10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	pi
	Bard Australia Pty Ltd
BA181	PowerPort	Titanium or MRI implantable port, 	6Fr - 8Fr	$630.00
	Open-ended Catheter, Single Chamber
BA208	PowerPort with Groshong Catheter	Titanium or MRI implantable Port, 	8Fr	$630.00
	Closed-Ended Catheter, Single 
	Chamber
	Cook Medical Australia Pty Ltd
WC300	Vital-Port	Standard, power-injectable single 	7.5-9.5Fr pre-attached or 	$630.00
	chamber titanium Port which may 	detached catheter or valve 
	include micropuncture or standard 	system
	introducer set
	Denward Dell Pty Ltd TA Surimex
DW006	T-Port Contrast set - Vascular access	Injection infusion port system: 	6163653077:  Port Base 	$630.00
	 port.	titanium port chamber with silicone 	27mm x 13mm, CD 1.3 x 
	membrane: connectable polyurethane 	2.2mm, CL 75cm. 
	catheter; introducer kit.	6163652087: PB 27mm x 
	13mm, CD 1.6 x 2.6mm, CL 
	75cm. 6163663077: PB 
	23mm x 10mm, CD 1.3 x 
	2.2mm, CL 
	75cm.6163662087: PB 
	23mm x 10mm, CD 1.6 x 
	2.6mm, CL 75cm.
DW007	pfm Contrast Port	High pressure injection port system: 	Port: length 32.1mm, width 	$630.00
	plastic or plastic/titanium port with 	23.6mm, height 13.2mm. 
	silicone mebrane; connectable 	Catheter: 6.6 or 8.4 French, 
	polyurethane catheter; introducer kit	length 750mm
	Medical Specialties Australia Pty Ltd
MS014	Injection/Infusion Ports Sterile	Plastic/titanium, single lumen	5-15F	$630.00
MS016	Injection/Infusion Ports Sterile	Plastic/titanium, paediatric	5, 6, 7,8, 9.6F	$630.00
10.09.05 - Infuser Ports, Multiple Chamber
	Bard Australia Pty Ltd
BA059	Dual Lumen Subcutaneous Ports	Silicone, Polyurethane or ChronoFlex	7 - 10 French Catheter	$786.00
	 Open-ended Catheter
Prostheses List by Category, Groups and Sponsor	Page 721 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Cook Medical Australia Pty Ltd
WC164	Cook Implantable 	Dual or Multiple Chamber Titanium 	3 - 12 Fr pre-attached or 	$786.00
	Injection/Infusion Ports	Port which may include 	detached catheter or valve 
	micropuncture or standard introducer 	system
	Medical Specialties Australia Pty Ltd
MS015	Injection/Infusion Ports Sterile	Plastic/titanium, dual lumen	10, 10.5, 12F	$786.00
10.10.01 - Peritoneal Dialysis, Long Term Implantable Catheters
	cu
	Kendall Australasia Pty Ltd TA Covidien Pty Ltd
KA001	Tenckhoff Peritoneal Dialysis 	Adult 2 cuff, Adult 1 cuff, Adult 0 Cuff	42cm to 47cm length. All 	$175.00
	Catheter	Peritoneal Catheters 
	excluding the Swan Neck 
	Fast Flow Catheter, have an 
	internal diameter of 2.67mm 
	and an external diameter of 
	4.95 mm.
KA002	Tenckhoff Peritoneal Dialysis 	Paediatric 2 cuff, Paediatric 1 cuff, 	31cm to 37 cm length. All 	$175.00
	Catheter	Neonatal 1 cuff	Peritoneal Catheters 
	excluding the Swan Neck 
	Fast Flow Catheter, have an 
	internal diameter of 2.67mm 
	and an external diameter of 
	4.95 mm.
KA003	Fast Flow Peritoneal Dialysis 	Swan Neck, 2 cuff	Int.diam: 3.2mm; ext diam 	$175.00
	Catheter 	5.49mm.All Peritoneal 
	Catheters excluding the 
	Swan Neck Fast Flow 
	Catheter, have an internal 
	diameter of 2.67mm and an 
	external diameter of 4.95 mm.
KA004	Swan Neck Curl Peritoneal Dialysis	Adult 2 cuff, left	62 cm length. All Peritoneal	$175.00
	 Catheter	 Catheters excluding the 
	Swan Neck Fast Flow 
	Catheter, have an internal 
	diameter of 2.67mm and an 
	external diameter of 4.95 mm.
Prostheses List by Category, Groups and Sponsor	Page 722 of 1059

10 - VASCULAR
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
KA005	Swan Neck or Swan neck Tenckhoff 	Adult-left, Adult-right, Adult, 2 cuff-	20 to 25cm external segment	$175.00
	Peritoneal Dialysis Catheter	left, Adult, 2 cuff-right	 or 43cm length. All 
	Peritoneal Catheters 
	excluding the Swan Neck 
	Fast Flow Catheter, have an 
	internal diameter of 2.67mm 
	and an external diameter of 
	4.95 mm.
KA006	Tenckhoff Peritoneal Dialysis 	Adult, 2 cuffs	57 to 62cm length. All 	$175.00
	Catheter, Curl	Peritoneal Catheters 
	excluding the Swan Neck 
	Fast Flow Catheter, have an 
	internal diameter of 2.67mm 
	and an external diameter of 
	4.95 mm.
Prostheses List by Category, Groups and Sponsor	Page 723 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.01.01 - Cemented
	11.01.01.01 - Unpolished
	B Braun Australia Pty Ltd
BB275	Excia Hip System	Cemented stem cobalt chromium	9mm-18mm	$1,850.00
	Biomet Australia Pty Ltd
BI039	Integral Hip System	 Femoral Stem, Chrome Cobalt, 	9-17mm	$1,850.00
	Cemented unpolished 
BI047	Echo FX Stem	 Femoral Stem, Chrome Cobalt, 	7-17mm	$1,850.00
	Cemented unpolished 
BI050	Bi-Metric Hip System	Titanium unpolished cemented 	7-17mm	$1,850.00
BI063	Bimetric Hip System	Chrome Cobalt Cemented, unpolished	7-17mm	$1,850.00
BI069	Biomet Taperloc Hip System	Titanium unpolished	7.5mm to 20mm diameter	$1,850.00
BI132	Mallory Head Hip System	 Cobalt Chrome, Unpolished	7-19mm	$1,850.00
	DJO Australasia Pty Ltd
DD006	Foundation Hip System 450, 460	Foundation Non-porous, cemented 	8, 9, 10.5, 12, 13.5, 15, and 	$1,850.00
	Stem	16.5
	Exactech Australia
EX012	Exotech Novation C femoral stem	Femoral stem cemented unpolished	1-8	$1,850.00
EX053	Novation Cemented Plus Femoral 	The Exatech Novation Cemented 	Size 10, 11, 12, 13, 14, 15, 17	$1,850.00
	Stem	Femoral Stems are a line addition to 
	the AcuMatch C-Series Cemented 
	femoral stems, as follows: The 
	trapezoidal cross-sectional area was 
	modified to a circulo-trapezoidal 
	geometry. A change to the sizing 
	range and neck length.
	Johnson & Johnson Medical Pty Ltd
DP180	Charnley Standard Femoral Stem	Stainless steel, (Ortron 90) fixed & 	Sizes less than 200mm	$1,850.00
	attachable femoral heads
DP203	Elite Plus Femoral Stem	Stainless steel, Ortron 90, cemented 	CDH, Size 1-7 and all 	$1,850.00
	femoral stem, unpolished
JJ573	Summit Cemented Femoral Stem	CoCr, tapered, unpolished	Sizes 0-10, with various 	$1,850.00
	offsets
Prostheses List by Category, Groups and Sponsor	Page 724 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO015	LINK Lubinus SPII Hip Prosthesis	Stem	Left & right 01-5	$1,850.00
	Mathys Orthopaedics Pty Ltd
MA016	CCA Cemented Femoral Stem	CoCr, straight, not polished	7.50mm -17.5mm	$1,850.00
	Smith & Nephew Surgical Pty Ltd
SN010	Basis Femoral Component	Hip stem, Cobalt Chromium Grit Blast	Length 115 - 135mm	$1,850.00
SN301	Spectron and Synergy	Femoral Stem Non Porous Offset	1- 20	$1,850.00
	Stryker Australia Pty Ltd
ST576	Stryker Omnifit Cemented Stem	Cemented  femoral component Cobal 	Stem sizes 4-11	$1,850.00
	Chrome 
	Zimmer Pty Ltd
ZI337	Natural Hip System	Unpolished, straight, Femoral Stem, 	140 - 160mm	$1,850.00
	CoCr
	Removable Neck
	DJO Australasia Pty Ltd
DD026	R120 Cemented Femoral Stem	CoCr, unpolished, tapered, collared, 	Size 1 to 6	$1,850.00
	separate neck
	11.01.01.02 - Unpolished - precoat
	Orthotech Pty Ltd
OH397	Furlong Hemi Range	Cemented femoral stem	XXS, XS, S, M & L	$2,100.00
	Stryker Australia Pty Ltd
HW031	Definition PM Femoral Component	Femoral Stem -  Vitallium	Stem sizes 1 - 7	$2,100.00
	11.01.01.03 - Polished
	Austofix
AX068	Experion Hip System	Polished, stainless steel, tapered stem	Sizers 1-4, Offsets 35.5 - 	$2,100.00
	44mm
AX098	E2 Cemented Stem	Cemented Femoral Stems	size 0 - 4	$2,100.00
	B Braun Australia Pty Ltd
BB240	BiContact cemented	Cemented stem cobal chrome	8-18	$2,100.00
Prostheses List by Category, Groups and Sponsor	Page 725 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BI066	Stanmore Total Hip System	Polished Femoral Stem - Standard and 	Size 1-5 	$2,100.00
	Straight, Chrome Cobalt
BI925	Mallory Head Hip System	Femoral Stem, Cobalt Chrome, Polished	7-19mm	$2,100.00
	Corin Australia Pty Ltd
CR024	Taperfit Femoral Stem	Double taper stainless steel femoral 	sizes 0-4 with 4 different 	$2,100.00
	stem	offsets
	Global Orthopaedic Technology
GO164	Global Cemented Femoral Stem	CoCr, polished, double taper, 	Sizes 0-4, various offsets	$2,100.00
	Johnson & Johnson Medical Pty Ltd
DP546	C- Stem & C- Stem AMT Femoral 	Stainless steel Ortron 90, highly 	Size 1-8 standard, Size 1-8 	$2,100.00
	Stems	polished, triple taper	High Offset, CDH and 0A to
	 3A sizes
JJ786	Corail Hip System Cemented 	Stainless steel cemented, polished 	Size 8 - 20	$2,100.00
	Femoral Stem	femoral stem, standard and high offsets
	Lima Orthopaedics Australia Pty Ltd
LC005	Friendly Femoral Stem	Femoral Stem Cemented Tapered 	0, 1, 2, 3	$2,100.00
	Polished FeCrNiMnMoNbN
LC026	Lima Accent Hip System	Femoral Stem Cemented, tapered, 	1 -6	$2,100.00
	polished
	Mathys Orthopaedics Pty Ltd
MA463	twinSys Cemented Femoral Stem	stainless steel, highly polished, triple	8 sizes in standard and 	$2,100.00
	 tapered	lateral version (Size 9, 10, 
	11, 12, 13, 14, 15, 16)
	Medacta Australia Pty Ltd
MU001	CONE Cemented Femoral Stem	CoCr, highly polished, triple taper	Standard sizes 1 to 8, 	$2,100.00
	Lateralized sizes 2 to 7
MU004	Quadra Hip Cemented Femoral Stem	High nitrogen stainless steel alloy, 	Std 0 to 7	$2,100.00
	highly polished, double taper	Lat 1 to 7
MU110	X-Acta Femoral Stems	Stainless Steel Femoral Stems	Sizes 0 - 4 / Offsets 35.5 - 44	$2,100.00
	 mm
	Signature Orthopaedics
SF041	Global Cemented Femoral Stem	CoCr, polished, double taper, 	Sizes 0-4, various offsets	$2,100.00
Prostheses List by Category, Groups and Sponsor	Page 726 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN268	CPCS	Femoral Stem Polished Non Porous, 	1 - 5	$2,100.00
	Std and High Offset 
	Removable Neck
	Global Manufacturing Technology Pty Ltd
GM149	Absolut Cemented Femoral Stem	CoCr, highly polished, tapered, with 	0 to 14	$2,100.00
	neck
	Lifehealthcare Pty Ltd
LH067	Groupe Lepine Total Hip 	Cemented Stainless steel polished	Size 6, 7, 9, 9, 10, 11	$2,100.00
	Replacement
	Wright Medical Australia
WR085	Profemur Xm Femoral Stem	Femoral Stem, CoCr, Cemented, 	0, 1, 2, 3, 4	$2,100.00
	Polished
	SCP
	Stryker Australia Pty Ltd
HW041	Exeter Hip System	Stainless Steel (Orthinox)	Stem Sizes 0-6, Offsets 30, 	$2,500.00
	33, 35.5, 37.5, 44, 50 & 56mm
	Zimmer Pty Ltd
ZI009	Zimmer CPT Hip Systems Femoral 	Co Cr (Zimaloy), polished and tapered	Sizes 1 - 5	$2,500.00
	Stem
ZI373	MS-30 Hip prosthesis	Stainless steel, polished tapered	6 to 16	$2,500.00
11.01.02 - Cemented, Long Lengths (≥200mm)
	11.01.02.01 - Polished and Unpolished, Conventional
	Johnson & Johnson Medical Pty Ltd
DP013	Wroblewski Resection femoral Stem	Stainless steel, polished, includes 	200mm-250mm	$3,550.00
	segmental support rings x 3
DP175	Charnley Hip Long Femoral Stem	Stainless steel Ortron 90 stem	10"- 15" (250-375mm) 	$3,550.00
DP212	Elite Plus Long Femoral Stem	Stainless steel, Ortron 90, cemented 	Sizes 3-5 (200-250mm)	$3,550.00
	femoral stem, unpolished
DP550	C- Stem & C- Stem AMT Femoral Stem	Stainless steel Ortron 90, highly 	Size 3-8 x 200-240mm 	$3,550.00
	polished, triple taper, long stem
Prostheses List by Category, Groups and Sponsor	Page 727 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO012	LINK Endo - Model Saddle 	Cobal Chrome, unpolished and long	170mm / Sizes 01-5	$3,550.00
	Signature Orthopaedics
SF032	Adapter GHE Femoral Long Stem 	CoCr, non polished, long stem	200mm - 350mm	$3,550.00
	Cemented 
	Stryker Australia Pty Ltd
HW040	Exeter Hip System	Stainless Steel (Orthinox) polished 	37.5 and 44mm offsets	$3,550.00
	long 
ST584	Osteonics omnifit cemented long stem	cobalt chrome unpolished long 	Stem sizes  5-11, stem 	$3,550.00
	length 200, 250 AND 300mm
	Zimmer Pty Ltd
ZI025	Zimmer VerSys CRC Hip Systems 	 Cobalt Chrome, unpolished long stem	13 - 19	$3,550.00
	Femoral Stem	 with calcar attachment option
ZI301	CPT Hip System	Cobalt Chrome, polished, tapered, 	Sizes 1 - 4	$3,550.00
	long stems 
	Tumour
	Lima Orthopaedics Australia Pty Ltd
LC001	Lima RPS Femoral System	Cemented tumor Stem	130, 165, 200mm	$7,176.00
11.01.03 - Uncemented
	11.01.03.01 - Grit Blast
	Biomet Australia Pty Ltd
BI980	Echo Hip System	Press Fit Femoral Component, 	7 - 17mm	$3,870.00
	DJO Australasia Pty Ltd
DD007	Foundation Hip System, 440, 470, 	Foundation Porous, Press Fit, fracture	8, 9, 10.5, 12, 13.5, 15, 16.5,	$3,870.00
	480	 Stem with or without collar	 18.0
DD048	CLP Hip System - Femoral 	Non modular femoral hip stem, 	14 x standard offset 	$3,870.00
	Component, Ti, Grit Blast, non HA, 	designed for uncemented use, and to 	components and 12 lateral 
	standard and lateral offset	be used with CoCro or Ceramic heads 	offset components
	in total hip arthroplasty, or Bipolar 
	heads in hemi-arthroplasty
Prostheses List by Category, Groups and Sponsor	Page 728 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lima Orthopaedics Australia Pty Ltd
LC011	C2 Femoral Stem	C2 Femoral Stem Standard / 	02 to 12	$3,870.00
	Lateralised / Revision 12/14 Taper 
	Ti6AI4V
	Link Orthopaedics  Australia
LO107	Beta-Cone Cementless Hip 	Titanium, grit blast, non HA	9 Stem sizes 1-9 plus 	$3,870.00
	additional 9 stems with XL 
	neck length. Total 18 sizes
	Mathys Orthopaedics Pty Ltd
MA019	CBC Non Cemented Femoral Stem	Titanium, grit blast, non HA, 	5-20mm	$3,870.00
MA427	CBH Non Cemented Femoral Stem	Titanium, grit blast, non HA, 	00-12	$3,870.00
	Medacta Australia Pty Ltd
MU025	Quadra S Femoral Stem	Titanium, grit blast, non HA,	Standard #0 to #10 and #0 	$3,870.00
	to #3 with a shorter neck.  
	Lateralized #1 to #7 and #1 
	to #3 with a shorter neck.
	Motion Orthopaedics Pty Ltd
BJ001	SCR Revision Stem	Femoral Stem for Revision of THR 	1 size (195mm)	$3,870.00
	(Double-tapered straight Stem with 
	rectangular profile)
	Smith & Nephew Surgical Pty Ltd
SM012	SL & SLR Plus Femoral Stem	Titanium, grit blast, non HA, 	Sizes 01-12 for SL & 1-6 for 	$3,870.00
	SLR
SM126	SL Plus MIA Femoral Stem	Titanium, grit Blasted, double tapered	01-12 various offsets	$3,870.00
SN842	Platform Hip Stem	Titanium grit blasted stem	0-12	$3,870.00
	Zimmer Pty Ltd
ZI376	Cone Hip prosthesis	Titanium, grit blast, non HA	13 to 24mm	$3,870.00
	Removable Neck
	DJO Australasia Pty Ltd
DD027	R120 Uncemented Femoral Stem	Femoral Stem porous/HA coated, 	Size 1 to 6	$3,870.00
	Modular, CrCo, standard lengths
	Wright Medical Australia
WR142	Profemur E Hip System	Profemur E Stem - without HA grit 	1 Standard - 9 Standard	$3,870.00
	blasted 'Titanium
Prostheses List by Category, Groups and Sponsor	Page 729 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SCP
	Zimmer Pty Ltd
ZI462	Alloclassic Hip Stem	Titanium, grit blast, non HA, standard	1 - 14	$4,270.00
	 and high offset
ZI463	Alloclassic Hip Stem	Zweymuller, Ti alloy, Short Cone, 	01, 0, 1, 10-13	$4,270.00
	Slender Neck
ZI468	CLS Cementless Hip	Titanium, grit blast, non HA	5 - 20	$4,270.00
	11.01.03.02 - Beaded
	DJO Australasia Pty Ltd
DD001	Linear Hip Stem	Linear Hip Stem Standard or Lateral 	Sizes 5, 6, 7, 8, 9, 10, 11, 12,	$4,350.00
	Offset (reduced neck)	 13, 14, 15, 17 and 19 
	(standard and lateral offsets)
DD047	Revelation Hip System - Femoral 	Non modular femoral hip stem, 	16 stems: 8 sizes Left & 8 	$4,350.00
	Component, Ti, Grit Blast, non HA, 	designed for uncemented use, left & 	sizes Right - 8.0, 9.0, 10.5, 
	standard & lateral offset	right specific with 130 degree neck 	12.0, 13.5, 15.0 & 16.5
	angle & 12 degrees of built-in 
	anteversion.  Proximal circumferential 
	"3D" beading, a highly polished neck 
	& highly polished distal stem
	Johnson & Johnson Medical Pty Ltd
DY516	Solution Implantable Hip System	Revision Standard & MMA 8 straight 	6 inch (150mm) size 10.5 - 	$4,350.00
	or bowed porous coated collarless, 	22.5
	coxa vara or high offset uncemented 
	stem
JJ604	Tri-lock Femoral Stem	Titanium, proximally beaded, 	Sizes 0-10 with various 	$4,350.00
	(porocoat) not HA, 	offsets
JJ813	Summit Femoral Hip	Titanium, beaded proximally, distal 	0-12	$4,350.00
	grit blast
	Smith & Nephew Surgical Pty Ltd
SM171	MIS Stem	Short, tapered, uncemented "press fit" 	Size 1-9 (73mm -101mm)	$4,350.00
	femoral stem with modular neck 
	functionality
SN270	Echelon	Femoral Stem Porous Co Cr, Std and 	9 - 19	$4,350.00
	High Offset
Prostheses List by Category, Groups and Sponsor	Page 730 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN305	Synergy	Femoral stem Beaded Titanium Alloy, 	9-20	$4,350.00
	Std and High Offset
	11.01.03.03 - Mesh
	Johnson & Johnson Medical Pty Ltd
JJ777	Tri-Lock Gription Femoral Stem	Titanium, Femoral stem, GRIPTION 	Size 0-12 standard and high	$4,450.00
	coated	 offset
	Zimmer Pty Ltd
ZI006	Mayo Hip	Titanium, mesh (fibre metal), non HA	Small, medium, large and 	$4,450.00
	extra large.
ZI016	Zimmer 'VerSys Hip Systems 	Titanium, mesh (fibre metal), non HA	9 - 18	$4,450.00
	Femoral Stem
ZI492	Trabecular Metal Femoral Stem	Titanium, porous tantalum 	Sizes 9 to 18 with standard 	$4,450.00
	and extended offsets
	11.01.03.04 - Plasma
	Biomet Australia Pty Ltd
BI049	Bi-Metric Hip System	Titanium, plasma non HA	7-17mm	$4,500.00
BI981	Echo Hip System Bi Metric Femoral 	Echo Bi Metric Cementless Titanium 	7 - 17mm	$4,500.00
	Stem	Femoral Component
	Global Orthopaedic Technology
GO176	APEX K1tm Hip System	K1 Femoral Stem - titanium plasma 	Stem std and lat sizes 1 to 	$4,500.00
	uncemented non-HA
	Orthotech Pty Ltd
OH439	Multifit	Modular stem	125-165mm	$4,500.00
	RQSolutions Medical Devices Distribution Support
RQ073	GHE Hip Stem	anatomic shaped femoral stem for THR 	The GHE Hip stem is 	$4,500.00
	with a 3D-open structure for bony 	avaliable for the left and 
	ingrowth	right body size. For each 
	body side the stem is 
	available in 7 sizes (90mm - 
	150mm in 10mm steps)
	Stryker Australia Pty Ltd
SR027	Accolade HFx	CoCr,plasma not HA 	Stem sizes 1-8, 127 degree 	$4,500.00
	neck
Prostheses List by Category, Groups and Sponsor	Page 731 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR253	Profemur Hip System	Primary stem, tapered wedge, plasma 	1-12	$4,500.00
	coated
WR254	Profemur Hip System	Primary stem, tapered wedge, plasma 	1-12	$4,500.00
	coated, fixed neck
	Zimmer Pty Ltd
ZI296	Anatomic II Hip System Femoral 	Titanium, plasma Spray, no HA 	Sizes 9 - 19	$4,500.00
	Stems
ZI327	M/L Taper Femoral Stem	Titanium, plasma spray, non HA 	9mm - 18mm in 1mm 	$4,500.00
	increments, 10 sizes in all
	Removable Neck
	Zimmer Pty Ltd
ZI554	M/L Taper Hip Stem with Kinectiv 	Titanium, plasma, non HA	size 5, 6, 7.5, 9, 10, 11, 12.5,	$4,500.00
	Technology	 13.5, 15,16.25,17.5
	SCP
	Biomet Australia Pty Ltd
BI074	Biomet Taperloc Hip System	Titanium unpolished	7.5mm - 20mm diameter	$4,900.00
BI139	Mallory Head Hip System	Titanium, plasma 	7-19mm x 135 -180mm 	$4,900.00
11.01.04 - Uncemented, HA Coated
	11.01.04.01 - Grit Blast
	Austofix
AX044	Hyperion Uncemented Stem	Titanium, gritblast, HA coated, 	Sizes 9 to 20	$4,300.00
	collared, collarless and high offset
AX097	CL2 Cementless Femoral Stem	Titanium, grit plast full HA coating	8 - 18	$4,300.00
	B Braun Australia Pty Ltd
BB239	BiContact Cementless	Femoral stem, grit blast and HA 	8-21	$4,300.00
	Biomet Australia Pty Ltd
BH043	Exception Femoral Stem	Standard or Varised, Left or Right 	Sizes 1-9	$4,300.00
	Titanium Alloy, HA coated
	Corin Australia Pty Ltd
CR117	Metafix Femoral Stem	Titanium femoral stem striated and 	standard, lateralised and 	$4,300.00
	fully coated with HA	125 degree
Prostheses List by Category, Groups and Sponsor	Page 732 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX002	Novation Element HA	Novation Press-Fit Element Stems are 	collarless: standard offset, 	$4,300.00
	intended for press-fix fixation and 	12/14, sizes 8-18 Extended 
	manufactured from Titanium 6A1-4V 	offset 12/14, sizes 8-18, 
	and have rectangular cross-sectional 	collared: standard offset 
	geometry with transverse proximal 	12/14, sizes 8-18
	grooves and distal parallell grooves.
	Johnson & Johnson Medical Pty Ltd
DY514	Kar (Corail Revision) Femoral Stem	Titanium, grit blast, full HA coating, 	Size ≤13, (length less than 	$4,300.00
	fluted distally	200mm)
	Lifehealthcare Pty Ltd
LH366	Pavi / Targos Femoral Stem	Titanium, grit blast with HA	One piece varus neck in 	$4,300.00
	sizes 10-16 in lengths 140 -
	 170mm.  One piece standard
	 neck in sizes 9 -16 , lengths
	 140 - 170mm.
	Lima Orthopaedics Australia Pty Ltd
LC003	Lima Total Hip Replacement System	F2L Multineck Femoral Stem 	1 - 6	$4,300.00
	Uncemented, beaded, with HA
LC013	FIT Femoral Stem	FIT Femoral Stem 12/14 Taper 	Size 1-7, Left & Right	$4,300.00
	Ti6AI4V HA Coated
LC144	ColloMis Femoral Stem	The COLLO-MIS Femoral Stem	Sizes 1 to 9	$4,300.00
LC159	H-Max S Femoral Stem	H-Max S Femoral Stem HA Coated 	9 - 18	$4,300.00
	Ti6AI4V
	Link Orthopaedics  Australia
LO034	CFP Hip Stem	Titanium, grit blast,  HA	Extra small to Extra Large	$4,300.00
LO111	Beta-Cone Cementless Hip 	Titanium, grit blast, with HA	9 Stem sizes 1-9 plus 	$4,300.00
	additional 9 stems with XL 
	neck length.  Total 18 Sizes
	Mathys Orthopaedics Pty Ltd
MA462	twinSys Non Cemented Femoral 	Titanium, grit blast, fully HA	Various offsets and sizes 	$4,300.00
	under 200mm length
	Medacta Australia Pty Ltd
MU003	Quadra Hip Femoral Stem 	Titanium, grit blast, fully HA,	Std 0 to 10	$4,300.00
	Std (shortneck) 00 to 10
	Lat 1 to 7
	Lat (shortneck) 1 to 7
Prostheses List by Category, Groups and Sponsor	Page 733 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO066	APTA Hip Stem	Anatomic, Titanium, HA Coated, 	Sizes 1-8 in Left & Right, 	$4,300.00
	Modular Uncemented Femoral Stem	Collarless & Collared
OO069	Hydra Hip Stem	Tapered, Titanium, HA Coated, 	Sizes 9 - 18	$4,300.00
	Modular Uncemented Femoral Stem
	Signature Orthopaedics
SF029	Cementless Stem	Cementless Stems are inteded for 	collarless: standard offset, 	$4,300.00
	press-fit fixation and manufactured 	12/14, sizes 8-18 Extended 
	from titanium 6AI-4V and are fully HA	offset 12/14, sizes 8-18, 
	 coated	collared: standard offset 
	12/14, sizes 8-18
	Smith & Nephew Surgical Pty Ltd
SN306	Synergy	Femoral stem: HA coated Titanium 	9-20	$4,300.00
	Alloy, Std and High Offset
SN894	Anthology HAC	Femoral Stem - Titanium grit blasted 	01-18 90mm-122mm	$4,300.00
	HA coated
	Stryker Australia Pty Ltd
ST573	Omnifit hip stem	Titanium, grit blast and HA	Stem sizes 4-14	$4,300.00
	Wright Medical Australia
WR147	Profemur Anca-fit Hip System	Anca-fit Femoral Stem with 1/3 	9.5, 11, 12, 13, 14, 15, 16, 	$4,300.00
	proximal HA, grit blast	17.5, left and right
WR222	Profemur L	Profemur L Hip Stem	Size 1 - 11	$4,300.00
	Zimmer Pty Ltd
ZI556	Avenir- Muller Stem	Titanium, grit blast, with HA	Standard sizes 1-8;  Lateral 	$4,300.00
	sizes 1-8
	Removable Neck
	Amplitude Australia
LI054	Acor Anatomic Femoral Stem for 	Anodised titanium, fully HA Coated, 	7 Sizes	$4,300.00
	Modular Neck	curved stem and used with separate 
	neck
LI056	Integrale Femoral Stem	Anodised titanium, fully HA 	7 Sizes	$4,300.00
	Coated,straight stem and used with 
	separate neck
Prostheses List by Category, Groups and Sponsor	Page 734 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	SCP
	Johnson & Johnson Medical Pty Ltd
DP943	Corail Femoral Stem	Titanium, grit blast, full HA coating,  	Size 6 to 20 or in lengths 	$4,700.00
	110 -190mm
	Orthotech Pty Ltd
OH279	JRI Furlong Total Hip System	Uncemented Femoral Stem, titanium, 	12 /14 Taper, and 5mm 	$4,700.00
	grit blast, with HA,  	offset, short and standard 
	spigot
	Zimmer Pty Ltd
ZI520	Alloclassic Zweymuller Hip Stem 	Titanium, grit blast, with HA	1 - 12	$4,700.00
	HA Coated
	11.01.04.02 - Beaded
	Johnson & Johnson Medical Pty Ltd
DY134	Summit Femoral Stem	Titanium, beaded proximally with HA,	Size 1-10	$4,850.00
	 duofix distal grit blast
DY424	Proxima Femoral Stem	Titanium, beaded with HA (duofix), 	Size 1 to 9	$4,850.00
	metaphyseal stem
JJ814	Silent Hip System-Femoral 	Neck preserving femoral stem, 	Sizes 18-28 x 45-70	$4,850.00
	Component	titanium, beaded with HA (Duofix)
	Smith & Nephew Surgical Pty Ltd
SN303	Synergy	Femoral Stem HA Coated beaded 	9 - 18	$4,850.00
	Titanium Alloy, Std and High offset
SN678	Echelon with HA	Cobalt Chromium with 	11-20	$4,850.00
	Hyrdoxyapetite Coating, beaded
SN825	Birmingham Mid Head Resection 	Titanium, Beaded and HA 	1-19	$4,850.00
	Stem
SN843	Anthology Hip System	Titanium, Beaded and HA 	0-20	$4,850.00
	11.01.04.03 - Mesh
	Zimmer Pty Ltd
ZI014	Zimmer Epoch Hip Systems Femoral 	Cobalt Chrome, Core, PAEK outer 	14 - 18 mm	$4,950.00
	Stem	matrix, Titanium mesh with HA
Prostheses List by Category, Groups and Sponsor	Page 735 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI017	Zimmer 'VerSys Hip Systems 	Titanium, mesh (fibre metal), with HA	9 - 18	$4,950.00
	Femoral Stem
ZI365	Natural Hip System	Titanium stem with cancellous spray 	00 to 7	$4,950.00
	titanium coating with HA, standard 
	and high offset
	11.01.04.04 - Plasma
	B Braun Australia Pty Ltd
BB274	Excia Hip System	plasma titanium, HA	8mm-18mm	$5,000.00
	Biomet Australia Pty Ltd
BH038	Bi Metric Hip	Femoral Stem, HA coated, porous 	(7 to 21) mm diameter, 	$5,000.00
	plasma spray, titanium	Standard or lateralised
	Corin Australia Pty Ltd
CR086	Tri-Fit  TS Femoral Stem	Titanium stem proximally coated with 	Sizes 1- 11	$5,000.00
	plasma spray and HA
CR157	MiniHip Stem	Short stem, Titanium, Plasma Spray 	9 sizes	$5,000.00
	with HA
	Exactech Australia
EX009	Novation Tapered and Splinned 	Novation Press-Fit femoral 	tapered: Standard Offset, 	$5,000.00
	Femoral Stem	components are manufactured from 	size 9-18, Extended Offset, 
	titanium alloy.  The stem has a circulo-	Size 9-18; HA, Standard 
	trapezoidal cross-sectional geometry 	Offset, Size 9-18; HA, 
	and distal taper.	Extended Offset, Size 9-18, 
	splinned: Standard Offset, 
	Size 9-18; Extended Offset, 
	Size 9-18, RDD Standard 
	Offset size 11-18, RDD 
	Extended Offset size 11-
EX013	Exactech Femoral Stem	Novation Hip System	9-18	$5,000.00
	Global Manufacturing Technology Pty Ltd
GM133	K2 Global Modular Femoral Stem	K2 Mid Stem	Size 2 to 12	$5,000.00
	Lima Orthopaedics Australia Pty Ltd
LC015	Sam-Fit modular stem	Modular stem	1 - 7	$5,000.00
	Oceania Orthopaedics
OO041	Mutars RS revision system - 	RS Cementless stem HA	14/16/18/20mm dia stems, 	$5,000.00
	cementless stem HA	15mm length
Prostheses List by Category, Groups and Sponsor	Page 736 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH232	Exactech Femoral Stem	Novation Hip System	9-18	$5,000.00
OH280	JRI Furlonjg active stem	JRI Furlong Active Stem, Titanium 	12 / 14 Taper, 9-16mm	$5,000.00
	Aloy with Supravit Coating, 12/14 
	Taper
	RQSolutions Medical Devices Distribution Support
RQ074	GHE Hip Stem CaP-Coated	anatomic shaped femoral stem for THR 	the GHE Hip stem CaP-	$5,000.00
	with a 3D-open calcium phosphate 	coated is available for the 
	coatd structure for bony growth	left and right body size. For 
	each body side the stem is 
	available in 7 sizes (90mm - 
	150mm in 10mm steps)
	Smith & Nephew Surgical Pty Ltd
SM013	SL & SLR PLUS Femoral Stem	Titanium, Plasma spray, proximal HA 	01 to 12 for SL & 1-6 for 	$5,000.00
	coating	SLR, various offsets
SM122	Polarstem	Titanium Stem, Plasma Spray & Full 	01-10, various offsets	$5,000.00
	HA coating
SM127	SL Plus MIA Femoral Stem	Titanium, Plasma spray, proximal HA 	01-12, various offsets	$5,000.00
	coating
SN900	NANOS Neck Preserving Stem	.Neck preserving femoral stem with 	Size 0 to Size 9	$5,000.00
	vacuum plasma spray titanium porous 
	coating and Calcium Phosphate 
	electro chemical deposition process 
	coating (Bonit Coating) for use 
	without modular femoral neck choices
	Stryker Australia Pty Ltd
HW024	ABG11 Hip Stem 	Titanium, Plasma coated with HA 	Stem sizes 1 - 8 Left,  1 - 8 	$5,000.00
	Right
HW529	Accolade II Femoral Hip System	Femoral Hip Stem (127 & 132 neck 	Size 0 - 11	$5,000.00
	angle)
SK447	Rejuvinate SPT (Monolithic Stems, 	Titanium (TMZF), plasma coated, HA	4-12	$5,000.00
	TMZF) Hip System
ST575	ACCOLADE hip prostheses	Titanium, plasma coated, HA	Stems sizes 0-11	$5,000.00
	Zimmer Pty Ltd
ZI493	M/L Taper   Stem	Plasma sprayed titanium with HA 	Sizes 5 to 22 with standard 	$5,000.00
	and extended offsets
Prostheses List by Category, Groups and Sponsor	Page 737 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI495	Zimmer Anatomic II 	Titanium, plasma spray with HA	Sizes 1 - 12, left and right	$5,000.00
	Removable Neck
	B Braun Australia Pty Ltd
BB295	Metha - modular short stem	Short stem, plasma, HA 	1 -6	$5,000.00
	Global Manufacturing Technology Pty Ltd
GM090	APEX Global Femoral Stem	Titanium, plasma coated, proximal HA 	Sizes 2-8	$5,000.00
	, standard and short lengths
GM117	MSA Global Femoral Stem	Titanium, plasma spray, with HA, 	0 - 6	$5,000.00
	distal flute & polished
GM120	K2 Global Femoral Stem	Titanium, plasma spray, proximal HA	Size 0to size 12	$5,000.00
	Lifehealthcare Pty Ltd
LH069	MBA stem 	Titanium, grit blast with HA	1 - 8	$5,000.00
LH183	Lyderic II HA Modular Stem	Titanium, plasma with HA	Size 6-11	$5,000.00
	Signature Orthopaedics
SF043	MSA Global Femoral Stem	Titanium, plasma spray, with HA, 	0 - 6	$5,000.00
	distal flute & polished
	Wright Medical Australia
WR098	Profemur Renaissance Hip System	Titanium Stem with HA Plasma Spray,	Size 10 -18	$5,000.00
	 standard & reduced flare
WR123	Profemur R Hip System	Titanium Tapered Stem - HA Plasma 	Sizes 9 to 18 in 1 mm 	$5,000.00
	Spray	increments
	Zimmer Pty Ltd
ZI555	M / L Taper Hip Stem with Kinectiv 	Titanium, plasma spray with HA	size 5,  6 , 7.5, 9, 10, 11, 	$5,000.00
	Technology	12.5, 13.5, 15, 16.25, 17.5
	SCP
	Biomet Australia Pty Ltd
BI075	Biomet Taperloc Hip System	titanium, plasma, HA	7.5mm - 22.5mm	$5,400.00
BI141	Mallory Head Hip System	Titanium, plasma and HA	7-19mm 	$5,400.00
	Stryker Australia Pty Ltd
ST541	SecurFit Plus Max	Titanium, plasma, HA 	Stem sizes 7-14	$5,400.00
ST574	SecurFit HA Max Hip Stem	Titanium, plasma coated, HA	Stem sizes 4-14 in 127 and 	$5,400.00
	132 degree neck angles
Prostheses List by Category, Groups and Sponsor	Page 738 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.01.05 - Uncemented, Long Lengths (≥200mm)
	11.01.05.01 - Grit Blast
	Biomet Australia Pty Ltd
BI097	Kent Hip System	Titanium, grit blast, non HA, distal 	Narrow, Std.  Size 6 - 16 	$5,410.00
	screw holes 	hole 
BI778	PLR Splined Revision Stem	Splined Straight Stem, Ti, grit blast, 	14-24mm x 270mm	$5,410.00
	non HA
	Lima Orthopaedics Australia Pty Ltd
LC160	C2 Revision Stem	C2 Revision Stem	Size 7-9 x 202 to 213mm 	$5,410.00
	Length
	Motion Orthopaedics Pty Ltd
BJ004	SCR Revision Stem	Femoral Stem for Revision of THR 	8 sizes (4 - 11)	$5,410.00
	(Double - tapered straight Stem with 	200mm-243mm
	rectangular profile)
	Smith & Nephew Surgical Pty Ltd
SM014	SLR Plus Long Femoral Stem	Titanium, grit blast, non HA, long 	Sizes 7-12	$5,410.00
	Zimmer Pty Ltd
ZI377	Wagner Revision Hip Prosthesis	Uncemented Stem Titanium, grit blast, 	190/14 to 385/25	$5,410.00
	non HA
	11.01.05.02 - Beaded
	Johnson & Johnson Medical Pty Ltd
DY517	Solution Implantable Hip System	Revision Standard & MMA 8 straight 	8 inch (200mm) size 10.5 - 	$5,750.00
	or bowed porous coated collarless, 	22.5
	coxa vara or high offset uncemented 
	stem
	11.01.05.04 - Plasma
	Biomet Australia Pty Ltd
BI052	Bi-Metric Hip System	Revision 200 Stem, Titanium, plasma 	9-17mm	$5,900.00
	non HA
BI053	Bi-Metric Hip System	Revision 250 Stem, Titanium,  plasma, 	9-17mm	$5,900.00
	non HA
Prostheses List by Category, Groups and Sponsor	Page 739 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI054	Bi-Metric Hip System	Revision 300mm Femoral  Stem, 	9-17mm	$5,900.00
	Titanium, plasma non HA
BI692	Reach Revision Hip System	Titanium plasma no HA	Sizes 13 - 19 (L&R) by 200 	$5,900.00
	- 250mm)
11.01.06 - Uncemented, Long Lengths, HA Coated (≤200mm)
	11.01.06.01 - Grit Blast
	Johnson & Johnson Medical Pty Ltd
DY515	Kar (Corail Revision) Femoral Stem	Titanium, grit blast, full HA coating, 	Sizes 14 - 20, (length 	$5,750.00
	fluted distally	200mm & greater)
	Mathys Orthopaedics Pty Ltd
MA475	twinSys Non Cemented Long 	Titanium, grit blast, fully HA, long	Various offsets and sizes > 	$5,750.00
	Femoral Stem	200mm length (14 & 15)
	Medacta Australia Pty Ltd
MU058	Quadra-R Hip Revision Stem	Uncemented revision stem, HA 	From size 0 to size 9`	$5,750.00
	Orthotech Pty Ltd
OH281	JRI Furlong revision Total Hip 	Modular femoral stem, Grit blast, HA 	12 / 14 Taper, 200mm long, 	$5,750.00
	System	200ml long 5mm offset
	11.01.06.04 - Plasma
	Global Manufacturing Technology Pty Ltd
GM134	K2 Global Modular Femoral Stem	K2 Stem	K2 Stem Size 2, K2 Stem 	$6,400.00
	Size3, K2 Stem Size 4, K2 
	Stem Size 5, K2 Stem Size 6 ,
	 K2 Stem Size 7, K2 Stem 
	Size 8, K2 Stem Size 10, K2 
	Stem Size 11,
	Oceania Orthopaedics
OO042	Mutars RS revision system - 	RS Cementless stem HA long	14/16/18/20mm dia stems, 	$6,400.00
	cementless stem HA long	200/250mm length
	Orthotech Pty Ltd
OH282	JRI Total Hip System	JRI Furlong Revision Stems, Titanium 	12 / 14 taper, 250mm long, 	$6,400.00
	Alloy with Supravit Coating, 12 / 14 	250ml long 5mm offset
	Taper
Prostheses List by Category, Groups and Sponsor	Page 740 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OH283	JRI Total Hip System	JRI Furlong Revision Plus Stem, 	12 / 14 Taper, 200mm long 	$6,400.00
	Titanium Alloy with Supravit Zoned 	and 200ml long with 5mm 
	Coating, 12 / 14 Taper	offset
OH284	JRI Total Hip System	JRI Furlong Revision Plus Stem, 	12 / 14 Taper, 250mm long, 	$6,400.00
	Titanium Alloy with Supravit Zoned 	and 250ml long with 5ml 
	Coating, 12 / 14 Taper	offset
	Smith & Nephew Surgical Pty Ltd
SM015	SLR Plus Long Femoral Stem	Titanium, Plasma spray, proximal HA 	7-11, various offsets	$6,400.00
	coating, long stem
11.01.07 - Uncemented, Modular
	11.01.07.01 - Grit Blast
	Body
	Global Manufacturing Technology Pty Ltd
GM052	SMR Modular Femoral Stem 	Titanium, grit blast, non HA, 	40 to 70mm	$2,860.00
	Proximal Body
GM055	SMR Modular Hip System	Calcar Component	40 to 70mm	$2,860.00
	Lima Orthopaedics Australia Pty Ltd
LC009	Modulus Femoral Body	Femoral Body 12/14 Taper CCD 125* 	A & B x Small to Large	$2,860.00
	to 130* - Ti6AI4V
LC027	Revision Modular Femoral Body	Revision Modular Femoral Body 	Std & Lat x 50-70mm - Body	$2,860.00
	12/14 Taper with Locking Screw 	 Height
	Link Orthopaedics  Australia
LO020	Link MP Recontruction Hip 	Titanium, Grit blast, femoral Body 	35-65mm / 126 & 135 CCD	$2,860.00
	Prosthesis
	Mathys Orthopaedics Pty Ltd
MA524	Modular Revision Stem	Proximal body, grit Blasted Titanium	50-70mm	$2,860.00
	Orthotech Pty Ltd
OH429	MGS Revision Modular stem neck	Modular Neck	65 - 95 mm	$2,860.00
	Smith & Nephew Surgical Pty Ltd
SM016	Modular Plus Femoral System 	Titanium, grit blasted, with stem 	sizes AS/AL/BS/BL/CS/AX	$2,860.00
	Proximal Femoral Body	locking bolt	 less than 75mm, various 
	offsets
Prostheses List by Category, Groups and Sponsor	Page 741 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Cone
	Exactech Australia
EX018	Exactech M Series Total Hip System	Femoral Cone with calcar 	21-31mm	$3,120.00
	Spacer
	Link Orthopaedics  Australia
LO026	Link spacer	Titanium, grit blast, non HA 	10mm - 40mm	$1,215.00
	Wright Medical Australia
WR093	Profemur R Hip System	Extension Piece for the profemur R, 	L26 x D19mm, D21mm & 	$1,215.00
	Titanium, grit blast	D23mm;
	Stem
	Biomet Australia Pty Ltd
BI081	ARCOS Modular Revision Hip 	Grit Blast Distal Stems, non HA	150mm - 200mm	$3,120.00
	System
	Global Manufacturing Technology Pty Ltd
GM144	SMR Femoral Stem	SMR Distal Component <200mm	SMR Distal Component 14 	$3,120.00
	x 160mm, SMR Distal 
	Component 16 x 160mm, 
	SMR Distal Component 17 
	x 160mm, SMR Distal 
	Component 18 x 160mm, 
	SMR Distal Component 19 
	x 160mm, SMR Distal 
	Component 20 x 160mm, 
	SMR Distal Component  22 
	x 160mm, SMR Distal 
	Component 14
	Johnson & Johnson Medical Pty Ltd
JJ841	Reclaim Revision Hip System - 	Standard distal stem	14-31mm x 140-190mm	$3,120.00
	Standard Distal Stem
	Lima Orthopaedics Australia Pty Ltd
LC010	Modulus Modular Femoral Stem	Modulus Modular Femoral Stem	Size A & B x 13 to 26mm 	$3,120.00
	diameter
LC030	Revision Modular Femoral Stem	Revision Modular Femoral Stem 	14-24mm Diameter x 140mm 	$3,120.00
	Ti6A4I	Length
Prostheses List by Category, Groups and Sponsor	Page 742 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO021	Link MP Reconstruction Hip 	Stem, grit blast, titanium non HA	12 - 25mm x 160mm	$3,120.00
	Prosthesis
	Mathys Orthopaedics Pty Ltd
MA500	Lima Revision Total Hip System	Titanium, grit blast, non HA	14, 16, 18	$3,120.00
	Orthotech Pty Ltd
OH430	MGS Revision Modular stem	Modular stem	130-210mm	$3,120.00
	Smith & Nephew Surgical Pty Ltd
SN899	MDF Revision System	Femoral Stem - Titanium grit blasted 	10-25 - 150mm - 190 mm	$3,120.00
	for use with moduylar femoral neck 
	choices anteverted, retroverted, 
	standard and multiple height.  Allows
	 fixation of proximal sleeve in various 
	shapes (suffix - N, SV & MOD3)
	Stryker Australia Pty Ltd
SK059	Stryker Modular Revision Hip 	Titanium Alloy Bowed Conical Distal	Restoration Modular bowed	$3,120.00
	 Stems	 conical distal stem 195mm, 
	235mm
	Zimmer Pty Ltd
ZI611	Revitan Modular Straight Stem	Titanium, grit blast, non HA, cobalt 	14 x 175, 140mm; 18 x 	$3,120.00
	chrome junction	140mm; 20, 22, 24 x 195mm
ZI613	ZMR Modular Revision Hip System 	Titanium, grit blast, non HA	150 to 17mm	$3,120.00
	- Stem
	11.01.07.02 - Beaded
	Cone
	Johnson & Johnson Medical Pty Ltd
DP982	SROM ZTT Femoral Sleeve	Titanium, beaded without HA, 	12A-24F	$3,120.00
	proximal femoral cone
	Smith & Nephew Surgical Pty Ltd
SN895	MDF Revision System	Modular sleeve with Stiktite titanium 	Small, Medium, Large and 	$3,120.00
	porous coating	X-Large - sizes 10-25
Prostheses List by Category, Groups and Sponsor	Page 743 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stem, Tumour
	Zimmer Pty Ltd
ZI739	Segmental Trabecular Metal Femoral 	00-5850-032-38 Proximal TM Femur, 	28mm & 46mm	$4,778.00
	Component	38mm offset
	00-5850-032-46 Proximal TM Femur, 
	46mm offset
	11.01.07.04 - Plasma
	Body
	Biomet Australia Pty Ltd
BH032	ARCOS Revision Hip System - 	Broached proximal body porous 	Standard or High Offset A B	$3,120.00
	Broached proximal body	plasma spray	 C D E and F
BH034	ARCOS Calcar Proximal Body	Calcar Proximal Body porous plasma 	Calcar body 50mm Std +10 	$3,120.00
	spray	+20 bodies, Std or high 
	offset Body A To E
BH130	ARCOS Revision Hip System Cone 	Cone Proximal Body Porous plasma 	50mm body	$3,120.00
	Proximal Body	sprayed coated
BI015	Reach Revision Hip System	Titanium, Cobal Chrome, non HA	Proximal Body #1-6	$3,120.00
BI126	Modular Calcar Mallory Head 	Femoral body, Titanium, plasma, non 	34, 45, 55 resection levels x 	$3,120.00
	Revision Hip System	HA	size a,b,c,d,e 
	Consensus Australia Pty Ltd
CX006	UniSyn Proximal Femoral Body non	Titanium, plasma spray, non HA	single height, variable 	$3,120.00
	 HA	diameter and variable medial
	 projections
	Oceania Orthopaedics
OO099	Mutars RS revision system- 	RS metaphyseal component, silver 	25mm/30mm	$3,120.00
	Metaphyseal component	coated
	Cone
	Exactech Australia
EX014	Exactech M series modular Hip 	Modular Titanium Revision Hip - 	25-27mm, S, M, L, XL	$3,120.00
	System	Metaphyseal Segment
EX015	Exactech M series modular Hip 	Femoral cone, titanium, plasma, not 	21 - 23mm, S, M, L, XL	$3,120.00
	System
EX016	Exactech Total Hip System	Modular Titanium Revision Hip - 	29-31mm, S, M, L, XL	$3,120.00
	Metaphyseal Segment
Prostheses List by Category, Groups and Sponsor	Page 744 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stem
	Biomet Australia Pty Ltd
BH132	ARCOS Modular Revision Hip 	Distal Stem bullet or slottedtip, 	115mmE	$3,520.00
	System Short Distal Stems	porous plasma spray
BI127	Modular Calcar Mallory Head 	Femoral Component, Distal. Titanium	170-300mm	$3,520.00
	Revision Hip System
	Consensus Australia Pty Ltd
CX005	UniSyn Hip Plasma Femoral Stem	Titanium, plasma spray, non HA	<200mm	$3,520.00
	Wright Medical Australia
WR132	Profemur R Hip System	Titanium tapered, Straight or bowed 	Length 95 - 215mm, 	$3,520.00
	Stem, plasma coated 	Diameter 10 - 22.5mm
	11.01.07.05 - Unpolished and Polished
	Body, Tumour
	Biomet Australia Pty Ltd
BI889	Orthopaedic Salvage System	Proximal Femoral Component, Letson 	7cm Left or Right	$5,150.00
	or Finn, Anatomic, Ti
	Corin Australia Pty Ltd
CR123	METS Smooth Trochanter	Titanium, uncoated	small and standard	$5,150.00
	Oceania Orthopaedics
OO117	Mutars Proximal Femur	Mutars Proximal Femur	50/70mm length	$5,150.00
	RQSolutions Medical Devices Distribution Support
