.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler	(β-TCP) and Type I bovine collagen.
SK471	VITOSS Foam - Compression 	Highly porous bone graft material 	Large Cup 56mm Diameter	$1,988.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler	(β-TCP) and Type I bovine collagen.
Prostheses List by Category, Groups and Sponsor	Page 518 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SK479	VITOSS Foam - Compression 	Highly porous bone graft material 	10cc Foam Pack	$1,988.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler.	(β-TCP) and Type I bovine collagen
	06.03.15.11 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >10cc - 20cc
	Medtronic Australasia Pty Ltd
MC662	Mastergraft	Matrix	20cc	$2,256.00
MI144	Mastergraft	Mastergraft Strip	>10cc-20cc	$2,256.00
	Stryker Australia Pty Ltd
SK469	VITOSS Foam - Compression 	Highly porous bone graft material 	20cc Foam strip (25x100x8)	$2,256.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 
	Bone Void Filler	(β-TCP) and Type I bovine collagen.
	06.03.15.12 - Composite (Extracellular Collagen Matrix with DBM or Ceramic), >20cc
	Medtronic Australasia Pty Ltd
MI145	Mastergraft	Mastergraft Strip	>20cc	$3,000.00
	Stryker Australia Pty Ltd
SK475	VITOSS Foam - Compression 	Highly porous bone graft material 	Sheet (Wide Strip) 	$3,000.00
	Resistant Synthetic Cancellous 	made from beta-tricalcium phosphate 	75x100x4mm
	Bone Void Filler.	(β-TCP) and Type I bovine collagen.
	06.03.15.13 - Biologically Active Bone Inductor, 0 - 2.5mg
	Medtronic Australasia Pty Ltd
MC806	Infuse Bone Graft	Recombinant human bone 	Extra Small 2.1mg	$1,500.00
	morphogenetic protein rhBMP-2
MC807	Infuse Bone Graft	Recombinant human bone 	Mini 1.05mg	$1,500.00
	morphogenetic protein rhBMP-2
	06.03.15.14 - Biologically Active Bone Inductor, >2.5mg - 5mg
	Medtronic Australasia Pty Ltd
MC808	Infuse Bone Graft	Recombinant human bone 	Small 4.2mg	$3,200.00
	morphogenetic protein rhBMP-2
Prostheses List by Category, Groups and Sponsor	Page 519 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.15.15 - Biologically Active Bone Inductor, >5mg - 10mg
	Medtronic Australasia Pty Ltd
MC683	Infuse Bone Graft	Recombinant human Bone 	Medium 8.4mg	$6,000.00
	Morphogenetic Protein rhBMP-2
	06.03.15.16 - Biologically Active Bone Inductor, >10mg
	Medtronic Australasia Pty Ltd
MC684	Infuse Bone Graft	Recombinant human Bone 	Large 12mg	$6,400.00
	Morphogenetic Protein rhBMP-2
	Stryker Australia Pty Ltd
ST865	OP-1 Implant - Osteogenic Protein 	Osteoinductive and osteoconductive 	1 vial	$6,400.00
	1, 3.5mg	bone graft substitute
	06.03.15.17 - Metal Scaffold
	Biomet Australia Pty Ltd
BH359	OsseoTi Porous Metal Foot & 	Porous Titanium Reconstructive 	15mm x 15mm x 4mm to 	$1,283.00
	Ankle Reconstructive Wedges	Wedges	24mm x 20mm x 11mm
	Wright Medical Australia
WR071	BioFoam Bone Wedge	Titanium metal scaffold for angular 	Depth 14 - 44mm	$1,283.00
	correction in ankle and foot	Width 10 - 44mm
	Thickness
	6.3.15.3 - Calcium and/or hydroxyapatite, biologically active additive
	1b, 0-5cc, SDS
	Austspine Pty Ltd
AJ041	i-FACTOR Peptide Enhanced Bone 	P-15, ABM, Osteoinductive, 	0 - 5.0mL	$1,579.00	$6,400.00
	Graft	Osteoconductive bone graft 
	2b, 5cc-10cc, SDS
	Austspine Pty Ltd
AJ042	i-FACTOR Peptide Enhanced Bone 	P-15, ABM, Osteoinductive, 	5.0ml - 10ml	$1,988.00	$12,000.00
	Graft	Osteoconductive bone graft 
Prostheses List by Category, Groups and Sponsor	Page 520 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	6.3.15.4.1 Composite (Extracellular Collagen Matrix with DBM or Ceramic), 0 - 5cc
	SDS
	Austspine Pty Ltd
AJ043	i-FACTOR Flex Peptide Enhanced 	P-15, ABM, Osteoinductive, 	25mm x 25mm x 4mm	$850.00	$6,400.00
	Bone Graft - 25mm	Osteoconductive bone graft 
	6.3.15.4.2 Composite (Extracellular Collagen Matrix with DBM or Ceramic), >5cc - 10cc
	SDS
	Austspine Pty Ltd
AJ044	i-FACTOR Flex Peptide Enhanced 	P-15, ABM, Osteoinductive, 	50mm x 25mm x 4mm, 100mm	$1,988.00	$12,000.00
	Bone Graft - 50 & 100mm	Osteoconductive bone graft 	 x 25mm x 4mm
06.03.16 - Meshes
	06.03.16.01 - Metallic
	Johnson & Johnson Medical Pty Ltd
DP223	Thackray Mesh	Stainless Steel Ortron 90 mesh	200x200mm	$949.00
	Lima Orthopaedics Australia Pty Ltd
LC066	TNP® Calcaneus Bone Plate Ti	TNP® Calcaneus Bone Plate Ti	Plate has holes to 	$949.00
	accommodate screw sizes 
	from 2 to 6mm
LC069	TNP® SRT Net Plate Ti	TNP® SRT Net Plate Ti	One size	$949.00
LC070	TNP® Net Plate Ti	TNP net plate Ti	13x23mm	$949.00
	Stryker Australia Pty Ltd
HW525	Exeter Hip X-Change Revision 	X-Change Stainless steel Revision 	Small, medium and large	$949.00
	System	Mesh - Medial Wall,Rim, Femoral. Flat
	Zimmer Pty Ltd
ZI329	CPT Impaction Grafting Mesh	Titanium Femoral or acetabular mesh	6 sizes acetabular rim (small 	$949.00
	and large), medial wall 
	(small and large), flat and 
	femoral meshes
	06.03.16.02 - Non Metallic
	Oceania Orthopaedics
OO101	Mutars Attachment Tube	Mutars attachment tube	33/55mm	$288.00
Prostheses List by Category, Groups and Sponsor	Page 521 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN777	GTS Sleeve	Polypropylene non-absorbable 	one size only	$288.00
	woven mesh
06.03.17 - Tumour / Limb Deficiency
	06.03.17.02 - Spacer
	Oceania Orthopaedics
OO121	MUTARS - Arthodesisbody	Arthodesis Body	120mm	$6,571.00
	06.03.17.04 - Central Screw
	Surgien Pty Ltd
BR001	OPRA System	Central screw - titanium	One size only	$1,860.00
	06.03.17.05 - Healing Cylinder
	RQSolutions Medical Devices Distribution Support
RQ051	Taper Sleeve Connector (as a 	Orthodynamics The Integral Leg 	1 size only	$3,150.00
	component of the Orthodynamics 	Prosthesis -Taper Sleeve Connector
	The Integral Leg Prosthesis)
	Surgien Pty Ltd
BR002	OPRA System	Healing cylinder - titanium	One size only	$3,150.00
	06.03.17.06 - Healing Screw
	Surgien Pty Ltd
BR003	OPRA System	Healing screw - titanium	One size only	$2,460.00
	06.03.17.07 - Fixture
	RQSolutions Medical Devices Distribution Support
RQ046	Orthodynamics The Integral Leg 	Orthodynamics The Integral Leg 	82 items with sizes ranging 	$36,900.00
	Prosthesis - Modular Femoral Stem 	Prosthesis-Modular Femoral Stem	in stem length from 140mm 
	(as a component of The Integral Leg 	to 180mm
	Prosthesis)
Prostheses List by Category, Groups and Sponsor	Page 522 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgien Pty Ltd
BR004	OPRA System	Fixture - titanium	16 - 20mm	$36,900.00
	06.03.17.08 - Abutment
	RQSolutions Medical Devices Distribution Support
RQ048	Orthodynamics The Integral Leg 	Orthodynamics The Integral Leg 	6 sizes	$19,250.00
	Prostheses-Dual Cone Extension 	Prosthesis-Dual Cone Extension
	(as a component of the 
	Orthodynamics The Integral Leg 
RQ049	Silicone cap (as a component of the 	Orthodynamics The Integral Leg 	1 size	$19,250.00
	Orthodynamics The Integral Leg 	Prosthesis-Silicone Cap
	Prosthesis
	Surgien Pty Ltd
BR005	OPRA System	Abutment - titanium	Length 47 - 77mm	$19,250.00
	06.03.17.09 - Abutment Screw
	Surgien Pty Ltd
BR006	OPRA System	Abutment screw - titanium	Length 57 - 87mm	$5,775.00
	06.03.17.10 - Oncology Humeral Stem
	Oceania Orthopaedics
OO133	MUTARS humeral stem	MUTARS humeral stems	7-13mm 7mm length	$5,775.00
	06.03.17.12 - Humerus Extension Piece
	Oceania Orthopaedics
OO129	MUTARS extension piece	MUTARS humerus extension piece	20mm/40mm/60mm	$4,393.00
OO130	MUTARS humerus reducer	MUTARS humerus reducer	80mm	$4,393.00
	06.03.17.14 - Humerus Connection Piece
	Oceania Orthopaedics
OO128	MUTARS Humerus connecting part	MUTARS Humerus connecting part	80mm	$4,580.00
Prostheses List by Category, Groups and Sponsor	Page 523 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.17.17 - Humerus Connecting Screw
	Oceania Orthopaedics
OO131	MUTARS humerus screw	MUTARS humerus screw	15mm,35mm,55mm,75mm	$653.00
	06.03.17.22 - Humeral Head/Cap
	Oceania Orthopaedics
OO125	MUTARS Glenosphere	MUTARS glenosphere	40mm	$4,260.00
OO126	MUTARS Head	MUTARS Head	50mm	$4,260.00
OO127	MUTARS Humerus cap	MUTARS Humerus cap	Small, medium and large. +5 	$4,260.00
	and +10mm offset
	06.03.17.23 - Distal Humerus Flange
	Biomet Australia Pty Ltd
BH346	Comprehesive Segmental Revision 	Comprehensive SRS Flange	Small, large	$4,347.00
	System (SRS)
	06.03.17.30 - METS Humeral Shaft
	Oceania Orthopaedics
OO123	MUTARS Distal Humerus	MUTARS Distal Humerus	50mm, 30mm	$3,243.00
OO124	MUTARS Humerus diaphyseal 	MUTARS Humerus diaphyseal 	8-9 mm diameter, 100mm 	$3,243.00
	implant	length
	06.03.17.35 - METS Bayley Walker Glenoid Component
	Oceania Orthopaedics
OO135	MUTARS Glenoid	MUTARS Glenoid	1 size	$7,485.00
	06.03.17.37 - Femoral Stem - Uncemented
	Oceania Orthopaedics
OO082	MUTARS - Arthrodesis stems	Arthrodesis tibial and femoral stems, 	11-20mm x 100 - 250mm 	$3,920.00
	cvd, straight, cemented/cementless	length
Prostheses List by Category, Groups and Sponsor	Page 524 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	06.03.17.39 - Tibial Stem - Uncemented
	Oceania Orthopaedics
OO119	MUTARS - Arthodesis Tibial 	MUTARS - Arthodesis femoral 	45mm	$6,571.00
	component	component
	06.03.17.41 - Valgus Sleeve
	Oceania Orthopaedics
OO120	MUTARS - Arthodesis femoral 	MUTARS - Arthodesis femoral 	45mm left and right	$6,571.00
	component	component
6.3.7 - Wire/Cable Accessories
	6.3.7.2 - Hook/Grip
	Smith & Nephew Surgical Pty Ltd
SN735	Accord	Orthopaedic Cable System, Std Cable 	85-265mm	$2,000.00
	Grip
Group 10: Shoulder - Humeral
	Stryker Australia Pty Ltd
HW216	Howmedica Modular Resection 	Distal Humerus Cone -  Vitallium	One size only	$4,580.00
	System
HW217	Howmedica Modular Resection 	Distal Humerus Flange -  Vitallium	One size only	$4,347.00
	System
HW218	Howmedica Modular Resection 	Humerus Connection Piece -  	One size only	$4,122.00
	System
HW221	Howmedica Modular Resection 	Humerus Extension Piece -  Vitallium	5, 15, 30, 45, 60, 75, 90, 	$5,243.00
	System	105, 120, 135, 150, 165mm
HW255	Howmedica Modular Resection 	Oncology Humeral Body -  Titanium	40 - 140mm in 20mm 	$2,827.00
	System	increments
Prostheses List by Category, Groups and Sponsor	Page 525 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Group 10b: Humeral Stem
	Stryker Australia Pty Ltd
HW222	Howmedica Modular Resection 	Humeral Anchorage Piece -  Vitallium	9, 10, 11, 12mm	$4,393.00
	System
HW256	HMRS Oncology Humeral Stem	Cobalt Chromium	7x75mm, 7x115mm, 9x75mm,	$4,778.00
	 9x115mm, 11x115mm, 
	25mmx75mm, 25mmx100mm,
	 50mmx75mm, 
	50mmx100mm,75mmx100mm
	, 100mmx50mm
	Group 10f: Standard Humeral Head
	Stryker Australia Pty Ltd
HW254	HMRS Oncology Humeral 	Cobalt Chromium	40, 44mm, Cap	$4,260.00
Group 11: Shoulder – Glenoid
	Group11e: Other
	Stryker Australia Pty Ltd
HW200	Howmedica Modular Resection 	Plug Screw Axis -  Vitallium	One size only	$217.00
	System
HW202	Howmedica Modular Resection 	Wedge -  Vitallium	One size only	$211.00
	System
HW219	Howmedica Modular Resection 	Humerus Connecting Screw -  Vitallium	One size only	$653.00
	System
HW220	Howmedica Modular Resection 	Humerus Hex Socket Bolt -  Vitallium	One size only	$565.00
	System
Prostheses List by Category, Groups and Sponsor	Page 526 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
Group 14: Intramedullary Nails
	Group 14c: Humeral
	P, D
	Biomet Australia Pty Ltd
BH357	VersaNail IM Nailing Platform	Humeral Nails, Universal and 	7-10 mm x 150-280mm	$2,195.00
	Proximal, Titanium, Locking, 
	cannulated
	Group 14d: Other
	Biomet Australia Pty Ltd
BH264	Small Bone Fixation System - Small 	Intramedullary Nail	1.6mm and 1.1mm	$700.00	$950.00
	Bone Flexible Nail
Group 15: Intramedullary Nail Accessories
	Group 15a: Screws
	Smith & Nephew Surgical Pty Ltd
SN520	TriGen	Captured Screws Titanium	4.5 & 5.0mm diameters, 20-	$120.00
	110mm lengths 
	Stryker Australia Pty Ltd
SK204	Stryker Trauma Locking Nail 	SCN	Nut for Condyle Screws 	$232.00
Group 16: Plates
	Group 16b: Small – 2.71 – 4.49mm
	Smith & Nephew Surgical Pty Ltd
SN731	Accord	Orthopaedic Cable System, Sm Cable 	75-255mm	$1,400.00
	Grip
	Group 16d: Other
	Com
	Synthes Australia Pty Ltd
SY111	AO/ASIF Plates	Specially manufactured plate	1.0mm - 6.5mm	$3,914.00
Prostheses List by Category, Groups and Sponsor	Page 527 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
Group 17: Screws
	Group 17f: Other
	Smith & Nephew Surgical Pty Ltd
SN713	Trigen	Stable-Lok Nut	One Size Only	$346.00
	HA Coated
	Biomet Australia Pty Ltd
BI820	EBI XFIX DynaFix System	Screw, HA coated, cortical, cancellous	Dia 2-6mm	$274.00
Group 18: Pins
	Group 18b: Threaded
	Stryker Australia Pty Ltd
ST038	Stryker Plating System -  Reduction 	4.5mm Diameter, Stainless Steel	One size only	$175.00
	Pin
Group 22: Soft Tissue Fixation Devices
	Group 22a: No Suture
	Johnson & Johnson Medical Pty Ltd
JJ083	Mitek GII Anchor Threader Tab	Titanium Suture Anchor	2.4 x 8.8mm	$287.00
Group 31: Other Devices
	Biomet Australia Pty Ltd
BI855	EBI XFIX Dynafix System	Wrench	Ex Small, Small, Adult, 3-6mm	$200.00
	Global Manufacturing Technology Pty Ltd
GM110	OsteoBridge	Nail	7mm, 8mm, 9mm, 10mm, 	$4,322.00
	12mm, 14mm, 16mm & 18mm
Prostheses List by Category, Groups and Sponsor	Page 528 of 1059

06 - SPECIALIST ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GM111	OsteoBridge	Spacer, Straight & Angled	25mm, 40mm, to 70mm	$6,571.00
	30mm, 40mm, to 70mm
	20mm, 20mm, to 70mm
GM112	OsteoBridge	OsteoBridge Reducing Sleeve	20mm, 25mm & 30mm	$3,400.00
Group 9: Elbow
	Group 9g: Other
	Stryker Australia Pty Ltd
HW213	Howmedica Modular Resection 	Humeral Bearing -  Vitallium	One size only	$175.00
	System
Prostheses List by Category, Groups and Sponsor	Page 529 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
07.01.01 - Mesh - Metal
	07.01.01.01 - <0.2mm thick, 1-50cm²
	Medical & Optical Instruments Australia Pty Ltd
MO291	Martin Level One Fixation	Mesh, Titanium	<0.2mm thick, 1 to 10cm² area	$165.00
	07.01.01.02 - <0.2mm thick, 51-100cm²
	Medical & Optical Instruments Australia Pty Ltd
MO290	Martin Level One Fixation	Mesh, Titanium	<0.2mm, 51 to 100cm² area	$380.00
	07.01.01.03 - 0.2-0.49mm thick, 1-10cm²
	Medical & Optical Instruments Australia Pty Ltd
MO298	Martin Level One Fixation	Mesh, Titanium	0.2 to 0.49mm thick, 1 to 	$350.00
	10cm² area
	Complex
	Medical & Optical Instruments Australia Pty Ltd
MO303	Martin Level One Fixation	Mesh, Titanium	0.2 to 0.49mm thick, 1 to 	$725.00
	10cm² area
	Synthes Australia Pty Ltd
SY577	AO/ASIF Plate	Titanium contourable mesh; Orbital &	<0.5mm	$725.00
	 Pre-Shaped
	07.01.01.04 - 0.2-0.49mm thick, 11-50cm²
	Australian Surgical Innovations Pty Ltd
AI005	ASI Plates and Screws	Mesh	.	$700.00
	Biomet Australia Pty Ltd
BI604	W Lorenz Osteosynthesis System	Sheet, 1mm System. Titanium	85x50x0.2mm	$700.00
BI645	W Lorenz Osteosynthesis System	Mesh panel, 1.5mm System Titanium	(41-83) x (39-54mm) (0.3 or 	$700.00
	0.2mm)
Prostheses List by Category, Groups and Sponsor	Page 530 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
JJ850	Bioplate Biomesh System	Titanium cranial biomesh	0.3 to 0.45mm thickness, 	$700.00
	32-60mm x 43-60mm
	Lifehealthcare Pty Ltd
LH508	Martin Osteosynthesis 1.5mm 	Mesh, Titanium	0.2-0.49mm thick, 11-50cm2	$700.00
	System Mesh thin 50cm2
	Medical & Optical Instruments Australia Pty Ltd
MO409	Martin Level One Fixation	Mesh, Titanium	0.9-0.49mm thick, 11-50cm²	$700.00
	Medtronic Australasia Pty Ltd
MC889	TiMesh	Square-rectangular Gridmesh Panel	11 to 25 cm2 area	$700.00
MC914	TiMesh Titanium Rigid Fixation 	FlexMesh 1.5mm System. 	26 to 50 cm2 area; 0.3mm 	$700.00
	Bone Grafting and Plating System	Composition: Titanium	thick
	Surgiplas Medical
SP068	Plates	Micro, Mini, Maxi	Mesh 50mm x 74mm Mesh 	$700.00
	26 to 50cm2 area
SP080	Plates	Micro, Mini	Mesh 50mm x 37, 36 x 	$700.00
	50mm, Mesh 11 to 25cm2 
	area
SP107	OsteoMed Plating & Fixation System	Plates	40 x 40mm Osteoform Mesh, 	$700.00
	Mesh 11 to 25cm2 area.
	Complex
	Stryker Australia Pty Ltd
HW528	Stryker Neuro Mesh Plates	Titanium malleable mesh plates for 	0.2-0.49mm	$850.00
	cranial reconstruction
	Synthes Australia Pty Ltd
SY578	AO/ASIF Plate	Titanium contourable mesh; Mastoid, 	0.2mm-0.49mm	$850.00
	Cranial & Pre-Shaped
	07.01.01.05 - 0.2-0.49mm thick, 51-200cm²
	Johnson & Johnson Medical Pty Ltd
JJ851	Bioplate Biomesh System	Titanium cranial biomesh	0.45mm thickness, 85-	$1,400.00
	132mm x 90-134mm
Prostheses List by Category, Groups and Sponsor	Page 531 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH512	Martin Osteosynthesis 1.5mm 	3D Mesh, Titanium	0.2-0.49mm thick, 51-200cm2	$1,400.00
	System 3D Mesh 200cm2
	Medical & Optical Instruments Australia Pty Ltd
MO347	Martin Level One Fixation	Mesh, Titanium & 3D	0.2-0.49mm thick, 51-200cm²	$1,400.00
	Medtronic Australasia Pty Ltd
MC524	TiMesh	Isogrid Panel	One size only	$1,400.00
MC525	TiMesh	Sugar Mesh Panel / Grid	11 x 7.5cm	$1,400.00
MC887	TiMesh	Titanium Mesh Panel	51 to 100 cm2 area	$1,400.00
MC890	TiMesh	Square-rectangular Gridmesh Panel	51 to 100 cm2 area	$1,400.00
MI084	TiMesh Rigid Fixation Bone 	FlexMesh 1.0 - 1.5mm system. 	51 to 100cm² area, 0.3mm 	$1,400.00
	Grafting and Plating System	Composition: Titanium	thickness
	Stryker Australia Pty Ltd
SK582	Stryker Leibinger Plating System	Craniofacial Titanium Mesh System	0.2 - 0.49mm thick, 51 - 	$1,400.00
	200cm²
	Surgiplas Medical
SP078	Plates	Micro, Mini	Mesh Sheet 100mm x 74mm 	$1,400.00
	Mesh 51 to 100cm2 area
SP109	OsteoMed Plating & Fixation System	Plates	90 x 90mm Osteoform Mesh, 	$1,400.00
	Mesh 51 to 100cm2 area.
	Synthes Australia Pty Ltd
SY488	AO/ASIF Plate	Titanium Contourable mesh plate	<0.5mm	$1,400.00
	Complex
	Biomet Australia Pty Ltd
BH024	W Lorenz Osteosynthesis System	Pre-contoured Neuro Mesh, titanium	163 x 115 x 0.3mm	$1,480.00
	07.01.01.06 - 0.2-0.49mm thick, >200cm²
	Biomet Australia Pty Ltd
BH018	W Lorenz Osteosynthesis System	Sheet 1.5mm System. Titanium	(203-206)mm x (123-	$1,500.00
	127)mm x (0.2-0.3)mm
	Johnson & Johnson Medical Pty Ltd
JJ441	Titanium Mesh	Titanium Mesh Sterile	0.2mm thickness, 15cm x 	$1,500.00
	15cm
Prostheses List by Category, Groups and Sponsor	Page 532 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC387	TiMesh Rigid Fixation Bone 	Titanium, Square Grid Mesh	Large	$1,500.00
	Grafting and Plating System
	Surgiplas Medical
SP106	OsteoMed Plating & Fixation System	Plates	111 x 191mm Mesh Plate, 	$1,500.00
	Mesh > 200cm2 area.
	Synthes Australia Pty Ltd
SY786	AO/ASIF Plate	Titanium Contourable mesh, Cranial 	<0.5mm	$1,500.00
	Neuro
	07.01.01.07 - 0.5-0.8mm thick, 1-10cm²
	Medical & Optical Instruments Australia Pty Ltd
MO330	Martin Level One Fixation	Mesh Titanium	0.5-0.8mm thick, 1-10cm²	$315.00
	Medtronic Australasia Pty Ltd
MC389	TiMesh Rigid Fixation Bone 	Titanium, Square Grid Mesh	Small	$315.00
	Grafting and Plating System
	Stryker Australia Pty Ltd
ST245	Leibinger Titanium Implant System	Leibinger Mesh Implants Titanium	75 x 12 x 0.5mm	$315.00
	07.01.01.08 - 0.5-0.8mm thick, 11-50cm²
	Biomet Australia Pty Ltd
BH023	W Lorenz Osteosynthesis System	Panel, Regular or Small Grid. 	(42-85) x (40-53)mm x 	$510.00
	0.6mm
BI644	W Lorenz Osteosynthesis System	Mesh panel, 1.5mm System. Titanium	83 x 51mm x 0.6mm	$510.00
	Johnson & Johnson Medical Pty Ltd
JJ852	Bioplate Biomesh System	Titanium cranial biomesh	0.6mm thickness, 36-65 x 	$510.00
	52-65mm
	Lifehealthcare Pty Ltd
LH509	Martin Osteosynthesis 1.5mm 	Mesh, Titanium	0.5-0.8mm thick, 11-50cm2	$510.00
	System Mesh 50cm2
	Medical & Optical Instruments Australia Pty Ltd
MO411	Martin Level One Fixation	Mesh, Titanium	0.5-0.8mm thick, 11-50cm²	$510.00
Prostheses List by Category, Groups and Sponsor	Page 533 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC915	TiMesh Titanium Rigid Fixation 	FlexMesh 1.5mm System. 	26 to 50 cm2 area; 0.6mm 	$510.00
	Bone Grafting and Plating System	Composition: Titanium	thick
	Stryker Australia Pty Ltd
HW507	Stryker Leibinger Plating System	Craniofacial Titanium Mesh System	0.5 - 0.8mm thick, 11 - 	$510.00
	Surgiplas Medical
SP093	OsteoMed Plating & Fixation System	Plates - Reconstruction	Mesh Malleable/Ridgid, 74 	$510.00
	x 50mm, Mesh, 0.5 to 0.8mm 
	thick, 26 to 50cm3 area
SP108	OsteoMed Plating & Fixation System	Plates	40 x 40mm Osteoform Mesh, 	$510.00
	Mesh 11 to 25cm2 area.
	07.01.01.09 - 0.5-0.8mm thick, 51-200cm²
	B Braun Australia Pty Ltd
BB315	Aesculap CranioPlate System/Plate 	Cranial fixation system, internal 	Plate Neuro, 65 x 90 mm, 	$1,175.00
	Neuro, 65 x 90mm, 0.6mm mesh	fracture, non biodegradable. Consists 	0.6mm Mesh
	of screws, plates.
	Johnson & Johnson Medical Pty Ltd
JJ799	BIOPLATE Biomesh	Titanium cranial biomesh	0.6mm thickness, 90-127 x 	$1,175.00
	92-131mm
	Lifehealthcare Pty Ltd
LH510	Martin Osteosynthesis 1.5mm 	Mesh, Titanium	0.5-0.8mm thick, 51-200cm2	$1,175.00
	System Mesh 64cm2
	Medical & Optical Instruments Australia Pty Ltd
MO251	Martin Level One Fixation	Mesh, Titanium	0.50 to 0.80mm thick, 51 to 	$1,175.00
	100cm² area
	Medtronic Australasia Pty Ltd
MC877	TiMesh Rigid Fixation Bone 	Titanium, Mesh	51 to 100 cm2 area, 0.6mm 	$1,175.00
	Grafting and Plating System	thickness
MI085	TiMesh Rigid Fixation Bone 	FlexMesh 1.0 - 2.2mm system. 	51 to 100cm² area, 0.6mm 	$1,175.00
	Grafting and Plating System	Composition : Titanium	thickness
	National Surgical Pty Ltd
NK025	Jeil Medical Meshes - 51-200cm²	Craniofacial fixation plate	36cm² and 100cm²	$1,175.00
Prostheses List by Category, Groups and Sponsor	Page 534 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
ST250	Leibinger Titanium Implant System	Mesh: Micro, Dumbach, Dynamic	Diameter 1.0mm - 2.3mm; Up	$1,175.00
	 to 90 x 90mm
	Surgiplas Medical
SP110	OsteoMed Plating & Fixation System	Plates	90 x 90mm Osteoform Mesh, 	$1,175.00
	Mesh 51 to 100cm2 area.
	Synthes Australia Pty Ltd
SY579	AO/ASIF Plate	Titanium mesh	0.5mm-0.8mm	$1,175.00
	07.01.01.10 - 0.5-0.8mm thick, >200cm²
	Biomet Australia Pty Ltd
BH019	W Lorenz Osteosynthesis System	Sheet 1.5mm System. Titanium	206 x 123 x 0.6mm	$2,243.00
	Johnson & Johnson Medical Pty Ltd
JJ260	BIOPLATE Biomesh	Titanium cranial biomesh 3ME, 	20 x 20cm	$2,243.00
	packaged non-sterile
	Lifehealthcare Pty Ltd
LH492	Standard Approach Mesh	Pre-contoured titanium mesh implants	0.6mm thick	$2,243.00
	 for 11 standard approaches.
LH511	Martin Osteosynthesis 1.5mm 	Mesh, Titanium	0.5-0.8mm thick, >200cm2	$2,243.00
	System Mesh 200cm2
	Medtronic Australasia Pty Ltd
MI083	TiMesh Titanium rigid Fixation 	FlexMesh 1.5mm - 2.2mm system. 	148 - 154mm x 148 - 154mm,	$2,243.00
	Bone Grafting and Plating System	Composition: Titanium	 0.6mm
	National Surgical Pty Ltd
NK026	Jeil Medical Meshes - >200cm²	Craniofacial fixation mesh	225cm² and 400cm²	$2,243.00
	Surgiplas Medical
SP112	OsteoMed Plating & Fixation System	Plates	125 x 180mm Mesh Plate, 	$2,243.00
	150 x 300mm Mesh Plate, 
	Mesh >200cm2 area.
	Synthes Australia Pty Ltd
SY785	AO/ASIF Plate	Titanium Contourable Mesh, Cranial 	0.5mm-0.8mm	$2,243.00
	Neuro
Prostheses List by Category, Groups and Sponsor	Page 535 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
07.01.02 - Mesh - Non-metal
	07.01.02.01 - <0.2mm thick, 1-10cm²
	Medtronic Australasia Pty Ltd
MC551	Macropore	Protective Disc	25mm	$165.00
MC554	Macropore	CraniDisk	23 - 28mm	$165.00
MC568	Macropore	Bur Hole Cover	25mm	$165.00
	07.01.02.02 - <0.2mm thick, 11-25cm²
	Johnson & Johnson Medical Pty Ltd
JJ687	PDS Plates	Absorbable synthetic (poly-p-	0.25mm x 30mm x 40mm         	$515.00
	dioxanone) plate/foil	                                     0.5mm x 
	30mm x 40mm                            
	                    0.25mm x 40mm x 
	50mm                                           
	   0.5mm x 40mm x 50mm         
	                            
	07.01.02.03 - 0.2-0.49mm thick, 1-10cm²
	Biomet Australia Pty Ltd
BI399	Lactosorb Resorbable 	Panel or Sheet, Solid or Holed, 	0.25mm x 25x25mm	$450.00
	Craniomaxillofacial Fixation System	PGA/PLA
	Medical & Optical Instruments Australia Pty Ltd
MO299	Martin Level One Fixation Resorb x 	Mesh PDLLA (resorbable)	0.20 to 0.49mm thick, 1 to 	$450.00
	& SonicWeld	10 cm2 area
	07.01.02.04 - 0.2-0.49mm thick, 11-25cm²
	Biomet Australia Pty Ltd
BI400	Lactosorb Resorbable 	Cover, Solid or Holed, PGA/PLA	(0.25, 0.5, 0.75mm) x 	$680.00
	Craniomaxillofacial Fixation System	38x38mm
BI401	Lactosorb Resorbable 	Cover, Solid or Holed, PGA/PLA	0.25mm x 50x50mm	$680.00
	Craniomaxillofacial Fixation System
Prostheses List by Category, Groups and Sponsor	Page 536 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ049	Inion GTR Biodegradable System	PLGA/TMC Copolymer: membrane & 	a) 30 x 40mm membrane kit; 	$680.00
	tacks	b) 6 tack kit and applicator
	07.01.02.05 - 0.2-0.49mm thick, 26-50cm²
	Medical & Optical Instruments Australia Pty Ltd
MO188	Martin Level One Fixation Resorb x 	Mesh, PDLLA (resorbable)	0.20 to 0.49mm thick, 26 to 	$1,490.00
	& SonicWeld Rx	50cm² area
	07.01.02.06 - 0.2-0.49mm thick, 51-100cm²
	Biomet Australia Pty Ltd
BI998	Lactosorb Resorbable 	Panel or Sheet, Solid or Holed, 	0.25mmx100x100mm	$1,750.00
	Craniomaxillofacial Fixation System	PGA/PLA
	07.01.02.07 - 0.5-0.8mm thick, 1-10cm²
	Biomet Australia Pty Ltd
BI417	Lactosorb Resorbable 	Cover, Solid or Holed, PGA/PLA	(0.5 or 0.8mm) x 25 x 25mm	$600.00
	Craniomaxillofacial Fixation System
	Medical & Optical Instruments Australia Pty Ltd
MO402	Martin Level One Fixation Resorb X	Mesh, PDLLA (resorbable)	0.50 to 0.80mm thick, 1 to 	$600.00
	 & SonicWeld RX	10cm²
	Medtronic Australasia Pty Ltd
MC630	Macropore FRP (fast resorbing 	Polylactide and Polyglycolide 	25mm x 25mm x 0.75mm	$600.00
	polymer)
MI088	Macropore	Protective Sheets	1 to 10cm² area; 0.5mm thick	$600.00
	07.01.02.08 - 0.5-0.8mm thick, 11-25cm²
	Biomet Australia Pty Ltd
BI418	Lactosorb Resorbable 	Panel, Lactosorb. 1.5mm System. 	25 x 50mm (5 x 10 hole)	$945.00
	Craniomaxillofacial Fixation System	PGA/PLA
BI419	Lactosorb Resorbable 	Cover, Solid or Holed, PGA/PLA	(0.5 or 0.8)mm x 50x50mm	$945.00
	Craniomaxillofacial Fixation System
Prostheses List by Category, Groups and Sponsor	Page 537 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC629	Macropore FRP (fast resorbing 	Polylactide and Polyglycolide 	50mm x 50mm 0.75mm	$945.00
	polymer)
MC893	Macropore	Protective Sheets	11 to 25 cm2 area, 0.5mm 	$945.00
	thick
	Surgical Specialties
SQ052	CPS Bioabsorbable Fixation System	CPS Systems and Baby System Plates.	1.5-2.5 mesh plate, 7 x 7 	$945.00
	  Polylactic Acid Trimethylene 	holes; 1.5mm baby mesh 
	Carbonate Copolymer	plate 7 x 7 holes
	Synthes Australia Pty Ltd
SY544	PolyMax Rapid-Resorbable 	Mesh Plate	0.5-0.8mm	$945.00
	Fixation System
	07.01.02.09 - 0.5-0.8mm thick, 26-50cm²
	Medical & Optical Instruments Australia Pty Ltd
MO346	Martin Level One Fixation	Mesh PDLLA resorbable	0.5-0.8mm thick, 26-50cm²	$1,230.00
	Medtronic Australasia Pty Ltd
MC560	Macropore	Protective Sheets	60 x 80 x 0.5mm - 60 x 80 x 	$1,230.00
	0.8mm
MC628	Macropore FRP (fast resorbing 	Polylactide and Polyglycolide 	60mm x 80mm x 0.75mm	$1,230.00
	polymer)
	07.01.02.10 - 0.5-0.8mm thick, 51-100cm²
	Biomet Australia Pty Ltd
BI999	Lactosorb Resorbable 	Panel or Sheet, Solid or Holed, 	(0.5 or 0.8)mm 100x100mm	$1,940.00
	Craniomaxillofacial Fixation System	PGA/PLA
	Medtronic Australasia Pty Ltd
MC627	Macropore FRP (fast resorbing 	Polylactide and Polyglycolide 	100mm x 100mm x 0.75mm	$1,940.00
	polymer)
MC899	Macropore	Protective Sheets	51 to 100 cm2 area; 0.5mm 	$1,940.00
	thick
Prostheses List by Category, Groups and Sponsor	Page 538 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Specialties
SQ066	CPS Bioabsorbable Fixation System	CPS Systems and Baby System Plates.	1.5-2.5 mesh plates, 14 x 14 	$1,940.00
	  Polylactic Acid Trimethylene 	holes; 1.5mm baby mesh 
	Carbonate Copolymer	plate 14 x 14 holes
	Synthes Australia Pty Ltd
SY547	PolyMax Rapid-Resorbable 	Mesh Plate	0.5-0.8mm	$1,940.00
	Fixation System
	07.01.02.11 - 0.5-0.8mm thick, 101-200cm²
	Medical & Optical Instruments Australia Pty Ltd
MO358	Martin Level One Fixation	Mesh PDLLA resorbable	0.5-0.8mm thick, 101-200cm²	$2,100.00
	07.01.02.12 - >0.8mm thick, 1-10cm²
	Medical & Optical Instruments Australia Pty Ltd
MO344	Martin Level One Fixation	Mesh PDLLA resorbable	>0.8mm thick, 1-10cm²	$600.00
	Medtronic Australasia Pty Ltd
MC896	Macropore	Protective Sheets	1 to 10 cm2 area; 1.0mm thick	$600.00
	07.01.02.13 - >0.8mm thick, 11-25cm²
	Biomet Australia Pty Ltd
BI427	Lactosorb Resorbable 	Mesh, Mandibular Lactosorb 2.5mm 	1.42mm x 42x42mm	$950.00
	Craniomaxillofacial Fixation System	System. PGA/PLA
	Medical & Optical Instruments Australia Pty Ltd
MO231	Martin Level One Fixation Resorb x 	Mesh, PDLLA (resorbable)	>0.80mm thick, 11 to 25cm² 	$950.00
	& SonicWeld Rx	area
	Medtronic Australasia Pty Ltd
MC894	Marcropore	Protective Sheets	11 to 25 cm2 area, 1.0mm 	$950.00
	thick
	Synthes Australia Pty Ltd
SY545	PolyMax Rapid-Resorbable 	Mesh Plate	>0.8mm	$950.00
	Fixation System
Prostheses List by Category, Groups and Sponsor	Page 539 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.02.14 - >0.8mm thick, 26-50cm²
	Medical & Optical Instruments Australia Pty Ltd
MO345	Martin Level One Fixation	Mesh PDLLA resorbable	>0.8mm thick, 26-50cm²	$1,020.00
	Stryker Australia Pty Ltd
ST516	Stryker Leibinger Resorbable 	Resorbable plate: blank panel 	55x55mm 	$1,020.00
	Fixation System	Tripolymer
ST526	Stryker Leibinger Resorbable 	Resorbable Mesh Tripolymer	55x55mm	$1,020.00
	Fixation System
	07.01.02.15 - >0.8mm thick, 51-100cm²
	Medtronic Australasia Pty Ltd
MC900	Macropore	Protective Sheets	51 to 100 cm2 area; 1.0mm 	$1,175.00
	thick
	Synthes Australia Pty Ltd
SY546	PolyMax Rapid-Resorbable 	Mesh Plate	>0.8mm	$1,175.00
	Fixation System
	07.01.02.16 - >0.8mm thick, 101-200cm2
	Medical & Optical Instruments Australia Pty Ltd
MO359	Martin Level One Fixation	Mesh PDLLA resorbable	>0.8mm thick, 101-200cm2	$2,100.00
07.01.03 - Mesh - Composite
	07.01.03.01 - 0.5-0.8mm thick, 1-25cm²
	Stryker Australia Pty Ltd
HW443	E-POR Biomaterial/ Panel - Porous 	Panel - Porous Polyethylene 	0.5mm - 0.8mm thick, 38mm 	$900.00
	Polyethlene Titanium Mesh 	Titanium Mesh Composite	x 50mm
	Composite
	Synthes Australia Pty Ltd
SY699	SynPOR	Anatomical Porous Polyethylene 	08.mm - 1.5mm thick	$900.00
	with Titanium
Prostheses List by Category, Groups and Sponsor	Page 540 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.03.02 - 0.5-0.8mm thick, 26-50cm²
	Stryker Australia Pty Ltd
HW440	E-POR Biomaterial/ Panel - Porous 	Panel - Porous Polyethlene Titanium 	>0.8mm thick, 38mm x 50mm	$975.00
	Polyethlene Titanium Mesh 	Mesh Composite
	Composite
HW444	E-POR Biomaterial/ Panel - Porous 	Panel - Porous Polyethylene 	0.5mm-0.8mm thick, 76mm x 	$975.00
	Polyethlene Titanium Mesh 	Titanium Mesh Composite	50mm
	Composite
	07.01.03.03 - >0.8mm thick 26-50cm²
	Stryker Australia Pty Ltd
HW441	E-POR Biomaterial/ Panel - Porous 	Panel - Porous Polyethylene 	>0.8mm thick, 76mm x 50mm	$1,150.00
	Polyethylene Titanium Mesh 	Titanium Mesh Composite
	Composite
	Synthes Australia Pty Ltd
SY697	SynPOR	Porous Polyethylene with Titanium	> 08.mm thick	$1,150.00
07.01.04 - Non-mesh
	Stryker Australia Pty Ltd
SK515	Nasal Sheet (Strut).	Nasal Sheet (Strut). Model 9536	Nasal Sheet (Strut): 40 x 9 x 	$220.00
	1.1mm
	07.01.04.01 - Resorbable
	Biomet 3i Australia Pty Ltd
NW005	OsseoGuard Resorbable Collagen 	Dental Resorbable Collagen Membrane	15mm x 20mm, 20mm x 	$345.00
	Membrane	30mm, 30mm x 40mm
Prostheses List by Category, Groups and Sponsor	Page 541 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Henry Schein-Halas Pty Ltd
HD010	Bio-Gide	Bio-Gide & Bio-Gide Perio are 	30mm x 40mm	$345.00
	collagen membranes containing 
	porcine collagen in a bilayer 
	structure.  They are used for guided 
	bone regeneration and peridontal 
	tissue regeneration in oral and 
HD011	Bio-Gide	Bio-Gide & Bio-Gide Perio are 	25mm x 25mm	$345.00
	collagen membranes containing 
	porcine collagen in a bilayer 
	structure.  They are used for guided 
	bone regeneration and peridontal 
	tissue regeneration in oral and 
HD012	Bio-Gide	Bio-Gide & Bio-Gide Perio are 	13 x 25mm	$345.00
	collagen membranes containing 
	porcine collagen in a bilayer 
	structure.  They are used for guided 
	bone regeneration and peridontal 
	tissue regeneration in oral and 
HD013	Bio-Gide Perio	Bio-Gide & Bio-Gide Perio are 	Bio-Gide perio - 16mm x 	$345.00
	collagen membranes containing 	22mm
	porcine collagen in a bilayer 
	structure.  They are used for guided 
	bone regeneration and peridontal 
	tissue regeneration in oral and 
HD022	Mucograft	Collagen Matrix	15mm x 20mm, 20mm x 30mm	$345.00
	Medical & Optical Instruments Australia Pty Ltd
MO302	Martin Level One Fixation Resorb x 	Reconstruction sheet not mesh 	25x25mm-0.1mm	$345.00
	& SonicWeld	PDLLA (resorbable)
	07.01.04.02 - Polymer
	Johnson & Johnson Medical Pty Ltd
JJ303	Cranioplastic Kit (Type 1)	Cranioplastic kit containing 2 	30grams	$240.00
	complete sets.  Consists of 2 bags of 
	sterile powder, 2 vials sterile liquid, 2
	 sterile matrix bags
Prostheses List by Category, Groups and Sponsor	Page 542 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW006	Biopore Ultra thin Sheet	An implantable device intended to 	38 x 50mm	$240.00
	support, contour, and provide 
	structure for the craniofacial anatomy 
	during reconstructive and plastic 
	surgery procedures. Made of high-
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs.
MW007	Biopore Ultra Thin Sheet Large	An implantable device intended to 	76 x 127mm	$240.00
	support, contour, and provided 
	structure for the craniofacial anatomy 
	during reconstructive and plastic 
	surgery procedures. Made of high- 
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs
	Stryker Australia Pty Ltd
HW416	Micro Thin Sheet	Model/s 8438, 83020, 83022, 83029	8438: 30 x 50 x 0.4mm,  	$240.00
	83020: 38 x 50 x 0.25mm, 
	83022: 38 x 50 x 0.35mm, 
	83029: 38 x 50 x 0.45mm
HW417	Sheet	Porus Polyethylene. Models 6330, 	Sheets 6330: 38 x 50 x 	$240.00
	6331, 8662, 9562. Micro single 	1.5mm, 6331: 50 x 76 x 
	channel sheet, model 9528. Barrier 	1.5mm, 8662: 76 x 127 x 
	microplate single channel sheet, 	1.5mm, 9862: 38 x 50 x 3mm.
	model 9527 Medpor Titan Implant 	 Microplate single channel 
	Sheets Plain, Barrier & Double 	Sheet 9528: 38 x 50 x 
	Barrier, and Medpor Titan Orbital 	0.85mm. Barrier microplate 
	floor and wall sheets 8102	single channel Sheet 9527: 
	38 x 50 x 0.85mm. Titan 
	implant sheets 81020: 76 x 
	50 x
Prostheses List by Category, Groups and Sponsor	Page 543 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW418	Barrier Sheet: Barrier Sheet - Orbital	Porus Polyethylene. Barrier  sheet - 	 Barrier  sheet - Rectangle: 	$240.00
	 Floor	Rectangle, models 8312 and 9312. 	50 x 76  x 1mm, 50 x 76 x 
	Orbital floor implants, models 8305 	1.6mm: 50 x 76 x 1mm, 50 x 
	and 9305	76 x 1.6mm.  Orbital Floor: 
	38 x 50 x 1mm, 38 x 50 x 
	1.6mm
HW426	Ultra Thin Sheet	Porus Polyethylene. Model 7214	76 x 127 x 0.85mm	$240.00
HW427	Ultra Thin Sheet	Porus Polyethylene. Model 7216	127 x 178 x 0.85mm	$240.00
HW428	Sheet - Multi Channel, Barrier 	Porus Polyethylene. Miniplate 	Miniplate channel: 40 x 52 	$240.00
	Channel.	channel sheet, model 9529. 	x 2.3mm. Mircoplate 
	Microplate channel sheet, model 	channel: 40 x 52 x 2.3mm. 
	9530. Barrier Miniplate and 	Barier Miniplate and 
	Microplate Channel Sheets, Models 	Microplate Channel Sheets: 
	40 x 52 x 2.3mm, 40 x 52 x 
HW442	E-POR Biomaterial/ Sheet - Porous 	Sheet - Porous Polyethylene	30mm - 50mm x 0.4mm - 3mm	$240.00
	Polyethylene
SK513	Ultra Thin Sheet	Porus Polyethylene. Models 7210	38 x 50 x 0.85mm	$240.00
SK516	Ultra Thin Sheet	Porus Polyethylene. Model 7212	50 x 76 x 0.85mm	$240.00
SK517	Sheet - Barrier Single Channel 	Porus Polyethylene. Barrier Single 	Barrier Single Channel: 38 x	$240.00
	Channel Sheet, Model 9527.	 50 x 0.85mm
	Synthes Australia Pty Ltd
SY696	SynPOR	Porous Polyethylene	0.45mm - 3.0mm thick	$240.00
	07.01.04.03 - Block
	Anatomics Pty Ltd
AT072	E-POR Biomaterial	Block	Preform - various 3D 13mm -	$825.00
	 63mm
Prostheses List by Category, Groups and Sponsor	Page 544 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW001	Bipore Flexible Block	An implantable device intended to 	38 x50 x 3mm and 76 x 50 x 	$825.00
	support, contour, and provide 	9mm
	structure for the craniofacial anatomy 
	during reconstructive and plastic 
	surgery procedures. Made of high 
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs.
	Stryker Australia Pty Ltd
HW506	Stryker MEDPOR Implant	Porous Polyethylene Mesh	Block	$825.00
SK520	Medpor Porous Polyethylene 	Porous Polyethylene Biomaterial 	Custom designed and made 	$825.00
	Biomaterial Custom Made Implant	Custom Made Product for ear, nose, 	from CT scan image
	face and Orbit reconstruction
07.01.05 - Fracture or Reconstruction Plates
	07.01.05.01 - <0.5mm thick, <4 holes
	Biomet Australia Pty Ltd
BI949	Neurological Packs	Plate & screws: Neuro pack - single 	1.5mm or 2mm system	$65.00
	plate or thinflip 2 hole plate set
	Johnson & Johnson Medical Pty Ltd
JJ535	BIOPLATE Low Profile	Low Profile 2-hole Straight Plate	11mm - 14mm length	$65.00
	Medical & Optical Instruments Australia Pty Ltd
MO389	KLS Martin Neuro Fixation System	Ultra low profile neuro plates	0.3mm thick 2 holes	$65.00
	Surgiplas Medical
SP076	Plates	Micro, Midface & Mini	Straight Plate - 2 Hole, 	$65.00
	Plate < 4 holes.