RQ035	MML Tumor Revision System	Trochanteric Module - Cemented 	Left or Right with Taper 	$5,150.00
	Adapter Version, CoCr, Smooth	Locking 12/14
	Stryker Australia Pty Ltd
SK158	Howmedica Modular Resection 	GMRS Proximal Femoral Component, 	Standard, Trochanteric, 	$5,150.00
	System	Cast Chrome Cobalt	Smooth
	Spacer, Tumour
	Corin Australia Pty Ltd
CR129	METS Principal Shaft	Titanium shaft	45mm-150mm	$4,279.00
	RQSolutions Medical Devices Distribution Support
RQ037	MML Tumor Revision System	Extension Module with Taper 	7 Sizes in 10mm increments;	$4,279.00
	Locking 16/18	 30mm - 160mm Length
Prostheses List by Category, Groups and Sponsor	Page 745 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stem
	Consensus Australia Pty Ltd
CX003	UniSyn Hip Fluted Femoral Stem	Titanium, highly polished, fluted	<200mm	$3,520.00
	Exactech Australia
EX017	Exactech M series modular Hip 	Modular femoral stem, titanium, 	11 - 21mm x 135-165mm	$3,520.00
	System	polished, non HA
	Perios Pty Ltd
PF004	ESOP HA	ESOP Femoral Stem Diaphyseal Ti 	Size 9-15	$3,520.00
	polished
	Smith & Nephew Surgical Pty Ltd
SN817	Emperion Revision Hip	Polished modular stem with option of 	+10, +20mm	$3,520.00
	calcar
	Stryker Australia Pty Ltd
SK022	Modular Revision System Fluted 	Titanium, polished, fluted, no HA	Stem Lengths 127 & 167mm	$3,520.00
	Distal Stems	 straight & bowed. Diameter
	 11-26mm
	Stem, SCP
	Johnson & Johnson Medical Pty Ltd
JJ749	SROM Femoral Stem	Titanium, fluted, distal polished 	Sizes 6-21	$4,120.00
	femoral stem & neck
JJ750	SROM Calcar Replacement Femoral 	Titanium, fluted, distal polished 	Sizes 6-21	$4,120.00
	Stem	femoral stem & neck, with calcar 
	replacement
	Smith & Nephew Surgical Pty Ltd
SN749	Emperion Revision Hip	Polished non HA	Short & Long	$4,120.00
	Stem, Tumour
	Corin Australia Pty Ltd
CR128	METS Total Femoral Link 	Curved titanium link shaft	165mm, 225mm	$4,279.00
	Component
CR147	METS Smooth Integral Shaft & Stem	Titanium, uncoated, shaft and stem 	L=15,30mm D=27,,30mm 	$4,279.00
	with round or oval collar	(round) D=30x38, 36x44 
	(oval)
Prostheses List by Category, Groups and Sponsor	Page 746 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	RQSolutions Medical Devices Distribution Support
RQ039	MML Tumor Revision System	Adapter Stem with Taper for Tibia and 	10 to 16mm Diameters, each 	$4,279.00
	Femur - Cemented	120 & 160mm in Length
11.01.08 - Uncemented, Modular, HA Coated
	11.01.08.01 - Grit Blast
	Body
	Johnson & Johnson Medical Pty Ltd
DP005	Reef Hip Proximal Body & Neck	Titanium neck combined with small 	25-35mm	$3,120.00
	proximal body of varying size, grit 
	blast, HA. With locking screw
	Link Orthopaedics  Australia
LO133	Link MP Reconstruction Hip 	Link body, Titanium, grit blast, HA	35-65mm IN 126 & 135 	$3,120.00
	Prosthesis	degrees
	Orthotech Pty Ltd
OH379	Securus Modular Revision Hip 	Modular Proximal Body	Std & 5mm offset	$3,120.00
	System
	Perios Pty Ltd
PF003	ESOP HA	Esop Femoral body Metaphyseal grit 	Left and Right Size 5-20	$3,120.00
	blast Ti/HA, 
	Stem
	Lima Orthopaedics Australia Pty Ltd
LC158	H-Max M Femoral Stem Ti6AI4V	H-Max M Femoral Stem HA Coated 	9 - 18	$3,520.00
	Ti6AI4V
	Link Orthopaedics  Australia
LO136	 Link MP Reconstruction Hip 	Stem	12 x 160, 180, 210, 250 - 	$3,520.00
	Prosthesis	MP; 14 x 160, 180 -MP; 16 
	x 160, 180 - MP; 18 x 160, 
	180 - MP; 20 x 160, 180 - 
	MP; 22.5 x 160, 180 -MP; 
	25 x 160, 180 - MP
	11.01.08.02 - Beaded
	Cone
	Johnson & Johnson Medical Pty Ltd
DP981	SROM ZTHA Femoral Sleeve	Titanium, grit blasted with HA, 	Small / Large /XX Large  	$2,930.00
	(proximal femoral cone)	size 14B-24F
Prostheses List by Category, Groups and Sponsor	Page 747 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN819	Emperion Revision Hip	Proximal Modular Cone Standard, 	0, 1, 2, 3, 4, standard and 	$2,930.00
	beaded HA coated 	long
SN820	Emperion Revision Hip	Proximal Modular Cone Long	0, 1, 2, 3, 4	$2,930.00
	Spacer
	Smith & Nephew Surgical Pty Ltd
SN896	MDF Revision System	Modular Sleeve with Stiktite titanium	Small, Medium, Large, and 	$3,120.00
	 porous coating and HA coating	X-Large - sizes 10-25
	11.01.08.04 - Plasma
	Body
	Biomet Australia Pty Ltd
BI128	Modular Calcar Mallory Head 	Femoral body, Titanium, plasma, HA, 	34, 45, 55 resection levels x 	$4,020.00
	Revision Hip System	Calcar	size a,b,c,d,e 
BI837	Reach Revision Hip System	Modular Reach Proximal Body - 	Proximal Body #1 - 6	$4,020.00
	Collared/Collarless, Ti, HA Coated
	Wright Medical Australia
WR141	Profemur Total Hip System	Titanium uncemented proximal body - 	X-Small, Small, Standard 1, 	$4,020.00
	HA Plasma sprayed	Standard 2, Standard 3, 
	Standard 4, Large
	Cone
	Consensus Australia Pty Ltd
CX007	UniSyn Proximal Femoral Body 	Titanium, plasma spray, with HA	single height, variable 	$3,520.00
	with HA	diameter and variable medial
	 projections
	Oceania Orthopaedics
OO040	Mutars RS revision system - 	RS metaphyseal component	0mm, 50mm, 40mm tapered, 	$3,520.00
	metaphyseal component	50mm tapered
	Stem
	Stryker Australia Pty Ltd
SK058	Stryker Modular Revision Hip 	Porous Distal Stems Titanium Plasma 	Stem Lengths 127 & 167mm	$3,920.00
	Spray	 straight & bowed. Diameter
	 11-26mm
Prostheses List by Category, Groups and Sponsor	Page 748 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.01.08.05 - Unpolished and Polished
	Body, Tumour
	Corin Australia Pty Ltd
CR124	METS Spiked Trochanter	Titanium, HA coated	Small and Standard	$4,520.00
	Stem, Tumour
	Corin Australia Pty Ltd
CR139	METS stippled Integral Shaft and 	Titanium, HA coated, shaft and stem 	L=15,30mm; D=27,30mm 	$4,920.00
	Stem	with round or oval collar	(round); D=30x38,36x44mm
	 (oval)
11.01.09 - Uncemented, Modular, Long Lengths (Stem ≥200mm;  Body 
	11.01.09.01 - Grit Blast
	Body
	Johnson & Johnson Medical Pty Ltd
JJ843	reclaim Revision Hip System - 	Proximal Body	20-28 x 75-105mm	$3,860.00
	Proximal Body
	Mathys Orthopaedics Pty Ltd
MA525	Modular Revision Stem	Proximal Body, Long, Grit Blasted 	80mm-110mm	$3,860.00
	Titanium
	Wright Medical Australia
WR144	Profemur R Hip System	Titanium uncemented proximal body, 	X-small, Small, Standard 1, 	$3,860.00
	grit blast 	Standard 2, Standard 3, 
	Standard 4, Large
	Zimmer Pty Ltd
ZI490	Revitan Modular Proximal Body	Titanium, grit blast, non HA, femoral 	55, 65, 75, 85, 95 and 	$3,860.00
	body	105mm heights
	Body, Tumour
	Zimmer Pty Ltd
ZI728	MOST Proximal Femur with Tissue 	MOST Proximal Femur with Tissue 	80mm in length	$7,400.00
	Attachment	Attachment
ZI729	MOST Basic Proximal Femur	MOST Basic Proximal Femur	80mm in length	$7,400.00
Prostheses List by Category, Groups and Sponsor	Page 749 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stem
	Global Manufacturing Technology Pty Ltd
GM143	SMR Femoral Stem	SMR Distal Component 240mm	SMR distal component 14x 	$4,620.00
	240mm, SMR distal 
	component 16 x 240mm, 
	SMR distal component 
	17x240mm, SMR distal 
	component 18 x 240mm, 
	SMR distal component 19 x 
	240mm, SMR distal 
	component 20 x 240mm, 
	SMR distal component 22 x 
	240mm
	Johnson & Johnson Medical Pty Ltd
JJ842	Reclaim Revision Hip System - 	Long distal stem	14-31mm x 240-290mm	$4,620.00
	Long Distal Stem
	Lima Orthopaedics Australia Pty Ltd
LC161	Revision Modular Stem	Revision Modular Stem Ti6AI4V	14 - 24mm Diameter x 	$4,620.00
	200mm Length
	Link Orthopaedics  Australia
LO137	 Link MP Reconstruction Hip 	Stem	14 - 25mm x 210, 250, 290 	$4,620.00
	Prosthesis	& 330mm; 
	Mathys Orthopaedics Pty Ltd
MA501	Lima Revision Total Hip System	Titanium, grit blast, non HA	20, 22, 24	$4,620.00
	Smith & Nephew Surgical Pty Ltd
SM017	Modular 'PLUS Femoral Stem	Titanium, grit blast, straight & curved,	1 to 12 (all over 200mm)	$4,620.00
	 long
SN897	MDF Revision System	Femoral stem - Titanium grit blasted 	10-25 - 200mm - 360mm	$4,620.00
	for use with modular femoral neck - 
	choices anteverted, retroverted, 
	standard & multiple height.  Allows 
	fixation of proximal sleeve in various 
	shapes (suffix-N,SV & MOD3)
	Stryker Australia Pty Ltd
ST011	Stryker Modular Hip System	Conical distal stems titanium, grit 	Length 155mm, Diameter 14	$4,620.00
	blasted	 - 28mm
Prostheses List by Category, Groups and Sponsor	Page 750 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR143	Profemur R Hip System	Titanium tapered Splined, Straight or 	Length 95 - 215mm, 	$4,620.00
	bowed Stem, grit blasted 	Diameter 10 - 22.5mm
	Zimmer Pty Ltd
ZI612	Revitan Modular Straight Stem	Titanium, grit blast, non HA, cobalt 	14, 16, 18, 20, 22, 24, 26, 28	$4,620.00
	chrome junction	 x 255mm; 16, 18, 20, 22, 24,
	 26 x 315mm
ZI614	ZMR Modular Revision Hip System 	Titanium, grit blast, non HA	205, 220, 255, 270mm 	$4,620.00
	- Stem	Straight & Bowed
	11.01.09.04 - Plasma
	Body
	Biomet Australia Pty Ltd
BH131	ARCOS Revision Hip System Cone 	Cone Proximal Body Porous plasma 	60-80mm body	$4,520.00
	Proximal Body	sprayed coated
	Zimmer Pty Ltd
ZI049	'ZMR Taper System Modular 	Titanium body, plasma coating, non HA	A - F	$4,520.00
	Revision Hip 
	Stem
	Biomet Australia Pty Ltd
BH133	ARCOS Modular Revision Hip 	Distal Stem bullet or slotted tip, 	150 to 250mm length.	$5,520.00
	System Distal Stems	porous plasma spray
BI118	Modular Calcar Mallory Head Hip 	Femoral Stem,  Titanium, plasma, no 	220 - 300mm long, 12mm to 	$5,520.00
	System	HA, long	26mm diameter
BI119	Mallory Head Hip System	Femoral Stem, Calcar, Titanium	260mm, Size 9-19mm	$5,520.00
	11.01.09.05 - Unpolished and Polished
	Spacer, Tumour
	Lima Orthopaedics Australia Pty Ltd
LC002	Lima RPS Femoral System	Modular Spacer	60 - 120mm	$3,640.00
	Stem
	Consensus Australia Pty Ltd
CX004	UniSyn Hip Fluted Long Femoral 	Titanium, highly polished, fluted, 	>200mm	$5,520.00
	Stem	long, straight & bowed
Prostheses List by Category, Groups and Sponsor	Page 751 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX019	Exactech Total Hip System	Modular stem Titanium polished, non 	11-21mm x 200mm	$5,520.00
	HA
EX020	Exactech Total Hip System	Modular stem Titanium polished, non 	11-21mm x 250mm	$5,520.00
	HA
EX021	Exactech Total Hip System	Modular Titanium Revision Hip - 	11-21mm x 300mm	$5,520.00
	Smith & Nephew Surgical Pty Ltd
SN818	Emperion Revision Hip	Long Stem polished Modular 	+10, +20mm	$5,520.00
	Titanium Calcar Build-up, 
	Stryker Australia Pty Ltd
SR046	Stryker Modular Revision Hip 	Modular Long Bowed Titanium 	Length 217mm, 267mm and 	$5,520.00
	Polished Fluted Stem	317mm. Diamter 11mm-
	26mm
	Stem, SCP
	Johnson & Johnson Medical Pty Ltd
DY510	SROM  Femoral  Calcar Replacement	Titanium, fluted, distal polished 	9 -21mm diameter, greater 	$5,720.00
	 Stem, long	femoral long stem & neck, bowed and 	than 200mm length
	straight with Calcar Replacement
DY511	SROM Femoral Stem Long	Titanium, fluted, distal polished 	9 -21mm diameter, greater 	$5,720.00
	femoral long stem & neck, bowed and 	than 200mm length
	straight
11.01.10 - Uncemented, Modular, HA Coated, Long Lengths (Stem 
	11.01.10.01 - Grit Blast
	Spacer
	Wright Medical Australia
WR107	Profemur R Hip System	Revision Hip Proximal Body 	L52 x D21mm; 	$2,615.00
	Extension Piece, Titanium
	Stem
	Amplitude Australia
LI049	Extreme Hip System Femoral Stem	Stem component of modular femoral 	4 lengths - 250 to 400mm, 6 	$5,020.00
	stem, titanium, HA, with distal screw 	diameters
	holes
Prostheses List by Category, Groups and Sponsor	Page 752 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DP009	Reef Hip Femoral Stem	Titanium modular femoral stem with 	Length 225 - 375mm	$5,020.00
	optional distal locking, grit blast and 
	full HA coating
	Link Orthopaedics  Australia
LO138	Link MP Reconstruction Hip 	Stem, titanium, grit blast, HA	14 - 25mm x 210, 250, 290 	$5,020.00
	Prosthesis	& 330mm; 12 x 160, 180, 
	210, 250 - MP; 14 x 160, 
	180 -MP; 16 x 160, 180 - 
	MP; 18 x 160, 180 - MP; 20
	 x 160, 180 - MP; 22.5 x 
	160, 180 -MP; 25 x 160, 
	Orthotech Pty Ltd
OH378	Securus Modular Revision Hip 	Curved Femoral Stem	250 - 300mm	$5,020.00
	System
	11.01.10.04 - Plasma
	Zimmer Pty Ltd
ZI557	Fitmore Stem	Curved uncemented MIS Stem with 	 A 140° size 1-14 ; B137° 	$4,500.00
	TiVPS coating	size 1-14 ; B extended offset 
	129° size 1-14 ; C127° size 
	1-14
	Body
	Amplitude Australia
LI050	Extreme Revision Hip Monobloc 	Combined metaphyseal and 	4 sizes	$4,520.00
	Epiphysis Metaphyseal Section	epiphyseal sections, adjustable 
	rotation, anodized titanium with HA 
	Stryker Australia Pty Ltd
HW523	Restoration Modular Body	Milled, Broached, Cone and Calcar 	Milled: Dia 19-25mm with 	$4,520.00
	body options	2 mill Depths; 27-29mm 
	with Mill Depths
	Broach: 1-8
	Cone: Diam 19-31mm, 
	Heights +0, +10, +20, +30
	Calcar: Diameter 19-29mm, 
	3 Heights each
Prostheses List by Category, Groups and Sponsor	Page 753 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stem
	Amplitude Australia
LI051	Optimal Revision Stem	Cementless, modular revision / 	Sizes 1-5	$5,920.00
	reconstruction stem
	Biomet Australia Pty Ltd
BI120	Mallory Head Hip System	Femoral Stem, titanium plasma HA  	220mm, Size 9-19mm	$5,920.00
BI121	Mallory Head Hip System	Femoral Stem, Calcar, HAP Coated, 	250 - 260mm, Size 9-19mm	$5,920.00
	Titanium 
	Stryker Australia Pty Ltd
SR045	Stryker Modular Revision Hip 	Modular Long Bowed Titanium 	Length 217mm, 267mm and 	$5,920.00
	Plasma HA Stem	317mm. Diameter 11mm - 
	26mm
11.01.11 - Calcar Replacement
	11.01.11.01 - Short and Standard Length
	Biomet Australia Pty Ltd
BI051	Bi-Metric Hip System	Head Neck calcar Femoral Stem, 	9-15mm 	$3,700.00
	Chrome Cobalt, Cemented, unpolished
	 200 and 250 lengths
	Smith & Nephew Surgical Pty Ltd
SN273	Echelon/Spectron	Revision Hip Stem - Non-porous	135mm - 200mm	$3,700.00
	Stryker Australia Pty Ltd
ST586	Osteonics omnifit head/neck hip 	Cobal Chrome, Unpolished, standard 	Stem sizes  5, 7 & 9	$3,700.00
	and long with calcar
	11.01.11.02 - Long Length (≥200mm)
	Johnson & Johnson Medical Pty Ltd
DP121	Solution Calcar Replacement 	CoCr calcar replacement stem, 	Size 7-10 inch (175 - 	$6,900.00
	Femoral Stem	uncemented, beaded (Porocoat)	250mm)
	Smith & Nephew Surgical Pty Ltd
SN271	Echelon	Revision Hip Stem - Non-porous	225mm - 300mm	$6,900.00
Prostheses List by Category, Groups and Sponsor	Page 754 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.01.13 - Monoblock Hemis
	Biomet Australia Pty Ltd
BI060	Austin Moore Self Locking Hip 	Straight Standard Femoral Prostheses,	38-55mm	$615.00
	Prosthesis System	 Titanium
BI062	FR Thompson Hip Prosthesis 	Modular Curved Femoral Stem, 	38mm - 55mm 	$615.00
	Titanium.
	Johnson & Johnson Medical Pty Ltd
DP167	Thompson Hip	Stainless steel (Ortron 90), Thompson	head size 40-54	$615.00
	 unipolar monoblock femoral 
DP168	Austin Moore Hip Prosthesis	Stainless steel (Ortron 90), AMP 	Head size 38-60mm	$615.00
	unipolar monoblock femoral 
	Orthotech Pty Ltd
OH299	JRI Total Hip System	JRI Austin Moore Standard Stems 	Head Sizes range from 39mm	$615.00
	Hemiarthroplasty. These prusct has an	 - 56mm
	 all-in-one head and stem
	Smith & Nephew Surgical Pty Ltd
SM037	Fracture Head Unipolar Femoral Head	Stainless Steel or CoCr	38-60 S/M	$615.00
SN277	Endoprosthesis	CoCr	38 - 54mm	$615.00
	Stryker Australia Pty Ltd
HW025	Austin Moore Endoprosthesis	Long Stem - Vitallium cobalt chrome 	Head size 38 to 63	$615.00
HW026	Austin Moore Endoprosthesis	Standard Stem - Vitallium	105-165mm length, Head 	$615.00
	size: 38 to 57
SK196	Exeter Hip System - ETS 	Orthinox Stainless Steel 	40mm Offset body with 	$615.00
	(endoprosthesis trauma stem)	Endoprosthesis unipolar monoblock	monoblock head sizes 
	38mm, 40mm, 41mm, 42mm, 
	43mm, 44mm, 45mm, 46mm, 
	47mm, 48mm, 49mm, 50mm, 
	52mm, 54mm, 56mm
Prostheses List by Category, Groups and Sponsor	Page 755 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.01.14 - Femoral Neck
	Amplitude Australia
LI052	Modular Neck for Acor & Integrale 	Titanium neck, with varying 	4 sizes	$1,227.00
	Femoral Stems	alignments & tapers
	DJO Australasia Pty Ltd
DD028	R120 Femoral Neck	CoCr, varying offsets & versions	32-38mm length, varying 	$1,227.00
	degrees
	Lifehealthcare Pty Ltd
LH184	Modular U Necks	Cobalt chrome	Standard, varus, valgus, 	$1,227.00
	antiverted right, antiverted 
	left
	Lima Orthopaedics Australia Pty Ltd
LC004	Lima F2L modular neck 	Titanium	Short & Long (Straight & 	$1,227.00
	Angled)
LC014	Sam-Fit modular neck	Modular neck	S1-S6, L1-L6	$1,227.00
LC029	Modular Neck	Modular Neck Segment - CoCrMo	Size 1-6, Sm & Lg in STD, 	$1,227.00
	LAT, AVR/RVL, AVL/RVR
	Oceania Orthopaedics
OO072	Modula SC Neck	The complete series of MODULA SC 	OX, OY, OZ, OA, OB, OC, 	$1,227.00
	necks, all patented, consists of 15 	9X, 9Y, 9Z, 9A, 9B, 9C, 
	sizes and makes it possible to 	9AA, 9BB, 9CC
	optimise the reciprocal position of the
	 stem and neck cup on the basis of the 
	articular needs of the patient, by 
	restoring the physiological off-set and
	Orthotech Pty Ltd
OH440	Multifit Modular Neck	Modular Neck	S, M, L	$1,227.00
	RQSolutions Medical Devices Distribution Support
RQ024	Adapter Femoral Neck	CoCr, varying versions & offsets	One Size	$1,227.00
Prostheses List by Category, Groups and Sponsor	Page 756 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN898	MDF Revision System	Modular Neck - CoCr highly polished	24mm - 36.5mm	$1,227.00
	 trapezoidal for MDF stem/MIS stem 
	multiple options of version height 
	and neck length
	Wright Medical Australia
WR139	Profemur Modular Neck	Titanium and CoCr Femoral Necks	Length 27 - 38.5mm; 	$1,227.00
	Neutral to Ante/Retro - 
	Varus Valgus 2
	Zimmer Pty Ltd
ZI553	M/L Taper Kinectiv Neck	Neck component for M/L taper stem	size K, S, A, E, P, X, B, G, R,	$1,227.00
	 C, J, D, K1, S1, AA, E1, P1, 
	X1, K2, E2, BB, G1, R1 ,S2, 
	P2, G2, CC, J1, X2, R2, J2, DD
	Complex
	Consensus Australia Pty Ltd
CX001	UniSyn Hip Complex Neck	Titanium, with lateral extension for 	30-36mm non calcar, 45-	$1,727.00
	stem connection, includes calcar & 	55mm for calcar
	non calcar replacement necks, separate
	 locking bolt
	Exactech Australia
EX024	Exactech M Series body 	Titanium, complex neck segment 	32 - 49mm, -5 - +30mm	$1,727.00
	Global Manufacturing Technology Pty Ltd
GM091	Apex Global & K2 & MSA Femoral 	Titanium and CoCr with lateral 	25mm - 35mm to 35mm - 50mm	$1,727.00
	Neck	extension for stem connection
	Signature Orthopaedics
SF042	Apex Global & K2 & MSA Femoral 	Titanium and CoCr with lateral 	25mm - 35mm to 35mm - 50mm	$1,727.00
	Neck	extension for stem connection
	Wright Medical Australia
WR165	Guardian Limb Salvage System	Guardian Femoral Neck	One Size Only	$1,727.00
	Complex (Neck)
	Oceania Orthopaedics
OO118	Mutars RS revision system - 	RS proximal component	127 degrees, 32/42mm, 135 	$1,727.00
	Proximal component	degrees, 32/42mm
Prostheses List by Category, Groups and Sponsor	Page 757 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.02.01 - Conventional Femoral Heads, ≤32mm
	11.02.01.01 - Stainless Steel
	Amplitude Australia
LI058	metallic femoral head	M30NW femoral head with 10/12 	28mm-32mm with short, 	$800.00
	medium or long neck
	Austofix
AX074	Experion Head	Stainless Steel	28mm and 32mm, various 	$800.00
	sizes
	Lifehealthcare Pty Ltd
LH065	Groupe Lepine Total Hip 	Stainless Steel Head	.-5mm/0mm/+5mm/ +10mm	$800.00
	Replacement
	Mathys Orthopaedics Pty Ltd
MA028	Mathys Stainless Steel Femoral 	Stainless Steel, 	22-32mm	$800.00
	Smith & Nephew Surgical Pty Ltd
SN697	Femoral Head	Stainless steel	22-32mm,+0-+16mm	$800.00
	Stryker Australia Pty Ltd
HW038	V40 Orthinox Head	Stainless Steel	22 - 28mm dia	$800.00
	Zimmer Pty Ltd
ZI052	Femoral Head	Zimaloy - Stainless Steel	22mm, 28mm, 32mm	$800.00
	11.02.01.02 - Cobalt Chrome
	Austofix
AX047	Hyperion Cobalt Chrome Femoral 	Cobalt Chrome, 12/14 Taper	Sizes 22, 28 and 32 mm	$800.00
	Head
AX105	F2 Femoral Head	Femoral Heads, CoCr	Diameter 32mm, -4, 0, +4, +8	$800.00
	B Braun Australia Pty Ltd
BB246	Metal Head	Isodur CoCr Femoral Head	22.5mm, 26mm, 28mm, 32mm	$800.00
	Biomet Australia Pty Ltd
BI094	Mallory Head Hip System	Femoral Head, Offset, Chrome Cobalt	28,32mm	$800.00
Prostheses List by Category, Groups and Sponsor	Page 758 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI973	Modular Head Implants	Femoral Modular Head	22 - 32mm diameter, - 6 to 	$800.00
	=12mm neck, collared, no 
	collar
	Consensus Australia Pty Ltd
CX008	Consensus Femoral Head	CoCr	22-32mm	$800.00
	Corin Australia Pty Ltd
CR029	CoCr Femoral Head	CoCr femoral head 	22,26,28,32mm with 3 	$800.00
	choices of taper
CR135	METS CoCr Femoral Head	CoCr	28mm-32mm	$800.00
	DJO Australasia Pty Ltd
DD039	R120 Metal Femoral Head	R120 Metal Femoral Head <32mm	28mm, 32mm	$800.00
DD050	FMP Acetabular System - CoCro 	CoCro femoral heads in 22mm and 	22mm in +0,+4,+8mm and 	$800.00
	Femoral Heads	32mm diameters to fit with FMP 	32mm in -4.0, +4, +8, 
	acetabular liners and FMP acetabular 	+12mm, diameters
	shells
	Exactech Australia
EX022	Exactech Femoral Head 	Cobalt Chrome Head	-2 to -5mm, +0 to 10mm	$800.00
	Global Manufacturing Technology Pty Ltd
GM056	SMR Femoral Head	CoCr	22 to 40mm	$800.00
GM092	Apex Global Femoral Head	CoCr	28mm to 40mm	$800.00
GM146	BioBall Femoral Head	Femoral Head Vivium < 32mm	28mm,  32mm	$800.00
	Johnson & Johnson Medical Pty Ltd
DP124	DePuy Femoral Head	CoCr Femoral Head Various Tapers & 	22-32 mm 	$800.00
	Neck Lengths
	Lima Orthopaedics Australia Pty Ltd
LC032	Modular Head	Modular Head CoCrMo	28-32mm Diameter Small to 	$800.00
	XXXLarge
	Link Orthopaedics  Australia
LO022	Link Prosthesis Femoral Head	Prosthesis Head "B" CoCrMo	Short/medium-	$800.00
	short/medium/Long
	Mathys Orthopaedics Pty Ltd
MA469	Mathys CoCr Femoral Head 	Hip Prosthesis Femoral Head 	28 mm & 32mm, 	$800.00
	CoCrMo ≤32mm	(S,M,L,XL,XXL)
Prostheses List by Category, Groups and Sponsor	Page 759 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU005	Quadra Hip Femoral Head	CoCr	Dia 22mm (S to M)	$800.00
	Dia 28mm (S to XXL)
	Dia 32mm (S to XXL)
	Oceania Orthopaedics
OO034	IC-Head CoCrMo	IC Head, CoCrMo	22,28,32mm - S-M-L-XL	$800.00
OO070	Adler CoCr Head	Cobolt Chrome Femoral Heads for 	Short, Medium, Long in 22 	$800.00
	Adler Stems 22,28mm OD	and 28 mm
	Orthotech Pty Ltd
OH293	JRI Femoral Head	Cobalt Chrome Femoral; Heads	28mm, and 32mm head sizes	$800.00
OH434	Samo acetabular cup femoral head	CoCr femoral head	S, M, L and XL	$800.00
	Perios Pty Ltd
PF005	ESOP HA	Femoral Head CoCr	22.2 -32mm	$800.00
	RQSolutions Medical Devices Distribution Support
RQ028	ESKA Metal Femoral Head	CoCr	28mm - 32mm	$800.00
	Signature Orthopaedics
SF033	Metal Femoral Head	Cobalt Chrome	28mm - 32mm	$800.00
SF046	Signature Femoral Head <=32mm	Cobalt Chrome Femoral head	Offsets S, M, L & XL	$800.00
	Smith & Nephew Surgical Pty Ltd
SM055	Universal Femoral Head	Chrome Cobalt	=< 32mm	$800.00
SN280	Femoral Head	CoCr	<=32mm	$800.00
	Stryker Australia Pty Ltd
HW032	Stryker CoCr Femoral Head	Hip - Femoral Head	22, 26, 28, 30, 32mm	$800.00
	Wright Medical Australia
WR084	Femoral Head	Femoral Head Cast Cobalt Chrome 	22.5mm - 32mm Femoral 	$800.00
	Alloy	Head and neck ranging from 
	-3.5mm to +7mm
WR130	Gladiator Bipolar Hip System	Gladiator bipolar hip system, bipolar 	22mm short, 28mm short, 	$800.00
	CoCr head 22mm to 32mm	medium, long 32mm short 
	medium long
	Zimmer Pty Ltd
ZI051	Femoral Head	Zimaloy - Co Cr	22mm, 28mm, 32mm	$800.00
ZI358	Durasul Ballhead for Inserts	CoCr femoral head	22, 28, 32	$800.00
Prostheses List by Category, Groups and Sponsor	Page 760 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI380	Femoral Head	Head - Metal (Zweymuller Allopro) - 	22mm, 28mm, 32mm	$800.00
	CoCr
	Low Frequency Ion Treatment
	Stryker Australia Pty Ltd
SR026	Stryker CoCr Femoral Head	Cobal Chrome with LFIT Treatment	22-32mm	$2,100.00
	11.02.01.03 - Alumina
	Amplitude Australia
LI073	Ball Heads 12 - 14 Taper (Alumina)	Ceramic femoral head, bilox forte	≤32mm	$2,000.00
	Austofix
AX065	Austofix Ceramic System	Biolox Ceramic Femoral Head	28 and 32 mm	$2,000.00
	Biomet Australia Pty Ltd
BI058	Modular Ceramic System	Ceramic Head, Aluminium Alloy, 	28-32mm -6mm to +12mm	$2,000.00
	biolox Delta
	DJO Australasia Pty Ltd
DD041	R120 Ceramic Femoral Head	R120 Ceramic, Biolox Femoral Head 	28mm - 3.5mm to +3.5mm       	$2,000.00
	<32mm	                                      32mm - 
	4.0mm to +4.0mm
	Exactech Australia
EX023	Exactech Femoral Head 	Ceramic/Femoral Head, Biolox Forte	-2 to -5mm, +0 to +10mm	$2,000.00
	Global Manufacturing Technology Pty Ltd
GM057	SMR Ceramic Femoral Head	Ceramic, Biolox Forte	28 to 36mm	$2,000.00
GM093	Apex Global Ceramic Femoral Head	Ceramic, Biolox Forte	28mm to 36mm	$2,000.00
	Johnson & Johnson Medical Pty Ltd
JJ751	DePuy Ceramic Heads	Ceramic (Biolox Forte) Femoral head 	≤32mm	$2,000.00
	various tapers & neck lengths
	Lifehealthcare Pty Ltd
LH462	10/12/14 Alumina Head	Alumina Head Biolox Forte	28mm - 32mm	$2,000.00
	Link Orthopaedics  Australia
LO023	Link Prosthesis Femoral  Head	Prosthesis Head "A" Biolox forte 	Short/medium - short /medium	$2,000.00
	Ceramic
Prostheses List by Category, Groups and Sponsor	Page 761 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Mathys Orthopaedics Pty Ltd
MA020	Mathys Ceramic Femoral Head	Ceramic, Bionit (alumina)	diameter 28-32mm	$2,000.00
	Medacta Australia Pty Ltd
MU006	Quadra Hip Ceramic Femoral Head	Ceramic, Biolox Forte	Dia 28mm (S,M,L) 32mm 	$2,000.00
	(S,M,L)
	Orthotech Pty Ltd
OH292	JRI Ceramic femoral Head 	Total Hip Replacement (THR) Ceramic	12 / 14 Taper, Biolox Delta 	$2,000.00
	 Femoral Heads, Biolox Delta Ceramic,	Ceramic head sizes 28mm, 
	 and Alumina Oxide	32mm. Alumina Oxide head 
	sizes 28mm
OH433	Samo acetabular cup ceramic head	Ceramic femoral head	S, M, L, and XL	$2,000.00
	Perios Pty Ltd
PF006	ESOP HA	Femoral Head Alumina Ceramic	28 and 32mm Diameter	$2,000.00
	RQSolutions Medical Devices Distribution Support
RQ020	Eska Ceramic Femoral Head	Ceramic, biolox forte	28-32mm	$2,000.00
	Signature Orthopaedics
SF026	Ceramic Femoral Head	Ceramic femoral head	-2 to -5mm, +0 to +10mm	$2,000.00
	Smith & Nephew Surgical Pty Ltd
SN299	Femoral Head	Ceramic, AlO3	<=32mm	$2,000.00
	Stryker Australia Pty Ltd
HW017	Stryker Biolox Forte Alumina 	Hip - Femoral Head	28, 32mm	$2,000.00
	Femoral Head
	Wright Medical Australia
WR124	Transcend/Lineage Articulation 	Head ceramic	28mm, 32mm, 3 lengths	$2,000.00
	System
	Zimmer Pty Ltd
ZI055	Ceramic Femoral Head	Ceramic Head 12/14 Taper, Biolox 	28 - 36mm	$2,000.00
	Forte
ZI346	Ceramic Femoral head for hip 	Femoral Head - Biolox Ceramic	28 to 32mm	$2,000.00
	prosthesis 
ZI355	Cerasul - Ceramic	Ceramic Femoral Head	28mm 	$2,000.00
ZI381	Ceramic Head - Sulox	Head - Ceramic	22 to 32mm	$2,000.00
Prostheses List by Category, Groups and Sponsor	Page 762 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sleeve
	Orthotech Pty Ltd
OH294	JRI Total Hip System	Ceramic femoral head with sleeve 	28, 32, 36mm	$2,200.00
	Stryker Australia Pty Ltd
SR023	Stryker Revision Femoral Head, 	With pre assembled titanium sleeve	28, 32mm	$2,200.00
	Biolox Forte Alumina
	11.02.01.05 - Ceramic Mix
	Austofix
AX106	DC2 Femoral Head	Delta Ceramic Femroal Heads	Diameter 28mm, 32mm, S, M,	$2,100.00
	 L, XL
	B Braun Australia Pty Ltd
BB250	Biolox Delta Ceramic Head	Biolox Delta Ceramic Head	28 & 32mm diameter	$2,100.00
	Corin Australia Pty Ltd
CR180	Ceramic modular head	Biolox Delta Ceramic heads 32mm or 	28 and 32mm	$2,100.00
	less
CR193	Biolox Option (≤32mm)	Biolox Option Ceramic Femoral Heads	28mm, 32mm	$2,100.00
	Global Manufacturing Technology Pty Ltd
GM131	Biolox Delta Ceramic Femoral Heads	Biolox Delta Ceramic Femoral Heads 	Biolox Delta Femoral Head 	$2,100.00
	28mm 32mm	28mm - -3.5mm to +3.5mm 
	and Biolox Delta Femoral 
	Head 32mm - 3.5mm to 
	+7mm
	Johnson & Johnson Medical Pty Ltd
DY551	Delta modular head	Delta ceramic modular head	32mm	$2,100.00
JJ752	DePuy Delta Heads	Delta femoral head various tapers & 	≤32mm	$2,100.00
	neck lengths
	Lima Orthopaedics Australia Pty Ltd
LC152	Modular Biolox Delta Head	Modular Biolox Delta Head	28 - 32mm Small to Large	$2,100.00
	Mathys Orthopaedics Pty Ltd
MA482	Ceramys Ceramic Femoral Head	Ceramic, zirconia alumina 	28 L,  28 M, 28 S, 32 L, 32 	$2,100.00
	M, 32 S
Prostheses List by Category, Groups and Sponsor	Page 763 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU096	Biolox Delta Ceramic Ball Heads	Ceramic femoral heads, BIOLOX® 	Ball Head 12/14 Ø 28 	$2,100.00
	Delta AI2 O3 -ZrO2	Sizes: S, M and L
	Ball Head 12/14 Ø 32 sizes:
	 S, M, L and XL
MU117	Mectacer Biolox Option Ceramic 	Biolox Option Ceramic Femoral Heads	28mm & 32mm	$2,100.00
	Heads (<32)
	Motion Orthopaedics Pty Ltd
BJ006	Ceramic modular head	Biolox Delta Ceramic heads 32mm or 	28 and 32mm	$2,100.00
	less
	Oceania Orthopaedics
OO032	IC- Head Biolux delta	Biolux delta ceramic head	28 and 32mm. Small, medium	$2,100.00
	 and large.
OO067	Adler Ceramic Head <32	Ceramic Femoral Heads for Adler 	Short, Medium, Long in 28 	$2,100.00
	Stems.  Biolox Forte and Delta. 	and 32mm
	28,32mmOD
	Signature Orthopaedics
SF044	Signature Delta Femoral Head 	Ceramtec Delta Ceramic Femoral Head	Offsets S, M, L & XL	$2,100.00
	<=32mm
	Smith & Nephew Surgical Pty Ltd
SM144	Universal Delta Ceramic Femoral 	Delta Ceramic	<=32 - S, M, L, XL,XXL	$2,100.00
	Head
SM165	Revision Delta Ceramic Femoral Head	Biolox Option Head	≤32mm	$2,100.00
	Stryker Australia Pty Ltd
SR028	Stryker Delta Ceramic Heads	Femoral Head - Delta Ceramic 	<32mm	$2,100.00
	Tornier Pty Ltd
TO084	Meije Duo Femoral Head Delta 	Femoral Head Ceramic	Short, Med, Long, Extra 	$2,100.00
	Ceramic <32	Long, 22.2mm or 32mm
	Wright Medical Australia
WR101	Delta Modular Heads	Biolox Delta Heads	28mm, 32mm in -3.5mm, 	$2,100.00
	0mm, + 3.5 neck lengths
	Zimmer Pty Ltd
ZI538	Ceramic primary & revision femoral 	Biolox Delta Ceramic	28 & 32mm	$2,100.00
	head
Prostheses List by Category, Groups and Sponsor	Page 764 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Sleeve
	Johnson & Johnson Medical Pty Ltd
JJ818	DePuy Delta TS Heads	Delta ceramic femoral head with 	≤32mm, +1 to +12	$2,300.00
	titanium sleeve
	Lima Orthopaedics Australia Pty Ltd
LC153	Revision Modular Biolox Delta Head	Revision Modular Biolox Delta Head 	28 - 32mm Small to Xlarge	$2,300.00
	Ti6AI4V 12/14 Taper
	Mathys Orthopaedics Pty Ltd
MA484	Ceramys Ceramic Revision Femoral 	Ceramic, zirconia alumina 	28 L, 28 M, 28 S, 28 XL, 32 	$2,300.00
	Head	combination, supplied with titanium 	L, 32 M, 32 S, 32 XL, 28, 32
	taper sleeve
	Medacta Australia Pty Ltd
MU079	BIOLOX OPTION	Ceramic Biolox Delta with Titanium 	Diameter 28 S.M.L.XL, 	$2,300.00
	sleeve	diameter 32 S,M,L,XL
	11.02.01.06 - Ceramicised Metal
	Joint Research Australia
JR002	DC2 System: DC2 Head 32mm	Femoral head, Biolox Delta, ≤32mm	-4mm, +0mm, +4mm, +8mm	$2,100.00
	Smith & Nephew Surgical Pty Ltd
SN687	Femoral Head	12/14, 14/16 Taper, Oxinium	22 - 32mm, -3 - +16mm	$2,100.00
11.02.02 - Conventional Femoral Heads, >32mm
	11.02.02.01 - Stainless Steel
	Austofix
AX075	Experion Head	Stainless Steel	36mm, various sizes	$811.00
	Global Manufacturing Technology Pty Ltd
GM145	BioBall Femoral Head	Femoral Head Vivium > 32mm	36mm to 58mm	$811.00
	Lima Orthopaedics Australia Pty Ltd
LC156	Cephalic Head	Cephalic Head AISI 316L	41 - 57mm Diameter	$811.00
	Mathys Orthopaedics Pty Ltd
MA467	Mathys Unipolar Femoral Head	Stainless steel, unipolar head	42 mm - 58mm	$811.00
Prostheses List by Category, Groups and Sponsor	Page 765 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU018	Medacta Unipolar Head	Stainless steel, solid head	Size 40-56mm with variable 	$811.00
	offsets
	Smith & Nephew Surgical Pty Ltd
SN813	Femoral Head	Stainless steel	>32mm,+0-+16mm	$811.00
	Stryker Australia Pty Ltd
HW395	V40 Orthinox Head	Stainless Steel	>32mm	$811.00
	11.02.02.02 - Cobalt Chrome
	Austofix
AX099	F2 Large Femoral Head	Femoral heads, CoCr	Diameter 36mm, -4, 0, +4, +8	$950.00
AX103	U2 Femoral Head	Unipolar Femoral heads, CoCr	Size 42 - 56mm	$950.00
	Biomet Australia Pty Ltd
BI875	Endo II Head	Modular Head - CoCr	41 mm through 61mm	$950.00
BI877	Freedom 36 mm Modular Head	Modular Head	36mm,  -6mm to +9mm	$950.00
BI974	Modular Head Implants	Femoral Modular Head	36mm diameter , - 6 to + 	$950.00
	12mm neck, collared, no 
	collar
	Corin Australia Pty Ltd
CR084	Unipolar Modular Head, CoCr	CoCr Modular Head	38 - 60mm, short, standard 	$950.00
	and long necks
	DJO Australasia Pty Ltd
DD038	R120 Metal Femoral Head	R120 Metal Femoral Head >32mm	36mm	$950.00
DD049	Foundation Unipolar System - CoCr	CoCr unipolar femoral heads, 40mm to 	40mm to 64mm in 2mm 	$950.00
	 Unipolar Femoral Heads	64mm. Unipolar Femoral Heads	increments
	Exactech Australia
EX003	L-Series Unipolar Head	L-Series unipolar is a modular 	unipolar head: 42mm, 43mm,	$950.00
	endoprosthesis consisting of a 	 44mm, 45mm, 46mm, 47mm, 
	truncated spherical head and 	48mm, 49mm, 50mm, 51mm, 
	interchangeable neck sleeves. The 	52mm, 53mm, 54mm, 55mm    
	device is fully machined from cobalt 	 taper sleeve: 12/14-3.5mm, 
	chrome conforming to ASTMF 1537-94	12/14 +0mm, 12/14 +3.5mm,
	 12/14 +7mm, 12/14 +10mm
Prostheses List by Category, Groups and Sponsor	Page 766 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Manufacturing Technology Pty Ltd
GM066	BioBall Femoral Head	Femoral Head Vivium > 32mm	36mm to 58mm	$950.00
	Johnson & Johnson Medical Pty Ltd
DY026	Elite Unipolar Femoral Head	CoCr unipolar head	42 - 60 mm	$950.00
DY402	Cathcart Unipolar Head	CoCr Unipolar Femoral head. Needs 	41 to 60mm	$950.00
	to be used with DY403 Head Taper 
	Lima Orthopaedics Australia Pty Ltd
LC157	Modular Head	Modular Head CoCrMo	36mm Diameter Small to 	$950.00
	XXXLarge
	Medacta Australia Pty Ltd
MU097	Femoral Head	CoCr Femoral Ball Head 12/14	Ø 36mm & Ø 40mm: both of 	$950.00
	sizes S-M-L-XL-XXL
	Signature Orthopaedics
SF025	Unipolar Femoral head	Femoral head manufactured from 	unipolar head: 42mm, 43mm,	$950.00
	Cobalt Chrome	 44mm, 45mm, 46mm, 47mm, 
	48mm, 49mm, 50mm, 51mm, 
	52mm, 53mm, 54mm, 55mm
SF047	Signature Delta Femoral Head 	Cobalt Delta Femoral Head	Offsets S, M, L & XL	$950.00
	>=36mm
	Smith & Nephew Surgical Pty Ltd
SN308	Unipolar Head	Co Cr	12/14 42 - 61mm	$950.00
SN809	Femoral head	CoCr	>32mm	$950.00
	Stryker Australia Pty Ltd
ST570	UNITRAX	Vitallium alloy /CoCr	38-64mm OD 2mm 	$950.00
	increments
	Wright Medical Australia
WR129	Gladiator Bipolar Hip System 	Gladiator Bipolar Hip System Bipolar	36mm Short Medium Long	$950.00
	Bipolar CoCR Head	 CoCR Head 36mm
	Zimmer Pty Ltd
ZI054	Femoral Head	Cobal Chrome femoral Head	38 - 63mm	$950.00
ZI347	Femoral Head	CoCr femoral head	42 to 60 	$950.00
ZI359	Large Zimmer Femoral Heads	CoCr femoral head	34 - 38mm	$950.00
Prostheses List by Category, Groups and Sponsor	Page 767 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI500	Femoral Head	Head - Metal (Zweymuller Allopro) - 	36mm, 38mm	$950.00
	CoCr
	Low Frequency Ion Treatment
	Stryker Australia Pty Ltd
SK405	LFIT Femoral Heads	Femoral head with low friction ion 	36mm-72mm	$2,300.00
	treatment
	11.02.02.03 - Alumina
	Amplitude Australia
LI055	Alumina Head	Ceramic femoral head, biolox forte	>32mm	$2,055.00
	Austofix
AX064	Austofix Ceramic System	Biolox ceramic femoral head	36mm	$2,055.00
	DJO Australasia Pty Ltd
DD040	R120 Ceramic Femoral Head	R120 Ceramic, Biolox Femoral Head > 	36mm	$2,055.00
	32mm
	Lifehealthcare Pty Ltd
LH463	10/12/14 Alumina Head	Alumina Head Biolox forte	36mm	$2,055.00
	Mathys Orthopaedics Pty Ltd
MA517	Bionit Ceramic Femoral Head	Femoral Head, Ceramic	36 to 54mm	$2,055.00
	Medacta Australia Pty Ltd
MU007	Quadra Hip Large Ceramic Femoral 	Ceramic, Biolox Forte, larger	36mm (S,M,L)	$2,055.00
	Head
	Smith & Nephew Surgical Pty Ltd
SM167	Revision Delta Ceramic Femoral Head	Biolox Option Head	>32mm	$2,055.00
SN811	Reflection	Head Ceramic, AlO3, Biolox Forte	>32mm	$2,055.00
	Stryker Australia Pty Ltd
HW394	Stryker large ceramic femoral head 	Biolox Forte	36mm - 60mm	$2,055.00
	Wright Medical Australia
WR089	Alumina Femoral Head	Head ceramic	36-56mm, short, medium, 	$2,055.00
	long
Prostheses List by Category, Groups and Sponsor	Page 768 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.02.02.05 - Ceramic Mix
	Austofix
AX100	DC2 Large Femoral Head	Delta Ceramic Femoral Heads	Diameter 36mm, 40mm, 	$2,300.00
	44mm, S, M, L, XL
	B Braun Australia Pty Ltd
BB302	Biolox Delta Ceramic Head	Biolox Delta Ceramic Head	36 & 40mm diameter	$2,300.00
	Biomet Australia Pty Ltd
BH036	Biolox Delta Option Ceramic 	ceramic modular head, biolox delta	36mm to 60mm	$2,300.00
	Femoral Heads
	Corin Australia Pty Ltd
CR179	Ceramic Modular head	Biolox Delta Ceramic heads  > 32mm	36, 40 and 44mm	$2,300.00
CR194	Biolox Option (>32mm)	Biolox Option Ceramic Femoral Head	36mm and 40mm	$2,300.00
	Global Manufacturing Technology Pty Ltd
GM108	BioBall Delta Femoral Head	Femoral Head Biolox Delta	36mm, 38mm, 40mm, 44mm, 	$2,300.00
	48mm
GM132	Biolox Delta Ceramic Femoral Heads	Biolox Delta Femoral Head 36mm	Biolox Delta Femoral Head 	$2,300.00
	36mm -4.0mm to +8.0mm, 
	40mm -4.0mm to +8.0mm
	Johnson & Johnson Medical Pty Ltd
DY464	DePuy Delta Ceramic Femoral Head	Ceramic delta >32mm	>32mm	$2,300.00
DY552	Delta modular head	Delta ceramic modular head	36-58mm	$2,300.00
	Lifehealthcare Pty Ltd
LH399	Delta Modular head	Biolox Delta ceramic femoral ball head	>36mm	$2,300.00
	Lima Orthopaedics Australia Pty Ltd
LC154	Modular Biolox Delta Head	Modular Biolox Delta Head	36 - 40mm Small to Large	$2,300.00
	Mathys Orthopaedics Pty Ltd
MA483	Ceramys Large Ceramic Femoral 	Ceramic, zirconia alumina 	36 L, 36 M, 36 S	$2,300.00
	Head	combination, large diameters 
Prostheses List by Category, Groups and Sponsor	Page 769 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU095	Biolox Delta Ceramic Ball heads	Ceramic femoral heads, BIOLOX® 	Ball Head 12/14 Ø 36 	$2,300.00
	Delta Ai2 O3 -ZrO2	Sizes: S, M, L and XL
	Ball Head 12/14 Ø 40 
	Sizes: S, M, L and XL
	Ball Head 12/14 Ø 44 
	Sizes: S, M, L and XL
MU118	Mectacer Biolox Option Ceramic 	Biolox Option Ceramic Femoral Heads	36mm, 40mm, 44mm	$2,300.00
	Heads (>32)
	Motion Orthopaedics Pty Ltd
BJ005	Ceramic Modular head	Biolox Delta Ceramic heads  > 32mm	36, 40 and 44mm	$2,300.00
	Oceania Orthopaedics
OO071	Adler Ceramic Head >32	Biolux delta ceramic head	Short, Medium, Long; in 	$2,055.00
	36mm and 48mm
	Orthotech Pty Ltd
OH300	JRI Total Hip System	Total Hip Replacement (THR) Ceramic	12 / 14 Taper, Biolox Delta 	$2,300.00
	 Femoral Heads, Biolox Delta Ceramic,	Ceramic head sizes 36mm. 
	 and Alumina Oxide	Alumina Oxide head sizes 
	28mm
	Signature Orthopaedics
SF023	Ceramic Femoral Head	Ceramic Femoral Head - Delta	36 to 44mm	$2,300.00
SF045	Signature Delta Femoral Head 	Ceramtec Delta Femoral Head	offsets S, M, L & XL	$2,300.00
	>=36mm
	Smith & Nephew Surgical Pty Ltd
SM095	Universal Delta Ceramic Femoral 	Delta Ceramic	>32mm	$2,300.00
	Head
	Stryker Australia Pty Ltd
SR029	Stryker Large Femoral Head - Delta 	Delta Ceramic 	36mm - 50mm	$2,300.00
	Ceramic 
	Tornier Pty Ltd
TO083	Meije Duo Femoral Heads Delta 	Femoral Head Delta Ceramic >32	short, med, long, extra long, 	$2,300.00
	Ceramic >32	36mm
	Wright Medical Australia
WR100	Delta Modular Heads	Biolox Delta Heads	36mm - 44mm in -3.5mm, 	$2,300.00
	0mm, +3.5 neck lengths
Prostheses List by Category, Groups and Sponsor	Page 770 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI539	Ceramic primary & revision femoral 	Biolox Delta Ceramic	36 - 48mm	$2,300.00
	head
	Sleeve
	Johnson & Johnson Medical Pty Ltd
JJ819	DePuy Delta TS Heads	Delta ceramic femoral head with 	>32mm, +1 to +12	$2,500.00
	titanium sleeve
	Lima Orthopaedics Australia Pty Ltd
LC155	Revision Modular Biolox Delta Head	Revision Modular Biolox Delta Head 	36 - 40mm Small to Xlarge	$2,500.00
	Ti6AI4V 12/14 Taper
	Mathys Orthopaedics Pty Ltd
MA485	Ceramys Large Ceramic Revision 	Ceramic, zirconia alumina 	36 L, 36 M, 36 S, 36 XL, 36	$2,500.00
	Femoral Head	combination, large diameters, 
	supplied with titanium taper sleeve
	Medacta Australia Pty Ltd
MU080	BIOLOX OPTION	Ceramic Biolox Delta with Titanium 	Diameter 36 S.M.L.XL	$2,500.00
	Sleeve
	11.02.02.06 - Ceramicised Metal
	Joint Research Australia
JR001	DC2 System: DC2 Head 36mm	Femoral head, Biolox Delta, >32mm	-4mm, +0mm, +4mm, +8mm	$2,300.00
	Oceania Orthopaedics
OO033	IC-Head Biolux delta	Biolux delta ceramic head	36mm. Small, medium and 	$2,300.00
	large.
	Smith & Nephew Surgical Pty Ltd
SN812	Femoral Head	12/14, 14/16 Taper, Oxinium	>32mm, -3 - +16mm	$2,300.00
11.02.03 - Metal on Metal Heads
	Biomet Australia Pty Ltd
BI056	Exceed M2A Femoral Head 	Head, Chrome Cobalt, Metal on metal	28mm, -6mm to +12mm neck	$2,400.00
BI068	Stanmore Hip System	Head, Chrome Cobalt, metal on metal 	28mm, -6mm to +12mm neck	$2,400.00
Prostheses List by Category, Groups and Sponsor	Page 771 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI070	Biomet Taperloc Hip System	Head, Chrome Cobalt, metal on metal 	28mm or 32mm, -6mm to 	$2,400.00
	+12mm neck
BI896	M2A Magnum System	Femoral  Head, Cobalt Chrome, metal 	38-60mm	$2,400.00
	on metal 
BI944	M2a 38 Femoral Head	Metal on Metal Femoral Head, Cobalt 	38mm	$2,400.00
	Chrome
	Corin Australia Pty Ltd
CR016	Optimom Modular Head	Metal on metal, CoCr	>32mm	$2,400.00
CR020	Metalok Femoral Head	Metal on metal, CoCr	Head 28mm (short/med/long	$2,400.00
	 neck)
	DJO Australasia Pty Ltd
DD051	FMP Femoral Head	CoCr Femoral Head	22-32mm	$2,400.00
DD052	FMP Femoral Head	CoCr Femoral Head	34-38mm	$2,400.00
	Global Orthopaedic Technology
GO047	ICON Femoral Head	CoCr, metal on metal, large diameter	38-58mm	$2,400.00
	Johnson & Johnson Medical Pty Ltd
DY530	Pinnacle Femoral Head	CoCr metal on metal	33-48mm	$2,400.00
DY531	Pinnacle Femoral Head	CoCr metal on metal	28-32mm	$2,400.00
	Mathys Orthopaedics Pty Ltd
MA519	Metamys Metal on Metal Femoral 	CoCr metal on metal	28mm, 32mm, 36mm	$2,400.00
	Head
	Medacta Australia Pty Ltd
MU057	ROMAX Resurfacing System - Large	Large femoral head for metal-metal 	From diameter 38mm to 	$2,400.00
	 Femoral Head	articulation	diameter 60mm, every 2mm
	Oceania Orthopaedics
OO068	Adler Metal on Metal Head	Metal on Metal Articulating Femoral 	Short, Medium, Long in 	$2,400.00
	Heads for Adler Stems 32,36,40mm 	32,36 and 40 mm
	RQSolutions Medical Devices Distribution Support
RQ029	Silver Surf Large Metal Head 	CoCr, metal on metal, dimpled, large	36mm - 48mm	$2,400.00
	Smith & Nephew Surgical Pty Ltd
SN741	Birmingham Modular Femoral Head	Cobalt Chrome	38 - 58mm	$2,400.00
Prostheses List by Category, Groups and Sponsor	Page 772 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR088	Transcend/Lineage Articulation 	Metal femoral head CoCr	32mm, 4 lengths	$2,400.00
	System
WR091	Transcend/Lineage Articulation 	Metal femoral head CoCr	36mm, 4 lengths	$2,400.00
	System
WR092	BFH Total, A-class	Cobalt Chrome super finished femoral 	36mm to 56mm in 2mm 	$2,400.00
	head. Size range from 36mm to 56mm 	increments each with - 
	in 2mm increments with 3 head 	3.5mm, 0mm, + 3.5mm head 
	lengths per size	lengths
WR116	CONSERVE Total hip head	CoCr SLT Taper Femoral Head	Sizes 38mm-54mm in 2mm 	$2,400.00
	increments, -3.5 to +3.5 
WR126	Transcend/Lineage Articulation 	Metal femoral head CoCr	28 and 32mm, 4 lengths	$2,400.00
	System
	Zimmer Pty Ltd
ZI472	Durom (Metasul) Resurfacing 	Forged CoCr femoral head	A1 to L1	$2,400.00
	System - Ballhead
ZI734	Metasul Femoral Head	Wrought forged High Carbon Cobalt 	36 - 60mm	$2,400.00
	Chrome metal on metal
ZI735	Metasul Femoral Head	Wrought Forged High carbon Cobalt 	28mm - 32mm	$2,400.00
	Chrome metal on metal
11.02.04 - Resurfacing, Cemented
	11.02.04.01 - Metal
	Biomet Australia Pty Ltd
BI839	Resurfacing Hip System	Femoral Head CoCr, Cemented	38 - 60mm	$3,350.00
	Corin Australia Pty Ltd
CR047	Cormet Resurfacing Head Cemented	CoCr Resurfacing Head	Dia 40 -56mm	$3,350.00
	Global Orthopaedic Technology
GO049	ICON Resurfacing Head	CoCr, cemented, resurfacing, metal on 	38-58mm head	$3,350.00
	metal
	MatOrtho
MJ001	ADEPT MoM Resurfacing Head	Resurfacing Head MoM, Cast CoChr	38-58 going up in 2mm 	$3,350.00
	increments
Prostheses List by Category, Groups and Sponsor	Page 773 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU054	ROMAX Resurfacing Femoral Head	Cemented resurfacing femoral head	From diameter 38-60mm, 	$3,350.00
	every 2mm
	Smith & Nephew Surgical Pty Ltd
SN743	Birmingham Hip Resurfacing 	Cobal Chrome	38 - 58 mm heads	$3,350.00
	Prostheses -  Femoral Component 
	Wright Medical Australia
WR111	Conserve Plus A-CLASS 	CoCr A-CLASS super finished 	36mm to 56mm in 2mm 	$3,350.00
	Resurfacing Head	resurfacing femoral head	increments each with - 
	3.5mm, 0mm, + 3.5mm head 
	lengths
WR138	CONSERVE PLUS Total Hip 	CoCr Femoral Head - Super Polished	Sizes 36mm - 54mm in 2mm 	$3,350.00
	Resurfacing System	increments
11.02.05 - Resurfacing, Uncemented
	11.02.05.01 - Metal
	Biomet Australia Pty Ltd
BI840	Resurfacing Hip System	Femoral Head CoCr, Ti, no HA	38 - 60mm	$3,850.00
	Corin Australia Pty Ltd
CR090	Cormet Resurfacing Head  Bi Coated	CoCr with titanium plasma spray and 	40mm-56mm	$3,850.00
	HA
CR122	Cormet Resurfacing Head Fully Bi 	CoCr with Titanium plasma spray and 	44 to 56mm	$3,850.00
	Coated	HA
11.02.06 - Bipolar/Multipolar
	11.02.06.01 - Bipolar
	Austofix
AX045	Hyperion Moonstone Bipolar Cup	Stainless Steel Shell, UHMWPE liner	Sizes 39 - 59	$857.00
	 with locking ring
	B Braun Australia Pty Ltd
BB249	Bipolar Head	Bipolar shell plus liner	38 - 60mm	$857.00
Prostheses List by Category, Groups and Sponsor	Page 774 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX008	L-Series Bipolar Head	The L-Series Bipolar Head is a 	28mm 40mm OD, 28mm 	$857.00
	modular two piece device consisting 	41mm OD, 28mm 42mm OD, 
	of a spherical cobalt chrome shell and 	28mm 43mm OD, 28mm 
	interchangeable polyethylene liner 	44mm OD, 28mm 45mm OD, 
	inserts	28mm 46mm OD, 28mm 
	47mm OD, 28mm 48mm OD, 
	28mm 49mm OD, 28mm 
	50mm OD, 28mm 51mm OD, 
	28mm 52mm OD, 28mm 
	53mm OD, 28mm 54mm OD, 
	28mm 55mm OD, 28mm 
	57mm OD, 28mm 59 mm OD,
	 28
	Johnson & Johnson Medical Pty Ltd
DP171	Hastings Bipolar Prosthesis	Bipolar femoral head, CoCr with fixed 	Size 36 - 56	$857.00
	UHMWPE insert
DP188	Self Centering Bipolar Head	Bipolar femoral head, CoCr with 	28mm inner diameter, 39-	$857.00
	UHMWPE insert	65mm outer diameter
	Lifehealthcare Pty Ltd
LH064	Groupe Lepine	Bipolar shell and UHMPE liner	42 - 60mm in 1mm increments	$857.00
	Link Orthopaedics  Australia
LO036	LINK Vario bipolar Cup	Shell with unmodified polyethylene 	44-65mm	$857.00
	plus locking ring 
	Mathys Orthopaedics Pty Ltd
MA025	Mathys Bipolar Femoral Head	Stainless steel with fixed UHMWPE 	28mm Inner diameter, 42-	$857.00
	insert	58mm outer diameter
	Medacta Australia Pty Ltd
MU021	Medacta Bipolar Head	Stainless Steel, with UHMWPE 	For ballhead diameter 	$857.00
	28mm- 
	42,44,46,48,50,52,54,56,58,
	60mm.  For ballhead 
	diameter 22.2mm - 
	39,40,41,42,43,44,45,46,47,
	48,49,50,51,52mm
Prostheses List by Category, Groups and Sponsor	Page 775 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO035	Bi-polar head	Bipolar head	44mm - 60mm	$857.00
	Orthotech Pty Ltd
OH398	Furlong Hemi Range	Bipolar head	40-58mm	$857.00
	Smith & Nephew Surgical Pty Ltd
SN267	Tandem/Convene	Shell/Liner	22 - 64mm	$857.00
	Stryker Australia Pty Ltd
ST566	Osteonics hip prostheses	Bipolar shell and polyethylene insert 	ID 22, 26, 28, 32mm dia 	$857.00
	(factory Assembled)
	Wright Medical Australia
WR110	SLR Biploar Acetabular Shell	Cast Cobalt Chrome Alloy	38mm - 65mm in millimetre 	$857.00
	increments
WR128	Gladiator Bipolar Hip System	Gladiator Bipolar	36mm x 22mm, 	$857.00
	37mmx22mmx38mmx22mm, 
	39mmx22mm, 40mmx22mm, 
	41mmx22mm, 42mmx28mm, 
	43mmx28mm, 44mmx28mm, 
	45mmx28mm, 46mmx32mm, 
	47mmx32mm, 48mmx32mm, 
	49mmx32mm, 50mmx36mm, 
	51mmx36mm, 52mmx36mm, 
	53mmx36mm, 54mmx36mm, 
	55mmx36mm, 56mmx36mm, 
	57mmx36mm, 58mmx36mm, 
	5
	Zimmer Pty Ltd
ZI286	Zimmer Acetabular Cup	Multipolar (Bipolar) Cup-Co Chr 	Outer Diameter 38 - 72mm, 	$857.00
	W/WHMWPE	Inner Diameter 22,28, or 
	32mm
Prostheses List by Category, Groups and Sponsor	Page 776 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.02.06.02 - Tripolar/Multipolar
	Biomet Australia Pty Ltd
BI096	Tripolar Acetabular Cup Series	Ringloc Series shell, UHMWPE liner 	24-28mm	$1,248.00
	and Chrome Cobalt head
	Lima Orthopaedics Australia Pty Ltd
LC162	Lock Bipolar Head and Liner	Self Centering Head CoCrMo and 	Diameter x 28mm x OD 41-	$1,248.00
	UHMWPE Liner	57mm
LC163	Met Poly Mobile Liner	Met Poly Mobile Liner UHMWPE	ID 28mm x OD 40-58mm	$1,248.00
	RQSolutions Medical Devices Distribution Support
RQ045	ESKA Bipolar Femoral Head	CoCr, UHMWPE with inner femoral 	various diameters	$1,248.00
	head included 
11.03.01 - Cups, Cemented
	11.03.01.01 - Unmodified polyethylene
	Austofix
AX046	Hyperion Emergence Cemented Cup	Acetabular Cup, UHMWPE	Sizes 42 - 54	$750.00
	B Braun Australia Pty Ltd
BB236	Polyethylene Acetabular Cup	Unmodified Polyethylene	22.2mm-32mm articulations;	$750.00
	 40mm-64mm diameters
	Biomet Australia Pty Ltd
BI067	Stanmore Total Hip System	Acetabular Cup, unmodified 	25-32mm x size 40-53mm	$750.00
BI129	Mallory Head Hip System	Acetabular cup, UHMWPE	40-80mm	$750.00
	Corin Australia Pty Ltd
CR042	Cenator Acetabular Cup	Flanged Cemented UHMWPE	Dia 40 - 62mm, 22, 26, 28 	$750.00
	heads
Prostheses List by Category, Groups and Sponsor	Page 777 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX052	All Polyethylene cemented 	The All Polyethylene cemented 	22mm ID: 44mm OD, 46mm 	$750.00
	acetabular component	acetabular components are indicated 	OD, 48mm OD, 50mm OD, 
	for use in skeletally mature 	52mm OD, 54mm OD              
	individuals undergoing primary 	              28mmID: 48mmOD, 
	surgery for total hip replacement due 	50mmOD, 52mmOD, 54mm 
	to osteoarthritis, rheumatoid arthritis, 	OD, 56mm OD, 58mm OD, 
	osteonecrosis, ankylosing 	60mm OD                  32mm 
	ID: 52mm OD, 54mmOD, 
	56mm OD, 58mm OD, 60mm 
	OD
	Global Manufacturing Technology Pty Ltd
GM128	Contile Fin II Acetabular, Mueller 	Mueller Cup	28mm Neutral and 10 	$750.00
	Cup 28mm and 32mm	Degree, 32mm Neutral and 
	10 Degree
	Johnson & Johnson Medical Pty Ltd
DP182	Charnely Hip System Bore, LPW 	UHMWPE cup, cemented 	28mm inner diameter, 38 - 	$750.00
	and Flanged Cups	53mm outer diameter
JJ755	OGEE Cemented Cup	UHMWPE cup, cemented	22 - 32mm inner diameter, 	$750.00
	40-53mm outer diamter
JJ756	Wroblewski Cemented Cup	UHMWPE cup, cemented	22mm inner diamter, 40 - 	$750.00
	53mm outer diameter and 
	angled bored
JJ757	LPW Cemented Cup	UHMWPE cup, cemented	28mm inner diameter, 40 - 	$750.00
	53mm outer diameter
	Lima Orthopaedics Australia Pty Ltd
LC007	Lima Total Hip Replacement System	Mueller Ceramic and UHMWPE Cup 	44 - 62mm	$750.00
	(Cemented)
LC020	Lima Cemented Cup	UHMWPE Cemented Cup 	28-36mm OD x 44-58mm 	$750.00
	OD 20*
	Link Orthopaedics  Australia
LO018	LINK IP Acetabular Cup	UHMWPE unmodified	40 - 58mm	$750.00
	Mathys Orthopaedics Pty Ltd
MA027	CCB Cemented UHMWPE Cup	UHMWPE, low & full profile	28/32 ID - 42/64 OD	$750.00
Prostheses List by Category, Groups and Sponsor	Page 778 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO138	IC Muller PE Cup	PE acetabulum cup with 0 and10 	44-62mm, 28-32mm	$750.00
	degree lip - cemented
	Orthotech Pty Ltd
OH105	Lima Mueller Cup	UHMWPE Cup unmodified Cemented	44 - 62mm	$750.00
OH290	JRI Cemented Cup	UHMWPE Cup unmodified Cemented	28mm and 32mm	$750.00
	Smith & Nephew Surgical Pty Ltd
SN288	Reflection	Acetabular Cup Unmodified 	22 - 36mm, 42 - 76mm	$750.00
	Wright Medical Australia
WR120	WMT Acetabular Cups All Poly	UHMWPE unmodified 	42 - 68mm in 2mm increments	$750.00
	Zimmer Pty Ltd
ZI027	ZCA Acetabular Cup	UHMPE unmodified	47 - 61	$750.00
ZI384	Low Profile Cup - Cups cemented	UHMPE unmodified	22/36 to 32/64	$750.00
	11.03.01.02 - Modified polyethylene
	Austofix
AX101	P2 Cemented Cup	Cemented Acetabular Cup	Size 49 - 61	$936.00
	Johnson & Johnson Medical Pty Ltd
JJ689	Marathon Cup System Cemented 	Cemented modified UHMWPE 	Inner diameter 22-36mm, 	$936.00
	Acetabular Cup	acetabular cup with flange	outer diameter 38-53mm
	Smith & Nephew Surgical Pty Ltd
SN696	Reflection	Acetabular Cup - XLPE	22-36mm,40-61mm	$936.00
	Stryker Australia Pty Ltd
HW029	Duration Polyethelene cemented 	Duration Poly Cup -  Enhanced 	22 - 36 mm ID	$936.00
	acetabular component	Polyethylene
SK460	Exeter Rim Fit Flanged X3 Cup	X3 Highly crosslinked Cup	40 - 60 OD, 22 - 44 ID	$936.00
	Zimmer Pty Ltd
ZI314	ZCA All Poly Acetabular Cup - 	UHMPE modified 	22, 26, 28 & 32 mm heads; 	$936.00
	47-61mm diameter; flanged 
	and non-flanged
Prostheses List by Category, Groups and Sponsor	Page 779 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Flange
	Stryker Australia Pty Ltd
HW030	Contemporary Hip System Range	Exeter Contemporary Flanged 	ID: 26, 28, 32.  OD 46, 48, 	$961.00
	modified  Enhanced Polyethylene 	50, 52, 54, 56, 58, 60
	11.03.01.03 - Constrained, modified and unmodified polythylene
	Link Orthopaedics  Australia
LO019	Lubinus eccentric Acetabular Cup	UHMWPE constrained	44 - 58mm	$832.00
	Oceania Orthopaedics
OO137	IC Muller PE snap lock cup	PE acetabulum cup , constrained	44 – 62mm, 28 or 32mm	$832.00
	RQSolutions Medical Devices Distribution Support
RQ021	ESKA Cemented UHMWPE Cup	UHMWPE, neutral & hooded 	.	$832.00
	Stryker Australia Pty Ltd
HW043	Brunswick Cup	Polyethylene	44, 48, 50, 52, 54, 56mm OD	$832.00
SK430	Trident Constrained All Poly 	UHMWPE constrained cemented cup	40-70mm	$832.00
	Acetabular Cup
	11.03.01.04 - Metal Shell
	Amplitude Australia
LI059	Saturne Cemented Tripolar Cup	Stainless steel cemented acetabular 	Sizes 44 - 60 in 2mm 	$1,800.00
	cup with an anatomical anti-	increments
	disloction profile
	Biomet Australia Pty Ltd
BH040	Avantage Dual Mobility Cemented 	Acetabular shell, polished inner 	44mm - 50mm	$1,800.00
	Acetabular Cup	surface, Stainless Steel
	Smith & Nephew Surgical Pty Ltd
SM133	Polar Cup Cemented Acetabular 	Stainless steel, cemented shell that 	43-63MM	$1,800.00
	has polished inner surface for dual 
	mobility with constrained UHMWPE
	Tornier Pty Ltd
TO086	Dual Mobility Cup, Shell Cemented	Acetabular Shell, Cemented stainless 	42mm to 60mm	$1,800.00
	steel with groove, internal mirror 
	polished
Prostheses List by Category, Groups and Sponsor	Page 780 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.03.02 - Shells, Uncemented
	11.03.02.01 - Grit Blast
	Mathys Orthopaedics Pty Ltd
MA498	SeleXys Acetabular TH+ Shell	Uncemented Ti acetabular shell, grit 	42mm - 72mm in 2mm 	$2,300.00
	blast, non HA	increments
	Zimmer Pty Ltd
ZI874	Allofit IT Shell	Titanium Shell, Macro texture, Non 	Shell outer diameter: 42mm-	$2,300.00
	74mm in 2mm increments
	SCP
	Zimmer Pty Ltd
ZI353	Allofit Cup	Titanium, macro texture, non HA	46 - 68mm	$2,700.00
	11.03.02.02 - Beaded
	DJO Australasia Pty Ltd
DD023	FMP Acetabular Shell	Titanium, non HA, beaded, variable 	42-70mm	$2,508.00
	screw holes
	Johnson & Johnson Medical Pty Ltd
DP360	Duraloc Acetabular Shells	Titanium, beaded, (Porocoat) non HA,	Size 36-76	$2,508.00
	 with or without holes &/or spikes
DY521	Pinnacle Acetabular Shell	Titanium, beaded (Porocoat), not HA, 	38 - 80mm	$2,508.00
	acetabular cups
	Mathys Orthopaedics Pty Ltd
MA496	SeleXys Acetabular PC Shell	Uncemented Ti acetabular shell, 	42mm - 72mm in 2mm 	$2,508.00
	beaded, non HA	increments
	Smith & Nephew Surgical Pty Ltd
SN285	Reflection	Acetabular Cup, Beaded Titanium 	42 - 80mm	$2,508.00
SN290	Reflection	Acetabular Shell Ceramic, Porous 	46-66mm OD	$2,508.00
	Titanium Alloy
	Wright Medical Australia
WR109	Procotyl L Acetabular System / 	Beaded Acetabular shell non HA	42 - 68mm in 2mm increments	$2,508.00
	Acetabular shell non HA
Prostheses List by Category, Groups and Sponsor	Page 781 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR114	Dynasty Acetabular System/ 	Beaded Acetabular shell non HA	42 - 76mm in 2mm increments	$2,508.00
	Actebular Shell
WR127	Lineage and Transcend Acetabular 	Titanium, beaded, non HA	Shells 40 - 80mm in 2mm 	$2,508.00
	Systems	increments
WR146	Lineage Acetabular System	Titanium Deep Profile Multi Hole 	46 - 74mm in 2mm increments	$2,508.00
	Acetabular Shell
	11.03.02.03 - Mesh
	Oceania Orthopaedics
OO073	Fixa Ti-Por Cup	Porous Matrix Titanium, Screw Holes 	Size 44-66mm	$2,500.00
	with Plugs, Hemispherical Acetabular
	 Cup
	RQSolutions Medical Devices Distribution Support
RQ026	BS Acetabular Shell non HA	CoCr, Titanium spray, 3 dimensional 	46-68mm	$2,500.00
	metal, variable screw holes, without 
RQ043	2000 Plus Acetabular Metal Shell	CoCr, Titanium Spray, 3 Dimensional 	44-68mm	$2,500.00
	Metal, Variable Screw Holes,
	Zimmer Pty Ltd
ZI042	Trilogy Acetabular Cup	Titanium mesh (fibre metal) non HA 	48 - 70	$2,500.00
	for ceramic insert
ZI386	Fitmore Cup	Titanium mesh non HA 	42 to 68mm	$2,500.00
	Flange
	RQSolutions Medical Devices Distribution Support
RQ030	BS Dysplasia Acetabular Shell 	CoCr, Titanium spray, 3 dimensional 	46-66mm	$3,500.00
	metal, variable screw holes and 
	proximal flange, without HA
	SCP
	Zimmer Pty Ltd
ZI034	Trilogy Acetabular Cup	Titanium mesh (fibre metal) non HA 	38 - 80	$2,900.00
	for UHMPE insert
Prostheses List by Category, Groups and Sponsor	Page 782 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.03.02.04 - Plasma
	Biomet Australia Pty Ltd
BI111	Mallory Head Hip System	Acetabular shell, Titanium Alloy, 	40-80mm	$2,300.00
	plasma, non HA
	Exactech Australia
EX011	Novation Crown Cup Shell - plasma	Novation Crown Cup and Liners: No-	Shell: No-Hole shell size 	$2,300.00
	 coated	Hole and Cluster Hole design 	48-68, 2mm increments; 
	options, shells manufactured from 	Cluster Hole Size 48-68, 
	titanium (Ti) alloy with plasma 	2mm increments; Multi-
	coating, sphere and taper inner 	Hole Size 48-56, Multi-
	Hole with Rim Fixation, 
	Mathys Orthopaedics Pty Ltd
MA497	SeleXys Acetabular TPS Shell	Uncemented Ti acetabular shell, Ti 	42mm - 72mm in 2mm 	$2,300.00
	plasma spray, non HA	increments
	Signature Orthopaedics
SF028	Cementless Cup plasma coated	Cementless Cup are availbe with No-	Shell: No-Hole shell size 	$2,300.00
	Hole and Cluster Hole design 	48-68, 2mm increments; 
	options, shells manufactured from 	Cluster Hole Size 48-68, 
	titanium (Ti) alloy with plasma 	2mm increments; Multi-
	coating, sphere and taper inner 	Hole Size 48-56, Multi-
	Hole with Rim Fixation, 
	Smith & Nephew Surgical Pty Ltd
SM025	EP Fit Acetabular Shell	Titanium, plasma spray, non HA, with 	40 - 68mm Dia	$2,300.00
	variable number of holes for 
	UHMWPE,ceramic & metal inserts
SM128	POLAR CUP ACETABULAR 	Stainless steel with titanium plasma 	43-67MM	$2,300.00
	Cementless Shell	spray coating that has polished inner 
	surface for dual mobility with 
	constrained UHMWPE liner/head
	Flange
	Smith & Nephew Surgical Pty Ltd
SM129	POLAR CUP ACETABULAR 	Stainless steel with titanium plasma 	43-67MM	$3,300.00
	Cementless Shell	spray coating and pegs & flanges, that
	 has polished inner surface for dual 
	mobility with constrained UHMWPE
	 liner/head
Prostheses List by Category, Groups and Sponsor	Page 783 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.03.02.05 - Porous Metal
	Austofix
AX093	C2 Acetabular Shell	titanium Cup with sintered titanium 	48 - 68mm	$3,350.00
	coating
	Biomet Australia Pty Ltd
BI971	Regenerex Ringloc+	Acetabular shell, solid, limited hole 	48 to 72mm OD	$3,350.00
	or multi hole, Porous Ti Alloy
	Johnson & Johnson Medical Pty Ltd
JJ653	Pinnacle Hip System - Gription Cup	Porous metal acetabular cup	38 - 80mm	$3,350.00
	Lima Orthopaedics Australia Pty Ltd
LC164	Delta TT Acetabular Cup	Delta TT Acetabular Cup Ti6AI4V	44 - 76mm	$3,350.00
LC165	Delta One TT Acetabular Cup	Delta One TT Acetabular Cup 	44 - 66mm	$3,350.00
	Stryker Australia Pty Ltd
SK428	Trident Tritanium Acetabular Shells	Acetabular Shell, tritanium	40mm - 80mm	$3,350.00
	Zimmer Pty Ltd
ZI325	Trabecular Metal Modular 	Titanium, porous tantalum 	38-80mm diameter; Cluster, 	$3,350.00
	Acetabular System	Multiholed, No Holes
ZI617	Continuum Acetabular Shell	Trabecular Metal Acetabular Shell	40CC, 42DD, 44EE, 46FF, 	$3,350.00
	48GG, 50HH, 5II, 54JJ, 
	56KK, 58LL, 60MM, 
	62NN, 64OO, 66PP, 68QU,
	 70RR, 72SS, 74TT, 76UU, 
	78VV, 80W
11.03.03 - Shells, Uncemented, HA
	11.03.03.01 - Grit Blast
	Amplitude Australia
LI060	Horizon Acetabular Shell	Anodised titanium, HA encoated with	42 - 70 mm	$2,700.00
	 screw holes for ceramic inserts
	Johnson & Johnson Medical Pty Ltd
JJ702	Gyros Hip System	Dual mobility acetabular cup, 	44-68mm	$2,700.00
	stainless steel, grit blasted with HA
Prostheses List by Category, Groups and Sponsor	Page 784 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH068	Pavi	Titanium, grit blast with HA	46 - 64mm in 2 mm 	$2,700.00
	increments & 0 or 10 Degrees
	Link Orthopaedics  Australia
LO032	Link acetabular cup system	Titanium, grit blast, HA	40 - 68mm	$2,700.00
LO150	BetaCup Cementless Acetabular 	Acetabular Cup system comprising of 	Ø	$2,700.00
	Cup System	16 metal casings, TiCaP coating, 3 
	Ceramic or 4 UHMWPE Inserts, head 
	diameters from Ø 26mm and Ø 36mm
	Orthotech Pty Ltd
OH286	JRI CSF Cup 	Grit blast with HA, titanium	44mm - 70mm	$2,700.00
	Perios Pty Ltd
PF010	Atlas Acetabular Cup System	Titanium, grit blast & HA	Atlas Cup 40-74mm	$2,700.00
	Stryker Australia Pty Ltd
HW014	ABG 11Cup with Hydroxyapatite	Titanium, grit blast and HA for 	Sizes 42mm to 74mm OD in 	$2,700.00
	UHMPE insert	2mm increments
HW015	ABG 11Cup with Hydroxyapatite	Titanium, grit blast and HA for 	Sizes 44mm to 66mm OD in 	$2,700.00
	ceramic insert	2mm increments
	SCP
	Stryker Australia Pty Ltd
ST548	Trident acetabular component 	Titanium, arc deposited,  with HA	40-74mm OD in 2mm 	$3,100.00
	increments
	Shell & Insert
	Stryker Australia Pty Ltd
SK092	Stryker Hydroxyapatite coated cup 	Shell with Biolox forte ceramic liner	44 - 80mm OD	$3,400.00
	with ceramic liner
	11.03.03.02 - Beaded
	Johnson & Johnson Medical Pty Ltd
DP557	Duraloc Acetabular Shell with HA	Titanium, beaded, Duofix,HA, with or 	Inner 36-70	$2,908.00
	without holes 
DY031	Duraloc Option Acetabular Shell	Titanium, beaded with HA (duofix)	46-66 mm	$2,908.00
DY520	Pinnacle Acetabular Shell	Titanium. Beaded with HA (Duofix) 	38 - 80mm	$2,908.00
	acetabular cup
Prostheses List by Category, Groups and Sponsor	Page 785 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN286	Reflection	Acetabular Cup HA Coated Titanium 	42 - 80mm	$2,908.00
	Alloy, beaded
	Wright Medical Australia
WR095	Procotyl L  Acetabular Cup	Beaded, Titanium HA coated cup	42 - 68mm	$2,908.00
WR135	Transcend/Lineage Articulation 	Beaded, Titanium HA coated cup	42 - 74mm in 2mm increments	$2,908.00
	System
	Flange
	Johnson & Johnson Medical Pty Ltd
JJ701	Gyros Hip System	Dual mobility acetabular cup, 	44-68mm	$3,100.00
	stainless steel, grit blasted with HA 
	and flanges for screw fixation
	11.03.03.03 - Mesh
	RQSolutions Medical Devices Distribution Support
RQ025	BS Acetabular Shell with HA	CoCr, Titanium spray, 3 dimensional 	46-68mm	$2,900.00
	metal, variable screw holes, HA
RQ032	2000 Plus Acetabular Metal Shell	CoCr, Titanium Spray, 3 Dimensional 	44-68mm	$2,900.00
	Metal, Variable Screw Holes, HA
	Zimmer Pty Ltd
ZI041	Trilogy Acetabular Cup	Titanium mesh (fibre metal) with HA 	38 - 80	$2,900.00
	for ceramic insert
ZI618	Trilogy IT HA/TCP Acetabular 	Titanium mesh (fibre metal) with HA	40CC; 42DD; 44EE; 46FF,;	$2,900.00
	System	 48GG; 50HH; 52II; 54JJ; 
	56KK' 58LL' 60MM' 
	62NN; 64OO; 66PP; 
	68QU; 70RR; 72SS; 74TT
	SCP
	Zimmer Pty Ltd
ZI035	Trilogy Acetabular Cup	Titanium mesh (fibre metal) with HA 	38 - 80	$3,300.00
	for UHMPE insert
Prostheses List by Category, Groups and Sponsor	Page 786 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.03.03.04 - Plasma
	Amplitude Australia
LI061	Saturne Press Fit Dual Mobility 	A cementless, stippled and 	Sizes: 44 - 64 in 2mm 	$2,700.00
	Acetabular Cup	peripherally expanded, acetabular cup.	increments
	  Flattened pole and an elevated rim to 
	help prevent dislocation.
	Austofix
AX082	Plasmaloc Acetabular Cup	Titanium, plasma spray, HA	46-66mm	$2,700.00
	B Braun Australia Pty Ltd
BB243	Plasmacup	Titanium, plasma, HA	44mm-68mm	$2,700.00
BB296	Metha - Modular neck adaptors	Modular neck adaptors made from 	CCD - 130°, 135 °, 140°; 	$2,700.00
	CoCr  	Offset  - 0mm, -5mm ,+5mm; 
	Version - 7.5° left ante/right
	 retro, 0 °, 7.5 ° left 
	retro/right ante
	Biomet Australia Pty Ltd
BH039	Avantage Reload Dual Mobility 	Revision Acetabular Cup polished 	44mm - 64mm	$2,700.00
	Cementless Acetabular Cup	inner surface, with flanges, Porous 
	HA Coating, Stainless Steel
BI110	Mallory Head Hip System	Acetabular Shell	40-80mm	$2,700.00
BI112	Mallory Head Hip System	Acetabular shell, solid, plasma, HA	40-80mm	$2,700.00
BI770	Exceed Acetabular System	Acetabular shell, solid, plasma, HA	Shell sizes 40-70mm	$2,700.00
	Corin Australia Pty Ltd
CR165	Trinity Acetabular Cup	Tri-liner hemispherical shell. Titanium	44 - 68 mm in 2mm 	$2,700.00
	 (Ti6A14V) material with Titanium 	increments
	and HA coated plasma spray
	Exactech Australia
EX007	Novation Crown Cup Shell - plasma	Novation Crown cup and liners - no-	Shell: No-Hole Shell size 	$2,700.00
	 and HA coated	hole and cluster hole design options. 	48-68, 2mm increments; 
	Shells manufactured from titanium (Ti) 	Cluster Hole Size 48-68, 
	alloy with plasma coating and an 	2mm increments; Multi-
	additional hydroxylapitite (HA) 	Hole Size 48-56, Multi-
	coating option. Sphere and taper inner	Hole with Rim Fixation, 
	 diameter geometry.
Prostheses List by Category, Groups and Sponsor	Page 787 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Manufacturing Technology Pty Ltd
GM047	Fin II Acetabular Shell	titanium, Plasma sprayed, HA, with 	44 to 72mm	$2,700.00
	variable screw options
GM113	Global Acetabular Shell	Titanium, plasma spray, HA with 	42-72mm	$2,700.00
	variable number of holes
	Global Orthopaedic Technology
GO233	Novae Dual Mobility Cup	A cementless metal acetabular dual 	43mm to 69mm diameter in 	$2,700.00
	mobility cup designed to be used 	2mm increments
	with a polyethylene liner.
	Lima Orthopaedics Australia Pty Ltd
LC166	Delta PF Acetabular Cup	Delta PF Acetabular Cup Ti6AI4V + 	44 - 76mm	$2,700.00
	Poro + HA
LC167	Met Acetabular Cup	Met Acetabular Cup CoCrMo + Poro 	42 - 64mm OD x 38 - 58mm ID	$2,700.00
	+ HA
	Medacta Australia Pty Ltd
MU008	Versafitcup Acetabular Shell	Titanium, plasma spray, with HA, 	40 to 64	$2,700.00
	variable holes
MU022	Versafitcup Dual Mobility 	Stainless steel, with titanium plasma 	from diameter 46mm to 64mm	$2,700.00
	Acetabular Shell	coating and HA, and polished inner 	 in 2mm increments
	surface for dual articulation
	Motion Orthopaedics Pty Ltd
BJ009	Global Acetabular Shell	Titanium, plasma spray, HA with 	42-72mm	$2,700.00
	variable number of holes
	Oceania Orthopaedics
OO075	Fixa Cup	Solid Titanium, Porous & HA Coated,	44-66mm	$2,700.00
	 Screw Holes with Plugs, 
	Hemispherical Acetabular Cup
	Orthotech Pty Ltd
OH295	JRI CSF Plus Cup	Titanium, plasma, HA for ceramic insert	44mm - 70mm O/D	$2,700.00
OH296	JRI CSF Plus Cup	Titanium, plasma, HA for modified 	44mm - 70mm O/D	$2,700.00
	poly insert
OH436	Samo Acetabular Cup	Acetabular cup	40 - 70	$2,700.00
	Signature Orthopaedics
SF038	Global Acetabular Shell	Titanium, plasma spray, HA with 	42-72mm	$2,700.00
	variable number of holes
Prostheses List by Category, Groups and Sponsor	Page 788 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM024	EP Fit Acetabular Shell	Titanium, plasma spray,  and HA, with	40 - 72mm Dia	$2,700.00
	 variable number of holes for 
	UHMWPE,ceramic & metal inserts
	Stryker Australia Pty Ltd
SK500	Restoration ADM Cup (Anatomic 	Chobalt-Chome; HA Coated; 	Left and Right; 48-46mm	$2,700.00
	Dual Mobility) Cup	Anatomic Dual Mobility Cup
	Flange
	Smith & Nephew Surgical Pty Ltd
SM131	POLAR CUP ACETABULAR 	Stainless steel with titanium plasma 	43-67MM	$3,700.00
	Cementless Shell	spray coating and HA and pegs & 
	flanges, that has polished inner 
	surface for dual mobility with 
	constrained UHMWPE liner/head
	Tornier Pty Ltd
TO085	Dual Mobility Cup, shell uncemented	Acetabular shell titanium Plasma 	42 to 68mm	$3,700.00
	spray + HA, flanges and/or hook.
	11.03.03.05 - Porous Metal
	Stryker Australia Pty Ltd
SK429	Trident Tritanium Acetabular Shells 	Acetabular Shell, HA Coating, 	40mm - 80mm	$3,500.00
	(PA coated)
11.03.04 - Insert/Liner
	11.03.04.01 - Unmodified polyethylene
	Austofix
AX072	Plasmaloc Poly Liner	UHMWPE	46mm to 66mm, Neutral & 	$820.00
	10 degree
	B Braun Australia Pty Ltd
BB237	Plasmacup PE insert	UMHPE unmodified liner	44mm-68mm diameters, 	$820.00
	22.2mm-32mm articulations
	Global Manufacturing Technology Pty Ltd
GM048	Fin II UHMWPE Insert	UHMWPE	44 to 72mm, 0 & 5 degree 	$820.00
	hood
Prostheses List by Category, Groups and Sponsor	Page 789 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GM115	Global Acetabular UHMWPE 	UHMWPE	44-72mm	$820.00
	Johnson & Johnson Medical Pty Ltd
DP112	Duraloc Enduron Liner	UHMWPE liner	Inner diameter 22-32mm, 36-	$820.00
	76mm outer diameter
DP222	DePuy Custom Made Acetabular 	UHMWPE custom liner for obsolete 	Made to order	$820.00
	Liners	DePuy shells
DP946	Octopus UHMWPE Liner	UHMWPE liner used with Octopus 	22.2, 28 and 32mm Size 55, 	$820.00
	Acetabular Reconstruction Shell 	50
	(DP945)
DP968	SROM Acetabular UHMWPE Liner	UHMWPE 	22-32mm	$820.00
	Link Orthopaedics  Australia
LO033	Link aceta bular Insert	UHMWPE acetabular Insert 	40 - 68mm	$820.00
LO152	BetaCup Cementless Acetabular 	UHMWPE Insert	26mm>	$820.00
	Cup System
	Mathys Orthopaedics Pty Ltd
MA419	SeleXys Acetabular UHMWPE 	UHMWPE 	44mm-72mm	$820.00
	Medacta Australia Pty Ltd
MU010	Medacta UHMWPE Liner	UHMWPE	Internal diameter 22,28,32 	$820.00
	mm, hooded & neutral, 
	hooded & neutral
MU023	Versafitcup UHMWPE  Liner	Fixed UHMWPE Liner for Versafitcup	For head diameter  22.2mm 	$820.00
	 Dual Mobility Acetabular Shell	sizes 46 - 48mm ; for head 
	diameter 28mm sizes 48 - 
	64mm
	Orthotech Pty Ltd
OH287	JRI CSF Cup insert 	UHMWPE unmodified 	28mm, 32mm, 36mm	$820.00
OH435	Samo acetabular cup poly insert	X linked poly insert	22 - 36	$820.00
	Perios Pty Ltd
PF011	Atlas Acetabular Cup System	liner polyethylene liner, Titanium & 	Atlas Poly Insert Std. Dia 	$820.00
	28 and 32mm
	RQSolutions Medical Devices Distribution Support
RQ018	2000 Plus Acetabular UHMWPE 	UHMWPE, titanium or CoCr locking 	28-32mm inner diameter	$820.00
	Liner	lug, neutral & hooded
RQ031	BS Acetabular UHMWPE Liner	UHMWPE, for all head sizes 	28mm-48mm inner diameter	$820.00
Prostheses List by Category, Groups and Sponsor	Page 790 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM026	EP Fit & MPF UHMWPE Insert	UHMWPE	40 - 68mm Dia	$820.00
	Stryker Australia Pty Ltd
ST561	Strker Omnifit/SecurFit Acetabular 	Series I and II inserts, UHMPE	22 - 36mm ID for cups 40 - 	$820.00
	Insert	80mm OD
	Tornier Pty Ltd
TO087	Dual Mobility Cup, Liner	Acetabular Liner UHMWPE	Head 22.2mm or 28mm, 	$820.00
	Diameter 42 mm to 68mm
	Wright Medical Australia
WR094	SLR Bipolar Acetabular Liners	UHMWPE	22mm - 32mm ID, ranging 	$820.00
	from 38mm to 65mm
WR119	WMT  Acetabular Liners	Duramer UHMWPE unmodified Liner	Grp 0, Grp 1, Grp 2, Grp 3, 	$820.00
	Grp 4, Grp 5, and Grp 6
WR140	Procotyl-E cup	unmodified polyethylene liner	Group 1 - 3 sizes 22 - 32	$820.00
	Zimmer Pty Ltd
ZI033	Trilogy Oblique liner	UHMPE unmodified	38 - 62	$820.00
ZI037	Trilogy  liner	UHMPE unmodified	38 - 80 in 22, 28, 32	$820.00
	11.03.04.02 - Modified polyethylene
	Austofix
AX095	C2 XL2 Polyethylene Liner	XL2 Polyethylene Liner	32-48mm, 32-50mm, 32-	$1,160.00
	52mm, 32-54mm, 32-56mm, 
	32-58mm, 32-60mm, 32-
	62mm, 32-64mm, 32-66mm, 
	36-68mm, 36-52mm, 36-
	54mm, 36-56mm, 36-58mm, 
	36-60mm, 36-62mm, 36-
	64mm, 36-66mm, 36-68mm.
	Biomet Australia Pty Ltd
BI106	Mallory Head Hip System	Acetabular Liner, UHMWPE, 	36mm	$1,160.00
BI972	E-Poly HXLPE Liner	Highly cross linked PE liner, 	28mm to 44mm in 4mm 	$1,160.00
	stabilised with Vit E	increments
Prostheses List by Category, Groups and Sponsor	Page 791 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR163	Trinity polyethylene liner	Highly cross linked Polyethylene 	28mm, 32mm, 36mm, 40mm	$1,160.00
	liner in neutral +4mm offset +4mm 
	oblique and 4mm elevated wall 
	variants for use with the Trinity 
	acetabular multi-bearing shell
	DJO Australasia Pty Ltd
DD044	FMP Acetabular System - 	Acetabular cup inserts, UHMWPE 	ID of 22mm, 28mm, 32mm to 	$1,160.00
	Acetabular Cup Insert UHMWPE	compression moulded and cross-	suit Acetabular shells of 
	linked.  22mm, 28mm and 32mm 	OD 40mm-70mm, available 
	Internal Diameters available in 0-	in 0,10,20-degree hooded 
	degree (neutral), 10-degree hooded 	options
	and 20-degree hooded options.
	Exactech Australia
EX004	Novation GXL Liner	The GXL Liner are indicated for use in	Liner Neutral: Group 1: 	$1,160.00
	 skeletally mature individuals 	28mm ID, Group 2: 28mm 
	undergoing primary surgery for total 	IS, 32mm ID, Group 3: 
	hip replacement	32mm ID, 36mm ID; Group 
	4: 32mm, 36mm, Group 5: 
	32mm, 36mm, Liner 
	"Lipped": Group 1: 28mm, 
	Group2: 28mm, 32mm, 
	Group 3: 36mm, Group 4: 
	32mm, 36mm, Group 5: 
	36mm, Liner "+5 
	Lateralised" G
Prostheses List by Category, Groups and Sponsor	Page 792 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Manufacturing Technology Pty Ltd
GM125	Global Acetabular System HCLA 	HCLA (highly Cross-Linked and 	68-76mm/36	$1,160.00
	(highly Cross-Linked and 	Annealed) Acetabular Insert	68-76mm/32
	Annealed) Acetabular Liner	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58mm/32
	56-58mm/28
	52-54/32
	52-54mm/28
	50mm/28
	46-48mm/28
	
	10 Degree
	
	68-76mm/36
	68-76mm/32
	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58
GM129	Contile Fin II Acetabular Insert 	Acetabular Insert Highly Cross 	Diameter 28mm 44mm to 	$1,160.00
	Highly Cross Linked Polyethylene	Linked Polyethylene	72mm Neutral to 10 Degree, 
	Diameter 32mm 44mm to 
	72mm Neutral to 10 Degree, 
	Diameter 36mm 44mm to 
	72mm Neutral to 10 Degree, 
	Diameter 40mm 44mm to 
	72mm Neutral to 10 Degree
	Johnson & Johnson Medical Pty Ltd
DY036	Duraloc Marathon Acetabular 	UHMWPE, highly cross linked, 	Sizes 36-76mm	$1,160.00
	UHMWPE Cross Linked Liner
DY210	Pinnacle Acetabular Cross Linked 	UHMWPE, highly cross linked insert	22-48mm ID	$1,160.00
	UHMWPE Insert
	Lifehealthcare Pty Ltd
LH174	GL - U Hooded Liner	Hooded/Flat Insert	46, 48, 50, 52, 54, 56, 58, 	$1,160.00
	60, 62, 64mm
Prostheses List by Category, Groups and Sponsor	Page 793 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lima Orthopaedics Australia Pty Ltd
LC170	Delta Non Constrained Liner	Delta Non Constrained Liner 	ID 28mm x OD 40 - 58mm	$1,160.00
	UHMWPE X Lima Ti6AI4V Neutral 
	and Protruded
LC171	SPH Constrained Poly Liner	SPH Constrained Poly Liner 	ID 32mm x Size B, C, D, E	$1,160.00
	UHMWPE protruded 20*
	Mathys Orthopaedics Pty Ltd
MA503	Selexys Acetabular Cup Liner	Insert / Liner, modified polyethylene.  	Articulation 28, 32, 36mm; 	$1,160.00
	Highly crossed link polyethylene, 	Cup size AA to LL (42 to 
	stabilised with Vit E.	70mm)
	Medacta Australia Pty Ltd
MU019	Medacta Highly Crosslinked 	Highly Crosslinked UHMWPE	Internal diameter 22, 	$1,160.00
	UHMWPE Liner	28,32,36, 40 mm neutral & 
	hooded
	Motion Orthopaedics Pty Ltd
BJ008	Global Acetabular System HCLA 	HCLA (highly Cross-Linked and 	68-76mm/36	$1,160.00
	(highly Cross-Linked and 	Annealed) Acetabular Insert	68-76mm/32
	Annealed) Acetabular Liner	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58mm/32
	56-58mm/28
	52-54/32
	52-54mm/28
	50mm/28
	46-48mm/28
	
	10 Degree
	
	68-76mm/36
	68-76mm/32
	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58
Prostheses List by Category, Groups and Sponsor	Page 794 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO077	Adler PE Acetabular Liners	XLPE Liners - for Fixa Cups	Neutral, 15 degree, in 	$1,160.00
	22,28,32,36mm ID
	Orthotech Pty Ltd
OH298	JRI CSF Plus Cup Insert 	UHMWPE modified 	10 degree liners 28mm, 	$1,160.00
	32mm, 36mm
	Signature Orthopaedics
SF027	Cross Linked Acetabular Liner	Highly Cross linked Acetabular Liner	Liner Neutral: Group 1: 	$1,160.00
	28mm ID, Group 2: 28mm 
	IS, 32mm ID, Group 3: 
	32mm ID, 36mm ID; Group 
	4: 32mm, 36mm, Group 5: 
	32mm, 36mm, Liner 
	"Lipped": Group 1: 28mm, 
	Group2: 28mm, 32mm, 
	Group 3: 36mm, Group 4: 
	32mm, 36mm, Group 5: 
	36mm, Liner "+5 
	Lateralised" G
Prostheses List by Category, Groups and Sponsor	Page 795 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SF039	Global Acetabular System HCLA 	HCLA (highly Cross-Linked and 	68-76mm/36	$1,160.00
	(highly Cross-Linked and 	Annealed) Acetabular Insert	68-76mm/32
	Annealed) Acetabular Liner	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58mm/32
	56-58mm/28
	52-54/32
	52-54mm/28
	50mm/28
	46-48mm/28
	
	10 Degree
	
	68-76mm/36
	68-76mm/32
	68-76mm/28
	60-66mm/36
	60-66mm/32
	60-66mm/28
	56-58mm/36
	56-58
	Smith & Nephew Surgical Pty Ltd
SM029	EP Fit & MPF Highly cross linked 	Modified UHMWPE	42 -76mm Dia, all head sizes	$1,160.00
	UHMWPE Insert
SN291	Reflection	Acetabular Liner XLPE modified 	22 - 44mm inner diameter, 	$1,160.00
	UHMPE	42 - 80mm outer diameter
	Stryker Australia Pty Ltd
HW072	Vitalock Acetabular system 12  	UHMPE 	22mm,26mm,28mm, 32mm ID	$1,160.00
	Crossfire liner
SK318	X3 Trident Acetabular Inserts	Modified UHMPE	Inner diameters: 22mm, 	$1,160.00
	26mm, 28mm 32mm, 36mm, 
	38 - 64mm.  For outer 
	diameter shells 40mm - 
	80mm.