	Synthes Australia Pty Ltd
SY561	Matrix	Micro Y Plate	< 4 holes	$65.00
Prostheses List by Category, Groups and Sponsor	Page 545 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.05.02 - <0.5mm thick, 4-7 holes
	Johnson & Johnson Medical Pty Ltd
JJ845	Bioplate Plating System	Plates of various shape	4 to 7 holes	$140.00
	Medical & Optical Instruments Australia Pty Ltd
MO390	KLS Martin Neuro Fixation System	Ultra low profile neuro plates	0.3mm thick 4-7 holes	$140.00
	Synthes Australia Pty Ltd
SY562	Matrix	Micro X, Frame plates	4  - 7 Holes	$140.00
	Burr
	Johnson & Johnson Medical Pty Ltd
JJ544	BIOPLATE Low Profile	Low Profile Flex Contoured Burr 	Low profile 0.3mm, 1.5mm 	$190.00
	Hole Cover	diam hole, 12 - 18mm diam 
	plate
	Lifehealthcare Pty Ltd
LH495	Martin Level One Fixation	Plate, titanium	<0.5mm thick, 4 to 7 holes	$190.00
	Medical & Optical Instruments Australia Pty Ltd
MO121	Martin Level One Fixation	Plate, titanium	<0.5mm thick, 4 to 7 holes	$190.00
	07.01.05.03 - <0.5mm thick, 8-15 holes
	Johnson & Johnson Medical Pty Ltd
JJ543	BIOPLATE Low Profile	Low Profile 8-hole Boxcar Plate	10 x 24mm	$281.00
	Lifehealthcare Pty Ltd
LH504	Martin Osteosynthesis 1.5mm 	Plate, Titanium	<0.5mm thick, 8-15 holes	$281.00
	System 8-15 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO391	KLS Martin Neuro Fixation System	Ultra low profile neuro plates	0.3mm thick 8-15 holes	$281.00
	Synthes Australia Pty Ltd
SY563	Matrix	Micor Orbital curved plate	12 hole	$281.00
Prostheses List by Category, Groups and Sponsor	Page 546 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.05.04 - <0.5mm thick, 16-32 holes
	Lifehealthcare Pty Ltd
LH506	Martin Osteosynthesis 1.5mm 	Plate, Titanium	<0.5mm thick, 16-32 holes	$380.00
	System 16-32 hole plate
	Synthes Australia Pty Ltd
SY558	Matrix	Micro Adaption, Strut Plates	18-20 hole	$380.00
	07.01.05.05 - 0.5-0.99mm thick, <4 holes
	Australian Surgical Innovations Pty Ltd
AI004	ASI Plates and Screws	Plate	Straight, Left, Right, X, T 	$95.00
	and Y shaped
	B Braun Australia Pty Ltd
BB304	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 2 hole 11 & 	$95.00
	 Neuro, 2 hole straight	fracture, non biodegradable.  Consists 	16mm straight
	of screws, plates
	Biomet Australia Pty Ltd
BI677	W Lorenz Osteosynthesis System	Plate, Neuro Straight, 1.5mm System, 	2 hole (medium or long)	$95.00
	Titanium
	Johnson & Johnson Medical Pty Ltd
JJ853	Bioplate Plating System	Plates of various shape	Less than 4 holes	$95.00
	Lifehealthcare Pty Ltd
LH502	Martin Osteosynthesis 1.5mm 	Plate, 0.6mm thick, titanium	2-4 hole	$95.00
	System 2 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO283	Martin Micro Plate Osteosynthesis 	1.5mm system Straight Plate Titanium	2 hole, 0.6mm profile	$95.00
	System
	Medtronic Australasia Pty Ltd
MC872	TiMesh Rigid Fixation Bone 	Titanium, Straight Plate	< 4 holes	$95.00
	Grafting and Plating System
MC908	Timesh	Rigid Straight Plates	< 4 holes	$95.00
	National Surgical Pty Ltd
NK022	Jeil Medical - Plate , 4 holes	Craniofacial fixation plate	One size	$95.00
Prostheses List by Category, Groups and Sponsor	Page 547 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW497	Stryker Leibinger Plating System	Craniofacial Fixation Plates	0.5 - 0.99mm thick, <4 holes	$95.00
	Surgiplas Medical
SP075	Plates	Micro, Midface & Mini	Straight Plate - 2 Hole, 	$95.00
	Plate < 4 holes.
SP101	Bioresorbable Fixation System	Plates	Neuro Fixation Set	$95.00
	Burr
	Medtronic Australasia Pty Ltd
MC867	TiMesh Rigid Fixation Bone 	Titanium, Plate	Ohata Tristar 8.4 10mm, < 4 	$140.00
	Grafting and Plating System	hole
	Stryker Australia Pty Ltd
SK267	Leibinger Titanium Implant System	Burr Hole Cover 1.0mm - 2.3mm	Diameter 7, 10, 14 & 20mm	$140.00
	Compression
	Johnson & Johnson Medical Pty Ltd
JJ275	BIOPLATE Plating System	Titanium cranial compression plate	2 holes	$140.00
	Lifehealthcare Pty Ltd
LH493	Neuro Flap Fix Kit (Sterile)	Neuro Flapfix Kit (sterile) consists of 	Plates: length 15mm / width	$140.00
	three low-profile 2-hole plates & six 	 1mm /thick 0.6mm
	self-drilling 1.5-mm	Screws: length 4mm/ width 
	maxDrive screws.	1.5mm
	Synthes Australia Pty Ltd
SY580	AO/ASIF Plate	Titanium adaption plate	<4 holes	$140.00
	Resorbable
	Synthes Australia Pty Ltd
SY512	AO/ASIF Plate	Rapid resorbable reconstruction plate	<4 holes	$180.00
	07.01.05.06 - 0.5-0.99mm thick, 4-7 holes
	Aus Systems Pty Ltd
AU007	Aus Systems Titanium Miniplates 	Plate Titanium	0.7mm profile 4-7 holes	$170.00
	(Bone Plates)
Prostheses List by Category, Groups and Sponsor	Page 548 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	B Braun Australia Pty Ltd
BB305	Aesculap CranioPlate System/Plate 	Cranial fixation system, internal 	Plate Neuro, 6 hole 10 x 17 	$170.00
	Neuro, 6 hole rectangular	fracture, non biodegradable.  Consists 	mm rectangular
	of screws, plates.
BB306	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 4 hole 10mm 	$170.00
	 Neuro, 4 hole square	fracture, non biodegradable.  Consists 	square
	of screws, plates.
BB307	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 4 hole 17 & 20	$170.00
	 Neuro, 4 hole straight	fracture, non biodegradable.  Consists 	 mm straight
	of screws, plates.
BB308	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 6 hole 15 & 	$170.00
	 Neuro, 6 hole double Y	fracture, non biodegradable.  Consists 	17mm, double Y shape
	of screws, plates.
BB309	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 5 hole 17mm, 	$170.00
	 neuro, 5 hole Y	fracture, non biodegradable.  Consists 	Y shape
	of screws, plates
BB313	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 6 hole x 16 & 	$170.00
	 Neuro, Burr hole cover 12 & 16mm	fracture, non biodegradable.  Consists 	20mm Burr hole cover
	of screws, plates.
	Biomet Australia Pty Ltd
BI348	W Lorenz Osteosynthesis System	L-Plate, 2mm System, Left or Right. 	2 x 2 hole, Mini or Low 	$170.00
	Titanium	Profile
BI351	W Lorenz Osteosynthesis System	L-Plate, 2mm System, Left or Right. 	2 x 2 hole, long	$170.00
	Titanium
BI605	W Lorenz Osteosynthesis System	Plate, Matrix, 1.0 or 1.5mm System, 	6 hole	$170.00
	Titanium
BI617	W Lorenz Osteosynthesis System	Plate, Straight, 1mm System. Titanium	4 hole	$170.00
BI620	W Lorenz Osteosynthesis System	Plate, Straight, low profile, 2.0mm 	4 - 8 hole	$170.00
	System, Titanium
BI621	W Lorenz Osteosynthesis System	Plate, L , 2.5mm or 2m system, 	2 x2 or 3x3 hole	$170.00
	Titanium
BI622	W Lorenz Osteosynthesis System	Z-Shape Plate, Left or Right, 1.5mm or 	2 x 2 hole	$170.00
	2mm System. Titanium
BI623	W Lorenz Osteosynthesis System	T-Plate, Left or Right, 1.5mm System. 	3x3 hole, 7x7 hole	$170.00
	Titanium
Prostheses List by Category, Groups and Sponsor	Page 549 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI624	W Lorenz Osteosynthesis System	T-Plate 90 degrees, Left or Right, 2mm	2x5hole, 3x3hole, 2x3hole	$170.00
	 System. Titanium
BI625	W Lorenz Osteosynthesis System	Plate, Y, Double Y, X, 1.5mm System 	One size only	$170.00
	or 2.0mm System, Titanium
BI627	W Lorenz Osteosynthesis System	Plate, Straight, 1.5mm System, Titanium	4 or 6 hole	$170.00
BI638	W Lorenz Osteosynthesis System	Plate, Orbital. 1mm System, Titanium	One size only	$170.00
BI639	W Lorenz Osteosynthesis System	Plate, Square. 1mm System. Titanium	4 hole	$170.00
BI656	W Lorenz Osteosynthesis System	Plate, Orbital, 1.5mm, 2.0mm System, 	6 hole	$170.00
	Titanium
BI717	W Lorenz Osteosynthesis System	Neuro Gap Plate, Titanium	6 hole, 45mm length	$170.00
BI718	W Lorenz Osteosynthesis System	Neuro Gap Plate, Titanium	6 hole 25mm length	$170.00
BI720	W.Lorenz Osteosynthesis System	Neuro Gap Plate; titanium	6 hole, 35mm length	$170.00
BI728	W.Lorenz Osteosynthesis System	Neuro Square or Rectangular Plate, 	1.5mm system, 4 hole	$170.00
	titanium
BI988	W Lorenz Osteosynthesis System	Plate Straight 2mm System	4 - 7 hole	$170.00
	Johnson & Johnson Medical Pty Ltd
JJ847	Bioplate Plating System	Plates of various shape	4 to 7 holes	$170.00
	Lifehealthcare Pty Ltd
LH503	Martin Osteosynthesis 1.5mm 	Plate, 0.6mm thick, Titanium	4-7 hole	$170.00
	System 4-7 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO401	Martin Level One Fixation	Plate Titanium	0.5 to 0.99mm thick, 4 - 7 	$170.00
	holes
	Medtronic Australasia Pty Ltd
MC393	TiMesh Rigid Fixation Bone 	Titanium, Z Plate Left and Right	4 hole - 5mm, 9.5mm	$170.00
	Grafting and Plating System
MC519	TiMesh	Squareplate	4 holes x 1mm - 4 holes x 	$170.00
	2.2mm
MC520	TiMesh	X Plate	4 holes x 1mm - 4 holes x 	$170.00
	2.2mm
MC576	Timesh	Double Y Plates	3 Hole - 2.5mm - 7mm	$170.00
MC870	TiMesh Rigid Fixation Bone 	Titanium, Y Plate Double and Single	4 - 7 hole	$170.00
	Grafting and Plating System
Prostheses List by Category, Groups and Sponsor	Page 550 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC875	TiMesh Rigid Fixation Bone 	Titanium, T Plate	4 - 7 hole	$170.00
	Grafting and Plating System
MC883	TiMesh Rigid Fixation Bone 	Titanium, L Plate (Left and right 	4 to 7 holes	$170.00
	Grafting and Plating System	configurations)
MC885	TiMesh Rigid Fixation Bone 	Titanium, H Plate	4 - 7 hole	$170.00
	Grafting and Plating System
MC891	Macropore	Oblique Plates	4 to 7 holes	$170.00
MC909	Timesh	Rigid Straight Plates	4 - 7 holes	$170.00
	National Surgical Pty Ltd
NK023	Jeil Medical - Plates - 4-7 Holes	Craniofacial fixation plates	Straight plate: Holes 6, Burr	$170.00
	 hole plates: Holes: 5 -6, 
	Diam: 15mm - 22mm
	Stryker Australia Pty Ltd
HW498	Stryker Leibinger Plating System	Craniofacial Fixation Plates	0.5 - 0.99mm thick, 4 -7 holes	$170.00
	Surgiplas Medical
SP074	Plates	Micro, Midface, Mini, BSSO, TR 	4 Hole BSSO Plate Short, 	$170.00
	BSSO	Medium, Long; TR BSSO 
	Plate, Short, Long; 4 & 6 
	Hole Straight Plate 1.0mm 
	thick, Plate 4 to 7 holes.
SP084	Plates	Mini & Maxi	4 & 5 Hole compression 	$170.00
	Plates 4 to 7 Holes
SP087	Plates	Mini & Maxi	Zygomatic Plates, Pyriform 	$170.00
	Plates, Orthognathic, Y 
	Plates, Y Plate, H Plate, 5 
	Hole straight plate, 13mm &
	 16mm L Plate - Left & 
	Right, 19mm T Plate, X 
	Plate; 10mm Square Plate; 
	13mm, 15mm & 22mm L 
	Plate - Left & Right, 9mm & 
	11mm ZED Plate - Left & 
	Right
Prostheses List by Category, Groups and Sponsor	Page 551 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Burr
	Aus Systems Pty Ltd
AU014	Aus Systems Titanium Miniplates 	Low profile burr hole cover	10mm, 14mm, 18mm, 22mm	$170.00
	(Bone Plates)
	Biomet Australia Pty Ltd
BI353	W Lorenz Osteosynthesis System	Plate, Burr Hole, 1mm, 1.5mm, 2mm 	13mm, 17mm, 18.5mm	$170.00
	system
BI721	W Lorenz Osteosynthesis System	Plate, Burr Hole, 1.5mm System, 	22mm, 25mm	$170.00
	Titanium
BI870	Neurological Packs	Plate & screws: Neuro pack Burr 	1.5mm or 2mm system	$170.00
	cover or multi plate set.  Thinflap 4 
	hole plus plate sets
	Johnson & Johnson Medical Pty Ltd
JJ848	Bioplate Plating System	Titanium Burr Hole Covers	4 to 7 holes	$170.00
	Lifehealthcare Pty Ltd
LH507	Martin Osteosynthesis 1.5mm 	Burr Hole Plate, Titanium	0.6mm thick, 4-7 holes	$170.00
	System Burr hole plate
	Medtronic Australasia Pty Ltd
MC868	TiMesh Rigid Fixation Bone 	Titanium, Plate	Fan Blade 11-18mm, Mesh 	$170.00
	Grafting and Plating System	11-25mm, 4 - 7 hole
	Stryker Australia Pty Ltd
ST141	Leibinger Titanium Implant System	Leibinger Burr Hole Cover: curved  	7, 10, 14mm	$170.00
	Titanium
	Surgiplas Medical
SP072	Plates	Micro, Mini, Maxi	Burr Hole Plates, Calvarium	$170.00
	 Plate - Small & Large - 
	Calvarium Plate, Plates 4 to 
	7 Holes
	Synthes Australia Pty Ltd
SY319	AO/ASIF Plate	Low profile neurosurgical plate, burr 	4-7 holes	$170.00
	hole
	Complex
	Biomet Australia Pty Ltd
BI591	W Lorenz Osteosynthesis System	Chin Plates, Paulus, 2mm System, 	4 - 12mm	$246.00
	Titanium
Prostheses List by Category, Groups and Sponsor	Page 552 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical & Optical Instruments Australia Pty Ltd
MO224	Martin Level One Fixation	Plate, titanium	0.5-0.99mm thick, 4-7 holes	$246.00
	Surgiplas Medical
SP070	Plates	Micro, Mini, Maxi	Gap Plates, Plates 4 to 7 	$246.00
	holes
	Synthes Australia Pty Ltd
SY582	AO/ASIF Plate	Titanium adaption plate	4-7 holes	$246.00
	Compression
	Biomet Australia Pty Ltd
BI349	W Lorenz Osteosynthesis System	Plate, Compression Straight, 2mm 	4 hole	$170.00
	System. Titanium
	Stryker Australia Pty Ltd
HW501	Stryker Leibinger Plating System	Craniofacial Fixation Plates, 	0.5 - 0.9mm thick, 4 -7 holes	$170.00
	Compression
	Surgiplas Medical
SP033	OsteoMed Plating & Fixation System	Compression Plates - Micro, Mini & 	Micro: 2 x 3 Hole 	$170.00
	Maxi	Compression T Plate, 
	Oblique Left & Right 
	Compression T Plate, 4 
	Hole Straight Compression 
	Plate; 5 Hole Straight Plate,
	 13mm Left & Right L Plate, 
	19mm T Plate, 2 x 3 Hole 
	Quad Plate; Mini: 4 Hole 
	Left & Right L Plate, 4 Hole
	 Left & Rig
	Synthes Australia Pty Ltd
SY581	AO/ASIF Plate	Titanium adaption plate	4-7 holes	$170.00
	Locking
	Stryker Australia Pty Ltd
HW500	Stryker Leibinger Plating System	Craniofacial Fixation Plates ,Locking	0.5 - 0.9mm thick, 4 -7 holes	$195.00
	Resorbable
	Biomet Australia Pty Ltd
BH001	Lactosorb Resorbable 	Lactosorb Plates, 2mm System, All 	4 - 7 hole	$200.00
	Craniomaxillofacial Fixation System	shapes PGA/PLA
Prostheses List by Category, Groups and Sponsor	Page 553 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI990	Lactosorb Resorbable CMF System	Lactosorb Plates, 1.5mm System	4 - 7 hole	$200.00
	Medtronic Australasia Pty Ltd
MC550	Macropore	Rectangle Plates	4-8 hole	$200.00
MC553	Macropore	Oblong Plates	6 - 8 hole	$200.00
MC562	Macropore	Y Plates	7 hole	$200.00
MC563	Macropore	Straight Plates	4 hole	$200.00
	Stryker Australia Pty Ltd
HW499	Delta Resorbable Fixation System	Craniofacial Resorbable Fixation 	0.5 -0.99mm thick, 4 - 7 holes	$200.00
	Synthes Australia Pty Ltd
SY504	AO/ASIF Plate	Rapid resorbable reconstruction plate	4-7 holes	$200.00
	07.01.05.07 - 0.5-0.99mm thick, 8-32 holes
	Aus Systems Pty Ltd
AU060	Aus systems titanium Miniplates 	titanium miniplates	8,19 hole	$204.00
	(Bone plates)
	B Braun Australia Pty Ltd
BB310	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 8 hole 10 x 24 	$204.00
	 Neuro, 8 hole rectangular	fracture, non biodegradable.  Consists 	mm rectangular
	of screws, plates.
BB317	Aesculap CranioPlate System/ Plate	Cranial fixation system, internal 	Plate Neuro, 16 hole 63mm 	$204.00
	 Neuro, 16 hole straight	fracture, non biodegradable.  Consists 	straight
	of screws, plates.
	Biomet Australia Pty Ltd
BI641	W Lorenz Osteosynthesis System	Plate, Matrix.  1mm System, 1.5mm 	2 x 4 hole	$204.00
	System. Titanium
BI658	W Lorenz Osteosynthesis System	Plate, Orbital. 1.5mm System, 2mm 	8-10 hole	$204.00
	System. Titanium
BI719	W Lorenz Osteosynthesis System	Neuro Sub-Temporal Plate, Titanium	medium	$204.00
BI773	W Lorenz Osteosynthesis System	Neuro sub-temporal plate, 1.5 system, 	Small	$204.00
	titanium
BI985	W Lorenz Osteosynthesis System	Plates Straight, 1.5, 2.0 or 1.0mm 	15 - 32 holes	$204.00
	System
Prostheses List by Category, Groups and Sponsor	Page 554 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI989	W Lorenz Osteosynthesis System	Plate Straight, 2mm System	8 - 15 hole	$204.00
	Johnson & Johnson Medical Pty Ltd
JJ846	Bioplate Plating System	Plates of various shape	8 to 32 holes	$204.00
	Lifehealthcare Pty Ltd
LH505	Martin Osteosynthesis 1.5mm 	Plate, 0.6mm thick, Titanium	8-32 hole	$204.00
	System 8-32 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO328	Martin Level One Fixation	Plate Titanium	0.5-0.99mm thick, 8-32 holes	$204.00
	Medtronic Australasia Pty Ltd
MC678	TiMesh Rigid Fixation Bone 	Titanium, Universal Plate	12h	$204.00
	Grafting and Plating System
MC871	Ti Mesh Rigid Fixation Bone 	Titanium ,Straight Plate	8 - 32 holes	$204.00
	Grafting and Plating System
MC876	TiMesh Rigid Fixation Bone 	Titanium, T Plate	8 - 15 hole	$204.00
	Grafting and Plating System
MC884	TiMesh Rigid Fixation Bone 	Titanium, L Plate (Left and right 	8 - 15 hole	$204.00
	Grafting and Plating System	configurations)
MC886	TiMesh Rigid Fixation Bone 	Titanium, H Plate	8-15 hole	$204.00
	Grafting and Plating System
MC892	Macropore	Oblique Plates	8 to 15 holes	$204.00
MI091	TiMesh	Rigid Straight Plate	8 -32 holes	$204.00
	Stryker Australia Pty Ltd
HW502	Stryker Leibinger Plating System	Craniofacial Fixation Plates	0.5 - 0.99mm thick, 8 -32 	$204.00
	holes
	Surgiplas Medical
SP077	Plates	Micro, Midface & Mini	Quad Plate, Quad Plate - 	$204.00
	Short, Plate 8 to 15 holes.
SP083	Plates	Mini & Maxi	16 & 18 Hole Straight 	$204.00
	Plate, 18 Hole Straight 
	Plate, Plates 15 to 32 Holes
Prostheses List by Category, Groups and Sponsor	Page 555 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SP085	Plates	Mini & Maxi	Curved Plate, 8 Hole 	$204.00
	Straight Plate; Mini : 10 
	Hole Straight Plate,  
	Extended Y Plate, Rigid 10 
	Hole Straight Plate, 12 
	Hole Straight Plate, Y Plate
	 - 13 Hole, 12 Hole Curved 
	Plate, 10 Hole Straight 
	Plate; 10 Hole Curved 
	Plate, Straight Plate 10 
	Hole, Y P
	3D
	Surgiplas Medical
SP071	Plates	Micro, Mini, Maxi	Quad Plates, Medium 2 x 4 	$210.00
	Hole Quad Plate, Plates 8 
	to 15 holes
	Burr
	Medtronic Australasia Pty Ltd
MC869	TiMesh Rigid Fixation Bone 	Titanium, Plate	Ohata Kerf Cover, 5 - 32 hole	$430.00
	Grafting and Plating System
	Stryker Australia Pty Ltd
SK355	Universal Neuro Titanium Low 	Titanium Low Profile plates used for 	Small, large, 20mm burr 	$430.00
	Profile Plate	the fixation of cranial bone flaps	hole, 16 hole without bar
	Complex
	Biomet Australia Pty Ltd
BI774	W Lorenz Osteosynthesis System	Lefort plate, 1.5mm system, 0.6mm 	Flat, 2-11mm	$280.00
	thickness, titanium
	Stryker Australia Pty Ltd
SK345	Leibinger Titanium Implant System -	Le Fort 1 Plate, Right/Left	11hole, Advancement 2 - 	$280.00
	 Universal CMF Plate	10mm
	Surgiplas Medical
SP082	Plates	Micro, Mini	Sub - Temporal Plates, 	$280.00
	Plates 8 to 15 Holes
	Synthes Australia Pty Ltd
SY585	AO/ASIF Plate	Titanium adaption plate	8-32 holes	$280.00
Prostheses List by Category, Groups and Sponsor	Page 556 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Compression
	Synthes Australia Pty Ltd
SY583	AO/ASIF Plate	Titanium adaption plate	8-32 holes	$200.00
	Locking
	Stryker Australia Pty Ltd
HW486	Stryker Leibinger Hybrid MMF Plate	SMARTLOCK Hybrid MMF Plate, 	One size - 9 Hole Straight 	$312.00
	Locking	Plate, for maxilla and 
	System - Universal SMARTLOCK 	Mandible
	Hybrid MMF
	Component - MMF Plate
HW504	Stryker Leibinger Plating System	Craniofacial Locking Fixation Plates	0.5 - 0.99mm thick, 8 -32 	$312.00
	holes
	Resorbable
	Biomet Australia Pty Ltd
BH002	Lactosorb Resorbable 	Lactosorb Plates, 2mm System, All 	8 - 15 hole	$215.00
	Craniomaxillofacial Fixation System	shapes PGA/PLA
BI991	Lactosorb Resorbable CMF System	Lactosorb Plates, 1.5mm System	8 - 15 hole	$215.00
BI992	Lactosorb Resorbable CMF System	Lactosorb Plates, 1.5mm System	16 - 32 holes-	$215.00
	Medtronic Australasia Pty Ltd
MC547	Macropore	Z Plates	10 hole	$215.00
MC559	Macropore	L Plates	8 hole, Left & Right	$215.00
MI089	Macropore	Straight Plates	8 -20 hole	$215.00
	Stryker Australia Pty Ltd
HW503	Delta Resorbable fixation System	Craniofacial Resorbable Fixation 	0.5 - 0.99mm thick, 8 -32 	$215.00
	holes
	Synthes Australia Pty Ltd
SY397	PolyMax Resorbable Fixation System	1.5 Burr Hole Cover	8 Hole	$215.00
SY584	AO/ASIF Plate	Rapid resorbable reconstruction plate	8-32 holes	$215.00
	07.01.05.08 - 0.5-0.99mm thick, >32 holes
	Johnson & Johnson Medical Pty Ltd
JJ255	BIOPLATE Biomesh	Titanium, lattice, 48 hole, packaged 	32 x 44mm	$300.00
	non-sterile
Prostheses List by Category, Groups and Sponsor	Page 557 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgiplas Medical
SP081	Plates	Micro, Mini	40 Hole Straight Plate, 	$300.00
	Mesh 18 row, Plate >32 
	Synthes Australia Pty Ltd
SY466	AO/ASIF Plate	Titanium adaption plates	>32 holes	$300.00
	Resorbable
	Biomet Australia Pty Ltd
BI993	Lactosorb Resorbable CMF System	Lactosorb Plates, 1.5mm System	32+ holes-	$380.00
	Synthes Australia Pty Ltd
SY514	AO/ASIF Plate	Rapid resorbable reconstruction plate	>32 holes	$380.00
	07.01.05.09 - 1.0-1.99mm thick, <4 holes
	Medical & Optical Instruments Australia Pty Ltd
MO054	Martin Level One Fixation	Plate, titanium	1 to 1.99mm thick, <4 holes	$115.00
	Stryker Australia Pty Ltd
HW505	Stryker Leibinger Plating System	Mandible Fixation Plates	1.0 - 1.99mm thick, <4 holes	$115.00
	Synthes Australia Pty Ltd
SY317	AO/ASIF Plate	Titanium Plate - straight	1.6mm Profile, 2-4 holes	$115.00
	Resorbable
	Surgical Specialties
SQ055	CPS Bioabsorbable Fixation System	CPS Systems and Baby System Plates.	1.5-2.5mm plates:- 2-10 	$220.00
	  Polylactic Acid Trimethylene 	hole plates and extended, c-
	Carbonate Copolymer	plate & x-plate 7 hole, H-
	plate 8 hole, orthognathic 
	hole and L-plate L & R 7 
	Synthes Australia Pty Ltd
SY506	AO/ASIF Plate	Rapid resorbable reconstruction plate	<4 holes	$220.00
	07.01.05.10 - 1.0-1.99mm thick, 4-7 holes
	Aus Systems Pty Ltd
AU061	Aus Systems Titanium Miniplates 	Titanium Miniplates	1.0-1.99mm thick, 4-7 holes	$165.00
	(bone Plates)
Prostheses List by Category, Groups and Sponsor	Page 558 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BH026	Mandibular Fracture System	Plates, Angled or Curved, 2.0 	4 - 7 hole	$165.00
	Mandibular System, Titanium
BH028	Manibular Fracture System	Plates, matrix shape, 2.0 mandibular 	4 or 6 hole	$165.00
	system. Titanium
BI635	W Lorenz Osteosynthesis System	Plate, DoubleT, Double Y, 1mm, 2mm 	4-7 Hole	$165.00
	system, plate thickness 0.6 or 1mm, 
	Titanium
BI755	Mandibular Fracture System	Plates, Y Shapek, 2.0 Mandibular 	5 hole long, 5 hole medium, 	$165.00
	Fracture System, Titanium	5 hole regular
BI764	Mandibular Fracture System	Plates, 2.0 / 2.4 Mandibular Fracture 	4-7 hole	$165.00
	System, Titanium
	Lifehealthcare Pty Ltd
LH513	Martin Osteosynthesis 1.5mm 	Plate, Titanium	1.0-1.99mm thick, 4-7 holes	$165.00
	System Mesh 1mm 4-7 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO403	Martin Level  One Fixation Plate	Martin Level One Fixation	1.0-1.99mm thick, 4-7 holes	$165.00
	Medtronic Australasia Pty Ltd
MC517	TiMesh	Mandibular "J" Plate	One size only	$165.00
	Stryker Australia Pty Ltd
HW492	Stryker Leibinger Plating System	Mandible Fixation plates	1.0 - 1.99mm thick, 4 - 7 	$165.00
	holes
	Surgiplas Medical
SP073	Plates	Micro, Midface, Mini, BSSO, TR 	2 x 3 Hole Quad Plate, Plate	$165.00
	BSSO	 4 to 7 holes.
	Complex
	Stryker Australia Pty Ltd
SK131	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$350.00
	 Universal Mandible Fracture Plate	fixation of mandibular fractures and 	Fracture Plate, C-shaped, 4 
	tumour resection.
SK132	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$350.00
	 Universal Mandible Fracture Plate	fixation of mandibular fractures and 	Fracture Plate, Angled 
	tumour resection.	Shaped, 6 holes, 115-140 deg
Prostheses List by Category, Groups and Sponsor	Page 559 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgiplas Medical
SP018	Plates	Micro, Midface, Mini & Maxi	Chin Plate 2, 3, 4, 6, 8, 10 &	$350.00
	 12mm, Plates 4 to 7 holes.
	Compression
	Biomet Australia Pty Ltd
BI754	Mandibular Fracture System	Plates, Compression, 2.0 Mandibular 	4 hole	$165.00
	Fracture System, Titanium
BI756	Mandibular Fracture System	Plates, Compression, 2.0 Mandibular 	4-6 hole	$165.00
	Fracture System, Titanium
	Stryker Australia Pty Ltd
SK129	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$165.00
	 Universal Mandible Compression 	fixation of mandibular fractures and 	Compression Plate, 4-6 
	Plate	tumour resection.
	Surgiplas Medical
SP028	OsteoMed Plating & Fixation System	Plates - Fracture	4 hole Fracture Plate 32 -	$165.00
	37mm; EDC Plate 32mm & 
	34mm, 4 to 7 hole 
	compression plate.
SP034	OsteoMed Plating & Fixation System	Compression Plates - Maxi	Maxi: 4, 5 & 6 Hole Straight	$165.00
	 Plate
	Synthes Australia Pty Ltd
SY498	AO/ASIF Plate	Mandible plate	4-7 holes	$165.00
	Locking
	Medical & Optical Instruments Australia Pty Ltd
MO342	Martin Level One Fixation	Plate Titanium locking	1.0 to 1.99 mm thick, 4 - 7 	$470.00
	holes
	Stryker Australia Pty Ltd
HW493	Stryker Leibinger Plating System	Mandible Locking Fixation Plates	1.0 -1.9mm thick, 4 - 7 holes	$470.00
	Surgiplas Medical
SP027	OsteoMed Plating & Fixation System	Plates - Fracture	8 Hole Fracture Plate, 4 & 6 	$470.00
	hole locking fracture plate, 
	4 to 7 hole locking plate.
	Synthes Australia Pty Ltd
SY587	AO/ASIF Plate	Titanium mandible locking plate, 	4-7 holes	$470.00
	complex shape
Prostheses List by Category, Groups and Sponsor	Page 560 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Resorbable
	Medical & Optical Instruments Australia Pty Ltd
MO185	Martin Level One Fixation Resorb x 	Mesh, PDLLA (resorbable)	1.0 to 1.99mm thick, 4 to 7 	$260.00
	& SonicWeld Rx	holes
	Medtronic Australasia Pty Ltd
MC567	Macropore	Clover Leaf Plates	4 hole	$260.00
	Stryker Australia Pty Ltd
ST519	Stryker Leibinger Resorbable 	Resorbable plate: L-shape plate, 110 	7 holes	$260.00
	Fixation System	deg, right/left Tripoymer
	Surgical Specialties
SQ054	CPS Bioabsorbable Fixation System	CPS Systems and Baby System Plates.	1.5mm plates:- 20 holes, c-	$260.00
	  Polylactic Acid Trimethylene 	plate & x-plate 7 hole, L-
	Carbonate Copolymer	plate 7 hole L & R. burrhole
	Synthes Australia Pty Ltd
SY507	AO/ASIF Plate	Rapid resorbable reconstruction plate	4-7 holes	$260.00
	07.01.05.11 - 1.0-1.99mm thick, 8-15 holes
	Biomet Australia Pty Ltd
BH027	Mandibular Fracture System	Plates, Angled or Curved, 2.0 	8 hole	$420.00
	Mandibular System, Titanium
BH029	Mandibular Fracture System	Plates, matrix shape, 2.0 mandibular 	8 to 16 hole	$420.00
	system. Titanium
BI767	Mandibular Fracture System	Plates, Straight, 2.0 Mandibular 	8-15 hole	$420.00
	Fracture System, Titanium
	Lifehealthcare Pty Ltd
LH514	Martin Osteosynthesis 1.5mm 	Plate, Titanium	1.0-1.99mm thick, 8-15 holes	$420.00
	System 1mm 8-15 hole plate
	Medical & Optical Instruments Australia Pty Ltd
MO400	Martin Level One Fixation	Plate ,Titanium	1.0 to 1.99mm thick, 8 -15 	$420.00
	holes
	Medtronic Australasia Pty Ltd
MC522	TiMesh	Curved Plate:  Standard, Rigid, Left, 	1mm x 12 holes	$420.00
	Right
Prostheses List by Category, Groups and Sponsor	Page 561 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW508	Stryker Leibinger Plating System	Mandible Locking Fixation Plates	1.0 - 1.99mm thick, 8 - 15 	$420.00
	holes
	Surgiplas Medical
SP086	Plates	Mini & Maxi	12 Hole Straight Plate 1.0 	$420.00
	mm thick, 8 Hole Straight 
	Plate 1.0 mm thick, Plates 8 
	to 15 holes
	Locking
	Stryker Australia Pty Ltd
HW494	Stryker Leibinger Plating System	Mandible Fixation Plates	1.0 - 1.99mm thick, 8 -15 	$645.00
	holes
	Surgiplas Medical
SP117	OsteoMed Plating & Fixation System	Mandible Locking plates	8-15 Hole Plates, 1.0-1.99 	$645.00
	mm thick
	Synthes Australia Pty Ltd
SY588	AO/ASIF Plate	Titanium mandible locking plate, 	8-15 holes	$645.00
	complex shape
	Resorbable
	Medical & Optical Instruments Australia Pty Ltd
MO326	Martin Level One Fixation Resorb x 	Plate PDLLA (resorbable)	1.0 to 1.99mm thick, 8 to 15 	$420.00
	& Sonic Weld	holes
	Medtronic Australasia Pty Ltd
MC566	Macropore	C Plates	8 hole	$420.00
	Surgical Specialties
SQ062	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Plates 6 & 8 hole	$420.00
	copolymer
	Synthes Australia Pty Ltd
SY508	AO/ASIF Plate	Rapid resorbable reconstruction plate	8-15 holes	$420.00
	07.01.05.12 - 1.0-1.99mm thick, 16-32 holes
	Aus Systems Pty Ltd
AU019	Aus Systems Titanium Miniplates 	Plate Titanium	1mm & 1.2mm profile 16 & 	$204.00
	(Bone Plates)	19 hole
Prostheses List by Category, Groups and Sponsor	Page 562 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BI762	Mandibular Fracture System	Plates, 2.4 Mandibular Fracture 	16 - 24 Hole	$204.00
	System, Titanium
	Lifehealthcare Pty Ltd
LH515	Martin Osteosynthesis 1.5mm 	Plate, Titanium	1.0-1.99mm thick, 16-32 	$204.00
	System 1mm 16-32 hole plate	holes
	Medical & Optical Instruments Australia Pty Ltd
MO295	Martin Level One Fixation	Plate Titanium	1.0 to 1.99mm thick, 16 to 	$204.00
	32 holes
	Stryker Australia Pty Ltd
HW495	Stryker Leibinger Plating System	Mandible Fixation Plates	1.0 - 1.9mm thick, 16- 32 	$204.00
	holes
	Surgiplas Medical
SP067	Plates	Micro, Mini, Maxi	16 Hole Straight Plate, 	$204.00
	1.0mm thick, Plate 15 to 32 
	holes
	3D
	Medical & Optical Instruments Australia Pty Ltd
MO294	Martin Level One Fixation	Plate, titanium	1.0 to 1.99mm thick, 16 to 	$818.00
	32 holes
	Locking
	Stryker Australia Pty Ltd
HW496	Stryker Leibinger Plating System	Mandible Fixation Plates	1.0 -1.9mm thick, 16 - 32 	$818.00
	holes
	Surgiplas Medical
SP118	OsteoMed Plating & Fixation System	Mandible Locking Plates	16-32 Hole Plates, 1.0-1.99 	$818.00
	mm thick
	Locking, Complex
	Synthes Australia Pty Ltd
SY493	AO/ASIF Plate	Titanium Mandibular locking plate, 	16-32 holes	$1,400.00
	complex shape
Prostheses List by Category, Groups and Sponsor	Page 563 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Resorbable
	Medical & Optical Instruments Australia Pty Ltd
MO293	Martin Level One Fixation Resorb x 	Plate, PDLLA (resorbable)	1.0 to 1.99mm thick, 16 to 	$420.00
	& SonicWeld Rx	32 holes
	Surgical Specialties
SQ053	CPS Bioabsorbable Fixation System	CPS Systems and Baby System Plates.	1.5mm baby plates:- 20 	$420.00
	  Polylactic Acid Trimethylene 	hole, c-plate & x-plate 7 
	Carbonate Copolymer	hole, 2 hole
	Synthes Australia Pty Ltd
SY589	AO/ASIF Plate	Rapid resorbable reconstruction plate	16-32 holes	$420.00
	07.01.05.13 - 1.0-1.99mm thick, >32 holes
	Complex
	Synthes Australia Pty Ltd
SY700	AO/ASIF Plate	Titanium Mandibular locking plate, 	>32 holes	$840.00
	complex shape
	Resorbable
	Synthes Australia Pty Ltd
SY511	AO/ASIF Plate	Rapid resorbable reconstruction plate	>32 holes	$420.00
	07.01.05.14 - 2.0-2.99mm thick, 4-7 holes
	Surgiplas Medical
SP120	OsteoMed  Plating & Fixation System	Mandible locking plates	4-7 Holes, 2.0-2.99 mm 	$620.00
	Compression
	Synthes Australia Pty Ltd
SY499	AO/ASIF Plate	Titanium mandible plate	4-7 holes	$720.00
	07.01.05.15 - 2.0-2.99mm thick, 8-15 holes
	Compression
	Synthes Australia Pty Ltd
SY497	AO/ASIF Plate	Titanium mandible plate	8-15 holes	$780.00
Prostheses List by Category, Groups and Sponsor	Page 564 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Locking
	Biomet Australia Pty Ltd
BI447	Lorenz 2.4mm Locking 	Plate, Curved, Std Thickness, 2.4mm 	8 or 15 hole	$950.00
	Reconstruction System	System, Titanium
BI987	Lorenz 2.4mm Locking 	Plates Plate, Angled 2.4mm System, Ti	5 x 11 hole	$950.00
	Reconstruction System
	Stryker Australia Pty Ltd
SK140	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$950.00
	 Universal Mandible 	fixation of mandibular fractures and 	Reconstruction Plate, 11 - 
	Reconstruction Plate	tumour resection.	17 holes, straight with 
	Synthes Australia Pty Ltd
SY599	AO/ASIF Plates	Titanium mandible locking plate	8-15 holes	$950.00
	07.01.05.16 - 2.0-2.99mm thick, 16-32 holes
	Complex, Locking
	Synthes Australia Pty Ltd
SY780	AO/ASIF Plate	Anatomical Preformed Complex 	Small, Medium, Large	$1,320.00
	Locking Reconstruction Plates
	Compression
	Synthes Australia Pty Ltd
SY500	AO/ASIF Plate	Titanium mandible plate	15-32 holes	$900.00
	Locking
	Biomet Australia Pty Ltd
BI448	Lorenz 2.4mm Locking 	Plate, curved, std or low profile, 	16-32 hole	$1,100.00
	Reconstruction System	2.4mm system, titanium
BI452	Lorenz 2.4mm Locking 	Plate, curved. Std or low profile, 	16 hole	$1,100.00
	Reconstruction System	2.4mm System, Titanium
BI455	Lorenz 2.4mm Locking 	Plate, Double Angled, 2.0 or 2.4mm 	5 x (22 or 24) x 5 hole	$1,100.00
	Reconstruction System	System, Titanium
BI986	Lorenz 2.4mm Locking 	Plates Plate, Angled 2.4mm System Ti	5 x (22 -24) hole	$1,100.00
	Reconstruction System
	Medical & Optical Instruments Australia Pty Ltd
MO399	KLS Martin Plating System	Preshaped reconstruction plates, in 	2.0mm and 2.5mm thickness 	$1,100.00
	left and right options	with 26 holes
Prostheses List by Category, Groups and Sponsor	Page 565 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK138	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$1,100.00
	 Universal Mandible 	fixation of mandibular fractures and 	Reconstruction Plate, 
	Reconstruction Plate	tumour resection.	(Full), 6 + 13 + 6 holes, 
	with template
SK141	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$1,100.00
	 Universal Mandible 	fixation of mandibular fractures and 	Reconstruction Plate, 
	Reconstruction Plate	tumour resection	(Hemi), Right and Left, 6 + 
	17 holes with template
SK142	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible 	$1,100.00
	 Universal Mandible 	fixation of mandibular fractures and 	Reconstruction Plate, 
	Reconstruction Plate	tumour resection	(Full), 6 + 17 + 6 holes, 
	with template
	Surgiplas Medical
SP026	OsteoMed Plating & Fixation System	Plates - Fracture	Rigid Comminuted Fracture 	$1,100.00
	Plate
	Synthes Australia Pty Ltd
SY600	AO/ASIF Plate	Titanium mandible locking plate	16-32 holes	$1,100.00
	07.01.05.17 - 2.0-2.99mm thick, >32 holes
	Complex
	Synthes Australia Pty Ltd
SY472	AO/ASIF Plate	Titanium mandible locking plate, 	>32 holes	$1,450.00
	complex shape
	07.01.05.18 - ≥3mm thick, 4-7 holes
	Complex
	Synthes Australia Pty Ltd
SY550	Titanium Sternal Fixation System	Locking Plate - Star	Star: 6 holes	$1,480.00
	07.01.05.19 - ≥3mm thick, 8-15 holes
	Complex
	Lifehealthcare Pty Ltd
LH500	Martin Sternal Talon®	An advanced system for rigid sternal 	Widths: XS, S, M, L,	$1,480.00
	fixation made of titanium alloy. Single 	 Foot plate lengths: 11, 14 
	sternal talon         ( Two legs)	,17 ,20mm
Prostheses List by Category, Groups and Sponsor	Page 566 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY551	Titanium Sternal Fixation System	Locking Plate - Straight , H or Star	Straight: 12holes, H: small 	$1,480.00
	& large, Star: 12 holes
	Locking
	Medical & Optical Instruments Australia Pty Ltd
MO002	Martin Level One Fixation	Plate, titanium	=>3mm thick, 8 to 15 holes	$630.00
	07.01.05.20 - ≥3mm thick, 16-32 holes
	Complex
	Lifehealthcare Pty Ltd
LH501	Martin Sternal Talon®	an advanced system of rigid sternal 	Widths: S, M; Four foot 	$1,800.00
	fixation made of titanium alloy. 	plate depths: 11, 14, 17, 
	Double sternal talon     (4 legs)	20mm
	Synthes Australia Pty Ltd
SY347	Titanium Sternal Fixation System	Locking Plate - straight	20 or 30 holes	$1,800.00
	Compression
	Synthes Australia Pty Ltd
SY501	AO/ASIF Plate	Titanium mandible plate	16-32 holes	$1,350.00
	Locking
	Medical & Optical Instruments Australia Pty Ltd
MO410	Martin Level One Fixation	Plate, Titanium	≥3mm thick, 16 to 32 Holes	$1,420.00
07.01.06 - Screws
	07.01.06.01 - Diameter ≤1.24mm
	Biomet Australia Pty Ltd
BH013	W Lorenz Osteosynthesis System	Small Fragment Titanium System, 	Screw, 1.2mm diameter, 	$70.00
	Titanium	1.4mm diameter
	Medical & Optical Instruments Australia Pty Ltd
MO287	Martin Level One Fixation	Screw Titanium	diameter <1.24mm	$70.00
	Medtronic Australasia Pty Ltd
MC574	Timesh	X-Drive Screws	2 - 15mm	$70.00
MC879	TiMesh Rigid Fixation Bone 	Titanium, Screw - Cruciate Head, 12 	Diameter <1.24mm	$70.00
	Grafting and Plating System	point Flat Head
Prostheses List by Category, Groups and Sponsor	Page 567 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW511	Stryker Leibinger Plating System	Micro Screws	1.0 - 1.2mm diameter, 3 - 	$70.00
	15mm length
	Surgiplas Medical
SP088	Screws	Micro, Maxi & Self Drilling	"Size1.2mm self-drilling 	$70.00
	screws, 1.2mm x (2 - 14)mm, 
	Screws diameter < 1.24mm"
	Synthes Australia Pty Ltd
SY559	AO/ASIF Screw	CMF screw; cortex, cortical, 	1.0mm-1.20mm various 	$70.00
	emergency, self-tapping,self-drilling	lengths
	Compression
	Surgiplas Medical
SP031	OsteoMed Plating & Fixation System	Lag Screws - Micro, Mini	1.2mm x (6 - 16)mm; 1.6mm x	$80.00
	 (10-12)mm; 2.0mm x (8 - 
	22)mm;
	07.01.06.02 - Diameter 1.25-3.24mm
	Aus Systems Pty Ltd
AU059	Aus systems titanium bone screws	titanium bone screws	1.5mm diameter - 2.3mm 	$43.00
	diameter, 3mm length to 
	15mm length
	Australian Surgical Innovations Pty Ltd
AI007	ASI Plates and Screws	Screw	Width 1.0 - 3.0mm. Length 	$43.00
	3.0 - 25mm
	B Braun Australia Pty Ltd
BB314	Aesculap CranioPlate System/ 	Cranial fixation system, internal 	Screws Neuro, Emergency, 	$43.00
	Screws Neuro Emergency, self 	fracture, non biodegradable.  Consists 	self tapping, magazine of 8, 
	tapping, 1.8mm x 3 & 5mm	of screws, plates.	1.8mm x 3 & 5mm lengths
BB316	Aesculap CranioPlate 	Cranial fixation system, internal 	screws neuro, self drilling, 	$43.00
	System/Screws Neuro, self-drilling, 	fracture, non biodegradable.  Consists 	magazine of 8, 1.5mm x 3, 4 
	of screws, plates.	& 5 mm lengths
	Biomet Australia Pty Ltd
BH016	TMJ System	Screw, Cross Drive, Fossa. Titanium	2.0mm dia x (5 - 13)mm	$43.00
BH017	TMJ System	Screw, Cross Drive, Fossa. Titanium	2.3mm Dia x (5 - 13)mm	$43.00
Prostheses List by Category, Groups and Sponsor	Page 568 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BH020	W Lorenz Osteosynthesis System	Bone Screw, Cross Drive or Centre 	1.5mm dia x (3.5 - 17)mm	$43.00
	Drive. Titanium
BH021	W Lorenz Osteosynthesis System	Bone Screw, Cross Drive or Centre 	1.8mm dia x (3.5 - 17)mm	$43.00
	Drive. Titanium
BI360	W Lorenz Osteosynthesis System	Bone Screw, Cross or Centre Drive, 	2.0mm x (4 - 7) mm	$43.00
	Std or Self Drilling; Titanium
BI365	W Lorenz Osteosynthesis System	Bone Screw, Cross or Centre Drive; 	2.0mm x (9 - 19) mm	$43.00
	Titanium
BI723	Mandibular Fracture System	Screw, High Torque 2.0/2.4 	2.7 x (6-20)mm	$43.00
	Mandibular Fracture, Titanium
BI726	Mandibular Fracture System	Screw, High Torque (HT), Emergency, 	Dia 2.3mm x 4.0, 5.0, 7.0, 	$43.00
	2.0/2.4 Mandibular Fracture System, 	9.0, 11.0, 13.0, 15.0mm  
	Titanium	Lengths
BI733	W.Lorenz Osteosynthesis System	Bone Screw, Self Drilling, Cross 	1.5 mm (dia) x 6.0, 7.0mm 	$43.00
	Drive, Titanium	[lengths]
BI734	W.Lorenz Osteosynthesis System	Bone Screw, Self Drilling, Cross 	1.5 mm (dia) x 3.5, 4.0, 	$43.00
	Drive, Titanium	5.0mm, [lengths]
BI735	W.Lorenz Osteosynthesis System	Bone Screw, Cross or Centre Drive; 	2.3mm x (5 - 9) mm	$43.00
	Titanium
BI742	TMJ System	Screw, Cross Drive Mandibular 	(2.7 - 3.2mm) x (8 - 12mm)	$43.00
	Component, Titanium
BI744	Mandibular Fracture System	Screw, High Torque 2.0/2.4 	2.0 x (9-17)mm	$43.00
	Mandibular Fracture, Titanium
BI748	Mandibular Fracture System	Screw, High Torque (HT), 2.0/2.4 	Dia 2.4 x 6.0mm, 8.0, 10.0, 	$43.00
	Mandibular Fracture System, Titanium	12.0, 14.0, 16.0, 18.0mm 
	Lengths
	Johnson & Johnson Medical Pty Ltd
JJ854	Bioplate Plating System	Titanium Screws	1.25 to 3.24mm Diameter	$43.00
	Lifehealthcare Pty Ltd
LH516	Martin Osteosynthesis 1.5mm 	Self retaining, Titanium	3-7mm length, 1.5-1.8mm 	$43.00
	System Screw	diam
	Medical & Optical Instruments Australia Pty Ltd
MO329	Martin Level One Fixation	Screw Titanium	Diameter 1.25 to 3.24mm	$43.00
	Medtronic Australasia Pty Ltd
MC571	Timesh	12 Point Screws	3 - 20mm	$43.00
Prostheses List by Category, Groups and Sponsor	Page 569 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC880	TiMesh Rigid Fixation Bone 	Titanium, Screw - Cruciate Head, 12 	Diameter 1.25 - 1.74mm	$43.00
	Grafting and Plating System	point Flat Head
MI092	TiMesh	Internal Drive Screws	Diameter: 1.5 - 1.8mm	$43.00
MI093	TiMesh	Rescue Screws	Diameter: 1.8 - 2.4mm	$43.00
	National Surgical Pty Ltd
NK024	Jeil Medical- Screws	Screw for craniofacial bone fracture 	Diameter 1.5mm and 1.8mm: 	$43.00
	fixation	Length 3.0 - 5.0mm
	Stryker Australia Pty Ltd
HW491	Stryker Leibinger Plating System	Craniofacial Fixation Screws	1.5 - 2.7mm diameter, 3 - 	$43.00
	20mm length
	Surgiplas Medical
SP089	Screws	Micro, Maxi & Self Drilling	"Size1.6mm x (4-8)mm self-	$43.00
	drilling screws,1.5mm 
	Safety ,Screws diameter  
	1.25-1.75mm"
SP090	Screws	Micro, Maxi & Self Drilling	"Size2.0mm x (4-8)mm self-	$43.00
	drilling screws,1.9mm 
	Safety ,Screws diameter  
	1.75-2.24mm"
SP091	Screws	Micro, Maxi & Self Drilling	2.4mm x (4-22)mm self-	$43.00
	drilling screws, 2.7mm x (8-
	20)mm; 2.7mm Safety 
	Screws, diameter 2.25-2.74mm
	Synthes Australia Pty Ltd
SY590	AO/ASIF Screw	Cortex, Cortical, Emergency, Self-	1.25-3.24mm	$43.00
	tapping, Self-drilling; Low Profile 
	Screws
	Compression
	Stryker Australia Pty Ltd
SK152	Leibinger Screw - Universal 	Items used for reconstruction and 	Universal Mandible Lag 	$121.00
	Mandibular Screws	fixation of mandibular fractures and 	Screws, 2.0mm Diameter, 
	tumour resection	24mm-42mm Length
	Distractor
	Synthes Australia Pty Ltd
SY591	External Midface Distractor System	Fixation; Set - Screws	1.25-3.24mm	$85.00
Prostheses List by Category, Groups and Sponsor	Page 570 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Locking
	Biomet Australia Pty Ltd
BI457	Lorenz 2.4mm Locking 	Screw, Locking Reconstruction 	2.4 x (6-18)mm	$90.00
	Reconstruction System	Modular. Titanium
	Medical & Optical Instruments Australia Pty Ltd
MO312	Martin Level One Fixation	Screw, titanium	Diameter 2.25 - 2.74mm	$90.00
	Stryker Australia Pty Ltd
HW487	Stryker Leibinger Hybrid MMF 	SMARTLock Hybrid MMF Screws, 	Two Sizes - 	$90.00
	Screws	Locking	2.0mm Diameter, 6mm 
	System - Universal SMARTLock 	Length
	Hybrid MMF	2.0mm Diameter, 8mm 
	Component - MMF Screws	Length
HW509	Stryker Leibinger Plating System	Universal Mandibular Locking Screws	2.0 - 2.7mm diameter, 3 - 	$90.00
	24mm length
	Surgiplas Medical
SP094	OsteoMed Plating & Fixation System	Screws	2.4mm x (6-22)mm Locking 	$90.00
	Screws, Screws 2.25-
SP116	OsteoMed Plating & Fixation System	Locking Screws	Diameter 2.0mm, length 4-	$90.00
	18mm
	Synthes Australia Pty Ltd
SY592	AO/ASIF Screw	Cortex, Cortical, Emergency, Self-	1.25-3.24mm	$90.00
	tapping, Self-drilling; Locking 
	Resorbable
	Biomet Australia Pty Ltd
BI415	Lactosorb Resorbable 	Bone Screw,  2 Pack, Endobrow, 	2 x 5mm	$141.00
	Craniomaxillofacial Fixation System	Lactosorb. PGA/PLA
BI994	Lactosorb Resorbable 	Bone Screw Lactosorb, single screw 	1.5mm dia	$141.00
	Craniomaxillofacial Fixation System	(multiple screws per pack) PGA/PLA
BI995	Lactosorb Resorbable 	Bone Screw Lactosorb, single screw 	2.0mm dia	$141.00
	Craniomaxillofacial Fixation System	(multiple screws per pack) PGA/PLA
BI996	Lactosorb Resorbable 	Bone Screw Lactosorb,single screw 	2.5mm dia	$141.00
	Craniomaxillofacial Fixation System	(multiple screws per pack) PGA/PLA
BI997	Lactosorb Resorbable 	Bone Screw Lactosorb, single screw 	2.8mm dia	$141.00
	Craniomaxillofacial Fixation System	(multiple screws per pack) PGA/PLA
Prostheses List by Category, Groups and Sponsor	Page 571 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical & Optical Instruments Australia Pty Ltd
MO331	Martin Level One Fixation Resorb x 	Sonic Pin PDDLA (resorbable)	Diameter 1.25 - 3.24mm	$141.00
	& Sonic Weld
	Medtronic Australasia Pty Ltd
MC626	Macropore FRP (fast resorbing 	Polylactide and Polyglycolide 	1.8mm x 3-8mm	$141.00
	polymer)
MI090	Macropore	Screws	1.75 - 2.75 x 2.24 - 3.24mm	$141.00
	Stryker Australia Pty Ltd
HW510	Delta Resorbable Fixation System	Resorbable Screws	1.7mm diameter, 3 -6mm 	$141.00
	length
	Surgical Specialties
SQ051	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Screws 1.5 - 2.5mm dia x 5-	$141.00
	copolymer	8mm long
SQ056	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Screws 2.8 x 6-23mm, 3.1 x 	$141.00
	copolymer	6-8mm
SQ057	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Screws 3.1 x 6 - 30mm and 	$141.00
	copolymer	2.5 x 30mm
SQ060	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Screws 2 x 9-19mm, 2.5 x 	$141.00
	copolymer	10-23mm and 2.8 x 10 - 23mm
	Synthes Australia Pty Ltd
SY593	PolyMax Rapid-Resorbable 	Polyactide Resorbable Screw/Tack	1.25-3.24mm	$141.00
	Fixation System
	07.01.06.03 - Diameter ≥3.25mm
	Resorbable
	Surgical Specialties
SQ059	CPS Bioabsorbable Fixation System	OTPS fixation system: PLGA/TMC 	Screws 4.5 x 20-55mm, 3.1 x 	$310.00
	copolymer	40mm
07.01.07 - Ancillary Components
	07.01.07.01 - Pin
	Synthes Australia Pty Ltd
SY345	Titanium Sternal Fixation System	Titanium Emergency Release Pin	One Size only	$95.00
Prostheses List by Category, Groups and Sponsor	Page 572 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.07.02 - Tack
	Medtronic Australasia Pty Ltd
MC570	Macropore	Tacks	1.5 x 4mm - 2.0 x 6mm	$52.00
	Surgical Specialties
SQ050	Inion GTR Biodegradable System	PLGA/TMC Copolymer: membrane & 	6 tack kit	$52.00
	tacks
	07.01.07.03 - Washer
	Stryker Australia Pty Ltd
SK146	Leibinger Titanium Implant System -	Items used for reconstruction and 	Universal Mandible Bi-	$30.00
	 Universal Mandible Biconcave 	fixation of mandibular fractures and 	concave Washer
	Washer	tumour resection
	07.01.07.04 - Wedges and Burr Hole Covers
	Stryker Australia Pty Ltd
HW435	E-POR Biomaterial/ Craniotomy 	Craniotomy Gap Wedge Porous 	One Size - V and T shape	$385.00
	Gap Wedge Porous Polyethylene	Polyethylene
HW439	E-POR Biomaterial/ Burr Hole 	Burr Hole Cover, Porous Polyethylene	15mm x 3mm x 5mm; 29mm x 	$385.00
	Cover, Porous Polyethylene	7mm x 14mm
	07.01.07.05 - Anchor Bone
	Surgiplas Medical
SP096	OsteoMed Plating & Fixation System	Screws	MMF / Anchorage Screws 	$140.00
	1.2/1.6/2.0mm Anchor, 
	07.01.07.06 - Clamps
	B Braun Australia Pty Ltd
BB072	Craniofix Titanium Clamps	Titanium	11mm	$95.00
BB073	Craniofix Titanium Clamps	Titanium	16mm	$95.00
BB168	Craniofix	Titanium skull fixation clamp	20mm	$95.00
Prostheses List by Category, Groups and Sponsor	Page 573 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB289	CranioFix Absorbable	Double sided Cranial clamp, 	11mm, 16mm	$95.00
	absorbable polyester
	Biomet Australia Pty Ltd
BI714	RapidFlap Cranial Clamp	Clamp, Burr Hole or Craniotomy Line,	12, 16, 20mm	$95.00
	 Titanium
	Cantley Medical Services
CF005	Cranial Loop	Cranial Loop is a smart system for 	One size - is suitable for 	$95.00
	fixing Bone Flaps resulting from 	1.5mm up to 24mm bone 
	craniotomies. Its instrument free, made 	thickness as it is adjustable
	from Peek - Optima, allows the 
	surgeon complete control not artifacts 
	seen on MRI/CT, its fast and easy and 
	takes less than a minute for the bone 
	to be fixed in place
	Johnson & Johnson Medical Pty Ltd
JJ849	Bioplate ZIP	Titanium Clamp	11 to 20 mm	$95.00
	Medtronic Australasia Pty Ltd
MI094	Invisx Locks	Invisx polymer cranial fixation system	One size	$95.00
	Synthes Australia Pty Ltd
SY252	AO/ASIF Facio-Maxillary Plates	Flapfix - Plates for fixation of cranial 	10 - 20mm	$95.00
	bone flaps
	07.01.07.07 - Screws
	Surgiplas Medical
SP095	OsteoMed Plating & Fixation System	Screws	Locking Screw Inserts, 	$140.00
	Other ancillary
	Synthes Australia Pty Ltd
SY784	SynPOR	Chin Connector	One Size	$140.00
	07.01.07.08 - Locks
	Medtronic Australasia Pty Ltd
MC580	Macropore	Locks	2 - 20mm	$700.00
Prostheses List by Category, Groups and Sponsor	Page 574 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.01.07.09 - Probe
	Cook Medical Australia Pty Ltd
WC264	SYSTEM-  Doppler Blood Flow 	The Cook-Swartz Implantable 	Cuff Lengths: 17.4 and 	$390.00
	Monitoring System. COMPONENT 	Doppler Flow Probe is an implantable	32mm
	- Cook-Swartz Implantable Doppler 	 20MHz Probe with epoxy-coated 
	Flow Probe	Crystal and patented Silicone Cuff 
	which provides continuous direct 
	vessel monitoring of microvascular 
	anastomoses. A 30cm wire with 
	external Retention Tabs is attached to 
	the 1mm diameter Crystal.