ST546	Stryker Acetabular Crossfire Insert	Modified UHMPE	22 -36mm  ID	$1,160.00
ST549	Trident acetabular component 	Trident polyethlene liner, enhanced 	22, 26, 28, 32mm dia	$1,160.00
	polyethlene
Prostheses List by Category, Groups and Sponsor	Page 796 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ST931	Stryker Acetabular Insert	Enhanced Polyethylene insert	22 - 36mm ID	$1,160.00
	Wright Medical Australia
WR087	Lineage A-Class Crosslinked 	Standard and lateralized, 0deg and 	28, 32, 36ID	$1,160.00
	Polyethylene Liner	15deg lipped crosslinked
WR103	Dynasty Acetabular System /poly 	A-class Crosslinked polyethylene 	ID 22,28,32,36, 38,40,42,46	$1,160.00
	liner, standard and lipped, large head 
WR106	Procotyl L A-class Crosslinked 	A-class crosslinked poly liners, 	28, 32, 36, 40 ID	$1,160.00
	polyethylene liner,standard & 	standard and lipped liners
	lipped, large head options
	Zimmer Pty Ltd
ZI360	Converge	Durasul Insert - Special UHMWPE	22/39 to 38/81mm 	$1,160.00
ZI491	Trabecular Metal Acetabular 	UHMPE modified 	28mm x 48mm-80mm - 0deg 	$1,160.00
	Revision System Longevity Liner 	& 10deg; 32mm x 54-80mm -
	 0deg & 10 deg; 36mm x 
	58mm-80mm - 0deg & 
	10deg; 40mm x 62-80mm - 
	0deg & 10 deg
ZI620	Continuum Acetabular System	HXPE Liner (Highly Cross Linked) - 	28mm Neutral - EE to QU; 	$1,160.00
	Neutral, Elevated, Offset and Oblique	32mm Neutral GG to VV; 
	36mm Neutral II to W; 
	40mm Neutral KK to VV; 
	22mm Elevated - CC to FF; 
	28mm Elevated EE to QU; 
	32mm Elevated GG to VV; 
	36mm Elevated II to VV; 
	28mm 7 mm Offset CC28 to 
	QU28; 32mm 7mm Offset 
	EE32 to QU32; 36m
	SCP
	Zimmer Pty Ltd
ZI045	Longevity XLPE Acetabular liner	UHMPE modified	46 - 70	$1,560.00
ZI046	Acetabular Cup	Longevity XLPE Polyethylene Liner 	38 - 80	$1,560.00
	20 Degree
ZI047	Acetabular Cup	Longevity XLPE Polyethylene Liner 	38 - 80	$1,560.00
	10 Degree
ZI048	Acetabular Cup	Longevity XLPE Polyethylene Liner 	38 - 80	$1,560.00
	0 Degree 
Prostheses List by Category, Groups and Sponsor	Page 797 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI357	Alpha Durasul Insert	UHMPE modified 	22mm x 42 to 28mm x 68	$1,560.00
	11.03.04.03 - Ceramic
	Amplitude Australia
LI044	Horizon Ceramic Liner	Ceramic insert, Biolox Forte	9 sizes for 28, 32 and 36mm 	$2,560.00
	heads
	Austofix
AX063	Austofix Ceramic System	Captiv ceramic liner - Biolox	48-69mm	$2,560.00
AX070	Plasmaloc Ceramic Liner	Biolox Forte	46mm to 66mm	$2,560.00
	Biomet Australia Pty Ltd
BI073	Modular Ceramic System	Acetabular Ceramic/ Polyethylene 	28mm to 44mm in 4mm 	$2,560.00
	Liner, UHMWPE	increments
	Exactech Australia
EX001	Novation Ceramic AHS Liner	Novation Ceramic AHS is indicated 	Group 1 brown 28mm ID, 	$2,560.00
	for use in primary total hip 	Group 2 Blue 32mm ID, 
	arthroplasty in skeletally mature 	Group 3 gray 36mm, Group 
	patients with non-inflmmatory 	4 purple 36mm ID, Group 5 
	green 36mm ID
	Global Manufacturing Technology Pty Ltd
GM049	Fin II Ceramic Insert	Ceramic, Biolox Forte	44 to 72mm	$2,560.00
GM114	Global Acetabular Ceramic Insert	Ceramic, Biolox Delta	44-72mm	$2,560.00
	Johnson & Johnson Medical Pty Ltd
DY034	Duraloc Option Acetabular Shell 	Ceramic, Biolox Forte	46-66 mm	$2,560.00
	Ceramic Insert
	Lifehealthcare Pty Ltd
LH177	GL - Alumina U Liner	Ceramic Insert Biolox	46-64mm (increment by 2mm)	$2,560.00
	Link Orthopaedics  Australia
LO151	BetaCup Cementless Acetabular 	Ceramic Insert	28mm>	$2,560.00
	Cup System
	Mathys Orthopaedics Pty Ltd
MA421	SeleXys Acetabular Bionit Ceramic 	Bionit ceramic (alumina)	44-72mm	$2,560.00
	Liner
Prostheses List by Category, Groups and Sponsor	Page 798 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU012	Versafitcup Ceramic Insert	Ceramic, Biolox Forte	Head dia 28mm (48 to 64) or	$2,560.00
	 32mm (52 to 64) or 36mm 
	(54 to 64)
	Oceania Orthopaedics
OO078	Adler Ceramic Acetabular Liners	Ceramic Liners - for Fixa Cups	Biolox Forte & Delta, 	$2,560.00
	28,32,36 & 40 mm ID
OO139	Implantcast delta ceramic liner	Biolux delta cup liner	32/39, 32/44,36/44, 	$2,560.00
	32/48,36/48,32/52, 36/52
	Orthotech Pty Ltd
OH288	JRI CSF Cup Ceramic Insert	Ceramic Inserts, Alumina oxide, 	28mm	$2,560.00
	Biolox Forte
OH297	JRI CSF Plus Cup ceramic Insert	CSF Plus Cup Liner, Delta Liner 	28mm, 32mm, 36mm	$2,560.00
OH437	Samo acetabular cup ceramic insert	Ceramic insert	28 - 40	$2,560.00
	RQSolutions Medical Devices Distribution Support
RQ019	2000 Plus Acetabular Ceramic Liner	Ceramic, (Alumina & Polyurethane), 	28-32mm inner diameter	$2,560.00
	hooded & neutral
	Smith & Nephew Surgical Pty Ltd
SM027	EP Fit & MPF Ceramic Insert	Ceramic, Biolox Forte	For 42 -76mm shells, all 	$2,560.00
	head sizes
SN297	Reflection 	Acetabular Liner Ceramic, AlO3 	28 - 36mm, 46 - 66mm OD	$2,560.00
	biolox forte
	Stryker Australia Pty Ltd
ST565	Alumina acetabular inserts	Ceramic insert, alumina	28, 32 & 36mm dia	$2,560.00
	Tornier Pty Ltd
TO082	Dynacup Insert Ceramic	Hip Acetabular Insert, Biolox Delta 	32mm or36mm Head	$2,560.00
	Ceramic
	Wright Medical Australia
WR125	Transcend/ Lineage Articulation 	Ceramic Liner, biolox forte	28mm & 32mm Group 1,2,3 	$2,560.00
	System	& 4
WR134	Procotyl-E cup ceramic inserts	Ceramic insert, biolox forte	Group 1 - 3, Size 28 and 32	$2,560.00
	Zimmer Pty Ltd
ZI044	Trilogy AB Ceramic Liner	Biolox forte	48 - 70	$2,560.00
Prostheses List by Category, Groups and Sponsor	Page 799 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Ring
	Lima Orthopaedics Australia Pty Ltd
LC169	Delta Liner - Biolox Forte	Delta Liner - Biolox Forte + Ti6AI4V	28 - 40mm ID x Size A to E	$2,660.00
	Sandwich
	Perios Pty Ltd
PF009	Atlas Acetabular Cup System	liner - ceramic and poly 'Titanium & HA	Atlas Alumina Insert Dia 	$2,560.00
	28mmort
	11.03.04.04 - Metal
	Biomet Australia Pty Ltd
BI057	M2A taper 	Metal Acetabular Insert, Chrome 	Standard	$2,100.00
	Corin Australia Pty Ltd
CR164	Trinity Metal Liner	Metal liner for use with the Trinity 	28mm, 32mm, 36mm, 40mm	$2,100.00
	acetabular shell
	Global Manufacturing Technology Pty Ltd
GM119	Global Metal Acetabular Inserts	CoCr, metal on metal, varying diameter	Multiple sizes	$2,100.00
GM127	Contile Finn II, Acetabular system, 	Acetabular Insert Metal	metal on metal 28mm 44mm 	$2,100.00
	insert metal	to 50mm
	metal on metal 32mm 48mm 
	to 62mm
	metal on metal 36mm 52mm 
	to 72mm
	Global Orthopaedic Technology
GO234	Novae Double Mobility Cup Insert	A cementless metal acetabular dual 	22mm x 43 - 69mm diameter 	$2,100.00
	mobility cup designed to be used 	in 2mm increments
	with a polyethylene liner.	28mm x 47 - 69mm diameter 
	in 2mm increments
	Lima Orthopaedics Australia Pty Ltd
LC012	Lima Cup 	Metal Liner	28mm, 32mm and 36mm	$2,100.00
	Mathys Orthopaedics Pty Ltd
MA495	SeleXys Acetabular metal (metamys) 	metal on metal acetabular liner	42mm, 44mm, 50mm, 54mm 	$2,100.00
	inlays	and 56mm
	Oceania Orthopaedics
OO076	Adler Metal Acetabular Liners	Metal Liners - for Fixa Cups	Metal Liner 32.36, 40mm ID	$2,100.00
Prostheses List by Category, Groups and Sponsor	Page 800 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN845	Reflection	CoCr Acetabular Insert	52 - 60mm	$2,100.00
	Stryker Australia Pty Ltd
HW485	MDM CoCr Liner	Modular Dual Mobility (MDM) CoCr 	The MDM CoCr Liner 	$2,100.00
	Liner	comes in a range of inner 
	diameters of 36mm - 58mm
	Wright Medical Australia
WR090	Transcend/Lineage Articulation 	Metal CoCr Liner	Grp 1, Grp 2, Grp 3, Grp 4  	$2,100.00
	System	28, 32 & 36mm
WR104	Dynasty Acetabular System / metal 	Dynasty Metal liner	ID 28,32,36,38,40,42,44,48	$2,100.00
	liner, large head options
WR108	Procotyl L metal liner, large head 	CoCr superfinished Metal liners	28,32,36ID	$2,100.00
	options
	Zimmer Pty Ltd
ZI619	Continuum Acetabular System	Metasul Taper Liners	28mm DD28 to GG28; 	$2,100.00
	32mm FF32 to II32; 36mm 
	HH36 to TT36; 40mm JJ40 
	to W40
	Sandwich
	DJO Australasia Pty Ltd
DD043	FMP Acetabular System - 	Modular metal on metal liner, 	28mm ID, 34mm ID, 38mm 	$2,300.00
	Acetabular cup insert, metal on 	available in 28mm ID, 34mm ID, 38mm	ID, to fit FMP Acetabular 
	 ID, to fit FMP Acetabular Cup system	Cups from 48 mm to 70mm OD
	Mathys Orthopaedics Pty Ltd
MA494	SeleXys Acetabular metal (metamys) 	metal on metal acetabular liner with 	42mm - 72mm in 2mm 	$2,300.00
	inlays	UHWPE- metal sandwich for larger 	increments
	sizes
	Zimmer Pty Ltd
ZI389	Metasul Liner for CLS,  Fitmore and 	UHMPE unmodified with metal insert	28mm	$2,300.00
	Allofit
Prostheses List by Category, Groups and Sponsor	Page 801 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.03.04.05 - Constrained
	Amplitude Australia
LI045	Saturne acetabular liner	Polyethylene liner for double 	Sizes 44/22; 46/22; 48/28; 	$1,836.00
	mobility cup	50/28; 54/28; 56/28; 
	60/28; 64/28; 66/28
	Biomet Australia Pty Ltd
BH041	Avantage Dual Mobility Acetabular	UHMWPE Dual Mobility Liner	44-66mm diameter shells	$1,836.00
	 Cup Inlay
BI092	Mallory Head Hip System	Acetabular Liner,  Constrained, 	28-38mm	$1,836.00
	Ringloc, UHMWPE
BI878	Freedom Constrained Liner	Constrained Acetabular Liner - 	23mm to 62mm in 1mm 	$1,836.00
	UHMWPE, Ti	increments
BI928	Tripolar Acetabular Cup Series	Ringloc Series, UHMWPE, Chrome 	24-28mm	$1,836.00
	Cobalt
	DJO Australasia Pty Ltd
DD046	FMP Acetabular System - 	28mm constrained liner and titanium 	28mm ID, from MP5 to 	$1,836.00
	Constrainer Liner	locking ring is used with the FMP 	MP12 (40mm through to 
	acetabular system to treat recurrent 	70mmOD)
	dislocation.
	Exactech Australia
EX005	Novation Crown Cup Constrained 	Sphere and taper liner diameter 	Locking Ring is one size 	$1,836.00
	Liner and Ring	geometry for compatability with the 	and Constrained Liner: 
	Novation Crown Cup	Group 1: 48/50mm, shells, 
	38mm ID; Group 2: 
	53/54mm, shells, 32mm ID; 
	Group 3: 56/58mm shells, 
	36mm ID; Group 4: 
	60/62mm shells, 36mm ID; 
	Group 5: 64/66/68mm 
	shells, 36mm ID
	Global Manufacturing Technology Pty Ltd
GM124	Global Acetabular System- Highly 	highly cross linked and annealed 	28mm, 32mm  36mm 	$1,836.00
	cross-linked and Annealed 	constrained liner	Diameter Neutral, 10 degree 
	constrained liner	and 20 degree size range 
	44mm to 72mm
Prostheses List by Category, Groups and Sponsor	Page 802 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GM126	Global acetabular system - 	constrained polyethylene liner	Diameter 28mm, 32mm and 	$1,836.00
	constrained liner	36mm 44mm to 72mm 
	Neutral, 10 degree and 20 
	degree
	Johnson & Johnson Medical Pty Ltd
DP969	SROM Acetabular Constrained 	UHMWPE Constrained liner 	0Deg, 10 Deg, 28mm, 32mm,	$1,836.00
	UHMWPE Liner	includes locking ring
JJ703	Gyros Hip System	Dual mobility constrained liners, 	44-68mm	$1,836.00
	unmodified UHMWPE for Gyros Cup.
	Medacta Australia Pty Ltd
MU024	Versafitcup UHMWPE  Constrained	UHMWPE Constrained Liner for 	For head diameter 22mm 	$1,836.00
	 Liner	Versafitcup Dual Mobility Acetabular	sizes 46 - 64mm. For had 
	 Shell	diameter 28mm sizes 48 - 
	64mm.
MU098	Versafitcup HX UHMWPE 	HighCross UHMWPE Constrained 	From Ø 46 to Ø 64mm for 	$1,836.00
	Constrained Liner	Liner for Versafitcup Dual Mobility 	head Ø 22mm. From Ø 48 to 
	Acetabular Shell	Ø 64mm for head Ø 28mm.
	Oceania Orthopaedics
OO036	IC Polaric head	IC Polaric head	38, 40, 42, 44, 46, 48, 50, 	$1,836.00
	52, 54, 56, 58
	RQSolutions Medical Devices Distribution Support
RQ033	PE Liner 2000 Plus S-Snap Lock	Constrained Acetabular Liner - 	32mm inner diameter, 52-	$1,836.00
	UHMWPE, neutral	68mm outer diameter
	Signature Orthopaedics
SF037	Global Acetabular System- Highly 	highly cross linked and annealed 	28mm, 32mm  36mm 	$1,836.00
	cross-linked and Annealed 	constrained liner	Diameter Neutral, 10 degree 
	constrained liner	and 20 degree size range 
	44mm to 72mm
	Smith & Nephew Surgical Pty Ltd
SM134	POLAR Dual Mobility Constrained	UHMWPE	FOR '22.2-28MM Head 	$1,836.00
	 Liner	sizes and 43-72MM 
	diameter shells
SM135	POLAR Dual Mobility Constrained	Modified UHMWPE	FOR '22.2-28MM Head 	$1,836.00
	 Highly Cross Linked Liner	sizes and 43-72MM 
	diameter shells
SN689	Reflection	Constrained Acetabular Liner 	22 - 32mm, 42 - 76mm	$1,836.00
	unmodified UHMWPE
Prostheses List by Category, Groups and Sponsor	Page 803 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN856	R3 Acetabular System	XLPE Constrained Acetabular liner	40-78mm	$1,836.00
	Stryker Australia Pty Ltd
SK501	Restoration Anatomic Dual 	The polyethylene insert for the 	42mm - 58mm  Inserts are 0 	$1,836.00
	Mobility Polyethylene Insert	Restoration ADM component 	degrees with an inner 
	articulates with the highly polished 	diameter of 28mm
	inner surface of the Restoration ADM 
	cup and is articul;ated with a standard
	 cobalt-chrome or ceramic 28mm 
	diameter femoral head
SR067	Anatomic X3 Liners	Anatomic X3 Liner with constraint	36mm, 40mm, 44mm, 48mm 	$1,836.00
	and 52mm
ST539	Constrained acetabular insert 	UHMPE & cobalt chrome bipolar 	22, 26, 28, 32mm dia	$1,836.00
	constrained insert
	Zimmer Pty Ltd
ZI030	Trilogy Constrained Liner - 	UHMPE unmodified 	50 - 80	$1,836.00
	Polyethylene
ZI561	Trabecular Metal Acetabular 	Cemented Constrained Liner	50x28mm; 52x28mm; 	$1,836.00
	Revision System	54x32mm; 56x32mm; 
	58x36mm; 60x36mm; 
	66/68/70x36mm; 
	72/74x36mm; 
	76/78/80x36mm
ZI568	Trilogy Acetabular System	Longevity Constrained Liner	50/52/54mmODx28mmID; 	$1,836.00
	56mmODx32mmID; 
	58mmODx32mmID; 
	60mmODx36mmID; 
	62mmODx36mmID; 
	64mmODx36mmID; 
	66mmODx36ID; 
	68mmODx36mmID; 
	70mmODx36mmID; 
	72mmODx36mmID; 
	74mmODx36mmID; 
	76mmODx36mmID; 
	78mmODx36mmID; 
	80mmODx36mmID
Prostheses List by Category, Groups and Sponsor	Page 804 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Cup & Ring
	Johnson & Johnson Medical Pty Ltd
DP014	Duraloc & Pinnacle Constrained 	UHMWPE, constrained liner with 	Inner diameter 28-44mm, 36-	$1,836.00
	Inserts	titanium alloy locking ring	76mm outer diameter
	Stryker Australia Pty Ltd
ST932	Stryker Trident Constrained 	Two pre assembled components: 	Sizing 22 - 32mm in 0 	$1,836.00
	Acetabular Insert	Outer insert component and a 	degrees & 10 degrees
	captured UHR (Universal Head) 
	component.  Composition - Cobalt 
	chrome alloy and UHMWPE (ultra 
	high molecular weight polyethylene) 
	with a Titanium 6A1-4V ELI alloy 
	Zimmer Pty Ltd
ZI737	LONGEVITY CONSTRAINED 	Longevity HXPE constrained Liner 	Inner Diameter: 28mm, 	$1,836.00
	LINER	with Titanium Alloy Locking Ring	32mm and 36mm head size.  
	Outer Diameter 50mm to 
	80mm shell size in 2mm 
	increments.
	11.03.04.06 - Ceramic Mix
	B Braun Australia Pty Ltd
BB235	Plasmacup Ceramic Insert	Biolox liner	26mm, 28mm, 32mm, 36mm	$2,620.00
	Corin Australia Pty Ltd
CR158	Biolox Delta Acetabular Liner	Biolox Delta ceramic acetabular liner	28mm, 32mm, 36mm, 40mm	$2,620.00
	Global Manufacturing Technology Pty Ltd
GM130	Contile Fin II Acetabular Biolox 	Contile Fin II Acetabular Biolox 	Inserts 28mm 44mm to 	$2,620.00
	Delta Ceramic Liners	Delta Ceramic Liner inserts 	46mm, Inserts 32mm 48mm 
	28mm,32mm, 36mm & 46mm	to 66mm, Inserts 36mm 
	52mm to 66mm, Inserts 
	40mm 56mm to 66mm
	Global Orthopaedic Technology
GO247	Contile Fin II Acetabular Biolox 	Contile Fin II Acetabular Biolox 	Inserts 28mm 44mm to 	$2,620.00
	Delta Ceramic Liners	Delta Ceramic Liner inserts 	46mm, Inserts 32mm 48mm 
	28mm,32mm, 36mm & 46mm	to 66mm, Inserts 36mm 
	52mm to 66mm, Inserts 
	40mm 56mm to 66mm
Prostheses List by Category, Groups and Sponsor	Page 805 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY512	Pinnacle Acetabular Cup System	Pinnacle ceramic liner	44 - 66mm	$2,620.00
	Lima Orthopaedics Australia Pty Ltd
LC168	Delta Ceramic Liner Biolox Delta	Delta Ceramic Liner Biolox Delta	28 - 40mm ID x Small to 	$2,620.00
	Large
	Mathys Orthopaedics Pty Ltd
MA486	SeleXys Acetabular Ceramys 	Ceramys ceramic (zirconia & alumina 	28/AA, 28/BB, 28/CC, 	$2,620.00
	Ceramic Liner	combination)	28/DD, 32/CC, 32DD, 
	32/EE, 32/FF,36/EE, 36/FF,
	 36/GG, 386HH,36/II, 36/JJ,
	 36/KK, /36/LL
	Medacta Australia Pty Ltd
MU013	Delta Ceramic Liners	Ceramic, Delta	28mm (A to G), 32mm (C to 	$2,620.00
	G), 36mm (E to G), 40mm (F 
	to G)
	Motion Orthopaedics Pty Ltd
BJ007	Biolox Delta Acetabular Liner	Biolox Delta ceramic acetabular liner	28mm, 32mm, 36mm, 40mm	$2,620.00
	Signature Orthopaedics
SF031	Biolox Delta Acetabular Liner	Biolox Delta ceramic acetabular liner	28mm, 32mm, 36mm, 40mm, 	$2,620.00
	44mm, 48mm
	Smith & Nephew Surgical Pty Ltd
SM143	EP fit & MPF Delta Ceramic Insert	Ceramic Delta Acetabular Liners	44mm-72mm *28mm - 44mm	$2,620.00
	Wright Medical Australia
WR099	Procotyl L Delta Ceramic Liner	Delta ceramic liners	28, 32, 36, 40, 44 ID	$2,620.00
	Zimmer Pty Ltd
ZI621	Continuum Acetabular System	Biolox Delta Taper Ceramic Liner	28mm: EE28 to HH28; 	$2,620.00
	32mm: GG32 to JJ32; 
	36mm: II36 to TT36; 40mm: 
	KK40 to VV40
	Ring
	Smith & Nephew Surgical Pty Ltd
SN855	R3 Acetabular system	Delta Ceramic Liner	40-78mm	$2,620.00
Prostheses List by Category, Groups and Sponsor	Page 806 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.03.05 - Bonded Shell/Liner
	11.03.05.01 - Unmodified polyethylene
	Mathys Orthopaedics Pty Ltd
MA513	RM Acetabular Cup, Metal on Metal	Titanium bonded UHMWPE Cup, 	46 to 68mm	$3,000.00
	with and without lugs
	11.03.05.02 - Modified polyethylene
	Mathys Orthopaedics Pty Ltd
MA502	RM Pressfit Acetabular Cup	Acetabular component - Bonded Shell	28, 32, 36mm 	$3,340.00
	 / Liner - polyethylene modified.  Ti 	(Articulation); 44 to 70mm 
	coated monoblock, bearing surface is 
	Vit E stabilised highly cross linked 
	polyethylene
	11.03.05.04 - Metal
	Sandwich
	Mathys Orthopaedics Pty Ltd
MA512	RM Classic Acetabular Cup, Metal 	Titanium bonded UHMWPE Cup, 	46 - 68mm	$4,200.00
	on Metal	with metal inlay bearing surface, with 
	and without lugs
	11.03.05.05 - Ceramic Mix
	B Braun Australia Pty Ltd
BB318	Plasmacup Delta	36mm combination plasmacup HA 	32mm x 44mm - 46mm 	$5,220.00
	coated shell & Biolox Delta liner	diameter
	36mm x 48mm - 54mm 
	diameter
	Johnson & Johnson Medical Pty Ltd
DY547	Delta motion acetabular cup	Titanium, plasma with HA cup with 	42 - 68mm OD	$5,220.00
	preassembled delta ceramic liner
Prostheses List by Category, Groups and Sponsor	Page 807 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.03.06 - Solid Metal, Not Resurfacing
	Biomet Australia Pty Ltd
BI055	M2A taper 	Metal on Metal Acetabular Shell, 	46 - 70mm	$2,300.00
	Titanium
BI783	M2a Modular Head Component & 	Metal on Metal Acetabular, Chrome 	48-70 mm	$2,300.00
	Special Acetabular Cup	Cobalt, Ti, no HA
11.03.07 - Resurfacing Cup
	11.03.07.01 - Metal
	Biomet Australia Pty Ltd
BI841	Resurfacing Hip System	Acetabular Shell CoCr, Ti	44 - 66mm	$4,650.00
	Wright Medical Australia
WR086	Conserve Total SUPERFIX Shell	Porous coated, super finished, 	50mm - 72mm OD	$4,650.00
	revision resurfacing cup with fins and 
	Zimmer Pty Ltd
ZI467	Durom resurfacing cup 	CoCr and Titanium, plasma spray, non 	A - V	$4,650.00
	HA 
	11.03.07.02 - Metal, HA Coated
	Biomet Australia Pty Ltd
BI842	Resurfacing Hip System	Acetabular Shell CoCr, Ti, HA Coated	44 - 66mm	$5,150.00
	Corin Australia Pty Ltd
CR048	Cormet Resurfacing Cup	Metal on Metal bearing surface, 	Dia 40 -56mm	$5,150.00
	Titanium, Plasma spray with HA 
	Coating (Bicoat)
	Global Orthopaedic Technology
GO048	ICON Acetabular Cup	CoCr, beaded, HA coating, with fins, 	44-66mm cups	$5,150.00
	resurfacing, metal on metal
	MatOrtho
MJ002	Adept MoM Acetabular Component	Porocast beaded Shell , Co Cr, HA 	44-66mm Outer diameter 	$5,150.00
	coated size 44-66mm	going up in 2mm increments
Prostheses List by Category, Groups and Sponsor	Page 808 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU055	ROMAX Acetabular Cup	Cementless Acetabular Cup, HA coated	From diameter 44-66mm, 	$5,150.00
	every 2mm
	Smith & Nephew Surgical Pty Ltd
SN742	Birmingham Hip Resurfacing 	Cobal Chrome, beaded, HA	44 - 66 mm cups	$5,150.00
	Prostheses - Acetabular Cup
	Wright Medical Australia
WR122	CONSERVE PLUS Total Hip 	Titanium Acetabular Shell - Super 	ID 36 - 54mm, OD 42 - 	$5,150.00
	Resurfacing System	Polished	70mm
WR145	Conserve Plus Total Hip 	Titanium Thin Acetabular Shell - 	36 - 54mm ID in 2mm 	$5,150.00
	Resurfacing System	Super Polished	Increments
	Flange
	Corin Australia Pty Ltd
CR087	Cormet Dysplasia Cup	Dysplasia cup with three-holed 	48, 52, 56, 60, 64mm	$7,000.00
	proximal flange, Metal on Metal 
	bearing surface, Titanium, Plasma 
	spray with HA Coating (Bicoat)
	MatOrtho
MJ003	Adept MoM Acetabular Component 	Porocast beaded Shell , Co Cr, HA 	46-66mm Outer diameter 	$7,000.00
	- Extra Fixation Cup	coated, dysplasia flange 	going up in 4mm increments
	Smith & Nephew Surgical Pty Ltd
SN744	Birmingham Hip Resurfacing 	Cobal Chrome, beaded, HA with 	Dysplasia Cups:  46 - 66 	$7,000.00
	Dysplasia Cup	screw fixation	mm cups
	Wright Medical Australia
WR113	Quadra-Fix Acetabular Shell	Dysplasia Cup, Porous Coated, HA	O.D. 44mm - 66mm	$7,000.00
11.03.08 - Acetabular Reconstruction Devices
	11.03.08.01 - Shell
	Amplitude Australia
LI046	Saturne reconstruction cup	Dual coated, mobile, cementless 	Sizes: 50 - 66mm	$3,166.00
	reconstruction cup
	B Braun Australia Pty Ltd
BB247	Reconstruction Shell	Isotan	52-64mm, left and right	$3,166.00
Prostheses List by Category, Groups and Sponsor	Page 809 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BI704	Par 5 Protrusio Acetabular System	Acetabular reconstruction Shells - 	56 - 72mm	$3,166.00
	Titanium Metal, no HA
BI836	Par 5 Protrusio Acetabular System	Acetabular reconstruction Shell CrCo,	56 - 72mm	$3,166.00
	 Ti, HA Coated
BI970	Regenerex Revision Shell	Acetabular support component 	54 to 76mm OD,  44 to 66 	$3,166.00
	Porous Ti Alloy
	Johnson & Johnson Medical Pty Ltd
DP945	Octopus Acetabular Reconstruction	Titanium, grit blast, HA coating, 	Size 50, 55mm	$3,166.00
	 Shell	rimmed, used in conjunction with 
	Octopus Outer Reconstruction Ring 
	(DP948) 
	Lima Orthopaedics Australia Pty Ltd
LC022	Delta Revision TT Acetabular Cup	Delta Revision TT Acetabular Cup Ti	50 - 66mm	$3,166.00
	Link Orthopaedics  Australia
LO013	Link  Acetabular Reconstruction 	Acetabular reconstruction shell	45 - 55 mm	$3,166.00
	Cup System
	RQSolutions Medical Devices Distribution Support
RQ023	Cranial Acetabular Reconstruction 	CoCr, Titanium, 3 dimensional, non 	52mm - 72mm Left and Right	$3,166.00
	Shells	HA, various locking & flanges from 
	eccentric to small & large proximal 
	flanges
	Wright Medical Australia
WR133	Procotyl-E cup	acetabular reconstruction shell 	52mm - 76mm, in 2mm 	$3,166.00
	titanium alloy	increments
	Zimmer Pty Ltd
ZI249	Trabecular Metal Reconstruction 	Porous tantalum, reconstruction shell 	22 and 28mm diameter	$3,166.00
	Eccentric
	Johnson & Johnson Medical Pty Ltd
DP975	SROM Oblong Acetabular Shell	Titanium, beaded, non HA, double 	51-66mm - L, R or neutral	$4,295.00
	bubble  
Prostheses List by Category, Groups and Sponsor	Page 810 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	11.03.08.02 - Cage
	Biomet Australia Pty Ltd
BI982	Mainstream Burch/Schneider 	Burch/Schneider Reinforcement Ring 	44/50 Left and Right, 50-56	$1,426.00
	Reinforcement Ring	Cemented	 Left and Right
BI983	Max-Ti Modular Protrusio Cage	Acetabular Support Component, 	52, 56, 60, 64, 68 and 72mm 	$1,426.00
	Porous Ti Alloy	Left and 52, 56, 60, 64, 68 
	and 72 mm Right
	Global Manufacturing Technology Pty Ltd
GM051	Fin II Revision Ring	Titanium with hook & flanges	52 to 72mm	$1,426.00
	Johnson & Johnson Medical Pty Ltd
DP948	Octopus Reconstruction Ring	Titanium ring with proximal flanges &	Size 50-55mm	$1,426.00
	 distal hook, used in conjunction 
	with Acetabular Reconstruction shell 
	(DP945)
DY064	Protrusio Acetabular 	Titanium, grit blast, proximal distal 	49-69ID	$1,426.00
	Reconstruction Cage	flange, left & right sided
DY169	Ultima Acetabular Reconstruction 	Titanium, acetabular reconstruction 	40 - 70mm	$1,426.00
	Ring	cage with proximal rim
	Lifehealthcare Pty Ltd
LH175	B2C Espace Acetabular Cup	Acetabular cage	Espace Shell 0 degrees peak	$1,426.00
	 - diam 50mm, 54mm, 58mm, 
	62mm with plastic insert, 
	Espace Shell 20 degrees 
	peak - diam 50mm, 54mm, 
	58mm, 62mm with plastic 
	insert,  Espace Shell 8mm 
	extension - diam 50mm, 
	54mm, 58mm, 62mm with 
	plastic insert, Espace Shell 
	14mm
	Lima Orthopaedics Australia Pty Ltd
LC021	Acetabular Plate	Acetabular Reconstruction Plate Ti	50 - 66mm x Standard or 	$1,426.00
	Long
	Link Orthopaedics  Australia
LO028	LINK Partial Pelvis Replacement	Acetabular reconstruction cage	48-67mm	$1,426.00
Prostheses List by Category, Groups and Sponsor	Page 811 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LO029	LINK Partial Pelvis Replacement	Acetabular reconstruction cage with 	48-67mm	$1,426.00
	inferior flange
	Mathys Orthopaedics Pty Ltd
MA024	CCE Acetabular Reinforcing Ring	Titanium, grit blast, acetabular 	Dia 42 - 58mm	$1,426.00
	reconstruction cage with proximal rim
	Oceania Orthopaedics
OO037	IC Reinforcement cage	Acetabular Reinforcement cage	Left and Right. 44mm, 	$1,426.00
	50mm, 56mm, 62mm
OO038	IC titanium ring	Acetabular recontrusction ring	42mm, 44mm, 46mm, 48mm, 	$1,426.00
	50mm, 52mm, 54mm, 56mm, 
	58mm
	Orthotech Pty Ltd
OH291	JRI Reconstruction Ring 	Acetabular reconstruction cage 	44mm, 47mm, 50mm, 54mm	$1,426.00
OH431	Samo Revision Hip System 	Acetabular reinforcement ring with 	44 - 64 mm	$1,426.00
	hook
OH432	Samo Revision Hip System 	Acetabular reinforcement ring	44 - 64 mm	$1,426.00
	Smith & Nephew Surgical Pty Ltd
SN265	Contour	Acetabular  Reinforcement cage	44 - 74mm OD	$1,426.00
	Stryker Australia Pty Ltd
HW064	Kerboull -  Vitallium	Petrusio cage	44, 48, 52, 56, 60mm OD	$1,426.00
ST557	Restoration  gap cup II acetabular 	Acetabular reconstruction cage with 	48-72mm OD in 2mm 	$1,426.00
	cage	extended plates 	increments 
	Wright Medical Australia
WR096	Procotyl-E L Plates	titanium alloy	One size only for left and 	$1,426.00
	right
WR112	Procotyl-E double plate	titanium alloy	4, 5 and 6 holes left and 	$1,426.00
	right sides
WR137	Procotyl-E T Plate	titanium alloy plates	One size only for left and 	$1,426.00
	right
	Zimmer Pty Ltd
ZI001	Zimmer Acetabular roof ring	Acetabular reconstruction cage 	46 - 60mm	$1,426.00
ZI002	Zimmer Acetabular Reconstruction 	Acetabular Reconstruction Cage - 	52, 58, 64mm OD	$1,426.00
	Cage 	Left, right
ZI390	Acetabular Reinforcement	Roof Ring - Ti alloy	44 to 58mm	$1,426.00
Prostheses List by Category, Groups and Sponsor	Page 812 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI391	Acetabular Reinforcement	Roof Ring with Hook - Ti alloy	36/23 to 64/23mm	$1,426.00
ZI392	Acetabular Reinforcement	Protrusio Cage - Ti alloy	44 to 50mm (left and right)	$1,426.00
ZI540	Trabecular metal acetabular revision 	Modular cup-cage titanium alloy	56-80 Long & short flanged	$1,426.00
	system modular cup-cage	 left & right
	11.03.08.03 - Saddle
	Link Orthopaedics  Australia
LO009	LINK Endo - model Saddle 	Saddle Component	One size only	$4,976.00
	11.03.08.04 - Saddle Base
	Link Orthopaedics  Australia
LO010	LINK Endo - Model Saddle 	Saddle Base Component	Sizes 1-7	$3,909.00
	11.03.08.05 - Hooks, Flanges, Blades
	Biomet Australia Pty Ltd
BI700	Par 5 Protrusio Acetabular System	Obturator Hook or Blade or Flange, Ti	Short, Medium or Long	$500.00
	Link Orthopaedics  Australia
LO030	LINK Partial Pelvis Replacement	Hook for Obturator Foramen Width 	6-12mm	$500.00
	Medacta Australia Pty Ltd
MU015	Versafitcup Attachable Proximal 	Stainless Steel attachable flange/lug 	4.5 L 35-40-45-50-55mm	$500.00
	Flange	with screw
MU016	Versafitcup Attachable Obturator 	Stainless Steel Obturator Hook	.	$500.00
	Hook
	Wright Medical Australia
WR097	Procotyl-E hooks	titanium alloy hook	18mm, 23mm, 28mm	$500.00
Prostheses List by Category, Groups and Sponsor	Page 813 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.01 - Augment
	Biomet Australia Pty Ltd
BI984	Max-Ti Modular Protrusio Cage	Acetabular Augment, Porous Ti Alloy	Dome Augment (1 Hole 	$1,400.00
	Large, 2 Hole Large, 1 Hole 
	Small), iliac flange Augment
	 (6 mm)
	Johnson & Johnson Medical Pty Ltd
DP173	PLAD Acetabular Rim Augment	Metal & polyethylene curved plate for	22- 28mm	$1,400.00
	 screw attachment to UHMWPE 
	cemented cups. Includes 4 screws.
	Lima Orthopaedics Australia Pty Ltd
LC025	Delta Hemispheric Acetabular Cup	Delta Hemispheric Acetabular Cup 	50 - 62mm & Eccentricity 	$1,400.00
	Ti6AI4V	12-18mm
	Zimmer Pty Ltd
ZI271	Trabecular Metal acetabular Medial 	Tantalum disc	26mm, 32mm and 38mm	$1,400.00
	wall augment
	Bone Reconstruction
	Biomet Australia Pty Ltd
BI960	Regenerex revision cup	acetabular augment, Porous Ti Alloy	48 to 58mm, small medium 	$3,300.00
	or large version
Prostheses List by Category, Groups and Sponsor	Page 814 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
Prostheses List by Category, Groups and Sponsor	Page 815 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW473	Restoration Acetabular Wedge 	The Restoration Acetabular Wedge 	Outer Diameter 46mm, Inner 	$3,300.00
	Augment System	Augment System is designed for hip 	Diameter 48, Thickness 
	surgeries requiring additional 	15mm Screw Holes 3
	acetabular component support in 	Outer Diameter 46mm, Inner 
	cases where host bone is insuficient. 	Diameter 48, Thickness 
		20mm Screw Holes 4
		Outer Diameter 46mm, Inner 
	The Wedge Augments provide the 	Diameter 48, Thickness 
	intraoperative flexibility to optimize 	25mm Screw Holes 4
	screw placement.	Outer Diameter 50mm, Inner 
	Diameter 52, Thickness 
	15mm Screw Holes 3
	Outer Diameter 50mm, Inner 
	Diameter 52, Thickness 
	20mm Screw Holes 4
	Outer Diameter 50mm, Inner 
	Diameter 52, Thickness 
	25mm Screw Holes 4
	Outer Diameter 54mm, Inner 
	Diameter 56, Thickness 
	15mm Screw Holes 4
	Outer Diameter 54mm, Inner 
	Diameter 56, Thickness 
	20mm Screw Holes 6
	Outer Diameter 54mm, Inner 
	Diameter 56, Thickness 
	25mm Screw Holes 6
	Outer Diameter 58mm, Inner 
	Diameter 60, Thickness 
	15mm Screw Holes 6
	Outer Diameter 58mm, Inner 
	Diameter 60, Thickness 
	20mm Screw Holes 6
	Outer Diameter 58mm, Inner 
	Diameter 60, Thickness 
	25mm Screw Holes 6
	Outer Diameter 62mm, Inner 
	Diameter 64, Thickness 
	15mm Screw Holes 6
	Outer Diameter 62mm, Inner 
	Diameter 64, Thickness 
	20mm Screw Holes 8
	Outer Diameter 62mm, Inner 
	Diameter 64, Thickness 
	25mm Screw Holes 8
	Outer Diameter 66mm, Inner 
Prostheses List by Category, Groups and Sponsor	Page 816 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Diameter 68, Thickness 
	15mm Screw Holes 6
	Outer Diameter 66mm, Inner 
	Diameter 68, Thickness 
	20mm Screw Holes 8
	Zimmer Pty Ltd
ZI276	Trabecular Metal Acetabular 	Tantalum acetabular augment	40 - 70mm x 10, 15, 20 	$3,300.00
	&30mm
	Bone Reconstruction
	Johnson & Johnson Medical Pty Ltd
MN150	Pinnacle Acetabular System	Gripton Ti-Foam Augments	Wedges 52-72, buttress 56-	$3,300.00
	68 or shim 5 to 15 degrees
11.04.02 - Bolt
	Biomet Australia Pty Ltd
BI122	Mallory Head Hip System	Trochanter Bolt, Titanium	Round/Oblong	$400.00
	Johnson & Johnson Medical Pty Ltd
JJ844	Reclaim Revision Hip System - Bolt	Locking Bolt	75-105mm	$400.00
	Link Orthopaedics  Australia
LO024	Link MP Reconstruction Hip  	Locking bolt 	38 & 58 mm	$400.00
	Prosthesis
	Oceania Orthopaedics
OO030	Mutars RS revision system - bolt	RS bolt	40,50,65,75,90,100,115,12	$400.00
	5mm
	Orthotech Pty Ltd
OH381	Securus Modular Revision Hip 	Modular Locking Bolt	One Size	$400.00
	System
	Zimmer Pty Ltd
ZI726	MOST Tissue Attachment Bold - 	MOST Tissue Attachment Bold - 	13.5mm	$400.00
	Short
Prostheses List by Category, Groups and Sponsor	Page 817 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI733	MOST Tissue Attachment Bolt - 	MOST Tissue Attachment Bolt - Long	20mm	$400.00
ZI860	Segmental Trabecular Proximal 	4mm Bolt	4mm and 7mm	$400.00
	Femoral Component - Bolt	7mm Bolt
	Set Screw
	Oceania Orthopaedics
OO142	MUTARS RS screw for coupling 	RS coupling device screw	12mm,14mm,16mm,18mm, x 	$400.00
	device	150,200mm
11.04.03 - Bone Screw
	Amplitude Australia
LI047	Femoral Shaft Locking Screw	Titanium femoral locking screw	4.5 and 6.5 diameters, 13 	$137.00
	lengths in 5 mm increments
LI048	Horizon Acetabular Fixation Screw	Titanium countersunk cancellous screw	Diam 6.5mm, lenghts 16 - 55	$137.00
	 mm
	Austofix
AX050	Hyperion Captiv Bone Screw	Titanium, cancellous self tapping 	6mm, 20 to 45 mm lengths	$137.00
	bone screw
AX081	Plasmaloc Acetabular Screws	6.5mm Cancellous Bone Screws	25-60mm	$137.00
	B Braun Australia Pty Ltd
BB238	Acetabular Fixation Screws	Isotan	16mm-68mm	$137.00
	Biomet Australia Pty Ltd
BI109	Mallory Head Hip System	Screw, Acetabular	(6.5 - 5.5)mm dia x (15 - 	$137.00
	70)mm length
BI702	Par 5 Protrusio Acetabular System	Screws - Titanium Metal	6.5mm	$137.00
	Corin Australia Pty Ltd
CR070	Titanium Counter Sunk Screw	Titanium Counter Sunk Screw	Lengths 15-70mm	$137.00
CR126	METS Trochanter Screw	Titanium	Short, Medium, Long	$137.00
	DJO Australasia Pty Ltd
DD025	FMP Acetabular Screws	Titanium, cancellous screws	25mm to 50mm	$137.00
Prostheses List by Category, Groups and Sponsor	Page 818 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX006	Novation Crown Cup Screws	Titanium cortical bone screws	Full radius tip: 6.5mm x 	$137.00
	15mm, 6.5mm x 20mm, 6.5mm
	 x 25mm, 6.5mm x 30mm, 
	6.5mm x 35mm, 6.5mm x 
	40mm, 6.5mm x 45mm, 6.5mm
	 x 50mm, 6.5mm x 55mm, 
	6.5mm x 60mm, 6.5mm x 
	70mm; Peripheral Rim 
	screw: 4.5mm x 25mm, 
	4.5mm x 30mm, 4.5mm x 
	35mm, 4.5mm x 40mm, 4.5mm 
	Global Manufacturing Technology Pty Ltd
GM058	Fin II Acetabular Screw	Titanium, '6.5mm Cancellous Bone 	15 - 80mm	$137.00
	Screws
GM059	SMR Distal Locking Screw	Titanium, '4.5mm Cortical Bone 	20 to 80mm	$137.00
GM116	Global Acetabular Cancellous 	Titanium 6.5mm cancellous bone 	15mm to 50mm	$137.00
	Global Orthopaedic Technology
GO261	Novae Double Cup Cortical Bone 	Cortical Bone Screw	5mm diameter, 30 to 65mm 	$137.00
	Screw	length in 5mm increments
	Johnson & Johnson Medical Pty Ltd
DP944	DePuy Hip Bone Screws	Titanium, cancellous screws	Size 3.5-6.5 diameter 5-	$137.00
	120mm length
JJ704	Gyros Hip System	Stainless steel screws for Gyros 	20 - 65mm	$137.00
	acetabular cup with flanges
	Lifehealthcare Pty Ltd
LH062	Groupe Lepine	Acetabular Screws	5.5mm dia in 15mm-60mm 	$137.00
	length 5mm increments 
	Lima Orthopaedics Australia Pty Ltd
LC024	Lima Bone Screw	Titanium  Bone Screw	20 - 60mm	$137.00
	Mathys Orthopaedics Pty Ltd
MA514	Acetabular Screws	Titanium cancellous bone screws	varying lengths and sizes	$137.00
Prostheses List by Category, Groups and Sponsor	Page 819 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO031	Mutars RS revision system - bone 	RS bone screw	25mm, 30mm, 40mm, 42mm, 	$137.00
	screws	45mm, 50mm, 55mm, 60mm
OO074	Adler Bone Screw	Bone Screw for Acetabular Cup	6.5mm Diameter. 20-50mm	$137.00
	Orthotech Pty Ltd
OH289	JRI CSF Hip System	CSF Bone Screws, Titanium Alloy	15mm - 50mm	$137.00
OH438	Samo Acetabular Cup bone screw	Bone screw	20 - 40 mm	$137.00
	Perios Pty Ltd
PF012	Atlas Acetabular Cup System	Screw	Atlas Screw Dia 6.5mm 15-	$137.00
	50mm L
	Signature Orthopaedics
SF034	Bone Screw	Titanium, cancellous screw	15mm - 90mm	$137.00
SF040	Global Acetabular Cancellous 	Titanium 6.5mm cancellous bone 	15mm to 50mm	$137.00
	Smith & Nephew Surgical Pty Ltd
SM041	Universal Cancellous Bone Screws	Cancellous bone screw titanium	15-60mm long 6.4mm dia	$137.00
SM137	Polar Cup Acetabular Screws	Stainless Steel Cortical Screws 	4.5mm by 40-60mm	$137.00
	Stryker Australia Pty Ltd
HW011	ABG Hip System	Bone screw - Titanium, used with 	12,15,20,25,30,35,40,45 	$137.00
	ABG11 Cups	and 50mm lengths
HW047	Exeter Hip System	X-Change Bone Screws -  Stainless 	3.5mm X 10, 15, 20, 25, 30, 	$137.00
	Steel	35mm
ST545	Osteonics hip prostheses 	Cancellous bone screw, Titanium	6.5mm & 5.5mm dia	$137.00
	Tornier Pty Ltd
TO089	Dynacup Titanium Screws	Cancellous bone screw, Titanium	7 Lengths from 20mm to 	$137.00
	55mm
	Wright Medical Australia
WR105	Quadra-Fix Acetabular Shell 	Quadra-Fix Double threaded, 6.5mm 	35mm - 80mm in 5mm 	$137.00
	Cancellous bone Screw	increments
WR121	Procotyl-E screws	titanium alloy	Diameter 5.5mm, Length 15 	$137.00
	- 60mm
WR131	Transcend/Lineage Articulation 	Bone screw titanium	6.5mm x 1.5 - 6cm in 0.5cm 	$137.00
	System	increments long
Prostheses List by Category, Groups and Sponsor	Page 820 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI036	Acetabular Cup	Trilogy Bone Screw - Titanium	15 - 60	$137.00
	Austofix
AX094	C2 Cancellous Screws	titanium, Cancellous Screws	15mm - 50mm	$137.00
	Medacta Australia Pty Ltd
MU014	Medacta Acetabular Screws	Titanium, cancellous screws	6.5 L 15-70mm	$137.00
MU127	Mpact Cortical Bone Screws	Titanium cortical bone screws	25 - 55 mm	$137.00
11.04.04 - Calcar Block
	Zimmer Pty Ltd
ZI024	Zimmer 'VerSys CRC Hip Systems 	 Modular Calcar Block	One size only	$572.00
11.04.05 - Cement Restrictor
	Austofix
AX076	Experion Cement Restrictor	UHMWPE	Universal, one size	$120.00
	Corin Australia Pty Ltd
CR041	Canal Occluder	Cement plug, UHMWPE, multi-layered	08/10mm, 12/14mm, 	$120.00
	16/18mm,20/22mm and 
	universal.