07.02.01 - Chin
	Device Technologies Australia Pty Ltd
DE320	Facial Implant Chin	Anotomical chin	Small, medium, large/left, 	$286.00
	right
DE321	Facial Implant Chin	Chin	Small, medium, large/left, 	$286.00
	right
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW010	Biopore Chin Two Piece 	An implantable device intended to 	78 x 9mm	$286.00
	Anatomical contour.	support, contour, and provide 
	structure for the chin. Made of high 
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs.
Prostheses List by Category, Groups and Sponsor	Page 575 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW412	Chins	Extended chin implants: Round RZ 	Extended chin Implants 	$286.00
	(Models 8313 - 8315) and extended 	design RZ round small: 45 x
	square RZ (Models 8316, 8318). Two 	 47 x 3mm, medium 45 x 47 x 
	piece chin design (Models 8320 - 	5mm, large 45 x 47 x 7mm; 
	8322). Single piece chin design, 	Extneded Chin Implants 
	contoured (Models 7520 - 7522). 	square small 45 x 47 x3mm; 
	Additional chin shapes (Models 6341	Medium 45 x 47 x 5mm; 
	 - 6344) Contoured t	Large 45 x 47 x 7mm; Two 
	piece design small 46 x 33 x 
	5mm; Medium 56 x 36 x 7mm
	Surgiplas Medical
SP004	Facial Prosthesis	Silicone elastomer	Small / Medium / Large / X-	$286.00
	Large
	Complex
	Synthes Australia Pty Ltd
SY782	SynPOR	Porous Polyethylene Chin Implant	4-9mm	$950.00
07.02.02 - Cranium
	Medtronic Australasia Pty Ltd
MC548	Macropore	Cranial Recon	29 - 165mm	$481.00
	07.02.02.01 - Complex
	Australian Surgical Innovations Pty Ltd
AI006	ASI Plates and Screws	Custom Mesh	.	$6,700.00
	Biomodelled
	Medtronic Australasia Pty Ltd
MC528	TiMesh	Cranial Custom Mesh	121mm x 72mm - 152  x 	$9,930.00
	152mm
	Synthes Australia Pty Ltd
SY772	PSI	Biomodelled Patient Specific 	Custom	$9,930.00
	Craniofacial implant, PEEK Titanium
Prostheses List by Category, Groups and Sponsor	Page 576 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomodelled Three Piece
	Synthes Australia Pty Ltd
SY774	PSI	Biomodelled Patient Specific 	Custom	$10,930.00
	Craniofacial implant, PEEK Titanium, 
	3 Piece
	Biomodelled Two Piece
	Synthes Australia Pty Ltd
SY773	PSI	Biomodelled Patient Specific 	Custom	$10,430.00
	Craniofacial Implant, Titanium, 2 
	Biomodelled, Dual Mesh
	Medtronic Australasia Pty Ltd
MC625	Modified Dual TiMesh	TiMesh Surgical Mesh Modified, 	121mm x 77mm - 152mm x 	$10,500.00
	includes two cranial plates. 	152mm.
	Composition: Titanium
	07.02.02.02 - Polymer
	Anatomics Pty Ltd
AT061	E-POR Biomaterial/ Contour 	Contour Porous Polyethylene	One Size 56mm x 91mm	$1,300.00
	Porous Polyethylene
	Stryker Australia Pty Ltd
HW437	E-POR Biomaterial/ Mastoid, 	Mastoid, Pterional, Contourable 	Left, Right, 43mm - 57mm x 	$1,300.00
	Pterional, Contourable Porous 	Porous Polyethylene	0.6mm, 1.5mm
	Polyethylene
	Complex
	Anatomics Pty Ltd
AT063	E-POR Biomaterial/ Patient Specific	Patient Specific Cranial Implant, 	Cranial Shape - Customised	$9,930.00
	 Cranial Implant, Porous 	Porous Polyethylene
Prostheses List by Category, Groups and Sponsor	Page 577 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW009	Biopore Custom Made Implant	An implantable device made of high-	Custom designed and 	$9,930.00
	density polyethylene material with an	biomodelled from patient's 
	 interconnecting pore structure that 	CT scan image.
	supports tissue ingrowth. The device 
	is custom made/biomodelled from 
	individual patient's CT scan, on 
	doctors prescription, used for 
	correction and reconstruction of any 
	facial, head or any non weight bearing
	 bone structure.
	07.02.02.03 - Composite
	Surgiplas Medical
SP113	OsteoMed Plating & Fixation System	Plates	90 x 90mm, 95 x 165mm, & 	$2,600.00
	Large Pre-formed Osteoform 
	Mesh, Cranium.
	07.02.02.04 - Surgical Guide
	Biomodelled
	Synthes Australia Pty Ltd
SY777	ProPlan	Patient Specific Cranical Surgical 	Custom	$2,650.00
	Guides, Implants
07.02.03 - Ear
	07.02.03.01 - Helical Rim
	Stryker Australia Pty Ltd
HW420	Ear Reconstruction	Porus Polyethylene. Helical rim, 	Helical rim: 37 x 62mm	$420.00
	models 8328 and 8329
	07.02.03.02 - Ear Base
	Stryker Australia Pty Ltd
HW432	Ear Reconstruction	Porus Polyethylene. Ear base left and 	Ear base: 29 x 55 x 13mm, 	$600.00
	right, models 7542 and 7525  - 7527. 	32 x 65 x 16mm. Ear base 
	Ear base extended left and right, 	extended: 30 x 60mm.
	models 8330 and 8331.
Prostheses List by Category, Groups and Sponsor	Page 578 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
07.02.04 - Malar
	Device Technologies Australia Pty Ltd
DE333	Facial Implant Malar	Malar Anatomical	Small, medium, large/left or 	$330.00
	right
	Stryker Australia Pty Ltd
HW413	Genioplasty Wedge	Porus Polyethylene. Genioplasty 	Small 60 x 25 x 5mm, 	$330.00
	wedges, models 8340 - 8343	medium 60 x 25 x 7.5mm, 
	large 60 x 25 x 10mm
HW414	Prejowl Shape	Porus Polyethylene. Model 8319	45 x 41 x 4mm	$330.00
SK512	Malar Shape	Porus Polyethylene. Design RZ malar 	Design RZ malar shapes: 	$330.00
	shapes, super petite and petite, left 	super petite left and right 50
	and right (Models 9501 - 9504). 	 x 19 x 3mm, Design RZ 
	Design M malar shapes, left and right 	malar shapes petite left and 
	(Models 9507 - 9512). Additional 	right 50 x 19 x 5mm. Design 
	malar shapes, extended contoured left 	malar shapes: small left and 
	and right (Models 9513 - 9518) 	right  64 x 19 x 3mm, left and
	 right medium 64 x 19 x 
	4.5mm, Left and right large 
	64 x 19 x 
	07.02.04.01 - Complex
	Stryker Australia Pty Ltd
HW434	E-POR Biomaterial/ Midface 	Midface Contour Porous 	One size	$1,150.00
	Contour Porous Polyethylene
HW438	E-POR Biomaterial/ Temporal Fossa	Temporal Fossa Implant Porous 	61mm - 105mm x 18mm - 	$1,150.00
	 Implant Porous Polyethylene	Polyethylene	20mm
	Synthes Australia Pty Ltd
SY783	SynPOR	Porous Polyethylene Malar Implant	3-5 mm	$1,150.00
Prostheses List by Category, Groups and Sponsor	Page 579 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.02.04.02 - Polymer
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW004	Biopore Malar Implant	An implantable device intended to 	Left and Right (47mm x 	$430.00
	support, contour and provide 	24mm x 4mm)
	structure for the face including the 
	cheeks and eye sockets. Made of high-
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs.
	Stryker Australia Pty Ltd
HW436	E-POR Biomaterial/ 	Transphenoidal Sellar Contourable 	2.5mm x 20mm - 40mm	$500.00
	Transsphenoidal Sellar Contourable	Porous Polyethylene
	 Porous Polyethylene
07.02.05 - Mandible, Maxilla and Temperomandibular Joint (TMJ)
	07.02.05.01 - Mandible, Full
	Medtronic Australasia Pty Ltd
MC513	TiMesh	Full Mandible	One size only	$1,520.00
	Surgiplas Medical
SP092	Osteo Plating & Fixation System	Plates - Reconstruction	5 x 20 x 5 Hole Full 	$1,520.00
	Mandible Plate; 5 x 16 x 5 
	Hole Full Mandible Plate; 
	Mandible, Full
	07.02.05.02 - Fossa Replacement
	Biomet Australia Pty Ltd
BI569	TMJ System	Fossa Component, Left or Right; 	Small, Medium Large	$5,850.00
	Titanium, UHMWPE
Prostheses List by Category, Groups and Sponsor	Page 580 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.02.05.03 - Mandibular Angle
	Compression
	Stryker Australia Pty Ltd
ST369	Luhr Fixation System 	Luhr Mandibular Compression 	Curved: 30,38, 45mm, 	$152.00
	System: curved, straight, metacarpal 	Straight: 30, 40, 50, 60, 
	plate Vitallium	80mm, metacarpal: 41, 45mm
	Surgiplas Medical
SP069	Plates	Micro, Mini, Maxi	Angled EDC Plate, Angled 	$152.00
	Long EDC Plate, 40mm 6 
	Hole Fracture Plate, 6 Hole 
	Curved EDC Plate, 33mm & 
	38mm 4 Hole EDC Plate, 
	48mm 6 Hole EDC Plate, 
	Mandible, 
	Mandible/Reduction, 
	Mandible Angle
	Polymer
	Anatomics Pty Ltd
AT073	E-POR Biomaterial	Contoured Mandible Shape	Various Dimensional Angles	$1,485.00
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW003	Biopore Mandible (Left / Right)	An implantable device intended to 	74 x 33 x5mm	$1,485.00
	support, contour, and provide 
	structure for the mandible. Made of 
	high-density polyethylene material 
	with an interconnecting pore 
	structure that supports tissue 
	ingrowth. The device can be cut by 
	the surgeon to meet the patient's 
	specific needs.
	Stryker Australia Pty Ltd
HW422	Mandibular angle	Porus Polyethylene. RZ mandibular 	RZ mandibular angles: 65 x 	$1,485.00
	angles left and right (Models 9955 - 	35 x 3 x 6.5 x 3 x 3mm, 65 x 
	9960); Porus Polyethylene. 	35 x 7 x 6.5 x 3 x 3mm, 65 x 
	Contoured mandibular angles left and 	35 x 11 x 6.5 x 3 x 3mm. 
	right (Models 88037 - 88038)	Contoured mandibular 
	angles left and right:59 x 29
	 x 7 x 11mm.
Prostheses List by Category, Groups and Sponsor	Page 581 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.02.05.04 - Condylar Device
	Biomet Australia Pty Ltd
BI792	Lorenz 2.4mm Locking 	Condyle left or right, chrome cobalt 	One size only	$1,545.00
	Reconstruction System	(CoCr)
	Medical & Optical Instruments Australia Pty Ltd
MO024	Martin Level One Fixation	Temporary condylar impant, titanium	5cm	$1,545.00
	Stryker Australia Pty Ltd
SK218	Leibinger Titanium Implant System -	Items used for reconstruction 	Universal Mandible 	$1,545.00
	 Universal Mandible Condylar 	following trauma or tumor resection of	Condylar Device Left and 
	 the mandible. Included are 2x cross 	Right
	pin fixation screw.
	Synthes Australia Pty Ltd
SY694	Condylar Head Add-On System	Condylar Head - Left, Right	One Size	$1,545.00
	Fixation Plate
	Synthes Australia Pty Ltd
SY695	Condylar Head Add-On System	Fixation Plate 0-6mm positions	2 Holes	$645.00
	07.02.05.05 - Plate
	Biomet Australia Pty Ltd
BI559	TMJ System	Mandibular Component, Left or Right,	(40 - 60mm), 5-13 hole	$6,875.00
	 Titanium
	Biomodelled
	Synthes Australia Pty Ltd
SY776	ProPlan	Biomodelled Patient specific 	Custom	$4,200.00
	Mandible Complex Locking 
	Hemimandible
	Medtronic Australasia Pty Ltd
MC515	TiMesh	Hemimandible, Left/Right	One size only	$645.00
	Surgiplas Medical
SP024	OsteoMed Plating & Fixation System	Plates - Reconstruction	5 x 16 Hole plate Right & 	$645.00
	Left
Prostheses List by Category, Groups and Sponsor	Page 582 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Maxilla
	Medtronic Australasia Pty Ltd
MC512	TiMesh	Maxillary Prosthesis	One size only	$2,124.00
	Symphsis
	Medtronic Australasia Pty Ltd
MC516	TiMesh	Mandibular Symphysis	One size only	$1,294.00
	07.02.05.06 - External Midface System
	Synthes Australia Pty Ltd
SY594	Mandible External Fixator	Hemi, 3/4, Full and Ramus	Various	$1,460.00
	07.02.05.07 - Surgical Guide
	Biomodelled
	Synthes Australia Pty Ltd
SY778	ProPlan	Pateint specific Maxillofacial Surgical	Custom	$2,650.00
	 Guides, Implants
07.02.06 - Nose and Zygoma
	07.02.06.01 - Nasal Dorsum
	Device Technologies Australia Pty Ltd
DE322	Facial Implant Nasal	Zygomatic	Right, left	$279.00
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW005	Biopore Nasal Dorsum Shape	An implantable device intended to 	53 x 5mm, 66 x 6 mm, 76 x 	$279.00
	support, contour, and provide 	15mm, 40 x 9mm
	structure for the nose and zygoma. 
	Made of high-density polyethylene 
	material with an interconnecting pore 
	structure that supports tissue 
	ingrowth. The device is available in 
	various shapes and can be cut by the 
	surgeon to meet the patient's specific 
	needs.
Prostheses List by Category, Groups and Sponsor	Page 583 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW423	Nasal Shape. Petite Nasal Dorsum.	Porus Polyethylene. Petite Nasal 	Petite Nasal Dorsum: 4 x 4 x	$279.00
	Dorsum ( Models 84000 - 84004).	 45mm, 4 x 4 x 55mm, 5 x 5 x 
	45mm, 5 x 5 x 55mm, 6 x 9 x 
	55mm.
	07.02.06.02 - Nasal Arch
	Stryker Australia Pty Ltd
HW415	Nasal Shape or Rhinoplasty Shape	Porus Polyethylene. Nasal Arch 	Nasal arch shapes: small 70 	$350.00
	shapes, nasal arch and nasal sheet 	x 13 x 2mm, medium 70 x 15 
	(Models 9533 - 9536). Nasal dorsum 	x 2mm, large 70 x 15 x 2mm, 
	shapes, design A and design B 	sheet 40 x 9 x 1.1mm. Nasal 
	(Models 7516 - 7518). Nasal valve 	dorsum shapes: design A 
	support, lateral nasal valve support 	small 53 x 5mm, design A 
	large 66 x 8mm, design B 67 
	x 6.5mm. Nasal valve 
	support: lateral nasal valve 
	13 x 0.85 x 3.5mm
	07.02.06.03 - Nasal Shell Shape
	Stryker Australia Pty Ltd
HW425	Nasal Shell Shapes.	Nasal Shell Shapes, Regular and 	Regular: 38 x 21 x 17mm, 	$490.00
	Large with Inserts Small and Large 	Insert Small 30 x 4 x 9mm, 
	(included). Models 9553 - 9554. Thin 	Insert Large 38 x 2.5 x 9mm. 
	Nasal Shell 84006	Large: 40 x 20 x 18mm, 
	Insert Small 32 x 4 x 9mm, 
	Insert Large 41 x 3 x 9mm. 
	Thin Nasal Dorsal Shell 
	42.7mm x 16.4mm x 21.8mm
	07.02.06.04 - Nasal Valve Support
	Stryker Australia Pty Ltd
HW424	Nasal Valve Support.	Lateral Nasal Valve, Model 7545. 	Lateral Nasal Valve:13 x 3.5	$227.00
	External Nasal Valve Batten, Model 	 x 0.85mm, External Nasal 
	7546. External Nasal Valve Batten - 	Valve Batten: 25 x 11 x 
	Thin, Model 7167	0.85mm, External Nasal 
	Valve Batten - Thin: 24 x 
	11.5 x 0.6mm.
Prostheses List by Category, Groups and Sponsor	Page 584 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.02.06.05 - Naso-orbital Ethmoid Implant
	Complex
	Medtronic Australasia Pty Ltd
MC521	TiMesh	Naso-Orbital-Ethmoid 	1mm - 2.2mm;  Complex 1, 	$541.00
	Complex 2, Complex 3
07.02.07 - Orbit
	07.02.07.01 - Complete Orbital Shape
	Stryker Australia Pty Ltd
HW411	Complete Orbital Shape	Porus Polyethylene. Complete and 2 /	Inferior: 83 x 78mm	$1,940.00
	 3 orbit shapes. Inferior 2 / 3 left and 
	right. Models 9567, 9568
HW421	Complete Orbital Shape	Complete left and right.  Models 9569,	Complete 61 x 76mm	$1,940.00
	 9570
	07.02.07.02 - Orbital Floor
	Biomet Australia Pty Ltd
BI738	W.Lorenz Osteosynthesis System	Orbital Floor Plate; Titanium	1.5mm system, Large	$890.00
BI740	W.Lorenz Osteosynthesis System	Orbital Floor Plate (Small) or NOE 	Small or NOE plate	$890.00
	plate, 1.5mm System, Titanium
BI924	Lactosorb Resorbable 	Orbital Floor Plate, 1.5mm System, 	Left or right	$890.00
	Craniomaxillofacial Fixation System	PGA/PLA
	Stryker Australia Pty Ltd
HW522	Stryker Leibinger 3D Orbital Floor 	Stryker Leibinger 3D Orbital Floor 	Small, Right	$890.00
	Plate	Plate	Small, Left
	Large, Right
	Large, Left
	Surgiplas Medical
SP079	Plates	Micro, Mini	Orbital Plate, Orbital Plate 	$890.00
	Large
	Synthes Australia Pty Ltd
SY391	Orbital Fixation System	Orbital Floor Plate	S, M, L	$890.00
SY698	SynPOR	Anatomical Porous Polyethylene	0.8mm - 1.5mm thick	$890.00
Prostheses List by Category, Groups and Sponsor	Page 585 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Coated
	Stryker Australia Pty Ltd
HW433	E-POR Biomaterial/ Orbital Wall 	Orbital Wall and Floor Porous 	41 x 42 x 0.6-1.0mm	$985.00
	and Floor Porous Polyethylene 	Polyethylene Titanium Mesh 
	Titanium Mesh Composite (large)
	07.02.07.03 - Rim
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW008	Biopore Orbital Rim, Extended	An implantable device intended to 	Left and Right (44mm x 	$395.00
	support, contour, and provide 	38mm)
	structure for the face including the 
	cheeks and eye socket. Made of high-
	density polyethylene material with an
	 interconnecting pore structure that 
	supports tissue ingrowth. The device 
	is available in various shapes and can 
	be cut by the surgeon to meet the 
	patient's specific needs.
	Stryker Australia Pty Ltd
SK511	Orbital Rim	Orbital rims, left and right extended. 	Left & right extended 	$395.00
	Models 9539, 9540 Orbital Rim 	models 47 x 40mm Oribtal 
	Onlay Implants 81001, 81002	Rim Onlay Implants left & 
	right 40 x 40mm
	07.02.07.04 - Wedge for Orbit
	Stryker Australia Pty Ltd
HW410	Enophthalmos Wedge	Regular left and right. Large left and 	Regular: 22 x 31 x 7mm. 	$460.00
	right. (Models 9541 - 9544)	Large: 28 x 40 x 7.5mm
07.02.08 - External Prostheses, Bone Attachment
	07.02.08.01 - Endosseous Implant
	Cochlear Limited
CO042	Vistafix™ Fixture ST	Titanium self-tapping fixtures for the 	3mm and 4mm	$635.00
	retention of midface and orbital 
	prostheses.
Prostheses List by Category, Groups and Sponsor	Page 586 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Concave
	Cochlear Limited
CO058	Cochlear Vistafix 3 VXI300 Implants	Titanium implant with TiOblast™ for 	3 mm and 4 mm	$1,082.00
	Vistafix one-stage or two-stage surgery
	Flanged
	Cochlear Limited
CO030	Flange fixture ST 3mm and 4mm	Self tapping titanium flange fixture 	Self Tapping 4mm and 3mm	$1,035.00
	pre-mounted with a disposable fixture 
	mount.  Available in two sizes: 3mm 
	and 4mm.  Used in two stage surgical 
	procedures.
	07.02.08.02 - Abutment, Permanent
	Cochlear Limited
CO036	Standard Abutments	Abutment Complete - Titanium	3.0mm - 90780, 4.0mm - 	$412.00
	90778, 5.5mm - 90776, 
	7.0mm - 90774
	Angled/Offset
	Cochlear Limited
CO037	Face to Face	Console Abutment Unigrip - Titanium	30, 60, 90, 110 Degrees	$895.00
	Concave
	Cochlear Limited
CO061	Cochlear Vistafix 3 VXA300 	Titanium  abutment for Vistafix one-	3.5 mm, 4.5 mm, 6 mm, 7.5 	$936.00
	Abutments	stage and two-stage surgery. VXA 	mm
	Abutments are only compatible with 
	VXI300 Implants
	07.02.08.03 - Abutment, Temporary or Healing
	Cochlear Limited
CO038	Face to Face	Healing Abutment Unigrip - Titanium	7mm	$285.00
Prostheses List by Category, Groups and Sponsor	Page 587 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
CO059	Cochlear Vistafix 3 VXA300 	Titanium healing abutment can be 	9 mm	$285.00
	Healing Abutment	used during healing to avoid having 
	to select the abutment length during 
	surgery. The markings can be used to 
	indicate thickness of the soft tissue. 
	The healing abutment is mounted on 
	the implant and is only compatible 
	with theVXI300 implants
	07.02.08.04 - Abutment Fixtures
	Cochlear Limited
CO035	Face to Face	Cover Screw with Internal Hexagon	One Size Only	$142.00
CO060	Cochlear Vistafix 3 Cover screw 	Cover screw conical for Vistafix 	One size	$142.00
	conical	VXI300 implant. The Cover screw is 
	only compatible with VXI300 implants
07.02.09 - Anatomical Biomodel
	Synthes Australia Pty Ltd
SY775	PSI	Patient specific Craniofacial 	Custom	$2,000.00
	Anatomical Biomodel
SY779	ProPlan	Patient Specific Craniofacial 	Custom	$2,000.00
	Anatomical Biomodel
07.03.01 - Abutment
	07.03.01.01 - Permanent
	Biomet 3i Australia Pty Ltd
NW001	3i Abutment Complete	Titanium	3.25 - 6mm diameter	$175.00
	More Group Pty Ltd
MV005	MIS Abutments	Abutments	Height: 1mm - 5mm, Crown 	$175.00
	height: 4 - 11mm, Platform: 
	Narrow, Standard or Wide
	Neoss Australia Pty Ltd
NJ003	Neoss Titanium Abutment	Neoss Abutment Titanium	Universal	$175.00
Prostheses List by Category, Groups and Sponsor	Page 588 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NJ004	Neoss Gold Abutment	Neoss Abutment Gold 	Universal	$175.00
	Nobel Biocare Australia Pty Ltd
NR001	Nobel Biocare Abutments	Abutment, complete	Np, RP, WP 6.0mm	$175.00
	07.03.01.02 - Temporary
	DENTSPLY IH Pty Ltd
DH001	Astra Tech Cover Screws	Cover Screw	Diameter 3.0mm, 3.5mm, 	$70.00
	4.0mm, 4.5/5.0mm Short, 
	4.5/ 5.0mm Long
DH003	Astra Tech Healing Abutments	Healing Abutments, Healing 	Healing Abutments 3.0,1.5, 	$70.00
	3.0, 4.5, 6.0mm; Healing 
	Abutment 5.5mm Ultra, 
	Short, Long; 7.0mm Short, 
	Long; ST Short, Long; ST 
	5.5mm Short, Long; ST 
	7.0mm Short, Long; 
	Temporary Abutment 3.5, 
	4.0 4.0/5.0mm
DH004	Astra Tech Abutments	Temporary Abutment	Diam 3.0 - 5.0mm	$70.00
	Neoss Australia Pty Ltd
NJ009	Neoss Implant System	Healing Abutment with Screw	Universal	$70.00
	Nobel Biocare Australia Pty Ltd
NR004	Nobel Biocare Abutments	Abutment, temporary or healing, 	NP, RP, WP, 6.0mm	$70.00
	complete
	Straumann Pty Ltd
SB004	Straumann Bone Level Implant 	Straumann Healing Abutment NC/RC	Height 0 - 6 mm	$70.00
	Healing Abutment
	07.03.01.03 - Cover Screw/Cap
	More Group Pty Ltd
MV006	MIS Cover Screws and Healing 	Cover screws and healing caps 	1.5mm - 6mm height, 4mm - 	$52.00
	(Biocom, Seven, Mistral)	6.3mm diameter
	Nobel Biocare Australia Pty Ltd
NR002	Nobel Biocare Cover Screws	Cover screw	NP, RP, WP, 6.0mm	$52.00
Prostheses List by Category, Groups and Sponsor	Page 589 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Straumann Pty Ltd
SB002	Straumann Pty Ltd	Straumann Healing Cap 	Height 1.5 - 4.5 mm	$52.00
07.03.02 - Zygomatic Bone Implant
	Henry Schein-Halas Pty Ltd
HD015	Southern Zygomatic and Oncology 	Zygomatic Titanium dental implants 	4 to 6mm diameter, 27 to 	$800.00
	Implants	with 45 or 55 degree angulation	52.5mm length
	Nobel Biocare Australia Pty Ltd
NR007	Branemark Titanium Fixture	Zygomaticus Fixture	30, 35, 42.5, 40, 45, 47.5, 	$800.00
	50, 52.5mm Length
07.03.03 - Endosseous Implant
	07.03.03.01 - Screws
	Medical & Optical Instruments Australia Pty Ltd
MO337	Martin Level One Fixation	Orthodontic Locking Screw	2mm	$78.00
MO338	Martin Level One Fixation	Screw Titanium	Diameter 1.25 to 1.74mm	$78.00
	Stryker Australia Pty Ltd
SK422	Orthodontic Skeletal Anchor Screw	Anchor Screw for Mandibular 	1.7mm	$78.00
	Maxillary Fixation Screw, Self-Drilling
SK423	Orthodontic Skeletal Anchor Screw	Anchor Screw for Mandibular 	2.0mm	$78.00
	Maxillary Fixation Screw, Self-Drilling
	Synthes Australia Pty Ltd
SY750	Orthodontic Bone Anchor System	Anchor Screw, Self Drilling, Self 	1.5mm - 1.8mm	$78.00
	Tapping
	07.03.03.02 - Plates
	Medical & Optical Instruments Australia Pty Ltd
MO412	Martin Level One Fixation	Orthodontic skeletal anchorage plate	0.5 to 0.99mm thick, 2 to 7 	$226.00
	holes
Prostheses List by Category, Groups and Sponsor	Page 590 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK420	Orthodontic Skeletal Anchor Plate	Orthodontic Skeletal Anchor Plate, 	1.7mm	$226.00
	Standard
	Synthes Australia Pty Ltd
SY749	Orthodontic Bone Anchor System	Anchor Plate, Various Designs	4-5 Holes	$226.00
	Locking
	Stryker Australia Pty Ltd
SK421	Orthodontic Skeletal Anchor Plate	Orthodontic Skeletal Anchor Plate 	1.7mm	$320.00
	Locking
	07.03.03.03 - Implants and Fixtures
	Biomet 3i Australia Pty Ltd
NW002	3i Self Tapping Threaded Implants 	Osseotite/Ice	3.25 - 6mm diameter	$360.00
	and 3i Coverscrew
	DENTSPLY IH Pty Ltd
DH002	Astra Tech MicroThread Fixtures 	Titanium fixture with microthreaded 	Diameter 3.0 - 5.0mm, 	$360.00
	and MicroThread Osseospeed 	cervical neck	Length 8-19mm
	Henry Schein-Halas Pty Ltd
HD016	Southern Dental Implants	Titanium dental implants in External-	3.25 to 6.0mm diameter, 6.0 	$360.00
	Hex, Tri-Nex or Internal Octagon (IT) 	to 52.5mm length
	connection
	More Group Pty Ltd
MV004	MIS Implants	Titanium implants (Biocom, Seven, 	3mm - 6mm Diameter, 6mm - 	$360.00
	Mistral)	16mm length
	Neoss Australia Pty Ltd
NJ001	NEOSS IMPLANT SYSTEM	TITANIUM DENTAL IMPLANT	DIAMETERS 3.25, 3.5, 4.0, 	$360.00
	4.5, 5.0, 5.5mm in Lengths: 
	7, 9, 11, 13, 15, 17mm
	Nobel Biocare Australia Pty Ltd
NR003	Branemark Fixtures	Titanium Fixture	3, 4, 5mm	$360.00
NR006	Branemark Novum System	Titanium - Kit Fixture System	One size only	$360.00
NR009	NobelDirect Implant	Dental Implant Endosseous 	10mm, 13mm, 16mm	$360.00
	incorporating abutment, Titanium
NR010	Replace Implant	Dental Implant Endosseous, Titanium	10mm, 13mm, 16mm	$360.00
Prostheses List by Category, Groups and Sponsor	Page 591 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NR011	NobelPerfect Implant	Dental Implant Edosseous, Titanium	10mm, 13mm, 16mm	$360.00
NR012	Groovy Implants (NobelReplace 	Dental Implants, endosseous	Diameter 3.5 - 6.0mm; 	$360.00
	Straight Groovy, NobelReplace 	Length 8.0 - 18.0mm
	Tapered Groovy, NobelSpeedy 
	Replace, Branemark System Mk III 
	Groovy, NobelSpeedy Groovy)
NR013	NobelActive implants	Dental implants, endosseous	Diameter 3.5 - 5.0mm; 	$360.00
	Length 8.5 - 18.0mm
	Straumann Pty Ltd
SB001	Straumann Pty Ltd	Straumann Dental Implant 	Diameter 3.3 - 4.8mm 	$360.00
	NNI/RN/WNI	Length 6 - 16mm
SB003	Straumann Bone Level Implants 	Straumann Bone Level Implants NC/RC	Diameter 3.3 - 4.8 mm 	$360.00
	NC/RC	Length 8-14 mm
	Summit Healthcare Solutions
HS011	Periosave Z1-M Transgingival 	Periosave Z1-M Zirconia-titanium 	All Ø3.2mm transgingival 	$360.00
	dental implant.	Transgingival hybrid dental implant.	implants have a zirconia 
	platform of 4.4mm, all 
	Ø3.90mm transgingival 
	implants have zirconia 
	platform of 5.0mm, all 
	Ø4.7mm transgingival 
	implants have a zirconia 
	platform of 6.0mm.
	Zirconia gingival collar 
	height of all implants = 
	1.5mm. All above implant 
	diameters are available in 
	lengths of 8mm, 10.0mm, 
	11.5mm, 13.0mm, 15mm
	07.03.03.04 - Graft Material <0.5ml
	Straumann Pty Ltd
SB005	Straumann Bone Ceramic	070.203 Straumann Bone Ceramic 400	070.203 Straumann Bone 	$98.00
	 -700	Ceramic 400 -700, Granule 
	size 400 - 700 microns, Unit
	 size 0.25 g, Volume: approx
	 0.3 ml
Prostheses List by Category, Groups and Sponsor	Page 592 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.03.03.05 - Graft Material 0.5ml-<1.0ml
	Biomet 3i Australia Pty Ltd
NW006	Endobon Xenograft Granules	Hydroxyapatite granules, 0.5-1mm 	0.5ml	$300.00
	diameter
	Henry Schein-Halas Pty Ltd
HD019	Bio-Oss Pen	Pen applicator with natural bone 	0.25 to 1mm; 0.25g 	$300.00
	mineral derived from bovine bone	(0.5125cc)
	Straumann Pty Ltd
SB006	Straumann Bone Ceramic	070.204 Straumann Bone Ceramic 500	070.204 Straumann Bone 	$300.00
	 -1000	Ceramic 500 -1000, Granule
	 size: 500 -1000 microns, 
	Unit size: 0.5 g, Volume: 
	approx 0.95 ml
	07.03.03.06 - Graft Material ≥1.0ml
	Biomet 3i Australia Pty Ltd
NW007	Endobon Xenograft Granules	Hydroxyapatite granules, 0.5-1mm 	2 - 8ml	$300.00
	diameter or 1-2mm diameter
	Henry Schein-Halas Pty Ltd
HD018	Bio-Oss	Natural bone mineral derived from 	1 to 2mm: 0.5g (1.5cc)	$300.00
	bovine bone
HD020	Bio-Oss Pen	Pen applicator with natural bone 	0.25 to 1mm; 0.5g (1.025cc)	$300.00
	mineral derived from bovine bone
HD021	Bio-Oss Pen	Pen applicator with natural bone 	1 to 2mm; 0.5g (1.5cc)	$300.00
	mineral derived from bovine bone
	Straumann Pty Ltd
SB007	Straumann Bone Ceramic	070.205 Straumann Bone Ceramic 500	070.205 Straumann Bone 	$300.00
	 -1000	Ceramic 500 -1000, Granule
	 size: 500 -1000 microns, 
	Unit Size 1g, Volume 
	approx 1.9 ml
Prostheses List by Category, Groups and Sponsor	Page 593 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
07.04.01 - Complete
	07.04.01.01 - External Midface System
	Multivector
	Medical & Optical Instruments Australia Pty Ltd
MO236	Martin Distraction Osteogenesis 	Distractor System, Complete, External,	one size only	$8,100.00
	Rigid External Distraction (Polley 	 Midface, Aluminium, Carbon Fibre
	RED II)
	Synthes Australia Pty Ltd
SY401	External Midface Distractor System	Head Frame Assembly, Carbon Fibre 	One size only	$8,100.00
	Rods
	Single Vector
	Medical & Optical Instruments Australia Pty Ltd
MO233	Martin Distraction Osteogenesis	Distractor System, Complete, other, 	1.5mm	$7,100.00
	titanium
	07.04.01.02 - External Set
	Multivector
	Synthes Australia Pty Ltd
SY349	Multi Vector Distractor Set	Titanium Multi Vector Distractor	MVD Arms:15mm-85mm. 	$1,955.00
	Pin holding clamps-
	ramus,body,universal,limite
	d bone stock ramus and 
	body. Assembly left & right 
	35mm. K wires 2.0mm 
	150mm length. Connecting 
	bar 4.0mm 100mm-200mm 
	length
	07.04.01.03 - Internal/Intraoral
	Multivector
	Medical & Optical Instruments Australia Pty Ltd
MO239	Martin Distraction Osteogenesis	Distractor System, Complete, other, 	15-60 mm distraction length	$3,100.00
	titanium
Prostheses List by Category, Groups and Sponsor	Page 594 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK183	Leibinger Intraoral Distractor 	Manufactured from stainless steel, 	Frame 20mm - 35mm, 2.0mm 	$3,100.00
	(Multiguide II)	allows gradual, independent, and 	diameter, 50 - 90 mm length 
	simultaneous distraction of the 	Auto - Pilot Pins
	mandible in 3 planes.
	Surgiplas Medical
SP045	Logic Distraction System	Distractor, spacers & activation set	Straight, Curved 18-52mm	$3,100.00
	Synthes Australia Pty Ltd
SY753	Curvilinear Distraction System	Curvilinear Distraction, Right Left	30mm - 100mm radius	$3,100.00
	Single Vector
	Biomet Australia Pty Ltd
BI823	Alveolar Ridge Distraction System -	distraction device, single tooth	10-20mm	$1,955.00
	 titanium
BI824	Alveolar Ridge Distraction System -	distraction device, multi tooth	10-20mm	$1,955.00
	 titanium
	Medical & Optical Instruments Australia Pty Ltd
MO135	Martin Distraction Osteogenesis	Distractor System, Complete, 	10 to 20 mm	$1,955.00
	internal/intraoral, titanium
	Synthes Australia Pty Ltd
SY399	Alveolar Distractor	Vertical mandibular, maxilla alveolar 	8-16mm	$1,955.00
	ridge distractor
	Single VectorResorbable
	Biomet Australia Pty Ltd
BI934	Lactosorb Distraction System	Plate, drive screw and distractor, 	Small, Medium, Large	$3,500.00
	PGA/PLLA, Ti
07.04.02 - Component
	07.04.02.01 - Distractor Body
	Medical & Optical Instruments Australia Pty Ltd
MO396	KLS Martin Distractor	Zurich II distractor bodies	15mm - 30mm distraction 	$2,200.00
	length
	Synthes Australia Pty Ltd
SY515	Midface Distractor System	Distractor System, Distractor Body	10-40mm distraction length	$2,200.00
Prostheses List by Category, Groups and Sponsor	Page 595 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.04.02.02 - Footplate
	Medical & Optical Instruments Australia Pty Ltd
MO242	Martin Distraction Osteogenesis 	Distractor System, Component, 	1.5mm	$156.00
	Rigid External Distraction (Polley 	Footplate, titanium
	RED II)
	Synthes Australia Pty Ltd
SY406	External Midface Distractor System	Titanium Zygomatic, Maxxilary 	3 holes, 40mm	$156.00
	Footplate
	Assembly
	Synthes Australia Pty Ltd
SY595	External Midface Distractor	Distractor Footplate	Various	$480.00
	07.04.02.03 - Cross Bar/Rod
	Medical & Optical Instruments Australia Pty Ltd
MO246	Martin Distraction Osteogenesis 	Distractor System, Component, Cross 	one size only	$990.00
	Rigid External Distraction (Polley 	Bar, aluminium.carbon fibre
	RED II)
	Synthes Australia Pty Ltd
SY402	External Midface Distractor System	Horizontal Rod Assembly	One size only	$990.00
	07.04.02.04 - Shim Plate
	Biomet Australia Pty Ltd
BI825	Alveolar Ridge Distraction System -	Shim plate, titanium	1-3mm	$100.00
	 titanium
	07.04.02.05 - Pin
	Medical & Optical Instruments Australia Pty Ltd
MO234	Martin Distraction Osteogenesis 	Distractor System, Component, 	45-55mm	$148.00
	Rigid External Distraction (Polley 	Screws/Pins (other than bone screws),
	RED II)	 titanium
Prostheses List by Category, Groups and Sponsor	Page 596 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.04.02.06 - Screws
	Synthes Australia Pty Ltd
SY517	Midface Distractor System	Distractor System, Screw	4-10mm	$75.00
	07.04.02.07 - External Distractor Component
	Medical & Optical Instruments Australia Pty Ltd
MO240	Martin Distraction Osteogenesis 	Distractor System, Component, Other, 	1.5-1.58mm	$1,461.00
	Rigid External Distraction (Polley 	titanium, aluminium
	RED II)
	07.04.02.08 - Body Extension
	Medical & Optical Instruments Australia Pty Ltd
MO397	KLS Martin Distractors	Zurich II remote release activators	20mm - 50mm	$500.00
	Synthes Australia Pty Ltd
SY518	Midface Distractor System	Distractor System , Body extensions	20-40mm	$500.00
07.05.01 - Muscular
	07.05.01.01 - Calf Implant
	Device Technologies Australia Pty Ltd
DE316	Calf Implants	Asymmetrical shape, silicone gel 	85-180cc	$517.00
	smooth  surface
DE325	Calf Implants	Symmetrical shape, silicone gel	12-140cc	$517.00
	Precise Medical Supplies
PR007	ContourFlex Calf Implant	Calf implant	70-170cc	$517.00
	07.05.01.02 - Gluteal
	Device Technologies Australia Pty Ltd
DE327	Gluteal Implants filled with Gel	Oval Shape, Silicone Gel, Textured 	200-400cc	$620.00
	Surface
DE328	Gluteal Implants filled with Gel	Round Shape, Silicone Gel, Smooth 	200-300cc	$620.00
	Surface
Prostheses List by Category, Groups and Sponsor	Page 597 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Precise Medical Supplies
PR008	ContourFlex Gluteal Implant	Gluteal Implant	280-460cc, Round and 	$620.00
	Anatomical
	07.05.01.03 - Pectoral
	Precise Medical Supplies
PR009	PowerFlex Pectoralis Implant	Pectoralis Implant	Length: 14.2-17.6cm, 	$950.00
	Width: 9.0-13.5cm, Depth: 
	1.6-3.2cm,Shape: Symetrical
	 or Asymetrical.
07.05.02 - Tissue Expanders
	07.05.02.01 - Skin or Mammary
	Device Technologies Australia Pty Ltd
DE336	Silimed Tissue Expander	various shapes, textured, magnetic port	150ml-1000ml	$670.00
	J T Medical Pty Ltd
JT005	Polytech Smooth Tissue Expander 	Smooth with integrated or remote 	The  tissue expanders vary 	$670.00
	with integrated or remote magnetic 	in maximum volume from 
	valve	100 - 960mls
	Johnson & Johnson Medical Pty Ltd
MN001	Mentor Radovan Tissue Expander	Tissue Expander	Volume 25cc - 1000cc	$670.00
	Surgiplas Medical
SP010	Nagor Tissue Expander	Two Stage, Valved	10 to 2000cc	$670.00
	Expander Implant
	Allergan Australia Pty Limited
AW012	McGhan Style 150 Biodimensional 	Full height, Short Height, textured	9.6 -16cm width x 8 - 17cm 	$2,040.00
	Biocell Textured Expand Gel/Saline 	height x 4.2 - 7.1cm 
	Filled Mammary Implant, Low Pole	projection
	Expander Implant, Textured
	Johnson & Johnson Medical Pty Ltd
MN013	Mentor Siltex Becker 	Textured Becker Expander/Mammary 	145 to 800cc	$2,040.00
	Expander/Mammary Implant	Implant
Prostheses List by Category, Groups and Sponsor	Page 598 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Multiple Chamber
	Device Technologies Australia Pty Ltd
DE335	Silimed Tissue Expander	Double chamber, textured, magnetic, 	470mm-780mm	$1,250.00
	with suture tabs. Catalogue number: 
	20799
	Self Expanding
	Spectrum Surgical
SO042	Osmed Tissue Expanders	Self inflating, Hydrogel	0.24ml-650ml	$1,250.00
	Textured
	Allergan Australia Pty Limited
AW013	Allergan Biospan Tissue Expander	Silicone Elastomer. Saline filled.	150-950 cm3	$1,050.00
	Device Technologies Australia Pty Ltd
DE337	Silimed Tissue Expander	Anatomical superior-pole/inferior-	200ml-840ml	$1,050.00
	pole shape, textured, magnetic
	J T Medical Pty Ltd
JT006	Polytech Textured Mammary or  	Textured with integrated or remote 	The tissue expanders vary in	$1,050.00
	Tissue Expander with integrated or 	valve.	 maximum volume from 100 - 
	remote magnetic valve	960mls
JT007	Polytech Textured Mammary 	Textured  with integrated or remote 	The mammary expanders 	$1,050.00
	Expander with integrated or remote 	magnetic valve. Anatomically shaped 	vary in maximum volume 
	magnetic valve	with reinforced inner base	from 200 - 960mls
	Johnson & Johnson Medical Pty Ltd
MN002	Mentor Siltex Contour Profile 	Siltex Contour Tissue Expander	Volume 250cc - 850cc	$1,050.00
	Breast Tissue Expander
MN042	Mentor Siltex Contour Breast Tissue	Siltex Contour Tissue Expander with 	250-850cc	$1,050.00
	 Expander	suture tab (CPX3)
	Textured, Multiple Chamber
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW011	PMT Integra tissue expander	Tissue/skin Expander	5cc to 1400cc	$1,250.00
Prostheses List by Category, Groups and Sponsor	Page 599 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.05.02.02 - Orbital
	Self Expanding
	Spectrum Surgical
SO041	Osmed Sphere / Hemisphere tissue 	Self inflating, Hydrogel	6mm, 8mm, 9mm, 10mm	$865.00	The provision of the prosthesis is 
	expander	for a child who is under 18 years 
	of age.
	
	See rule 5B for effect of Condition.
07.05.03 - Skin, Artificial
	07.05.03.01 - <50cm²
	Integra Neurosciences Pty Ltd
IG034	Integra Artificial Skin (IDRT) 	INTEGRA  Dermal Regeneration 	5cm x 5cm	$900.00
	Terminally Sterile	Template is a bilayer membrane system
	 for skin replacement made of a porous 
	matrix of fibers of cross-linked bovine 
	tendon collagen and 
	glycosaminoglycan and polysiloxane 
	layer.
	07.05.03.02 - 50-149cm²
	Integra Neurosciences Pty Ltd
IG035	Integra Artificial Skin (IDRT) 	INTEGRA  Dermal Regeneration 	10cm x 12.5cm	$1,140.00
	Terminally Sterile	Template is a bilayer membrane system
	 for skin replacement made of a porous 
	matrix of fibers of cross-linked bovine 
	tendon collagen and 
	glycosaminoglycan and polysiloxane 
	layer.
Prostheses List by Category, Groups and Sponsor	Page 600 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	07.05.03.03 - 150-400cm²
	Integra Neurosciences Pty Ltd
IG036	Integra Artificial Skin (IDRT) 	INTEGRA  Dermal Regeneration 	10cm x 25cm	$1,740.00
	Terminally Sterile	Template is a bilayer membrane system
	 for skin replacement made of a porous 
	matrix of fibers of cross-linked bovine 
	tendon collagen and 
	glycosaminoglycan and polysiloxane 
	layer.
	07.05.03.04 - >400cm²
	Integra Neurosciences Pty Ltd
IG037	Integra Artificial Skin (IDRT) 	INTEGRA  Dermal Regeneration 	20cm x 25cm	$3,380.00
	Terminally Sterile	Template is a bilayer membrane system
	 for skin replacement made of a porous 
	matrix of fibers of cross-linked bovine 
	tendon collagen and 
	glycosaminoglycan and polysiloxane 
	layer.
07.05.04 - Coupler
	LMT Surgical Pty Ltd
LM030	Synovis Coupler	High Density polyethylene (ring); 	Diameter 1-3mm	$625.00
	Stainless Steel (pins)
07.06.01 - Saline Filled
	07.06.01.01 - <500cc
	Textured
	Johnson & Johnson Medical Pty Ltd
MN053	Mentor Siltex Round Saline Implant	Textured, round implant	<500cc	$685.00
Prostheses List by Category, Groups and Sponsor	Page 601 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Valved
	Johnson & Johnson Medical Pty Ltd
MN045	Mentor Spectrum Saline Tissue 	Smooth, round adjustable implant 	<500cc	$715.00
	Expander/Adjustable Implant	with posterior spectrum valve
MN118	Mentor Smooth Round Saline 	Smooth Round implant with Anterior 	<500cc	$715.00
	Diaphragm Valve
	Surgiplas Medical
SP011	Nagosil SFS-LP-Saline Filled Low 	Smooth surface	100 to 600cc	$715.00
	Profile Smooth Surface Breast 
	Prostheses, Nagosil SFS-HP-Saline 
	Filled High Profile Smooth Surface 
	Breast Prostheses
	Valved, Textured
	Johnson & Johnson Medical Pty Ltd
MN049	Mentor Spectrum Saline Tissue 	Textured, round adjustable implant 	105 to 475cc	$715.00
	Expander/Adjustable Implant	with posterior spectrum valve
	Surgiplas Medical
SP012	Nagotex SFX-LP-Saline Filled Low 	Textured surface	100 to 600cc	$715.00
	Profile Textured Surface, Nagotex 
	SFX-HP-Saline Filled High Profile 
	Textured Surface Breast 
	Valved, Textured, Pre-shaped
	Johnson & Johnson Medical Pty Ltd
MN047	Mentor Spectrum Saline Tissue 	Textured, Contour Profile adjustable 	<500cc	$715.00
	Expander/Adjustable Implant	implant with posterior spectrum valve
MN120	Mentor Siltex Contour Profile 	Textured, Contour Profile implant 	<500cc	$715.00
	Saline Implant	with Anterior Diaphragm Valve
	07.06.01.02 - ≥500cc
	Valved
	Johnson & Johnson Medical Pty Ltd
MN046	Mentor Spectrum Saline Tissue 	Smooth, round adjustable implant 	≥500cc	$640.00
	Expander/Adjustable Implant	with posterior spectrum valve
MN119	Mentor Smooth Round Saline 	Smooth Round implant with Anterior 	≥500cc	$640.00
	Diaphragm Valve
Prostheses List by Category, Groups and Sponsor	Page 602 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Valved, Textured, Pre-shaped
	Johnson & Johnson Medical Pty Ltd
MN048	Mentor Spectrum Saline Tissue 	Textured, Contour Profile adjustable 	≥500cc	$685.00
	Expander / Adjustable Implant	implant with posterior spectrum valve
MN121	Mentor Siltex Contour Profile 	Textured, Contour Profile implant 	≥500cc	$685.00
	Saline Implant	with Anterior Diaphragm Valve
07.06.02 - Gel Filled
	07.06.02.01 - <500cc
	Allergan Australia Pty Limited
AW008	Allergan Type SLD, SHD, SRL, 	Low, Medium, High or Extra High 	100 - 800 grams	$610.00
	SRM, SRF, SRX Smooth Silicone 	Profile
	Gel-filled Mammary Implant
AW010	Allergan Style 40, 45, SSL, SSM, 	Round: low, medium, high & extra 	110 - 800 grams	$610.00
	SSF, SSX Intrashiel Gel-Filled 	high profile
	Round Mammary Implant
	Johnson & Johnson Medical Pty Ltd
MN122	Mentor Smooth Round Gel Implant	Smooth, Round, Cohesive l Gel 	<500cc	$610.00
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW012	Cereform Silicone Gel-filled Breast 	Silicone Gel-filled Breast Implant	100cc to 500cc	$610.00
	Implant, Round, Smooth and 
	Textured Surface
MW014	Cereform "Aptima" Silicone Gel 	Silicone gel-filled breast implant with	100cc to 500cc	$610.00
	Filled Breast Implant	 very high profile and filled with 
	"Aptima" high cohesive gel
	Surgical Supplies Australia Pty Ltd
ZW002	Eurosilicone Breast Implants	Round Cohesive Gel Breast Implants 	100cc to 900cc	$610.00
	for Plastic and Reconstructive 
	Surgiplas Medical
SP048	Gel Filled Mammary Prosthesis 	Smooth Round	80 to 800ml	$610.00
	Models RGI-D, RGI-DH and RGI-
	DEH
Prostheses List by Category, Groups and Sponsor	Page 603 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Pre-shaped
	J T Medical Pty Ltd
JT003	Sublime Line Mammary Implant	The Sublime Line Mammary Implants 	Low Profile, Moderate 	$1,000.00
	are silicone gel-filled implants with 	Profile, High Profile and 
	either a smooth, textured or 	Extra High Profile. Sizes 
	Microthane surface and are available 	45-495cc.
	in sizes less than 500cc. The implants 
	either have a round base with a central
	 or anatomical-projection or an oval 
	base with an anatomical projection. 
	The filling level of the Sublime Line 
	implants is maximised to provide more
	 volume. The implants are very close 
	to the haptics and motional properties
	 of the female breast tissue.
	Surgical Supplies Australia Pty Ltd
ZW003	Eurosilicone Breast Implants	Anatomical Cohesive Gel Breast 	100cc to 500cc	$1,000.00
	Implants for Plastic and 
	Reconstructrive Surgery
	Textured
	Allergan Australia Pty Limited
AW005	Allergan Type MLP, MHP, TRL, 	Low, Medium, High & Extra High 	80 - 800 grams	$760.00
	TRM, TRF, TRX Low, Medium, High	profile, textured surface
	 & Extra High Profile Gel-Filled 
	Mammary Implant
AW009	Allergan styles CML, CMH, TSL, 	Silicone Cohesive Gel-Filled Breast 	80 - 800 grams	$760.00
	TSM, TSF, TSX	Implant
	Device Technologies Australia Pty Ltd
DE362	Silimed Textured Mammary Implant	Silimed Textured Mammary Implant	40cc - 499cc	$760.00
	Johnson & Johnson Medical Pty Ltd
MN124	Mentor Siltex Round Gel Implant	Textured, Round Cohesive l Gel 	<500cc	$760.00
	implant
MN128	Mentor Perthese Sensitive Gel 	Perthese Sensitive Textured, Round 	<500cc	$760.00
	Breast Implants	Implants
MN130	Mentor Siltex Round Gel Implant	Textured, Round Cohesive Gel ll 	<500cc	$760.00
	Implant
Prostheses List by Category, Groups and Sponsor	Page 604 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Surgical Supplies Australia Pty Ltd
ZW001	Eurosilicone Breast Implants	Textured Cohesive Gel Breast 	100cc to 900cc	$760.00
	Implants for Plastic and 
	Surgiplas Medical
SP047	Gel Filled Mammary Prosthesis 	Textured Round	80 to 800ml	$760.00
	Models GFX-LP, GFX and GFX-EHP
SP114	Nagor Breast Implants	Silicone Firm and Stable Gel Breast 	150 - 620cc	$760.00
	Implants
	Textured, Pre-shaped
	Device Technologies Australia Pty Ltd
DE338	Silimed Anatomical Textured 	Anatomical shape, textured surface, 	115cc to 600cc	$1,000.00
	Mammary Implant	silicone gel filled mammary implant
	Johnson & Johnson Medical Pty Ltd
MN126	Mentor Contour Profile Gel Implant	Textured, Contour Profile, Cohesive 	<500cc	$1,000.00
	lll, Gel implant
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW016	Cereform Silicone Breast Implant, 	Silicone Gel-Filled Breast Implant	100cc to 500cc	$1,000.00
	Anatomical, Textured Surface
	07.06.02.02 - ≥500cc
	Johnson & Johnson Medical Pty Ltd
MN123	Mentor Smooth Round Gel Implant	Smooth, Round Cohesive l Gel 	≥500cc	$685.00
	Pre-shaped
	Allergan Australia Pty Limited
AW004	Style 510 Dual Gel Breast Prosthesis	Anatomical textured implant with 	LX sizes from 130-575 	$1,200.00
	dual gel for projection of 	grams, MX sizes from 145-
	nipple/areola complex, concave base 	600 grams, FX sizes from 
	and tapered edges for minimisation of 	165-630 grams
	edge/thoracic wall palpability.
AW007	McGhan Style 410 & 410 Soft 	Full, moderate or low height, Extra 	125 - 775 grams	$1,200.00
	Touch Biodimensional Biocell 	Full, Full, moderate or low projection
	Textured Cohesive Gel-filled 
Prostheses List by Category, Groups and Sponsor	Page 605 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	J T Medical Pty Ltd
JT004	Sublime Line Mammary Implant	The Sublime Line Mammary Implants 	Low Profile, Moderate 	$1,200.00
	are silicone gel-filled implants with 	Profile, High Profile and 
	either a smooth, textured or 	Extra High Profile. Sizes 
	Microthane surface and are available 	500-1035cc.
	in sizes 500cc and above. The 
	implants either have a round base 
	with a central or anatomical-
	projection or an oval base with an 
	anatomical projection. The filling 
	level of the Sublime Line implants is 
	maximised to provide more volume. 
	The implants are very close to the 
	haptics and motional properties of the 
	female breast tissue.
	Surgiplas Medical
SP049	Gel Filled Mammary Prosthesis 	CoGel High Cohesive	100 to 790gm	$1,200.00
	Models CoGel-XR, CoGel-XRH, 
	CoGel-XL, CoGel- XM and CoGel XF
	Textured
	Allergan Australia Pty Limited
AW011	McGhan Style 110 & 120 Biocell 	Round: Moderate or high profile	90 - 650 grams	$760.00
	Textured, Intrasheild barrier Gel-
	Filled Mammary Implant
	Device Technologies Australia Pty Ltd
DE340	Silimed Polyurethane Breast 	Polyurethane coated silicone gel 	40cc to 695cc	$760.00
	breast implant
DE363	Silimed Textured Mammary Implant	Silimed Textured Mammary Implant	500cc - 695cc	$760.00
	Johnson & Johnson Medical Pty Ltd
MN125	Mentor Siltex Round Gel Implant	Textured, Round Cohesive l Gel 	≥500cc	$760.00
	implant
MN129	Mentor Perthese Sensitive Gel 	Perthese Sensitive Textured, Round 	≥500cc	$760.00
	Breast Implants	Implants
MN131	Mentor Siltex Round Gel Implant	Textured, Round Cohesive Gel ll 	≥500cc	$760.00
	Implant
Prostheses List by Category, Groups and Sponsor	Page 606 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW013	Cereform Silicone Gel-filled Breast 	Silicone Gel-filled Breast Implant	500cc to 650cc	$760.00
	Implant, Round, Smooth and 
	Textured Surface
MW015	Cereform "Aptima" Silicone Gel 	Silicone gel-filled breast implant with	500cc to 650cc	$760.00
	Filled Breast Implant	 very high profile and filled with 
	"Aptima" high cohesive gel
MW019	Cereform Silicone Gel-filled Breast 	Silicone Gel-filled Breast Implant	650cc to 850cc	$760.00
	Implant, Round, Smooth and 
	Textured Surface
MW020	Cereform "Aptima" Silicone Gel 	Silicone gel-filled breast implant with	650cc to 850cc	$760.00
	Filled Breast Implant	 very high profile and filled with 
	"Aptima" high cohesive gel
	Textured, Pre-shaped
	Device Technologies Australia Pty Ltd
DE341	Silimed Anatomical Polyurethane 	Polyurethane coated silicone gel 	115cc to 640cc	$1,200.00
	Breast Implant	breast implant
	Johnson & Johnson Medical Pty Ltd
MN127	Mentor Contour Profile Gel Implant	Textured, Contour Profile, Cohesive 	≥500cc	$1,200.00
	lll, Gel implant
	Medical Vision Australia Plastic and Cosmetic Pty Ltd
MW017	Cereform Silicone Breast Implant, 	Silicone Gel-Filled Breast Implant	500cc to 650cc	$1,200.00
	Anatomical, Textured Surface
MW018	Cereform Silicone Breast Implant, 	Silicone Gel-Filled Breast Implant	650 cc to 850cc	$1,200.00
	Anatomical, Textured Surface
	07.06.02.03 - Pectoral Implant
	Device Technologies Australia Pty Ltd
DE334	Pectoral Implants	Gel - Smooth surface	190cc - 300cc	$950.00
	07.06.02.04 - Adjustable
	Johnson & Johnson Medical Pty Ltd
MN028	Mentor Spectra Adjustable Gel 	Smooth Round Spectra Adjustable 	190cc-760cc	$1,050.00
	Breast Implants	Gel Implant
Prostheses List by Category, Groups and Sponsor	Page 607 of 1059

07 - PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MN029	Mentor Spectra Adjustable Gel 	Textured Round Spectra Adjustable 	190cc - 760cc	$1,050.00
	Breast Implants	Gel Implant
07.07.01 - Bar
	Biomet Australia Pty Ltd
BI472	Pectus Bar	Pectus Bar, Stainless Steel	80-432mm	$1,256.00
07.07.02 - Stabiliser
	Biomet Australia Pty Ltd
BI483	Pectus Bar	Stabilizer, Triangular or Elongated, 	One size only	$505.00
	Stainless Steel
Prostheses List by Category, Groups and Sponsor	Page 608 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.01.01 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex 
	a
	Sorin Group Australia Pty Ltd
SA149	PARADYM VR 8250	Single Chamber implantable 	Dimensions: 58.4 x 73.4 x 	$42,640.00
	cardioverter defibrillator with rate 	11mm; Weight: 90 grams; 
	response	Volume: 32.6cc
	St Jude Medical Australia Pty Ltd
SJ066	Atlas + VR - C Model V-193C ICD	Single chamber implantable cardio-	38cc, 77g	$42,640.00
	verter defibrillator
	a, d
	Biotronik Australia Pty Ltd
BT098	Lumax 340 VR-T XL	Single-chamber ICD with 40 J output, 	Dimensions: 66mm x 55mm 	$42,640.00
	Home Monitoring and Extended 	x 13mm, Volume: 37cc, 
	Longevity	Mass: 92g
	Boston Scientific Australia Pty Ltd
BS136	TELIGEN 100 HE VR DF-1/IS-1	Single chamber ICD, High Energy 	31.5cc, 9.9mm	$42,640.00
	with RF
BS204	ENERGEN VR ICD	High energy single chamber ICD with	31.5cc, 9.9mm, 72g	$42,640.00
	 DF-1 RV connector
BS208	INCEPTA VR ICD	High energy single chamber ICD with	31.5cc, 9.9mm, 72g	$42,640.00
	 DF-1 RV connector
	a, d, e
	Boston Scientific Australia Pty Ltd
BS132	Teligen 100 HE VR 4-SITE	Single chamber ICD, high energy with	30.5cc, 9.9mm	$43,390.00
	 RF
BS199	ENERGEN DF-4 VR ICD	High energy single chamber ICD with	30.5cc, 9.9mm, 72g	$43,390.00
	 DF-4 RV connector
BS210	INCEPTA DF-4 VR ICD	High energy single chamber ICD with	30.5cc, 9.9mm, 72g	$43,390.00
	 DF-4 RV connector
Prostheses List by Category, Groups and Sponsor	Page 609 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.01.02 - Features of 8.1.1 plus auto test sensing parameters, auto 
	a, d
	Biotronik Australia Pty Ltd
BT100	Lumax 540 VR-T	Single-Chamber ICD with 40 J output 	Dimensions: 66mm x 55mm 	$43,920.00
	with Advanced Patient Management, 	x 13mm, Volume: 37cc, 
	Home Monitoring, Automatic 	Mass: 92g
	Threshold Monitoring and Extended 
	Longevity.
BT124	Lumax 540 VR-T DX	Lumax 540 VR-T DX high energy 	66 x 55 x 13 W x H x D 	$43,920.00
	single-chamber ICD, with Atrial 	(mm); Volume 37.2(cm3); 
	Diagnostics and Home Monitoring® 	Mass 92(g)
	functionality
	Medtronic Australasia Pty Ltd
MC813	Secura VR Model D234VRG	Fully Automatic, Wireless 	37cc, 68g	$43,920.00
	Implantable cardioverter defibrillator 
	with high energy capability and 
	therapies for ventricular 
MI015	PROTECTA XT VR D354VRG	Single chamber implantable 	Volume 37cc, Mass 68g	$43,920.00
	cardioverter defribillator with 
	SmartShock Technology, OptiVol 2.0 
	Fluid Status Monitoring and 
	Complete Capture Management 
	Specifications (DF-1)
	St Jude Medical Australia Pty Ltd
SJ147	Current Accel VR RF CD1215-36	Single Chamber Cardioverter 	79g, 38cc	$43,920.00
	Defibrillator with RF Telemetry
SJ251	Fortify ST VR CD1235-40	Single chamber cardioverter 	35cc, 75g	$43,920.00
	defibrillator with 40J delivered 
	energy and ST segment monitoring
SJ296	Ellipse VR CD1277-36	Single chamber cardioverter 	66g, 31cc	$43,920.00
	defibrillator with 36J delivered 
	energy and ST segment monitoring
SJ299	Fortify Assura VR CD1259-40	Single chamber cardioverter 	76g, 35cc	$43,920.00
	defribrillator with 40J delivered 
	energy and ST segment monitoring
Prostheses List by Category, Groups and Sponsor	Page 610 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a, d, e
	Medtronic Australasia Pty Ltd
MI024	Protecta XT VR D354VRM	Single chamber implantable 	Volume 38cc, Mass 73g	$44,670.00
	cardioverter defibrillator with 
	SmartShock Technology, OptiVol 2.0 
	Fluid Status Monitoring and 
	Complete Capture Management 
	Specifications (DF-4)
MI054	Secura VR Model D214VRM	Fully Automatic, Wireless 	37cc	$44,670.00
	Implantable cardioverter defibrillator 
	with high energy capability and 
	therapies for ventricular 
	tachyarrhythmia. DF-4 lead connector.
	St Jude Medical Australia Pty Ltd
SJ232	Current Accel VR CD1215-36Q	Single Chamber Cardioverter 	80g, 42cc	$44,670.00
	Defibrillator with RF Telemetry and 
	SJ4 connector
SJ247	Fortify ST VR 1235-40Q	Single chamber cardioverter 	35cc, 75g	$44,670.00
	defibrillator with 40J delivered 
	energy and ST segment monitoring 
	and SJ4 connector
SJ309	Fortify Assura VR CD1259-40Q	Single chamber cardioverter 	35cc, 75g	$44,670.00
	defribrillator with 40J delivered 
	energy and ST segment monitoring 
	and DF4 connector
SJ311	Ellipse VR CD1277-36Q	Single chamber cardioverter 	67g, 30cc	$44,670.00
	defibrillator with 36J delivered 
	energy and ST segment monitoring 
	and DF4 connector
	a,d
	Biotronik Australia Pty Ltd
BT143	Ilesto 7 VR-T	Single Chamber ICD, rate adaptive 	W x H x D (mm) 65 x 55 x 	$43,920.00
	pacing, max. 40J shock energy, Home 	11, Volume: 31cc, Mass: 
	Monitoring, MRI conditional, IS-
	1/DF-1 connector
Prostheses List by Category, Groups and Sponsor	Page 611 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BT144	Ilesto 7 VR-T DX	Single Chamber ICD, rate adaptive, 	W x H x D (mm) 65 x 55 x 	$43,920.00
	additional atrial detection, max. 40J 	11, Volume: 31cc,  Mass: 80g
	shock energy, Home Monitoring, MRI
	 conditional, IS-1/DF-1 connector
	Medtronic Australasia Pty Ltd
MI112	Evera XT VR DF1	Single Chamber Implantable 	33cm³ 77g	$43,920.00
	Cardioverter Defibrillator with 
	PhysionCurve Design, Optimised 
	Battery Chemistry, SmartShock 
	Technology 2.0, Optivol 2.0 Fluid 
	Status Monitoring, Complete Capture 
	Management. DF1
MI114	Evera S VR DF1	Single Chamber Implantable 	33cm³ 77g	$43,920.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, DF1
	Sorin Group Australia Pty Ltd
SA157	PARADYM™ RF VR 9250	Single Chamber, High Energy, 	69.5 x 73.4 x 11mm 38.6cc 	$43,920.00
	Implantable Cardioverter Defibrillator	95g
	 with rate response and remote 
	monitoring.
	St Jude Medical Australia Pty Ltd
SJ326	Ellipse VR CD1377-36/CD1377-36C	Single Chamber Cardioverter 	31cc, 66g	$43,920.00
	Defribrillator
SJ333	Fortify Assura VR CD1359-	Single Chamber Cardioverter 	76g , 35cc	$43,920.00
	40/CD1359-40C	Defibrillator with 40J delivered energy
	a,d,e
	Medtronic Australasia Pty Ltd
MI111	Evera XT VR DF4	Single Chamber Implantable 	33cm³ 77g	$44,670.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, Optivol 2.0 Fluid 
	Status Monitoring, Complete Capture 
	Management. DF4
Prostheses List by Category, Groups and Sponsor	Page 612 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI113	Evera S VR DF4	Single Chamber Implantable 	33cm³ 77g	$44,670.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, DF4
	St Jude Medical Australia Pty Ltd
SJ318	Fortify Assura VR CD1359-	Single Chamber Cardioverter 	75g, 35cc	$44,670.00
	40Q/CD1359-40QC	Defibrillator
SJ332	Ellipse VR CD1377-36Q/CD1377-	Single Chamber Cardioverter 	67g, 30cc	$44,670.00
	36QC	Defibrillator with 36 J delivered 
	d
	St Jude Medical Australia Pty Ltd
SJ213	Current Accel VR RF CD1215-30	Single chamber cardioverter 	73g, 37cc	$41,820.00
	defibrillator with RF telemetry
	a,d
	Biotronik Australia Pty Ltd
BT129	Lumax 740 VR-T DX	High Energy Single Chamber ICD 	W x H x D (mm) 66 x 55 x 	$43,920.00
	with Atrial Diagnostics and Home 	13, Volume: 37.2cc, Mass: 
	Monitoring. Conditionally MRI 	92g
	compatible
BT131	Lumax 740 VR-T	Single Chamber ICD with 40J output 	WxHxD (mm) 66 x 55 x 13, 	$43,920.00
	with Advanced Patient Management, 	Volume: 37cc, Mass: 92g
	Home Monitoring, Automatic 
	Threshold Monitoring and MRI 
	Conditional compatibility
	a,d,e
	Biotronik Australia Pty Ltd
BT150	Ilesto 7 VR-T DF-4	Single Chamber ICD, rate adaptive, 	W x H x D (mm) 65 x 55 x 	$44,670.00
	max. 40J shock energy, Home 	11, Volume: 31cc, Mass: 
	Monitoring, MR conditional, IS-
	1/DF4 connector
Prostheses List by Category, Groups and Sponsor	Page 613 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.02.01 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex 
	a
	Sorin Group Australia Pty Ltd
SA147	Paradym DR 8550	Dual Chamber, High Energy, 	Weight: 90 grams; Volume: 	$45,760.00
	Implantable Cardioverter Defibrillator	32.6cc; Dimensions: 58.4 x 
	 with rate response	73.4 x 11mm
	a, d
	Biotronik Australia Pty Ltd
BT086	Lumax 340 DR-T	Dual-chamber ICD with 40 J output 	Dimensions: 66mm x 55mm 	$45,760.00
	and Home Monitoring	x 13mm, Volume: 37cc, 
	Mass: 92g
BT101	Lumax 540 DR-T	Dual-Chamber ICD with 40 J output 	Dimensions: 66mm x 55mm 	$45,760.00
	with Advanced Patient Management, 	x 13mm, Volume: 37cc, 
	Home Monitoring, Automatic 	Mass: 92g
	Ventricular Threshold Monitoring 
	and Extended Longevity.
	Boston Scientific Australia Pty Ltd
BS135	Teligen 100 DR DF-1/IS-1	Dual chamber ICD, high energy with 	31.5cc, 9.9mm	$45,760.00
	RF
BS200	ENERGEN DR ICD	High energy dual chamber ICD with 	32cc, 9.9mm, 72g	$45,760.00
	DF-1 RV connector
BS206	INCEPTA DR ICD	Hight energy dual chamber ICD with 	31.5cc, 9.9mm, 72g	$45,760.00
	DF-1 RV connector
	a, d, e
	Boston Scientific Australia Pty Ltd
BS134	TELIGEN 100 HE DR 4-SITE	Dual Chamber ICD, high energy with 	31.55cc, 9.9mm	$46,510.00
	RF IS4
BS201	ENERGEN DF-4 DR ICD	High energy dual chamber ICD with 	31.5cc, 9.9mm, 72g	$46,510.00
	DF-4 RV connector
BS207	INCEPTA DF-4 DR ICD	High energy dual chamber ICD with 	31.5cc, 9.9mm, 72g	$46,510.00
	DF-4 RV connector
Prostheses List by Category, Groups and Sponsor	Page 614 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a,d
	Biotronik Australia Pty Ltd
BT130	Lumax 740 DR-T	Dual Chamber ICD with 40J output 	WxHxD (mm) 66 x 55 x 13, 	$45,760.00
	with Advanced Patient Management, 	Volume: 37cc, Mass: 92g
	Home Monitoring, Automatic 
	Ventricular Threshold Monitoring 
	and conditionally MRI compatible.
08.02.02 - Features of 8.2.1 plus auto test sensing parameters, auto 
	a, c, d
	Medtronic Australasia Pty Ltd
MC814	Secura DR Model D234DRG	Fully Automatic, Wireless 	37cc, 68g	$47,130.00
	Implantable cardioverter defibrillator 
	with high energy capability and 
	therapies for ventricular and atrial 
MI016	PROTECTA XT DR D354DRG	Dual chamber implantable 	Volume 37cc, Mass 68g	$47,130.00
	cardioverter defribillator with 
	SmartShock Technology, OptiVol 2.0 
	Fluid Status Monitoring and 
	Complete Capture Management 
	a, c, d, e
	Medtronic Australasia Pty Ltd
MI025	Protecta XT DR D354DRM	Dual chamber implantable 	Volume 41cc, Mass 73g	$47,880.00
	cardioverter defribillator with 
	SmartShock Technology, OptiVol 2.0 
	Fuild Status Monitoring and 
	Complete Capture Management 
MI034	Secura DR Model D214DRM	Fully Automatic, Wireless 	37cc	$47,880.00
	Implantable cardioverter defibrillator 
	with high energy capability and 
	therapies for ventricular and atrial 
	tachyarrhythmia. DF-4 lead connector.
Prostheses List by Category, Groups and Sponsor	Page 615 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a, d
	St Jude Medical Australia Pty Ltd
SJ153	Current Accel DR RF CD2215-36	Dual Chamber Cardioverter 	80g, 42cc	$47,130.00
	Defibrillator with RF Telemetry
SJ248	Fortify ST DR CD2235-40	Dual chamber cardioverter 	35cc, 76g	$47,130.00
	defibrillator with 40J delivered 
	energy and ST segment monitoring
SJ297	Fortify Assura DR CD2259-40	Dual chamber cardioverter 	35cc, 76g	$47,130.00
	defibrillator with 40J delivered 
	energy and ST segment monitoring
SJ300	Ellipse DR CD2277-36	Dual chamber cardioverter 	66g, 31cc	$47,130.00
	defibrillator with 36J delivered 
	energy and ST segment monitoring
	a, d, e
	St Jude Medical Australia Pty Ltd
SJ239	Current Accel DR CD2215-36Q	Dual Chamber Cardioverter 	80g, 41cc	$47,880.00
	Defibrillator with RF Telemetry and 
	SJ4 connector
SJ250	Fortify ST DR CD2235-40Q	Dual chamber cadioverter defibrillator	35cc, 75g	$47,880.00
	 with 40J delivered energy and ST 
	segment monitoring
SJ310	Fortify Assura DR CD2259-40Q	Dual Chamber cardioverter defrillator 	35cc, 75g	$47,880.00
	with 40J delivered energy and ST 
	segment monitoring with DF4 
	connector
SJ313	Ellipse DR CD2277-36Q	Dual chamber cardioverter 	68g, 31cc	$47,880.00
	defibrillator with 36J delivered 
	energy and ST segment monitoring 
	with DF4 connector
Prostheses List by Category, Groups and Sponsor	Page 616 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a,c,d
	Medtronic Australasia Pty Ltd
MI116	Evera XT DR IS1/DF1	Dual Chamber Implantable 	34cm³ 78g	$47,130.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, Optivol 2.0 Fluid 
	Status Monitoring, Complete Capture 
	Management and Atrial Therapies. DF1
MI118	Evera S DR IS1/DF1	Dual Chamber Implantable 	34cm³ 78g	$47,130.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, DF1
	a,c,d,e
	Medtronic Australasia Pty Ltd
MI115	Evera XT DR IS1/DF4	Dual Chamber Implantable 	34cm³ 78g	$47,880.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, Optivol 2.0 Fluid 
	Status Monitoring, Complete Capture 
	Management and Atrial Therapies. DF4
MI117	Evera S DR IS1/DF4	Dual Chamber Implantable 	34cm³ 78g	$47,880.00
	Cardioverter Defibrillator with 
	PhysioCurve Design, Optimised 
	Battery Chemistry, Smart Shock 
	Technology 2.0, DF4
	a,d
	Biotronik Australia Pty Ltd
BT145	Ilesto 7 DR-T	Dual Chamber ICD, rate adaptive, 	W x H x D (mm) 65 x 55 x 	$47,130.00
	Max. 40J shock energy, Home 	11, Volume: 31cc, Mass: 
	Monitoring, MRI conditional, IS-
	1/DF-1 connector
Prostheses List by Category, Groups and Sponsor	Page 617 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sorin Group Australia Pty Ltd
SA156	PARADYM™ RF DR 9550	Dual Chamber Implantable 	69.5 x 73.4 x 11mm 38.6cc 	$47,130.00
	Cardioverter Defibrillator with rate 	95g
	response, high output extended 
	longevity and remote monitoring.
	St Jude Medical Australia Pty Ltd
SJ324	Fortify Assura DR CD2359-	Dual Chamber Cardioverter 	75g, 35cc	$47,130.00
	40/CD2359-40C	Defibrillator
SJ327	Ellipse DR CD2377-36/CD2377-	Dual Chamber ICD	66g, 31cc	$47,130.00
	a,d,e
	St Jude Medical Australia Pty Ltd
SJ325	Fortify Assura DR CD2359-	Dual Chamber Cardioverter 	75g, 35cc	$47,880.00
	40Q/CD2359-40QC	Defibrillator with 40J delivered energy
SJ331	Ellipse DR CD2377-36Q/CD2377-	Dual Chamber Cardioverter 	68g, 31cc	$47,880.00
	36QC	Defibrillator with 36J delivered energy
	d
	St Jude Medical Australia Pty Ltd
SJ214	Current Accel DR RF CD2215-30	Dual chamber cardioverter 	74g, 38cc	$46,030.00
	defribillator with RF telemetry
	a,d,e
	Biotronik Australia Pty Ltd
BT151	Ilesto 7 DR-T DF-4	Dual chamber ICD, rate adaptive, max. 	W x H x D (mm) 65 x 55 x 	$47,880.00
	40J shock energy, Home Monitoring, 	11, Volume: 31 cc, Mass: 80g
	MR conditional, IS-1/DF4 connector
08.03.01 - Dual Chamber, Bivent pacing, Vent tachyarrhythmia 
	a
	Sorin Group Australia Pty Ltd
SA145	PARADYM CRT-D 8750	Implantable Cardioverter Defibrillator	34cc,  94 grams;  61.8 x 73.4	$47,840.00
	 with Cardiac Resynchronisation 	 x 11mm
	therapy, High Energy
Prostheses List by Category, Groups and Sponsor	Page 618 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a, d
	Biotronik Australia Pty Ltd
BT102	Lumax 540 HF-T	CRT-ICD with 40 J output with 	Dimensions: 66mm x 59mm 	$47,840.00
	Advanced Patient Management, Home	x 13 mm, Volume: 39.8cc, 
	 Monitoring, Automatic right and left-	Mass: 94g
	ventricular Threshold Monitoring and
	 Extended Longevity.
	Boston Scientific Australia Pty Ltd
BS139	COGNIS 100 HE (DF-1/IS-1 & DF-	CRT-D high energy with RF	32.5cc, 9.9mm	$47,840.00
	1/LV-1)
BS203	ENERGEN CRT-D	High energy CRT-D with DF-1 RV 	32.5cc, 9.9mm, 72g	$47,840.00
	connector and IS-1 LV connector
BS209	INCEPTA CRT-D	High energy CRT-D with DF-1 RV 	32.5cc, 9.9mm, 72g	$47,840.00
	connector & lS-1 (N163) or LV-1 
	(N165) LV connector
	a, d, e
	Boston Scientific Australia Pty Ltd
BS138	COGNIS 100 HE 4-SITE	CRT-D high energy with RF IS4	32cc, 9.9mm	$48,590.00
BS202	ENERGEN DF-4 CRT-D	High energy CRT-D with DF-4 RV 	32cc, 9.9mm, 72g	$48,590.00
	connector and IS-1 LV connector
BS205	INCEPTA DF-4 CRT-D	High energy CRT-D with DF-4 RV 	32cc, 9.9mm. 72g	$48,590.00
	connector and  lS-1 LV connector
	a,d
	Biotronik Australia Pty Ltd
BT128	Lumax 740 HF-T	CRT-ICD with 40J output with 	W x H x D (mm) 66 x 59 x 	$47,840.00
	Advanced Patient Management, Home	13, Volume: 39.8cc, Mass: 
	 Monitoring, automatic right and left 	94g
	ventricular Threshold Monitoring and
	 conditionally MRI compatible
Prostheses List by Category, Groups and Sponsor	Page 619 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.03.02 - Features of 8.3.1 plus auto test sensing parameters, auto 
	a, c, d
	Medtronic Australasia Pty Ltd
MC812	Consulta CRT-D Model D234TRK	Fully Automatic, Wireless 	38cc, 68g	$52,000.00
	Implantable cardioverter defibrillator 
	with cardiac resynchronization 
	therapy (CRT), and therapies for 
	ventricular and atrial tachyarrhythmia
MI017	Protecta XT CRT-D D354TRG	Implantable Cardioverter Defibrillator	Volume 38cc, Mass 68g	$52,000.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Technology, 
	OptiVol 2.0 Fluid Status Monitoring 
	and Complete Capture Management 
	Specifications (DF-1)
	a, c, d, e
	Medtronic Australasia Pty Ltd
MC983	Consulta CRT-D Model D214TRM	Fully Automatic, Wireless 	38cc	$52,750.00
	Implantable cardioverter defribillator 
	with cardiac resynchronization 
	therapy (CRT), and therapies for 
	ventrilcular and atrial 
MI026	Protecta XT CRT-D D354TRM	Implantable Cardioverter Defibrillator	Volume 40cc, Mass 73g	$52,750.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Technology, 
	OptiVol 2.0 Fluid Status Monitoring 
	and Complete Capture Management 
	Specifications (DF-4)
MI070	VIVA XT CRT-D DTBA2D4	Implantable Cardioverter Defibrillator	35cc, 82g	$52,750.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Technology, 
	OptiVol 2.0 Fluid Status Monitoring, 
	Complete Capture Management 
	Specifications (DF4), and 
	a, d
	St Jude Medical Australia Pty Ltd
SJ150	Promote Accel RF CD3215-36	Cardiac Resynchronisation Therapy 	82g, 43cc	$52,000.00
	Defibrillator with RF Telemetry
Prostheses List by Category, Groups and Sponsor	Page 620 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SJ246	Unify CRT CD3235-40	Cardiac Resynchronisation Therapy 	36cc, 78g	$52,000.00
	Defibrillator with 40J delivered
SJ253	Promote Quadra CRT CD3239-40	Cardiac Resynchronisation Therapy 	46cc, 88g	$52,000.00
	Defibrillator with 40J delivered 
	energy and VectSelect Quartet 
	Programmable LV pulse configuration
SJ271	Unify Quadra CRT CD 3251-40	Cardiac Resynchronisation Therapy 	40cc, 83g	$52,000.00
	Defibrillator with 40J delivered plus 
	Quadripolar pacing
SJ281	Promote Quadra CRT CD3237-40	Cardiac Resynchronisation Therapy 	46cc, 88g	$52,000.00
	Defibrillator with 40J delivered 
	energy, VectSelect Quartet 
	Programmable LV pulse configuration
	 and Multisite Pacing
SJ298	Quadra Assura CD3267-40	Cardiac Resynchronisation Therapy 	40cc, 83g	$52,000.00
	Defibrillator with 40J delivered and 
	Multisite Left Ventricular Pacing and 
	Quadripolar pacing
SJ301	Unify Assura CD3261-40	Cardiac Resynchronisation Therapy 	36cc, 78g	$52,000.00
	Defribrillator with 40J delivered 
	a, d, e
	St Jude Medical Australia Pty Ltd
SJ236	Promote Accel CD3215-36Q	Cardiac Resynchronisation Therapy 	82g, 43cc	$52,750.00
	Defibrillator with RF Telemetry and 
	SJ4 connector
SJ244	Unify CRT CD3235-40Q	Cardiac Resynchronisation Therapy 	36cc, 77g	$52,750.00
	Defibrillator with 40J delivered 
	energy and SJ4 connector
SJ252	Promote Quadra CRT CD3239-40Q	Cardiac Resynchronisation Therapy 	46cc, 88g	$52,750.00
	Defibrillator with 40J delivered 
	energy and VectSelect Quartet 
	Programmable LV pulse configuration
	 and SJ 4 connector
SJ272	Unify Quadra CRT CD 3251-40Q	Cardiac Resynchronisation Therapy 	38cc, 81g	$52,750.00
	Defibrillator with 40J delivered 
	energy with quadripole pacing and 
	SJ4 connector
Prostheses List by Category, Groups and Sponsor	Page 621 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SJ312	Quadra Assura CD3267-40Q	Cardiac Resynchronisation Therapy 	38cc, 81g	$52,750.00
	Defribrillator with 40J delivered 
	energy, Multisite Left Ventricular 
	Pacing plus Quadripolar pacing and 
	SJ4 connector
SJ314	Unify Assura CD3261-40Q	Cardiac Resynchronisation Therapy 	36cc, 77g	$52,750.00
	Defribrillator with 40J delivered 
	energy and SJ4 connector
	a,c,d
	Medtronic Australasia Pty Ltd
MI069	VIVA XT CRT-D DTBA2D1	Implantable Cardioverter Defibrillator	35cc, 82g	$52,000.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Technology, 
	OptiVol 2.0 Fluid Status Monitoring, 
	Complete Capture Management 
	Specifications (DF1), and 
MI071	VIVA S CRT-D DTBB2D1	Implantable Cardioverter Defibrillator	35cc, 82g	$52,000.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Tehnology, 
	OptiVol 2.0 Fluid Status Monitoring 
	and Complete Capture Management 
	Specifications (DF1)
	a,c,d,e
	Medtronic Australasia Pty Ltd
MI072	VIVA S CRT-D DTBB2D4	Implantable Cardioverter Defibrillator	35cc, 82G	$52,750.00
	 with Cardiac Resynchronisation 
	therapy, SmartShock Tehnology, 
	OptiVol 2.0 Fluid Status Monitoring 
	and Complete Capture Management 
	Specifications (DF4)
	a,d
	Biotronik Australia Pty Ltd
BT146	Ilesto 7 HF-T	Triple Chamber CRT-D device, rate 	W x H x D (mm) 65 x 58.5 x 	$52,000.00
	adaptive, max. 40J shock energy, 	11, Volume: 33 cc, Mass: 80g
	Home Monitoring, MRI conditional,  
	IS-1/DF-1 connector
Prostheses List by Category, Groups and Sponsor	Page 622 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sorin Group Australia Pty Ltd
SA158	PARADYM™ RF CRT-D 9750	Implantable Cardioverter 	69.5 x 73.4 x 11mm 38.6cc 	$52,000.00
	Defibrillator, for resyncronisation of 	95g
	heart failure, high output extended 
	longevity and home monitoring.
SA159	PARADYM™ RF CRT-D SonR 	Implantable Cardioverter Defibrillator	69.5 x 73.4 x 11mm 38.6cc 	$52,000.00
	 for resyncronisation of heart failure, 	95g
	high output, extended longevity and 
	home monitoring, and in conjunction 
	with a dedicated atrial lead with SonR
	 sensor provides automatic adjustment
	 of AV/VV delays for optimisation of 
	resynchronisation therapy.
	St Jude Medical Australia Pty Ltd
SJ319	Quadra Assura MP CD3371-	Cardiac Resynchronisation Therapy 	83g, 40cc	$52,000.00
	40/CD3371/40C	Cardioverter Defibrillator
SJ320	Unify Assura CD3361-40/CD3361-	Cardiac Resynchronisation Therapy 	78g, 36cc	$52,000.00
	40C	Cardioverter Defibrillator
SJ323	Quadra Assura CD3367-	Cardiac Resynchronisation Therapy 	83g, 40cc	$52,000.00
	40/CD3367-40C	Defibrillator with 40J delivered energy
SJ328	Unify Quadra MP CD 3255-40	Cardiac Resynchronisation Therapy 	40cc, 83g	$52,000.00
	Defibrillator with 40J delivered and 
	Multisite Left Ventricular Pacing and 
	Quadripolar pacing
	a,d,e
	Medtronic Australasia Pty Ltd
MI109	VIVA QUAD XT CRT-D IS4/DF4	ICD with CRT. PhysioCurve Design, 	35cm³ 81g	$52,750.00
	AdaptivCRT Algorithm, CardioSync 
	Optimisation, VextorExpress, LV 
	Automated Test, Optimised Battery 
	Chemistry, Smart Shock Technology 
	2.0, Optivol 2.0 Fluid Status 
	Monitoring, Complete Capture 
	Management and Atrial Therapies. IS4
	 DF4
Prostheses List by Category, Groups and Sponsor	Page 623 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI110	VIVA QUAD S CRT-D IS4/DF4	ICD with CRT. PhysioCurve Design, 	35cm³ 81g	$52,750.00
	CardioSync Optimisation, 
	VectorExpress, V Automated Test, 
	Optimised Battery Chemistry, Smart 
	Shock Technology 2.0. Complete 
	Capture management. IS4 DF4
	St Jude Medical Australia Pty Ltd
SJ282	Promote Quadra CD3237-40Q	Cardiac Resynchronisation Therapy 	44cc, 87g	$52,750.00
	Defibrillator with 40J delivered 
	energy and VectSelect Quartet 
	Programmable LV pulse configuration
	 plus Multisite Left Ventricular 
	Pacing and SJ4 connector.
SJ321	Quadra Assura MP CD3371-	Cardiac Resynchronisation Therapy 	80gm, 38cc	$52,750.00
	40Q/CD3371-40QC	Defibrillator
SJ322	Unify Quadra MP CD 3255-40Q	Cardiac Resynchronisation Therapy 	38cc , 81g	$52,750.00
	Defibrillator with 40J delivered 
	energy, Multisite Left Ventricular 
	Pacing plus Quadripolar pacing and 
SJ329	Unify Assura CD3361-	Cardiac Resynchronisation Therapy 	77g, 36cc	$52,750.00
	40Q/CD3361-40QC	Cardioverter Defibrillator
SJ330	Quadra Assura CD3367-	Cardiac Resynchronisation Therapy 	80g, 38cc	$52,750.00
	40Q/CD3367-40QC	Defibrillator with 40J delivered energy
	d
	St Jude Medical Australia Pty Ltd
SJ145	Promote Accel CD3215-30	Cardiac Resyncronisation Therapy 	76g, 39cc	$49,760.00
	Defibrillator with RF Telemetry
Prostheses List by Category, Groups and Sponsor	Page 624 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	a,d
	Medtronic Australasia Pty Ltd
MI130	VIVA QUAD XT CRT-D IS4/DF1	ICD with CRT. PhysioCurve Design, 	35cm³ 81g	$52,000.00
	Adaptiv CRT Algorithm, CardioSync 
	Optimisation, VectorExpress, LV 
	Automated Test, Optimised Battery 
	Chemistry, Smart Shock Technology 
	2.0, Optivol 2.0 Fluid Status 
	Monitoring, Complete Capture 
	Management and Atrial Therapies. IS4
	 DF1
MI131	VIVA QUAD S CRT-D IS4/DF1	ICD with CRT. PhysioCurve Design, 	35cm³ 81g	$52,000.00
	CardioSync Optimisation, 
	VectorExpress, LV Automated Test, 
	Optimised Battery Chemistry, Smart 
	Shock Technology 2.0. Complete 
	capture management. IS4 DF1
	a,d,e
	Biotronik Australia Pty Ltd
BT152	Ilesto 7 HF-T DF-4	Triple Chamber CRT-D device, rate 	W x H x D (mm) 65 x 56 x 	$52,750.00
	adaptive, max. 40J shock energy, 	11, Volume: 33 cc, Mass: 80g
	Home Monitoring, MR conditional, 
	lS-1/DF4 connector.