	Johnson & Johnson Medical Pty Ltd
DP233	Hardinge Cement Restrictor	Hardinge cement Restrictor (ea)	One size only	$120.00
DP448	BIO Stop G	Biostop Restrictor (Gelatin, 	size 8-20	$120.00
	Glkycerol, PHBM, Water)
DP575	C-Stem End Cap	End Cap Biostop Restrictor (Gelatin, 	Size 8- 20 	$120.00
	Glycerol, PHBM, water)
JJ753	Hardinge Cement Restrictor	UHMWPE cement restrictor	One size only	$120.00
JJ754	DePuy Femoral Cement Restrictor	UHMWPE cement restrictor	Size 0 to 10	$120.00
Prostheses List by Category, Groups and Sponsor	Page 821 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO106	LINK Intramedullary Plug	P/E Intramedullary Plug	12 to 20 mm	$120.00
	Mathys Orthopaedics Pty Ltd
MA018	Intramedullary Plug	Cement Restricter	Small to Extra Large	$120.00
	Medacta Australia Pty Ltd
MU111	MectaPlug PE	Cement Restrictor	12 - 30 mm	$120.00
	Oceania Orthopaedics
OO102	IC Intramedullary Plug	Intramedullary Plug	9mm, 14mm	$120.00
	Signature Orthopaedics
SF036	Cement Pug	UHMWPE Cement Plug	18.5 - 35mm	$120.00
	Smith & Nephew Surgical Pty Ltd
SN263	Buck	Cement Restrictor 	18.5 - 35mm	$120.00
	Stryker Australia Pty Ltd
HW001	Hardinge Cement Restrictor	PMMA	6,9 and 12 Leaf	$120.00
SK505	BioPrep Bone Preparation System	Femoral Preparation Kit with cement 	18.5 - 25mm O.D.	$120.00
	restrictor
ST582	Osteonics hip prostheses 	Cement restrictor Polyethylene	Universal and sizes 1-8	$120.00
	Zimmer Pty Ltd
ZI226	Zimmer Bone Plug	Allen Medullary Plug	8 - 23mm	$120.00
ZI356	Medullary Plug, MS 30	Centring Plug, cement restrictor, hip - 	1 to 7	$120.00
	PE
11.04.06 - Centraliser
	Austofix
AX077	Experion Distal Centraliser	PMMA	Universal	$158.00
	B Braun Australia Pty Ltd
BB245	Distal centraliser	PMMA	7mm - 18mm	$158.00
BB276	Excia Hip System	Distal Centraliser, PMMA	8mm-18mm	$158.00
	Biomet Australia Pty Ltd
BI131	Mallory Head Hip System	Femoral Centraliser, UHMWPE	9-17mm	$158.00
Prostheses List by Category, Groups and Sponsor	Page 822 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX054	Novation Distal Centralizer, 	The Exatech distal centralizer is used 	Size 10mm, 11mm, 12mm, 	$158.00
	for cemented only hip arthroplasty, it 	13mm, 14mm, 15mm, 17mm
	centralises the stem position in the 
	femur.
	Global Orthopaedic Technology
GO166	Global Distal Centraliser	PMMA, 	Various	$158.00
GO167	R120 Distal Centraliser	PMMA, 	Various	$158.00
	Johnson & Johnson Medical Pty Ltd
DP297	Universal Femoral Stem Distal 	PMMA Distal Centralisers includes 	10-20mm	$158.00
	Centraliser	Charnley, Elite Plus, C-Stem and 
	Summit centralisers
DP584	PLA Centraliser	Poly Lactic Acid+D108 Centraliser	9-20mm	$158.00
JJ584	Femoral Prep Kit	Femoral Preparation Kit	One size only	$158.00
	Lima Orthopaedics Australia Pty Ltd
LC150	Proximal Centraliser PMMA	Proximal Centraliser PMMA	Left & Right Size 0-3	$290.00
	Medacta Australia Pty Ltd
MU002	CONE Femoral Stem Distal 	PMMA	10mm to 18mm	$158.00
	centraliser
	Signature Orthopaedics
SF030	PMMA Centraliser	PMMA centraliser used for cemented 	Size 10mm, 11mm, 12mm, 	$158.00
	total hip arthroplasty	13mm, 14mm, 15mm, 17mm
	Smith & Nephew Surgical Pty Ltd
SN269	CPCS	Polished Cemented Stem Distal 	8 - 18	$158.00
	Centraliser
SN359	Invis	Distal Centraliser PMMA	7 - 21mm	$158.00
	Stryker Australia Pty Ltd
HW034	Definition PM Femoral Component	Distal Centraliser -  PMMA -  Ring 	11-22mm	$158.00
	Centraliser
SK315	Exeter Hip System	Exeter Distal Centraliser -PMMA	One Size Only	$158.00
ST581	Osteonics hip prostheses	Distal spacer  PMMA	8-15mm	$158.00
	Wright Medical Australia
WR249	Cement Cetraliser	Profemur XM Cement Centraliser	N/A	$158.00
Prostheses List by Category, Groups and Sponsor	Page 823 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI013	Zimmer distal centralisers CPT, 	 PMMA Centraliser  	Size 1	$158.00
	VerSys, Natural and MS30
ZI020	Zimmer VerSys 	Proximal Centraliser - PMMA	11 - 17	$158.00
ZI021	Zimmer Hip Systems Femoral Stem	VerSys Distal Centraliser - PMMA	10 - 18	$158.00
ZI366	Natural Hip System	Distal Centraliser - PE	10 to 19	$158.00
ZI374	MS-30 Hip prosthesis 	Centralizer for Cemented Stems 	8 to 18	$158.00
	(Protek) - metal alloys
	Austofix
AX104	E2 PMMA Centraliser	PMMA distal Centraliser	20mm	$158.00
	Global Orthopaedic Technology
GO165	Global Centraliser	Femoral Centraliser	Various	$158.00
11.04.07 - Claw
	Biomet Australia Pty Ltd
BI124	Modular Calcar Mallory Head 	Trochanteric Claw, Titanium	Medium, Large 	$460.00
	Revision Hip System
11.04.08 - Connector
	Biomet Australia Pty Ltd
BI125	Modular Calcar Mallory Head 	Trochanteric Connector	Sizes 40-70mm	$570.00
	Revision Hip System
	RQSolutions Medical Devices Distribution Support
RQ038	MML Tumor Revision System	Connection Module - Connects the 	Various	$570.00
	Extension modules with the dual 
RQ044	MML Tumor Revision System	Connection Module for Intramed, 	T10/12 - 16/18, IK16/18 - 	$570.00
	Prosthesis and Arthodesis-Connection	16/18 with 70mm in Length
Prostheses List by Category, Groups and Sponsor	Page 824 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.09 - Dome Plug
	Johnson & Johnson Medical Pty Ltd
DY077	Apex Hole eliminator 	Hole eliminator screw Titanium	One size only	$160.00
	Orthotech Pty Ltd
OH380	Securus Modular Revision Hip 	Modular Body Cap	One size	$160.00
	System
	Smith & Nephew Surgical Pty Ltd
SN294	Reflection	Tapered hole cover (Reflection 	One size only	$160.00
SN295	Reflection	Threaded hole cover (Reflection)	One size only	$160.00
	Stryker Australia Pty Ltd
ST551	Osteonics Hip Prostheses	Dome hole plug titanium	One size only	$160.00
	Tornier Pty Ltd
TO088	Dynacup Hole Oturator	Hole plug for dynacup shell, Ti, HA 	One size only	$160.00
	coated
	Wright Medical Australia
WR115	Transcend/Lineage Articulation 	Apical dome plug titanium	One size only	$160.00
	System
	Zimmer Pty Ltd
ZI875	Allofit Polar Screw Hole Plug	Titanium Polar Screw Hole Plug	One size	$160.00
	Austofix
AX096	C2 Hole Eliminator	Titanium Screw Hole Plug	6.3 x 3.2mm, 11.3 x 4.2mm	$160.00
	Zimmer Pty Ltd
ZI622	Continuum Acetabular System	Continuum Hole Plugs	One Size - Dome Hole Plug	$160.00
	
Prostheses List by Category, Groups and Sponsor	Page 825 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.10 - Head Taper Insert
	Biomet Australia Pty Ltd
BH037	Biolox Delta Option Taper	Taper Sleeve, Titanium	-6mm, -3mm, Std, +3mm and 	$520.00
	+6mm
BI876	Endo II Head	Modular Head Taper Insert - CoCr	-6mm to +6mm	$520.00
BI895	M2A Magnum Prosthesis	Taper Insert, Cobalt chrome	42 - 50mm, -6, -3, STD, +3, 	$520.00
	+6, +9; 52 - 60mm, -6, -3, 
	STD, 
	3, +6, +9
	Johnson & Johnson Medical Pty Ltd
DY403	Cathcart Taper Insert	CoCr head taper insert for use with 	-3 to +10mm	$520.00
	Unipolar Head (DY402)
	Smith & Nephew Surgical Pty Ltd
SN307	Unipolar	Taper Sleeve Co Cr	12/14 and 14/16 tapers, +0,-	$520.00
	3,+4,+8,+12mm.
	Stryker Australia Pty Ltd
ST569	Head Taper Insert	Neck extention, vitallium alloy	-4 TO +12mm	$520.00
	Austofix
AX102	U2 Taper Sleeve	Taper Sleeve, Unipolar	-4, 0, +4, +8	$520.00
11.04.11 - Neck Adapter
	Corin Australia Pty Ltd
CR098	Taper Adaptor Sleeve	Adaptor sleeve to adjust taper from 	2 Sizes	$520.00
	10-12 to 12-14,Titanium, for Ceramic 
	Heads
Prostheses List by Category, Groups and Sponsor	Page 826 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Manufacturing Technology Pty Ltd
GM042	BioBall - Revision Neck Adaptor	Titanium, varying tapers & lengths, 	12/14 standard, 12/14 	$520.00
	for ceramic & metal heads	offset, 14/16 standard,V40 
	standard, V40 offset, PCA 
	standard, PCA offset, Type 1
	 standard, PCA offset 11/13 
	standard, 11/13 offset, small 
	to 5 XL, M to 5 XL, M to 
	5XL for each.
GM107	APEX Global Neck Adaptor	Titanium neck adaptor for variable 	variable tapers	$520.00
	tapers, used in revision with ceramic 
	head
	Medacta Australia Pty Ltd
MU056	Romax Neck Adaptor	Adaptor for Large Heads	Adaptor 12/14: size S, size 	$520.00
	M, size L and size XL
	Stryker Australia Pty Ltd
SK482	Stryker Neck Taper Adaptor	Adaptor Sleeve for Stryker stems	-5, -4, 0, +4, +5, +8 +10, 	$520.00
	+12, +15, +16mm offset
	Zimmer Pty Ltd
ZI567	Zimmer Hip System	VerSys Endo Adaptors	+7.0mm; +10.5mm; +14.0mm	$520.00
11.04.12 - Nut
	Consensus Australia Pty Ltd
CX002	UniSyn Hip Connecting Nut	Titanium, locking nut, supplied 	short & long	$204.00
	seperately
11.04.13 - Pin
	Johnson & Johnson Medical Pty Ltd
DP976	SROM Acetabular Insert Locking 	Titanium pin provided seperately from	3.5mm - 5.0mm	$181.00
	 insert
	Smith & Nephew Surgical Pty Ltd
SN292	Reflection	Fixation peg Titanium Alloy	One size only	$181.00
Prostheses List by Category, Groups and Sponsor	Page 827 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.14 - Plug - Including Dome Plug
	Austofix
AX091	Plasmaloc Hole Occluder	Plasmaloc Acetabular Cup Screw 	Screw hole size	$160.00
	Hole Occluder	
		Polar hole size
	Plasmaloc Acetabular Cup Polar Hole
	 Occluder
	B Braun Australia Pty Ltd
BB277	Excia Hip System	Cement plug	8mm-18mm	$160.00
	Biomet Australia Pty Ltd
BI130	Bio-Plug Cement Restrictor	Canal Plug, UHMWPE	7-20mm	$160.00
	Johnson & Johnson Medical Pty Ltd
DP998	DePuy Acetabular Apical Plugs	Titanium, apical hole plug for 	One size only	$160.00
	Duraloc, Pinnacle & SROM 
	Medacta Australia Pty Ltd
MU017	Medacta Acetabular Plug	Titanium Plug	.	$160.00
	Wright Medical Australia
WR118	WMT Perfecta Hip System	PMMA cement Plug	9 - 21mm in 1mm increments	$160.00
	Zimmer Pty Ltd
ZI451	Allofit screw hole plugs	Sterile, 7 per set	One size only	$160.00
ZI876	Alofit IT Screw Hole plugs	titanium Screw Hole Plug, 5 per set	One size	$160.00
11.04.15 - Plug and Hood
	Lima Orthopaedics Australia Pty Ltd
LC149	Lima Plug and hood 	UHMWPE Cement Plug with distal 	10mm - 20mm	$290.00
	femoral stem hood
LC151	Cement Plug UHMWPE	UHMWPE Cement Restrictor / Plug	Size 1 - 3	$290.00
Prostheses List by Category, Groups and Sponsor	Page 828 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.17 - Ring
	Biomet Australia Pty Ltd
BI140	Mallory Head Hip System	Acetabular Shell, Ringloc.  	Size 1	$171.00
	Replacement Ring, Titanium alloy
	DJO Australasia Pty Ltd
DD045	FMP Acetabular System - 	28mm constrained liner locking ring, 	one size, to fit all 28mm ID 	$171.00
	Constrained Liner Locking Ring	manufactured from titanium, is used 	constrained liners
	with the FMP constrained acetabular 
	liners.
	Johnson & Johnson Medical Pty Ltd
DP250	Duraloc Cup Locking System	Titanium locking Ring for Duraloc 	Size 36-76mm	$171.00
	insert, seperately listed, only for 
	revision
	Smith & Nephew Surgical Pty Ltd
SN701	Reflection	Constrained acetabular liner - adaptor 	42 - 76mm	$171.00
	ring
	Zimmer Pty Ltd
ZI473	APR Conversion Ring	Titanium ring	39 to 71	$171.00
ZI738	Titanium Alloy Locking Ring for 	Titanium Alloy Locking Ring	Outer diameter 50mm to 	$171.00
	Longevity Constrained Liner	80mm Shell size in 2mm 
	increments
11.04.18 - Screw
	Biomet Australia Pty Ltd
BI098	Kent Hip System	Transverse Screws, Titanium	4.5mm x (26-55mm)	$200.00
	Corin Australia Pty Ltd
CR033	Cormet Dysplasia Cup Screw	Dual threaded locking screw	Lengths 25 - 70mm	$200.00
	Global Manufacturing Technology Pty Ltd
GM053	SMR Locking Screw	Locking Screw for Proximal Body to 	40 to 70mm	$200.00
	Stem
Prostheses List by Category, Groups and Sponsor	Page 829 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY020	SROM Trochanteric Washer Screw	Titanium, attaches washer to calcar 	42mm, 52mm, 62mm	$200.00
	replacement stem
	Link Orthopaedics  Australia
LO011	LINK Endo - Model Saddle 	Saddle Set Screw for Base Component	One size only	$200.00
LO031	LINK Endo-Model Partial Pelvis 	Fixation Screws, for Obturator 	20mm - 35mm; four (4) sizes	$200.00
	Replacement	Foramen, including screw lock
	Oceania Orthopaedics
OO043	IC bone screw	Cancellous bone screw	6.5mm x 	$200.00
	15/20/25/30/35/40/45/50/
	55/60mm length.
	Orthotech Pty Ltd
OH382	Securus Modular Revision Hip 	Distal locking screws	30-70mm	$200.00
	System
	RQSolutions Medical Devices Distribution Support
RQ034	MML Tumor Revision System	Screw for Trochanter Module	20 to 50mm in Length, in 	$200.00
	10mm increments
RQ036	MML Tumor Revision System	Locking Screw	One size	$200.00
	Smith & Nephew Surgical Pty Ltd
SN284	Screws	Cancellous	15mm - 50mm	$200.00
	Zimmer Pty Ltd
ZI399	Cancellous Screws	Screws- Cancell - Ti alloy	6.5/15 to 6.5/70mm	$200.00
11.04.19 - Sleeve
	Corin Australia Pty Ltd
CR196	Biolox Option (Titanium Sleeve)	Titanium Sleeve for use with the 	28mm, 32mm 36mm and 40mm	$260.00
	Biolox Option Ceramic Femoral Heads
Prostheses List by Category, Groups and Sponsor	Page 830 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	DJO Australasia Pty Ltd
DD042	Foundation Unipolar System - CoCr	Unipolar sleeves are used in 	-3.5mm,+0mm (neutral), 	$260.00
	 Unipolar Sleeves	conjunction with Unipolar CoCr 	+3.5mm, +7mm & +10mm
	Femoral Heads to provide -3.5mm, 
	+0mm, +3.5mm, +7.0mm & +10mm neck
	 length options when used in 
	conjunction with a femoral hip 
	component in hemi-arthroplasty 
	operations.
	Exactech Australia
EX010	L-Series Taper Sleeve for Unipolar 	The L-series unipolar is a modular 	taper sleeve: 12/14 -3.5mm, 	$260.00
	Head	endoprosthesis consisting of a 	12/14 +0mm, 12/14 +3.5mm,
	truncated spherical head and 	 12/14 +7mm, 12/14 +10mm
	interchangeable neck sleeves.  The 
	device is fully machined from cobalt 
	chrome conforming to ASTM F1537-
	94.
	Johnson & Johnson Medical Pty Ltd
DY553	Delta Modular Head - sleeve	 sleeve for use with Delta Modular 	S - XL, -3.5 to +7	$260.00
	Head
	Medacta Australia Pty Ltd
MU116	Mectacer Biolox Option Sleeves	Biolox Option Titanium Sleeve	S, M, L, XL	$260.00
	Perios Pty Ltd
PF013	Pharo	Intermediate Sleeve	-5 to +10 (six sizes)	$260.00
	Signature Orthopaedics
SF024	Taper Sleeve	Taper Sleeve for femoral head	taper sleeve: 12/14 -3.5mm, 	$260.00
	12/14 +0mm, 12/14 +3.5mm,
	 12/14 +7mm, 12/14 +10mm
	Smith & Nephew Surgical Pty Ltd
SM166	Revision Delta Ceramic Femoral 	Biolox Option Sleeve	≤32mm	$260.00
	Head Sleeve
SM168	Revision Delta Ceramic Femoral 	Biolox Option Sleeve	>32mm	$260.00
	Head Sleeve
SN850	Birmingham Hip	Modular Resurfacing Head Sleeve	-8mm to +16mm	$260.00
	Stryker Australia Pty Ltd
ST821	Titanium Adapter Sleeve	For use with new ceramic heads	One size only	$260.00
Prostheses List by Category, Groups and Sponsor	Page 831 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR250	Neck Sleeve	For use with modular femoral heads	Short, Medium, Long, Extra 	$260.00
	Long
	Zimmer Pty Ltd
ZI474	Durom Hip Resurfacing System - 	Forged CoCr allo	A1 to L1	$260.00
	Adaptor Sleeves
11.04.20 - Spacer- Unique
	Biomet Australia Pty Ltd
BI953	Stage One Hip Mold	Spacer mold, stainless steel, silicon.	9 - 17mm x 43 - 64 Head	$1,560.00
	Zimmer Pty Ltd
ZI311	Spacer-G	Temporary implantable device for the 	Short Stems,  Head size 	$1,560.00
	treatment of infected total hip 	46mm, 54mm, 60mm
	replacement, Composition - stainless 
	steel core surrounded by PMMA 
	impregnated with Gentamicin
ZI312	Spacer-G	Temporary implantable device for the 	Long Stems, Head size 	$1,560.00
	treatment of infected total hip 	46mm, 54mm, 60mm
	replacement, Composition - stainless 
	steel core surrounded by PMMA 
	impregnated with Gentamicin
11.04.21 - Spike - Acetabular
	Stryker Australia Pty Ltd
HW012	ABG Hip System	Spikes - Titanium, used with ABG11 	7mm, 8mm, 9mm lengths	$87.00
	Cups
11.04.22 - Trochanter Plate
	Biomet Australia Pty Ltd
BI123	Mallory Head Hip System	Trochanter Plate, Titanium  	Sizes 40-70	$460.00
Prostheses List by Category, Groups and Sponsor	Page 832 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR125	METS Trochanter plate	Titanium with plasma spray of 	One size	$460.00
	titanium and HA
11.04.23 - Trochanteric Replacement
	Johnson & Johnson Medical Pty Ltd
DP001	Reef Femoral Wing 	Titanium grit blasted with HA 	Sizes 1-3	$1,000.00
	trochanteric replacement/augment
11.04.24 - Washer
	Johnson & Johnson Medical Pty Ltd
DP986	SROM Trochanteric Washer	Titanium, fixation with separate screw 	40 x 31, 60 x 45, 70 x 54	$577.00
	(DY020) to calcar replacing SROM 
	Femoral Stem
	Zimmer Pty Ltd
ZI724	MOST Tissue Attachment Washer - 	MOST Tissue Attachment Washer - 	9mm	$577.00
	Long	Long
ZI727	MOST Tissue Attachment Washer - 	MOST Tissue Attachment Washer - 	5mm	$577.00
	Short	Short
ZI861	Segmental Trabeculer Metal 	4mm Flat Washer	4mm and 7mm	$577.00
	Proximal Femoral Component - 	&mm Flat Washer
	4mm Curved Washer
11.04.25 - Wire - Cobalt Chrome
	Corin Australia Pty Ltd
CR127	METS Trochanter Reattachment 	CoCr	0.6m	$80.00
Prostheses List by Category, Groups and Sponsor	Page 833 of 1059

11 - HIP
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
11.04.26 - Wire - Stainless Steel
	Johnson & Johnson Medical Pty Ltd
DP224	Charnley & Wroblewski 	Stainless steel wire for trochanteric 	0.5-3.00mm, 18 to 20g	$250.00
	Trochanteric Spring Wire	attachment
11.04.27 - Insert Orientation Spacer Ring
	Lima Orthopaedics Australia Pty Ltd
LC023	DELTA Coupling / Spacer / Liner	DELTA Coupling / Spacer / Adaptor /	40 - 42mm	$1,560.00
	 Liner CoCrMo
Prostheses List by Category, Groups and Sponsor	Page 834 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.01.01 - Cemented, Alloy
	12.01.01.01 - Minimally Stabilised
	Advanced Surgical Design & Manufacture Ltd
AE039	Active Knee Femoral Component 	Femoral Component, Cemented, CoCr 	Sizes 00 - 5 Left & Right	$3,300.00
	Amplitude Australia
LI062	Score Knee System Femoral 	Femoral component, Cemented, CoCr, 	7 sizes	$3,300.00
	Component	with extended patellar groove 
	B Braun Australia Pty Ltd
BB205	Columbus Total Knee System (TKS) 	Femoral component, cemented, CoCr	F1 - F7, Left and Right	$3,300.00
	Femoral Component 
	Biomet Australia Pty Ltd
BI147	AGC System femoral component 	Femoral Component, cemented, CoCr, 	55-80mm	$3,300.00
	left and right sided (anatomic)
BI898	Vanguard Total Knee System	Femoral Component, CR, Cemented, 	55, 57.5, 60, 62.5, 65, 67.5, 	$3,300.00
	anatomic, CoCr.	70, 75, 80 Left and Right
BI902	ROCC Femoral Compoent 	Femoral Component, cemented, 	1-8	$3,300.00
	posterior stabilised, CoCr
	DJO Australasia Pty Ltd
DD017	3D Knee System Femoral 	Femoral Component, cemented, CoCr 	Size 2 to 12	$3,300.00
	Euros Orthopaedics Australia Pty Ltd
EU013	Europ standard cemented condyle	Knee cemented condyle	1 to 6, right and left	$3,300.00
	Exactech Australia
EX031	Optetrak Total Knee System Femoral	Femoral Component, cemented, CoCr	Size 1 -  6	$3,300.00
	 Component 
	Global Orthopaedic Technology
GO006	RBK Total Knee System Femoral 	Femoral Component, CoCr, cemented	0 - 5	$3,300.00
	Component 
GO196	Apex Knee - Cemented Femoral 	CR Cemented Femoral Component, 	Size 1 Left & Right, size2 	$3,300.00
	Component	Non-Porous, Size 1 to 6	Left & Right, size 3 Left & 
	Right, size 4 left & Right, 
	size 5 Left & Right, size 6 
	Left & Right
Prostheses List by Category, Groups and Sponsor	Page 835 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DY471	PFC Sigma Knee System femoral 	Femoral component, cemented, CoCr	Size 1-6 including narrow 	$3,300.00
	component	sizes
	Link Orthopaedics  Australia
LO154	Link Gemini Femoral Component	Femoral component, cemented, CoCR, 	Extra small - Extra large	$3,300.00
	microporous
	Mathys Orthopaedics Pty Ltd
MA108	balanSys Femoral Component	Femoral component, cemented, CoCr	XS TO F Left and Right	$3,300.00
MA490	balanSys Knee System / Femoral 	Balansys Femoral Component/ CR 	XS to F, left and right	$3,300.00
	Component, CR, cemented, TiNbN 	cemented, TiNbN coated
	coated
	MatOrtho
MJ005	Saiph Knee System Femoral 	CoCr Polished Cemented Femoral 	1 - 8 Left & Right	$3,300.00
	Component Cemented	Component
MJ020	MRK (Medial Rotation Knee) Total 	Pegged Femoral Component, 	0-5 Left and Right	$3,300.00
	Knee System Femoral Component 	Cemented, CoCr
	Medacta Australia Pty Ltd
MU026	Evolis Knee System Femoral 	Femoral component, cemented, CoCr 	1- 6, left and right	$3,300.00
	Component 
MU043	Cinétique Knee System Femoral 	Femoral component, cemented, CoCr 	Sizes 1 to 6, Left and Right	$3,300.00
	Component 
MU063	GMK cemented standard femur	cemented standard femoral component	sizes 1 to 7, left to right	$3,300.00
MU112	GMK Cemented Standard Femur - 	Cemented standard femoral 	sizes 1 to 7, left to right	$3,300.00
	TiNbN coated	component, with TiNbN surface 
	Oceania Orthopaedics
OO001	ACS Knee System - Femoral 	Cemented resurfacing femoral 	Left/Right 1-6	$3,300.00
	component cemented	component for use in knee athroplasty
	Orthotech Pty Ltd
OH020	Optetrak Total Knee System Femoral	Femoral Component, cemented, CoCr	Size 1 -  6	$3,300.00
	 Component 
OH419	Samo TCK Revision Knee System	Revision femoral, preset for stems, 	1-5	$3,300.00
	offset
OH427	Trekking Knee System - Femoral 	Femoral component cemented	1 - 5	$3,300.00
	Component
Prostheses List by Category, Groups and Sponsor	Page 836 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM064	VKS (Vario) Knee System Femoral 	Femoral Component, CoCr, cemented	1-12	$3,300.00
	Component
SN321	Genesis II Knee System Femoral 	Femoral Component, cemented, CoCr	Left/Right Size 1-8	$3,300.00
	Component
	Stryker Australia Pty Ltd
SK324	Triathlon Knee System Femoral 	Minimally stabilised, cemented, CoCr	Sizes 1 to 8	$3,300.00
	Component
SK332	Scorpio NRG Knee System Femoral 	Minimally stabilised, cemented, CoCr	Sizes 3,4,5,6,7,9,11,13	$3,300.00
	Component 
SR063	Scorpio Knee System Femoral 	Minimally stabilised, cemented, CoCr 	3 Left, 3 Right, 5 Left, 5 	$3,300.00
	Component 	with TiNi surface treatment (LFIT - 	Right, 7 Left, 7 Right, 9 
	Low friction ion treatment)	Left, 9 Right, 11 Left, 11 
	Right, 13 Left, 13 Right
ST634	Scorpio Knee System Femoral 	Minimally stabilised, cemented, CoCr	3, 5, 7, 9, 11, 13	$3,300.00
	Component 
	Wright Medical Australia
WR202	Advantim Total Knee System	Cemented femoral component, CoCr	Small, Medium, Large, Xlarge	$3,300.00
WR262	Medial pivot Knee System	Cemented, grit blasted, minimally 	1, 2, 3, 4, 5, 6, 7 & 8	$3,300.00
	stabilised, femoral component 
	Zimmer Pty Ltd
ZI559	Natural Knee II Flex Femur	Femoral Component, cemented, CoCr, 	Sizes 1 to 5 GSM Left and 	$3,300.00
	High Flex 	Right and Sizes 0 to 4 GSF 
	Left and Right
	Ceramic Surface
	Johnson & Johnson Medical Pty Ltd
DY374	LCS Complete Knee System femoral 	Femoral component, cemented, 	Sizes small to large+	$3,450.00
	component 	Titanium with TiN surface treatment 
	Medacta Australia Pty Ltd
MU027	Evolis Knee System Femoral 	Femoral Component, cemented, CoCr, 	1 - 6, left and right	$3,450.00
	Component 	with TiNi (TiNibN) surface coating
MU044	Cinétique Knee System Femoral 	Femoral Component, cemented, CoCr, 	Sizes 1 to 6, Left and Right	$3,450.00
	Component 	with TiNi (TiNibN) surface coating
Prostheses List by Category, Groups and Sponsor	Page 837 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Fixed Stem
	MatOrtho
MJ021	MRK (Medial Rotation Knee) Total 	Stemmed Femoral Component, 	0-5 Left and Right	$4,558.00
	Knee System Revision Femoral 	Cemented, CoCr
	Component
	Revision
	Johnson & Johnson Medical Pty Ltd
DY368	LCS Complete Knee System femoral 	Femoral component, cemented, CoCr	Sizes small to large+	$6,050.00
	component 
	Medacta Australia Pty Ltd
MU081	GMK Revision cemented standard 	Cemented minimally stabilised femoral	Sizes 1 to 6, Left and Right	$6,050.00
	femur	 component
	Oceania Orthopaedics
OO017	ACS Knee System - ACS LS 	Cemented femoral component, 	Left/Right Sizes 2/3/4/5/6	$6,050.00
	Revision Femoral component, 	revision, for use with stems
	Cemented
	Smith & Nephew Surgical Pty Ltd
SM085	TC (Tri Compartment) PLUS Knee 	Femoral Component, CoCr, cemented	2 - 10	$6,050.00
	System Femoral Component
	Wright Medical Australia
WR180	Medial Pivot Knee System	Stemmed condular medial pivot 	1, 2, 3, 4, 5  All in Left & 	$6,050.00
	component, cemented, grit blasted, 	Right
	minimally stabilised, femoral 
	component, CoCr, usually used with a
	 anterior lipped insert
	SCP
	Johnson & Johnson Medical Pty Ltd
DP004	LCS Complete Knee System femoral 	Femoral cemented, CoCr	Sizes small to large+	$3,800.00
	component 
	Zimmer Pty Ltd
ZI420	Natural Knee Femoral Component 	Femoral Component,  Cemented, CoCr 	Size 00 to 5	$3,800.00
Prostheses List by Category, Groups and Sponsor	Page 838 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	12.01.01.02 - Posterior Stabilised
	B Braun Australia Pty Ltd
BB206	Columbus Total Knee System (TKS) 	Femoral component, cemented, CoCr, 	F1 - F7, Left and Right	$3,400.00
	Femoral Component 	posterior stabilised
	Biomet Australia Pty Ltd
BI150	AGC System femoral component 	Femoral Component, cemented, CoCr, 	55 to 80mm	$3,400.00
	left and right sided (anatomic), 
	posterior stabilised 
BI195	Vanguard Rotating Platform Femoral	Femoral Component, Cemented, CoCr, 	60-75mm	$3,400.00
	 Component	Posterior Stabilised
BI897	Vanguard Total Knee System	Femoral Component, Posterior 	55, 57.5, 60, 62.5, 65, 67.5, 	$3,400.00
	Stabilised, Cemented, anatomic, CoCr.	70, 75, 80 Left and Right
	Exactech Australia
EX033	Optetrak Total Knee System Femoral	Femoral Component, cemented, CoCr, 	Size 1 -  6	$3,400.00
	 Component 	posterior stabilised 
EX034	Optetrak Hi Flex Femoral 	Femoral Component, Cemented, CoCr, 	1-6	$3,400.00
	High Flex (Hi Flex), posterior 
	stabilised 
	Johnson & Johnson Medical Pty Ltd
DP149	PFC Sigma Knee System femoral 	 Femoral component, cemented, CoCr, 	Size 1-6 including narrow 	$3,400.00
	component	posterior stabilised	sizes
DY371	LCS Complete System femoral 	Femoral Component, cemented, CoCr, 	Sizes small to large+	$3,400.00
	component 	posterior stabilised
DY404	PFC Sigma Knee System 	Femoral component, cemented, CoCr, 	Size 1-6 including narrow 	$3,400.00
	RPF/PS150 femoral component	high flex, posterior stabilised 	sizes
	Mathys Orthopaedics Pty Ltd
MA487	balanSys Femoral Component	Femoral component, cemented, CoCr, 	XS to F, Left and Right	$3,400.00
	posterior stabilised 
MA493	Balansys Knee System / Femoral 	Balansys Femoral Component/PS 	XS to F, Left and Right	$3,400.00
	Component, PS, cemented, TiNbN 	cemented, TiNbN coated, CoCrMo, 
	coated	TiNbN
	Medacta Australia Pty Ltd
MU028	Evolis Knee System Femoral 	Femoral Component, cemented, CoCr, 	1 - 6, left and right	$3,400.00
	Component 	posterior stabilised 
Prostheses List by Category, Groups and Sponsor	Page 839 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MU029	Evolis Knee System Femoral 	Femoral Component, cemented, CoCr, 	1 - 6, left and right	$3,400.00
	Component 	posterior stabilised with TiNi 
	(TiNibN) surface coating
MU064	GMK posterior stabilised cemented 	cemented posterior stabilised femoral 	sizes 1 to 7, left to right	$3,400.00
	femur	component
MU113	GMK Posterior Stabilised 	Cemented posterior stabilised femoral 	sizes 1 to 7, left toright	$3,400.00
	Cemented Femur -TiNbN coated	component, with TiNbN surface 
	Oceania Orthopaedics
OO018	ACS Knee System - PS Femoral 	ACS posterior stabilised femoral 	Size 2,2.5,3,4,5,6 left/right	$3,400.00
	component, cemented	component, cemented
	Orthotech Pty Ltd
OH212	Optetrak Total Knee System Femoral	Femoral Component, cemented, CoCr, 	Size 1 -  6	$3,400.00
	 Component 	posterior stabilised 
OH233	Optetrak Hi Flex Femoral 	Femoral Component, Cemented, CoCr, 	1-6	$3,400.00
	High Flex (Hi Flex), posterior 
	stabilised 
	Smith & Nephew Surgical Pty Ltd
SN847	Journey Knee System Femoral 	Femoral Component, Cemented, CoCr, 	Sizes 1-10, Left and Right	$3,400.00
	Component	posterior stabilised
SN871	Genesis II Knee System Femoral 	Femoral component, cemented 	Left / Right 1-8	$3,400.00
	Component	posterior stabilised, CoCr
SN872	Profix Knee System Femoral 	Femoral component, cemented 	Left / Right 1-8	$3,400.00
	Component	posterior stabilised, CoCr
	Stryker Australia Pty Ltd
SR003	Scorpio NRG Knee System Femoral 	Posterior stabilised, cemented, CoCr	Sizes 3,4,5,6,7,9,11,13	$3,400.00
	Component 
SR009	Triathlon Knee System Femoral 	Posterior stabilised, cemented, CoCr, 	Sizes 1 to 8	$3,400.00
	Component 	with ability to add lugs or augments 
SR019	Scorpio Knee System  Femoral 	Posterior stabilised, cemented, CoCr 	3, 5, 7, 9, 11, 13	$3,400.00
	Component 
ST984	Scorpio Knee System  Femoral 	Posterior stabilised, cemented, CoCr 	3 Left, 3 Right, 5 Left, 5 	$3,400.00
	Component 	with TiNi surface treatment (LFIT - 	Right, 7 Left, 7 Right, 9 
	Low Friction Ion Treatment)	Left, 9 Right, 11 Left, 11 
	Right, 13 Left, 13 Right
Prostheses List by Category, Groups and Sponsor	Page 840 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO008	HLS Noetos Femoral Component	Femoral Component, cemented,  CoCr, 	1 - 6 CoCr	$3,400.00
	posterior stabilised using midline 
	condyle
TO060	HLS Kneetec - Femoral Implant	Femoral implant of the HLS Kneetec 	Left and Right, 10 sizes 	$3,400.00
	System, cemented, CoCr, Posterior 	each: 7 standard (1 to 7) and
	Stabilised	 3 "narrow" (3 to 5)
	Wright Medical Australia
WR263	Medial pivot Knee System	Cemented, grit blasted, prosterior 	1, 2, 3, 4, 5, 6, 7 & 8	$3,400.00
	stabilised, femoral component
	Zimmer Pty Ltd
ZI589	NexGen LPS Flex GSF Femoral 	Cobalt Chrome, High Flex, cemented, 	Sizes GSF C to G, Left to 	$3,400.00
	Components - Option	posterior stabilised	Right
ZI736	NexGen LPS-Flex Tivanium Femoral	LPS-Flex Tivanium Femoral 	00-5968-013-51 LPS-Flex 	$3,400.00
	 Component	Component, Size C Left	Tivanium Femoral 
	LPS-Flex Tivanium Femoral 	Component, Size C Left
	Component, Size C Right	00-5968-013-52 LPS-Flex 
	LPS-Flex Tivanium Femoral 	Tivanium Femoral 
	Component, Size D Left	Component, Size C Right
	LPS-Flex Tivanium Femoral 	00-5968-014-51 LPS-Flex 
	Component, Size D Right	Tivanium Femoral 
	LPS-Flex Tivanium Femoral 	Component, Size D Left
	Component, Size E Left	00-5968-014-52 LPS-Flex 
	LPS	Tivanium Femoral 
	Component, Size D 
	Revision
	Amplitude Australia
LI063	Score Knee System Femoral 	Femoral Component, CoCr, cemented, 	4 sizes in left and right	$6,150.00
	Component	Posterior Stabilised
	B Braun Australia Pty Ltd
BB196	E.motion Total Knee System	Posterior Stabilised Knee Component	F2 - F8 Right Left	$6,150.00
	 cemented
	Global Orthopaedic Technology
GO113	RBK Total Knee System Femoral 	Femoral Component, cemented, CoCr, 	Size 0 to 5	$6,150.00
	Component 	posterior stabilised 
Prostheses List by Category, Groups and Sponsor	Page 841 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GO255	Apex PS Revision System - Femoral 	The femoral component of a total knee 	Sizes 1-6, plus Sizes 1+ to 	$6,150.00
	Component	revisionsystem that incoprates a 	5+ Left and Right
	proportionally sized box
	Johnson & Johnson Medical Pty Ltd
DP268	SROM Noiles Posterior Stabilised 	Posterior stabilised, CoCr, cemented, 	Sizes xxsmall-large	$6,150.00
	Revision femoral component	femoral component
	Mathys Orthopaedics Pty Ltd
MA506	Balansys Revision Knee	Femoral component, contrained	A to E, right to left	$6,150.00
	Medacta Australia Pty Ltd
MU089	GMK Revision cemented posterior-	Cemented posterior stabilised femoral 	Sizes 1 to 6, Left and Right	$6,150.00
	stabilised femur	component
	Smith & Nephew Surgical Pty Ltd
SM141	TC (Tri Compartment) PLUS Knee 	Femoral Component, CoCr, Cemented 	2-10mm	$6,150.00
	System Femoral Component	posterior stabilised
	Tornier Pty Ltd
TO021	HLS Noetos Revision Femoral 	Femoral Component, cemented,  CoCr, 	1 to 6 right and left	$6,150.00
	Component 	posterior stabilised using midline 
	condyle
	Zimmer Pty Ltd
ZI423	Natural Knee Femoral Component 	Femoral component, cemented, CoCr, 	Size 00 to 4 (left & right), 	$6,150.00
	possterior stabilised 
	12.01.01.03 - Totally Constrained
	Exactech Australia
EX035	Optetrak Total Knee System CCK 	Femoral Component, cemented, CoCr, 	Size 1 - 6(CCK), Size 1-	$3,500.00
	and NMC (constrained Condylar 	totally stabilised	5(NMC)
	and Non-Modular Constrained 
	Knee) Femoral component
	Link Orthopaedics  Australia
LO170	LINK Endo Model Rotational and 	Femoral Components	Extra Small - Extra Large	$3,500.00
	Hinge Knee Prostheses
	Smith & Nephew Surgical Pty Ltd
SN660	Profix Knee System Femoral 	Femoral Component, CoCr, Cemented, 	Left & Right, 2-7	$3,500.00
	Component	totally constrained
Prostheses List by Category, Groups and Sponsor	Page 842 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN866	Profix Knee System Femoral 	Femoral component, cemented, totally 	Left / Right 1 - 8	$3,500.00
	Component	stabilised, CoCr
	Hinged
	Johnson & Johnson Medical Pty Ltd
DP254	SROM Noiles Knee System femoral 	Rotating Hinge, cemented, CoCr 	Sizes xxsmall-large	$6,750.00
	component 	femoral component.
	Smith & Nephew Surgical Pty Ltd
SM082	'RT (Rotating Hinge) PLUS Knee 	Femoral Component, CoCr, Cemented, 	0-10	$6,750.00
	System Femoral Component	hinged
	Zimmer Pty Ltd
ZI305	Nexgen Rotating Hinged Knee 	Femoral Component, with a fixed 	B-F	$6,750.00
	Femoral Component	rotating hinge on UHMWPE 
	bearings, cemented, CoCr 
	Revision
	Biomet Australia Pty Ltd
BI933	Vanguard SSK Knee System	Femoral Component, CoCr, Ti	55 to 80mm	$6,250.00
	Johnson & Johnson Medical Pty Ltd
DP150	PFC Sigma Knee System TC3 	Femoral component, cemented, CoCr, 	Size 1-6	$6,250.00
	femoral component	totally constrained
DY148	LCS Complete Knee System femoral 	Femoral component, cemented, CoCr, 	Sizes small to large+	$6,250.00
	component 	totally constrained
	Orthotech Pty Ltd
OH024	Optetrak Total Knee System CCK 	Femoral Component, cemented, CoCr, 	Size 1 - 6	$6,250.00
	(Constrained Condylar Knee) 	totally stabilised
	Femoral Component 
	Smith & Nephew Surgical Pty Ltd
SN851	Legion Knee System Femoral 	Femoral Component, CoCr, Cemented, 	Sizes 1-10, Left and Right	$6,250.00
	Component	totally constrained
SN865	Genesis II Knee System Femoral 	Femoral component, cemented, totally 	Left / Right 1 - 8	$6,250.00
	Component	stabilised, CoCr
	Stryker Australia Pty Ltd
SK440	Triathlon TS Knee System Femoral 	Totally constrained, cemented, CoCr	Left & Right Size 1-8	$6,250.00
	Component 
Prostheses List by Category, Groups and Sponsor	Page 843 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SR060	Scorpio Knee System Femoral 	Totally constrained, CoCr with TiNi 	3 Left, 3 Right, 5 Left, 5 	$6,250.00
	Component	surface treatment (LFIT - Low Friction	Right, 7 Left, 7 Right, 9 
	 Ion Treatment)	Left, 9 Right, 11 Left, 11 
	Right, 13 Left, 13 Right
ST602	Duracon TS Knee System Femoral 	Totally constrained, cemented, CoCr 	Extra Small, Small, Medium, 	$6,250.00
	Component	(Vitallium)	Medium Large, Large, Extra 
	Large
	Wright Medical Australia
WR185	Medial pivot Knee System	Cemented, grit blasted, totally 	1, 2, 3, 4, 5	$6,250.00
	constrained, femoral component, CoCr
	Zimmer Pty Ltd
ZI119	NexGen LCCK (Legacy 	Femoral component, totally 	A - H (L&R)	$6,250.00
	Constrained Condylar Knee)  	constrained, CoCr
	Revision, Hinged
	Biomet Australia Pty Ltd
BH120	RHK Knee - Femoral Component	Rotating hinge, cemented, CoCr with 	Small right, Standard right, 	$6,750.00
	hinge assembly.	Small left, Standard left.
	Global Orthopaedic Technology
GO169	RBK Total Knee System Femoral 	Femoral Component, cemented, CoCr, 	Size 0 to 5	$6,750.00
	Component 	totally constrained
GO250	SHiVA Modular Knee Hinge 	Hinge Knee Femoral Component	Sizes 2,3 and 4 Left and right	$6,750.00
	Prosthesis - Femoral Component
	Link Orthopaedics  Australia
LO157	LINK Endo Model M Modular 	Femoral Components	Extra Small - Extra Large	$6,750.00
	Knee Prostheses System
	Medacta Australia Pty Ltd
MU099	GMK Hinge femur	Rotating hinge femoral component	1 to 6 Left and Right	$6,750.00
	Smith & Nephew Surgical Pty Ltd
SM158	Legion Hinge Femur CoCr	The femoral component of the Legion 	Size 2 to 7	$6,750.00
	Hinge system.