08.04.02 - SSIR pacemakers with rate responsive feature
	St Jude Medical Australia Pty Ltd
SJ076	Verity Adx Model  XL SR 5157 M/S	Single Chamber  multi-programmable 	11cc, 23g	$5,928.00
	 implantable pacemaker	rate-adaptive pacing devices with 
	extended longevity
Prostheses List by Category, Groups and Sponsor	Page 625 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.04.03 - SSIR with small/compact size, multi-programmability & 
	Biotronik Australia Pty Ltd
BT109	Entovis SR	Fully automatic, single chamber 	Size: 53mm x 39mm x 6.5mm 	$5,928.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation and extended longevity	Mass: 24g
BT113	Evia SR	Fully automatic, single chamber 	Size: 53mm x 39mm x 6.5mm 	$5,928.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11 
	Stimulation and extended longevity	cm3, Mass: 24 g
	Boston Scientific Australia Pty Ltd
BS145	Altrua 20 SR	Single chamber rate responsive 	10cc - 15cc	$5,928.00
	pacemaker
BS147	Altrua 40 SR	Single chamber rate responsive 	10cc - 15cc	$5,928.00
	pacemaker
BS149	Altrua 50 SR	Single chamber rate responsive 	10cc - 15cc	$5,928.00
	pacemaker
BS152	Altrua 60 SR	Single chamber rate responsive 	10cc - 15cc	$5,928.00
	pacemaker
	Medtronic Australasia Pty Ltd
MC728	Adapta Pacemaker	SR PacemakerModels ADSR01, 	9.7 - 11.0cc21.5 - 22.5g	$5,928.00
	ADSR06, ADSR03
	Sorin Group Australia Pty Ltd
SA142	Reply™ SR	Single chamber permenent pacemaker 	37 x 41.5 x 6.1mm	$5,928.00
	with rate response modulation	19 Grams
	7.5 cm3
SA143	ESPRIT SR	Single Chamber Permanent Pacemaker 	Dimensions: 37.4 x 41.5 x 	$5,928.00
	with Rate Response Modulation	6.1mm Weight : 19grams. 
	Volume: 7.5 cm3
	St Jude Medical Australia Pty Ltd
SJ105	Zephyr SR 5620	Single Chamber Rate-Responsive 	8cc, 17g	$5,928.00
	Pacemaker
SJ131	Zephyr XL SR 5626	Single-Chamber Rate-Responsive 	23.5g and 10.4cc	$5,928.00
	Pacemaker
Prostheses List by Category, Groups and Sponsor	Page 626 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SJ205	Accent SR PM 1110	Single Chamber Rate Responsive 	18g, 9.5cc	$5,928.00
	Pacemaker
SJ255	Accent ST PM1122	Single Chamber Pacemaker with ST 	21g, 9.5cc	$5,928.00
	segment monitoring
SJ294	Accent MRI SR PM1124	Single Chamber Pacemaker with MRI 	23g, 13.1cc	$5,928.00
	testing capability
	f
	St Jude Medical Australia Pty Ltd
SJ027	St Jude Medical Microny II SR+ 	Single Chamber Rate Responsive 	Volume 5.9cc, Weight 12.8gm	$5,928.00
	Model 2525T Pacemaker	Pacemaker
	i
	Biotronik Australia Pty Ltd
BT108	Entovis SR-T	Fully automatic, single chamber 	Size: 53mm x 39mm x 6.5mm 	$5,928.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Home Monitoring and 	Mass: 24g
	extended longevity
BT110	Evia SR-T	Fully automatic, single chamber 	Size: 53mm x 39mm x 6.5mm 	$5,928.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Home Monitoring and 	Mass: 24g
	extended longevity
	Boston Scientific Australia Pty Ltd
BS220	INGENIO SR	Single Chamber Pacemaker	11.5cc	$5,928.00
BS223	ADVANTIO SR	Single Chamber Pacemaker	11.5cc	$5,928.00
BS233	ADVANTIO MRI SR	Single Chamber Pacemaker, MRI 	11.5cc	$5,928.00
	Compatible
BS236	INGENIO MRI SR	Single Chamber Pacemaker, MRI 	11.5cc	$5,928.00
	Compatible
	St Jude Medical Australia Pty Ltd
SJ200	Accent SR RF PM1210	Single Chamber Pacemaker with RF 	23g, 12.8cc	$5,928.00
	telemetry
SJ257	Accent ST RF PM1222	Single Chamber Pacemaker with ST 	12.8g, 23g	$5,928.00
	Segment Monitoring and RF 
SJ259	Accent MRI SR RF PM1224	Single Chamber Pacemaker with RF 	23g, 13.1cc	$5,928.00
	Telemetry and MRI testing capability
Prostheses List by Category, Groups and Sponsor	Page 627 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	St Jude Medical Australia Pty Ltd
SJ335	Endurity PM1160	Single Chamber Rate Responsive 	10.5cc, 19g	$5,928.00
	Pacemaker
	i
	Boston Scientific Australia Pty Ltd
BS267	VITALIO SR	Single Chamber Pacemaker, 	11.5cc	$5,928.00
	Compatible
BS271	VITALIO MRI SR	Single Chamber Pacemaker, MRI 	11.5cc	$5,928.00
	Compatible
	St Jude Medical Australia Pty Ltd
SJ334	Assurity PM1240	Single Chamber Rate-Responsive 	10.4cc, 20g	$5,928.00
	Pacemaker with RF Telemetry
SJ340	Assurity+ PM1260	Single Chamber Rate-Responsive 	10.4cc. 20g	$5,928.00
	Pacemaker with RF Telemetry
08.05.01 - DDD/VDD (Communication capability)
	Boston Scientific Australia Pty Ltd
BS150	Altrua 50 VDD	Dual chamber VDD pacemaker	10cc - 15cc	$5,200.00
08.05.02 - DDDR/VDDR including rate responsive feature
	Medtronic Australasia Pty Ltd
MC713	Adapta Pacemaker	VDDR PacemakerModels ADVDD01	11.1cc23.6g	$6,760.00
08.05.03 - DDDR with four or more advanced features
	Boston Scientific Australia Pty Ltd
BS144	Altrua 20 DR	Dual chamber rate responsive 	10cc - 15cc	$9,360.00
	pacemaker
Prostheses List by Category, Groups and Sponsor	Page 628 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS146	Altrua 40 DR	Dual chamber rate responsive 	10cc - 15cc	$9,360.00
	pacemaker
BS148	Altrua 50 DR	Dual chamber rate responsive 	10cc - 15cc	$9,360.00
	pacemaker
BS151	Altrua 60 DR	Dual chamber rate responsive 	10cc - 15cc	$9,360.00
	pacemaker
	Sorin Group Australia Pty Ltd
SA141	Reply™ DR	Dual Chamber permanent Pacemaker 	8cc, Weight: 20grams, 	$9,360.00
	with Rate Response Modulation	Dimensions:41.2 x 41.5 x 
	6.1mm
SA144	ESPRIT DR	Dual Chamber Permanent Pacemaker 	8cc, Weight: 20grams, 	$9,360.00
	with Rate Response Modulation	Dimensions:41.2 x 41.5 x 
	6.1mm
	St Jude Medical Australia Pty Ltd
SJ051	Verity ADX XL DR 5357 M/S	Dual - Chamber, multi-programmable, 	45x52x6mm,11cc, 23g, 5mm 	$9,360.00
	rate-responsive pacemaker withAF 	or 6mm M/S
	suppression
	i
	Boston Scientific Australia Pty Ltd
BS218	INGENIO EL DR	Dual Chamber Pacemaker, extended 	14cc	$11,440.00
BS219	INGENIO DR	Dual Chamber Pacemaker	12cc	$11,440.00
BS221	ADVANTIO EL DR	Dual Chamber Pacemaker, Extended 	14cc	$11,440.00
	Life
BS222	ADVANTIO DR	Dual Chamber Pacemaker	12cc	$11,440.00
BS231	ADVANTIO MRI EL DR	Dual Chamber Pacemaker, Extended 	14cc	$11,440.00
	Life, MRI Conditional
BS232	ADVANTIO MRI DR	Dual Chamber Pacemaker, MRI 	12cc	$11,440.00
	Compatible
BS234	INGENIO MRI EL DR	Dual Chamber Pacemaker, Extended 	14cc	$11,440.00
	Life, MRI Compatible
BS235	INGENIO MRI DR	Dual Chamber Pacemaker, MRI 	12cc	$11,440.00
	Compatible
Prostheses List by Category, Groups and Sponsor	Page 629 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.05.04 - DDDR with continuous threshold monitoring in atrium + 
	Biotronik Australia Pty Ltd
BT111	Entovis DR	Fully automatic, dual chamber 	Size: 53mm x 43mm x 6.5mm 	$11,440.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Vp suppression and 	Mass: 26g
	extended longevity
BT112	Evia DR	Fully automatic, dual chamber 	Size: 53mm x 43mm x 6.5mm 	$11,440.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Vp suppression and 	Mass: 26g
	extended longevity
	Medtronic Australasia Pty Ltd
MC726	Adapta Pacemaker	DR PacemakerModels ADDR01, 	11.1-14.2cc23.6g-31.3g	$11,440.00
	ADDRS1, ADDRL1, ADDR06, 
	ADDR03
	St Jude Medical Australia Pty Ltd
SJ103	Zephyr XL DR 5826 and DR 5820	Dual Chamber Rate-Responsive 	5826 - 23.5g, 11cc and 	$11,440.00
	Pacemaker	5820 - 18g, 8.5cc
SJ193	Accent DR PM 2112	Dual Chamber Pacemaker	19g, 10.5cc	$11,440.00
SJ256	Accent ST PM2122	Dual Chamber Pacemaker with ST 	10.5cc, 19g	$11,440.00
	segment monitoring
SJ295	Accent MRI DR PM2124	Dual Chamber Pacemaker with MRI 	24g, 13.1cc	$11,440.00
	testing capability
	g
	Medtronic Australasia Pty Ltd
MC933	Advisa DR MRI SureScan	Model A3DR01 Digital dual chamber 	13cc, 22g	$11,780.00
	pacemaker with SureScan Technology 
	(OAE-DDDR) MR Conditional with 
	MVP Mode, Complete Capture 
	Management Diagnostic (ACM, 
	RVCM), AT/AF Suite Diagnostics 
	and Therapies, OptiVol Fluid Status 
	Monitoring, and Therapy Guide Fea
Prostheses List by Category, Groups and Sponsor	Page 630 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC934	Advisa DR	Model A5DR01 Digital dual chamber 	13cc, 22g	$11,780.00
	pacemaker (OAE-DDDR)  MVP mode 
	with Complete Capture Management 
	Diagnostic (ACM, RVCM)  AT/AF 
	Suite Diagnostics and Therapies, 
	OptiVol Fluid Status Monitoring, and
	 Therapy Guide Feature
	i
	Biotronik Australia Pty Ltd
BT114	Evia DR-T	Fully automatic, dual chamber 	Size: 53mm x 43mm x 6.5mm 	$11,440.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Home Monitoring, Vp 	Mass: 26g
	suppression and extended longevity
BT115	Entovis DR-T	Fully automatic, dual chamber 	Size: 53mm x 43mm x 6.5mm 	$11,440.00
	pacemaker with Closed Loop 	(W x H x D), Volume: 11cc, 
	Stimulation, Home Monitoring, Vp 	Mass: 26g
	suppression and extended longevity
	St Jude Medical Australia Pty Ltd
SJ196	Accent DR RF PM2212	Dual chamber Pacemaker with RF 	236, 12.8cc	$11,440.00
	telemetry
SJ254	Accent ST RF PM2222	Dual Chamber Pacemeker with ST 	23g, 12.9cc	$11,440.00
	Segment Monitoring and RF 
SJ258	Accent MRI DR RF PM2224	Dual Chamber Pacemaker with RF 	24g, 13.1cc	$11,440.00
	Telemetry and MRI testing capability
	St Jude Medical Australia Pty Ltd
SJ336	Endurity PM2160	Dual Chamber Rate  Responsive 	10.4cc, 19g	$11,440.00
	Pacemaker 
	i
	Boston Scientific Australia Pty Ltd
BS264	FORMIO DR	Dual Chamber Pacemaker, Compatible	12cc	$11,440.00
BS265	VITALIO EL DR	Dual Chamber Pacemaker, extended 	14cc	$11,440.00
	life, Compatible
BS266	VITALIO DR	Dual Chamber Pacemaker, Compatible	12cc	$11,440.00
Prostheses List by Category, Groups and Sponsor	Page 631 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BS268	FORMIO MRI DR	Dual Chamber Pacemaker, MRI 	12cc	$11,440.00
	Compatible
BS269	VITALIO MRI EL DR	Dual Chamber Pacemaker, extended 	14cc	$11,440.00
	life MRI Compatible
BS270	VITALIO MRI DR	Dual Chamber Pacemaker, MRI 	12cc	$11,440.00
	Compatible
	St Jude Medical Australia Pty Ltd
SJ339	Assurity PM2240	Dual Chamber Rate Responsive 	10.4cc, 20g	$11,440.00
	Pacemaker with RF Telemetry
SJ341	Assurity+ PM2260	Dual Chamber Rate Responsive 	10.4cc, 20g	$11,440.00
	Pacemaker with RF Telemetry
08.06.01 - Dual Chamber, Biven pacing, programming enabling 
	Guidant Australia Pty Ltd
GU142	Contak Renewal TR2 CRT - P 	CRT-P	45x54x8.5mm, 14cc, 26gm	$12,480.00
	Model H140, Model H145
	i
	Biotronik Australia Pty Ltd
BT085	Stratos LV-T	Multiprogrammable biventricular 	Size: 55mm x 50mm x 6mm 	$12,480.00
	pacemaker with Home Monitoring	(W x H x D), Volume: 14 
	cm3, Mass: 30 g
	Boston Scientific Australia Pty Ltd
BS216	INVIVE LV-1	Cardiac Resynchronization Therapy 	15cc	$12,480.00
	Pacemaker
BS217	INVIVE IS-1	Cardiac Resyncronization Therapy 	15cc	$12,480.00
	Pacemaker
08.06.02 - Features of 8.6.1 plus continuous threshold monitoring in 
	St Jude Medical Australia Pty Ltd
SJ194	Anthem PM3112 CRT Pacemaker	Cardiac Resynchronisation Therapy 	21g, 11.5cc	$13,520.00
	Pacemaker
Prostheses List by Category, Groups and Sponsor	Page 632 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	g
	Medtronic Australasia Pty Ltd
MI012	Consulta CRT-P	Cardiac Resynchronisation Therapy 	One size only	$13,520.00
	Pacemaker, Model C3TR01
	i
	Biotronik Australia Pty Ltd
BT147	Evia HF-T	MRI conditional Multiprogrammable 	53mm x 49mm x 6.5mm (W x 	$13,520.00
	biventricular pacemaker with Home 	H x D), Volume: 14cm3 
	Monitoring	Mass: 26 grams
	St Jude Medical Australia Pty Ltd
SJ207	Anthem RF PM3212	CRT Pacemaker with RF telemetry	25g, 13.7cc	$13,520.00
	i
	Boston Scientific Australia Pty Ltd
BS262	INLIVEN IS-1	Cardiac Resynchronization therapy 	15cc	$13,520.00
	pacemaker
BS263	INLIVEN LV-1	Cardiac Resynchronization therapy 	15cc	$13,520.00
	pacemaker
	St Jude Medical Australia Pty Ltd
SJ337	Allure RF PM3222	CRT Rate Responsive Pacemaker with	14cc, 24g	$13,520.00
	 RF Telemetry
SJ338	Allure Quadra RF PM3242	CRT Quadripolar, Rate Responsive 	15cc, 27g	$13,520.00
	Pacemaker with RF Telemetry
08.07.01 - Coronary Sinus
	Medtronic Australasia Pty Ltd
MC026	Medtronic Transvene SVC Lead 	Model 6937-35, Model 6937-52, 	35 - 110cm x  660mm	$2,340.00
	Model 6937;	Model 6937-58, Model 6937-110; 
	Silicone;
Prostheses List by Category, Groups and Sponsor	Page 633 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.07.02 - Subcutaneous
	Guidant Australia Pty Ltd
GU123	Endotak SQ Array XP Lead Model 	Sub-Q Array for high DFT	70cm	$4,680.00
	0085
	Medtronic Australasia Pty Ltd
MC251	Implantable Subcutaneous 	Silicone and Platinum Alloy	Lengths 41-85cm inclusive	$4,680.00
	Defibrillator Lead Model 6996SQ 
	41cm, 58cm, 85cm
08.07.05 - Transvenous/Steroid/Passive
	Biotronik Australia Pty Ltd
BT092	Linox TD	Fractal and steroid coated passive 	65, 74 or 100cm length and 	$9,000.00
	fixation quadripolar ICD lead	16 or 18mm electrode spacing
BT093	Linox T	Single-shock coil ICD lead with 	Lengths: 65, 75 cm	$9,000.00
	passive fixation
BT119	Linox SMART TD	Dual-shock coil ICD lead with 	Lengths: 65, 75 cm, 	$9,000.00
	passive fixation and hydrophilic 	Diameter: 7.8Fr
	coating on lead body.
BT137	VIGILA 1 CT	Single-shock coil ICD lead with 	65, 75cm length	$9,000.00
	passive fixation
BT149	Linox Smart T	Single-shock coil ICD lead with 	65 cm length	$9,000.00
	passive fixation, and SilGlide 
	technology
	Guidant Australia Pty Ltd
GU115	Endotak Reliance Lead	Passive Dual Coil	59cm, 64cm, 90cm	$9,000.00
GU158	Endotak Reliance SG Passive	Passive Single Coil wih GORE 	54cm - 90cm	$9,000.00
	ePTFE covered coils
GU159	Endotak Reliance G Passive	Passive Dual Coil with GORE ePTFE	54cm - 90cm	$9,000.00
	 covered coils
Prostheses List by Category, Groups and Sponsor	Page 634 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC002	Medtronic Sprint Quattro Lead 	Silicone and polyurethane	65-100cm	$9,000.00
	Model 6944RV/SVC 65cm; Model 
	6944RV/SVC 75cm; or Model 
	6944RV/SVC 100cm; Medtronic 
	Sprint Quattro Lead Model 
	6944RV/SVC 58cm
	St Jude Medical Australia Pty Ltd
SJ158	Durata 7170, 7171	Passive fixation, true bipolar, dual 	60, 65 and 70cm	$9,000.00
	coil, steroid eluting, endocardial 
	defibrillation leads with Optium 
	insulation overlay
	e
	Boston Scientific Australia Pty Ltd
BS170	Endotak Reliance S 4-SITE	Passive fixation single coil 	50-70cm	$9,000.00
	defibrillation leads & 4-SITE 
BS180	Endotak Reliance G 4-SITE	Passive fixation dual coil 	50-70cm	$9,000.00
	defibrillation leads with ePTFE 
	covered coils & 4-SITE connector
BS181	Endotak Reliance SG 4-SITE	Passive fixation single coil 	50-70	$9,000.00
	defibrillation leads with ePTFE 
	covered coil & 4-SITE connector
BS183	Endotak Reliance 4-SITE	Passive fixation dual coil 	50-70cm	$9,000.00
	defibrillation leads with 4-SITE 
	St Jude Medical Australia Pty Ltd
SJ245	Durata 7170Q, 7171Q and 7172Q	7170Q/7171Q - passive fixation, 	52, 58 and 65cm, 7F 	$9,000.00
	bipolar, dual coil, 7172Q - passive 	introducer
	fixation, bipolar - single coil steroid 
	eluting endocardial defibrillation 
	leads with Optim insulation overlay 
	and SJ4 quadripolar lead connector
	Biotronik Australia Pty Ltd
BT154	Volta 1 CT	Singe-shock coil ICD lead with 	65cm length	$9,000.00
	passive fixation, and SilGlide 
Prostheses List by Category, Groups and Sponsor	Page 635 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	e
	Boston Scientific Australia Pty Ltd
BS261	RELIANCE 4-FRONT	Passive, single/dual coil, 	Length: 59cm - 70cm	$9,000.00
	defibrillation lead
08.07.06 - Transvenous/Steroid/Active
	Biotronik Australia Pty Ltd
BT084	Linox SD	Fractal coated and steroid electrode, 	65, 75cm length, 16, 18mm 	$9,000.00
	active fixation quadrapolar	elec dis
BT096	Linox S	Single-shock coil ICD lead with 	Lengths: 65, 75 cm	$9,000.00
	active fixation, fractal coating and 
	steroid elution
BT120	Linox SMART SD	Dual-shock coil ICD lead with active 	Lengths: 60, 65, 75 cm, 	$9,000.00
	fixation helix and hydrophilic coating	Diameter: 7.8Fr
	 on lead body.
BT125	Linox SMART SD X	LinoxSmart S DX pentapolar, single-	Length: 65cm. Distance of 	$9,000.00
	coil ICD lead with floating atrial 	dipole from tip: Linox Smart
	dipole. Permanent, transvenous 	 SD X 65/15: 15 (cm), Linox
	implantation in the right ventricle.	 Smart SD X 65/17: 17 (CM)
BT134	VIGILA 2 CR	Fractal coated and steroid electrode, 	65, 75cm length, 16, 18mm 	$9,000.00
	active fixation quadrapolar	electrode spacing
BT140	VIGILA 1 CR	Single shock coil ICD lead with 	Lengths 65, 75cm	$9,000.00
	active fixation, fractal coating and 
	steroid elution
BT142	VIGILA 2 CT	Fractal coated and steroid electrode, 	Lengths: 65, 75cm; 	$9,000.00
	active fixation, quadrapolar	Diameter: 7.8Fr
BT148	Linox Smart S	Single shock coil ICD lead with 	Lengths; 60, 65, 75 cm	$9,000.00
	active fixation, fractal coating and 
	steroid elution. Coated in SilGlide 
	silicone based coating for improved 
	Guidant Australia Pty Ltd
GU163	ENDOTAK RELIANCE G Active	Active Dual Coil with GORE ePTFE 	59-90cm	$9,000.00
	covered coils
GU164	ENDOTAK RELIANCE SG Active	Active Single coil with GORE ePTFE	59-90cm	$9,000.00
	 covered coils
Prostheses List by Category, Groups and Sponsor	Page 636 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC208	Medtronic Sprint Quattro Secure 	Leads, Defibrillator, Implantable, 	58-100cm	$9,000.00
	Lead Model 6947 58cm; Model 	Silicone, polyurethane, platinized 
	6947 65cm; Model 6947 75cm; 	tantalum coils, steroid eluting tip
	Model 6947 100cm
MC834	Sprint Quattro Secure S	Model 6935, Active Fixation Single 	52 - 100cm	$9,000.00
	Coil Defibrillation Lead
	St Jude Medical Australia Pty Ltd
SJ157	Durata 7120, 7121, 7122, 7130, 7131	Active fixation bipolar, dual-	60, 65, 75cm	$9,000.00
	coil/single coil Steroid-eluting 
	Endocardial Defibrillation Leads
	e
	Boston Scientific Australia Pty Ltd
BS174	Endotak Reliance SG 4-SITE	Active fixation single coil 	50-70cm	$9,000.00
	defibrillation leads with ePTFE 
	covered coil & 4-SITE connector.
BS178	Endotak Reliance 4-SITE	Active fixation dual coil defibrillation	50-70cm	$9,000.00
	 leads with 4-SITE connector
BS179	Endotak Reliance S 4-SITE	Active fixation single coil 	50-70mm	$9,000.00
	defibrillation leads & 4-SITE 
BS182	Endotak Reliance G 4-SITE	Active fixation dual coil defibrillation	50-70cm	$9,000.00
	 leads with ePTFE covered coils & 4-
	SITE connector.
	Medtronic Australasia Pty Ltd
MI033	Sprint Quattro Secure 6947M Lead	Active fixation, true bipolar, dual coil 	45-110cm	$9,000.00
	defibrillation leads with silicone 
	backfill and DF-4 connector
MI108	Sprint Quattro Secure S DF4	Dexamethasone acetate and 	49 - 97 cm	$9,000.00
	dexamethasone sodium phosphate 
	steroid-eluting, tripolar, screw-in, 
	ventricular lead with RV 
	defibrillation coil electrode
Prostheses List by Category, Groups and Sponsor	Page 637 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	St Jude Medical Australia Pty Ltd
SJ230	Durata 7120Q, 7121Q and 7122Q	7120/1Q - Adtive fixation, true 	52cm, 58cm and 65cm	$9,000.00
	bipolar; 7122Q - Active fixation true 
	bipolar - single coil steroid eluting 
	endocardial defibrillation leads with 
	Optim insulation overlay and SJ4 
	quadripolar lead connector.
	Biotronik Australia Pty Ltd
BT155	VOLTA 2 CR	Fractal coated and steroid electrode, 	60, 65, 75cm length, 16, 	$9,000.00
	active fixation quadrapolar	18mm electrode spacing
BT157	Volta 1CR	Single shock coil ICD lead with 	Lengths: 60, 65 and 75 cm	$9,000.00
	active fixation, fractal coating and 
	steroid elution. Coated in SilGlide 
	silicone based coating for improved 
BT158	Volta 2 CT	Fractal coated and steriod electrode, 	Lengths: 65, 75 cm, 	$9,000.00
	active fixation, quadrapolar	Diameter: 7.8Fr
	e
	Boston Scientific Australia Pty Ltd
BS260	RELIANCE 4-FRONT	Active, Single/Dual coil, 	Length: 59cm -70cm	$9,000.00
	defibrillation lead
08.07.07 - Epicardial Patches
	Medtronic Australasia Pty Ltd
MC027	Model 6721 Unipolar Epicardial 	Model 6721S-50, Model 6721M-50, 	370, 660, 840mm	$2,340.00
	Patch Leads S/M/L	Model 6721L-50; Silicone
08.08.01 - Non-transvenous, Bi-Polar, Steroid
	Boston Scientific Australia Pty Ltd
BS153	Myopore	Bipolar sutureless myocardial pacing 	25-54cm	$1,716.00
	lead
Prostheses List by Category, Groups and Sponsor	Page 638 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC011	Capsure EPI steroid eluting bipolar 	Silicone	25 - 60cm	$1,716.00
	epicardial lead Model 4968 - 
	St Jude Medical Australia Pty Ltd
SJ132	Myodex 1084T	Steroid-Eluting Bipolar Sutureless 	35cm and 54cm	$1,716.00
	Myocardial Pacing Lead with 
	Titanium Nitride Electrodes
SJ140	Myodex 1084T and FasTac Flex 	Steroid -Eluting Bipolar Sutureless 	35cm and 54cm, Lead 	$1,716.00
	Lead Implant Tool	Myocardial Pacing Lead with 	implant tool - 44cm
	Titanium Nitride Electrodes and Lead 
	implant tool with articulating distal 
08.08.02 - Non-transvenous, Uni-Polar, Steroid
	Medtronic Australasia Pty Ltd
MC053	Capsure EPI steroid eluting 	Silicone	25 - 50cm	$1,544.00
	unipolar epicardial lead Model 
08.08.03 - Non-transvenous, Uni-Polar, Non-Steroid
	Medtronic Australasia Pty Ltd
MC009	Medtronic Epicardial Pacing Leads 	Silicone	35 - 53cm	$1,144.00
	IS-1 Model 5071
08.08.04 - Transvenous, Uni-Polar, Passive, Steroid, Right 
	Medtronic Australasia Pty Ltd
MC254	CapSure Sense pacemaker lead 	Titanium Nitride	30 - 85cm	$1,248.00
	Models 4073
Prostheses List by Category, Groups and Sponsor	Page 639 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.08.06 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
	Biotronik Australia Pty Ltd
BT070	Corox OTW UP Steroid	Unipolar, steroid eluting coronary 	Lengths: 77, 87cm	$3,120.00
	sinus pacing lead
	Boston Scientific Australia Pty Ltd
BS133	Acuity Spiral	Unipolar passive fixation	80, 90 & 100cm	$3,120.00
	Medtronic Australasia Pty Ltd
MC225	Attain Over the Wire Model 4193	Titanium, polyurethane	78-88cm	$3,120.00
	Biotronik Australia Pty Ltd
BT156	Sentus OTW UP H	4.8F Unipolar, steroid eluting 	overall length 77, 87, 97 cm,	$3,120.00
	coronary sinus pacing lead	 4.8F
08.08.08 - Transvenous, Bi-Polar, Passive, Steroid, Right 
	Biotronik Australia Pty Ltd
BT066	Selox ST	Transvenous Bipolar Passive Steroid 	53 and 60cm lengths	$1,248.00
	Ventricular Pacing Lead, fractal 
BT067	Selox JT	Bipolar, passive fixation, steroid 	Lengths: 45, 53 cm	$1,248.00
	eluting pacing lead with fractal 
	coating and J-shape
BT117	Siello JT	Sub 6F, steroid-eluting, transvenous, 	Lengths: 45, 53 cm; 	$1,248.00
	endocardial, bipolar passive-fixation 	Diameter: 5.6Fr
	lead that carries a J-shaped distal end.
BT118	Siello T	Sub 6F, steroid-eluting, transvenous, 	Lengths: 53, 60 cm; 	$1,248.00
	endocardial, bipolar passive-fixation 	Diameter: 5.6Fr
	lead
BT138	TILDA T	Bipolar, passive fixation, steroid 	53, 60cm length	$1,248.00
	eluting pacing lead with fractal coating
Prostheses List by Category, Groups and Sponsor	Page 640 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BT141	TILDA JT	Bipolar, passive fixation, steroid 	Length 45, 53cm	$1,248.00
	eluting pacing lead with fractal 
	coating and J-shape
	Guidant Australia Pty Ltd
GU009	Fineline II Sterox IROX Lead	Bipolar passive fixation	52cm, 58cm	$1,248.00
GU011	Fineline II Sterox IROX Lead	Bipolar passive fixation	52cm, 58cm	$1,248.00
GU012	Fineline II Sterox IROX Lead	Bipolar, passive fixation	45cm, 52cm	$1,248.00
	Medtronic Australasia Pty Ltd
MC010	Medtronic Capsure SP Novus 	Bipolar, steroid, pasive fixation 	45 -110cm	$1,248.00
	Model 5092	pacing lead
MC229	Medtronic Capsure SP Novus 	Bipolar, steroid, passive fixation 	30-100cm	$1,248.00
	Model 5594 Lead	pacing lead
MC336	Medtronic Capsure Z Novus Model 	Silicone; Contents: 1 x lead with 	45-58cm	$1,248.00
	5054 Pacing Lead	anchoring sleeve, stylet & guide, 1 x 
	vein lifter, 2 x fixation tools, extra 
	stylets
MC337	Medtronic Capsure Z Novus Model 	Silicone; Contents: 1 x lead with 	45-58cm	$1,248.00
	5554 Pacing Lead	anchoring sleeve, stylet & guide, 1 x 
	vein lifter, 2 x fixation tools, extra 
	stylets
MC372	CapSure Sense MRI SureScan 	Bipolar, steroid, passive fixation 	Model 4074:  52 - 58cm; 	$1,248.00
	pacemaker leads Models 4074 & 	pacing lead	Model 4574: 45 - 53cm
	Pacing Importers Pty Ltd - Life Systems
PI023	Refino™ ER Series	Passive fixation, bi-polar, permanent 	44, 48, 52 and 58cm length	$1,248.00
	pacing leads with a steroid eluting 
	Sorin Group Australia Pty Ltd
SA152	Refino ER Series	Steroid eluting passive fixation 	The lead comes in 44, 48, 52	$1,248.00
	pacing lead.  Permanent pacing lead, 	 and 58cm lengths and has a 
	Model Refino ER, is indicated for the 	6.0F (polyurethane 6.3F 
	pacing and sensing of the ventricle.  	(silicone) lead body
	This permanent pacing lead is used in 
	conjunction with an IS-1 compatible 
	implantable pulse generator (pacema
Prostheses List by Category, Groups and Sponsor	Page 641 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SA154	Petite ER Series	Steroid eluting passive fixation 	The lead comes in 44, 48, 	$1,248.00
	pacing lead. Permanent pacing lead, 	52, 58, 70 and 78cm lengths
	Petite ER series, is indicated for the 	 and has a 4.8 F lead body.
	pacing and sensing of the ventricle.  
	This permanent pacing lead is used in 
	conjunction with an IS-1 compatible 
	implantable pulse generator (pacema
	St Jude Medical Australia Pty Ltd
SJ146	Isoflex 1944T & 1948T	Passive-Fixation, Bipolar, Steriod 	46cm, 52cm, 58cm	$1,248.00
	Eluting, Endocardial Pacing Lead 
	with Optim insulation
	k
	Guidant Australia Pty Ltd
GU028	Guidant Aust Selute Picotip VDD 	VDD bipolar, passive fixation	.	$1,544.00
	Lead
	Medtronic Australasia Pty Ltd
MC052	Medtronic Capsure VDD2 Model 	Silicone; Contents: 1 x lead with 	11.5cm, 13.5cm, 15.5cm	$1,544.00
	5038 AV Pacing Lead	anchoring sleeve, stylet & guide, 1 x 
	vein lifter, 2 x fixation tools, extra 
	stylets
08.08.09 - Transvenous, Bi-Polar, Active, Steroid, Right 
	Biotronik Australia Pty Ltd
BT083	Setrox S	Bipolar active fixation lead with 	length 45, 53, 60cm	$1,248.00
	fractal coated and steroid eluting 
BT097	Dextrus (marketed by Boston 	Bipolar, silicone, active fixation, 	Lengths: 45, 53 and 60 cm, 	$1,248.00
	Scientific)	steroid eluting, pacing lead	Diameter: 7Fr
BT116	Siello S	Sub 6F, steroid-eluting, trasvenous, 	Lengths: 45, 53, 60 cm; 	$1,248.00
	endocardial, bipolar active-fixation 	Diameter: 5.6Fr
	lead with an extendable/retractable, 
	electrically active screw.
Prostheses List by Category, Groups and Sponsor	Page 642 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BT123	Safio S	Steroid eluting active fixation 	Length: 53, 60cm; 	$1,248.00
	pacemaker lead with an electrically 	Diameter: 6.6F
	active extendable/ retractable screw 
	for fixating the lead in the 
	myocardium. The lead body is 
	insulated in Silicone. The entire lead 
	is conditionally safe to be used in a 
BT139	TILDA R	Bipolar active fixation lead with 	length 45, 53, 60cm	$1,248.00
	fractal coated and steroid eluting 
	Guidant Australia Pty Ltd
GU013	Fineline II EZ Sterox IROX Lead	Bipolar, active fixation	45cm, 52cm, 58cm	$1,248.00
GU016	Fineline II EZ Sterox IROX Lead	Bipolar, active fixation	45cm, 52cm, 58cm	$1,248.00
GU122	Flextend Lead Models 4086, 4087 	Bipolar, active fixation	45,52,59cm	$1,248.00
	& 4088
	Medtronic Australasia Pty Ltd
MC008	Medtronic Capsurefix Model 5568 	Bipolar, steroid, active fixation pacing	30 - 85cm	$1,248.00
	Pacing Leads	 lead
MC338	Medtronic Capsurefix Novus Model 	Silicone; Contents: 1 x lead with 	45-85cm	$1,248.00
	5076 Pacing Lead	anchoring sleeve, stylet & guide, 1 x 
	vein lifter, 2 x fixation tools, extra 
	stylets
MC833	CapSureFix Novus Model 4076 	Active fixation pacemaker lead	45 - 85cm	$1,248.00
	Pacing Lead
MC936	CapSure Fix MRI Pacing Lead	Model 5086, MRI Conditional	42, 52, 58 cm	$1,248.00
	Sorin Group Australia Pty Ltd
SA151	Physique ER Series	Steroid eluting active fixation pacing 	The lead comes in 44, 48, 52	$1,248.00
	lead.  Permanent pacing lead, Model 	 and 58cm lengths and has a 
	Physique ER is indicated for the 	4.8F lead body
	pacing and sensing of the ventricle or 
	atrium.  This permanent pacing lead is 
	used in conjunction with a 
	compatible implantable pulse 
Prostheses List by Category, Groups and Sponsor	Page 643 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SA153	PY2-ER Series	Steroid eluting active fixation pacing 	The lead comes in 44, 48, 	$1,248.00
	lead. Permanent pacing lead PY2-ER 	52, 58cm lengths and has a 
	series, is indicated for pacing and 	6.3F lead body
	sensing of the ventricle and/or atrium 
	of the heart. This lead is used in 
	conjunction with a compatible 
	implantable pulse generator 
	(Pacemaker)
	St Jude Medical Australia Pty Ltd
SJ073	Tendril SDX 1688TC	Endocardial Steroid-Eluting Active 	100cm, 25cm, 34cm, 40cm, 	$1,248.00
	Fixation Pacing Lead	46cm, 52cm, 58cm, 85cm, 7F
SJ129	Tendril ST 1888TC and 1882TC	Endocardial Bi-polar Steroid-Eluting 	46-65cm	$1,248.00
	Active Fixation Pacing Leads
SJ151	OptiSense Model 1999	Active-Fixation Bipolar, Steroid 	40, 46 & 52cm	$1,248.00
	Eluting, endocardial, atrial pacing 
	lead with Optim insulation
SJ238	Tendril STS 2088TC	Endocardial Bi-polar Steroid-Eluting 	34cm-100cm	$1,248.00
	Active Fixation Pacing Leads
SJ270	Tendril MRI LPA 1200M	The Tendril MRI™ lead, Model 	46cm, 52cm and 58cm	$1,248.00
	LPA1200M, is an MR Conditional, 
	bipolar, steroid-eluting, active 
	fixation implantable pacing lead with 
	Optim™  insulation.
	j
	Medtronic Australasia Pty Ltd
MC301	Model 3830 PACING LEADS	Active fixation pacemaker lead	59 - 75 cm	$2,600.00
	Composition: Insulation is 
	polyurethane, Electrodes are Titanium
	 Nitride coated Platinum, the screw is 
	steriod-coated
08.08.11 - Transvenous, Multi-Polar, Passive, Steroid, Left Ventricular
	Biotronik Australia Pty Ltd
BT095	Corox OTW BP; Corox OTW-S BP;	Bipolar, steroid eluting coronary 	Lengths: 77, 87 cm	$6,240.00
	sinus pacing lead with fractal coating
Prostheses List by Category, Groups and Sponsor	Page 644 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BT121	Corox OTW-L BP	Corox OTW-L BP is a bipolar 	Length: 75, 85cm; 	$6,240.00
	coronary sinus lead, intended for 	Diameter: 5.4F
	permanent implantation in the venous 
	system and left ventricular pacing 
	with appropriate single or multi 
	chamber cardiac pacemakers or ICDs 
	as part of cardiac resynchornisation 
BT135	CELERITY PILOT	Bipolar, steroid eluting coronary 	Lengths: 77, 87cm (in 	$6,240.00
	sinus pacing lead with fractal coating	model number as 75 and 85 
	for simplicity)
BT136	CELERITY 2D, CELERITY 3D	Bipolar, steroid eluting coronary 	Lengths: 77, 87cm (model 	$6,240.00
	sinus pacing lead with fractal coating.	shows 75 and 85 for 
	 2D preshaped curved distal end; 3D -	simplicity)
	 preshaped helix distal end
	Guidant Australia Pty Ltd
GU138	Easytrak 2, Model 4514, 4515, 	Bipolar, passive fixation	.	$6,240.00
	4516, 4517, 4518, 4519, 4520
GU153	Easytrak 2 Is-1 Lead - Models 4542,	Bipolar, passive fixation	80 to 100cm	$6,240.00
	 4543 & 4544
GU156	Easytrak 3 Lead - Models 4521, 	Bipolar, passive fixation	80 to 100cm	$6,240.00
	4522, 4523, 4524, 4525, 4526 and 
	4527
GU162	Easytrak 3 IS-1 Lead	Bipolar, passive fixation	Sizes 80 to 100cm	$6,240.00
GU165	Acuity Steerable Lead	Bipolar, passive fixation	80cm, 90cm ,100cm	$6,240.00
	Medtronic Australasia Pty Ltd
MC699	Attain OTW Model 4194 Lead	Model 4194	78cm, 88cm	$6,240.00
MC811	Attain Ability 4196 LV Lead	Over the wire dual electrode left 	78, 88, and 103 cm	$6,240.00
	ventricular lead
MI013	Attain Ability Plus 4296	Over the wire electrode left 	78cm, 88cm	$6,240.00
	ventricular lead
MI014	Attain Ability Straight 4396	Over the wire dual left ventricular 	78cm, 88cm	$6,240.00
	St Jude Medical Australia Pty Ltd
SJ243	Quartet 1458Q	Quadripolar, Left Ventricular Pacing 	75, 86 and 92cm, 5 French 	$6,240.00
	Lead with Optim Lead Insulation	introducer
Prostheses List by Category, Groups and Sponsor	Page 645 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	j
	St Jude Medical Australia Pty Ltd
SJ208	Quick Flex µ 1258T	4F Bipolar Left Ventricular Pacing 	75cm, 86cm, 92cm	$6,240.00
	Lead
	Medtronic Australasia Pty Ltd
MI129	Attain Perfoma Leads	LV lead family with four electrodes 	78, 88cm	$6,240.00
	and an IS4 connector for LV pacing 
	w/premium and standard IS4 CRT-D 
	devices. The Attain Perfoma™ Lead 
	provides LV pacing options to avoid 
	the following: phrenic nerve 
	stimulation, high pacing thresholds, 
	and ischemic tissue
08.08.13 - Transvenous, Active, Steroid, Left Ventricular
	Medtronic Australasia Pty Ltd
MC730	Attain StarFix LV Lead	Over the wire left Ventricular Lead	78, 88, 103cm	$5,000.00
08.09.01 - Pacemaker/ICD Adaptors
	Medtronic Australasia Pty Ltd
MC246	DF-I Y-Adaptor/Extender Model 	Silicone	Lengths 25cm, 37cm	$500.00
	6726 25cm & 37cm
MC778	Oscor Adaptor	Adaptor for LV-1 lead to unipolar and	10cm, 17cm and 40cm	$500.00
	 bipolar IS-1
MI045	Adaptor Kit Model 5866-24M, 	5866-24M: 5mm Bifurcated Bipolar 	14cm	$500.00
	5866-40M, 5866-37M	Lead or Two 5mm Unipolar Leads to 
	IS-1 Bipolar IPG; 5866-40M: 3.2mm 
	BI Lead to IS-1 BI IPG; 5866-37M: 
	5mm UNI Lead to IS-1 UNI IPG
MI046	Bipolar Lead Adaptor Kit Model 	Two IS-1 BI Leads to IS-1 BI IPG	One size only	$500.00
Prostheses List by Category, Groups and Sponsor	Page 646 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI053	5019 Adaptor	Adapts DF-4 lead to enable use of 	One size	$500.00
	additional leads for high 
	defibrillation thresholds
08.10.01 - Pacemaker/ICD Adaptors
	Medtronic Australasia Pty Ltd
MC831	Medtronic Lead Extender Kit 	6984M: IS-1 BI Lead to IS-1 BI IPG; 	37 - 50cm	$530.00
	Model: 6984M, 6981M, 	6981M: IS-1 UNI Lead to IS-1 UNI 
	IPG; 6986M: 3.2mm BI Lead to IS-1 
	BI IPG; 6985M: IS-1 UNI Lead to EPG
08.11.01 - Pacemaker/Lead Accessories
	Boston Scientific Australia Pty Ltd
BS212	Pacemaker/Defibrillator port safety 	Pacemaker/Defibrillator Plug that 	3.2mm x 38mm	$80.00
	plug	seals unused IS-1 and DF-1 port
BS213	Lead Cap Kit	Caps used to protect lead terminal 	4.75mm and 3.2mm	$80.00
	connector pin
	Medtronic Australasia Pty Ltd
MI042	Medtronic Lead End Cap Kit 	Lead End Cap Kit	One size only	$80.00
	Model: 5867-3M
MI043	Medtronic DF-1 Port Pin Plug Kit: 	DF-1 unipolar connector port pin 	One size per model	$80.00
	Model 6719; Medtronic IS-1 Port 	plug, one per kit
	Pin Plug Kit: Model 6725
MI044	Medtronic Upsizing Sleeve: Model 	5866-45: IS1 UNI Lead to 5/6mm 	18-25mm	$80.00
	5866-45, Model 5866-46	UNI IPG; 5866-46: IS1 UNI Lead to 
	5mm UNI IPG or 5mm Bifurcated BI 
08.12.01 - Drug Eluting
	08.12.01.01 - General Purpose
	Abbott Australasia Pty Ltd
AY023	Xience Everolimus Eluting Stent 	Everolimus Eluting Stent System	2.25mm to 4.0mm widths, 	$3,450.00
	System	8mm to 28mm lengths
Prostheses List by Category, Groups and Sponsor	Page 647 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AY037	 Xience PRIME LL Everolimus 	Coronary Artery Stent, Drug Eluting	XIENCE PRIME LL 2.50; 	$3,450.00
	Eluting Coronary Stent; Xience 	2.75; 3.00; 3.50; 4.0 x 
	PRIME Everolimus Eluting 	33MM;  XIENCE PRIME 
	Coronary Stent;  Xience PRIME SV 	LL 2.50; 2.75; 3.00; 3.50; 
	Everolimus Eluting Coronary Stent	4.0 x 38MM;  XIENCE 
	PRIME SV 2.25 x 08; 12; 
	15; 18; 23; 28MM; 
	XIENCE PRIME 2.50 x 08; 
	12; 15; 18; 23; 28MM;  
	XIENCE PRIME 2.75 x 08; 
	12; 15; 18; 23; 28MM;  
	XIENCE
AY040	XIENCE Xpedition Everolimus 	Coronary Artery Stent, Drug Eluting	Xience Xpedition DES - 	$3,450.00
	Eluting Coronary Stent System	2.25 x (8,12,15,18,23,28) 
	RX CE, 2.50 x 
	(8,12,15,18,23,28,33,38) 
	RX CE; 2.75 x 
	(8,12,15,18,23,28,33,38) 
	RX CE; 3.00 x 
	(8,12,15,18,23,28,33,38) 
	RX CE; 3.25 x 
	(8,12,15,18,23,28,33,38) 
	RX CE; 3.50 x 
	(8,12,15,18,23,28,33,38) 
	RX CE; 4.00 x 
	(8,12,15,18,23,28,33,38) 
	RX CE;
	Boston Scientific Australia Pty Ltd
BS175	PROMUS Element	Platinum chromium alloy stent coated 	8mm to 38mm with a 	$3,450.00
	with a blended polymer mixed with 	reference vessel diameter of 
	everolimus.	2.25mm - 4.0mm.
BS176	Taxus Element	Platinum chromium alloy stent coated 	(8mm to 38mm) with a 	$3,450.00
	with a blended polymer mixed with 	reference vessel diameter of 
	Paclitaxel	2.25mm - 4.5mm
BS224	PROMUS Element Plus	Platinum chromium alloy stent coated 	8mm to 38mm in length, 	$3,450.00
	with a blended polymer mixed with 	diameter of 2.25mm to 4mm.
	everolimus.
	Medical Logistics Australia Pty Ltd
JE001	BioMatrix Flex Drug Eluting 	Coronary Artery Stent, Drug Eluting	Diameter: 2.25mm to 4.0mm	$3,450.00
	Coronary Stent System	
Prostheses List by Category, Groups and Sponsor	Page 648 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC732	Endeavour Drug Eluting Coronary 	Cobalt Alloy, ABT - 578	Diameter: 2.25mm-4.5mm; 	$3,450.00
	Stent System	Length: 8.00mm-38.0mm
MC769	Endeavor Sprint Drug Eluting Stent	Cobals Alloym ABT - 578	Diameter: 2.25mm-4.0mm; 	$3,450.00
	 System	Length: 8.0mm-30.0mm
MC816	Endeavor Resolute Drug Eluting 	Cobalt Alloy, ABT - 578, BioLinx 	Diameter:2.25mm-4.0mm; 	$3,450.00
	Coronary Stent System	Polymer	Length: 8.00mm-30.0mm
MI037	Resolute Integrity Zotarolimus-	Cobalt-alloy, ABT-578, BioLinx 	Small Vessel - Diameter: 	$3,450.00
	Eluting Coronary Stent System	Polymer	2.25mm-2.75mm; Length: 
	8.0mm-30.0mm
	Medium Vessel - Diameter: 
	3.0mm-4.0mm; Length: 
	9.0mm-38.0mm
08.12.02 - Bare Metal
	08.12.02.01 - General Purpose
	Abbott Australasia Pty Ltd
AY028	Multilink Coronary Stent System - 	Cobalt chrome stent	2.25mm to 4.0mm widths, 	$1,248.00
	Vision	8mm to 38mm lengths
AY039	MULTI-LINK 8 Coronary Stent 	The MULTI-LINK 8,  MULTI-LINK 8	MULTI-LINK 8: Diam: 2.5, 	$1,248.00
	System, MULTI-LINK 8 SV 	 SV, MULTI-LINK 8 LL Coronary 	2.75, 3.0, 3.5, 4.0mm, Stent 
	Coronary Stent System and MULTI-	Stent System (CSS) is comprised of 	Length: 8, 12, 15, 18, 23, 
	LINK 8 LL Coronary Stent System	two main components: the cobalt 	28mm; MULTI-LINK 8 SV 
	chromium (CoCr) stent and the 	CSS: Diam: 2.25mm, Stent 
	balloon expandable delivery system.	Length: 8, 12, 15, 18, 23, 
	28mm; MULTI-LINK 8 LL 
	CSS: Diam: 2.5, 2.75, 3.0, 
	3.5, 4.0mm, Stent Length: 
	33 and 38mm
	Atrium Australia - Pacific Rim Pty Limited
AC030	Cinatra Cobalt Chromium Coronary 	The Cinatra Cobalt Chromium 	Diameter range: 2.5mm - 	$1,248.00
	Stent System	Coronary Stent System consists of a 	3.5mm.  Length range: 8mm -
	balloon expandable Cobalt Chromium 	 25mm
	stent premounted on a rapid exchange 
	system
Prostheses List by Category, Groups and Sponsor	Page 649 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Bio Excel Australia Pty Ltd
BE001	Gazelle Coronary Stent	Stainless Steel	Diam 2.25-4.0mm  Length 8-	$1,248.00
	28mm
	Biotronik Australia Pty Ltd
BT082	PRO-Kinetic	Coronary Cobalt Chromium stent 	Diameters: 2 -5mm, 	$1,248.00
	system	Lenghts: 8 - 40mm
BT107	PRO-Kinetic Energy	Balloon-expandable cobalt chromium 	Lengths: 8 - 40mm, 	$1,248.00
	(CoCr) stent. The stent surface is fully 	Diameters: 2.0 - 5.0mm.
	coated with amorphous hydrogen-rich
	 silicon carbide (aSiC:H).
	Boston Scientific Australia Pty Ltd
BS069	Liberte Coronary Stent System	Consists of a balloon expandable 	Stent lengths: 	$1,248.00
	stent, pre-mounted on a Maverick 2 	8,12,16,20,24,28 & 32 mm 
	Monorail delivery catheter.	Stent diameters: 2.25, 2.5, 
	2.75, 3.0, 3.5, 4.0, 4.5 & 5.0 
	mm
BS211	OMEGA Bare Metal Stent	Platinum Chromium Bare Metal Stent	2.25mm to 4.50mm Diameter.	$1,248.00
	 8mm to 38mm Length.
	Imaxeon Pty Ltd
IX001	Amazonia CroCo	Balloon expandable intracoronary 	Lengths:  8mm, 12mm, 	$1,248.00
	cobalt chromium stent premounted 	16mm, 20mm, 24mm, 28mm, 
	onto a rapid exchange delivery 	32, 36, and 40mm.  
	Diameters:  2.25mm, 2.5mm, 
	2.75mm, 3.0mm, 3.5mm, 
	4.0mm, 4.50 and 5.00 mm in 
	all lengths
	Johnson & Johnson Medical Pty Ltd
DY534	Presillion Plus CoCr Coronary 	Cobalt Chromium, bare metal coronary	Stent length 8 - 40mm x 	$1,248.00
	Stent on RX System	 stent	Stent Diameter 2.5 - 5.0 mm
	Medtronic Australasia Pty Ltd
MC329	Medtronic Driver, Micro Driver 	Cobalt Alloy	Driver Stent: diameter (2.25 	$1,248.00
	Coronary Stent System	- 4.5mm), length (8-30mm); 
	Micro-Driver Stent: 
	diameter (2.25 - 2.75mm), 
	length (8 - 24mm)
MC932	Driver Sprint Coronary Stent 	Cobalt Alloy	Diameter: 2.25 - 4.5 mm; 	$1,248.00
	Length: 8-30mm
Prostheses List by Category, Groups and Sponsor	Page 650 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC956	Integrity Coronary Stent System	Cobalt Alloy Coronary Stent	Diameter: 2.25 - 4.5mm; 	$1,248.00
	Length: 8 - 30mm
	OrbusNeich  Medical Pty Ltd
NM004	Azule Coronary Stent Delivery 	L605 Cobalt Chromium alloy balloon 	Expanded Stent Diameter 	$1,248.00
	System	expandable vascular prosthesis	2.5 to 4.0mm, Stent Length 
	9 to 33mm
	Reid Healthcare
RH010	Avantgarde Chrono Carbostent	The Avantgarde Chrono Carbostent 	Lengths: from 7mm to 31 	$1,248.00
	device consists of a coronary stent 	mm; Sizes: from 2.25mm to 
	firmly held on the distal end of a semi 	4.5mm
	compliant balloon catheter. The 
	coronary stent is a flexible 
	implantable deivce that can be 
	expanded using a PTCA catheter. The 
	stent is made of cobalt chronmium 
	alloy coated with Carbofilm. Two 
	radio-opaque platinum markers are 
	located at either end of the stent.
	Terumo Corporation Australia
TU001	Tsunami Gold	Stainless Steel mounted on balloon 	Diameter 2.0mm - 4.0mm, 	$1,248.00
	catheter	Length 8mm - 30mm length
TU044	Kaname Coronary Stent System	BMS Coronary Stent	Diameter: 2.5mm; 2.75mm; 	$1,248.00
	3.0mm; 3.5mm; 4.0mm  x  
	Lengths : 9mm; 12mm; 
	15mm; 18mm; 24mm; 28mm.
	08.12.02.02 - Special Purpose for specific indications
	l, m
	Abbott Australasia Pty Ltd
AY012	JoStent Coronary Stent Graft	Stainless Steel/PTFE	9 - 26 mm x 2.5 - 5 mm	$3,222.00
	n.2
	Imaxeon Pty Ltd
IX002	Nile CroCo	Intracoronary stent pre-mounted on 	Diameter : 2.50 - 3.50mm.  	$1,750.00
	two rapid exchange delivery systems 	MB and 2.00-3.00mm SB
	for bifurcation lesions treatment	Lengths 18 mm and 24 mm
Prostheses List by Category, Groups and Sponsor	Page 651 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	n.3
	Imaxeon Pty Ltd
IX003	Minvasys Nile Delta Coronary 	Balloon expandable Amazonia 	Nile Delta 2.50mm diameter 	$1,248.00
	Stent System	intracoronary cobalt chromium stent 	x 8mm length; Nile Delta 
	premounted onto a rapid exchange 	3.00mm diameter x 8mm 
	delivery catheter with tapered 	length
08.13.01 - Cardiac Defect Occluders
	St Jude Medical Australia Pty Ltd
SJ280	Amplatzer Duct Occluder II 	Single use implantable transcatheter 	0.2cm-0.6cm	$10,200.00
	Additional Sizes	device for minimally invasive closure 
	of Patent Ductus Arterious
	o
	Pyramed Pty Limited
PY032	Occlutech Figulla Flex ASD 	The Occlutech Figulla® Flex ASD 	6, 7.5, 9, 10.5, 12, 15, 18, 	$10,200.00
	occluder is an implant for closure of an	21, 24, 27, 30, 33, 36, 39, 40
	 Atrial Septal Defect of the heart (ASD
	 II=ASD of the Secundum Type) and is
	 deployed via a minimally invasive 
	catheter delivery system.
	The Occlutech Figulla® Flex ASD is 
	intended fo
PY033	Occlutech Figulla Flex PFO 	The Figulla® Flex PFO is an implant 	16/18, 23/25, 27/30 and 	$10,200.00
	for closure of a patent foramen ovale 	31/35
	(PFO) defect in the heart and is 
	deployed via a minimally invasive 
	catheter delivery system.  The 
	Figulla® Flex PFO is intended for 
	patients with substantiated Right-
Prostheses List by Category, Groups and Sponsor	Page 652 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
PY034	Figulla Flex II PFO Occluder	The Figulla® Flex II PFO is an 	Figulla Flex II PFO Disc Ø 	$10,200.00
	implant for closure of a patent foramen 	(mm): 23/25, 16/18, 27/30, 
	ovale (PFO) defect in the heart and is 	31/35
	deployed via a minimally invasive 
	catheter delivery system.  The 
	Figulla® Flex PFO is intended for 
	patients with substantiated Right-
	Left-Shunt in the contrast agent 
	echocardiography under Valsalva 
	maneuver and presence of a 
	"cryptogenic", paradoxical 
	thromboembolism.
PY035	Figulla Flex II ASD Occluder	Occlutech Flexx II ASD Occlusion 	Figulla Flex II ASD Waist 	$10,200.00
	device	Ø (mm): Size 
	4,5,6,7.5,9,10.5,12,13.5,15,
	16.5,18,21,24,27,30,33,36,3
	9,40
	St Jude Medical Australia Pty Ltd
SJ091	Premere PFO Closure System	Percutaneous, transcatheter, self-	Left Atrial Anchor diameter 	$10,200.00
	expanding, dual anchor, occlusion 	20mm, 25mm and 30mm
	and apposition device
SJ260	Amplatzer Duct Occluder	Nitinol Wire Mesh	5 - 24mm	$10,200.00
SJ261	Amplatzer Septal Occluder	Nitinol Wire Mesh	4mm - 40mm	$10,200.00
SJ262	Amplatzer Muscular VSD Occluder	Nitinol Wire Mesh	4 - 24mm	$10,200.00
SJ263	Amplatzer PFO Occluder	Nitinol Wire Mesh	25mm & 35mm	$10,200.00
SJ264	Amplatzer Membranous VSD 	Nitinol wire mesh, double disc 	4-24mm, Length 7-10mm	$10,200.00
	Occluder	occluder and delivery system
SJ267	AMPLATZER Duct Occluder II	Self expandable multiple Nitinol wire 	Waist diameter 3-6mm, 	$10,200.00
	mesh PDA occlusion device	Nominal length 4-6mm
	W L Gore & Associates
GT223	Helex 1.5 Septal Occluder	The GORE HELEX Septal Occluder 	Diameters: 15, 20, 25, 30 	$10,200.00
	consists of an implantable 	and 35mm
	endoprosthesis and a catheter 
	delivery system.  The Occluder is 
	comprised of a nickel-titanium 
	(Nitinol) wire frame covered with 
	expanded polytetrafluoroethylene 
	(ePTFE).  The ePTFE is treated with
Prostheses List by Category, Groups and Sponsor	Page 653 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT270	Gore Septal Occluder	 "The GORE® Septal Occluder 	15mm Nominal Disc 	$10,200.00
	consists of an implantable occluder 	Diameter; 20mm Nominal 
	comprised of a platinum-filled nickel-	Disc Diameter; 25mm 
	titanium (Nitinol) wire frame covered 	Nominal  Disc Diameter; 
	with expanded 	30mm Nominal Disc 
	polytetrafluoroethylene (ePTFE). The 	Diameter
	occluder is available in sizes of 15, 
	p
	Abbott Australasia Pty Ltd
AY038	Coherex FlatStent EF PFO Closure 	In-tunnel PFO closure device and 	13mm & 19mm	$10,200.00
	System	delivery system
08.13.02 - Vascular Occlusion Devices
	Cook Medical Australia Pty Ltd
WC294	Flipper PDA Closure Detachable 	Delivery system and one coil: the 	Delivery system: Length 	$600.00
	Coil Delivery System and Mreye 	Flipper PDA Closure Detachable Coil	80cm and 110cm. Extended 
	Flipper PDA Detachable 	 Delivery System is a TFE coated 	embolus lengths of: 3cm, 
	stainless steel delivery wire with a 	5cm, 6.5cm, 8cm, 10cm, 
	straightening mandril and a pin vise 	12cm.  Coiled embolus 
	handle for detachment. The Mreye 	diameters: 3mm, 5mm, 
	Flipper PDA Closure Detachable Coil	6.5mm, 8mm.  Configuration 
	 is made from Iconel material with 	loops of deployed coil: 3,4 
	synthetic fibers.	or 5 loops
WC295	Mreye Flipper PDA Detachable 	Coil only: the Mreye Flipper PDA 	Extended embolus lengths 	$250.00
	Embolization Coil	Closure Detachable Coil is made from 	of: 3cm, 5cm, 6.5cm, 8cm, 
	Iconel material with synthetic fibers.	10cm, 12cm.  Coiled 
	embolus diameters: 3mm, 
	5mm, 6.5mm, 8mm.  
	Configuration loops of 
	deployed coil: 3,4 or 5 loops
Prostheses List by Category, Groups and Sponsor	Page 654 of 1059

08 - CARDIAC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
08.14.01 - Implantable Cardiac Event Recorders
	Biotronik Australia Pty Ltd
BT153	BioMonitor	Implantable cardiac monitor for 	53.3mm x 42.7mm x 7.1mm, 	$3,900.00
	continuous remote monitoring of 	26 grams
	patients with Atrial Fibrillation (AF) 
	or unexplained syncope
	i
	Medtronic Australasia Pty Ltd
MI141	Reveal LINQ	Insertable Cardiac Monitor	45 x 7 x 3.5mm, 1.18cc	$3,900.00
08.15.01 - Uncovered
	Medical Vision Australia Cardiology Thoracic Pty Ltd
MY004	CP Stent	CP Stent Uncovered	16, 22, 28, 24, 39 & 45mm 	$1,800.00
	length
MY006	CP Stent	CP Stent Uncovered, mounted on BIB 	16, 22, 28, 24, 39 & 45mm 	$1,800.00
	balloon	length
08.15.02 - Covered
	Medical Vision Australia Cardiology Thoracic Pty Ltd
MY005	CP Stent	CP Stent Covered	16, 22, 28, 24, 39 & 45mm 	$3,000.00
	length
MY007	CP Stent	CP Stent Covered, mounted on BIB 	16, 22, 28, 24, 39 & 45mm 	$3,000.00
	balloon	length
Prostheses List by Category, Groups and Sponsor	Page 655 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
09.01.01 - Bi-Leaflet, rotatable
	Medtronic Australasia Pty Ltd
MC980	Open Pivot Heart Valve (Model 	Pyrolythic Carbon, Double Velour 	16-33mm	$6,000.00
	500FA)Open Pivot Heart Valve 	Polyester, Titanium
	(Model 500DM)
MC981	Open Pivot Heart Valve (Model 	Pyrolythic Carbon, Double Velour 	16-33mm	$6,000.00
	501DA)Open Pivot Heart Valve 	Polyester, Titanium
	(Model 501DM)
	Reid Healthcare
RH001	Aortic On-X Prosthetic Heart Valve 	Bileaflet Mechanical Heart Valve	27-29mm, 19mm, 21mm, 	$6,000.00
	Models ONXA-19; ONXA-21; 	23mm, 25mm, 25-33mm, 27-
	ONXA-23; ONXA-25; ONXA-	29mm, 31-33mm, 23mm, 25mm
	27/29; ONXM-23; ONXM-25; 
	ONXM-27/29; ONXM31/33; 
	Sorin Group Australia Pty Ltd
SA129	Optiform	Mechanical Valve	19mm to 33mm	$6,000.00
	St Jude Medical Australia Pty Ltd
SJ037	Masters Series Heart Valve Mitral 	Aortic Expanded Cuff, Aortic 	Aortic Expanded 19 - 31mm,	$6,000.00
	and Aortic - Expanded 	Hemodynamic Plus Cuff, Mitral 	 Aortic Hemodynamic 17 - 
	Cuff/Hemodynamic Plus	hemodynamic Cuff, Aortic & Mitral 	27mm, Mitral Hemodynamic 
	Rotatable Cuff	17 - 27mm, Rotable 17 - 33mm
SJ317	Regent Prosthetic Heart Valve	Standard Cuff	Standard cuff - 17-	$6,000.00
	23mm/25mm-29mm, Flex cuff
	 - 17-23mm/25mm-29mm
	Medtronic Australasia Pty Ltd
MI124	Open Pivot Heart Valve AP360 - 	Supra-annular mechanical valve; 	Mitral: 16, 18, 20, 22, 24, 	$6,000.00
	Mitral	Pyrolythic Carbon, Double Velour 	26,  28 and 30 mm
	Polyester, Titanium
MI125	Open Pivot Heart Valve AP360 - 	Supra-annular mechanical valve; 	Aortic: 16, 18, 20, 22, 24, 	$6,000.00
	Aortic	Pyrolythic Carbon, Double Velour 	26 and 28 mm
	Polyester, Titanium
Prostheses List by Category, Groups and Sponsor	Page 656 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
09.01.02 - Tilting Disc, rotatable
	Medtronic Australasia Pty Ltd
MC013	Medtronic Hall Heart Valve Aortic 	A7700/M7700 Titanium. Pyrolite. 	A7700 - Diameter 20-31mm,	$5,100.00
	Model A7700, Medtronic Hall 	Dacron, A7700EZ/M7700EZ 	 M7700 - Diameter 23-
	Heart Valve Mitral Model M7700, 	Titanium. Pyrolite. PET	33mm, A7700EZ - Diameter 
	Hall Easy Fit Aortic Heart Valve 	19-29mm, M7700EZ - 
	Model A7700, Hall Easy Fit Mitral 	Diameter 23-31mm
	Heart Valve Model M7700
09.02.01 - Stented, anatomical
	b
	Edwards Lifesciences Pty Ltd
EL056	Carpentier-Edwards PERIMOUNT 	Stented Bovine Pericardial Mitral 	25mm, 27mm, 29mm, 31mm, 	$5,000.00
	Magna Mitral Bioprosthesis 	Tissue Valve with a reduced profile 	33mm
	(Model: 7000TFX)	height and assymetric sewing band 
	design
EL058	Carpentier-Edwards PERIMOUNT 	Stented Bovine Pericardial Aortic 	19mm, 21mm, 23mm, 25mm, 	$5,000.00
	Magna Ease Aortic Bioprosthesis 	Tissue Valve with a reduced profile 	27mm and 29mm
	(Model: 3300TFX)	height
	p
	Edwards Lifesciences Pty Ltd
EL030	CE Supra Annular Aortic Valve 	Carpentier-Edwards SAV 	19mm-33mm	$5,000.00
	Model 2650 Carpentier-Edwards 	Bioprosthesis. Composition: Porcine 
	S.A.V Bioprosthesis Model 6650 	Valve; Elgiloy Alloy; Silicone 
	Mitral Valve	Rubber, Polytetrafluoroethylene
	Medtronic Australasia Pty Ltd
MC701	Mosaic Cinch, Aortic, Mitral	Models 305cxx, 310cxx	19mm - 35mm	$5,000.00
MC950	Mosaic Ultra Cinch II	Small Aortic Root Bioprosthesis	19mm - 29mm	$5,000.00
MC962	Mosaic Cinch II	Aortic Bioprosthesis	19mm -29mm	$5,000.00
MC993	Hancock II Aortic Cinch II	Aortic valve bioprosthesis	21mm to 29mm	$5,000.00
MI007	Hancock II Aortic Valve	Aortic bioprosthesis	21mm to 29mm	$5,000.00
MI008	Hancock II Mitral Valve	Mitral bioprosthesis	25mm to 33mm	$5,000.00
Prostheses List by Category, Groups and Sponsor	Page 657 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI009	Hancock II Ultra Aortic Valve	Small aortic root bioprosthesis	21mm to 29mm	$5,000.00
	St Jude Medical Australia Pty Ltd
SJ136	SJM Biocor Heart Valve	Stented Porcine tissue valve	Aortic Valves - Tissue 	$5,000.00
	Annulus Diameter - 21 - 
	29mm                                           
	                                  Mitral 
	Valves - Tissue Annulus 
	Diameter - 25-35mm
SJ192	Epic Flexfit	Triple-composite Bioprosthetic heart 	Aortic Valves 21-29mm 	$5,000.00
	valve	tissue annulus diameter, 14-
	20mm total height. Mitral 
	Valves 25-33mm tissue 
	annulus diameter, 15-20mm 
	total height.
SJ201	Epic FlexFit Supra	Triple-composite Bioprosthetic heart 	Tissue Annulus Diameter - 	$5,000.00
	valve for supra-annular placement in 	19mm-23mm. Total Height 
	the aortic position	14mm-16mm.
09.02.02 - Stented, non anatomical
	b
	Edwards Lifesciences Pty Ltd
EL031	Carpentier-Edwards Perimount 	Carpentier-Edwards Pericardial 	Models 2900/6900 19-	$5,000.00
	Pericardial Bioprosthesis - Models 	Bioprosthesis. Composition: Bovine 	33mm, Model 6900P 25, 27,
	2900/6900  Carpentier-Edwards 	Pericardium; Elgiloy Alloy; Silicone 	 29, 31, 33mm
	Perimount Plus Pericardial 	Rubber, Polytetrafluoroethylene
	Bioprosthesis Mitral - Model 
EL039	Edwards Perimount Magna Model 	Carpentier-Edwards Perimount 	19MM Aortic Pericardial 	$5,000.00
	3000	Magna composition: Glutaraldehyde 	Tissue Valve; 21MM Aortic
	treated bovine pericardium/elgiloy 	 Pericardial Tissue Valve; 
	wireform stent/polyester 	23MM Aortic Pericardial 
	band/silicone rubber suture 	Tissue Valve; 25MM Aortic
	ring/polytetrafluoroethylene 	 Pericardial Tissue Valve; 
	27MM Aortic Pericardial 
	Tissue Valve; 29MM Aortic
	 Pericardial Tissue Valve
	Sorin Group Australia Pty Ltd
SA130	Mitroflow	Pericardial Bioprosthesis	19-27mm	$5,000.00
Prostheses List by Category, Groups and Sponsor	Page 658 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SA155	Mitroflow	Mitroflow Aortic Pericardial Heart 	19, 21, 23, 25, 27mm	$5,000.00
	Valve (Model LX)
	St Jude Medical Australia Pty Ltd
SJ284	Trifecta Valve	Tri-leaflet, stented pericardial valve.	19-29mm Annulus diameter 	$5,000.00
	and 15-20mm height
	b bovine
	Edwards Lifesciences Pty Ltd
EL060	Carpentier-Edwards PERIMOUNT 	The Carpentenier-Edwards 	25, 27, 29, 31, 33mm	$5,000.00
	Magna Mitral Ease Tissue Valve	PERIMOUNT Magna Mitral Ease 
	Tissue is comprised of Bovine 
	Pericardial Tissue and is 
	bioengineered to withstand the 
	higher pressures encountered in the 
	mitral position, whilst maximising 
09.02.03 - Non-Stented
	e
	Medtronic Australasia Pty Ltd
MC982	3f Aortic Bioprosthesis (Model 	Model 1000 - EQUINE Pericardium 	19 - 29 mm	$5,100.00
	Bioprostheseis (non stented)
	p
	Medtronic Australasia Pty Ltd
MC015	Freestyle bioprosthesis	Models 995xx, 995MSxx	19 - 35mm	$5,100.00
09.03.01 - Mechanical Valve
	Medtronic Australasia Pty Ltd
MC979	Open Pivot Aortic Valved Graft 	Pyrolythic Carbon, Double Velour 	21- 33mm	$6,950.00
	(Model 502AG)	Polyester, Titanium
Prostheses List by Category, Groups and Sponsor	Page 659 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sorin Group Australia Pty Ltd
SA128	CarboSeal Ascending Aortic 	Mechanical Conduit	AP 21-33mm, CP 21 - 33mm	$6,950.00
	Prosthesis, sterile, CarboSeal 
	Ascending Aortic Prosthesis with 
	Handle Model AP21, Model AP23, 
	Model AP25, Model AP27, Model 
	AP29, Model AP31, Model AP33, 
	Carboseal Valsalva
	b
	St Jude Medical Australia Pty Ltd
SJ036	St Jude Medical Coated Aortic 	Coated Aortic Valved Graft 	21mm - 33mm	$6,950.00
	Valved Graft
SJ104	SJM Masters Series Aortic Valved 	St Jude Medical Mechanical Heart 	Annulus Diameter 19-29mm	$6,950.00
	Prosthesis - VAVGJ	Valve sewn into the base of a woven 
	polyester fibre graft which has been 
	impregnated with bovine-derived 
	gelatin
09.03.02 - Tissue Valve, stented anatomical
	p
	Medtronic Australasia Pty Ltd
MC012	Medtronic Hancock Valved Conduit	Porcine bioprosthesis, dacron	12, 14, 16, 18, 20, 22, 25, 	$6,800.00
	 Model 100/150	30mm.
09.04.01 - Ring, Standard
	Edwards Lifesciences Pty Ltd
EL028	Baxter Sterile Grafts, Implants & 	Carpentier-Edwards Classic 	24mm-40mm	$2,200.00
	Prostheses, Non-Animal Origin 	Annuloplasty Ring. Composition: 
	Annuloplasty: Ring-Mitral Ring 	Titanium Alloy; Silicone Rubber; 
	with Holder; Mitral Cosgrove-	Polyester Fabric Carpentier-Edwards 
	Edwards Annuloplasty System 	Physio Annuloplasty Ring. 
	Model 4600; Classic Annuloplasty 	Composition: Elgiloy Bands; 
	Polyester Film Strips; Silicone 
	Rubber; Polyester Cloth, Cosgrove-
	Edwards
Prostheses List by Category, Groups and Sponsor	Page 660 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medtronic Australasia Pty Ltd
MC005	Medtronic Duran Annuloplasty 	Annuloplasty Devices - Models 610R	Model 610R 25-35mm & 	$2,200.00
	Ring; Duran Ancore Ring 620R; 	 & 620R Silicone / Barium Sulphate, 	Model 620R 23-35mm
	Duran Ancore Chordal Model 620RG	Dacron.
	Sorin Group Australia Pty Ltd
SA127	AnnuloFlo Annuloplasty System	Annuloflex Ring or AnnuloFlo Ring	26-36mm	$2,200.00
	St Jude Medical Australia Pty Ltd
SJ035	SJM Tailor Annuloplasty Ring	Fully Flexible	25mm - 35mm	$2,200.00
09.04.02 - Ring, with modification
	Edwards Lifesciences Pty Ltd
EL049	McCarthy-Edwards IMR Etlogix 	Rigid mitral annuloplasty ring with 	24mm, 26mm, 28mm, 30mm, 	$2,400.00
	Annuloplasty Ring (Model: 4100)	an assymetric design	32mm, 34mm, 36mm
EL050	Edwards MC3 Tricuspid Ring 	3D rigid annuloplasty ring with a 	26mm, 28mm, 30mm, 32mm, 	$2,400.00
	Annuloplalsty System (Model: 	tricuspid specific design	34mm, 36mm
EL057	Geoform	Geoform annuloplasty ring Model 	26, 28, 30 and 32mm	$2,400.00
	4200 with Holder
EL059	Carpentier-Edwards PHYSIO ll 	PHYSIO II is a semi rigid mitral 	24, 26, 28, 30, 32, 34, 36, 	$2,400.00
	Mitral Annuloplasty Ring	annuloplasty ring, with an improved 	38, 40mm
	saddle shape and global disease based
	 design
EL061	Carpentier-Edwards Physio 	The Carpentier-Edwards Physio 	24,  26, 28, 30, 32, 34, 36mm	$2,400.00
	Tricuspid Annuloplasty Ring	Tricuspid annuloplasty ring, model 
	6200 is intended for use in patients 
	with tricuspid valvular insufficiency. 
	Designed with selective flexibility 
	and 3D waveform shape.
	Medtronic Australasia Pty Ltd
MC745	CG Future Composite Ring	Semi-rigid mitral annuloplasty ring, 	24, 26, 28, 30, 32, 34, 36 & 	$2,400.00
	with anterior flexibility	38mm
MC844	Profile 3D Annuloplasty Ring	3D, rigid annuloplasty ring with 	Diameter (mm) 24 - 40mm	$2,400.00
	physiologic mitral valve shape
MI121	Contour 3D Tricuspid 	Annuloplasty Ring: Titanium core 	26, 28, 30 32, 34, 36mm	$2,400.00
	Annuloplasty Ring	encapsulated with silicone, covered 
	with polyester fabric
Prostheses List by Category, Groups and Sponsor	Page 661 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sorin Group Australia Pty Ltd
SA150	MEMO 3D	Memo 3D Semirigid Mitral 	24-38mm	$2,400.00
	Annuloplasty Ring, with 3D 
	flexibility and coasted with Carbofilm
	St Jude Medical Australia Pty Ltd
SJ087	St Jude Medical Rigid Saddle Ring	Rigid Annuloplasty Ring	24 - 34mm	$2,400.00
SJ195	Attune Flexible Adjustable 	Flexible annuloplasty ring	25mm - 43mm	$2,400.00
	Annuloplasty Ring
SJ316	Seguin Annuloplasty Ring	Semi-rigid annuloplasty ring	24-40mm	$2,400.00
09.04.03 - Band, with modification
	Medtronic Australasia Pty Ltd
MC709	Posterior Annuloplasty Band;  	Annuloplasty - Model 610B & 620B 	Model 610B: 25-35mm; 	$2,200.00
	Colvin - Galloway Future Band 	Silicone / Barium Sulphate, Dacron. 	Models 620B & 620BG: 
	Model 638B; Duran Ancore Band 	Models 638B semi-regid metal alloy 	23-35mm, Model 638B - 26-
	620B; Duran Ancore Chordal 	core, silicone coating, polyester knit 	38mm
	Model 620BG	fabric, kit includes-band, malleable 
	handle, template with suture markers, 
	sizers
	St Jude Medical Australia Pty Ltd
SJ088	SJM Tailor Annuloplasty Band	Flexible double-velour, polyester 	25 - 35mm	$2,200.00
09.05.01 - Tissue
	09.05.01.01 - < 25cm²
	Baxter Healthcare Pty Ltd
BX292	Supple Peri-Guard (4 x 4cm)	Model No PC0404SN - 4 x 4cm 	4 x 4cm	$350.00
	Bovine pericardium patch
	09.05.01.02 -   25-75cm²
	Baxter Healthcare Pty Ltd
BX293	Supple Peri-Guard (6 x 8cm)	Model No PC0608SN -6 x 8cm 	6 x 8cm	$550.00
	Bovine pericardium patch
Prostheses List by Category, Groups and Sponsor	Page 662 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	09.05.01.03 - >75cm²
	Baxter Healthcare Pty Ltd
BX294	Supple Peri-Guard (10 x 16cm)	Model No PC1016SN - 10 x 16 	10 x 16cm	$760.00
	Bovine pericardium patch
BX295	Supple Peri-Guard (8 x 14cm)	Nodel No PC0814SN - 8 x 14 Bovine 	8 x 14cm	$760.00
	pericardium patch
	Edwards Lifesciences Pty Ltd
EL033	Baxter Augmentation / Substitution 	Edwards Pericardial Patch. Bovine 	10cm x 16cm	$760.00
	Material, Human or Animal Origin, 	Pericardium.
	Sterile Pericardial Patch. 
09.05.02 - Synthetic
	09.05.02.01 - Cardiovascular < 75cm²
	W L Gore & Associates
GT117	Gore-Tex - Cardiovascular Patch	ePTFE	0.4mm Thickness 2 x 9cm	$240.00
GT118	Gore-Tex - Cardiovascular Patch	ePTFE	0.4mm - 3 x 6cm0.6mm - 	$240.00
	2.5cm x 15cm & 5cm x 7.5cm
GT126	Acuseal Cardiovascular Patch 	ePTFE	0.5mm Thickness 1 x 9cm; 	$240.00
	Vascular	0.8 x 7.5cm
GT127	Acuseal Cardiovascular Patch 	ePTFE	0.5mm Thickness 3 x 6cm & 	$240.00
	5 x 7.5cm
	09.05.02.02 - Cardiovascular ≥ 75cm²
	W L Gore & Associates
GT120	Gore-Tex  Cardiovascular Patch	ePTFE	0.6mm Thickness 5 x 15cm	$521.00
GT121	Gore-Tex Cardiovascular Patch	ePTFE	0.6mm Thickness 10 x 15cm	$521.00
Prostheses List by Category, Groups and Sponsor	Page 663 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
09.06.01 - Non-cardiovascular < 100cm²
	W L Gore & Associates
GT122	Preclude Pericardial Membrane	ePTFE	0.1mm Thickness 6 x 12cm	$360.00
09.06.02 - Non-cardiovascular ≥100cm² and <200cm²
	W L Gore & Associates
GT123	Preclude Pericardial Membrane	ePTFE	0.1mm Thickness 8 x 16cm	$643.00
GT124	Preclude Pericardial Membrane	ePTFE	0.1mm Thickness 12 x 12cm	$643.00
09.06.03 - Non-cardiovascular  ≥200cm²
	W L Gore & Associates
GT125	Preclude Pericardial Membrane	ePTFE	0.1mm Thickness 15 x 20cm	$1,455.00
09.09.01 - Modified Tube (end modified eg valsalva)
	Terumo Corporation Australia
TU036	Gelweave Valsalva Graft	Woven vascular prosthesis, polyester,	Diameter 24 - 34 mm, 	$3,320.00
	 gelatin sealed	Overall length 18.4 - 
09.09.02 - Tube with one side branch
	Terumo Corporation Australia
TU038	Gelweave Graft	Straight Thoracic Graft, with antiflo 	20 -34 mm x 20-40 cm	$1,715.00
	side branch, Polyester, woven, gelatin
	 sealed
Prostheses List by Category, Groups and Sponsor	Page 664 of 1059

09 - CARDIOTHORACIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
09.09.03 - Tube with multiple side branches (more than 1)
	Terumo Corporation Australia
TU037	Gelweave Plexus Graft	Multi Branched, for Aortic Arch 	20 - 34 mm x 40 cm	$2,150.00
	reconstruction, Polyester, Woven, 
	gelatin sealed
09.09.04 - Hybrid stent graft (unbranched)
	Reid Healthcare
RH011	E-vita open plus stentgraft system	Hybrid device consisting of a 	Overall length: 180, 220, or	$20,000.00
	conventional vascular graft 	 230mm. Vascular graft 
	incorporated with and endovascular 	length 50, 70mm; Stentgraft 
	stent graft that allows treatment of the 	length 130, 150, 160mm. 
	ascending aorta, the arch and the 	Diameter 24-40mm
	descending aorta, in one procedure.
09.10.01 - Skeletal fixation, sternum
	Advanced Biomedical Pty Ltd
AB074	FLEXIGRIP (Various Sizes)	Nitinol Sternal Closure Clips - 	20mm - 40mm	$140.00
	various sizes
	Synthes Australia Pty Ltd
SY688	Sternal ZipFix System	Sternal Closure Tie with Needle	One Size	$140.00
Prostheses List by Category, Groups and Sponsor	Page 665 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.01.01 - Bare Metal Stents
	10.01.01.01 - Balloon Expandable
	Abbott Australasia Pty Ltd
AY022	Cobalt Chromium Balloon 	Cobalt Chromium	Diameter 4-10mm, Length 	$1,800.00
	Expandable Peripheral Stent	12-58mm
AY024	Omnilink Stainless Steel Balloon 	Stainless Steel Balloon Expandable 	018 & 035 system: 5-10mm 	$1,800.00
	Deployable Peripheral Stent	Peripheral Stent on 018/035 system	diameter by 12, 16, 18, 28, 
	38, 58mm length
	B Braun Australia Pty Ltd
BB244	Coroflex Blue	Cobalt Chromium Alloy L605	2-4mm diameter, 8-25mm 	$1,800.00
	length
	Bard Australia Pty Ltd
BA218	Lifestent Valeo	Stainless Steel Balloon Expandable 	6-10mm diameter 17-56mm 	$1,800.00
	Peripheral Stent	length
	Biotronik Australia Pty Ltd
BT094	Dynamic	PTA Balloon Expandable Stent	Diameters: 5-10mm, 	$1,800.00
	Lengths: 15, 25, 38, 56mm
	Boston Scientific Australia Pty Ltd
BS059	Express Vascular LD Stent; Express 	Stainless Steel, Balloon Expanding 	Stent Diameters up to 10mm 	$1,800.00
	Vascular SD Stent	Stent	and lengths up to 60mm
	Cook Medical Australia Pty Ltd
WC234	Formula 414 Rx Renal Stent System	Balloon Expandable Vasc/Biliary 	Rapid exchange 014/018, 	$1,800.00
	80-135cm delivery system. 
	Diameters 4-10mm, lengths 
	0.8 - 4cm
	Johnson & Johnson Medical Pty Ltd
JJ305	Palmaz Genesis Peripheral Stent on 	Stainless steel balloon expandable 	Diameter 4-8mm, length 12-	$1,800.00
	Opta Pro (Medium)	stent mounted on an Opta Pro 	39mm
JJ306	Palmaz Genesis Peripheral Stent on 	Stainless steel balloon expandable 	Diameter 4-12mm, length 	$1,800.00
	Opta Pro (Large)	stent mounted on an Opta Pro 	11-79mm
JJ567	PALMAZ® BLUE™ .018 	L605 Cobalt Chromium Alloy 	12, 15, 18, 24mm length 4, 	$1,800.00
	Peripheral Stent System	Balloon Expandable Stent	5, 6, 7mm diameter
Prostheses List by Category, Groups and Sponsor	Page 666 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ688	Palmaz Blue .014 Renal Stent 	CoCr balloon expandable stent	12, 15, 18, 24mm Lengths     	$1,800.00
	System (on Aviator Plus)	                                   40, 50, 
	60, 70mm diameters                 
	                   80, 142cm shaft 
	lengths
	MD Solutions Pty Ltd
MB009	ArchStent Ostial System	The ArchStent Ostial System is a 	7Fr: 5mm x 16mm x 135mm. 	$1,800.00
	0.14" guidewire-compatible, rapid 	7Fr: 6mm x 16mm x 135mm
	exchange balloon expandable stent 
	system for the treatment of 
	atherosclerotic stenosis at the renal-
	ostial junction. It consists of a 316L 
	stainless steel stent with flaring of the
	 proximal 1/5 segment, and a dual 
	balloon delivery catheter featuring a 
	Locator balloon that enables the 
	operator to precisely position and 
	conform the stent to aorto-ostial 
	anomalies.
	Medtronic Australasia Pty Ltd
MC328	Racer Renal Stent System	Cobalt Alloy	Diameter: 4-7mm; Lengths: 	$1,800.00
	12 &18mm
MC773	Assurant Cobalt Stent	Iliac balloon expandable stent system	Diameter:  6 - 10mm , 	$1,800.00
	Length:  20 - 80mm
MC959	Hippocampus Renal Stent System	Hippocampus Renal Rapid Exchange 	Diameter 4.0mm - 7.00mm 	$1,800.00
	Stainless Steel Stent system, 5F 	Length: 10mm - 24mm
	sheath, 0.014" guide wire compatible
MC977	Chromis deep cobalt Chromium, 	Chromis deep - Cobalt Chromium, pre-	Diameter: 2.0 mm 4.0mm 	$1,800.00
	infrapopliteal OTW stent	mounted balloon expandable, 0.014" 	Length: 10mm - 76mm
	compatable stent
	10.01.01.02 - Self Expandable, <150mm
	Abbott Australasia Pty Ltd
AY015	Xact/ Xact Flex Carotid Stent	Nitinol Self-Expanding stent on rapid	Diameter 7-10mm Length 20	$1,800.00
	 exchange delivery system	 + 30mm Straight; Diameter 
	8-6, 9-7, 10-8mm Length 20 
	+ 30mm Tapered
Prostheses List by Category, Groups and Sponsor	Page 667 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AY031	Xpert	Xpert is a laser cut nitinol self 	3 - 8mm in diameter, 20 - 	$1,800.00
	expanding stent, used to treat 	80mm in length
	peripheral vessel disease, Xpert is a 
	low profile system designed for small 
	vessels and is 4 french.
AY032	ACCULINK Peripheral Stent 	Nickel-Titanium Intra-vascular stent	4-10mm diameter, 13-56mm 	$1,800.00
	length
AY041	Absolute Self Expanding Peripheral	Laser cut nitinol self expanding stent, 	Size ranges from:	$1,800.00
	 stent	20mm - 120mm lengths	5.0X20MM, 80CM - 
	8.0x120MM, 135CM
AY043	Supera Peripheral Stent System	Interwoven Self-Expanding Nitnol 	20mm x 4,5,6,7mm	$1,800.00
	30mm x 4,5,6,7mm
	60mm x 4,5,6,7mm
	80mm x 4,5,6,7mm
	100mm x 4,5,6,7mm
	120mm x 4,5,6,7mm
	40mm, x 4, 5, 6, 7mm
	40mm x 8mm diameter
	60mm x 8mm diameter
	80mm x 8mm diameter
	100mm x 8mm diameter
	Bard Australia Pty Ltd
BA178	Peripheral Vascular Bare Metal 	Nitonol self expanding stent	4mm - 14mm diameters,	$1,800.00
	2cm - 12cm lengths
BA199	Lifestent	Laser cut nitinol self expanding stent, 	Diameter: 6-8mm, Length: 	$1,800.00
	used to treat peripheral disease	120mm
BA216	Lifestent	Lifestent cut nitinol self expanding 	6-10mm diameter 20mm-	$1,800.00
	120mm length
	Biotronik Australia Pty Ltd
BT072	Astron	Peripheral self expanding nitinol, 	Diameters: 6 - 12mm, 	$1,800.00
	coated stent	Lengths: 30 - 100mm
BT103	Astron Pulsar	Astron Pulsar is a 4F compatible, 	4-7mm by 20-80mm	$1,800.00
	Nitinol self expanding stent (OTW 
	design) used to treat peripheral vessel
	 disease.
BT126	Pulsar 18 Peripheral self expanding 	Pulsar 18  self expanding Nitinol 	Stent: Ø 4- 7mm length: 20-	$1,800.00
	Nitinol stent system	stent system	120mm Catheter length: 90-
	135mm
Prostheses List by Category, Groups and Sponsor	Page 668 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BT133	Pulsar 35 Peripheral self-expanding 	Pulsar 35 Peripheral self-expanding 	Diameter: 5-7mm; Length: 	$1,800.00
	Nitinol stent system	Nitinol stent system	30-120mm; Catheter length:
	 90cm
	Boston Scientific Australia Pty Ltd
BS035	Expandable Endoprosthesis	Biomedical superalloy, self expanding	Stent Diameters up to 30mm 	$1,800.00
	 stent	and lengths up to 100mm
BS056	Carotid Wall Stent	Elgiloy self expanding stent	Stent diameters up to 10mm 	$1,800.00
	and lengths up to 40mm
BS137	EPIC Nitinol Stent	Nitinol self expanding stent	Stent diameters up to 14mm 	$1,800.00
	and lengths up to 120mm
BS167	Placehit Wallstent	Biomedical cobalt-based alloy, self 	Stent diameters up to 19mm 	$1,800.00
	expanding stent	and lengths up to 100mm
BS168	Wallstent RP	Tracheobronchial, Iliac, Biomedical 	Diameter up to 10mm; 	$1,800.00
	Superalloy Wire, Braided Mesh, 	lengths up to 100mm
	Stainless Steel Stent with Unistep 
	Delivery System
BS189	Adapt Monorail Carotid Stent System	Nitinol self expanding stent	21-40mm length, 4-9mm 	$1,800.00
	diameter
BS196	Innova Self-Expanding Stent	Nitinol, self expanding stent	Diameters up to 8mm, 	$1,800.00
	lengths less than 150mm
	Cook Medical Australia Pty Ltd
WC168	Cook Vascular/Biliary Stent	Vascular/Biliary stent	5/6 Fr delivery system, 4 - 	$1,800.00
	14mm diameter, 2 - 8cm 
	length
WC287	Zilver® Flex 35™ Vascular Stent	The Zilver® Flew 35™ Stent (ZFV) is 	The Zilver®  Flex 35™ 	$1,800.00
	a self-expandable stent made of 	Stent is available in the 
	nitinol.  The special laser-cut pattern 	following sizes: stent outer 
	of the nitinol tube provides a 	diameters of 5 -10mm and 
	construction with a strong radial force	stent lengths of 20 -140mm.
	 and high flexibility.  The stent has 
	radiopaque markers at both ends.  The 
	stent is supplied preloaded in a 6.0 
	French inducer catheter. A radiopaque
	 marker on the distal tip of the sheath 
	is used to visualize deployment of the 
	stent. Stent deployment is controlled 
	by means of a hand held device.
Prostheses List by Category, Groups and Sponsor	Page 669 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC290	Zilver®  Vena ™ Venous Stent	The Zilver® Vena™ Venous Stent is a	14mm and 16mm diameters, 	$1,800.00
	 self-expanding, flexible, slotted-tube 	and 60mm/100mm/140mm 
	nitinol stent. Post-deployment, the 	lengths.
	stent is designed to impart an outward
	 radial force upon the inner lumen of 
	the vessel, establishing patency in the
	 stented region.
	Covidien Pty Ltd
AS189	Protégé GPS Peripheral Stent	Protégé RX Peripheral Stent	Diameter 6-10mm Length 	$1,800.00
	20-60mm
AS194	Protégé EverFlex Peripheral Stent	Protégé EverFlex is a self expanding 	Diameter 5-8, Length 20-	$1,800.00
	Nitinol stent premounted on an OTW 	120mm
	delivery system.
	Endotherapeutics Pty Ltd
ET037	SX-Ella Endovascular Stent	Uncovered, self-expanding nitinol 	Dia 6-16mm, length 22-77mm	$1,800.00
	Johnson & Johnson Medical Pty Ltd
JJ419	SMART Control Peripheral Stent 	SMART Control is a laser cut nitinol 	Dia 6 – 14mm; Length 20 – 	$1,800.00
	System	self expanding stent, used to treat 	100mm
	peripheral vessel disease.
JJ592	SMART Nitinol Stent System	Long 120mm Stent, 6F compatible	6-8mm diameter, 120mm 	$1,800.00
	stent length, 120cm 
	delivery system
JJ646	Precise Pro Rx Nitinol Stent System	Nitinol self expanding stent	Diameter:  5, 6, 7, 8, 9, 	$1,800.00
	10mm;  Length:  20, 30, 40mm
	Medtronic Australasia Pty Ltd
MC743	Complete SE Stent	Nitinol	20mm - 80mm	$1,800.00
MC744	Complete SE Stent	Nitinol	100mm - 120mm	$1,800.00
MC978	Cristallo Ideale Carotid Self 	Cristallo Ideale  Nitinol, Carotid Self 	Cylinder Diameter: 7.0mm - 	$1,800.00
	Expanding Stent System	Expanding Hybrid Stent system, 5F 	11.0 mm. Taper Diameter 
	introducer sheath compatible, Rapid 	6.0/9.0 - 7.0/10.0. Length 
	Exchange design, .014" guide wire 	20mm - 40 mm.
	compatible.
MI010	Maris Plus Peripheral Self-	Nitinol, self expanding, peripheral 	Diameter: 6.0-12.0mm; 	$1,800.00
	Expanding Stent System	stent system	Length: 30-120mm
Prostheses List by Category, Groups and Sponsor	Page 670 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Pyramed Pty Limited
PY028	Sinus-XL Stent	Self-expanding Nitinol stent	Diameter: 16mm - 24mm. 	$1,800.00
	Length: 40-100mm 
	nominal; 41-100 Expanded.
PY031	Optimed Sinus Stents	Sinus-wave nitinol stent	3-14mm Diameter x 20-	$1,800.00
	130mm Length
PY036	sinus-Venous Stents	sinus-Venous Stent used for treating 	12-18mm Diameter, 60-	$1,800.00
	venous insufficiency, occlusion and 	150mm Length
	stenosis
	Terumo Corporation Australia
TU056	MISAGO Rapid Exchange, Self-	Bare Metal, Rapid Exchange, Self-	6mm - 12mm Diameter; 	$1,800.00
	Expanding Peripheral Stent	Expanding Peripheral Stent	length 20mm - 140mm
	LD (large diameter, >25mm)
	Pyramed Pty Limited
PY029	Sinus-XL Stent ≥25mm	Self-expanding Nitinol stent	Diameter: 25mm - 34mm. 	$2,970.00
	Length: 30-100mm 
	nominal; 32-102 Expanded.
	10.01.01.03 - Self Expandable, ≥150mm
	Abbott Australasia Pty Ltd
AY036	Absolute Pro (Long Length)	Laser cut nitinol self expanding stent 	Diameter 5mm to 10mm; 	$2,970.00
	≥150	length 150mm, 170mm, 
	200mm
AY042	Supera Peripheral Stent System	Interwooven Self-Expanding Nitinol 	150mm x 4, 5, 6mm	$2,970.00
	Stent	180mm x 4, 5, 6mm
	200 x 4, 5, 6mm
	Bard Australia Pty Ltd
BA217	Lifestent	Laser cut nitinol self expanding stent	Diameter 5mm to 10mm; 	$2,970.00
	length 150mm - 200mm
	Biotronik Australia Pty Ltd
BT127	Pulsar 18 Peripheral self expanding 	Pulsar 18  self expanding Nitinol 	Stent: 4-7mm Stent length: 	$2,970.00
	Nitinol stent system	stent system	150-200mm Catheter 
	length: 90-135mm
BT132	Pulsar 35 Peripheral self-expanding 	Pulsar 35 Peripheral self-expanding 	Diameter: 5-7mm; Length: 	$2,970.00
	Nitinol stent system	Nitinol stent system	150-200mm; Catheter 
	length: 90cm, 135cm
Prostheses List by Category, Groups and Sponsor	Page 671 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Boston Scientific Australia Pty Ltd
BS197	Innova Self-Expanding Stent	Nitinol, self expanding stent	Diameters up to 8mm, 	$2,970.00
	Lengths greater than 150mm
	Cook Medical Australia Pty Ltd
WC285	Zilver® Flex35™ Vascular Stent	The Zilver® Flex35™ Stent (ZFV) is a	Diameter: 5-8mm; 	$2,970.00
	 self-expandable stent made of nitinol. 	Length:170mm and 200mm
	 The special laser-cut pattern of the 
	nitinol tube provides a construction 
	with a strong radial force and high 
	flexibility.  The stent has radiopaque 
	markers at both ends.
	Covidien Pty Ltd
AS195	Protégé EverFlex Peripheral Stent	Protégé EverFlex is a self expanding 	Diameter 5-8mm, Length 	$2,970.00
	Nitinol stent premounted on an OTW 	150-200mm
	delivery system.
	Johnson & Johnson Medical Pty Ltd
JJ617	SMART Nitinol Stent System	Long 150mm stent, 6F compatible	6-8mm diameter, 150mm 	$2,970.00
	length, 120cm delivery 
	system
	Medtronic Australasia Pty Ltd
MC760	Complete SE Stent	Nitinol	150mm	$2,970.00
MI011	Maris Plus Peripheral Self-	Nitinol, self expanding, peripheral 	Diameter: 6.0-12.0mm; 	$2,970.00
	Expanding Stent System	stent system	Length: 150mm
	Pyramed Pty Limited
PY016	Optimed Iliac Sinus Stent - extra long	Sinus-wave nitinol stent - extra long	6-8 mm x 150-200mm	$2,970.00
PY037	sinus-Venous Stent	sinus-Venous stent used for treating 	18mm diameter, 150mm 	$2,970.00
	venous insufficiency, occlusion and 	Length
	stenosis
	Terumo Corporation Australia
TU055	MISAGO Self-expanding, Rapid 	Bare metal, Self Expanding, Rapid 	6mm - 12mm Diameter; 	$2,970.00
	Exchange Peripheral Stent	Exchange Peripheral Stent	length 150mm - 200mm
Prostheses List by Category, Groups and Sponsor	Page 672 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	10.01.01.04 - Self-Expanding, large diameter for treatment of aortic dissection disease
	Cook Medical Australia Pty Ltd
WC288	Zenith Dissection Endovascular 	The Zenith Dissection Endovascular 	Diameter: 46mm (designed 	$4,650.00
	Stent with the H&L-B One-Shot 	for vessel diameters 24-
	Introduction System is indicated for 	38mm). Length: 82, 123, 
	the endovascular treatment of patients 	164mm
	with aortic dissection distal to the left
	 subclavian artery.
WC316	Zenith Dissection Endovascular 	Dissection Endovascular Stent	Diameter: 36mm and 46mm	$4,650.00
	Stent with the Z-Trak Plus 	Lengths: 80mm, 120mm, 
	Introduction System	180mm, 185mm
10.01.02 - Drug Eluting Stents
	Cook Medical Australia Pty Ltd
WC289	Zilver PTX	The Zilver PTX Drug Eluting 	6French: 5, 6, 7, 8, 9, 10mm 	$2,400.00
	Peripheral Stent is a self-expanding 	diameters in 20, 30, 40, 60, 
	stent made of nitinol and coated with 	80, 100, 120mm lengths
	the drug Paclitaxel.  The stent is 
	preloaded in a 6.0 French delivery 
	catheter.  Stent deployment is 
	controlled by retraction of the handle 
	while holding the metal cannula 
	stationary.