	Stryker Australia Pty Ltd
HW143	MRH (Modular Rotating Hinge) 	MRH Rotating Hinge Femoral 	Left, Right	$6,750.00
	(Modular Rotating Hinge) Femoral 	component, CoCr (Vitallium), 
	Component 	cemented, w/attachable stem, Fixed
Prostheses List by Category, Groups and Sponsor	Page 844 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.01.02 - Cemented, Alloy, PMMA Coating
	12.01.02.01 - Minimally Stabilised
	Zimmer Pty Ltd
ZI590	NexGen CR Flex Femoral 	Cobalt Chrome, High Flex, Precoat 	Sizes A to G, Left to Right, 	$3,400.00
	Components - Precoat	cemented, Cruciate retaining	GSF C to G Left to Right
	Revision
	Zimmer Pty Ltd
ZI113	NexGen Knee Femoral Component	Femoral Component, cemented with 	A - H (L&R)	$6,150.00
	PMMA, CoCr
	SCP
	Zimmer Pty Ltd
ZI111	NexGen Knee Femoral Component	Femoral Component, cemented with 	A - H (L&R)	$3,900.00
	PMMA, CoCr
	12.01.02.02 - Posterior Stabilised
	Link Orthopaedics  Australia
LO153	LINK Gemini Femoral Component PS	Femoral component PS, cemented, 	Extra small - Extra Large	$3,500.00
	CoCr, microporus
	Zimmer Pty Ltd
ZI588	NexGen LPS Flex Femoral 	Cobalt Chrome, High Flex, cemented, 	Sizes A to G, Left to Right	$3,500.00
	Component - PreCoat	PMMA coating, posterior stabilised
	SCP
	Zimmer Pty Ltd
ZI117	NexGen  Femoral Component	Femoral Component, posterior 	A - H (L&R)	$4,000.00
	stabilised, PMMA coating, cemented, 
	CoCr 
12.01.03 - Cemented, Non-Alloy
	12.01.03.01 - Minimally Stabilised
	Ceramic Surface
	Smith & Nephew Surgical Pty Ltd
SN879	Genesis II / LEGION	Femoral component, Oxinium, cemented	Left / Right 1-9	$4,200.00
Prostheses List by Category, Groups and Sponsor	Page 845 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN880	Profix Knee System Femoral 	Femoral component, Oxinium, cemented	Left / Right 1-9	$4,200.00
	Component
	12.01.03.02 - Posterior Stabilised
	Ceramic Surface
	Smith & Nephew Surgical Pty Ltd
SN779	Journey Knee System Femoral 	Femoral Component, cemented, 	1-10	$4,300.00
	Component	Oxinium, posterior stabilised 
	(bicruciate substitute)
SN883	Genesis II / LEGION	Femoral Component, cemented, 	Left / Right 1-9	$4,300.00
	posterior stabilised, Oxinium
SN884	Profix Knee System Femoral 	Femoral Component, cemented, 	1-8	$4,300.00
	Component	posterior stabilised, Oxinium
	12.01.03.03 - Totally Constrained
	Revision
	Oceania Orthopaedics
OO016	ACS Knee System - ACS SC 	Cemented femoral component, 	Left/Right Sizes 	$7,500.00
	Revision Femoral component, 	Cemented
	Cemented
	Smith & Nephew Surgical Pty Ltd
SN736	Legion Knee System Femoral 	Femoral Component, Oxinium, 	Size 1 - 9	$7,500.00
	Component	Cemented, totally constrained
	Revision, Hinged
	Wright Medical Australia
WR151	Guardian Limb Salvage System	Resurfacing Femur with extensive 	2, 3, 4, Left & Right	$7,540.00
	distal femoral buildup 
12.01.04 - Uncemented, Alloy
	12.01.04.01 - Minimally Stabilised
	Biomet Australia Pty Ltd
BI159	AGC System femoral component 	Femoral Component, uncemented, 	55-80mm	$3,700.00
	CoCr with titanium plasma sprayed 
	surface (Porous plasma spray PPS) left
	 and right sided (anatomic), 
Prostheses List by Category, Groups and Sponsor	Page 846 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI886	Vanguard Total Knee System	Femoral Component, CR, uncemented, 	55, 57.5, 60, 62.5, 65, 67.5, 	$3,700.00
	anatomic, CoCr, Ti	70, 75, 80 Left and Right
	DJO Australasia Pty Ltd
DD018	3D Knee System Femoral 	Femoral Component, uncemented,  	Size 2 to 12	$3,700.00
	beaded, CoCr
	Euros Orthopaedics Australia Pty Ltd
EU015	Europ Standard Uncemented 	Knee Uncemented Condyle	1 to 6, right and left	$3,700.00
	Global Orthopaedic Technology
GO007	RBK Total Knee System Femoral 	Femoral Component, uncemented,  	1-5 Left and Right	$3,700.00
	Component	CoCr, Porous coated
GO195	Apex Knee, CR Femoral Component 	CR Femoral Component Porous 	Size 1 Left & Right, size 2 	$3,700.00
	Porous Coated	Coated Size 1 to 6 left & Right.	left & Right, size 3 Left & 
	Right, size 4 Left & Right, 
	size 5 left & Right, size 6 
	Left & Right
	Johnson & Johnson Medical Pty Ltd
DP148	PFC Sigma Knee System femoral 	Femoral component, uncemented, 	Size 1-6	$3,700.00
	component	CoCr, Beaded
JJ606	PFC Sigma Knee System femoral 	Femoral component, uncemented, 	Size 1-6	$3,700.00
	component	CoCr, beaded (Porocoat)
	Mathys Orthopaedics Pty Ltd
MA457	Balansys Femoral Component	Femur, CoCr with Ti vacuum plasma 	XS TO F Left and Right	$3,700.00
	spray coating
	Medacta Australia Pty Ltd
MU038	Evolis Knee System Femoral 	Femoral component, uncemented, 	1 - 6, left to right	$3,700.00
	Component 	CoCr, titanium plasma spray
	Oceania Orthopaedics
OO002	ACS Knee System - Femoral 	Porous coated resurfacing femoral 	Left/Right 1-6	$3,700.00
	component porous coated	component
	Smith & Nephew Surgical Pty Ltd
SM052	VKS (Vario) Knee System Femoral 	Femoral Component, CoCr, 	1-6	$3,700.00
	Component	uncemented, Titanium Plasma Spray 
	(Vacuum spray and triple layer)
SN326	'Genesis II Knee System Femoral 	Femoral Component, CoCr, 	Left/Right Size 1-8	$3,700.00
	Component	uncemented, beaded
Prostheses List by Category, Groups and Sponsor	Page 847 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SK387	Triathlon Knee System Femoral 	Minimally stabilised, uncemented, 	1 to 8	$3,700.00
	Component 	beaded, CoCr
ST033	Scorpio Knee System Femoral 	Minimally stabilised, uncemented, 	3,5,7,9,11,13	$3,700.00
	Component	beaded, (microstructure), CoCr
	Wright Medical Australia
WR184	Medial pivot KneeSystem	Uncemented, beaded, non HA, CoCr, 	1, 2, 3, 4, 5, 6	$3,700.00
	usually used with a anterior lipped 
	insert
WR201	Advantim Total Knee System	Beaded Femoral Component, CoCr 	Small, Medium, Large, Xlarge	$3,700.00
	Zimmer Pty Ltd
ZI418	Natural Knee Femoral Component 	Femoral Component, uncemented, 	Size 00 to 5	$3,700.00
	CSTi	CoCr, with Cancellous Structured 
	Titanium ingrowth surface 
ZI558	Natural Knee II Flex Femur CSTi	Femoral Component, uncemented, 	Sizes 1 to 5 GSM Left & 	$3,700.00
	CoCr, with cancellous structure 	Right and Sizes 0 to 4 GSF 
	titanium ingrowth CSTi High Flex 	Left and Right
ZI591	NexGen CR Flex Femoral 	Cobalt Chrome, High Flex, 	Sizes A to G, Left to Right, 	$3,700.00
	Components - Uncemented	Uncemented, Cruciate retaining	GSF C to G Left to Right
	Ceramic Surface
	Endotec Australia Pty Ltd
EA006	Buechel-Pappas Ultracoat Total 	Ceramic Coated, Titanium Femoral and	BP TKR Ultracoat Primary 	$3,850.00
	Knee Replacement System (Primary 	 Tibial components with mobile 	Femoral sizes 1-6(inc) Left 
	and Revision)	Polyethylene inserts, all 	& Right
	polyethylene patella ceramic coated, 
	titanium backed polyethylene mobile 
EA013	Buechel-Pappas Ultracoat Total 	Femoral Component, Titanium, 	 1-6(inc) Left & Right	$3,850.00
	Knee Replacement System Femoral 	uncemented, beaded, TiNi articular 
	Component 	and bone surface treatment
	Ceramic Surface, SCP
	Johnson & Johnson Medical Pty Ltd
DY373	LCS Complete Knee System femoral 	Femoral component, uncemented, 	Sizes small to large+	$4,350.00
	component	Porocoat, beaded Titanium with TiN 
	surface treatment 
Prostheses List by Category, Groups and Sponsor	Page 848 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Revision
	Wright Medical Australia
WR161	Medial Pivot Knee System	Stemmed Condylar medial pivot 	1, 2, 3, 4, 5, All in left & 	$6,650.00
	component, uncemented, beaded, non 	right
	HA, CoCr used with anterior lipped 
	insert, minimally constrained
	SCP
	Johnson & Johnson Medical Pty Ltd
DP003	LCS Complete Knee System femoral 	Femoral component, uncemented, 	Sizes small to large+	$4,200.00
	component 	CoCr, beaded (Porocoat)
	Zimmer Pty Ltd
ZI109	NexGen Knee Femoral Component 	Femoral Component, uncemented, 	A - H (L&R)	$4,200.00
	CoCr plus titanium fibre metal mesh 
	ingrowth
	12.01.04.02 - Posterior Stabilised
	Biomet Australia Pty Ltd
BI165	AGC System femoral component 	Femoral Component, uncemented, 	55-80mm	$3,800.00
	CoCr with titanium plasma sprayed 
	surface (Porous plasma spray PPS) left
	 and right sided (anatomic), posterior 
	stabilised 
BI910	Vanguard Rotating Platform Femoral	Femoral Component, uncemented, 	60 - 75mm	$3,800.00
	 Component	CoCr, Titanium plasma sprayed surface
	 (Porous plasma spray PPS), Posterior
	 Stabilised
BI951	Vanguard Total Knee System	Femoral Component, Posterior 	55-80	$3,800.00
	Stabilised, anatomic, Plasma Porous 
	Coated, CoCr & Ti alloy
	Exactech Australia
EX037	Optetrak Hi Flex Femoral 	Femoral Component, uncemented, 	1-6	$3,800.00
	CoCr beaded, high flex (Hi Flex), 
	posterior stabilised 
Prostheses List by Category, Groups and Sponsor	Page 849 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU039	Evolis Knee System Femoral 	Femoral component, uncemented, 	1 - 6, left to right	$3,800.00
	Component 	CoCr, titanium plasma spray, posterior
	 stabilised 
	Oceania Orthopaedics
OO004	ACS Knee System - Posterior 	Posterior stabilised, porous coated, 	Left/Right 1-6	$3,800.00
	stabilised femoral component 	femoral component for use in knee 
	porous coated	arthroplasty
	Orthotech Pty Ltd
OH234	Optetrak Hi Flex Femoral 	Femoral Component, uncemented, 	1-6	$3,800.00
	CoCr beaded, high flex (Hi Flex), 
	posterior stabilised 
	Smith & Nephew Surgical Pty Ltd
SM071	TC (Tri Compartment) PLUS Knee 	Femoral Component, CoCr, 	2-12	$3,800.00
	System Femoral Component	uncemented,Titanium Plasma Spray 
	(Vacuum spray and triple layer), 
	posterior stabilised
SN873	Genesis II Knee System Femoral 	Femoral component, CoCr, cementless,	Left / Right 1-8	$3,800.00
	Component	 beaded, posterior stabilised
SN874	Profix Knee System Femoral 	Femoral component, CoCr, cementless,	Left / Right 1-8	$3,800.00
	Component	 beaded, posterior stabilised
	Stryker Australia Pty Ltd
SK386	Triathlon Knee System Femoral 	Posterior stabilised, uncemented, 	Sizes 1 to 8	$3,800.00
	Component	beaded, CoCr
SR007	Scorpio Knee System Femoral 	Posterior stabilised, CoCr, 	3,5,7,9,11,13	$3,800.00
	Component	uncemented, beaded, 
	(microstructured), with TiNi surface 
	treatment (LFIT - Low friction ion 
	Zimmer Pty Ltd
ZI592	NexGen LPS Flex Femoral 	Cobalt Chrome, High Flex, 	Sizes A to G, Left to Right, 	$3,800.00
	Components - Uncemented	Uncemented, Posterior stabilised	GSF C to G Left to Right
	Revision
	Wright Medical Australia
WR170	Advantim / Ortholoc Revision Knee	Femoral component CoCr Posterior 	Small, Medium, Large, Xlarge	$6,550.00
	Stabilised, beaded, without buildup
Prostheses List by Category, Groups and Sponsor	Page 850 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR194	Advantim / Ortholoc Revision Knee	Femoral component CoCr Revision 	Small, Medium, Large, Xlarge	$6,550.00
	beaded varying distal and posterior 
	buildups 
	SCP
	Zimmer Pty Ltd
ZI115	NexGen Knee Femoral Component	Femoral Component, uncemented, 	A - H (L&R)	$4,300.00
	CoCr plus titanium fibre metal mesh 
	ingrowth, posterior stabilised 
	12.01.04.03 - Totally Constrained
	Revision
	Johnson & Johnson Medical Pty Ltd
DY149	LCS Complete Knee System femoral 	Femoral component, uncemented, 	Size 1 - 6 including narrow 	$6,850.00
	component 	CoCr, beaded (Porocoat), totally 	sizesss small to large
	constrained 
	Smith & Nephew Surgical Pty Ltd
SN383	Profix Knee System Femoral 	Femoral Component, CoCr, 	Right/Left Size 1-7	$6,850.00
	Component	uncemented, beaded, totally 
12.01.05 - Uncemented, Alloy, HA Coating
	12.01.05.01 - Minimally Stabilised
	Advanced Surgical Design & Manufacture Ltd
AE041	Active Knee Femoral Component 	Femoral Component, uncemented, 	Sizes 00 -- 5 Left & Right	$4,100.00
	distally beaded with HA  
	Amplitude Australia
LI064	Score Knee System Femoral 	Femoral Component, CoCr, 	7 Sizes	$4,100.00
	Component	uncemented, stippled surface, titanium
	 plasma spray with HA, pegged 
	B Braun Australia Pty Ltd
BB232	Emotion Total Knee System (TKS) 	Femoral Component, uncemented, 	F1 - F8, Left and Right	$4,100.00
	Femoral Component 	CoCr Titanium plasma spray 
	(Plasmapore), HA coated
	Biomet Australia Pty Ltd
BI962	Vanguard Total Knee System	Femoral Component, Cruciate 	55 - 80	$4,100.00
	Retaining, Anatomic, HA, Plasma 
	Porous Coated, CoCr & Ti alloy
Prostheses List by Category, Groups and Sponsor	Page 851 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO169	Link Gemini Femoral Component	Femoral Component, uncemented, 	Extra small - Extra large	$4,100.00
	CoCr, microporous, HX coating 
	(TiCap)/Calcium Phosphate.
	MatOrtho
MJ006	MRK (Medial Rotation Knee) Total 	Femoral Component, uncemented, 	0-5 Left and Right	$4,100.00
	Knee System Femoral Component 	CoCr with stippled surface titanium 
	plasma spray HA coated  
MJ007	Saiph Knee System Femoral 	CoCr Polished Cementless Femoral 	1 - 8 Left & Right	$4,100.00
	Component Cementless	Component, Porous Titanium and HA
	Medacta Australia Pty Ltd
MU066	GMK Uncemented Standard Femur	Uncemented standard femoral 	1 to 7, left and right	$4,100.00
	component with titanium porous 
	covered by an hydroxyapatite coating
	Oceania Orthopaedics
OO003	ACS Knee System - Femoral 	Tricalcium phosphate coated 	Left/Right 1-6	$4,100.00
	component Ti/TCP coated	resurfacing femoral component for use 
	in knee arthroplasty
	Smith & Nephew Surgical Pty Ltd
SN878	Profix Knee System Femoral 	Femoral component, CoCr, cementless,	Left / Right 1-8	$4,100.00
	Component	 beaded, HA
SN910	Genesis II	CR HA Porous	1-8	$4,100.00
	Stryker Australia Pty Ltd
SK325	Triathlon Knee System Femoral 	Minimally stabilised, CoCr, 	Sizes 1 to 8	$4,100.00
	Component 	uncemented, beaded with PA 
	(Hydroxyapatite)
SK334	Scorpio NRG Knee System Femoral 	Minimally stabilised, uncemented, 	Sizes 3,4,5,6,7,9,11,13	$4,100.00
	Component	with Hydroxyapatite, CoCr
ST030	Scorpio Knee System Femoral 	Minimally stabilised, uncemented, 	3,5,7,9,11,13	$4,100.00
	Component	beaded (microstructure) with PA, 
	(Hydroxyapatite), CoCr, 
	Wright Medical Australia
WR183	Medial Pivot Knee System	Uncemented femoral component, 	1 - 6 Left and Right	$4,100.00
	beaded, HA, CoCr, usually used with 
	a anterior lipped insert
Prostheses List by Category, Groups and Sponsor	Page 852 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI062	NexGen Knee Femoral Component	Femoral Component, uncemented, 	Sizes A-G Left & Right	$4,100.00
	high flex, CoCr plus titanium fibre 
	metal mesh ingrowth and HA/TCP
	SCP
	Zimmer Pty Ltd
ZI110	NexGen Knee Femoral Component 	Femoral Component, uncemented, 	A - H (L&R)	$4,600.00
	CoCr plus titanium fibre metal mesh 
	ingrowth and HA/TCP, cruciate 
	retaining
	12.01.05.02 - Posterior Stabilised
	Biomet Australia Pty Ltd
BI887	ROCC Femoral Component 	Femoral Component, uncemented, 	1-8	$4,200.00
	Titanium plasma sprayed surface 
	(Porous plasma spray PPS) with HA 
BI911	Vanguard Rotating Platform Femoral	Femoral Component, uncemented, 	60 -75mm	$4,200.00
	 Component	CoCr, Titanium plasma sprayed surface
	 (Porous plasma spray PPS) with HA, 
	Posterior Stabilised 
BI958	Vanguard Total Knee System	Femoral Component, Posterior 	55-80	$4,200.00
	Stabilised, Anatomic, HA, Plasma 
	Porous Coated, CoCr & Ti Alloy
	Link Orthopaedics  Australia
LO168	LINK Gemini Femoral Component PS	Femoral component PS Uncemented, 	Extra Small - Extra Large	$4,200.00
	CoCr, microporus, HX Coating 
	(TiCap)/Calcium phosphate
	Medacta Australia Pty Ltd
MU051	Cinétique Knee System Femoral 	Femoral component, uncemented, 	Sizes 1 to 6, Left and Right	$4,200.00
	Component 	CoCr, with titanium micro beads, with
	 HA, posterior stabilised 
MU078	GMK Uncemented Posterior 	uncemented posterior stabilised 	1 to 7, left to right	$4,200.00
	stabilised femur	femoral component with titanium 
	porus coating covered by an 
	hydroxyapatite coating
Prostheses List by Category, Groups and Sponsor	Page 853 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH428	Trekking Knee System - Femoral 	Femoral component uncemented	1 - 5	$4,200.00
	Component
	Smith & Nephew Surgical Pty Ltd
SN911	Genesis II	PS HA Porous	1-8	$4,200.00
	Stryker Australia Pty Ltd
SR004	Scorpio NRG Knee System Femoral 	Posterior stabilised, uncemented with	Sizes 3,4,5,6,7,9,11,13	$4,200.00
	Component	 Hydroxyapatite, CoCr, 
SR006	Scorpio Knee System Femoral 	Posterior stabilised, uncemented, 	3,5,7,9,11,13	$4,200.00
	Component	beaded (microstructure) with PA 
	(Hydroxyapatite), CoCr
SR024	Triathlon Knee System Femoral 	Posterior stabilised, uncemented, 	Size 1 - 8	$4,200.00
	Component	beaded with PA (Hydroxyapatite), 
	CoCr  
	Tornier Pty Ltd
TO018	HLS Noetos Femoral Component	Femoral Component, uncemented,  HA	1 - 6 CoCr	$4,200.00
	 coated, CoCr, posterior stabilised 
	using midline condyle
12.02.01 - Cemented, Alloy
	Biomet Australia Pty Ltd
BI031	Oxford Meniscal Knee System Uni 	Uni Femoral Component, CoCr, 	Small, Medium, Large, Extra 	$2,300.00
	Femoral Component 	Cemented (Phase III)	Large.
BI203	Repicci II Unicondylar Knee System	Uni Femoral Component, Cemented, 	35-60mm	$2,300.00
	 Uni femoral component 	CoCr 
	Device Technologies Australia Pty Ltd
DE424	Restoris MCK Knee - Femeral 	Femeral Component	LM/RL sizes 1 to 8	$2,300.00
	Component	RM/LL sizes 1 to 8
	Exactech Australia
EX044	Optetrak Uni Condylar Knee 	Uni Femoral Component, cemented, 	1-6	$2,300.00
	System Femoral Component  	CoCr
Prostheses List by Category, Groups and Sponsor	Page 854 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO032	Global re-surfacing uni-	Uni Femoral component, CoCr, 	Size 1-5 Right medial/left 	$2,300.00
	compartmental knee femoral 	cemented 	lateral; Size 1-5 Left 
	component	medial/right lateral
	Johnson & Johnson Medical Pty Ltd
DY112	Preservation Knee System uni 	Uni femoral component, cemented, 	Size 1-5	$2,300.00
	femoral component  	CoCr
JJ781	Sigma HP Unicompartmental Knee - 	Unicompartmental femoral component,	Size 1-6, LM/RL & RM/LL	$2,300.00
	Unicondylar femoral component	 cemented, CoCr
	Link Orthopaedics  Australia
LO059	LINK Endo-Model SLED Uni 	Uni Femoral Component, cemented, 	Short, medium-short, 	$2,300.00
	femoral componet 	CoCr	medium & large  
	Mathys Orthopaedics Pty Ltd
MA451	BalanSys UNI femoral component 	Uni Femoral component, cemented 	A, B,C,D,E	$2,300.00
	CoCr
	Medacta Australia Pty Ltd
MU060	Unicompartmental femoral 	cemented unicompartmental femoral 	1 to 4	$2,300.00
	component
	Orthotech Pty Ltd
OH230	Optetrak Uni Condylar Knee 	Uni Femoral Component, cemented, 	1-6	$2,300.00
	System Femoral Component  	CoCr
OH395	Freedom PKR / Active 	Uni Femoral component, cemented 	All sizes for Femoral 	$2,300.00
	Unicompartmental Knee System 	with hydroglaze (Electro-polished 	Component
	Femoral Component 	surface), CoCr
	Smith & Nephew Surgical Pty Ltd
SM049	UC (Unicompartment) PLUS 	Uni Femoral Component, CoCr, 	Femoral - 4, 6, 8, 10.	$2,300.00
	Solution Knee System Uni Femoral 	cemented
	Component
SM157	Journey Uni Femur- Cocr	Uni Femur - CoCr - It is UniCondylar 	Size 1 to Size 7	$2,300.00
	Femur
SN338	Genesis II Uni Femoral Component	Uni Femoral component, CoCr, 	X-Small - Magnum Plus	$2,300.00
	cemented
Prostheses List by Category, Groups and Sponsor	Page 855 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SR083	Triathlon PKR - Cemented Femoral 	Triathlon PKR - Uni Femoral 	12 -Femurs in total: 1 	$2,300.00
	Component	Component, CoCR, Cemented	through to 6, Left 
	Media/Right lateral + 1 
	through to 6, Right 
	Media/Left Lateral
	Tornier Pty Ltd
TO007	HLS Uni Femoral Component 	Femoral Component - Cemented, CoCr	1 - 4 CoCr	$2,300.00
	Wright Medical Australia
WR156	Advance-Unicondylar Knee System	Uni Femoral component, cemented, 	Sizes 1, 2, 3, 4	$2,300.00
	CoCR 
	Zimmer Pty Ltd
ZI401	Allegretto Unicompartmental Knee 	Uni Femoral component, cemented, 	Size 1 to 3, Size 1+ to 3+	$2,300.00
	Femoral Componen	CoCr
	Ceramic Surface
	Corin Australia Pty Ltd
CR059	Uniglide Uni Knee System Uni 	Uni Femoral Component, CoCr, 	1-4	$2,450.00
	Femoral Component	cemented, with TiNi surface  coating
	12.02.01.01 - PMMA Coating
	B Braun Australia Pty Ltd
BB197	Emotion Unicondylar Knee System 	Uni Femoral Component, cemented, 	F1 - F8, Left and Right	$2,300.00
	Uni Femoral Component 	CoCr, with PMMA 
	Zimmer Pty Ltd
ZI106	Miller Galante  Unicompartmental 	Femoral Component, Co Cr, Cemented 	Small to extra large 	$2,300.00
	Femoral Compoment 	for fixed insert  
ZI494	ZUK (Zimmer Uni-Compartmental 	Femoral Component, cemented, CoCr, 	Sizes A to G	$2,300.00
	High Flex Knee) Femoral 	high flex 
12.02.02 - Cemented, Non-Alloy
	Ceramic Surface
	Smith & Nephew Surgical Pty Ltd
SM156	Journey Uni Femur-Oxinium	Uni Femur - Oxinium - It is 	Size 1 to Size 7 Please refer 	$2,825.00
	UniCondylar Femur	to the pocket guide
Prostheses List by Category, Groups and Sponsor	Page 856 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN710	Genesis Uni Femoral Component	Uni Femoral component, Oxinium, 	X-Small - Magnum	$2,825.00
	cemented
12.02.03 - Uncemented, Alloy
	Biomet Australia Pty Ltd
BI967	Oxford Meniscal Knee System	Femoral Component, Porous Coated, 	Small - Extra Large	$2,300.00
	CoCr Ti
	12.02.03.01 - HA Coating
	Biomet Australia Pty Ltd
BI966	Oxford Meniscal Knee System	Femoral Component, Porous HA 	Small - Extra Large	$2,500.00
	Coated CoCr, Ti, HA
	Stryker Australia Pty Ltd
ST655	UNIX Unicompartmental Knee 	Uni Femoral component, uncemented 	1, 2, 3, 4	$2,500.00
	System Femoral Component	with Hydroxyapatite, CoCr
	Ceramic Surface
	Corin Australia Pty Ltd
CR058	Uniglide Uni Knee System Uni 	Uni femoral component, CoCr, 	1-4	$2,650.00
	Femoral Component	uncemented, Titanium plasma spray, 
	with calcium phosphate (HA) 
	ingrowth surface with TiNi articular 
	surface coating 
12.03.01 - Cemented, All polyethylene
	Exactech Australia
EX056	Optetrak Net Compression Molded 	The Exatctech Optetrak 	Size 1 - 9mm, 11mm, 13mm	$1,250.00
	Cruciate Retaining All 	Comprehensive Knee System is a knee	Size 2 - 9mm, 11mm, 13mm
	Polyethylene Tibial Component	 joint prosthesis intended for use in 	Size 3 - 9mm, 11mm, 13mm
	treating human knee joint diseases.  It 	Size 4 - 9mm, 11mm, 13mm
	consists of femoral components, tibial 	Size 5 - 9mm, 11mm, 13mm
	components, patella components and a	Size 6 - 11mm, 13mm
	 variety of optional augmentation 
	blocks and
Prostheses List by Category, Groups and Sponsor	Page 857 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
EX057	Optetrak Net Compression Molded 	The Exactech Optetrak 	Size 1 - 9mm, 11mm, 13mm	$1,250.00
	Posterior Stabilised All 	Comprehensive Knee System is a knee	Size 2 - 9mm, 11mm, 13mm
	Polyethylene Tibial Component	 joint prosthesis intended for use in 	Size 3 - 9mm, 11mm, 13mm
	treating human knee joint diseases.  It 	Size 4 - 9mm, 11mm, 13mm
	consists of femoral components, tibial 	Size 5 - 9mm, 11mm, 13mm
	components, patella components and a	Size 6 - 11mm, 13mm
	 variety of optional augmentation 
	Johnson & Johnson Medical Pty Ltd
JJ589	PFC Sigma Knee System tibial 	All poly UHMWPE, Cemented, 	Sizes  1 - 6.  8-30mm	$1,250.00
	baseplate
JJ590	PFC Sigma Knee System Tibial 	All poly UHMWPE, cemented, non 	Sizes  1 - 6.  8-30mm	$1,250.00
	Baseplate	pegged 
	Smith & Nephew Surgical Pty Ltd
SN869	Genesis II Knee System Tibial 	Tibial Baseplate, all poly, cemented	Left / Right 1 - 8	$1,250.00
	Baseplate
	Stryker Australia Pty Ltd
ST647	Scorpio Knee System Tibial 	Tibial baseplate, All UHMWPE, 	3, 5, 7, 9, 11, 13	$1,250.00
	Baseplate 	cemented 
	Wright Medical Australia
WR203	Advantim Total Knee System	All Poly Tibial UHMWPE	Small, Medium, Large, Xlarge	$1,250.00
	Zimmer Pty Ltd
ZI127	NexGen Knee Tibial Baseplate	Baseplate All Poly, cemented, 	1 - 10	$1,250.00
	UHMWPE
	Medacta Australia Pty Ltd
MU119	GMK Full-PE UC Tibial 	Tibial baseplate, All UHMWPE, 	sizes 1 - 6. 10 - 17mm	$1,250.00
	cemented, ultra congruent
MU120	GMK Full-PE Tibial Component	Tibial baseplate, All UHMWPE, 	Sizes 1 -6. 10 -17mm	$1,250.00
	cemented, postero stabilized
Prostheses List by Category, Groups and Sponsor	Page 858 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.03.02 - Cemented, Alloy
	Advanced Surgical Design & Manufacture Ltd
AE040	Active Knee Tibial Baseplate	Tibial baseplate, Cemented, CoCr	Sizes 1-5 	$2,150.00
	Biomet Australia Pty Ltd
BI182	Biomet Universal Tibial Baseplate 	Tibial baseplate, Cemented, one piece, 	59-91mm	$2,150.00
	Ti or CoCr
	DJO Australasia Pty Ltd
DD019	3D Knee System Tibial Baseplate 	Tibial Baseplate, cemented, CoCr	Size 1 to 12	$2,150.00
	Euros Orthopaedics Australia Pty Ltd
EU016	Europ Standard & Postero 	Knee Cemented Monobloc plate	1 to 6	$2,150.00
	Cemented Monobloc Plate
	Exactech Australia
EX032	Optetrak Total Knee System, Tibial 	Tibial Baseplate, titanium, fixed insert,	Size 1-6	$2,150.00
	Baseplate	 cemented
EX036	Optetrak Total Knee System, Tibial 	Tibial Baseplate, titanium, fixed insert 	Size 1-6	$2,150.00
	Baseplate	(finned, trapezoid, offset with locking 
	screw), cemented
	Global Orthopaedic Technology
GO194	Apex Knee, Tibial Base Plate - 	Tibial Baseplate, Cemented, Non-	Size 1 Left & Right, size 2 	$2,150.00
	Cemented	Porous, Size 1 - 7 Left & Right	Left & Right, size 3 Left & 
	Right, size 4 Left & Right, 
	size 5 Left & Right, size 6 
	Left & Right, size 7 Left & 
	Right.
	Johnson & Johnson Medical Pty Ltd
JJ662	PFC Sigma Knee System Tibial 	Tibial baseplate, cemented, keeled, 	Size 1-6	$2,150.00
	Baseplate	titanium, with capacity for stem 
	attachment
JJ663	PFC Sigma Knee System Tibial 	Tibial baseplate, cemented, cruciform 	Size 1-6	$2,150.00
	Baseplate	keeled, titanium
	Mathys Orthopaedics Pty Ltd
MA515	Balansys Tibial Baseplate	Tibial Baseplate cemented, CoCr	59mm to 85mm	$2,150.00
Prostheses List by Category, Groups and Sponsor	Page 859 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MA518	Balansys Tibial Baseplate	Tibial Baseplate cemented, CoCr, 	59mm to 85mm	$2,150.00
	TiNbN coated
	MatOrtho
MJ008	MRK (Medial Rotation Knee) Total 	Tibial Baseplate, cemented, Titanium 	1-5	$2,150.00
	Knee System Tibial Baseplate 	for fixed insert 
MJ009	Saiph Knee System Tibial 	CoCr Tibial Component, Cemented	A - F, Standard and Long 	$2,150.00
	Component Cemented	Stem
	Medacta Australia Pty Ltd
MU075	GMK Cemented fixed Tibia Tray	Asymmetric polished cemented fixed 	1 to 6, left to right	$2,150.00
	tibial component
MU114	GMK Cemented FIXED Tibial Tray -	Asymmetric polished cemented fixed 	1 to 6, left to right	$2,150.00
	TiNbN coated	tibial component, with TiNbN surface 
	coating
	Orthotech Pty Ltd
OH329	Optetrak Total Knee System, Tibial 	Tibial Baseplate, titanium, fixed insert,	Size 1-6	$2,150.00
	Baseplate	 cemented
OH330	Optetrak Total Knee System, Tibial 	Tibial Baseplate, titanium, fixed insert 	Size 1-6	$2,150.00
	Baseplate	(finned), cemented
OH417	Samo TCK Revision Knee System	Tibial Tray	T1-T5	$2,150.00
OH425	Trekking Knee System, Tibial 	Tibial component cemented	1 - 5	$2,150.00
	Component
	Smith & Nephew Surgical Pty Ltd
SM065	VKS (Vario) Knee System Tibial 	Tibial Baseplate, CoCr, Cemented, for 	1-12	$2,150.00
	Baseplate	fixed insert
SN848	Journey Knee System Tibial 	Tibial baseplate, cemented, Titanium, 	Sizes 1-8, Left and Right	$2,150.00
	for fixed insert
SN857	Genesis II Knee System Tibial 	Tibial Baseplate, cemented, Titanium, 	1 - 9	$2,150.00
	Baseplate	grit blasted
SN858	Profix Knee System Tibial Baseplate	Tibial Baseplate, cemented, Titanium, 	1 - 8	$2,150.00
	grit blasted
	Stryker Australia Pty Ltd
SK327	Triathlon Knee System Tibial 	Tibial baseplate, cemented, CoCr  	Sizes 1 to 8	$2,150.00
	Baseplate
ST066	Scorpio Knee System Tibial 	Tibial baseplate, cemented, CoCr 	3, 5, 7, 9, 11, 13	$2,150.00
	Baseplate 
Prostheses List by Category, Groups and Sponsor	Page 860 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Tornier Pty Ltd
TO034	HLS Noetos Tibial Baseplate, Fixed	Tibial Baseplate/Tray, Cemented, 	Size 1 to 6	$2,150.00
	Fixed Bearing, CoCr
TO062	HLS Kneetec - Fixed Tibial Tray	Fixed Tibial Tray for HLS Kneetec 	Sizes 1 to 8	$2,150.00
	System, CoCr, Cemented
	Wright Medical Australia
WR175	Advantim / Ortholoc Knee	Tibial Components Modular Stem 	Small, Small Plus, Medium, 	$2,150.00
	Base, cemented, non beaded CoCr	Medium Plus, Large, Large 
	Plus, Xlarge
WR188	Medial Pivot Knee System	Tibial component, CoCr, cemented	1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 	$2,150.00
	5+, 6, 7, 8, 8+
	Zimmer Pty Ltd
ZI413	Natural Knee Tibial Baseplate 	Tibial Baseplate, Cemented - Titanium 	Size 00 to 5	$2,150.00
	for fixed inserts 
ZI595	NexGen Knee Tibial Components 	Option - Titanium	1 to 10	$2,150.00
	Stemmed - Option
ZI608	Natural Knee II Modular Cemented 	Modular Cemented Baseplate	Sizes 00, 0, 1,2,3,4, 5 - Left 	$2,150.00
	Tibial Baseplate	and Right
	Hinged
	Link Orthopaedics  Australia
LO158	LINK Endo Model M Modular 	Tibial Components	Extra Small - Extra Large	$4,150.00
	Knee Prostheses System
	Revision
	B Braun Australia Pty Ltd
BB204	Columbus Total Knee System (TKS) 	Tibial baseplate, cemented, CoCr for 	T1 to T5	$3,650.00
	Tibial Baseplate 	fixed insert
	Biomet Australia Pty Ltd
BI169	Biomet Universal Tibial Baseplate 	Tibial baseplate, Cemented, Titanium, 	59-91mm	$3,650.00
	which allows for attachmnet of a 
	variety of different stems and for fixed 
	inserts
BI811	Offset Tibial Tray System 	Tibial baseplate, Cemented, Titanium, 	59-91mm	$3,650.00
	which allows for attachment of the 
	offset adaptor 
Prostheses List by Category, Groups and Sponsor	Page 861 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO256	Apex Revision Knee System	A modular tibial baseplate	sizes 1-6	$3,650.00
	Johnson & Johnson Medical Pty Ltd
DY467	PFC Sigma Knee System tibial 	Tibial baseplate, cemented, keeled, 	Size 1-6	$3,650.00
	baseplate	Titanium, standard and offset keels 
	with capacity for augment and stem 
	attachment 
JJ510	PFC Sigma Knee System tibial 	Tibial baseplate, cemented, keeled, 	Size 1-6	$3,650.00
	baseplate	forged CoCr, polished tibial insert 
	surface 
	Mathys Orthopaedics Pty Ltd
MA509	Balansys Revision Knee, Tibial 	Revision Tibial Baseplate, modular	64 to 85	$3,650.00
	Plateau
	Medacta Australia Pty Ltd
MU030	Evolis Knee System Tibial 	Tibial baseplate, cemented, titanium 	1 - 6	$3,650.00
	for fixed insert 
	Oceania Orthopaedics
OO020	ACS Knee System-ACS Revision 	Revision base plate, cemented, for use 	Left and Right, Sizes 	$3,650.00
	tibial component, cemented	with augments and straight or offset 	2,3,4,5,6
	stems
	Smith & Nephew Surgical Pty Ltd
SN824	Legion Knee System Tibial Baseplate	Tibial baseplate, cemented, Titanium, 	1-8	$3,650.00
	for fixed insert,
	Stryker Australia Pty Ltd
SR034	Triathlon TS Knee System Tibial 	Tibial baseplate, stemmed revision, 	1 to 8	$3,650.00
	Baseplate 	cemented, CoCr
SR080	Duracon Knee System Stemmed 	Stemmed revision baseplate, CoCr, 	XS1, XS2, S1, S2, M1, M2,  	$3,650.00
	Revision Baseplate	(Vitallium). Cemented, Fixed	L1, L2, Xl1, Xl2
ST034	Scorpio Knee System Tibial 	Tibial baseplate, cemented, ability to 	3,5,7,9,11,13	$3,650.00
	Baseplate 	attach stems, CoCr  
	Tornier Pty Ltd
TO026	HLS Noetos Revision Tibial 	Tibial Tray, CoCr, cemented, 	1 to 6	$3,650.00
	Baseplate 
Prostheses List by Category, Groups and Sponsor	Page 862 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR168	Medial Pivot Knee System	Revision tibial component, titanium, 	1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 	$3,650.00
	cemented with offset stem	5+ in Left & Right
WR198	Medial Pivot Knee System	Revision tibial component,  titanium, 	0+, 1, 1+, 2, 2+, 3, 3+, 4, 4+, 	$3,650.00
	cemented	5, 5+, 6
	Zimmer Pty Ltd
ZI126	NexGen Knee Tibial Baseplate 	Stemmed AP wedged tibial baseplate, 	1 - 10	$3,650.00
	cemented, for fixed insert, titanium, 
	PMMA coated, with capacity for 
	augment and stem attachment
ZI867	NexGen Stemmed Tibial Component 	Stemmed tibial baseplate, cemented,for	1-10	$3,650.00
	- cemented	 fixed insert, titanium PMMA coated, 
	with capacity for augment and stem 
	attachment
	Revision, Hinged
	Medacta Australia Pty Ltd
MU100	GMK Hinge fixed tibial tray	Tibial Component cemented CoCr	1 to 6 Left and Right	$4,150.00
	Smith & Nephew Surgical Pty Ltd
SM092	RT (Rotating Hinge) PLUS Knee 	Tibial Baseplate, CoCr, cemented, for 	0-10	$4,150.00
	System Tibial Baseplate	fixed insert
	Stryker Australia Pty Ltd
HW141	MRH (Modular Rotating Hinge) 	MRH Tibial baseplate, CoCr 	Small, Medium, Large	$4,150.00
	Tibial Baseplate	(Vitallium), fixed insert with central 
	hole for hinged insertion, 
	w/attachable stem
	12.03.02.01 - PMMA Coating
	Zimmer Pty Ltd
ZI122	NexGen Tibial Baseplate  	Pegged Tibial Baseplate, cemented, for	1  - 10	$2,250.00
	 fixed insert, titanium, PMMA coated  
ZI866	NexGen primary Tibial Component	Precoat-Titanium	1-10	$2,250.00
Prostheses List by Category, Groups and Sponsor	Page 863 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.03.03 - Cemented, Alloy, Moulded Polyethylene
	Biomet Australia Pty Ltd
BI153	AGC Knee System Tibial  Baseplate 	Tibial baseplate, CoCr,  Moulded, V2 	63-91mm	$3,150.00
	(version 2), UHMWPE, cemented
BI810	Vanguard  Complete Knee System	Tibial bearing & tray, ' Mono Lok' 	59 -91mm	$3,150.00
	Cruciate Retaining or Posterior 
	Stabilised, CoCr UHMWPE
12.03.04 - Cemented, Alloy, for Mobile Insert
	Biomet Australia Pty Ltd
BI196	Vanguard Rotating Platform Tibial 	Tibial Baseplate Chrome Cobalt	63-87mm	$2,400.00
	Baseplate 
BI894	ROCC Tibial Baseplate 	Tibial Baseplate, cemented, CoCr for 	1-8	$2,400.00
	mobile insert  
	Exactech Australia
EX040	Optetrak RBK (Rotating Bearing 	Tibial Baseplate, titanium with 	1-6	$2,400.00
	Knee) Tibial Baseplate 	polished insert surface, cemented, for a
	 mobile insert 
	Global Orthopaedic Technology
GO003	RBK Total Knee System Tibial 	Tibial baseplate, grit blast, CoCr, 	0 - 5	$2,400.00
	Baseplate 	cemented, for mobile bearing insert 
GO155	RBK Universal Knee System Tibial 	Tibial Baseplate, short keel,  	1 - 5	$2,400.00
	Baseplate 	cemented, CoCr, for mobile insert 
	Johnson & Johnson Medical Pty Ltd
DP032	MBT Knee System tibial baseplate 	Tibial baseplate, cemented, CoCr, for 	Sizes 1 - 7	$2,400.00
	rotating platform, (keeled and non 
	keeled) 
DP235	LCS Classic and Universal Knee 	Tibial baseplate, CoCr, cemented for 	Sizes small to large+	$2,400.00
	System tibial baseplate	rotating platform 
Prostheses List by Category, Groups and Sponsor	Page 864 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Link Orthopaedics  Australia
LO171	Link Endo Model Rotational and 	Tibial Components	Extra small - extra large	$2,400.00
	Hinge Knee Prostheses
LO176	Link Gemini Tibial Baseplate	Tibial baseplate, cemented	Extra small - extra large	$2,400.00
	Mathys Orthopaedics Pty Ltd
MA312	balanSys Tibial Baseplate	Tibial Baseplate for Mobile Bearing 	59mm to 85mm	$2,400.00
	Insert, cemented, CoCr
	Medacta Australia Pty Ltd
MU047	Cinétique Knee System Tibial 	Tibial Baseplate, cemented, with 	Sizes 1 to 7, Left and Right	$2,400.00
	Baseplate 	polished insert surface for mobile 
MU048	Cinétique Knee System Tibial 	Tibial Baseplate, cemented, titanium, 	Sizes 1 to 7, Left and Right	$2,400.00
	Baseplate 	with TiNi (TiNibN) surface coating of 
	insert surface for mobile insert 
MU077	GMK Mobile Cemented Tibia Tray	Asymmetric mobile cemented tibial 	1 to 6, left to right	$2,400.00
	component
MU115	GMK Mobile Cemented Tibial Tray  	Asymmetric mobile cemented tibial 	1 to 6, left to right	$2,400.00
	- TiNbN coated	component, with TiNbN surface 
	coating.
	Oceania Orthopaedics
OO006	ACS Knee System - ACS tibial 	Tibial base plate, cemented, for use 	2-7	$2,400.00
	component cemented	with mobile bearing insert, TiN 
OO008	Implant ACS Knee System - 	Tibial base plate, cemented, for use 	Sizes 2-7	$2,400.00
	cemented tibial component	with mobile bearing insert, TiN 
	Orthotech Pty Ltd
OH236	Optetrak RBK (Rotating Bearing 	Tibial Baseplate, titanium with 	1-6	$2,400.00
	Knee) Tibial Baseplate 	polished insert surface, cemented, for a
	 mobile insert 
OH422	Trekking Knee System, Tibial	Mobile tibial tray, cemented	1 - 5	$2,400.00
	Smith & Nephew Surgical Pty Ltd
SM030	TC (Tri Compartment) PLUS Knee 	Tibial Baseplate, CoCr, Cemented for 	2 to 12	$2,400.00
	System Tibial Baseplate	mobile insert, polished insert surface
SN369	Mobile Bearing Knee System Tibial 	Tibial baseplate, cemented, CoCr, 	Left & Right, Size 1-8	$2,400.00
	Baseplate	polished insert surface, for mobile 
	insert, 
Prostheses List by Category, Groups and Sponsor	Page 865 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
SR030	Triathlon Knee System Tibial 	Mobile bearing, tibial baseplate, 	1 to 8	$2,400.00
	Baseplate 	cemented, CoCr  
ST069	Scorpio Knee System Tibial 	Mobile bearing tibial baseplate, 	3, 5, 7, 9, 11, 13	$2,400.00
	Baseplate 	cemented, CoCr
	Tornier Pty Ltd
TO033	HLS Noetos Tibial Baseplate, mobile	Tibial Baseplate/Tray, Cemented, 	Size 1 to 6	$2,400.00
	Mobile Bearing, CoCr
TO061	HLS Kneetec - Mobile Tibial Tray	Mobile Tibial Tray for HLS Kneetec 	Sizes 1 to 8	$2,400.00
	System, CoCr, Cemented
	Revision
	Amplitude Australia
LI068	Score Knee System Tibial Baseplate 	Tibial Baseplate, Cemented, CoCr, 	7 Sizes	$3,900.00
	polished insert surface for mobile 
	B Braun Australia Pty Ltd
BB253	Columbus Total Knee System (TKS) 	Tibial Baseplate, Cemented, CoCr for 	T1- T5	$3,900.00
	Tibial Baseplate 	mobile insert, polished insert surface
	Global Orthopaedic Technology
GO115	RBK Total Knee System Tibial 	Tibial Baseplate, for mobile insert, 	Size 00 to 5	$3,900.00
	Baseplate 	CrCo, cemented
	Oceania Orthopaedics
OO019	ACS Knee System - ACS SC 	Revision MB base plate for use with 	Sizes 2,3,4,5,6	$3,900.00
	Revision Tibial component, 	augments and straight or offset stems
	Revision, Extra Thick
	Johnson & Johnson Medical Pty Ltd
JJ634	LCS Complete Knee System - MBT 	Thick Tibial Tray	1 to 6	$7,450.00
	Revision Thick Tray
JJ804	MBT Revision Thick Tibial Tray	Tibial Tray	Size range 2 to 5.  Tray 	$7,450.00
	Thickness of 25mm
	Revision, Hinged
	Biomet Australia Pty Ltd
BH122	RHK Knee - Stemmed Tibial Tray	Tibial Component, stemmed tray	63-71mm	$4,400.00
BH123	RHK Knee - Modular Tibial Tray	Tibial Component, modular tray	63 to 71mm	$4,400.00
Prostheses List by Category, Groups and Sponsor	Page 866 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO251	SHiVA Modular Knee Prosthesis - 	Tibial Tray	Size 2,3 and 4	$4,400.00
	Tibial Tray
	Johnson & Johnson Medical Pty Ltd
DP259	SROM Noiles Knee System tibial 	Tibial baseplate, CoCr, cemented, for 	Sizes xxsmall-large	$4,400.00
	component	rotating platform insert 
DY151	MBT Knee System Revision Tibial 	Tibial baseplate, cemented, CoCr, for 	Sizes 1-7	$4,400.00
	base Plate 	rotating platform, also usable with 
	specific hinged insert 
	Smith & Nephew Surgical Pty Ltd
SM160	Legion Hinge Tibial Baseplate	A tibial baseplate used for the Legion 	Size 2 to 7 Left, Right	$4,400.00
	Hinge system.
	Zimmer Pty Ltd
ZI308	Nexgen Rotating Hinge Tibial 	Stemmed Tibial Baseplate with 	1-6	$4,400.00
	Baseplate 	polished tibial insert surface, 
	cemented, PMMA coated for Nexgen 
	rotating hinged femoral component 
	Revision
	B Braun Australia Pty Ltd
BB201	e.MOTION Total Knee	Tibial baseplate, cemented, CoCR 	T1-T8, left and right	$3,900.00
	with polished surface for mobile insert
	12.03.04.01 - PMMA Coating
	Zimmer Pty Ltd
ZI415	Natural Knee	Primary Tibial Baseplate - Mobile 	Size 00 to 5	$2,500.00
	Bearing Non Porous - CoCr alloy
ZI862	NexGen Legacy Knee Tibial 	Tibial baseplate, cemented, CoCr, with	1 - 10	$2,500.00
	Baseplate	 PMMA coating for legacy posterior 
	stabilised mobile insert
Prostheses List by Category, Groups and Sponsor	Page 867 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.03.05 - Uncemented, Alloy
	Biomet Australia Pty Ltd
BI977	Regenerex Tibial Tray	Tibial Baseplate, modular. Regenerex 	59, 63, 67, 71, 75, 79, 83 mm	$2,300.00
	porous coat, Ti Alloy
	DJO Australasia Pty Ltd
DD020	3D Knee System Tibial Baseplate 	Tibial Baseplate, uncemented,  beaded,	Size 1 to 12	$2,300.00
	 CoCr and Titanium
	Smith & Nephew Surgical Pty Ltd
SM066	VKS (Vario) Knee System Tibial 	Tibial Baseplate, CoCr, uncemented, 	1-12	$2,300.00
	Baseplate	Titanium Plasma Spray (Vacuum spray
	 and triple layer), for fixed insert
SN859	Genesis II Knee System Tibial 	Tibial Baseplate, cementless, titanium,	Left / Right 1-8	$2,300.00
	Baseplate	 beaded, for fixed insert
SN860	Profix Knee System Tibial Baseplate	Tibial Baseplate, cementless, titanium,	Left / Right 1-8	$2,300.00
	 beaded, for fixed insert
	Stryker Australia Pty Ltd
HW086	Duracon Knee System Tibial 	Tibial baseplate, uncemented, beaded, 	Small, Medium, Large, 	$2,300.00
	Baseplate 	CoCr (Vitallium) 	Extra-Large
SK388	Triathlon Knee System Tibial 	Tibial baseplate, uncemented, beaded, 	Sizes 1 to 8	$2,300.00
	Baseplate 	CoCr
ST029	Scorpio Knee System Tibial 	Tibial baseplate, uncemented, beaded 	3,5,7,9,11,13	$2,300.00
	(microstructure), CoCr 
	Wright Medical Australia
WR176	Advantim / Ortholoc Knee	Tibial Components Modular Stem 	Small, Small Plus, Medium, 	$2,300.00
	Base, uncemented and beaded CoCr	Medium Plus, Large, Large 
	Plus, Xlarge
	Zimmer Pty Ltd
ZI086	Stemmed Tibial Tray:Porous	Ti	A - K	$2,300.00
ZI120	NexGen Tibial Baseplate 	Pegged tibial baseplate,  uncemented, 	1  - 10	$2,300.00
	titanium fibre metal mesh for fixed 
	insert  
Prostheses List by Category, Groups and Sponsor	Page 868 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI412	Natural Knee Tibial Baseplate CSTi 	Tibial Baseplate, uncemented,  	Size 00 to 5	$2,300.00
	Cancellous structure Titanium 
	ingrowth surface for fixed inserts 
ZI569	Nexgen Trabecular Metal Tibial Tray	Nexgen Trabecular Metal Tibial Tray	sizes 2, 3, 4, 5, 6, 7 & 8	$2,300.00
	Revision
	Medacta Australia Pty Ltd
MU040	Evolis Knee System Tibial 	Tibial baseplate, uncemented, titanium	1 -6	$3,800.00
	 with titanium plasma spray, for fixed 
	insert 
	Oceania Orthopaedics
OO021	ACS Knee System-ACS Revision 	Revision tibial component, 	Left and Right, Sizes 	$3,800.00
	tibial component, cementless porous	cementless porous coated, for use with	2,3,4,5,6
	 coated	 augments and straight or offset stems.