10.02.01 - Tube (Thoracic Aorta)
	10.02.01.01 - <180mm length
	Cook Medical Australia Pty Ltd
WC238	Zenith Thoracic Endovascular Graft	Thoracic Proximal Graft	22mm to 42mm diameter, 	$11,027.00
	115mm to 179mm Length
WC240	Zenith Thoracic Endovascular Graft	Thoracic Distal Graft	26mm to 42mm diameter, 	$11,027.00
	127mm to 179mm Length
Prostheses List by Category, Groups and Sponsor	Page 673 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC275	Zenith TX2 TAA Endovascular 	Short Thoracic Proximal Graft	Diameter 22mm - 42mm	$11,027.00
	Graft with Pro_Form and the Z-Trak 	Length 115mm - 167mm
	Plus Introduction System Short 
	Proximal Component
WC307	Zenith TX2 Dissection 	Short Thoracic Proximal Graft	Diameter 22mm - 42mm 	$11,027.00
	Endovascular Graft with Pro-Form 	Length 117mm - 165
	and the Z-Trak Plus Introduction 
	System (Short proximal component)
	Medical Specialties Australia Pty Ltd
MS052	Relay Thoracic Stent Graft	Duralloy Nitinol Surgical Graft 	Diameter 22 - 46mm, Length	$11,027.00
	Material Braided Polyester PFTE 	 103 - 179mm
	impregnated Suture Dual Sheath 
	Delivery System
	Medtronic Australasia Pty Ltd
MC206	Talent Thoracic Stent Graft	Talent Endoluminal Stent Graft - 	22 - 46mm x 130mm	$11,027.00
	Thoracic Stent Graft System
MC747	Valiant Endovascular Stent Graft	Nitinol and polyester system	22-46mm diameter, 110mm 	$11,027.00
	length
MC748	Valiant Endovasculat Stent Graft	Nitinol and polyester system	22-46mm diameter, 150mm 	$11,027.00
	length
MC809	Valliant Endovascular Stent Graft	Nitinol and polyester system	24 - 46 diameter, up to 179mm	$11,027.00
MC952	Valiant Captivia	Valient Stent Graft with Captivia 	22-46mm diameter, 150mm 	$11,027.00
	Delivery System	length
MC960	Valiant Captivia	Valiant Stent Graft with captivia 	22 - 46 mm diameter: 100mm	$11,027.00
	delivery system	 length
	W L Gore & Associates
GT191	Excluder Endovascular Prostheses	Thoracic Stent Graft Nitinol & ePTFE	Diameter 26-40mm x  10cm 	$11,027.00
	Length
GT259	Conformable GORE TAG Thoracic 	Conformable GORE TAG	Straight Stent Grafts:	$11,027.00
	Endoprosthesis	Diameters (mm): 21, 26, 28, 
	31, 34, 37, 40, 45
	Length (cm): 10
	Tapered Stent Grafts:
	Diameters (mm): 26x21; 
	31x26
	Lengths (cm): 10
Prostheses List by Category, Groups and Sponsor	Page 674 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT260	Conformable GORE TAG Thoracic 	Conformable GORE TAG	Diameters (mm): 28, 31, 34, 	$11,027.00
	Endoprosthesis	37, 40, 45
	Length (cm) 15
	10.02.01.02 - ≥180mm length
	Cook Medical Australia Pty Ltd
WC239	Zenith Thoracic Endovascular Graft	Thoracic Proximal Grft	22mm to 42mm diameter, 	$14,500.00
	180mm to 216mm Length
WC241	Zenith Thoracic Endovascular Graft	Thoracic Distal Graft	26mm to 42mm diameter, 	$14,500.00
	180mm to 207mm Length
WC276	Zenith TX2 TAA Endovascular 	Long Thoracic Proximal 	Diameter: 22mm-42mm 	$14,500.00
	Graft with Pro-Form and the Z-Trak 	Endovascular Graft	Length: 192mm-216mm
	Plus Introduction System - Long 
	Proximal Component
WC305	Zenith TX2 Dissection 	Long thoracic proximal graft	Diameter 28mm-42mm; 	$14,500.00
	Endovascular Graft with Pro-Form 	Length 194mm-218
	and the Z-Trak Plus Introduction 
	System (Long proximal component)
	Medical Specialties Australia Pty Ltd
MS053	Relay Thoracic Stent Graft	Duralloy Nitinol Surgical Graft 	Diamter 22 - 46mm,  Length 	$14,500.00
	Material Braided Polyester PFTE 	180 - 271mm
	impregnated Suture Dual Sheath 
	Delivery System
	Medtronic Australasia Pty Ltd
MC810	Valliant Endovascular Stent Graft	Nitinol and polyester system	24 - 46 diameter, 180 - 	$14,500.00
	227mm length
MC958	Valiant Captivia	Valiant Stent Graft with Captivia 	24-46mm diameter, 200mm 	$14,500.00
	Delivery System	length
	W L Gore & Associates
GT023	Excluder Endovascular Prostheses	Thoracic Stent Graft Nitinol & ePTFE	34, 37 & 40mm Diameter x 	$14,500.00
	20cm Lengths
GT261	Conformable GORE TAG Thoracic 	Conformable GORE TAG	Diameters (mm): 34, 37, 40, 	$14,500.00
	Endoprosthesis	45
	Length (cm): 20
Prostheses List by Category, Groups and Sponsor	Page 675 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.02.02 - Tube (Abdominal Aorta)
	Medtronic Australasia Pty Ltd
MC850	Endurant AAA Abdominal Tube	Endurant Endoluminal Stent Graft 	23 - 36mm X 85mm	$4,850.00
	System - Abdominal Tube
MI060	Endurant II AAA Abdominal Tube	Endurant II Endoluminal Stent Graft 	Proximal diameter: 23 to 	$4,850.00
	System - Abdominal Tube	36mm; Distal diameter: 23 
	to 36mm; Covered length: 
	70mm
	Cook Medical Australia Pty Ltd
WC232	Zenith Renu AAA Ancillary Graft - 	Stent graft indicated for the repair of in	Proximal diameter 22 - 	$4,850.00
	Main Body Extension	 situ AAA stent grafts	36mm, Length (covered 
	section) 43 - 100mm
10.02.03 - Tube (Aorto-uni-iliac)
	Cook Medical Australia Pty Ltd
WC235	Zenith Renu AAA Ancillary Graft - 	Stent graft indicated for the repair of in	Proximal diameter 22-36mm,	$10,200.00
	Converter	 situ AAA stent grafts	 distal diameter 12mm, 
	lengths 91-161mm
	Medtronic Australasia Pty Ltd
MC153	Talent AAA Aorto Uni lliac Stent 	Talent Endoluminal Stent Graft 	22 - 36mm x 75 - 310mm	$10,200.00
	Graft	System - AUI  Tapered System.
MC847	Endurant Aorto-Uni-Iliac (AUI)	Endurant Endoluminal Stent Graft 	23 - 36mm X 120mm	$10,200.00
	System - AUI
MC998	Endurant II AAA Aorto-Uni-Iliac	Endurant II Endoluminal Stent Graft 	Proximal diameter: 23 to 	$10,200.00
	System - AUI	36mm; Distal daimeter: 
	14mm; Covered length: 
	102mm
Prostheses List by Category, Groups and Sponsor	Page 676 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.02.04 - Bifurcated
	10.02.04.01 - Body and 2 limbs
	Terumo Corporation Australia
TU002	Anaconda Endovascular Graft System	Bifurcated Aortic System, Ultrathin 	18 - 34mm	$12,405.00
	woven polyester, nitinol ring stents, 
	tantalum markers
	10.02.04.02 - Body and 1 limb
	Medtronic Australasia Pty Ltd
MC845	Endurant AAA Stent Graft 	Endurant Endoluminal Stent Graft 	23 - 36mm x 13 - 20mm x 	$8,955.00
	System - Bifurcated Graft	135 -185mm
MC997	Endurant II AAA Stent Graft 	Endurant II Endoluminal Stent Graft 	Proximal diameters: 23 to 	$8,955.00
	Bifurcation	System - Bifurcated Graft	36mm; Distal diameters: 13 
	to 20mm; Covered lengths: 
	124 to 166mm
	W L Gore & Associates
GT024	Excluder AAA Endovascular 	AAA Abdominal Stent Graft Nitinol 	23-28.5mm Diameter, 14-	$8,955.00
	Prostheses	& ePTFE - two piece system (1/2) 	18cm Length
	Trunk - Ipsilateral Limb
GT263	GORE EXCLUDER AAA 	AAA Stent Graft Nitinol & ePTFE 	Diameters (mm): 23, 26, 	$8,955.00
	Endoprosthesis	Two piece system (1/2) Trunk-	28.5, 35mm
	ipsilateral component	Length: 12, 14, 16, 18cm
	Diameter: 31mm
	Lengths: 13, 15, 17cm
	Diameters: 35mm
	Lengths: 14, 16, 18cm
	10.02.04.03 - Body only
	Cook Medical Australia Pty Ltd
WC133	Zenith Flex AAA Endovascular 	Stainless steel	Dia 22 - 32mm, length 82 - 	$5,794.00
	Graft - body only	140mm
WC261	Zenith Fenestrated AAA 	Distal Bifurcated Body with Flexor 	Diameter 12 - 24mm, 1st 	$5,794.00
	Endovascular Graft with Flexor	sheath	length 28 - 62mm, 2nd 
	length 76 - 121mm
Prostheses List by Category, Groups and Sponsor	Page 677 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC277	Zenith Flex AAA Endovascular 	Zenith Flex with Z-trak main body - 	Diameter - 22mm - 36mm. 	$5,794.00
	Graft with the Z-Trak Introduction 	AAA endovascular graft	Length 82mm - 149mm.
	System - main body
WC293	Zenith Low Profile AAA 	Bifurcated main body graft	Diameter: 22-36mm, 	$5,794.00
	Endovascular Graft - Bifurcated 	Length: 70-128mm
	Main Body
10.02.05 - Branched
	Cook Medical Australia Pty Ltd
WC233	Zenith Branch Endovascular Graft - 	Bifurcated branch vessel stent graft 	Common iliac lengths 45 or 	$7,500.00
	Iliac Bifurcation	with openings to connect the common	61mm, external iliac lengths 
	 iliac, sidebranch, and external iliac 	41 or 58mm and distal cuff 
	segments. Made of stainless steel and 	diameters 10 or 12mm
	nitinol z-stents and woven polyester, 
	mounted on H&LB one shot delivery 
	system
	10.02.05.02 - Multiple Branch
	Cook Medical Australia Pty Ltd
WC312	Zenith Universal Distal Body 	The Zenith Universal Distal Body 	Diameters: 22 - 24mm	$7,500.00
	Endovascular Graft	Endovascular Graft (Unibody) 	Lengths: 81 - 32mm
	consists of a bifurcated graft loaded 
	into the H&L-B One-Shot delivery 
	L
	Cook Medical Australia Pty Ltd
WC313	Zenith t-Branch Endovascular Graft	The t-Branch is an endovascular graft 	Diameter: 34mm	$14,500.00
	designed for use in the 	Length: 202mm
	thoracabdominal aorta.
Prostheses List by Category, Groups and Sponsor	Page 678 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.02.06 - Fenestrated
	Cook Medical Australia Pty Ltd
WC263	Zenith Fenestrated AAA 	Proximal Fenestrated body with 	1 or 2 internal stents, 24 - 	$8,561.00
	Endovascular Graft with Flexor	Flexor sheath	36mm Diameter, 73 - 129mm 
	Length
10.02.07 - Accessory Component (Aortic)
	10.02.07.01 - Thoracic
	Cook Medical Australia Pty Ltd
WC160	Zenith TAA Endovascular Graft	Thoracic Proximal Extension	Dia 22 Length 77; Dia 24 	$6,300.00
	Length 77;Dia 26 Length 
	77; Dia 28 Length 80; Dia 
	30 Length 80; Dia 32 
	Length 80; Dia 34 Length 
	77; Dia 36 Length 77; Dia 
	38 Length 77; Dia 40 
	Length 81
	Diameter 42 Length 81
WC188	Zenith Thoracic Endovascular Graft	Thoracic Body Extension	22mm to 42mm diameter; 	$6,300.00
	77mm to 81mm length
WC274	Zenith TX2 TAA Endovascular 	Thoracic Proximal Extension	Diameter - 22mm - 42mm 	$6,300.00
	Graft with Pro-Form and the Z-Trak 	Length - 77mm - 81mm
	Plus Introduction System (thoracic 
	body extension)
WC306	Zenith TX2 Dissection 	Thoracic Proximal Extension	Diameter 22mm - 42mm; 	$6,300.00
	Endovascular Graft with Pro-Form 	Length 79mm - 83mm
	and the Z-Trak Plus Introduction 
	System (thoracic body extension)
	10.02.07.02 - Abdominal
	Cook Medical Australia Pty Ltd
WC045	Zenith Endovascular Graft	Converter	Diameter 20 through 36 	$2,555.00
	Length 80-85
WC048	Zenith Endovascular Graft	Body Extensions	Diameter 22 through 36	$2,555.00
Prostheses List by Category, Groups and Sponsor	Page 679 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC302	Zenith Low Profile AAA 	Converter	Proximal Diameter: 24-	$2,555.00
	Endovascular Graft - Converter	36mm, Distal Diameter: 
	12mm, Working Length: 
	66mm
WC303	Zenith Low Profile AAA 	Main Body Extension	Diameter: 22-36mm, 	$2,555.00
	Endovascular Graft - Main Body 	Working Length: 45-58mm
	Extension
	Medtronic Australasia Pty Ltd
MC158	Talent Aortic Extension Stent Graft	Talent Endoluminal Stent Graft - 	22 - 36mm x 26 - 30mm	$2,555.00
	Aortic Extension
MC849	Endurant AAA Aortic Extension	Endurant Endoluminal Stent Graft 	23 - 36mm x 60mm	$2,555.00
	System - Aortic Extension
MI061	Endurant II AAA Aortic Extension	Endurant II Endoluminal Stent Graft 	Proximal diameter: 23 to 	$2,555.00
	System - Aortic Extension	36mm; distal diameter: 23 to
	 36mm; Covered length: 
	49mm
	Terumo Corporation Australia
TU003	Anaconda Endovascular Graft System	Aortic Extension Cuff. Ultrathin 	18 - 34mm	$2,555.00
	woven polyester, nitinol ring stents, 
	tantalum markers
	W L Gore & Associates
GT189	GORE EXCLUDER AAA 	Abdominal Stent Graft Nitinol & 	Diameters: 23, 26, 28.5mm	$2,555.00
	Endoprosthesis	ePTFE - Aortic Extender	Lengths: 3.3cm
	Diameters: 32mm
	Length: 4.5cm
	Diameter: 36mm
	Length: 4.5cm
10.02.08 - Accessory Component (Other including iliac limb and 
	Cook Medical Australia Pty Ltd
WC047	Zenith Endovascular Graft	Leg Extensions	Diameter 18 through 24 	$3,308.00
	Length 55
WC259	Zenith AAA Endovascular Graft 	Leg extension with Captor valve	Diameters from 8 to 24mm, 	$3,308.00
	Contralateral/Ipsilateral Iliac Legs	lengths from 37 to 122mm
Prostheses List by Category, Groups and Sponsor	Page 680 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC286	Zenith® Spiral-Z AAA lliac Legs 	Zenith® Spiral-Z AAA lliac Leg	Proximal Diameter - 13mm	$3,308.00
	with Z-Trak™ Introduction System	Distal Diameter - 9mm to 24 
	mm
	Working Length - 39 mm to 
	122 mm
WC301	Zenith Low Profile AAA 	Contralateral/Ipsilateral lliac Leg	Diameter: 10-24mm, 	$3,308.00
	Endovascular Graft - 	Working Length: 36-
	Contralateral/Ipsilateral lliac Leg
	Medtronic Australasia Pty Ltd
MC846	Endurant AAA Contralateral Iliac 	Endurant Endoluminal Stent Graft 	10 - 28mm X 80 - 120mm	$3,308.00
	Limb	System - Contralateral Iliac Limb
MC848	Endurant AAA Iliac Extension	Endurant Endoluminal Stent Graft 	10 -  28mm x 80mm	$3,308.00
	System - Iliac Extension
MC994	Endurant II AAA Contralateral Iliac	Endurant II Endoluminal Stent Graft 	Proximal diameter: 16mm; 	$3,308.00
	 Limb	System - Contralateral Iliac Limb	Distal diameter: 10 to 
	28mm; Covered length: 
	82mm; 93mm; 124mm
MC995	Endurant II AAA Iliac Extension	Endurant II AAA Iliac Extension	Proximal diameter: 10 to 	$3,308.00
	28mm; Distal diameter: 10 
	to 28mm; Covered length: 
	82mm
	Terumo Corporation Australia
TU004	Anaconda Endovascular Graft System	Iliac Extension Cuff. Ultrathin woven 	8 - 18mm	$3,308.00
	polyester, nitinol ring stents, 
	tantalum markers
TU005	Anaconda Endovascular Graft System	Iliac Leg, Ultrathin woven polyester, 	8 - 23mm	$3,308.00
	nitinol ring stents, tantalum markers
TU041	Anaconda Endovascular Graft System	Flared iliac limb, Ultrathin woven 	Diameter: Proximal end 10-	$3,308.00
	polyester, nitinol ring stents, 	17mm, distal end 12-23mm: 
	tantalum markers	Length 80-130mm
	W L Gore & Associates
GT188	EXCLUDER AAA Endovascular 	AAA Stent Graft Nitinol & ePTFE 	Diameters: 12, 14.5, 23, 	$3,308.00
	Prostheses	Two piece system (2/2) Contralateral 	27mm
	Limb	Lenghts: 10, 12, 14cm
	Diameters: 16, 18, 20mm
	Lenghts: 9.5, 11.5, 13.5cm
GT190	Excluder AAA Endovascular 	Abdominal Stent Graft Nitinol & 	Diameters: 10, 12, 14.5mm	$3,308.00
	Prostheses	ePTFE - Iliac Extender	Lengths: 7cm
Prostheses List by Category, Groups and Sponsor	Page 681 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	L (long length)
	Medtronic Australasia Pty Ltd
MC996	Endurant II AAA Contralateral Iliac	Endurant II Endoluminal Stent Graft 	Proximal diameter: 16mm; 	$4,350.00
	 Limb	System - Contralateral Iliac Limb	Distal diameter: 10 to 
	28mm; Covered length: 
	156mm, 199mm
10.02.09 - Iliac Graft Plug
	Medtronic Australasia Pty Ltd
MC203	Talent Occluder System	Nitinol stents attached to polyester 	Standard Sizes, 8 - 24mm x 	$2,555.00
	graft sealed both ends	31 - 35mm
	Cook Medical Australia Pty Ltd
WC103	Zenith Iliac Plug	Zenith AAA Endovascular Graft	Diameter 14, 16, 18, 20, 22, 	$2,555.00
	24mm
10.02.10 - Tube, Peripheral, Balloon Expandable
	10.02.10.01 - ≤12mm diameter
	Atrium Australia - Pacific Rim Pty Limited
AC023	Advant PTFE V12 Stent Graft System	Balloon Expandable PTFE 	5mm - 12mm Diameter	$4,185.00
	Encapsulated Stainless Steel 
	Peripheral Vascular Stent
	10.02.10.02 - >12mm diameter
	Atrium Australia - Pacific Rim Pty Limited
AC027	Advanta V12 Stent Graft System	Balloon Expandable PTFE 	12 - 16 mm diameter 29mm 	$5,695.00
	Encapsulated Stainless Steel Vascular	length. 80cm and 120cm 
	 Stent	catheter lengths
AC028	Advanta V12 Stent Graft System	Balloon Expandable PTFE 	12 - 16 mm diameter 41mm 	$5,695.00
	Encapsulated Stainless Steel Vascular	length. 80cm and 120cm 
	 Stent	catheter lengths
Prostheses List by Category, Groups and Sponsor	Page 682 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AC029	Advanta V12 Stent Graft System	Balloon Expandable PTFE 	12 - 16 mm diameter 61mm 	$5,695.00
	Encapsulated Stainless Steel Vascular	length. 80cm and 120cm 
	 Stent	catheter lengths
10.02.11 - Tube, Peripheral, Self Expandable
	10.02.11.01 - <150mm length
	Bard Australia Pty Ltd
BA219	Encapsulated Carbon Lined Stent 	PTFE covered nitinol self-expanding 	4mm - 13.5mm diameter, 2cm 	$3,395.00
	Graft	stent	- 12cm length
	W L Gore & Associates
GT029	Gore Tips Endoprosthesis	ePTFE	8-12mm Diameter 4-8cm 	$3,395.00
	Graft-Lined Length 2cm 
	Unlined Length
	H
	W L Gore & Associates
GT225	Gore Viabahn ® endoprosthesis 	Gore Viabahn ® endoprosthesis with 	5mmx2.5cm 120cm 5mmx5cm	$3,495.00
	with heparin bioactive surface	heparin bioactive surface is a flexible, 	 120cm 6mmx2.5cm 120cm 
	self expanding endoluminal device 	6mmx5cm 75cm 6mmx5cm 
	consisting of an ePTFE lining with 	120cm 7mmx2.5cm 120cm 
	external nitinol support	7mmx5cm 75cm 
	7mmx5cm 120cm 8mmx2.5cm
	 120cm 8mmx5cm 75cm 
	8mmx5cm 120cm 9mmx 5cm 
	75cm 9mmx 5cm 120cm 
	10mmx 5cm 75cm 
	10mmx 5cm 120cm 11mmx 
	5cm 75cm 
	11mmx 5cm 120cm 13mmx 
	5cm 75cm 13mmx 5cm 
	120cm
Prostheses List by Category, Groups and Sponsor	Page 683 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT227	Gore Viabahn ® endoprosthesis 	Gore Viabahn ® endoprosthesis with 	5mmx 10cm 120cm 6mmx 	$3,495.00
	with heparin bioactive surface	heparin bioactive surface is a flexible, 	10cm 75cm 6mmx 10cm 
	self expandinbg endoluminal device 	120cm 7mmx 10cm 75cm 
	consisting of an ePTFE lining with 	7mmx 10cm 120cm 8mmx 
	external nitinol support	10cm 75cm 8mmx 10cm 
	120cm 
	9mmx 10cm 75cm 9mmx 
	10cm 120cm 
	10mmx 10cm 75cm 10mmx 
	10cm 120cm 
	11mmx 10cm 75cm 11mmx 
	10cm 120cm 
	13mmx 10cm 75cm 13mmx 
	10cm 120cm
	10.02.11.02 - 150-249mm length
	H
	W L Gore & Associates
GT226	Gore Viabahn ® endoprosthesis 	Gore Viabahn ® endoprosthesis with 	5mmx 15cm 120cm, 6mmx 	$4,125.00
	with heparin bioactive surface	heparin bioactive surface is a flexible, 	15cm 75cm 6mmx 15cm 
	self expanding endoluminal device 	120cm 7mmx 15cm 75cm 
	consisting of an ePTFE lining with 	7mmx 15cm 120cm 8mmx 
	external nitinol support	15cm 75cm 8mmx 15cm 
	120cm 9mmx 15cm 75cm 
	9mmx 15cm 120cm 10mmx 
	15cm 75cm, 10mmx 15cm 
	120cm 11mmx 15cm 75cm 
	11mmx 15cm 120cm 13mmx 
	15cm  75cm 13mmx 15cm 
	120cm
	10.02.11.03 - ≥250mm length
	H
	W L Gore & Associates
GT262	GORE VIABAHN® 	GORE VIABAHN® Endoprosthesis 	5mm x 25cm x 120CATH	$5,625.00
	Endoprosthesis with Heparin 	with Heparin Bioactive Surface is a 	6mm x 25cm x 120CATH
	flexible, self expanding endoluminal 	7mm x 25cm x 120CATH
	device consisting of an ePTFE lining 	8mm x 25cm x 120CATH
	with external nitinol support
Prostheses List by Category, Groups and Sponsor	Page 684 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.03.01 - Tube
	10.03.01.01 - ≤10cm length
	B Braun Australia Pty Ltd
BB025	Vascular Uni - Graft	Vascular graft	10cm	$245.00
	W L Gore & Associates
GT132	Gore-Tex Vascular Grafts	Standard Wall Grafts (ePTFE)	Diameter 4 - 8mm, Length 	$245.00
	10cm
GT138	Gore-Tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 4 - 8mm, Length 	$245.00
	10cm
GT149	Gore-Tex Vascular Grafts	Thin Wall Grafts (ePTFE)	Diameter 4 - 10mm, Length 	$245.00
	10cm
GT158	Gore-Tex Vascular Grafts	Thin Wall Grafts Stretch (ePTFE)	Diameter 4 - 10mm, Length 	$245.00
	10cm
GT167	Gore-Tex Vascular Grafts	Vascular Grafts - Aorto-Pulmonary & 	Diameter 3.5 - 5mm, Length 	$245.00
	Systemic-Pulmonary Shunts (ePTFE) 	5cm
	Stretch & Non Stretch
GT168	Gore-Tex Vascular Grafts	Vascular Grafts - Aorto-Pulmonary & 	Diameter 3.5 - 5mm, Length 	$245.00
	Systemic-Pulmonary Shunts (ePTFE) 	10cm
	Stretch & Non Stretch
	R
	Terumo Corporation Australia
TU029	SEALPTFE Graft	Standard Wall, Straight, Sealed, 	5 to 10mm x 10 to 40cm	$655.00
	Externally Reinforcement, PTFE
	10.03.01.02 - 11-20cm length
	Atrium Australia - Pacific Rim Pty Limited
AC079	Intergard W - Woven Straight	Woven Straight	15cm	$800.00
	B Braun Australia Pty Ltd
BB023	Vascular Uni - Graft	Vascular graft	20cm	$800.00
BB024	Vascular Uni - Graft	Vascular graft	15cm	$800.00
BB126	Vascugraft	Thin Wall Straight	Dia 3 - 8mm, length10 - 	$800.00
	40cm
Prostheses List by Category, Groups and Sponsor	Page 685 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB127	Vascugraft	Thin Wall Straight	Dia 3 - 8mm, length 10 - 40cm	$800.00
	Bard Australia Pty Ltd
BA020	Impra PTFE Vascular Grafts	ePTFE graft - thin wall, 10 - 50cm 	3mm - 10mm diameter	$800.00
BA025	Impra PTFE Vascular Grafts	ePTFE graft - regular wall, 10-50cm 	3 - 19mm diameter	$800.00
	long
	Bio Nova International Pty Ltd
BN004	Omniflow II Vascular Prosthesis - 	Biosynthetic vascular prosthesis for 	3 - 4 mm x 20 cm	$800.00
	Straight	peripheral revascularisation and 
	vascular access
	Lifehealthcare Pty Ltd
LH006	Thoratec, Vectra Vascular Graft - 	Vectra, Biocompatible Polyurethane 	Length 20cm	$800.00
	Synthetic	Vascular Access Graft
	Terumo Corporation Australia
TU048	Gelweave Graft	Straight Polyester Knitted	6-38mm x 15-20cm	$800.00
TU049	SEALPTFE Graft	Standard Wall, Straight, Sealed, PTFE	5 to 10mm x 10 to 20cm	$800.00
	W L Gore & Associates
GT009	Gore-Tex Vascular Grafts	Vascular Grafts - Aorto -Pulmonary & 	3.5-5mm Diameter x 15-	$800.00
	Systemic-Pulmonary Shunts (ePTFE)	20cm Length
GT146	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 12 - 24mm, Length	$800.00
	 20cm
GT150	Gore-Tex Vascular Grafts	Thin Wall Grafts (ePTFE)	Diameter 6 - 10mm, Length 	$800.00
	20cm
GT159	Gore-Tex Vascular Grafts	Thin Wall Grafts Stretch (ePTFE)	Diameter 6 - 10mm, Length 	$800.00
	20cm
GT195	Gore-Tex Vascular Graft	Standard wall grafts (ePTFE)	Diameter 6mm x 20cm length	$800.00
GT200	Gore-Tex Vascular Graft	Standard wall grafts stretch (ePTFE)	Diameter 6-12mm x 20cm 	$800.00
	length
	R
	Atrium Australia - Pacific Rim Pty Limited
AC056	Advanta PTFE Vascular Graft	Trilaminate PTFE Graft with Graft 	4mm - 8mm  11cm - 20cm 	$1,520.00
	Deployment System	length
Prostheses List by Category, Groups and Sponsor	Page 686 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	B Braun Australia Pty Ltd
BB120	Vascugraft	Straight Standard Wall with Helix 	Dia 6 - 10mm, length 10 - 	$1,520.00
	Support	50cm
	Bard Australia Pty Ltd
BA019	Impra PTFE Vascular Grafts	ePTFE graft - radially supported, thin 	4mm - 8mm diameter	$1,520.00
	wall, 10 - 50cm long
BA022	Impra PTFE Vascular Grafts	ePTFE graft - radially supported, 	4 - 19mm diameter	$1,520.00
	regular wall, 10-50cm long
	R, ID
	Atrium Australia - Pacific Rim Pty Limited
AC054	Advanta PTFE Vascular Graft with 	Trilaminate PTFE. Vascular Access 	4mm - 8mm diameter  11cm - 	$1,720.00
	Graft Deployment System	PTFE	20cm length
	10.03.01.03 - 21-49cm length
	Atrium Australia - Pacific Rim Pty Limited
AC083	Maquet InterVascular Straight 	Straight Vascular Grafts	5mm - 24mm diameter, 21 -	$870.00
	vascular Grafts	49am length
	B Braun Australia Pty Ltd
BB021	Vascular Uni - Graft	Vascular graft	40cm	$870.00
BB022	Vascular Uni - Graft	Vascular graft	30cm	$870.00
BB119	Vascugraft	PTFE, Straight Standard Wall	Dia 4 - 10mm, length 40 - 	$870.00
	50cm
BB142	Vascugraft	Easy Glide - Standard Wall Straight	Dia 6mm, length 40 - 60cm	$870.00
BB144	Vascugraft	Easy Glide - Thin Wall Straight	Dia 6 - 8mm, length 40 - 70cm	$870.00
	Bio Nova International Pty Ltd
BN026	Omniflow II Vascular Prosthesis	Biosynthetic vascular prosthesis for 	9 and 10mm internal 	$870.00
	peripheral revascularisation and 	diameter, 20 to 40cm length
	vascular access
BN027	Omniflow II Vascular Prosthesis	Biosynthetic vascular prosthesis for 	5, 6, 7 and 8mm internal 	$870.00
	peripheral revascularisation and 	diameter; 45 to 65cm length
	vascular access
Prostheses List by Category, Groups and Sponsor	Page 687 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BN028	Omniflow II Vascular Prosthesis	Biosynthetic vascular prosthesis for 	9 and 10mm internal 	$870.00
	peripheral revascularisation and 	diameter; 45 to 85cm length
	vascular access
BN029	Omniflow II Vascular Prosthesis	Biosynthetic vascular prosthesis for 	5, 6, 7 and 8mm internal 	$870.00
	peripheral revascularisation and 	diameter; 20 to 40cm length
	vascular access
	Lifehealthcare Pty Ltd
LH004	Thoratec, Vectra Vascular Graft - 	Vectra, Biocompatible Polyurethane 	Length 40cm	$870.00
	Synthetic	Vascular Access Graft
	Terumo Corporation Australia
TU008	Fluoropassiv Graft	Straight Graft - Thin Wall, Crimped. 	5 to10mm x 30 to 40cm	$870.00
	Fluoropolymer/polyester, Knitted
TU020	Gelsoft Plus Graft	Straight, Polyester, Knitted	6 - 24mm x 12.5 - 30cm	$870.00
TU025	SEALPTFE Graft	Thin Wall, Straight, Sealed, PTFE	5 to 10mm x 30 to 40cm	$870.00
TU047	Gelweave Graft	Straight Polyester Knitted	6-38mm x 25-40cm	$870.00
TU050	SEALPTFE Graft	Standard Wall, Straight, Sealed, PTFE	5 to 10cm x 20 to 40cm	$870.00
	W L Gore & Associates
GT139	Gore-Tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 6 - 10mm, Length 	$870.00
	20 - 30cm
GT147	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 12 - 24mm, Length	$870.00
	 30cm
GT148	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 12 - 24mm, Length	$870.00
	 40cm
GT151	Gore-Tex Vascular Grafts	Thin Wall Grafts (ePTFE)	Diameter 6 - 10mm, Length 	$870.00
	30cm
GT152	Gore-Tex Vascular Grafts	Thin Wall Grafts Stretch (ePTFE)	Diameter 6 - 10mm, Length 	$870.00
	40cm
GT160	Gore-Tex Vascular Grafts	Thin Wall Grafts Stretch (ePTFE)	Diameter 6 - 10mm, Length 	$870.00
	30cm
GT161	Gore-Tex Vascular Grafts	Thin Wall Grafts (ePTFE)	Diameter 6 - 10mm, Length 	$870.00
	40cm
GT193	Gore-Tex Vascular Grafts	Standard  Wall Grafts (ePTFE)	6-10mm Diameter x 40cm 	$870.00
	Length
GT240	Gore-Tex Vascular Graft	Stretch Standard Wall Graft (ePTFE)	10mm x 40cm	$870.00
GT241	Gore-Tex Vascular Graft	Stretch Standard Wall Graft (ePTFE)	6 & 8mm x 40cm	$870.00
Prostheses List by Category, Groups and Sponsor	Page 688 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	H
	W L Gore & Associates
GT221	Gor-Tex Propaten Stretch Thin 	Stretch Thin Walled Graft (ePTFE) - 	6-8mm diameter, non-	$970.00
	Walled Vascular Graft	Heparin Bonded	Ringed 40cm length
	ID
	Terumo Corporation Australia
TU039	Rapidax™ Rapid Access 	Triple layered self sealing 	6mm x 20-40cm	$1,300.00
	Haemodialysis Graft	haemodialysis Access Graft. ePTFE 
	internal and external layer with 
	proprietary elastomer inner layer - 
	Straight and Pre-curved
TU040	Rapidax™ Rapid Access 	Triple layered self sealing 	6mm x 45-50cm	$1,300.00
	Haemodialysis Graft	haemodialysis Access Graft. ePTFE 
	internal and external layer with 
	proprietary elastomer inner layer - 
	Straight and Per-curved
	R
	Atrium Australia - Pacific Rim Pty Limited
AC044	Advantra PTFE Vascular Graft	Trilaminate PTFE Aortic Graft with 	12mm - 24mm diameter 30cm	$1,520.00
	hydrostatic membrane	 length
AC057	Advanta PTFE Vascular Graft	Trilaminate PTFE Graft with Graft 	4mm - 8mm diameter 21cm - 	$1,520.00
	Deployment System	49cm length
	B Braun Australia Pty Ltd
BB132	Vascugraft	Thin Wall Centre Helix	Dia 6mm, length 45cm	$1,520.00
BB133	Vascugraft	Thin Wall Centre Helix	Dia 5 - 6mm, length 45 - 50cm	$1,520.00
BB146	Vascugraft	Easy Glide - Thin Wall Straight with 	Dia 6 - 8mm, length 40 - 80cm	$1,520.00
	Helix Support
	Terumo Corporation Australia
TU010	Fluoropassiv Graft	Straight Graft, Thin Wall, Externally 	5 to10mm x 30 to 40cm	$1,520.00
	Reinforced. Fluoropolymer/polyester, 
	Knitted
TU019	Gelsoft Plus Graft	Femoro-femoral, Polyester, Knitted, 	6mmx30cm to  8mmx40cm	$1,520.00
	Externally reinforced
Prostheses List by Category, Groups and Sponsor	Page 689 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	W L Gore & Associates
GT211	Gore-Tex Intering Stretch Thin 	ePTFE integrated rings in the wall of 	Diameter 6-8mm, 40cm 	$1,520.00
	Walled Vascular Graft	a stretch thin walled graft	radial supported length x 
	40cm length
GT252	Gore-Tex Stretch Removable Ringed	Stretch Removable Ringed Thin 	8mm diameter, 40cm length, 	$1,520.00
	 Vascular Graft	Walled Graft (ePTFE)	30cm removable ringed 
	section
GT253	Gore-Tex Stretch Removable Ringed	Stretch Removable Ringed Thin 	8mm diameter, 40cm length, 	$1,520.00
	 Vascular Graft	Walled Graft (ePTFE)	30cm removable ringed 
	section
	R, H
	W L Gore & Associates
GT235	Gore-Tex Propaten Vascular Graft	Stretch (ePTFE), Heparin Bonded, 	8mm diameter, 40cm length	$1,620.00
	Graft
GT264	Stretch Thin Walled Graft, 	Stretch Thin Walled Graft, Removable 	40cm length	$1,620.00
	Removable Rings (ePTFE) Heparin 	Rings (ePTFE) Heparin Bonded
	Bonded
	R, ID
	Atrium Australia - Pacific Rim Pty Limited
AC055	Advanta PTFE Vascular Graft with 	Trilaminate PTFE. Vascular Access 	4mm - 8mm diameter  21cm - 	$1,720.00
	Graft Deployment System	PTFE	49cm length
	10.03.01.04 - ≥50cm length
	Atrium Australia - Pacific Rim Pty Limited
AC052	Advanta PTFE Vascular Graft	Straight PTFE Vascular Graft	6mm - 10mm; 50cm - 90cm	$970.00
AC084	Maquet InterVascular Straight 	Straight Vascular Grafts	6mm - 24mm Diameter, 50-	$970.00
	Vascular Grafts	100cm length
	B Braun Australia Pty Ltd
BB018	Vascular Uni - Graft	Vascular graft	100cm	$970.00
BB019	Vascular Uni - Graft	Vascular graft	60cm	$970.00
BB020	Vascular Uni - Graft	Vascular graft	50cm	$970.00
BB123	Vascugraft	PTFE - Straight Standard Wall	Dia 5 - 10mm, length 80cm	$970.00
BB124	Vascugraft	PTFE - Straight Standard Wall	Dia 5 - 8mm, length 90 - 	$970.00
	100cm
Prostheses List by Category, Groups and Sponsor	Page 690 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB125	Vascugraft	Thin Wall Straight	Dia 3 - 8mm, length 70 - 	$970.00
	100cm
BB141	Vascugraft	Easy Glide - Standard Wall Straight	Dia 6mm, length 70 - 80cm	$970.00
	Bard Australia Pty Ltd
BA024	Impra PTFE Vascular Grafts	ePTFE graft - thin wall, greater than 	3 - 10 diameter	$970.00
	50cm long
BA026	Impra PTFE Vascular Grafts	ePTFE graft - regular wall, greater 	3 - 10mm diameter	$970.00
	than 50cm long
	Lifehealthcare Pty Ltd
LH005	Thoratec, Vectra Vascular Graft - 	Vectra, Biocompatible Polyurethane 	Length 50cm	$970.00
	Synthetic	Vascular Access graft
	Terumo Corporation Australia
TU006	Twillweave Graft	Straight, Polyester, Woven, Unsealed	6-24mm x 50-60cm	$970.00
TU009	Fluoropassiv Graft	Straight Graft - Thin Wall, Crimped. 	5 to10mm x 50 to 70cm	$970.00
	Fluoropolymer/polyester, Knitted
TU021	Gelsoft Plus Graft	Straight, Polyester, Knitted	6-24mm x 50-60cm	$970.00
TU023	Gelweave Graft	Straight, Polyester, Woven	6-38mm x 50-60cm	$970.00
TU026	SEALPTFE Graft	Thin Wall, Straight, Sealed, PTFE	5 to 10mm x 50 to 80cm	$970.00
TU028	SEALPTFE Graft	Standard Wall, Straight, Sealed, PTFE	5 to 10mm x 50 to 80cm	$970.00
	W L Gore & Associates
GT136	Gore-tex Vascular Grafts	Standard Wall Grafts (ePTFE)	Diameter 4 - 10mm, Length 	$970.00
	80cm
GT143	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 6 - 10mm, Length 	$970.00
	70cm
GT145	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch (ePTFE)	Diameter 4 - 10mm, Length 	$970.00
	90 - 100cm
GT157	Gore-Tex Stretch Thin Walled 	Thin Wall Grafts Stretch (ePTFE)	Diameter 4 - 10mm, Length 	$970.00
	Vascular Graft	90 - 100cm
GT164	Gore-Tex Vascular Grafts	Thin wall grafts (ePTFE)	Dia 3 - 10mm, length 70cm	$970.00
GT236	Gore-Tex Vascular Graft	Standard Wall Grafts (ePTFE)	10mm diameter, 70-80cm 	$970.00
	length
GT237	Gore-Tex Vascular Graft	Standard Wal Grafts(ePTFE)	5mm-8mm diameter, 70-80cm	$970.00
	 length
Prostheses List by Category, Groups and Sponsor	Page 691 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT238	Gore-Tex Vascular Graft	Standard Wal Grafts (ePTFE)	10mm diameter, 90-100cm 	$970.00
	length
GT239	Gore-Tex Vascular Graft	Standard Wall Grafts (ePTFE)	5-8mm diameter, 90-100cm 	$970.00
	length
GT242	Gore-Tex Stretch Standard Walled 	Stretch Standard Wall Graft (ePTFE)	10mm diameter, 80cm length	$970.00
	Vascular Graft
GT243	Gore-Tex Stretch Standard Walled 	Stretch Standard Walled Graft (ePTFE)	6-8mm diameter, 80cm 	$970.00
	Vascular Graft
GT244	Gore-Tex Stretch Thin Walled 	Thin Wall Graft Stretch (ePTFE)	10mm diameter, 70cm length	$970.00
	Vascular Graft
GT245	Gore-Tex Stretch Thin Walled 	Thin Wall Graft Stretch (ePTFE)	6-8mm diameter, 70cm 	$970.00
	Vascular Graft
GT246	Gore-Tex Stretch Thin Walled 	Thin Wall Graft Stretch (ePTFE)	10mm diameter, 80cm length	$970.00
	Vascular Graft
GT247	Gore-Tex Vascular Graft	Thin Wall Graft Stretch (ePTFE)	6-8mm diameter, 80cm 	$970.00
GT248	Gore-Tex Vascular Graft	Thin Wall Grafts (ePTFE)	10mm diameter, 80cm length	$970.00
GT249	Gore-Tex Vascular Graft	Thin Wall Grafts (ePTFE)	4-8mm diameter, 80cm 	$970.00
GT250	10mm Thin Walled Vascular Graft	Thin Walled Graft (ePTFE)	10mm x 90-100cm	$970.00
GT251	4-8mm Thin Walled Vascular Graft	Thin Walled Graft (ePTFE)	4-8mm x 90-100cm	$970.00
	H
	W L Gore & Associates
GT222	Gortex Stretch Thin Walled 	Stretch Thin Wall Graft (ePTFE)- 	6-8mm diameter Non-	$1,070.00
	Propaten Graft	Heparin Bonded	Ringed 80cm length
	R
	Atrium Australia - Pacific Rim Pty Limited
AC045	Advantra PTFE Vascular Graft	Trilaminate PTFE Graft with Graft 	4 - 8mm diameter 50cm - 	$1,630.00
	Deployment System	100cm lengths
AC053	Atrium PTFE Vascular Graft	Ringed PTFE	4mm - 10mm; 50cm - 100cm	$1,630.00
	B Braun Australia Pty Ltd
BB121	Vascugraft	Straight Standard Wall with Helix 	Dia 6 - 10mm, length 60 - 	$1,630.00
	Support	80cm
BB122	Vascugraft	Straight Standard Wall with Helix 	Dia 5 - 8mm, length 90cm	$1,630.00
	Support
Prostheses List by Category, Groups and Sponsor	Page 692 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB128	Vascugraft	Straight Standard Wall with Helix 	Dia 6mm x  length 100cm	$1,630.00
	Support
BB129	Vascugraft	Straight Standard Wall with Helix 	Dia 5 - 8mm, length 80 - 90cm	$1,630.00
	Support
BB130	Vascugraft	Straight Standard Wall with Helix 	Dia 4 - 6mm, length 50 - 70cm	$1,630.00
	Support
BB134	Vascugraft	Thin Wall Centre Helix	Dia 4 - 8mm, length 70 - 80cm	$1,630.00
BB137	Vascugraft	Standard with Centred Helix	Dia 4 - 8mm, length 70 - 90cm	$1,630.00
	Bard Australia Pty Ltd
BA021	Impra PTFE Vascular Grafts	ePTFE graft - radially supported, thin 	4 - 8mm diameter, greater 	$1,630.00
	wall.	than 50cm long
BA023	Impra PTFE Vascular Grafts	ePTFE graft - radially supported, 	4 - 10mm diameter, greater 	$1,630.00
	regular wall.	than 50cm long
	Terumo Corporation Australia
TU011	Fluoropassiv Graft	Straight Graft, Thin Wall, Externally 	5 to10mm x 50 to 70cm	$1,630.00
	Reinforced. Fluoropolymer/polyester, 
	Knitted
TU030	SEALPTFE Graft	Standard Wall, Straight, Sealed, 	5 to 10mm x 50 to 80cm	$1,630.00
	Externally Reinforcement, PTFE
TU045	Gelsoft Plus Graft	Polyester, Externally Reinforced, 	6 to 10cm x 75 to 100cm	$1,630.00
	Knitted
TU046	SEALPTFE Graft	Thin Wall, Straight, Sealed, 	5 to 10mm x 50 to 80cm	$1,630.00
	Externally Reinforced, PTFE
	W L Gore & Associates
GT008	Gore-Tex Vascular Ring Graft	Ringed Grafts removable thin wall - 	6-8mm Diameter x 80cm 	$1,630.00
	stretch (ePTFE)	Length - Ringed Section 
	70cm Length
GT179	Gore-Tex Vascular Ring Graft	Ringed Grafts Removable Thin Wall 	Diameter 5 - 6mm x 70cm 	$1,630.00
	(ePTFE)	Length,  Ringed Section 
	60cm Length
GT180	Gore-Tex Vascular Ring Graft	Ringed Grafts Removable Thin Wall 	Diameter 5 - 6mm x 80cm 	$1,630.00
	(ePTFE)	Length, Ringed Section 
	60cm Length
Prostheses List by Category, Groups and Sponsor	Page 693 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GT182	Gore-Tex Vascular Ring Graft	Ringed Grafts Removable Thin Wall 	Diameter 6mm, Lengths 80 - 	$1,630.00
	(ePTFE)	90 cm, Ringed Section 60cm
	 Length
GT183	Gore-Tex Vascular Ring Graft	Ringed Grafts Removable Thin Wall 	Diameter 8mm, Lengths 80 - 	$1,630.00
	(ePTFE)	90 cm, Ringed Section 70cm
	 Length
GT185	Gore-Tex Vascular Ring Graft	Ringed Grafts Removable Thin Wall 	Diameter 6mm x 80cm 	$1,630.00
	Stretch (ePTFE)	Length, Ringed Section 
	30cm Length
GT186	Gore-tex Stretch Removable Ringed 	Stretch Thin Walled Removable 	Diameter 6mm x 70cm 	$1,630.00
	Vascular Graft	Ringed (ePTFE) Graft	Length, Ringed Section 60cm
GT187	Gore-tex Stretch Removable Ringed 	Stretch Thin Walled Removable 	Diameter 6 - 8mm x 70cm 	$1,630.00
	Vascular Graft	Ringed (ePTFE) Graft	Length, Ringed Section 60 -
	 70cm Length
GT212	Gore-Tex Stretch Intering Vascular 	Stretch Thin Walled ePTFE graft with 	Dia 6-8mm, 60cm radial 	$1,630.00
	Graft	Integrated Rings	supported length x 60cm 
	length
GT213	Gore-Tex Intering Vascular Graft	ePTFE integrated rings in the wall of 	Dia 6-8mm, 80cm radial 	$1,630.00
	a stretch thin walled graft	supported length x 80cm 
	length
GT218	Gortex Propaten Vascular Graft	Stretch Thin Wall Graft (ePTFE)	6mm diameter 30cm 	$1,630.00
	Removable Ring - 70cm 
	length
	R (ringed)
	Atrium Australia - Pacific Rim Pty Limited
AC085	Maquet InterVascular redially 	Radially Supported Vascular Grafts	5mm - 24mm diameter, 50 -	$1,630.00
	Supported Vascular Grafts	100m length
	R, H
	W L Gore & Associates
GT234	Gore-Tex Stretch Propaten with 	Stretch Thin Walled (ePTFE), Heparin	6mm diameter, 70cm length, 	$1,730.00
	Removable Rings Vascular Graft	 Bonded, Graft with Removable Rings	60cm ringed section
GT254	Gore-Tex Stretch Propaten Vascular 	Stretch Thin Walled Graft, Removable 	6-8mm diameter, 80cm 	$1,730.00
	Graft	Rings (ePTFE), Heparin Bonded	length, 60-70cm Ringed 
	Section
GT265	Stretch Thin Walled Graft, 	Stretch Thin Walled Graft, Removable 	50cm	$1,730.00
	Removable Rings (ePTFE) Heparin 	Rings (ePTFE) Heparin Bonded
	Bonded
Prostheses List by Category, Groups and Sponsor	Page 694 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.03.02 - Bifurcated
	Atrium Australia - Pacific Rim Pty Limited
AC026	Advanta SST	Bifurcated PTFE Graft	12mm - 24mm X 6mm - 12mm	$975.00
	 Length 40cm
AC086	Maquet InterVascular Bifurcated 	Bifurcated Vascular Grafts	6mm - 24mm diameter, 50cm 	$975.00
	Vascular Grafts	length
	B Braun Australia Pty Ltd
BB027	Vascular Uni - Graft - Bifurcated	Vascular graft	12x7 to 12x12	$975.00
	Terumo Corporation Australia
TU007	Twillweave Graft	Bifurcated, Polyester, Woven, 	12mm x 6mm x 45cm to 	$975.00
	24mm x 12mm x 45cm
TU013	Gelweave Graft	Bifurcated, Polyester, Woven	12mmx 6mmx 45 cm to 	$975.00
	24mmx12mm x 45cm
TU014	Gelsoft Plus Graft	Bifurcated, Polyester, Knitted	12mmx6mmx45cm to 	$975.00
	24mmx12mmx45cm
	W L Gore & Associates
GT006	Gore-Tex Stretch Bifurcated Graft	Stretch Bifurcated Graft with Thin 	12x6mm to 24x12mm 40-	$975.00
	Walled Limbs (ePTFE)	50cm long
10.03.03 - Branched or Fenestrated
	Atrium Australia - Pacific Rim Pty Limited
AC064	Intergard W	Woven Aortic Arch	24mm x 10mm x 8mm x 8mm x	$1,950.00
	 50cm - 30mm x 10mm x 8mm 
	x 8mm
AC067	Intergard K	Knitted Axillobifemoral	Diameter (mm) Length (cm) 	$1,950.00
	8 x 8 100/60; 10 x 10 
	100/60; 8 x 6 x 6 85/55; 8 x 
	8 85/55; 8 x 8 100/55
Prostheses List by Category, Groups and Sponsor	Page 695 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Terumo Corporation Australia
TU018	Gelsoft Plus Graft	Axillo-bifemoral, Polyester, Knitted, 	8x8mm/100x60cm; 	$1,950.00
	Externally reinforced	8x7mm/90x40cm; 
	10x8mm/90x40cm
	W L Gore & Associates
GT216	Gore-Tex Axillobifemoral Vascular 	Stretch vascular graft with removable 	Diameter 8mm x 90cm 40cm	$1,950.00
	Graft	rings (ePTFE)
10.03.04 - Tapered or End-modified
	Atrium Australia - Pacific Rim Pty Limited
AC003	Atrium PTFE  Vascular Graft	Tapered PTFE Standard Wall	4-6mm x 30cm - 6-8mm x 90cm	$875.00
AC014	Atrium PTFE Vascular Graft	Tapered PTFE Thin Wall	4-6mm x 30cm - 6-8mm x 90cm	$875.00
AC046	Advantra PTFE Vascular Graft	Tapered Trilaminate PTFE Graft with 	4mm - 8mm diameter 50cm - 	$875.00
	Graft Deployment System	80cm lengths
AC047	Advantra PTFE Vascular Graft	Tapered Trilaminate PTFE Graft with 	4mm - 8mm diameter, 10 - 	$875.00
	Graft Deployment System	40cm lengths
	Australasian Medical & Scientific Ltd
AN010	Tayflow TFT SLF Graft	Spiral laminar flow graft	70cm length x 7mm diameter 	$875.00
	80cm length x 7mm diameter 
	70cm length x 8mm diameter 
	80cm length x 8mm diameter
	B Braun Australia Pty Ltd
BB026	Vascular Uni - Graft - Tapered	Vascular graft	12x6 to 24x12	$875.00
BB131	Vascugraft	Thin Wall Tapered	Dia 4 - 8mm, length 40 - 90cm	$875.00
BB136	Vascugraft	Standard Tapered	Dia 4 - 8mm, length 70 - 90cm	$875.00
BB138	Vascugraft	Standard with Short Taper	Dia 4 - 8mm, length 30 - 70cm	$875.00
BB139	Vascugraft	Standard with Short Taper	Dia 4 - 8mm, length 80cm	$875.00
BB143	Vascugraft	Easy Glide - Standard Wall with 	Dia 6 - 8mm, length 40 - 70cm	$875.00
	Helix Short Taper
Prostheses List by Category, Groups and Sponsor	Page 696 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB145	Vascugraft	Thin Wall Centred Helix Tapered	Dia 4 - 7mm, length 70cm	$875.00
BB155	Vascugraft	Standard Tapered	Dia 4 - 7mm, length 30 - 70cm	$875.00
BB156	Vascugraft	Standard Wall with Tapered Centre 	Dia 4 - 8mm, length 40 - 45cm	$875.00
	Helix
BB157	Vascugraft	Standard Wall Stepped Taper	Dia 4 - 8mm, length 40 - 45cm	$875.00
	Bard Australia Pty Ltd
BA028	Impra PTFE Vascular Grafts	Distaflo ePTFE graft with preformed 	6-10mm diameter, 40 - 80cm 	$875.00
	cuff and flex support	length
BA029	Impra PTFE Vascular Grafts	Venaflo ePTFE graft with preformed 	4mm - 8mm diameter, 10cm - 	$875.00
	cuff	50cm length
BA171	Dynaflo AK Bypass Graft	PTFE Graft	7 & 8mm diameter. 50, 60, 	$875.00
	70, 80cm lengths
	Terumo Corporation Australia
TU033	SEALPTFE Graft	Standard Wall, Tapered, Sealed, PTFE	4 to 7mm Taper x 45 to 50cm	$875.00
	W L Gore & Associates
GT171	Gore-tex Vascular Grafts	Standard Wall Grafts Stretch Tapered 	Diameter 4-6mm & 4-7 mm, 	$875.00
	(ePTFE)	Length 45 - 48cm
GT172	Gore-Tex Vascular Grafts	Standard Wall Grafts Stretch Tapered 	Diameter 4-7 mm, Length 	$875.00
	(ePTFE)	70cm
GT214	Gore-Tex Intering Vascular Graft	Internally radially supported vascular	4-6 tapered diameter 38cm 	$875.00
	 graft (ePTFE)	radial support length 45cm 
	length; 4-7 tapered diameter
	 38cm radial support length 
	45cm length; 6mm diameter 
	40cm radial support length 
	40cm length
	ID
	Atrium Australia - Pacific Rim Pty Limited
AC049	Advantra PTFE Vascular Graft with 	Trilaminate PTFE. Vascular Access 	4mm - 8mm diameter. 50 - 	$3,000.00
	Graft Deployment System	Graft	80cm length
Prostheses List by Category, Groups and Sponsor	Page 697 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	R
	W L Gore & Associates
GT175	Gore-tex Vascular Grafts	Ringed Grafts Removable Standard 	4-7 mm x 70cm - Rings 30cm	$875.00
	Wall Tapered (ePTFE)	  Length
	R (ringed)
	Medtel Australia Pty Ltd
ME195	Spiral Laminar Flow ™ graft	Spiral Laminar flow graft	Length (cm)     	$875.00
	50,60,70,80,50,60,70,80
	Diameter(mm)  6, 6,  6,  6,  8, 
	 8,  8,  8
10.04.01 - Vascular Patches
	10.04.01.01 - 0 - 100 sq cm
	Atrium Australia - Pacific Rim Pty Limited
AC041	Atrium Ultramax Patches	Knitted Double Velour Vascular 	6 sq cm	$205.00
AC042	Atrium Ultramax Patches	Knitted Double Velour Vascular 	19 – 76 sq cm	$205.00
	B Braun Australia Pty Ltd
BB017	Vascular Patch	Vascular patch	12x9 to 3x4	$205.00
	Bard Australia Pty Ltd
BA031	Grafts Vascular	Polyester soft tissue patch 1mm thick 	5cm x 10cm	$205.00
BA035	Grafts Vascular	PTFE Felt 2mm thick	5cm x 10cm	$205.00
BA089	Impra PTFE Vascular Grafts	ePTFE Cardiovascular Patch 0.4mm 	20 x 90mm	$205.00
	Oval
BA091	Impra PTFE Vascular Grafts 	ePTFE Cardiovascular, Patch 0.6mm, 	50 x 75mm	$205.00
	Rectangular
BA092	Impra PTFE Vascular Grafts 	ePTFE Cardiovascular, Patch 0.6mm, 	50 x 150mm	$205.00
	Rectangular
BA093	Impra PTFE Vascular Grafts 	ePTFE Cardiovascular, Patch 0.6mm, 	30 x 30mm, 10 x 90mm, 30 x 	$205.00
	Rectangular, Patch 0.4 Oval, 	60mm
	Rectangular
BA095	Impra PTFE Vascular Grafts 	ePTFE Cardiovascular, Patch 0.6mm, 	25 x 150mm	$205.00
	Rectangular
Prostheses List by Category, Groups and Sponsor	Page 698 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Bio Nova International Pty Ltd
BN020	Omniflow II Vascular Prostheses - 	Vascular Patch	1.5cm x 5cm (less than 8 sq. 	$205.00
	Straight	Cm)
BN021	Omniflow II Vascular Prostheses - 	Vascular Patch	2.5cm x 10cm (more than 8 	$205.00
	Straight	sq. cm
	Terumo Corporation Australia
TU042	Fluoropassiv Patch	Thin wall, Fluoropolymer/polyester, 	6-15mm x 5-7.5cm	$205.00
	Koper Knitted
	W L Gore & Associates
GT012	Soft Tissue Patch	ePTFE	1mm Thickness 5 x 10cm	$205.00
GT016	Soft Tissue Patch	ePTFE	2mm Thickness 5 x 10cm	$205.00
	10.04.01.02 - 101 - 150 sq cm
	Bard Australia Pty Ltd
BA032	Grafts Vascular	Polyester soft tissue patch 1mm thick 	10cm x 15cm	$295.00
BA036	Grafts Vascular	PTFE Felt 2mm thick	10cm x 15cm	$295.00
BA090	Impra PTFE Vascular Grafts 	ePTFE Cardiovascular, Patch 0.6mm, 	100 x 150mm	$295.00
	Circular
	Terumo Corporation Australia
TU043	Fluoropassiv Patch	Thin wall, Fluoropolymer/polyester, 	10-15mm x 7.5-10cm	$295.00
	Koper Knitted
	W L Gore & Associates
GT013	Soft Tissue Patch	ePTFE	1mm Thickness 10 x 15cm	$295.00
GT017	Soft Tissue Patch	ePTFE	2mm Thickness 10 x 15cm	$295.00
	10.04.01.03 - >150 sq cm
	Bard Australia Pty Ltd
BA033	Grafts Vascular	Polyester soft tissue patch 1mm thick 	15cm x 20cm	$400.00
BA034	Grafts Vascular	Polyester soft tissue patch 1mm thick 	20cm x 30cm	$400.00
BA037	Grafts Vascular	PTFE Felt 2mm thick	15cm x 20cm	$400.00
BA038	Grafts Vascular	PTFE Felt 2mm thick	20cm x 30cm	$400.00
Prostheses List by Category, Groups and Sponsor	Page 699 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	W L Gore & Associates
GT014	Soft Tissue Patch	ePTFE	1mm Thickness  15 x 20cm	$400.00
GT015	Soft Tissue Patch	ePTFE	1mm Thickness 20 x 30cm	$400.00
GT018	Soft Tissue Patch	ePTFE	2mm Thickness 15 x 20cm	$400.00
GT019	Soft Tissue Patch 	ePTFE	2mm Thickness 20 x 30cm	$400.00
	10.04.01.04 - Pledgets
	Bard Australia Pty Ltd
BA039	Grafts Vascular	Polyester pledgets	Rectangle, Oval, Circle, 	$87.00
	Square 2.9mm-8mm x 6mm - 
	9.5mm
10.05.01 - Vessel Bands
	AllVascular Pty Ltd
VA001	Venous Valve Ring	Dacron/silicone variable diameter 	52mmx15mmx0.09 mm	$1,065.00
10.06.01 - Venous
	B Braun Australia Pty Ltd
BB106	Temporary Vena Cava System	Phynox/ combination of various 	One size, expands to Max 	$2,348.00
	metals inc. Nickel,Copper, 	length 38mm/Max diameter 
	30mm
BB169	Vena Cava Filter System	PHYNOX Introducer system, 'J' 	Diameter 28 mm	$2,348.00
	Guidewire, Seldinger needle, 
	disposable scalpel
	Bard Australia Pty Ltd
BA010	Bard Inferior Vena Cava Filter	Nitinol self expanding vena cava filter	For IVC with a diameter less	$2,348.00
	 than or equal to 28mm 
	diameter
	Cook Medical Australia Pty Ltd
WC096	Cook Vena Cava Filter	Universal Filter	Diameter up to 40mm, 	$2,348.00
	Length up to 60mm
Prostheses List by Category, Groups and Sponsor	Page 700 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC283	Vena Cava Filter with NavAlign 	The filter consists of a non-magnetic 	Filter measures 30mm in 	$2,348.00
	Delivery System	filter (30mm diameter, 48mm long) 	diameter and 48mm long
	preloaded on a femoral filter 
	introducer and/or a jugular filter 
	introducer, an 8.5 French coaxial 
	introducer system (compatible with a 
	.035 inch wire guide) for introduction
	 and a hydrophilic coated dilator.