	Stryker Australia Pty Ltd
SR081	Duracon Knee System Stemmed 	Stemmed revision baseplate, CoCr, 	S1, S2, M1, M2, L1, L2 	$3,800.00
	Revision Baseplate	(Vitallium), uncemented, beaded, with 	XL1, XL2
	screw holes for screw fixation, fixed
	Wright Medical Australia
WR169	Medial Pivot Knee System	Tibial component, beaded, titanium	1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 	$3,800.00
	5+, 6
WR173	Advantim / Ortholoc Revision Knee	Tibial Components Modular Stem 	Small, Small Plus, Medium, 	$3,800.00
	Thickened Base (beaded)	Medium Plus, Large, Large 
	Plus, Xlarge
WR174	Advantim / Ortholoc Revision Knee	Tibial Components Modular Stem, 	Small, Small Plus, Medium, 	$3,800.00
	medial or lateral wedged base 	Medium Plus, Large, Large 
	(beaded) Titanium	Plus, Xlarge
	Zimmer Pty Ltd
ZI123	NexGen Tibial Baseplate 	Stemmed tibial baseplate,  	1  - 10	$3,800.00
	uncemented, titanium fibre metal mesh 
	for fixed insert  
ZI416	Natural Knee Tibial Baseplate CSTi 	Tibial Baseplate, uncemented,  with 	0 to 5	$3,800.00
	fixed long stems and capacity to attach
	 augments, Cancellous structure 
	Titanium ingrowth surface for fixed 
	inserts 
Prostheses List by Category, Groups and Sponsor	Page 869 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	12.03.05.01 - HA Coating
	Advanced Surgical Design & Manufacture Ltd
AE099	Active Knee Tibial Baseplate 	Tibial Baseplate, HA, uncemented, 	Sizes 1 to 5 (A-Narrow & B-	$2,700.00
	beaded, stemmed , CoCr	Wide)
	Biomet Australia Pty Ltd
BI186	Maxim Complete Knee System Tibial	Tibial baseplate, uncemented, 	59 - 91mm	$2,700.00
	 Baseplate 	Titanium plasma sprayed surface 
	(Porous plasma spray PPS) with HA
BI961	Tibial Tray System	Tibial Tray System - Primary, one 	59-91	$2,700.00
	piece, highly polished, uncemented, 
	HA, plasma porous coated
	Global Orthopaedic Technology
GO193	Apex Knee, Tibial Base Plate - 	Tibial Baseplate, Cementless	Size 1 Left & Right, Size 2 	$2,700.00
	Left & Right, Size 3 Left & 
	Right, Size 4 Left & Right, 
	Size 5 Left & Right, Size 6 
	Left & Right
	Johnson & Johnson Medical Pty Ltd
DP891	AMK Tibial Baseplate 	Tibial Baseplate, uncemented, CoCr, 	Size 1-5	$2,700.00
	beaded, HA (Duofix), for fixed insert 
	MatOrtho
MJ010	MRK (Medial Rotation Knee) Total 	Tibial Baseplate, uncemented, 	1-5	$2,700.00
	Knee System Tibial Baseplate 	Titanium with stippled surface 
	titanium plasma spray HA coated
MJ011	Saiph Knee System Tibial 	CoCr Tibial Component, Porous 	A - F, Standard an Long 	$2,700.00
	Component Cementless	Titanium and HA
	Medacta Australia Pty Ltd
MU067	GMK Uncemented Fixed Tibia Tray	Asymmetric uncemented fixed tibial 	1 to 6, left and right	$2,700.00
	component
	Orthotech Pty Ltd
OH426	Trekking Knee System, tibial 	Tibial component uncemented	1 - 5	$2,700.00
	component
	Smith & Nephew Surgical Pty Ltd
SN861	Genesis II Knee System Tibial 	Tibial baseplate, cementless, titanium, 	Left / Right 1 - 8	$2,700.00
	Baseplate	beaded, HA for fixed insert
Prostheses List by Category, Groups and Sponsor	Page 870 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN862	Profix Knee System Tibial Baseplate	Tibial baseplate, cementless, titanium, 	Left / Right 1 - 8	$2,700.00
	beaded, HA for fixed insert
	Stryker Australia Pty Ltd
SK326	Triathlon Knee System Tibial 	Tibial baseplate, uncemented, beaded 	Sizes 1 to 8	$2,700.00
	Baseplate 	with PA (Hydroxyapatite), without 
	screw holes, CoCr 
SK433	Triathlon Knee System Tibial 	Tibial baseplate, uncemented, beaded 	1-8	$2,700.00
	Baseplate 	with PA (Hydroxyapatite), with 
	screw holes, CoCr
ST031	Scorpio Knee System Tibial 	Tibial baseplate, uncemented, beaded 	3,5,7,9,11,13	$2,700.00
	Baseplate 	(microstructure) with PA 
	(Hydroxyapatite), ability to add 
	screws, CoCr
ST648	Scorpio Knee System & S7000 	Tibial baseplate, uncemented, with 	3, 5, 7, 9, 11, 13	$2,700.00
	Tibial Baseplate 	Hydroxyapatite, CoCr
	Zimmer Pty Ltd
ZI121	NexGen Tibial Baseplate 	Pegged tibial baseplate,  uncemented, 	1  - 10	$2,700.00
	titanium fibre metal mesh, with 
	HA/TCP for fixed insert  
ZI124	NexGen Tibial Baseplate 	Stemmed tibial baseplate,  	1  - 10	$2,700.00
	uncemented, titanium fibre metal mesh,
	 with HA/TCP for fixed insert  
	Revision
	Wright Medical Australia
WR181	Medial Pivot Knee System	Tibial component, beaded, titanium, HA	1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 	$2,700.00
	5+, 6
12.03.06 - Uncemented, Alloy, Moulded Polyethylene
	Biomet Australia Pty Ltd
BI863	AGC Knee System Tibial  Baseplate 	Tibial baseplate, titanium, Moulded, 	(63-91) x (8-22)mm	$3,300.00
	V2 (version 2), uncemented with 
	titanium plasma sprayed surface 
	(Porous plasma spray PPS)  
Prostheses List by Category, Groups and Sponsor	Page 871 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI295	NexGen Porous Tantalum Tibial 	One piece Trabecular Metal 	Sizes 3 - 8, Height 10mm - 	$3,300.00
	Baseplate and Insert	(Tantalum) Tibial Baseplate and Insert	17mm
	 UHMWPE (minimal and posterior 
12.03.07 - Uncemented, Alloy, for Mobile Insert
	Endotec Australia Pty Ltd
EA008	Buechel-Pappas Ultracoat Total 	Tibial Baseplate, uncemented, beaded, 	1-6(inc)	$2,950.00
	Knee Replacement System Tibial 	Titanium, TiNi Insert and bone 
	ingrowth surface treated, for a mobile 
	insert
	Global Orthopaedic Technology
GO004	RBK Total Knee System Tibial 	Tibial baseplate, CoCr, beaded, 	1-5	$2,950.00
	Baseplate 	uncemented, for mobile bearing insert 
GO156	RBK Universal Knee System Tibial 	Tibial Baseplate, short keel,  	1 - 5	$2,950.00
	Baseplate 	uncemented, CoCr, beaded, for mobile 
	insert 
	Johnson & Johnson Medical Pty Ltd
DP031	MBT Knee System tibial baseplate 	Tibial baseplate, uncemented, CoCr, 	Sizes 1 - 7	$2,950.00
	beaded (Porocoat) for rotating 
	platform, (keeled and non keeled) 
DY377	MBT knee system tibial baseplate 	Tibial baseplate, uncemented, 	Sizes 1 - 7	$2,950.00
	Titanium, TiN, beaded (Porocoat) for 
	rotating platform, (non keeled only) 
	Mathys Orthopaedics Pty Ltd
MA460	Balansys Tibial Baseplate	Tibial Baseplate for Mobile Bearing 	64/8mm - 85/15.5mm	$2,950.00
	insert, Uncemented, CoCr
	Oceania Orthopaedics
OO005	ACS Knee System - ACS tibial 	Tibial base plate, porous coated, for 	2-7	$2,950.00
	component cementless	use with mobile bearing insert, TiN 
	coated
OO009	ACS Knee System - porous coated 	Tibial base plate, porous coated, for 	Sizes 2-7	$2,950.00
	tibial component	use with mobile bearing insert, TiN 
	coated
Prostheses List by Category, Groups and Sponsor	Page 872 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM068	VKS (Vario) Knee System Tibial 	Tibial Baseplate, CoCr, uncemented, 	1-12	$2,950.00
	Baseplate	Titanium Plasma Spray (Vacuum spray
	 and triple layer), for mobile insert (SB
	 (Self aligning bearing))
SN370	Mobile Bearing Knee System Tibial 	Tibial baseplate, uncemented, beaded, 	Left & Right, Size 1-8	$2,950.00
	Baseplate	HA, CoCr, polished insert surface, for 
	mobile insert, 
	Zimmer Pty Ltd
ZI414	Natural Knee Tibial Baseplate CSTi 	Tibial Baseplate, uncemented,  with 	Size 00 to 5	$2,950.00
	fixed long stems and capacity to attach
	 augments, Cancellous structure 
	Titanium ingrowth surface for mobile 
	inserts 
	Revision
	Endotec Australia Pty Ltd
EA015	Buechel-Pappas Ultracoat Total 	Tibial Baseplate, uncemented, beaded, 	1-6(inc)	$4,300.00
	Knee Replacement System Tibial 	Titanium, TiNi Insert and bone 
	ingrowth surface treated, for a mobile 
	insert
	12.03.07.01 - HA Coating
	B Braun Australia Pty Ltd
BB233	Emotion Total Knee System (TKS) 	Tibial baseplate, uncemented, CoCr, 	T1 - T8	$3,350.00
	Tibial Baseplate 	Titanium plasma spray (Plasmapore) 
	with polished insert surface, HA 
	coated for mobile insert
	Biomet Australia Pty Ltd
BI900	ROCC Tibial Baseplate 	Tibial Baseplate, uncemented, 	1-8	$3,350.00
	Titanium plasma sprayed surface 
	(Porous plasma spray PPS) with HA 
	for mobile insert  
	Global Orthopaedic Technology
GO005	RBK Total Knee System Tibial 	Tibial baseplate, CoCr,  uncemented, 	1-5	$3,350.00
	Baseplate 	beaded, with Titanium plasma spray 
	and HA for mobile bearing insert 
Prostheses List by Category, Groups and Sponsor	Page 873 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GO157	RBK Universal Knee System Tibial 	Tibial Baseplate, short keel,  	1 -5	$3,350.00
	Baseplate 	uncemented, CoCr, beaded, with 
	titanium plasma spray and HA, for 
	mobile insert 
	Johnson & Johnson Medical Pty Ltd
DP035	MBT Knee System tibial baseplate 	Tibial baseplate, uncemented, CoCr, 	Size 1-7	$3,350.00
	HA (Duofix), beaded (Porocoat) for 
	rotating platform, ( non keeled only) 
	Link Orthopaedics  Australia
LO175	Link Gemini Tibial Baseplate	Tibial Baseplate, uncemented, 	Extra small - Extra large	$3,350.00
	Microporous, HX coating (hydroxy 
	apatite)
	Medacta Australia Pty Ltd
MU053	Cinétique Knee System Tibial 	Tibial Baseplate, uncemented, CoCr, 	Sizes 1 to 7, left and right	$3,350.00
	Baseplate 	with titanium micro beads, with HA, 
	with polished insert surface for mobile
	 insert 
MU076	GMK Uncemented mobile Tibia 	Asymmetric uncemented mobile tibia 	1 to 6, left and right	$3,350.00
	with titanium porous coating by an 
	hydroxyapatite coating
	Oceania Orthopaedics
OO007	ACS Knee System - TCP coated 	Tibial base plate, TCP coated for use 	Sizes 2-7	$3,350.00
	tibial component	with mobile bearing insert, TiN 
	Orthotech Pty Ltd
OH421	Trekking Knee System, Tibial	Mobile tibial tray, uncemented	1 - 5	$3,350.00
	Stryker Australia Pty Ltd
ST067	Scorpio Knee System Tibial 	Mobile bearing tibial baseplate, 	3, 5, 7, 9, 11, 13	$3,350.00
	Baseplate 	uncemented, beaded (microstructure) 
	with PA (Hydroxyapatite), CoCr
	Revision
	Amplitude Australia
LI069	Score Knee System Tibial Baseplate 	Tibial baseplate, CoCr, uncemented, 	7 Sizes	$4,850.00
	stippled surface, titanium plasma 
	spray with HA
Prostheses List by Category, Groups and Sponsor	Page 874 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN368	'Mobile Bearing Knee System Tibial	Tibial baseplate, uncemented, beaded, 	Left & Right Size 1-8	$4,850.00
	 Baseplate	CoCr, polished insert surface, for 
	mobile insert, 
12.04.01 - Cemented, Alloy Polyethylene
	Biomet Australia Pty Ltd
BI202	Repicci resurfacing Tibial Bearing	Uni tibial Component, all poly 	20-42mm	$1,250.00
	Cemented, UHMWPE
	Corin Australia Pty Ltd
CR091	Uniglide Uni Knee System Uni 	All poly uni tibial component, 	Sizes 3, 5 & 7, thicknesses 	$1,250.00
	Tibial Component 	cemented 	7mm to 13mm
	Exactech Australia
EX045	Optetrak Uni Condylar Knee 	Uni Tibial, all poly, Cemented	1-6	$1,250.00
	System Tibial Component  
	Global Orthopaedic Technology
GO031	Global re-surfacing uni-	All poly, uni compartment, tibial 	0-5 6.5mm - 9.5mm regular	$1,250.00
	compartmental knee tibial 	component, UHMWPE
	Johnson & Johnson Medical Pty Ltd
DY114	Preservation Knee System uni tibial	Uni all poly, cemented, tibial 	Sizes 1 - 5.  7-13.5mm	$1,250.00
	 baseplate	baseplate, UHMWPE
JJ778	Sigma HP Unicompartmental Knee - 	Unicompartmental all poly tibial 	Size 1-6, 8-12mm LM/RL & 	$1,250.00
	All poly tibial component	component UHMWPE cemented	RM/LL
	Medacta Australia Pty Ltd
MU070	GMK Unicompartmental Full - PE 	cemented unicompartmental all 	1 to 5, left and right, 	$1,250.00
	Tibia Component	polyethylene fixed component	8/9/10/11/12/14mm  
	thicknesses
	Orthotech Pty Ltd
OH231	Optetrak Uni Condylar Knee 	Uni Tibial, all poly, Cemented	1-6	$1,250.00
	System Tibial Component  
OH396	Freedom PKR / Active 	Uni tibial baseplate, cemented, all 	Sizes A to J	$1,250.00
	Unicompartmental Knee System 	UHMWPE
	Tibial Baseplate 
Prostheses List by Category, Groups and Sponsor	Page 875 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SN337	Genesis Uni Tibial Baseplate	Uni Tibial baseplate, all poly, 	Left & Right, X Small- 	$1,250.00
	Magnum Plus,  8mm-15mm
	Tornier Pty Ltd
TO016	HLS Evolution Uni Tibial insert  	Uni Tibial Insert All Polyethylene, 	1 - 6 UHMWPE	$1,250.00
	Cemented
	Wright Medical Australia
WR162	Advance-Unicondylar Knee System	Uni all poly tibial insert	Sizes 1, 2, 3, 4 in 7mm, 8mm, 	$1,250.00
	9mm, 10mm
	Zimmer Pty Ltd
ZI108	Unicompartmental All-Poly Tibia	All Poly Uni Tibial Baseplate, 	1 to 6	$1,250.00
	UHMWPE
12.04.02 - Cemented, Alloy
	Biomet Australia Pty Ltd
BI204	Repicci II Unicondylar Knee System	Uni Tibial baseplate,  Cemented, 	Std, Large, Xlarge	$1,550.00
	 Uni Tibial baseplate  	Titanium, for fixed insert 
	Device Technologies Australia Pty Ltd
DE425	Restoris MCK Knee - Tibial 	Tibial Baseplate	LM/RL and RM/LL, sizes 1 	$1,550.00
	to 8
	Johnson & Johnson Medical Pty Ltd
DY118	Preservation Knee System uni tibial	Uni tibial baseplate, cemented, CoCr, 	Size 1-5	$1,550.00
	 baseplate	for fixed insert
JJ780	Sigma HP Unicompartmental Knee - 	Unicompartmental tibial base plate, 	Size 1-6, LM/RL & RM/LL	$1,550.00
	Fixed bearing tibial tray	cemented, CoCr for fixed bearing insert
	Mathys Orthopaedics Pty Ltd
MA452	BalanSys UNI tibial baseplate 	Uni tibial baseplate for fixed bearing 	1,2,3,4,5	$1,550.00
	insert, cemented, CoCr
	Medacta Australia Pty Ltd
MU065	GMK Unicompartmental fixed tibial 	cemented unicompartmental fixed 	1 to 5, left and right	$1,550.00
	baseplate	tibial component with peg and 
Prostheses List by Category, Groups and Sponsor	Page 876 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM120	UC (Unicompartment) PLUS 	Uni Tibial Baseplate, CoCr, cemented 	Tibial - 40 - 56 x (8, 10, 12, 	$1,550.00
	Solution Knee System Uni Tibial 	for fixed insert	14mm)
	Baseplate
SN336	Genesis Uni Tibial Baseplate	Uni Tibial baseplate, cemented, CoCr 	XSmall-Magnum	$1,550.00
	for fixed insert
SN836	Journey Knee System Tibial Uni 	Uni Tibial Baseplate,Titanium, 	1-8	$1,550.00
	Baseplate	cemented, for fixed insert
	Stryker Australia Pty Ltd
SK497	Triathlon PKR - Cemented Tibial 	Uni tibial baseplate, cemented, CoCR	Size 1 to 6	$1,550.00
	component
	Tornier Pty Ltd
TO017	HLS Evolution Uni Tibial insert  	Uni Tibial Insert, Cemented, alloy, 	1 - 6 UHMWPE, CoCr	$1,550.00
	modular, CoCr
	Zimmer Pty Ltd
ZI107	Unicompartmental Tibial Plate	Uni 'Tibial baseplate, cemented, 	1 to 6	$1,550.00
	Titanium 
12.04.03 - Cemented, Alloy, Moulded Polyethylene
	Biomet Australia Pty Ltd
BI871	Vanguard unicondylar Knee System	Tibial Component, CoCr UHMWPE	(A-E) x (5-8)	$2,000.00
	Link Orthopaedics  Australia
LO060	LINK Endo-Model SLED Uni 	Uni tibial tray including UHMWPE 	7mm-13mm in 45, 50, 55 	$2,000.00
	Tibial Tray 	insert, cemented, CoCr tray	diameter
	Zimmer Pty Ltd
ZI403	Allegretto Unicompartmental Knee	Tibial Baseplate Monoblock - Ti alloy	7.5/38 to 15/48mm	$2,000.00
	 / PE
Prostheses List by Category, Groups and Sponsor	Page 877 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.04.04 - Cemented, Alloy, for Mobile Insert
	Biomet Australia Pty Ltd
BI033	Oxford Meniscal Knee System Uni 	Uni Tibial Baseplate, cemented, 	(38-53mm) x sizes 26-34	$1,750.00
	Tibial Baseplate 	polished insert surface, for mobile 
	insert (Phase III) 
	Corin Australia Pty Ltd
CR061	Uniglide Uni Knee System Uni 	Uni tibial component, CoCr, with 	Sizes 1 - 8 inclusive	$1,750.00
	Tibial Component 	TiNi insert surface coating for mobile 
	Johnson & Johnson Medical Pty Ltd
DY117	Preservation Knee System uni tibial	Uni tibial baseplate, cemented, CoCr, 	Size 1-5	$1,750.00
	 baseplate	for mobile insert
	Mathys Orthopaedics Pty Ltd
MA453	BalanSys UNI tibial baseplate 	Uni Tibial component for mobile 	1,2,3,4,5	$1,750.00
	insert, cemented, CoCr
MA477	BalanSys UNI tibial baseplate 	Uni Tibial baseplate for mobile insert, 	1, 2, 3, 4, 5	$1,750.00
	cemented, CoCr with convex surface 
	Zimmer Pty Ltd
ZI502	Natural Knee	Primary Tibial Baseplate - Mobile 	Size 00 to 5	$1,750.00
	Bearing Non Porous - CoCr alloy
12.04.05 - Uncemented, Alloy
	12.04.05.01 - HA Coating
	Stryker Australia Pty Ltd
SK329	UNIX Unicompartmental Knee 	Uni tibial baseplate, uncemented with	Sizes 1 to 4	$1,800.00
	System Tibial Baseplate	 Hydroxyapatite, CoCr 
12.04.06 - Uncemented, Alloy, for Mobile Insert
	Zimmer Pty Ltd
ZI430	Natural Knee	Unicompartmental -Tibia Baseplate - 	Por 1 to Por 6	$1,800.00
	Ti alloy
Prostheses List by Category, Groups and Sponsor	Page 878 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	12.04.06.01 - HA Coating
	Biomet Australia Pty Ltd
BI860	Oxford Meniscal Knee System Uni 	Uni Tibial Baseplate, uncemented 	(38-53) x (26-34)mm	$2,000.00
	Tibial Baseplate 	Titanium plasma sprayed surface 
	(Porous plasma spray PPS) with HA 
	(Phase III)
	Corin Australia Pty Ltd
CR057	Uniglide Uni Knee System Uni 	Uni tibial component, CoCr, 	1-8	$2,000.00
	Tibial Component 	uncemented, Titanium plasma spray, 
	with calcium phosphate  (HA) 
	ingrowth surface with TiNi insert 
	surface coating for mobile insert 
12.05.01 - Minimally Stabilised
	Advanced Surgical Design & Manufacture Ltd
AE251	Active Knee Tibial Insert	Tibial Insert, UHMWPE	Sizes 1 - 5 Thickness 6 - 	$1,140.00
	17.5mm
	Amplitude Australia
LI070	Score Knee System Tibial Insert  	Tibial Insert, mobile bearing, 	7 sizes, 5 thicknesses	$1,140.00
	UHMWPE
	B Braun Australia Pty Ltd
BB198	Emotion Total Knee System (TKS) 	Tibial Insert, UHMWPE, mobile	T1 to T8 Size: 10 to 24mm	$1,140.00
	Tibial Insert 
BB207	Columbus Total Knee System (TKS) 	Tibial Insert, UHMWPE, fixed 	T1 - T5	$1,140.00
	Tibial Insert  
BB255	Columbus Total Knee System (TKS) 	Tibial Insert, UHMWPE, Mobile	T1- T5	$1,140.00
	Tibial Insert  
	Biomet Australia Pty Ltd
BH124	RHK Knee - Tibial Bearing	Tibial Insert, ArCom Bi-Helical 	(63-71)mm x (12-20)mm	$1,140.00
	Rotating Bearing
BI149	AGC Total Knee System Tibial 	Tibial Insert 'Tradition' fixed, 	59-91mm	$1,140.00
	UHMWPE with locking pin 
Prostheses List by Category, Groups and Sponsor	Page 879 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI172	Maxim Complete Knee System Tibial	Tibial Insert,  UHMWPE, fixed with 	59-91mm	$1,140.00
	 Insert  	locking pin 
BI197	Rotating Platform Knee System	Tibial Bearing, UHMWPE	60-75mm	$1,140.00
BI888	Vanguard Total Knee System	Tibial Bearing, CR, curved or lipped, 	59, 63/67, 71/75, 79/83, 	$1,140.00
	UHMWPE	87/91 widths, 10, 12, 14, 
	16, 18, 20mm thicknesses
BI976	Vanguard E-Poly CR Tibial bearing	Vitamin E infused Highly Cross 	59 to 91 x (10 -18mm)	$1,140.00
	linked Polyethylene /cruciate 
	Retaining Tibial bearing.
	Corin Australia Pty Ltd
CR007	Rotaglide + Total Knee System, 	Tibial Insert, Mobile bearing, 	7mm - 17mm	$1,140.00
	Tibial Insert 	UHMWPE
CR008	Rotaglide + Total Knee System, 	Tibial Insert, fixed, UHMWPE	9.5mm - 17mm	$1,140.00
	Tibial Insert 
	DJO Australasia Pty Ltd
DD021	3D Knee System Tibial Insert 	Tibial insert, UHMWPE, fixed with 	Size 1 to 12, 9mm to 19mm	$1,140.00
	lateral pivot with locking screw
	Endotec Australia Pty Ltd
EA010	Buechel-Pappas Ultracoat Total 	Tibial Insert, UHMWPE, mobile 	1-6(inc)	$1,140.00
	Knee Replacement System Tibial 	bearing 
	Euros Orthopaedics Australia Pty Ltd
EU014	Europ standard Polyethylene 	Knee insert	SMALL (thickness: 	$1,140.00
	(UHMW) insert	7,9,11,13,15mm) MEDIUM 
	(thickness: 7,9,11,13,15mm)
	 LARGE (thickness: 
	7,9,11,13,15mm)
	Exactech Australia
EX039	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed 	Size 1-6	$1,140.00
	Insert	(Cruciate retained)
	Global Orthopaedic Technology
GO002	RBK Total Knee System Tibial 	Tibial Insert, UHMWPE, mobile 	1-5, 10-20mm	$1,140.00
	bearing
GO159	RBK Universal Tibial Insert 	Tibial Insert, UHMWPE, fixed, 	Size 1- 5, 10mm - 20mm	$1,140.00
	requiring fixation with separate bolt 
Prostheses List by Category, Groups and Sponsor	Page 880 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GO160	RBK Universal Tibial Insert 	Tibial Insert, UHMWPE, mobile 	1-5, 10mm - 20mm	$1,140.00
	bearing, requiring fixation with 
	separate bolt 
GO191	Apex Knee, Tibial Insert	Tibial Insert, Standard, Ultra & 	Size 1, 10mm to 20mm, size 	$1,140.00
	Congruent, Size 1-7, 10mm to 20mm.	2, 10mm to 20mm, size 3, 
	10mm to 20mm, size 4, 10mm
	 to 20mm, size 5, 10mm to 
	20mm, size 6, 10mm to 
	20mm, size 7, 10mm to 20mm.
	Johnson & Johnson Medical Pty Ltd
DP026	LCS Complete Knee System rotating	Tibial insert, for rotating platform, 	Sizes small to large+	$1,140.00
	 platform tibial Insert 	UHMWPE 
DP162	PFC Sigma Knee System  tibial 	Tibial insert for AMK Duofix tibial 	Sizes  1 - 6.  8-30mm	$1,140.00
	baseplate with locking post and clip, 
	UHMWPE
DP166	PFC Sigma Knee System  tibial 	Tibial Insert, rotating platform 	Sizes  1 - 6.  8-30mm	$1,140.00
	UHMWPE
DP238	LCS Classic and Universal Knee 	Tibial inserts, meniscal bearing medial	Sizes small to large+. 10-	$1,140.00
	System meniscal bearing tibial 	 and lateral (by 2 per procedure)	20mm
DY465	LCS Classic and Universal Knee 	Tibial insert, UHMWPE, rotating 	Sizes small to large+. 10-	$1,140.00
	System rotating platform tibial 	platform, standard and deep dish, used	30mm
	 for revising LCS classic and 
	universal TKA
DY481	PFC Sigma Knee System  tibial 	Tibial insert, UHMWPE, standard 	Sizes  1 - 6.  8-30mm	$1,140.00
	and posterior lipped
JJ509	PFC Sigma Knee System  tibial 	Tibial insert, UHMWPE, moderately 	Sizes  1 - 6.  8-30mm	$1,140.00
	cross linked
JJ658	LCS Complete Knee System APG 	Tibial Insert, Mobile, UHMWPE, 	Sizes small to large+	$1,140.00
	Tibial Insert	used with APG guide arm only
	Link Orthopaedics  Australia
LO155	LINK Endo Model M Modular knee	Insert	Extra Small - Extra Large	$1,140.00
	 Prosthesis System
LO172	Link Endo Model Rotational and 	Plastic insert	Extra small - Extra large	$1,140.00
	Hinge Knee Prostheses
LO177	Link Gemini Tibial Insert	Tibial Insert, UHMWPE, mobile/fixed	Extra small - Extra large	$1,140.00
	 insert
Prostheses List by Category, Groups and Sponsor	Page 881 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Mathys Orthopaedics Pty Ltd
MA311	balanSys Tibial Mobile Insert	Tibial Insert, Mobile bearing, 	XS/8mm to F/20.5mm	$1,140.00
	UHMWPE,
MA516	BalanSys Tibial Insert	Tibial Insert, ultra congruent and 	59/8mm to 85/20.5mm	$1,140.00
	minimally stabilised, UHMWPE
	MatOrtho
MJ012	MRK (Medial Rotation Knee) Total 	Tibial Insert, UHMWPE, Fixed	1/2/3, 8-18mm thickness	$1,140.00
	Knee System Tibial Insert
	Medacta Australia Pty Ltd
MU034	Evolis Knee System Tibial Insert   	Tibial Insert, UHMWPE, fixed  	1 - 6, 9/11/13/16/19mm 	$1,140.00
	thickness
MU049	Cinétique Knee System Tibial Insert	Tibial Insert, UHMWPE, mobile 	Size 1 to 6, 7/9/11/13/15mm	$1,140.00
	bearing, standard, 	 thicknesses
MU068	GMK Standard mobile tibial insert	posterior cruciate retaining mobile 	size 1 to 7, 	$1,140.00
	polyethylene insert	10/12/14/17/20mm 
MU071	GMK Standard Fixed Tibial Insert	Fixed polyethylene insert	size 1 to 6, left to right, 	$1,140.00
	10/12/14/17/20mm 
MU074	GMK ultracongruent Fixed tibial 	Ultracongruent fixed polyethylene 	1 to 6, left to right, 	$1,140.00
	Insert	10/12/14/17/20mm 
MU083	UC mobile insert for Cinetique 	Polyethylene ultra-congruent insert 	Size 1 to 6 each one 	$1,140.00
	femoral revision	for Cinetique femoral revision (using a	available in 3 thicknesses 
	 GMK revision femur)	(14, 17, 20mm)
MU084	GMK Revision System	Polyethylene minimally stabilised 	Size 1 to 6, each one 	$1,140.00
	fixed insert for evolis tibial revision 	available on 5 thicknesses: 
	(using a GMK tibia)	10, 12, 14, 17, 20 mm
MU092	UC fixed insert for Evolis tibial 	Polyethylene ultra-congruent fixed 	Size 1 to 6, each one 	$1,140.00
	revision	insert for Evolis tibial revision (using	available in 5 thicknesses: 
	 a GMK tibia)	10, 12, 14, 17 20mm
MU093	UC mobile insert for Cinetique 	Polyethylene ultra-congruent insert 	Size 1 to 6 each one 	$1,140.00
	tibial revision	for GMK and Cinetique tibial 	available in 3 thicknesses 
	revision (using a GMK tibia)	(14, 17, 20mm)
	Oceania Orthopaedics
OO103	ACS Knee Minimmaly Stabilised 	ACS PE Insert	10, 12.5, 15, 17.5, 20mm	$1,140.00
	Tibial Insert
Prostheses List by Category, Groups and Sponsor	Page 882 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH331	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed 	Size 1-6	$1,140.00
	Insert	(Cruciate retained)
	RQSolutions Medical Devices Distribution Support
RQ027	RP (Rotating Platform)Tibial Insert B	Tibial insert, UHMWPE, mobile, deep	8-10-12-14mm	$1,140.00
	 dish
	Smith & Nephew Surgical Pty Ltd
SL002	Genesis II Knee System Tibial Insert	Tibial Insert, UHMWPE, fixed, 	1-8; 9-25mm	$1,140.00
	without peg
SL003	Profix Knee System Tibial Insert	Tibial Insert, UHMWPE, Fixed	Left / Right 1 - 8	$1,140.00
SL004	VKS (Vario) Knee System Tibial 	Tibial insert, UHMWPE, Fixed	SZ 1-12	$1,140.00
	Insert
SM031	TC (Tri Compartment) PLUS Knee 	Tibial Insert, UHMWPE, mobile, deep	1-12 : 9-19mm	$1,140.00
	System Tibial Insert	 dished
SM063	Tibial Insert	Mobile Bearing Tibial Insert	1-12	$1,140.00
SM090	RT (Rotating Hinge) PLUS Knee 	Tibial Insert, UHMWPE,  fixed, for 	0-10	$1,140.00
	System Tibial Insert	hinged femoral and tibial components,
	 reinforced fixation clip and centeral 
	hole for femoral component hinge post
SM174	Verilast CR Insert	Cruciate Retaining Tibial Insert	Sizes 1-8, 9-25mm	$1,140.00
SN320	Genesis II Knee System Tibial Insert	Tibial Insert for mobile insert, 	Left & Right, Size 1-8, 9-	$1,140.00
	UHMWPE	15mm 
SN348	Genesis Knee System Tibial Insert	Tibial Insert, UHMWPE, fixed 	Left & Right XS-Magnum 	$1,140.00
	8MM-15MM
SN378	Profix Knee System Tibial Insert	Tibial Insert, UHMWPE, Mobile, 	Size 1-8 10-16mm	$1,140.00
	anterior lip (Conforming Plus)
SN379	Profix Knee System Tibial Insert	Tibial Insert, UHMWPE, Mobile	Size 1-8 10-16mm	$1,140.00
SN699	Profix Knee System Tibial Insert	Tibial Insert, UHMWPE, Mobile, 	1-8, 18-20mm	$1,140.00
	anterior lip (Conforming Plus) Larger 
	sized inserts
	Stryker Australia Pty Ltd
HW091	Duracon Knee System Tibial Insert 	Minimally stabilised, AP Lipped 	Small, Medium, Large, 	$1,140.00
	tibial insert, UHMWPE, (Duration)	Extra-Large in each 
	thickness 9mm, 11mm, 
	13mm, 16mm, 19mm, 22mm, 
Prostheses List by Category, Groups and Sponsor	Page 883 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW102	Duracon Knee System Tibial Insert 	Minimally stabilised, tibial insert to 	Small, Medium, Large, 	$1,140.00
	match PCA femur with Duracon 	Extra-Large in each 
	baseplate, UHMWPE (Duration)	thickness 9mm, 11mm, 
	13mm, 16mm, 19mm, 22mm, 
	25mm, 28mm, 31mm
HW160	Kinemax Knee System Tibial Insert	Minimally stabilised, tibial insert, 	8, 10, 12, 15, 18, 21, 25mm 	$1,140.00
	Low Stress, UHMWPE (Duration)	per size
HW162	Interax Knee System Patella	Patella, resurfacing, all UHMWPE 	8, 10, 12, 15, 18, 21mm per 	$1,140.00
	(Duration)	size
HW174	Kinemax Knee System Tibial Insert	Minimally stabilised tibial insert, 	8, 10, 12, 15, 18, 21, 25mm 	$1,140.00
	UHMWPE, (Duration)	per size
HW232	HMRS (Howmedica Modular 	HMRS Rotating Hinge Tibial insert, 	6, 10, 14mm	$1,140.00
	Replacement System) Rotating 	UHMWPE (Duration), Fixed 
	Hinge Tibial Insert
HW248	MRH (Modular Rotating Hinge) & 	MRH & GMRS Tibial insert, 	xsmall - xlarge	$1,140.00
	GMRS (Global Modular 	(Duration) UHMWPE, for MRH and 
	Replacement System) Tibial Inserts	GMRS Tibial baseplate, CoCr 
	(Vitallium), Fixed with central hole for
	 Hinge
SK091	Duracon Knee System CS Lipped 	Minimally stabilised, CS Lipped 	XS,S,M,L,XL Thickness 	$1,140.00
	Tibial Insert	tibial insert, deep dish, UHMWPE, 	9,11,13,16,19,22,25mm
	(Duration)
SK328	Triathlon Knee System Tibial Insert	Minimally stabilised, tibial insert, 	Sizes 1 to 8 	$1,140.00
	UHMWPE, (N2VAC)	(9/11/13/16/19/22/25mm 
	thickness)
SK333	Scorpio NRG Knee System Tibial 	Minimally stabilised tibial insert, 	Sizes 3,4,5,6,7,9,11,13, x 	$1,140.00
	Insert 	UHMPWE (N2VAC)	(8/10/12/15/18/21/24mm 
	thickness)
SK431	Triathlon Knee System CS Lipped 	Minimally stabilised, CS Lipped 	Sizes 1-8 _small - large) size	$1,140.00
	Insert	tibial insert deep dish, UHMWPE 	 increments, 9mm, 11mm, 
	13mm, 16mm, 19mm, 22mm, 
	25mm
SK432	Triathlon Knee System CS Lipped 	Minimally stabilised, CS Lipped 	Sizes 1-8 _small - large) size	$1,140.00
	Tibial Insert	tibial insert deep dish, UHMWPE, 	 increments, 9mm, 11mm, 
	13mm, 16mm, 19mm, 22mm, 
	25mm
SR031	Triathlon Knee System Tibial Insert 	Minimally stabilised, mobile bearing 	1 to 8, 9mm to 19mm	$1,140.00
	tibial insert, UHMWPE (N2VAC)
Prostheses List by Category, Groups and Sponsor	Page 884 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SR033	Triathlon Knee System Tibial Insert 	Minimally constrained, CS Lipped 	1 to 8, 9mm to 22mm	$1,140.00
	Tibial insert, deep dished (CS) 
	UHMWPE, N2VAC, mobile bearing
SR076	Triathlon X3 CR Tibial Insert	Intended use as part of a total knee 	Sizes 1-8 available in 	$1,140.00
	system in primary cemented and 	9,11,13,16,19mm thicknesses
	primary uncemented total knee 
	arthroplasty.
SR077	Scorpio NRG X3 CR Tibial Insert	Intended use as part of a total knee 	Sizes 3,5,7,9,11 in 	$1,140.00
	system in primary cemented and 	thicknesses: 
	primary uncemented total knee 	8,10,12,15,18,21,24mm
	arthroplasty.
SR079	Triathlon X3 CS Lipped Tibial 	Intended use as part of a total knee 	Sizes 1-8 available in 	$1,140.00
	system in primary cemented and 	9,11,13,16,19,22 and 25mm 
	primary uncemented total knee 	thicknesses
	arthroplasty.
ST032	Scorpio Knee System Tibial Insert	Minimally stabilised, mobile bearing 	8-24mm for all tibia sizes	$1,140.00
	tibial insert, UHMWPE (N2VAC)
ST608	Scorpio Knee System Tibial Insert	Minimally stabilised tibial insert, 	8-18mm in 2mm increments	$1,140.00
	UHMWPE (N2VAC)
ST912	Duracon ISA Knee System Tibial 	Minimally stabilised, mobile bearing 	Small, medium, large, X-	$1,140.00
	Insert	tibial insert, UHMWPE (Duration)	large - left, right
	Wright Medical Australia
WR204	Advantim Total Knee System	Tibial Inserts Total Condylar 	8-36mm in 2mm increments	$1,140.00
	UHMWPE, includes unconstrained 
	insert and minimally stabilised (LSI)
WR223	Medial Pivot Knee System	Minimally stabilised, fixed, tibial 	1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 	$1,140.00
	insert, UHMWPE	5+, 6, 6+, 7, 7+, 8, in 10 - 24 
	mm thicknesses
	Zimmer Pty Ltd
ZI077	Miller Galante I Tibial Insert 	Tibial Insert, UHMWPE, fixed 	8 - 22mm	$1,140.00
ZI088	Miller Galante II Tibial Insert 	Tibial Insert, UHMWPE, fixed 	9 - 23mm	$1,140.00
ZI134	NexGen Tibial Insert 	Tibial Insert, fixed, standard and 	9 - 23 mm	$1,140.00
	anterior lipped, UHMWPE
ZI135	NexGen Tibial Insert 	Ant. Constr. - UHMWPE	9 - 23mm	$1,140.00
ZI139	NexGen Tibial Insert 	Tibial Insert, UHMWPE, 	9 - 23mm	$1,140.00
	'anatomically rotated'
Prostheses List by Category, Groups and Sponsor	Page 885 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI408	Natural Knee Tibial Insert 	Tibial Insert, UHMWPE,  mobile 	00 to 5, 9 to 22mm	$1,140.00
	insert  
ZI410	Natural Knee Tibial Insert 	Tibial Insert, UHMWPE, fixed 	00 to 5, 9 to 22mm	$1,140.00
ZI450	Natural Knee Tibial Insert	Tibial Insert, UHMWPE, Highly 	00 to 5, 9 to 22mm	$1,140.00
	crossed linked (Durasul PE), 
	congruent and ultra congruent 
ZI515	NexGen Prolong Tibial Insert 	Tibial Insert, Highly Crosslinked - 	Sizes A - G 9mm to 20mm	$1,140.00
	UHMWPE (prolong), mobile bearing 
ZI584	NexGen Prolong Flex Articulating 	Highly Crosslinked - Ultra High 	Sizes 1 to 10, 9mm to 23mm	$1,140.00
	Surface	Molecular Weight Polyethylene - 
	Fixed Bearing - CR
ZI585	NexGen Prolong Flex Articulating 	Highly Crosslinked - Ultra High 	Sizes 1 to 10, 9mm to 23mm	$1,140.00
	Surface	Molecular Weight Polyethylene - 
	Mobile Bearing - CR
12.05.02 - Posterior Stabilised
	Amplitude Australia
LI071	Score Knee System Tibial Insert  	Tibial Insert, mobile bearing, 	20 sizes	$1,200.00
	posterior stabilised with 
	B Braun Australia Pty Ltd
BB199	Emotion Total Knee System (TKS) 	Tibial Insert, UHMWPE, mobile, 	T1 to T8 Sizes: 10 to 24mm	$1,200.00
	Tibial Insert 	posterior stabilised with peg
BB209	Columbus Total Knee System (TKS) 	Tibial Insert, UHMWPE, fixed, 	T1 - T5	$1,200.00
	Tibial Insert  	posterior stabilised with included 
	screw for fixation to baseplate
	Biomet Australia Pty Ltd
BI179	Maxim Complete Knee System Tibial	Tibial Insert,  UHMWPE, fixed with 	59-91mm	$1,200.00
	 Insert  	locking pin, posterior stabilised with 
	peg 
BI885	ROCC Tibial Insert	Tibial Insert, mobile bearing, rotating 	1-6 (tray size), 10-20mm 	$1,200.00
	platform, UHMWPE	(bearing size)
BI905	AGC Total Knee System Tibial 	Tibial Insert 'Tradition', Posterior 	59-91mm	$1,200.00
	Stabilised with peg, UHMWPE with 
	locking pin 
Prostheses List by Category, Groups and Sponsor	Page 886 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BI907	TRAC Knee System	Bearing Posterior Stabilised 	59 - 91mm	$1,200.00
BI975	Vanguard E-Poly PS bearing	Vitamin E infusion Highly Cross 	59 - 91 x (10 - 18mm)	$1,200.00
	linked Polythylene Posterior 
	Stabilised Tibial Bearing
	Exactech Australia
EX041	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed 	Size 1-6	$1,200.00
	Insert	(Posterior Stabilised)
EX042	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed (Hi 	Size 1-6	$1,200.00
	Insert	Flex)
EX043	Optetrak RBK (Rotating Bearing 	Tibial Insert, UHMWPE, mobile, 	1-6	$1,200.00
	Knee) Total Knee System Tibial 	posterior stabilised 
	Insert 
	Global Orthopaedic Technology
GO117	RBK Total Knee System Tibial 	Tibial Insert, UHMWPE, mobile 	Size 0 to 5, 10mm to 20mm 	$1,200.00
	bearing, posterior stabilised with peg,	thick
	 separate bolt fixation that passes 
	down the peg
GO257	Apex Revision Knee Tibial Insert	Apex Revision Knee Tibial Insert	size 1 to 6mm x 10 to 28mm	$1,200.00
	Johnson & Johnson Medical Pty Ltd
DP270	SROM Noiles Knee System tibial 	Tibial insert, UHMWPE, posterior 	Xsm-lrg. 10-30mm	$1,200.00
	insert	stabilised, rotating platform
DY372	LCS Complete Knee System rotating	Tibial insert, rotating platform with 	Sizes small to large+. 10-	$1,200.00
	 platform tibial insert 	post, UHMWPE 	30mm
DY405	PFC Sigma Knee System RPF tibial 	Tibial insert, UHMWPE, rotating 	Size 1 - 6.  10-30mm	$1,200.00
	insert	platform for high flex with post 
DY457	PFC Sigma Knee System  tibial 	Tibial insert, posterior stabilised, 	Sizes  1 - 6.  8-30mm	$1,200.00
	rotating platform UHMWPE
JJ508	PFC Sigma Knee System  tibial 	Tibial insert, UHMWPE, moderately 	Sizes  1 - 6.  8-30mm	$1,200.00
	cross linked, with peg 
JJ665	PFC Sigma Knee System Tibial Insert	Tibial insert, posterior stabilised, 	Sizes 1-6.  8-30mm	$1,200.00
	UHMWPE, with post
	Link Orthopaedics  Australia
LO178	Link Gemini Tibial Insert	Tibial Insert, UHMWPE, Fixed PS 	Extra small - Extra large	$1,200.00
	insert
Prostheses List by Category, Groups and Sponsor	Page 887 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Mathys Orthopaedics Pty Ltd
MA489	balanSys Tibial Insert	Tibial insert, posterior stabilised 	59/8mm to 85/23mm	$1,200.00
	UHMWPE
MA510	Balansys Revision Knee, Tibial 	Tibial insert, contrained, with 	64/10.5 to 85/23	$1,200.00
	stabilising screw for reinforcement
	MatOrtho
MJ013	Saiph Knee System APS Tibial Insert	Compression Moulded Anterior 	A - F, Left & Right 10 - 20mm	$1,200.00
	Posterior Stablilised Tibial Bearing
	Medacta Australia Pty Ltd
MU032	Evolis Knee System Tibial Insert   	Tibial Insert, UHMWPE, fixed, 	1 - 6, 9/11/13/16/19mm 	$1,200.00
	posterior stabilised 	thickness
MU059	GMK Posterior Stabilised fixed 	Posterior Stabilised fixed 	size 1 to 6, 	$1,200.00
	tibial insert	polyethylene insert	10/12/14/17/20mm 
MU073	GMK Ultracongruent Mobile Tibial	Ultracongruent Mobile Polyethylene 	size 1 to 7, 	$1,200.00
	 Insert	 Insert	10/12/14/17/20mm 
MU090	PS fixed insert for Evolis tibial 	Polyethylene posterior-stabilised 	Size 1 to 6, each one 	$1,200.00
	revision	fixed insert for Evolis tibial revision 	available in 5 thicknesses: 
	(using a GMK tibia)	10, 12, 14, 17 20mm
MU091	GMK Revision semi-constrained 	Semi-constrained Posterior Stabilised	Size 1 to 6, each one 	$1,200.00
	fixed tibial insert	 fixed Tibial Insert	available in 8 thicknesses: 
	10, 12, 14, 17, 20, 23, 26, 
	29mm
	Oceania Orthopaedics
OO104	ACS Knee - Posterior Stabilised 	ACS Posterior Stabilised Tibial PE 	10, 12.5, 15, 17.5, 20mm	$1,200.00
	Tibial Insert	Insert
	Orthotech Pty Ltd
OH235	Optetrak RBK (Rotating Bearing 	Tibial Insert, UHMWPE, mobile, 	1-6	$1,200.00
	Knee) Total Knee System Tibial 	posterior stabilised 
	Insert 
OH332	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed 	Size 1-6	$1,200.00
	Insert	(Posterior Stabilised)
OH333	Optetrak Total Knee System, Tibial 	Tibial Insert, UHMWPE, Fixed (Hi 	Size 1-6	$1,200.00
	Insert	Flex)
OH420	Trekking Knee System, Tibial	Mobile tibial insert	1 - 5 (+0/+7)	$1,200.00
OH424	Trekking Knee System, Tibial Insert	Tibial Insert	1 - 5 (+0/+13)	$1,200.00
Prostheses List by Category, Groups and Sponsor	Page 888 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SL005	Genesis II Knee System Tibial Insert	Tibial Insert, UHMWPE, Posterior 	SZ 1-8; 9-25mm	$1,200.00
	Stabalised with peg, Fixed
SM072	TC (Tri Compartment) PLUS Knee 	Tibial Insert, UHMWPE, fixed, 	2-12	$1,200.00
	System Tibial Insert	posterior stabilised with peg
SM175	Verilast PS Insert	Posterior Stabilized Tibial Insert	Sizes 1-8; 9-25mm	$1,200.00
SN349	Genesis Knee System Tibial Insert	Tibial Insert, UHMWPE, fixed, 	Right/Left S-XL 8mm-25mm	$1,200.00
	posterior stabilised with peg
SN780	Journey Knee System Tibial Insert	Tibial Insert, UHMWPE, Fixed 	8-30mm, 1-10	$1,200.00
	posterior stabilised with peg
SN876	Profix Knee System Tibial Insert	Tibial Insert, UHMWPE, posterior 	1-8	$1,200.00
	stabilised with peg, fixed
	Stryker Australia Pty Ltd
HW092	Duracon Knee System Tibial Insert 	Posterior stabilised tibial insert, with	Small, Medium, Large, 	$1,200.00
	 reinforcing pin, UHMWPE, 	Extra-Large in each 
	thickness 9mm, 11mm, 
	13mm, 16mm, 19mm, 22mm, 
SR002	Triathlon Knee System Tibial Insert 	Posterior stabilised insert, 	Sizes 1 to 8 	$1,200.00
	UHMWPE,(N2VAC) 	(9/11/13/16/19/22/25mm 
	thickness)
SR008	Scorpio Knee System Tibial Insert	Posterior stabilised tibial insert, 	8-18mm in 2mm increments	$1,200.00
	UHMWPE (N2VAC)
SR012	Scorpio NRG Knee System Tibial 	Posterior stabilised tibial insert, 	Sizes 3,4,5,6,7,9,11,13, x 	$1,200.00
	Insert 	UHMWPE, (N2VAC)	(8/10/12/15/18/21/24mm 
	thickness)
SR013	Scorpio Knee System Tibial Insert	Posterior stabilised mobile bearing 	10,12,15,18, 21mm 	$1,200.00
	insert,  UHMWPE (N2VAC)	thickness; sizews 
	3,5,7,9,11,13
SR020	S7000 Tibial Insert 	Posterior stabilised tibial insert, 	3, 5, 7, 9, 11, 13 in 8, 10, 12,	$1,200.00
	UHMWPE, (N2VAC), used for series 	 15, 18, 21,24mm
	7000 revisions 
SR032	Triathlon Knee System Tibial Insert	Posterior stabilised mobile bearing 	1 to 8, 9mm to 22mm	$1,200.00
	insert, UHMWPE (N2VAC)
Prostheses List by Category, Groups and Sponsor	Page 889 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SR074	Triathlon X3 PS Tibial Insert	Intended use as part of a total knee 	Sizes 1-8 available in 	$1,200.00
	system in primary cemented and 	9,11,13,16,19,22 and 25mm 
	primary uncemented total knee 	thicknesses
	arthroplasty. Intended to be used in 
	situation where the posterior cruciate 
	ligament is absent, or cannot be 
	preserved.
SR078	Scorpio NRG X3 PS tibial Insert	intended to be used in situations 	3,5,7,9,11 in thickness: 	$1,200.00
	where the posterior cruciate ligament 	8,10,12,15,18,21,24mm
	is absent, or cannot be preserved.