	Inovanz (PTY) LTD
IZ001	ALN Vena Cava Filter	The ALN Vena Cava Filter is 	One size, diameter up to 	$2,348.00
	implanted into the SVC via the 	32mm
	femoral, brachial and jugular vein to 
	prevent pulmonary emboli (PEs).
	Johnson & Johnson Medical Pty Ltd
JJ423	OPTEASE retrievable vena cava 	OPTEASE is a laser cut nitinol vena 	Suitable for vessels up to 	$2,348.00
	cava filter, used to treat patients at 	30mm
	high risk of pulmonary embolisation
10.06.02 - Arterial
	Abbott Australasia Pty Ltd
AY018	Emboshield	Embolic Protection Device, including	Large and small. Two wire 	$2,100.00
	 delivery system, device specific 	lengths: 190cm for 
	procedural wire, filter for capturing 	Monorail system and 315cm
	embolic matter and retrieval system	 for Over the wire
AY030	Accunet	Embolic Protection Device, including	4.5 - 7.5; 190cm, 300cm 	$2,100.00
	 delivery system, device specific 	length catheter
	procedural wire, filter for capturing 
	embolic matter and retrieval system.
	Boston Scientific Australia Pty Ltd
BS085	Filterwire EZ	Embolic Protection Device	Vessel compatibility 3.5mm 	$2,100.00
	- 5.5mm and delivery system
	 lengths up to 300cm.
Prostheses List by Category, Groups and Sponsor	Page 701 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Covidien Pty Ltd
AS192	Spider FX Embolic Protection 	The Spider FX is a rapid exchange 	Filter:  3.0 - 7.0mm; Capture 	$2,100.00
	device percutaneously delivered 	Wire:  190 and 320cm
	distal embolic protection device with 
	components designed to capture and 
	remove debris from vessels during 
	interventional procedures in the 
	vasculature.
	Johnson & Johnson Medical Pty Ltd
JJ480	Angioguard RX Emboli Capture 	Distal protection device and delivery 	Length 180cm, Diameter 	$2,100.00
	Guidewire System	system	0.014"; basket sizes 4mm, 
	5mm, 6mm, 7mm and 8mm
	Medtronic Australasia Pty Ltd
MC954	Mo.Ma Proximal Cerebral 	Mo.Ma Proximal Cerebral Protection 	Minimum sheath size = 8F 	$2,100.00
	Protection Device	Device. Protects the brain from 	or 9F, Minimum diameter of 
	embolisation, blocking antigrade 	inner working channel = 
	blood flow from the common Carotid 	0.069"/1.76mm (8F sheath) 
	Artery and retrograde blood flow from 	or 0.083"/2.12mm (9F 
	the External Carotid Artery.	sheath); 0.035" guide wire 
	compatible
MI035	Mo.Ma Ultra Proximal Cerebral 	Cerebral embolic protection device: 	Minimum sheath size = 8F 	$2,100.00
	Protection Device	blocks antegrade blood flow from the 	(5F inner working channel) 
	common carotid artery and retrograde 	or 9F (6F inner working 
	blood flow from the external carotid 	channel)
	artery. Embolic protection is 
	established before the lesion is 
10.07.01 - Arterial Closure Devices
	Abbott Australasia Pty Ltd
AY017	Starclose	6 Fr Exchange Sheath, Dilator, 	6 Fr	$410.00
	Guidewire, implantable nitinol clip 
	pre-mounted on a Clip Applier
AY033	Proglide	Suture Mediated Closure Device	5 - 8 French	$410.00
	Johnson & Johnson Medical Pty Ltd
JJ823	EXOSEAL (TM) Vascular Closure 	Vascular Closure Device	5 - 7F	$410.00
	Device
Prostheses List by Category, Groups and Sponsor	Page 702 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	MD Solutions Pty Ltd
MB008	Mynx Vascular Closure Device	Water-soluble synthetic sealant made 	5F, 6/7F	$410.00
	of a polyethylene glycol (PEG) The 
	sealant is resorbed by the body 
	within 30 days
	St Jude Medical Australia Pty Ltd
SJ014	Angio-Seal Vascular Closure 	Angio-Seal Haemostatic Puncture 	6F	$410.00
	Device - STS Platform and STS Plus	Closure Device, Models 6F-STS 
	Platform and 6F STS Plus
SJ015	Angio-Seal Vascular Closure 	Angio-Seal Haemostatic Puncture 	8F	$410.00
	Device - STS Platform and STS Plus	Closure Device, Models 8F-STS 
	Platform and 8F STS Plus
SJ094	Angio-Seal VIP	Angio-Seal Haemostatic Puncture 	6F	$410.00
	Closure Device Models 6F STS 
	Platform, 6F STS Plus and 7F VIP
SJ095	Angio-Seal VIP	Angio-Seal Haemostatic Puncture 	8F	$410.00
	Closure Device Models 8F STS 
	Platform, 8F STS Plus and 8F VIP
SJ155	Angio-Seal Evolution	Haemostatic Puncture Closure Device	6F and 8F	$410.00
	 6F-8F
SJ218	FemoSeal Vascular Closure System	Haemostatic Puncture Closure Device	One Size	$410.00
	large
	Abbott Australasia Pty Ltd
AY034	Prostar	Suture Mediated Closure Device - 	Up to 24 French	$750.00
	Closure of Large holes
10.08.01 - Particle
	Boston Scientific Australia Pty Ltd
BS034	Contour PVA, Contour SE	Polyvinyl Alcohol (PVA) 	Up to 1200 micron, volume 	$204.00
	embolization particles spherical-	up to 2ml.
	Device Technologies Australia Pty Ltd
DE294	Bead Block	Plyvinyl Alcohol hydrogel 	2ml- (100 - 300, 300 - 500, 	$204.00
	microspheres in pre-loaded syringe	500 - 700, 700 - 900, 900 - 
	1200 microns
Prostheses List by Category, Groups and Sponsor	Page 703 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Cook Medical Australia Pty Ltd
WC044	PVA Embolisation particles	Embolisation & Occlusion	Particle Size Ranges 	$204.00
	(microns) 50-100, 100-200, 
	200-300,300-500, 500-700,
	 700-1000, 1000-1500, 
	1500-2000, 2000-2800
10.08.02 - Coil, Peripheral
	10.08.02.01 -  ≤200mm length
	Cook Medical Australia Pty Ltd
WC190	Detachable Mreye Embolization 	Standard Mreye	Diameters: .035 and .038, 	$66.00
	Extended Lengths: 1cm to 
	20cm, Coil Diameters: 3mm 
	to 20mm
	P
	Boston Scientific Australia Pty Ltd
BS026	VortX and Pushable Coils	Pushable coils	Diameters up to 30mm and 	$143.00
	lengths up to 60mm
	Cook Medical Australia Pty Ltd
WC038	Coil - Embolisation Coils MWCE-	Tornado Platinum	Diameters: .018, .035 and 	$143.00
	TORNADO	.038, Coil Taper Diameters: 
	2mm to 10mm
WC039	Cook Embolization Coil	Hilal Platinum	Diameters: .018, Extended 	$143.00
	Lengths: .5cm to 6cm, Coil 
	Diameters: Straight to 10mm
	Johnson & Johnson Medical Pty Ltd
JJ224	TruFill Pushable coil	Platinum pushable  coil of 1. Straight, 	Size .014" outer diameter.  	$143.00
	2. C, 3. Flat spiral and 4. Complex 	Size 2 - 10mm and length 2 -
	shapes.  Embolic coil and delivery 	 100mm
	Pyramed Pty Limited
PY008	Platinum Spirale and Cirrus 	Embolisation coils with or without 	Spiral diameter 2mm - 16mm;	$143.00
	embolisation coils <100mm	fibers	 length 25mm - 80mm; coil 
	diameter 0.27mm - 0.82mm
Prostheses List by Category, Groups and Sponsor	Page 704 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
PY009	Platinum Spirale and Cirrus 	Embolisation coils with or without 	Spiral diameter 4mm - 10mm;	$143.00
	embolisation coils 100-150mm	fibers	 length 100mm - 150mm; 
	coil diameter 0.27mm - 
	0.82mm
	P (Platinum)
	Cook Medical Australia Pty Ltd
WC173	Cook Embolisation Coils	Nester Platinum	Recommended catheter ID 	$143.00
	and end hole  diameter inch:
	 .018 and .035inch. Coiled 
	embolus diameters:  2mm to 
	20mm. Extended embolus 
	lengths: 30 to 200mm.
	P, Gel
	Terumo Corporation Australia
TU051	AZUR Peripheral HydroCoil, 	AZUR Peripheral HydroCoil, 	2-20mm diameter, length 2-	$180.00
	pushable	15cm
	P, Gel, repositionable
	Terumo Corporation Australia
TU053	AZUR Peripheral HydroCoil	AZUR Peripheral Coil, detachable	3-20mm diameter, length 3-	$1,293.00
	50cm
	P, ids (Platinum, integral delivery system)
	Boston Scientific Australia Pty Ltd
BS021	Interlock Detachable Coils	Platinum-tungsten, Fibered 	Coil diameters up to 30mm 	$1,250.00
	Occlusion System	and lengths up to 100cm. 
	Delivery system lengths up 
	200cm
	P, repositionable
	Terumo Corporation Australia
TU052	AZUR Peripheral Framing Coil	AZUR Peripheral Coil,detachable, 	8-20mm diameter, length 20-	$1,250.00
	Framing Coil three dimensional 	50cm
	complex shape
Prostheses List by Category, Groups and Sponsor	Page 705 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	P, repositionable (Platinum, repositionable)
	Cook Medical Australia Pty Ltd
WC319	Detach Coil with Fibers	The Detach Coil with Fibers consists 	Diameters: 3-20mm	$1,250.00
	of a Teflon coated stainless delivery 	Length: 4-30cm
	wire with a premounted platinum 
	detachable coil with fibers.
WC320	Retracta Detachable Embolization 	The Retracta Detachable Embolization	Coiled embolus diameters: 	$1,250.00
	Coil	 Coil is a platinum coil with spaced 	4-20mm
	synthetic fibers, and is attached to a 	Length: 7-14cm
	delivery wire.
	10.08.02.02 - >200mm length
	P
	Pyramed Pty Limited
PY010	Platinum Spirale and Cirrus 	Embolisation coils with and without 	Spiral diameter 5mm - 16mm;	$286.00
	embolisation coils 200-450mm	fibers	 length 200mm - 450mm; 
	Coil diameter 0.82mm.
10.08.03 - Polymer
	10.08.03.01 - 0.5ml
	Endotherapeutics Pty Ltd
ET008	Embospheres	-	.5ml per implant	$320.00
	10.08.03.02 - 1ml
	Endotherapeutics Pty Ltd
ET007	Embospheres	-	1ml per implant	$420.00
	10.08.03.03 - 2ml
	Endotherapeutics Pty Ltd
ET006	Embospheres	-	2ml per implant	$630.00
Prostheses List by Category, Groups and Sponsor	Page 706 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.08.04 - Detachable Balloon or Sphere
	St Jude Medical Australia Pty Ltd
SJ265	Amplatzer Vascular Plug	Self expandable nitinol wire mesh	Diameter 4mm - 16mm, 	$1,900.00
	Length 7 & 8mm
SJ268	Amplatzer Vascular Plug III	AVP III is a self-expanding, Nitinol 	Size: (mm): 4, 6, 8, 10, 10, 	$1,900.00
	mesh occlusion device.	12, 12, 14, 14  Long Axis 
	(mm): 4, 6, 8, 10, 10, 12, 12, 
	14, 14 Length (mm): 6.5
SJ269	AMPLATZER Vascular Plug 4	The AMPLATZER Vascular Plug 4 	4mm 4 diameter 10.0 length	$1,900.00
	(AVP4) is a self-expanding, Nitinol 	
	mesh occlusion device. The Device 	5mm 5 diameter 10.5 length
	has a radiopaque marker band at each 	
	end and a micro screw attachment at 	6mm 6 diameter 11.0 length
	one end for attaching to the delivery 
	wire. The AVP4 fits through a 0.038 
	guidewire compatible diagnostic 
	catheter allowing the use of the same 
	catheter throughout the procedure 
	rather than having to exchange the 
	diagnostic catheter for a second 
	delivery catheter to place a plug.
Prostheses List by Category, Groups and Sponsor	Page 707 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	ids
	St Jude Medical Australia Pty Ltd
SJ266	AMPLATZER Vascular Plug - II	The AMPLATZER Vascular Plug II is	9-AVP2-003, 3mm 	$2,100.00
	 a self-expandable, multi-lobed 	Diameter, 6mm Plug Length,
	cylindraical device made from a 	 9-AVP2-004, 4mm 
	nitinol wire mesh.	Diameter, 6mm Plug Length,
	 9-AVP2-006, 6mm 
	Diameter, 6mm Plug Length,
	 9-AVP2-008, 8mm 
	Diameter, 7mm Plug Length,
	 9-AVP2-010, 10mm 
	Diameter, 7mm Plug Length,
	 9-AVP2-012, 12mm 
	Diameter, 9mm Plug Length,
	 9-AVP2-014, 14mm 
	Diameter, 10mm Plug 
	Length, 9-AVP2-016, 16mm
	 Diameter, 12mm Plug 
	Length, 9-AVP2-018, 18mm
	 Diameter, 14mm Plug 
	Length, 9-AVP2-020, 20mm
	 Diameter, 16mm Plug 
	Length, 9-AVP2-022, 22mm
	 Diameter, 18mm Plug Length
10.08.05 - Liquid
	Covidien Pty Ltd
AS190	Onyx	DSMO/Liquid Embolic Material	18, 20, 34 (formulations)	$2,300.00
	ids
	Covidien Pty Ltd
AS191	Onyx System	DSMO Liquid Embolic Material	500 Formulation	$4,950.00
Prostheses List by Category, Groups and Sponsor	Page 708 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.08.06 - Delivery Device For Occlusion Media
	10.08.06.01 - Catheter
	Boston Scientific Australia Pty Ltd
BS028	GDC and PVA Delivery Catheters	Microcatheter Delivery Systems	Delivery system lengths up 	$700.00
	to 175cm
	Cook Medical Australia Pty Ltd
WC296	Cantata Superselective Microcatheter	Cantata 2.5 and Cantata 2.8 	2.5F and 2.8F. Length: 100-	$700.00
	Microcatheter	150cm
	10.08.06.02 - Detachment Controller
	Terumo Corporation Australia
TU054	AZUR Peripheral Coil Detachment 	Hand held battery powered coil 	One size only	$350.00
	Controller	detachment controller
10.09.01 - Percutaneous Catheters, Single Lumen
	Cook Medical Australia Pty Ltd
WC111	Cook Central Venous 	Single lumen peripherally inserted 	3 - 6 Fr, 40 - 80cm	$119.00
	Catheterisation Kit	catheter set, which may include 
	catheter, standard or micropuncture 
	introducer set
WC113	Cook Central Venous 	Single lumen peripherally inserted 	Fr 3, 4, 5 and Length 50 and	$119.00
	Catheterisation Kit	catheter set, includes catheter, needle, 	 60cm
	J-wire, MPIS wire and introducer
WC201	Cook Central Venous Catherisation 	Turbo-Flo Peripherally Inserted 	4Fr - 60cm and 5Fr - 60cm	$119.00
	Kits	Central Venous Catheter Set, Single 
	Lumen Polyurethane with 
	Micropuncture Peel-Away Sheath 
	Introducer and Wire Guide
WC202	Cook Central Venous 	Turbo-Flo Peripherally Inserted 	5Fr - 60cm	$119.00
	Catheterisation Kits	Central Venous Catheter Set, Single 
	Lumen Polyurethane with Peel Away 
	Sheath Introducer and Wire Guide
Prostheses List by Category, Groups and Sponsor	Page 709 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WC204	Cook Central Venous 	Turbo-Flo Over-The-Wire 	4Fr - 60cm and 5Fr -60cm	$119.00
	Catheterisation Kits	Peripherally Inserted Central Venous 
	Catheter Set, Single Lumen 
	Polyurethane with Micropuncture 
	Peel-Away Sheath Introducer and 
WC207	Cook Central Venous 	PICC Peripherally Inserted Central 	3Fr - 50cm and 4Fr and 5Fr -	$119.00
	Catheterisation Kits	Venous Catheter Set, Catheter without	 60cm
	 Clamp, Single Lumen Silicone with 
	Micropuncture Peel-Away Sheath 
	Introducer and Wire Guide
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA008	Single Lumen Right Atrial Catheter	Central Venous Catheters constructed 	84cm, 1.3mm OD, 94cm 	$119.00
	of radiopaque silicone rubber	2.2mm OD, 94cm 3.2mm OD
	Mayo Healthcare Pty Ltd
YO001	Arrow Peripherally Inserted Central	Range of Polyurethane single lumen 	3 Fr, range of lengths	$119.00
	 Catheterisation Sets	peripherally inserted central catheters 
	with or without stylet
YO002	Arrow Peripherally Inserted Central	Range of Polyurethane single lumen 	4 Fr, range of lengths	$119.00
	 Catheterisation Sets  	peripherally inserted central catheters 
	with or without stylet
	cu
	Bard Australia Pty Ltd
BA049	Hickman/Broviac Catheters	Open-Ended CVC, Single Lumen	2.7Fr - 9.6Fr	$180.00
BA125	Groshong Central Venous Catheter	Closed-Ended CVC, Single Lumen	5.5Fr - 9.5Fr	$180.00
BA129	Groshong Peripherally Inserted 	Closed-Ended PICC, Single Lumen	3Fr - 5Fr	$180.00
	Central Catheter
	Cook Medical Australia Pty Ltd
WC117	Cook Central Venous Long Term 	Cook TPN single lumen catheter set	Fr 3, length 55; Fr 4, length 	$180.00
	Catheter	65cm, Fr 6.5 length 65, 
	90cm, Fr 9.5, length 90cm
	pi
	Bard Australia Pty Ltd
BA184	Peripherally Inserted Central 	Power Injectable PICC, Single Lumen	4Fr - 6Fr	$165.00
BA212	Peripherally Inserted Central 	Valved, Power Injectable PICC, 	4Fr - 6Fr	$165.00
	Single Lumen
Prostheses List by Category, Groups and Sponsor	Page 710 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BA220	Groshong Peripherally Inserted 	Closed-Ended, Power Injectable 	5Fr	$165.00
	Central Catheter	PICC, Single Lumen
	Medical Specialties Australia Pty Ltd
MS063	Peripherally Inserted Central 	Single Lumen Power Injectable PICC	3 - 5Fr; 55 - 65cm	$165.00
	pi (power injection)
	Emergo Asia Pacific Pty Ltd
ER134	Single Lumen Peripherally Inserted 	Power injectable with Pressure 	3F x55cm, 4F x 55cm, 5F x 	$165.00
	Central Catheter	Activated Safely Valve (PASV) 	55cm
	technology
	A (Anti-infective Agent Coating)
	Mayo Healthcare Pty Ltd
YO005	ARROWg+ard Blue Single Lumen 	A polyurethane central venous 	CS-24301 - 16g x 20cm, 	$150.00
	Central Venous Catheters	catheter with Blue FlexTip (of various 	Single Lumen, Adult
	lengths, sizes and lumen 	CS-24306E-16g x 16cm, 
	configurations) with antimicrobial 	Single Lumen Adult
	impregnation (chlorhexidine and 	CS-24701 - 14g x 20cm, 
	silver sulphadiazine) on the external 	Single Lumen Adult
	surface of the polyurethane catheter 	CS-24706E -14g x 16cm, 
	Single Lumen, Adult
	pi (power injection)
	Cook Medical Australia Pty Ltd
WC279	Turbo-Ject Peripherally Inserted 	3/4/5/6 Fr Single Lumen 	3, 4, 5, 6 French, 40 and 60 	$165.00
	Central Catheter Set ( Single Lumen)	Polyurethane PICC with 	cm catheter length, single 
	Micropuncture Peel-Away Sheath 	lumen catheter
	Mayo Healthcare Pty Ltd
YO011	Arrow single lumen pressure 	Single lumen pressure injectable 	3, 4, Fr single lumen 	$165.00
	injectable peripherally inserted 	peripherally inserted central catheter 	Pressure Injectable PICCs 
	central catheter (PICC) sets	(PICC) sets	various Pressure Injection 
	rates, various lengths.
Prostheses List by Category, Groups and Sponsor	Page 711 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.09.02 - Percutaneous Catheters, Multiple Lumen
	Bard Australia Pty Ltd
BA130	Groshong Peripherally Inserted 	Closed-Ended PICC, Multiple Lumen	3Fr - 5Fr	$119.00
	Central Catheter
	Cook Medical Australia Pty Ltd
WC112	Cook Central Venous 	Double or triple lumen peripherally 	3 - 8 Fr 40 - 80cm	$119.00
	Catheterisation Kit	inserted catheter set, which may 
	include catheter, standard or 
	micropuncture introducer set
WC114	Cook Central Venous 	Double lumen peripherally inserted 	Fr 6, 7 and Length 58 and 	$119.00
	Catheterisation Kit	catheter set, includes catheter, needle, 	60cm
	J-wire, MPIS wire and introducer
WC203	Cook Central Venous Catherisation 	Turbo-Flo Peripherally Inserted 	5Fr - 60cm	$119.00
	Kits	Central Venous Catheter Set, Dual 
	Lumen Polyurethane with Peel-Away
	 Sheath Introducer and Wire Guide
WC205	Cook Central Venous 	Turbo-Flo Over-The Wire 	5Fr - 60cm	$119.00
	Catheterisation Kits	Peripherally Inserted Central Venous 
	Catheter Set, Dual Lumen 
	Polyurethane with Micropuncture 
	Peel-Away Sheath Introducer and 
	Mayo Healthcare Pty Ltd
YO003	Arrow Peripherally Inserted Central	Range of Polyurethane double lumen 	4 and 5 Fr, range of lengths	$119.00
	 Catheterisation Sets	peripherally inserted central catheters 
	with or without stylet
	Antibatcterial
	Cook Medical Australia Pty Ltd
WC230	Cook Spectrum CVC Catheter 3 	Triple lumen CVC line with antibiotic	5Fr, 7Fr, 9Fr	$150.00
	Lumen with antibiotic impregnation	 impregnation
WC231	Cook Spectrum 5 Lumen CVC 	5 lumen CVC with antibiotic 	10Fr	$150.00
	Catheter with antibiotic 	impregnation
	cu
	Bard Australia Pty Ltd
BA051	Hickman/Leonard Catheters	Open-Ended CVC, Multiple Lumen	7Fr - 12.5Fr	$361.00
Prostheses List by Category, Groups and Sponsor	Page 712 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BA126	Groshong Central Venous Catheter	Closed-Ended CVC, Multiple Lumen	5.5Fr - 9.5 Fr	$361.00
BA209	HemoStar Long Term Haemodialysis	Dialysis Catheter, Multiple Lumen	14.5Fr - 16Fr	$361.00
	 Catheter
	Cook Medical Australia Pty Ltd
WC119	Cook Central Venous Long Term 	Cook TPN double lumen catheter set	Fr 7, length 65cm, Fr 9 	$361.00
	Catheter Set	length 90cm, Fr 12, 90, 
	special
WC122	Cook Central Venous Long Term 	Cook TPN triple lumen catheter set	Fr 8, length 90cm	$361.00
	Catheter
	Medical Specialties Australia Pty Ltd
MS009	Catheterisation kits(Horizon 	Central Venous Catheter - right atrial 	2.7 -14F	$361.00
	catheter, silicone
	pi
	Bard Australia Pty Ltd
BA183	Peripherally Inserted Central 	Power Injectable PICC, Multiple 	4Fr - 6Fr	$225.00
	Lumen
BA213	Peripherally Inserted Central 	Valved, Power Injectable PICC, 	4Fr-6Fr	$225.00
	Multiple Lumen
	Cook Medical Australia Pty Ltd
WC297	Turbo-Ject Peripherally Inserted 	Turbo-Ject Peripherally Inserted 	6Fr, Catheter length 60cm	$225.00
	Central Venous Catheters Set (Triple	Central Venous Catheters (PICC) Sets 
	 Lumen)	are intended for short- or long-term 
	use for venous pressure monitoring, 
	blood sampling, administration of 
	drugs (eg chemotherapy) and fluids 
	(eg TPN), and for use with power 
	injectors for delivery of contrast in CT
	 studies.
	Mayo group
CM024	Arrow Pressure Injectable Triple-	Pressure injectable triple lumen PICC 	6Fg x 50cm, triple lumen	$225.00
	Lumen PICC.	(Peripherally Inserted Central 
	Catheter) Set
	Medical Specialties Australia Pty Ltd
MS064	Peripherally Inserted Central 	Multiple Lumen Power Injectable 	5 - 7Fr; 55 - 65cm	$225.00
Prostheses List by Category, Groups and Sponsor	Page 713 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	pi (power injection)
	Emergo Asia Pacific Pty Ltd
ER135	Dual Lumen Peripherally Inserted 	Power injectable with Pressure 	5F x55cm, 6F x 55cm	$225.00
	Central Catheter	Accivated Safety Valve (PASV) 
	technology
ER136	Triple Lumen Peripherally Inserted 	Power injectable with Pressure 	6F x 55cm	$225.00
	Central Catheter	Activated Safety Valve (PASV) 
	technology
	A (Anti-infective Agent Coating)
	Cook Medical Australia Pty Ltd
WC321	Cook Spectrum Central Venous 	Double lumen CVC line with 	4 Fr, 5 Fr, 8 Fr. Catheter 	$150.00
	Catheter with antibiotic 	antibiotic impregnation	length 5-25cm
	impregnation - 2 lumen
	Mayo Healthcare Pty Ltd
YO006	ARROWg+ard Four & Five Lumen 	A polyurethane central catheter with 	CS-22854E - 8.5 Fr x 16cm, 	$150.00
	Central Venous Catheters	Blue FlexTip (of various lengths, sizes	Quad Lumen
	 and lumen configurations) with 	CS-25854E - 8.5Fr x 20cm, 
	antimicrobial impregnation 	Quad Lumen
	(chlorhexidine and silver 	CS-22855 - 8.5 x 16cm, Five
	sulphadiazine) on the external surface 	 Lumen
	of the polyurethane catheter material	CS-25855 - 8.5Fr x 20cm, 
	Five Lumen
Prostheses List by Category, Groups and Sponsor	Page 714 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
YO007	ARROWg+ard Blue Double & 	A polyurethane central venous 	CS-24402 - 4Fr x 13cm, 	$150.00
	Triple Lumen Central Venous 	catheter with Blue FlexTip (of various 	Dual Lumen CS-22502 -5Fr 
	lengths, sizes and lumen 	x 5cm, Dual Lumen CS-
	configurations) with antimicrobial 	25402 - 4Fr x 8cm, Dual 
	impregnation (chlorhexidine and 	Lumen CS-25502 - 5Fr x 
	silver sulphadiazine) on the external 	12cm, Dual Lumen
	surface of the polyurethane catheter 	CS-22702E - 7Fr x 16cm, 
	Double Lumen CS-26702 - 
	7Fr x 20cm, Double Lumen 
	CS-27702E - 7Fr x 20cm, 
	Double Lumen CS-25553 - 
	5.5Fr x 8cm, Triple Lumen 
	CS-22703E - 7Fr x 16cm, 
	Triple Lumen CS-26553 -
	5.5Fr x 13cm, Triple Lumen 
	CS-24703E - 7Fr x 30cm, 
	Triple Lumen
	CS-25703E - 7Fr x 20cm, 
	Triple Lumen
YO008	ARROWg+ard Blue Plus QUAD 	Central Venous Catheters (of various 	CS-42854E - 8.5Fr x 16cm, 	$150.00
	Lumen Central Venous Catheters	lengths, sizes and lumen 	Quad Lumen CS-45854E - 
	configurations with antimicrobial 	8.5Fr x 20cm, Quad Lumen
	impregnation on: 1. The external 
	indwelling surface of catheter material 
	(chorhexidine and silver 
	sulphadiazine) 2. The entire internal 
	fluid pathway including catheter, 
	extension-lines and hubs 
	(chlorhexidine acetate)
YO009	ARROWg+ard Blue Plus Double & 	Double & Triple  Lumen Central 	CS-45802E - 8 Fr x 20cm, 	$150.00
	Triple Lumen Central Venous 	Venous Catheters (of various lengths 	Dual Lumen CS-46702E - 
	Catheters	sizes and lumen configurations) with 	7Fr x 20cm, Dual Lumen CS-
	antimicrobial impregnation on: 1. The 	47702E - 7Fr x 20cm, Dual 
	external indwelling surface of catheter 	Lumen CS-42703E - 7Fr x 
	material (chlorhexidine and silver 	16cm, Triple Lumen CS-
	sulphadiazine) 2. The entire internal 	45703E - 7Fr x 20cm, Triple 
	fluid pathway including catheter, 	Lumen
	extension-lines and hubs 
	(chlorhexidine acetate)
Prostheses List by Category, Groups and Sponsor	Page 715 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	A (Anti-infective Agent Coating), pi (power injection)
	Mayo group
CM027	Pressure Injectable ARROWg+ard®	Pressure Injectable Multi Lumen 	CS42703HP: 16cm x 7Fr 	$225.00
	 Blue Plus Antimicrobial Multi-	Central Venous Catheters (of various 	Triple Lumen Catheter
	Lumen Central Venous Catheters	lengths sizes and lumen 	CS45703HP: 20cm x 7Fr 
	configurations) with antimicrobial 	Triple Lumen Catheter
	impregnation of the internal and 	CS42854HP: 16cm x 8.5Fr 
	external catheter with Chlorhexidine 	Quad Lumen Catheter
	and Silver Sulphadiazine.	CS45854HP: 20cm x 8.5Fr 
	Quad Lumen Catheter
	pi (power injection)
	Cook Medical Australia Pty Ltd
WC280	Turbo-Ject Peripherally Inserted 	4/5 Fr Double Lumen Polyurethane 	4 and 5 French, 60 cm 	$225.00
	Central Catheter Set (Double 	PICC with Micropuncture Peel-Away	Catheter length, double 
	 Sheath Introducer and Echogenic 	lumen catheter
	Mayo Healthcare Pty Ltd
YO010	Arrow multi lumen pressure 	Arrow multi lumen pressure injectable	4, 5, 6Fr multi lumen 	$225.00
	injectable peripherally inserted 	 PICC (peripherally inserted central 	Pressure Injectable PICCs 
	central catheter (PICC) sets	catheter) sets	various Pressure Injection 
	rates, various lengths. 
	Double & triple Lumen 
	configurations.
10.09.03 - Percutaneous Catheters, Multiple Lumen for Haemodialysis
	Bard Australia Pty Ltd
BA211	Haemodialysis Catheters	Haemodialysis Catheters, multiple 	11Fr - 13.5Fr	$127.00
	lumen
	Gambro Pty Ltd
GA001	GamCath Dolphin Protect 	Haemodialysis catheter with a 	109585 - 13Fr x 15cm 	$127.00
	HighFlow Haemodialysis Catheter 	modified anti-thrombogenic surface 	double lumen: 109584 - 
	(polymer system of 	13FRx 20cm double lumen, 
	polydimethysilxane blocks) and a 	109705 - 13Fr x 25cm 
	non-release anti-microbial coating 	double lumen; 109706 - 
	(Bismith copolymer film) on internal 	13Fr x 15cm curved double 
	and external surfaces of catheter.	lumen; 109707 - 13Fr x 
	20cm curved double lumen.
Prostheses List by Category, Groups and Sponsor	Page 716 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA007	Mahurkar Subclavian Catheter Kit	Chronic haemodialysis, long term 	36, 40cm	$127.00
	vascular access for haemodialysis and 
	apheresis. Constructed of radiopaque 
	silicone rubber.
KA012	Mahurkar Subclavian Catheter Kit	Acute haemodialysus, short term 	11.5 Fr, 13.5cm Straight 	$127.00
	vascular access. Catheters constructed	Exten, 11.5 Fr, 16cm 
	 of radiopaque polyurethane. Tips are 	Straight Exten, 11.5 Fr 
	made of polyvinyl chloride and are 	19.5cm Straight Exten, 10 Fr
	more radiopaque than the rest of the 	 12cm Curved Exten, 10 Fr 
	catheter.	15cm Curved Exten, 11.5 Fr 
	16cm Curved Exten, 11.5 Fr 
	16cm Curved Exten, 11.5 Fr 
	19.5cm Curved Exten
KA014	Mahurkar Maxid Catheters	Catheters constructed of radiopaque 	Size, 38, 43, 48, 53cm	$127.00
	polyurethans, high kink resistant.  
	The arterial lumen is shorter than the 
	venous lumen at the catheter's distal 
	end in order to reduce recirculation 
	during haemodialysis
KA019	Mahurkar 12Fr Triple Lumen 	Mahurkar 12Fr Triple Lumen Catheter 	12Fr - 13cm, 16cm, 19cm & 	$127.00
	Curved Extension Kit	24cm lengths available
KA020	Mahurkar 13.5Fr Q-Plus Dual 	Mahurkar 13.5Fr Q-Plus Curved 	13.5Fr - 13.5cm, 16cm, 19cm	$127.00
	Lumen Catheter	Extension Double Lumen Catheter 	 & 24cm lengths available
	cu
	Bard Australia Pty Ltd
BA140	Haemodialysis Catheters	Dialysis Catheter, Multiple Lumen	12.5Fr - 16FR	$330.00
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA011	Permcath Dual Lumen Catheter	Chronic Haemodialysis, long term 	36cm, 40cm	$330.00
	vascular access for haemodialysis and 
	aphaeresis.  Constructed of 
	radiopaque silicone rubber.
KA013	Permcath Dual Lumen Catheter	Chronic haemodialysis, long term 	28, 36, 40cm	$330.00
	vascular access for haemodialysis and 
	aphaeresis.  Constructed of 
	radiopaque silicone rubber.
Prostheses List by Category, Groups and Sponsor	Page 717 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
KA018	Palindrome	Haemodialysis catheter	14.5Fr. 19, 23, 28, 33, 55cm 	$330.00
	Insertion Lengths, with 36, 
	40, 45, 50, 72cm Overall 
	length, with side slots, 
	symmetric tip
	Mayo Healthcare Pty Ltd
YO012	Arrow Cannon II Plus Chronic 	Dual Lumen, Retrograde Tunneled, 	15Fg x 24 - 55cm	$330.00
	Haemodialysis Catheter Set	Cuffed, Tip First, Chronic 
	Haemodialysis Catheter Set
	Tekmed Pty Ltd
TK005	Medcomp Long Term Catheter sets 	ASH, TESIO-BioFlex with cuff	10, 14 French   24,28,32 & 	$330.00
	for Haemodialysis	36cm lengths
TK006	Medcomp Long Term Catheter sets 	HemoFlow HFS-Carbothane with cuff	14.5 French   24,28,32 & 	$330.00
	for Haemodialysis	36cm lengths
	pi
	Bard Australia Pty Ltd
BA215	Haemodialysis Catheter	Power Injectable, Triple Lumen 	13Fr	$368.00
	Haemodialysis Catheter
Prostheses List by Category, Groups and Sponsor	Page 718 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	A (Anti-infective Agent Coating)
	Mayo Healthcare Pty Ltd
YO004	ARROWg+ard Blue Haemodialysis 	Haemodialysis Catheters (of various 	CS-22122 - 12Fr 16cm, 	$158.00
	Catheters	lengths, sizes and lumen 	Dual Lumen CS-22123 – 
	configurations) with antimicrobial 	12Fr 16cm, Triple Lumen 
	impregnation (chlorhexidine and 	CS-25122 – 12Fr x 20cm, 
	silver sulphadiazine) on the external 	Dual Lumen CS-22142CF – 
	surface of the polyurethane catheter 	14Fr x 15cm, Dual Lumen, 
	Curved, Firm CS-22142F – 
	14Fr x 15cm, Dual Lumen 
	Firm CS-25122 – 12Fr x 
	20cm, Double Lumen CS-
	25123 – 12Fr x 20cm, Triple
	 Lumen CS- 25142CF – 
	14Fr x 20cm, Double 
	Lumen, Curve, Firm CS-
	25142F – 14Fr x 20cm, 
	Double Lumen, Firm CS-
	26142F – 14Fr x 25cm, 
	Double Lumen, Firm  CU-
	22122 – 12Fr x 16cm, 
	Double Lumen, Curved CU-
	23122 – 12Fr x 13cm, 
	Double Lumen, Curved CU-
	25122 – 12Fr x 20cm, 
	Double Lumen, Curved, 
	Dueal Lumen CS-22142CF -
	 14Fr x 15cm, Dual Lumen, 
	Curved, Firm CS-22142F - 
	14Fr x 15cm, Dual Lumen 
	Firm CS-25122 - 12Fr x 
	20cm
Prostheses List by Category, Groups and Sponsor	Page 719 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
10.09.04 - Infuser Ports, Single Chamber
	B Braun Australia Pty Ltd
BB170	Celsite Access Port for pain relief	Composition - polysulphone.  Kit 	Diameter of septum:11.7mm. 	$500.00
	includes tunnelling rod, filter, 	 Height: 11.5mm.  
	connectors, needles, syringe, tuohy 	Dimension: 25.8 x 37.8mm
	needle
	Bard Australia Pty Ltd
BA057	Groshong Subcutaneous Ports	Titanium or MRI Implatable Port, 	7Fr - 8 Fr	$500.00
	Closed-Ended Catheter, Single 
	Chamber
BA221	Implanted infusion Port	Titanium or MRI Implanted Port, 	6Fr - 9.6Fr	$500.00
	Open-Ended Catheter, Single 
	Cook Medical Australia Pty Ltd
WC093	Cook Implantable 	Petite or Standard, single or multiple 	3 - 12 Fr pre-attached or 	$500.00
	Injection/Infusion Ports	chamber Polysulfone Port which may 	detached catheter or valve 
	include micropuncture or standard 	system
	introducer set
WC115	Cook Implantable 	Mini, single or multiple chamber 	3 - 12 Fr pre-attached or 	$500.00
	Injection/Infusion Port	titanium Port which may include 	detached  catheter or valve 
	micropuncture introducer set	system
WC299	Vital-Port	Mini, petite or standard, single 	5-6.5Fr pre-attached 	$500.00
	chamber Titanium port which may 	catheter or valve system
	include micropuncture or standard 
	introducer set
	Denward Dell Pty Ltd TA Surimex
DW003	Jet Port Plus Set - Vascular Access 	Implantable injection / infusion port 	Port:  Diameter: 28.0mm, 	$500.00
	Port	system:  port chamber with silicone 	Height: 12.3mm; Catheter:  
	membrane; connectable polyurethane 	6.6 French, Length: 750mm
	catheter; and introducer kit.
DW004	Jet Port Plus Low Profile Peripheral	Implantable injection / infusion port 	Port:  Length: 24.0mm, 	$500.00
	 Set - Vascular Access Port	system:  low profile port chamber with	Width: 20.5mm, Height: 
	 silicone membrane; connectable 	10.3mm  Catheter: 6.6 
	polyurethane catheter; and introducer 	French, Length: 750mm
	kit
Prostheses List by Category, Groups and Sponsor	Page 720 of 1059