ST646	S7000 Tibial Insert, series II	Tibial Insert posterior stabilised - 	3, 5, 7, 9, 11, 13 in 8, 10, 12,	$1,200.00
	PSII UHMWPE	 15, 18, 21,24mm
ST925	Scorpio Knee System SuperFlex 	Posterior stabilised tibial insert, 	3, 5, 7, 9 , 11, 13 in 	$1,200.00
	Tibial Insert 	SuperFlex, UHMWPE (N2VAC)	thickness 8, 10, 12, 15, 18, 
	21, 24mm
	Tornier Pty Ltd
TO035	HLS Noetos Tibial insert, mobile	Tibial Insert, Mobile, UHMWPE, 	1 to 6, 9, 11 & 13mm	$1,200.00
	Posterior Stabilised
TO036	HLS Noetos Tibial insert, fixed	Tibial Insert, fixed, UHMWPE, 	1 to 6, 9, 11 & 13mm	$1,200.00
	posterior stabilised
TO063	HLS Kneetec - Mobile Tibial Insert	Mobile Tibial Insert for HLS Kneetec 	4 thicknesses: 9, 11, 13 and 	$1,200.00
	System, UHMWPE, posterior 	15 mm. 7 sizes for each 
	thickness: from 1 to 7/8
TO064	HLS Kneetec - Fixed Tibial Insert	Fixed Tibial part of the HLS Kneetec 	6 thicknesses: 9, 11, 13, 15, 	$1,200.00
	system, UHMWPE, posterior 	18 and 21 mm. 7 sizes for 
	each thickness: from 1 to 
	Wright Medical Australia
WR172	Advantim / Ortholoc Revision Knee	Tibial inserts posterior stabilised 	Small, Medium, Large, X-	$1,200.00
	UHMWPE (LSI and "unconstrained" 	Large - 10 to 35mm in 2mm 
	insert ranges)	increments
WR189	Medial Pivot Knee System	Posterior stabilised, fixed tibial 	1, 2, 3, 4, 5, 6, 7, 8, 10-24mm	$1,200.00
	insert, UHMWPE
	Zimmer Pty Ltd
ZI057	NexGen Flex Tibial Insert 	Tibial Insert, fixed, posterior 	Sizes 9 - 23mm	$1,200.00
	stabilised, high flex, UHMWPE
ZI058	NexGen LPS Tibial Insert 	Tibial Insert, posterior stabilised, 	Sizes 9 - 23mm	$1,200.00
	UHMWPE, mobile 
Prostheses List by Category, Groups and Sponsor	Page 890 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI136	NexGen Tibial Insert 	Tibial Insert, fixed, posterior 	9 - 23mm	$1,200.00
	stabilised, UHMWPE
ZI521	NexGen LPS Prolong Tibial Insert 	Tibial Insert, Highly Crosslinked - 	Sizes A - G, 9mm to 20mm	$1,200.00
	UHMWPE (prolong), fixed posterior 
	stabilised 
ZI586	NexGen Prolong Flex Articulating 	Highly Crosslinked - Ultra high 	Sizes 1 to 10, 9mm to 23mm	$1,200.00
	Surface	Molecular Weight Polyethylene - 
	Fixed Bearing - LPS
ZI587	NexGen Prolong Flex Articulating 	Highly Crosslinked - Ultra high 	Sizes 1 to 10, 9mm to 23mm	$1,200.00
	Surface	Molecular Weight Polyethylene - 
	Mobile Bearing - LPS
12.05.03 - Totally Constrained
	Biomet Australia Pty Ltd
BI181	Maxim Complete Knee System Tibial	Tibial Insert,  UHMWPE, fixed with 	59-91mm	$1,250.00
	 Insert  	locking pin, Totally constrained with 
	peg 
BI904	Vanguard Total Knee System	Tibial Bearing, PS, PS+.  UHMWPE	(59 to 91)mm width x (10 to 	$1,250.00
	24)mm thickness
BI939	Vanguard SSK Knee System	Tibial Bearing Insert, PSC, 	59-75mm x (10-24mm)	$1,250.00
BI954	AGC Dual Articular Knee System 	Tibial Insert, UHMWPE, totally 	59 - 83mm, 8 - 20mm Depth	$1,250.00
	Tibial Insert 	constrained, Rotating, reinforcement 
	post on baseplate 
	Exactech Australia
EX028	Optetrak Total Knee System Tibial 	Tibial Insert, UHMWPE, fixed and 	Size 1 - 6	$1,250.00
	Insert 	totally stabilised with peg and 
	reinforced with screw/post fixation 
	(Spine stiffening screw)
	Global Orthopaedic Technology
GO252	SHiVA Modular Knee Prosthesis - 	Rotating Bearing	Sizes 2,3 and 4 x 10mm	$1,250.00
	Rotating Bearing
	Johnson & Johnson Medical Pty Ltd
DP257	SROM Noiles Knee System tibial 	Tibial insert, rotating platform, 	XXSml - Large	$1,250.00
	insert	hinged, with metal axis ring 
	incorporated and polyethylene axis 
Prostheses List by Category, Groups and Sponsor	Page 891 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DY367	PFC Sigma TC3 Knee System  Tibial	Tibial Insert, totally constrained, 	Size 1.5 to 5 thickness of 	$1,250.00
	 Insert 	mobile bearing, UHMWPE, with post	10mm to 30mm
JJ532	LCS Complete Knee System tibial 	Tibial insert, UHMWPE, rotating 	Sizes small to large+. 10-	$1,250.00
	insert 	platform, totally constrained, with 	30mm
	reinforcing post  
JJ664	PFC Sigma Knee System TC3 Tibial 	Tibial insert, totally constrained, 	Sizes 1-6.  8-30mm	$1,250.00
	Insert	UHMWPE, with post
	Medacta Australia Pty Ltd
MU101	GMK Hinge fixed tibial insert	Tibial Insert for GMK Hinge 	1 to 6 10-26mm	$1,250.00
	prosthesis, UHMWPE, fixed, includes
	 hinge locking post
	Orthotech Pty Ltd
OH025	Optetrak Total Knee System Tibial 	Tibial Insert, UHMWPE, fixed and 	Size 1 - 6	$1,250.00
	Insert 	totally stabilised with peg and 
	reinforced with screw/post fixation 
	(Spine stiffening screw)
OH415	Samo TCK Revision Knee System	TCK poly insert	1-5,6-19mm	$1,250.00
	Smith & Nephew Surgical Pty Ltd
SM159	Legion Hinge Rotating Platform 	This tibial insert is used for the 	Sizes 2-7 11,13,15,18,21mm	$1,250.00
	construction of the Legion hinge.
SM161	Legion Hinge Guided Motion 	This tibial insert is used for the 	Sizes 2-7 11,13,15,18,21mm	$1,250.00
	Tibial Insert	construction of the Legion hinge.
SN340	Genesis Knee System Tibial Insert	Tibial Insert, UHMWPE, fixed, totally	Left/Right Small- XLarge 	$1,250.00
	 stabilised with peg	10mm - 25mm
SN353	Genesis Knee System Tibial Insert	Tibial Insert, UHMWPE, fixed, totally	Left/Right Constrained 	$1,250.00
	 stabilised with peg, to be used with 	Small - Xlarge, Crutiate 
	Genesis I baseplate and Tricon 	retaining Size 1-8, Post 
	Femoral Component	Stabilising Size 1-8, 
	Tricon/Genisis Small-
SN863	Genesis II Knee System Tibial Insert	Tibial insert, UHMWPE, fixed, totally	Left / Right 1 - 8	$1,250.00
	 constrained
SN864	Profix Knee System Tibial Insert	Tibial insert, UHMWPE, fixed, totally	Left / Right 1 - 8	$1,250.00
	 constrained
	Stryker Australia Pty Ltd
HW161	Kinemax Knee System Tibial Insert	Totally constrained tibial insert, with 	8, 10, 12, 15, 18, 21, 25mm 	$1,250.00
	metal post, UHMWPE (Duration)	per size
Prostheses List by Category, Groups and Sponsor	Page 892 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SK410	Scorpio Knee System Tibial Insert 	Totally constrained tibial insert, with 	3 - 11 mm 7F/5T, 5F/7T, 	$1,250.00
	metal post, UHMWPE (N2VAC)	11F/9T, 9F/11T10mm-24mm
SK438	Triathlon TS Knee System Tibial 	Totally constrained, TS (Total 	Tibial Insert Sizes: Left & 	$1,250.00
	Insert 	Stabilizer) Insert, with metal post, 	right 9-31mm sizes 1-8
	UHMWPE (X3)	Reinforced Post Sizes 9-
	31mm
SK439	Triathlon Knee System Tibial Insert 	Totally constrained tibial insert, with 	Tibial Insert Sizes: Left & 	$1,250.00
	metal post, +/- 2° int/ext rotation, 	right 9-31mm sizes 1-8
	UHMWPE (X3)	Reinforced Post Sizes 9-
	31mm
ST024	Scorpio Knee System Tibial Insert	Totally constrained tibial insert, with 	8-24mm for all tibia sizes	$1,250.00
	metal post, UHMWPE (X3)
ST601	Duracon TS Knee System Tibial 	Totally constrained tibial insert, with 	Extra Small, Small, Medium, 	$1,250.00
	metal post, UHMWPE (Duration)	Medium Large, Large, Extra 
	Large
	Wright Medical Australia
WR187	Medial Pivot Knee System	totally constrained, UHMWPE, fixed 	1, 2, 3, 4, 5, 6 in 10 - 30mm 	$1,250.00
	tibial insert with reinforcing peg	in 2mm increments
	Zimmer Pty Ltd
ZI137	NexGen LCCK Tibial Insert 	Tibial Insert, totally constrained, 	10 - 35mm	$1,200.00
	UHMWPE, fixed, with post
ZI307	Nexgen Rotating Hinge Tibial 	Tibial insert for NexGen Rotating 	12-26mm, sizes B-F	$1,250.00
	Hinge prosthesis, UHMWPE, mobile.
	 Includes hinge locking post.
12.06.01 - Tibial Insert: Uni-Compartmental Arthroplasty
	B Braun Australia Pty Ltd
BB203	Emotion Unicondylar Knee System 	Uni tibial insert, UHMWPE, fixed	F1 and F5, 7mm-11mm	$790.00
	Uni Tibial Insert  
	Biomet Australia Pty Ltd
BI205	Repicci II Unicondylar Knee System	Uni Tibial insert, fixed , UHMWPE	Std, Large, Xlarge	$790.00
	 Uni tibial insert 
BI861	Oxford Meniscal Knee System Uni 	Uni Tibial Insert conforming surface, 	(Small - Extra Large) x (3-9)	$790.00
	Tibial Insert 	mobile bearing, UHMWPE (Phase III)
Prostheses List by Category, Groups and Sponsor	Page 893 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR060	Uniglide Uni Knee System Uni 	Uni tibial insert, mobile bearing, 	Height 4, 5, 6, 7, 8, 9, 10, 	$790.00
	Tibial Insert 	UHMWPE	11, 12mm; Size 1-4
	Device Technologies Australia Pty Ltd
DE426	Restoris MCK Knee - Tibial Onlay 	Tibial Onlay Insert	Tibial Onlay Insert come in 	$790.00
	Insert	sizes 1 to 7, each size with 
	8, 9, 10 and 12mm thickness
	 options
	Johnson & Johnson Medical Pty Ltd
JJ660	Preservation Knee System Uni 	Uni Tibial Insert, Fixed Bearing, 	Sizes 1-5. 7-15mm	$790.00
	Tibial Insert	UHMWPE
JJ661	Preservation Knee System Uni 	Uni Tibial Insert, Mobile Bearing, 	Sizes 1-5. 7-15mm	$790.00
	Tibial Insert	UHMWPE
JJ779	Sigma HP Unicompartmental Knee - 	Unicompartmental tibial insert, fixed 	Size 1-6, 7-12mm LM/RL & 	$790.00
	Fixed bearing insert	bearing UHMWPE	RM/LL
	Mathys Orthopaedics Pty Ltd
MA454	BalanSys UNI tibial Insert 	Uni tibial insert, UHMWPE, fixed 	5,6,7,9	$790.00
MA455	BalanSys UNI tibial Insert 	Uni tibial insert, UHMWPE, mobile 	5,6,7,9	$790.00
MA478	BalanSys UNI tibial Insert 	Uni tibial insert, UHMWPE, mobile 	5, 6, 7, 9	$790.00
	convex for the uni convex tibial 
	baseplate 
	Medacta Australia Pty Ltd
MU062	GMK Unicompartmental fixed tibia 	cemented unicompartmental 	1 to 5, left and right, 	$790.00
	insert	polyethylene fixed tibial insert	8/9/10/11/12/14mm 
	thiknesses
	Smith & Nephew Surgical Pty Ltd
SM121	UC (Unicompartment) PLUS 	Uni Tibial Insert, UHMWPE, fixed	40 (8mm, 10mm, 12mm, 	$790.00
	Solution Knee System Uni Tibial 	14mm), 44 (8mm, 10mm, 12,, 
	Insert	14mm), 48 (8mm, 10mm, 
	12mm, 14mm), 52 (8mm, 
	10mm, 12mm, 14mm), 56 
	(8mm, 10mm, 12mm, 14mm)
SN334	Genesis Uni Tibial Insert	Uni Tibial Insert, UHMWPE, fixed	x-Small-Magnum 8mm-12mm	$790.00
Prostheses List by Category, Groups and Sponsor	Page 894 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN837	Journey Knee System Uni Tibial 	Uni Tibial Insert, for fixed bearing, 	10-18mm	$790.00
	Insert	UHMWPE
	Stryker Australia Pty Ltd
SK498	Triathlon PKR - X3 Polyethylene 	Uni tibial insert, X3 polyethylene, 	Size 1 to 6, thicknesses from	$790.00
	Tibial insert	 8mm to 12mm
ST656	UNIX Unicompartmental Knee 	Uni tibial insert, UHMWPE, Fixed	1, 2, 3, 4 in 8, 10, 12, 15mm	$790.00
	System Tibial Insert
	Zimmer Pty Ltd
ZI105	Unicompartmental Tibial Insert	Uni Tibial Insert, UHMWPE, fixed 	8 - 14 mm	$790.00
12.07.01 - Alloy 
	Biomet Australia Pty Ltd
BI945	Vanguard PFR	Femoral Component, Ti	XS to Xlarge	$2,750.00
	Global Orthopaedic Technology
GO035	RBK Total Knee System Patello 	Trochlear Component, cemented, CoCr	Size 00 to 5	$2,750.00
	Femoral (trochlear component)
	Johnson & Johnson Medical Pty Ltd
DY111	LCS Patellofemoral Joint Prosthesis	Femoral trochlear component, 	Sizes small to large+	$2,750.00
	 (femoral component) 	cemented, CoCr
JJ776	Sigma HP Trochlear Component	Femoral trochlear component, 	Sizes 1-5, left and right	$2,750.00
	cemented, CoCr
	Link Orthopaedics  Australia
LO058	LINK Lubinus Total Patella Glide 	Femoral trochlear Component, 	Small, medium, large, extra 	$2,750.00
	Replacement (femoral trochlear 	cemented, CoCr	large
	component)
	Stryker Australia Pty Ltd
ST600	Avon Patello Femoral System 	Trochlear component, CoCr 	Extra Small, Small, Medium, 	$2,750.00
	Femoral Component	(Vitallium), cemented	Large
	Zimmer Pty Ltd
ZI563	Zimmer Gender Solutions 	Patellofemoral joint fem implant 	Sizes 1 - 5 - Left & Right	$2,750.00
	Patellofemoral Joint System	PMMA precoat
Prostheses List by Category, Groups and Sponsor	Page 895 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.07.02 - Non-Alloy
	Ceramic Surface
	Smith & Nephew Surgical Pty Ltd
SN834	Journey Knee System Patella 	 Trochlear Component,cemented, 	Sm, Med Lg, XLg	$3,000.00
	Femoral Replacement Trochlear 	Oxinium
12.08.01 - Cemented, All Polyethylene
	Advanced Surgical Design & Manufacture Ltd
AE050	Active Knee Patella	Patella, cemented, UHMWPE 	Sizes 1 - 5	$600.00
AE136	HemiCAP Patello-Femoral 	An all-polyethylene patella 	20mm,25mm,30mm	$600.00
	Resurfacing System - Patella 	resurfacing device used alone or in 
	Component	conjunction with a femoral trochlear 
	component  Available in  2 
	configurations Button and Anatomic
	Amplitude Australia
LI072	Score Knee System Patellar 	All poly patella UHMWPE, cemented	6 Diameters	$600.00
	Component 
	B Braun Australia Pty Ltd
BB202	Emotion Total Knee System (TKS) 	All poly patellar, UHMWPE 	P1 to P6, 26 - 41 x 7 - 12mm	$600.00
	Patellar Component 	cemented, 3 pegs, onlay
BB208	Columbus Total Knee System (TKS) 	All poly patellar, UHMWPE 	P1 - P4	$600.00
	Patellar Component 	cemented, 3 pegs, onlay
	Biomet Australia Pty Ltd
BH121	RHK Knee - Patella	Patella	Small (31mm), Medium 	$600.00
	(34mm), Large (37mm)
BI176	Biomet Universal Patellar 	All poly Patella, cemented, 	size 25 to 37mm	$600.00
	UHMWPE, domed  
BI899	ROCC Patellar Component 	All poly Patella, cemented, 	1-8	$600.00
	UHMWPE, anatomically shaped 
	DJO Australasia Pty Ltd
DD022	3D Knee System Patellar component 	All poly, cemented patella, 3 pegs 	Size 26 to 38mm	$600.00
Prostheses List by Category, Groups and Sponsor	Page 896 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Endotec Australia Pty Ltd
EA012	Buechel-Pappas Ultracoat Total 	All poly patella, cemented, 3 pegs 	 1-6(inc)	$600.00
	Knee Replacement System Patellar 
	Component 
	Euros Orthopaedics Australia Pty Ltd
EU011	Europ standard & Postero cemented 	Europ Standard & Postero Cemented 	Diameters 25,29,32,35mm	$600.00
	Patella	Patella
	Exactech Australia
EX038	Optetrak Total Knee System	Patellar	26-41mm	$600.00
	Global Orthopaedic Technology
GO001	RBK Total Knee System Patella 	Patella component All poly, 	24mm - 40mm	$600.00
	component	UHMWPE, cemented, 3 pegs
GO189	Apex Knee, All-Poly Patella	All-Poly Dome 3 Peg Patella	29mm x 10mm & 8mm, 32mm 	$600.00
	x 10mm & 8mm, 35mm x 
	10mm & 8mm, 38mm x 10mm 
	& 8mm, 41mm x 10mm
GO253	SHiVA Modular Knee Hinge 	Patella Button	Sizes 2,3 and 4	$600.00
	Prosthesis - Patella Button
	Johnson & Johnson Medical Pty Ltd
DP152	PFC Sigma Knee System patella 	Cemented, all poly, oval dome, round 	25-50mm	$600.00
	component	dome and inset patella 
DP264	SROM Noiles Knee System patella	All poly, cemented patella 	Sizes 25 - 38mm	$600.00
DP524	LCS Complete Knee System patella 	All Poly patella, UHMWPE, 	Sizes small to large+	$600.00
	component 
	Link Orthopaedics  Australia
LO042	LINK Endo Model Knee Patella 	Patella Component, UHMWPE, 	Small, medium & large	$600.00
	Component 	cemented
LO057	LINK Lubinus Total Patella Glide 	Patella Component, UHMWPE, 	Small, medium & large	$600.00
	Replacement (patella component)	cemented
	Mathys Orthopaedics Pty Ltd
MA111	Balansys Patella Component	All Polyethylene, UHMWPE, 	Dia 25, 28, 31, 34, 37mm	$600.00
	cemented 
Prostheses List by Category, Groups and Sponsor	Page 897 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	MatOrtho
MJ014	MRK (Medial Rotation Knee) Total 	All Poly Patellar, UHMWPE, 1 	20-30mm	$600.00
	Knee System Patellar Component	central peg, This is a uncemented poly
MJ015	Saiph Knee System Patella 	Inset or Onset Polyethylene Patella 	Diameter 16mm - 30mm	$600.00
	Component	Component
	Medacta Australia Pty Ltd
MU031	Evolis Knee System Patella 	All poly patella, cemented, 	20, 24,28, 30, 33, 36, 39mm 	$600.00
	Component 	diam
MU041	Cinétique Knee System Patella 	All Poly Patella, UHMWPE, 	3 sizes: Size#1-2; #3-4; #5-	$600.00
	Component   	cemented, dome with 3 pegs
MU061	GMK  Inset Patella	Inset cemented polyethylene patella	sizes 1-2; 3-4; 5-6 	$600.00
	(20/24/28/32mm diameter)
MU072	GMK Resurfacing Patella	resurfacing three pegged cemented 	sizes 1, 2, 3, 4.	$600.00
	polyethylene patella
	Oceania Orthopaedics
OO012	ACS Knee System - PE patella 	ACS PE patella	26mm, 29mm, 32mm, 35mm	$600.00
	implant
OO057	MUTARS - Patella	Mutars PE Patella	Standard Large	$600.00
	Orthotech Pty Ltd
OH023	Optetrak Total Knee System	Patellar	26-41mm	$600.00
OH423	Trekking Knee System, Patellar	Patellar	30 - 40	$600.00
	RQSolutions Medical Devices Distribution Support
RQ022	RP (Rotating Platform) patella 	Patella, all polyethylene 	small, medium, large	$600.00
	component	(UHMWPE), can be used either 
	cemented or uncemented
	Smith & Nephew Surgical Pty Ltd
SN323	Genesis II Patella Component	Patella Component, Inlay, cemented, 	23-35mm 	$600.00
	UHMWPE, can be used for multiple 
	systems (Genesis II, Journey PFJ, 
	Journey Deuce, Legion)
SN382	Profix Knee System Patella 	Patella Component, UHMWPE, Inset 	23-35mm	$600.00
	Component	and Onlay, cemented
	Stryker Australia Pty Ltd
HW105	Duracon Knee System Patella 	Patella component, UHMWPE 	Small, Medium, Large, Xlarge	$600.00
	Component	(Duration), cemented
Prostheses List by Category, Groups and Sponsor	Page 898 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW140	Kinemax Knee System Patella 	Patella component Symmetric & 	Small, Medium, Large	$600.00
	Component	Asymmetric, UHMWPE (Duration), 
	cemented
HW182	PCA Modular Knee System Patella 	Patella component, UHMWPE, 	Small, Medium, Large, Extra 	$600.00
	Component	(Duration), cemented	Large
SK314	Avon Patello Femoral System 	Patella component, UHMWPE 	Small, Medium, Large	$600.00
	Patella Component	(Duration), Fixed, cemented
SK323	Triathlon Knee System Patella 	Patella Component, Cemented,  	Symmetric: 27mm x 8mm, 	$600.00
	Component	Asymmetric & Symmetric, (X3) 	29mm x 8mm, 31mm x 9mm, 
	UHMWPE	33mm x 9mm, 36mm x 10mm, 
	39mm x 11mm; Assymetric: 
	29mm x 9mm, 32mm x 10mm, 
	35mm x 10mm, 38mm x 
	11mm, 40mm x 11mm
SK415	Scorpio Knee System Patella 	Patella Component, Inset, Recessed, 	Concentric & Medialized 	$600.00
	Component	Medialized dome, Universal Dome, 	Dome patella sizes: 5, 7, 9 &
	Concentric Dome, UHMWPE (X3), 	 11; Universal Dome patella
	Fixed, Cemented	 sizes: 3, 5, 7, 9 & 11; Inset 
	& Recessed patella sizes: 
	26, 28, 30 and 32mm
SK419	Triathlon Knee System Patella 	Patella Component, Cemented,  	29 (X3)3 x 9mm, 32 x 36 x 	$600.00
	Component	Asymmetric, (X3) UHMWPE	10mm, 35 x 39 x 10mm, 38 x 
	42x 11mm, 40 x 44 x 11mm
ST636	Scorpio Knee System & S7000 Knee	Patella component, Inlay, UHMWPE 	3, 5, 7, 9, 11, 13	$600.00
	 System Patella Component	(N2VAC), cemented
	Tornier Pty Ltd
TO009	HLS Noetos System patella 	Patella, cemented, UHMWPE 	small, medium, large	$600.00
TO065	HLS Kneetec - Patella	Patellar implant of the HLS Kneetec 	Extra-small, Small, Medium, 	$600.00
	system, UHMWPE, Cemented dome 	Long
	design and anchoring pegs
	Wright Medical Australia
WR177	Advantim Total Knee System	Patella All Poly UHMWPE	25,28,32mm, 35mm, 38mm, 	$600.00
	41mm
WR190	Medial pivot Knee System	All poly patella, recessed and onlay, 	25, 28, 32, 35, 38, 41mm	$600.00
	single peg or tri-peg
Prostheses List by Category, Groups and Sponsor	Page 899 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI071	Insall-Burstein II Patella 	All poly, cemented, patella, 	32 - 41mm	$600.00
ZI093	Miller Galante II Patella 	All poly Patella, cemented, 	32 - 41mm	$600.00
ZI148	NexGen Patella Component   	Ally poly, cemented, patella, 	26 - 41	$600.00
ZI432	Natural Knee Patella 	All poly patella, cemented, 	Size 0/7mm to 3/10 mm	$600.00
ZI454	Natural Knee Patella CSTi	All Poly, Cemented, Patella	0-3	$800.00
12.08.02 - Cemented, Polyethylene, Metal Backed
	12.08.02.01 - Mobile
	Biomet Australia Pty Ltd
BI903	ROCC Patellar Component 	Patella Component, cemented, metal 	1-8	$1,352.00
	backed, CoCr,  with mobile poly 
	Johnson & Johnson Medical Pty Ltd
DP523	LCS Complete Knee System patella 	Metal backed, CoCr, rotating, 	Sizes small to large+	$1,352.00
	component 	cemented 
JJ669	LCS Patellofemoral Joint Prosthesis	Metal backed, CoCr, rotating, 	Sizes small to large+	$1,352.00
	 (patellar component	cemented, patella
	Medacta Australia Pty Ltd
MU045	Cinétique Knee System Patella 	Patella component, metal backed, 	3 Sizes: Size #1-2; #3-4; 	$1,352.00
	Component   	CoCr cemented, with mobile poly 
MU046	Cinétique Knee System Patella 	Patella component, metal backed, 	3 sizes: Size #1-2; #3-4; #5-6	$1,352.00
	Component   	CoCr cemented, with mobile poly and 
	TiNi (TiNbN) insert surface treatment 
	Oceania Orthopaedics
OO014	ACS Knee System - Cemented 	ACS cemented mobile bearing patella	2, 3, 4, 5, 6	$1,352.00
	mobile bearing patella
Prostheses List by Category, Groups and Sponsor	Page 900 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.08.03 - Uncemented, Polyethylene, Metal Backed
	12.08.03.01 - Mobile
	Biomet Australia Pty Ltd
BI901	ROCC Patellar Component 	Patella Component, uncemented, metal	1-8	$1,352.00
	 backed, Titanium plasma sprayed 
	surface (Porous plasma spray PPS)  
	with HA 
	Endotec Australia Pty Ltd
EA011	Buechel-Pappas Ultracoat Total 	Patellar component, metal backed, 	1-6(inc)	$1,352.00
	Knee Replacement System Patellar 	uncemented, beaded, Titanium, TiNi 
	Component 	surface treatment for bone and mobile 
	patella poly  
	Global Orthopaedic Technology
GO008	RBK Total Knee System Patella 	Patella component, metal back, CoCr, 	sizes 1 - 5	$1,352.00
	component	mobile, titanium plasma sprayed with 
	HA, uncemented
	Johnson & Johnson Medical Pty Ltd
DY502	LCS Complete Knee System patella 	Metal backed, CoCr, rotating, 	Sizes small to large+	$1,352.00
	component 	uncemented 
JJ668	LCS Patellofemoral Joint Prosthesis	Metal backed, CoCr, rotating, 	Sizes small to large+	$1,352.00
	 (patellar component	uncemented, patella
	Medacta Australia Pty Ltd
MU052	Cinétique Knee System Patella 	Patella component, metal backed, 	Size #1-2; #3-4; #5-6	$1,352.00
	Component   	CoCr uncemented, with titanium micro
	Oceania Orthopaedics
OO013	ACS Knee System - Cementless 	ACS Cementless mobile bearing 	2, 3, 4, 5, 6	$1,352.00
	mobile bearing patella
	12.08.03.02 - Moulded
	Smith & Nephew Surgical Pty Ltd
SM142	TC (Tri Compartment) PLUS Knee 	Patella Component, metal backed, 	8-26mm - 12/35mm	$800.00
	System and VKS Patella Component	uncemented,Titanium Plasma Spray 
	(Vacuum spray and triple layer), 
	moulded
Prostheses List by Category, Groups and Sponsor	Page 901 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW108	Scorpio Knee System Patella 	Patella component, Metal backed, 	Small, Medium, Large, Xlarge	$800.00
	Component	CoCr, uncemented, beaded, PA 
	(Hydroxyapatite), Moulded 
	UHMWPE (N2VAC), Fixed
ST609	Scorpio Knee System Patella 	Patella component, Metal backed, 	26-32mm in 2mm increments	$800.00
	Component	CoCr, uncemented, beaded, moulded 	 10mm thick
	polyethylene (N2VAC) 
	Zimmer Pty Ltd
ZI147	NexGen  Patella Component 	Metal backed, trabecular metal 	26 - 41	$800.00
	(Tantalum), patella component, with 
	moulded UHMWPE, uncemented
ZI431	Natural Knee Patella CSTi	Patella metal backed, with cancellous 	Size 0 to 3	$800.00
	structure Titanium ingrowth
	Revision
	Zimmer Pty Ltd
ZI266	NexGen Trabecular Metal 	Augmented trabecular metal  	Small, medium, large and x-	$1,200.00
	Augmented Patella	combined with NexGen all poly 	large
	patella component (2 piece)
12.08.04 - Polyethylene Insert for Mobile Patella
	Johnson & Johnson Medical Pty Ltd
JJ697	LCS Total Knee System - 	Replacement UHMWPE insert for 	Small+ to Large+	$600.00
	Replacement Patella Polyethylene	LCS mobile bearing patella
12.09.01 - Distal Femur
	12.09.01.01 - Condylar only (only when combined with a proximal tibial replacement)
	Oceania Orthopaedics
OO097	MUTARS - Genux Hinged knee 	Cemented Hinge Knee	Size 3,4,5 left and right	$7,540.00
	femoral component
Prostheses List by Category, Groups and Sponsor	Page 902 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Hinge included
	Corin Australia Pty Ltd
CR198	METS Femoral Knee and Stem	CoCR-molybdenum hinged 	Small and Std Left and 	$5,209.00
	component with stem includes axle, 
	bushes and circlip
	12.09.01.02 - Condylar, including metaphyseal and/or diaphyseal
	Biomet Australia Pty Ltd
BI865	Orthopaedic Salvage System	Femoral Component, Resurfacing or 	30 - 70mm	$8,008.00
	Segmental, CoCr,Ti
	Corin Australia Pty Ltd
CR183	METS Tibial Rotating Hinge 	CoCr-Molybedenum tibial component	Stem length 105mm and 	$8,008.00
	Polyethylene	114mm
CR185	METS Tibial Rotating Hinge Metal 	Ti casing and CoCr-Mo tibial 	Stem lengths 140mm and 	$8,008.00
	Casing	component	180mm
	Johnson & Johnson Medical Pty Ltd
DY188	Limb Preservation System	Distal Femoral Replacement 	XX Small and X Small	$8,008.00
	Component Left/Right
	Link Orthopaedics  Australia
LO156	LINK Endo Model M Modular 	Femoral Component	Extra Small - Extra Large	$8,008.00
	Knee Prostheses System
	Oceania Orthopaedics
OO106	Mutars Distal Femur	Mutars Distal Femur	Left/Right 90mm -110mm	$8,008.00
	Stryker Australia Pty Ltd
HW194	Howmedica Modular Resection 	Femoral Joint -  Vitallium	One size only	$8,008.00
	System
HW227	HMRS (Howmedica Modular 	HMRS Rotating Hinge Distal Femur, 	120, 140, 160mm	$8,008.00
	Replacement System) Rotating 	CoCr (Vitallium) uncemented, porous 
	Hinge Distal Femur Component	coated, Fixed
SK157	GMRS (Global Modular 	GMRS Distal Femoral component, 	Small Left 65mm, Small Left 	$8,008.00
	Replacement System) Distal Femoral	CoCr, uncemented, Fixed	75mm, Small Left 85mm, 
	 Component	Small Left 95mm, Small 
	Right 65mm, Small Right 
	75mm, Small Right 85mm, 
	Small Right 95mm, Standard
	 Left, Standard Right
Prostheses List by Category, Groups and Sponsor	Page 903 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Wright Medical Australia
WR158	Guardian Limb Salvage System	Special indication distal femur 	Left & Right	$8,008.00
	Zimmer Pty Ltd
ZI570	Zimmer segmental system - distal 	Distal femoral component	B & C, left and right	$8,008.00
	femoral component
	Complex
	Wright Medical Australia
WR160	Limb Salvage System for the 	Repiphysis non invasive expandable 	Custom Made	$67,600.00
	skeletally immature - Repiphysis	custom designed prosthesis for 
	proximal tibia, distal or total femur (all
	 components delivered as one unit)
	Hinge included
	Corin Australia Pty Ltd
CR200	METS Femoral Knee	CoCR-molybdenum hinged femoral 	Small left; small right; 	$8,736.00
	component includes axle, bushes and 	standard left; standard right
	circlip
12.09.02 - Proximal Tibia
	12.09.02.01 - Condylar only (only when combined with a proximal tibial replacement)
	Biomet Australia Pty Ltd
BH134	Orthopaedic Salvage System	Tibial Component, Resurfacing or 	63-83mm	$8,102.00
	Segmental, Non-Modular tray, CoCr, 
BH135	Orthopaedic Salvage System	Tibial Component, Resurfacing or 	63-83mm	$8,102.00
	Segmental, Non-Modular tray, CoCr, 
	Corin Australia Pty Ltd
CR152	METS Tibial Component Rotating 		Small and standard	$8,102.00
	Hinge	CoCr-Molybdenum with UHMWPE 
	bumper pad
	Oceania Orthopaedics
OO109	Mutars – Genux tibial plateau	Tibial plateau for hinged knee	X small, small, standard, large	$8,102.00
OO113	Mutars – Proximal Tibia	Mutars – Proximal Tibia	100mm	$8,102.00
	RQSolutions Medical Devices Distribution Support
RQ042	Tumor Revision System MML	Total femoral implant	various sizes	$8,102.00
Prostheses List by Category, Groups and Sponsor	Page 904 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW196	HMRS (Howmedica Modular 	HMRS Tibial Joint (baseplate) - 	5553	$8,102.00
	Replacement System) Tibial Joint 	uncemented, CoCr (Vitallium), porous 
	(Baseplate)	coated, w/medial & lateral flanges 
	moulde agaibnst tibia w/bar bolt 
	fixation, and metal 
	cHydroxyapatitember for axis of hinge
HW234	HMRS (Howmedica Modular 	HMRS stemmed tibial baseplate, CoCr	One size only	$8,102.00
	Replacement System) Stemmed 	 (Vitallium), uncemented, porous 
	Tibial Baseplate	coated, w/large connecting stem 
	attached for diaphyseal fixation, Fixed
	Wright Medical Australia
WR164	Guardian Limb Salvage System	Stemmed tibial tray	1 - 5	$8,102.00
	12.09.02.02 - Condylar, including metaphyseal and/or diaphyseal
	Corin Australia Pty Ltd
CR133	METS Tibial Fixed Hinge	CoCr-Molybdenum	Stem lengths 140mm and 	$8,034.00
	180mm
CR137	METS Proximal Tibia Fixed Hinge	CoCr-Molybdenum proximal tibial 	Small and standard	$8,034.00
	component including bumper
CR138	METS Proximal Tibia Fixed Hinge 	CoCr-Molybdenum with HA coated 	Small and standard	$8,034.00
	Coated	patella tendon reattachment 
	mechanism and bumper
CR151	METS Proximal Tibia Rotating 	Titanium with UHMWPE bearing	Small and standard	$8,034.00
CR197	METS Proximal Tibia Rotating 	Titanium with UHMWPE bearing and	Small and Std	$8,034.00
	Hinge Coated	 HA coated patella tendon 
	reattachment mechanism
	Johnson & Johnson Medical Pty Ltd
DY195	Limb Preservation System	Tibial Replacement Component	XX Small - Med	$8,034.00
	Link Orthopaedics  Australia
LO160	LINK Endo Model M Modular 	Tibial Components	Extra Small - Extra Large	$8,034.00
	Knee Prostheses System
	Oceania Orthopaedics
OO112	Mutars – Metaphyseal component	Mutars – Genux metaphyseal tibial 	Right/Left 25mm, 35mm, 	$8,034.00
	spacer	50mm
Prostheses List by Category, Groups and Sponsor	Page 905 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	RQSolutions Medical Devices Distribution Support
RQ040	ESKA Tumor Revision System 	Distal femoral implant	various sizes	$8,034.00
	Stryker Australia Pty Ltd
SK156	GMRS (Global Modular 	GMRS Proximal Tibial component, 	Small, Standard	$8,034.00
	Replacement System) Proximal 	CoCr, uncemented, porous coated, 7 x 
	Tibial Component	tendon/suture holes for soft tissue re-
	attachment, Fixed
	Wright Medical Australia
WR152	Guardian Limb Salvage System	Proximal Tibial replacement 	One Size Only	$8,034.00
	Zimmer Pty Ltd
ZI740	Zimmer Segmental System - Proximal	Zimmer Segmental System - Proximal 	1-3	$8,034.00
	 TM Tibia	TM Tibia
12.09.03 - Diaphyseal Extension Piece (Femoral or Tibial)
	Biomet Australia Pty Ltd
BI868	Orthopaedic Salvage System	Diaphyseal Segment or Diaphyseal 	Diaphyseal Segment 1-	$4,410.00
	Coupler, Stacking Adapter and 	23cm, Diaphyseal coupler 
	Locking Screws, Ti
	Corin Australia Pty Ltd
CR150	METS Tibial Shaft	Titanium shaft	45-115mm	$4,410.00
	Link Orthopaedics  Australia
LO161	LINK Endo Model M Modular 	Coupling	One Size only	$4,410.00
	Knee Prostheses System
	Oceania Orthopaedics
OO108	Mutars Tumour System	Mutars diaphyseal implant	100mm length x 	$4,410.00
	Stryker Australia Pty Ltd
SK162	GMRS (Global Modular 	GMRS Connection Piece, uncemented	Left 80, 90mm; Right 80, 	$4,410.00
	Replacement System) Connection 	 Titanium, to replace varying lengths 	90mm
	Piece 	of diaphyseal bone loss
	Wright Medical Australia
WR166	Guardian Limb Salvage System	Guardian mid section male/female taper	40, 50, 60, 70, 90, 110, 	$4,410.00
	140mm
Prostheses List by Category, Groups and Sponsor	Page 906 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI576	Zimmer segmental system - segments 	fem/tib segment male-female	Male/female x 30 - 220mm. 	$4,410.00
	- femoral/ tibial	Male/Male x 80- 90mm.
	Oceania Orthopaedics
OO140	MUTARS intrameduallary 	MUTARS intramedullary connecting 	180-440mm Length	$4,410.00
	connecting module	module
	12.09.03.01 - Incorporating Bone Fixation
	Johnson & Johnson Medical Pty Ltd
DY189	Limb Preservation System	LPS Diaphyseal Stem, Cemented, 	11mm - 17mm diameter x 150	$4,576.00
	Bowed, with 2cm Beaded Collar	 - 200mm length
DY193	Limb Preservation System	LPS Diaphyseal Stem, Cemented, 	9mm - 17mm diameter, 100 - 	$4,576.00
	Straight, with 2cm Beaded Collar	125mm length
	Stryker Australia Pty Ltd
SK161	GMRS (Global Modular 	GMRS Extension Piece, uncemented 	30, 40, 50, 60, 70, 80, 100, 	$4,576.00
	Replacement System) Extension 	Titanium, connects to anchorage piece	120, 140, 160, 180, 200, 
	 (optional) for increases diaphyseal 	220mm
	replacement
	Wright Medical Australia
WR150	Guardian Limb Salvage System	Guardian beaded extended collar 	10, 11, 12, 13, 14, 15, 16, 	$4,576.00
	Femoral Stem Straight/Tapered - 	17mm x 152mm
	Titanium
12.09.04 - Bone Anchorage Piece
	12.09.04.01 - With Compression
	Biomet Australia Pty Ltd
BI963	Compress Compliant Prestress System	Anchor Assembly: Plug, Transverse 	10-24mm femoral canal 	$10,360.00
	pin, spindle, nut, cap.	diameter,
Prostheses List by Category, Groups and Sponsor	Page 907 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.09.05 - Tibial Inserts
	Biomet Australia Pty Ltd
BH137	Orthopaedic Salvage System	Tibial bearing Insert UHMWPE	12-22mm Thick	$2,300.00
	Corin Australia Pty Ltd
CR184	METS Tibial Rotating Hinge 	UHMWPE tibial bearing component	N/A	$2,300.00
	Polyethylene
	Oceania Orthopaedics
OO056	MUTARS - PE Inlay	MUTARS - PE Inlay	xsmall, Small, Standard, 	$2,300.00
	Large
	RQSolutions Medical Devices Distribution Support
RQ041	ESKA Tumor Revision System 	Distal femoral implant	various sizes	$2,300.00
	Stryker Australia Pty Ltd
HW251	MRS (Modular Replacement System)	Tibial insert UHMWPE (Duration) 	Small and Medium in 11, 13,	$2,300.00
	 Tibial Insert 	for MRS Metal Encapsulated Rotating	 16, 21mm
	 Hinge Tibial component, Mobile.
	Wright Medical Australia
WR155	Guardian Limb Salvage System	Duramer specialised Tibial insert, 	8, 10, 12, 16, 20mm	$2,300.00
	UHMWPE
	Zimmer Pty Ltd
ZI566	Zimmer segmental system - 	Segmental articulating surface	B, C, D, E & F - 12, 14, 17, 	$2,300.00
	articulating surfaces	20, 23 & 26mm
12.09.06 - Augments
	Biomet Australia Pty Ltd
BI866	Orthopaedic Salvage System	Femoral or Tibial Augment, Ti	'Femoral Sleeve - One Size; 	$2,137.00
	OR Femoral Flange - One 
	Size; OR Tibial Block 
	Augment 10-20mm;  OR 
	Tibial Augment Sleeve - 
	Small/Large
Prostheses List by Category, Groups and Sponsor	Page 908 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR134	METS Tibial Plateau Plate	CoCr	Small and standard in 4 	$2,137.00
	thicknesses
CR153	METS Femoral Plateau Plate	Titanium	Small & Standard, 4 	$2,137.00
	thicknesses
	Link Orthopaedics  Australia
LO166	LINK Endo Model M Modular 	Augments	Small, Medium, Large	$2,137.00
	Knee Prostheses System
	Oceania Orthopaedics
OO111	Mutars – Genux Augments	Mutars – Genux Augments	Size, small, 3,4,5, 5mm, 	$2,137.00
	10mm, 15mm, 20mm
12.09.07 - Stems
	Biomet Australia Pty Ltd
BI864	Orthopaedic Salvage System	Stem, Cemented or Porous, Ti	(9-19)mm diameter x  (90-	$3,037.00
	300)mm length
	Corin Australia Pty Ltd
CR142	METS Stem	Titanium, curved and straight	6 diameters, 10-15mm	$3,037.00
CR145	METS Tibial Stem	Titanium	5 diameters 9-13mm	$3,037.00
CR149	METS Integral Shaft & Stem Coated	HA coated titanium collar, shaft and 	Shaft Length 15-55mm, stem	$3,037.00
	stem	 length 120mm
CR199	METS Intergral Shaft and Stem	Titanium stem for use with tibial 	Shaft 30-70mm, stem 120mm	$3,037.00
	Johnson & Johnson Medical Pty Ltd
DY190	Limb Preservation System	LPS Diaphyseal Stem Fully Beaded, 	Porocoat 12.5mm - 18.5mm 	$3,037.00
	Bowed, with 2cm Beaded Collar	diameter x 150mm - 200mm 
	length
DY194	Limb Preservation System	LPS Diaphyseal Stem Fully Beaded, 	Porocoat 10.5mm - 18.5mm 	$3,037.00
	Straight, with 2cm Beaded Collar	diameter x 100mm - 125mm 
	length
	Link Orthopaedics  Australia
LO167	LINK Endo Model M Modular 	Stems	Exrta Small - Extra Large	$3,037.00
	Knee Prostheses System
Prostheses List by Category, Groups and Sponsor	Page 909 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO048	MUTARS Oncology stems	Mutars oncology stems	120mm length, x 10-20mm 	$3,037.00
	width
	Stryker Australia Pty Ltd
HW247	Howmedica Modular Resection 	Oncology Femoral Stem -  Vitallium	127mm and 203mm length 	$3,037.00
	System	11, 13, 15, 17mm diameter
HW250	MRS (Modular Replacement System)	MRS Tibial Stem - cemented, CoCr 	127mm in 9, 11, 13mm 	$3,037.00
	 Tibial Stem 	(Vitallium), Fixed	diameter
SK166	GMRS (Global Modular 	GMRS Long Bowed Stem,Titanium, 	200mm stem length in 11, 	$3,037.00
	Replacement System) Long Bowed 	with Ti plasma coating, uncemented, 	12, 13, 14, 15, 16, 17, 18, 
	Stem	proximal 3cm Hydroxyapatite coated 	19mm
	(Purefix) 
SK167	GMRS (Global Modular 	GMRS Short Bowed Stem,Titanium, 	150mm in: 11, 12, 13, 14, 	$3,037.00
	Replacement System) Short Bowed 	with Ti plasma coating, uncemented, 	15, 16, 17, 18, 19mm
	Pressfit Stem	proximal 3cm Hydroxyapatite coated 
	(Purefix) 
SK168	GMRS (Global Modular 	GMRS Straight Fluted Stem,Titanium, 	125mm length in 8, 9, 10, 	$3,037.00
	Replacement System) Straight 	with Ti plasma coating, uncemented, 	11, 12, 13, 14, 15, 16, 17, 
	Fluted Stem	proximal 3cm Hydroxyapatite coated 	18, 19mm
	(Purefix) 
SK330	MRS (Modular Replacement System)	MRS Femoral stems with female taper, 	11 x 127mm,    13 x 127mm,   	$3,037.00
	 Femoral Stems	Titanium, uncemented, 	 15 x 127mm,    17 x 127mm
	Wright Medical Australia
WR153	Guardian Limb Slavage System	Guardian  Femoral Stem 	11, 13, 15, 17mm x 152mm	$3,037.00
	Straight/Tapered - Titanium
WR163	Guardian Limb Salvage System	Guardian Femoral Stem Straight - 	9, 11, 13 x 120mm	$3,037.00
	without plasma collar Titanium
WR167	Guardian Limb Salvage System	Guardian femoral Stem Straight With 	9, 11, 13 x 120mm	$3,037.00
	Plasma Collar - Titanium
	Zimmer Pty Ltd
ZI574	Zimmer segmental system - cemented 	Segmental cemented stem	9-19mm x 130mm; 190mm, 	$3,037.00
	stem	250mm
Prostheses List by Category, Groups and Sponsor	Page 910 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.09.08 - Couplers or adaptors, incorporating stem extenders, sleeves 
	12.09.08.01 - Collar
	Biomet Australia Pty Ltd
BI964	Compress Compliant Prestress System	Medullary Centering Sleeve	13-25mm	$4,498.00
	Corin Australia Pty Ltd
CR140	METS Stippled Collar	Titanium, HA coated, round or oval	4 sizes round, 4 sizes oval	$4,498.00
CR141	METS Smooth Collar	Titanium, uncoated, round or oval	4 sizes round, 4 sizes oval	$4,498.00
CR146	METS Tibial Collar Coated	Titanium collar with HA coating	5 diameters 20-32mm	$4,498.00
	Link Orthopaedics  Australia
LO164	LINK Endo Model M Modular 	Collar Couplings	10mm	$4,498.00
	Knee Prostheses System
	Zimmer Pty Ltd
ZI572	Zimmer segmental system - smooth 	Segmental smooth stem collar	12-16mm & 17-19mm	$4,498.00
	stem collar
ZI583	Zimmer segmental system - TM stem 	Segmental TM stem collar	12-16mm, 25mm: 12-16mm, 	$4,498.00
	collar	30mm: 12-16mm, 35mm; 17-
	19mm, 30mm; 17-19mm, 35mm
	12.09.08.02 - Adaptor
	Biomet Australia Pty Ltd
BI965	Compress Compliant Prestress System	Femoral Adapter	OSS or Finn Adapter	$1,700.00
	Johnson & Johnson Medical Pty Ltd
JJ825	Limb Preservation System - 	Diaphyseal Sleeve	18 - 28mm	$1,700.00
	Diaphyseal Sleeve
JJ826	Limb Preservation System - Sleeve 	Modular revison diaphyseal sleeve 	Extra small - large	$1,700.00
	Base
JJ827	Limb Preservation System - Sleeve 	Diaphyseal sleeve adapter	+0 to +10mm	$1,700.00
	Adapter
	Link Orthopaedics  Australia
LO165	LINK Endo Model M Modular 	Adaptor Coupling	Short, Long	$1,700.00
	Knee Prostheses System
Prostheses List by Category, Groups and Sponsor	Page 911 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO105	Mutars Diaphyseal connecting 	Mutars Diaphyseal connecting piece	100mm -120mm	$1,700.00
OO114	Mutars – reducer	Mutars – reducer	120mm/30mm	$1,700.00
OO115	Mutars – Proximal tibia connecting 	Mutars – Proximal tibia connecting 	105mm, 125mm	$1,700.00
	piece	piece
OO141	MUTARS RS Hip System. MUTARS	RS coupling device	30mm	$1,700.00
	 RS coupling device
	Stryker Australia Pty Ltd
SK172	Howmedica Modular Resection 	GMRS Adaptors Male/Female Taper, 	Male Taper; Female Taper	$1,700.00
	System	Titanium/Forged Cobalt Chrome
	Complex
	Johnson & Johnson Medical Pty Ltd
DY217	Limb Preservation System	Intercalary Segment Component 	55mm	$7,288.00
	(Male/Female)
	12.09.08.03 - Stem extender
	Johnson & Johnson Medical Pty Ltd
DY191	Limb Preservation System	Total Femoral Segment Component 	55 mm Length	$4,400.00
	(Male/Male)
DY192	Limb Preservation System	Segmental Component (Male/Male)	25 to 125mm Length	$4,400.00
	Link Orthopaedics  Australia
LO162	LINK Endo Model M Modular 	Stem extender, segment	30mm - 250mm	$4,400.00
	Knee Prostheses System
	Oceania Orthopaedics
OO107	Mutars Diaphyseal extension piece	Mutars Diaphyseal extension piece	40/100mm	$4,400.00
	Wright Medical Australia
WR154	Guardian Limb Salvage System	Male-Male Mid-Section extender 	40, 50, 60, 70, 90, 110, 	$4,400.00
	140mm
	Zimmer Pty Ltd
ZI730	Zimmer Segmental System, Variable 	Variable Stiffness Stem Extensions - 	9 to 19mm diameter, 130mm 	$4,400.00
	Stiffness Stems	Straight/Bowed and Precoat for 	and 190mm length
	Segmental System in various sizes.
ZI732	Zimmer Segmental System, 	Trabecular Metal Intercalary Segments	45mm, 55mm, 65 mm length	$4,400.00
	Intercalary Segments	 for various lengths
Prostheses List by Category, Groups and Sponsor	Page 912 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.10.01 - Cemented
	Smith & Nephew Surgical Pty Ltd
SN835	Journey Deuce Bicompartment 	Bicompartment Femoral Component, 	1-8	$4,300.00
	Femoral Component 	cemented, Oxinium 
12.11.01 - Augments
	Advanced Surgical Design & Manufacture Ltd
AE071	Active Knee Posterior  Block 	Posterior Femoral Block	1 - 5, 4 - 8mm	$1,283.00
AE072	Active Knee  Femoral Distal Spacer	Femoral Distal Block	1 - 5, 4 - 8mm	$1,283.00
AE073	Active Knee Femoral Augments 	Combined Distal and Posterior Block,	1-5,  4 - 8mm	$1,283.00
	  CoCr
AE074	Active Knee Revision System - 	Half Block Wedge	1-5, 5 - 10 Deg	$1,283.00
	Tibial Half Block Spacer
AE076	Active Knee Tibial Full Block 	Tibial full block of full wedge, CoCr	1-5,  5 - 10 Deg	$1,283.00
AE077	Active Knee Half Block Wedge	Half Block or Half Wedge, CoCr	1-5,  5 - 10 Deg	$1,283.00
	Amplitude Australia
LI065	Score Knee System Tibial and 	Tibial and Femoral half blocks, CoCr, 	31 sizes	$1,283.00
	Femoral Augments 	screw fixation used for femoral blocks, 
	tibial blocks cemented 
	B Braun Australia Pty Ltd
BB320	Emotion Total Knee System Tibial 	Medial/Lateral Tibial, Distal Femoral 	4mm to 12mm	$1,283.00
	and Femoral Augments	and Postero-Distal Augments
	Biomet Australia Pty Ltd
BH125	RHK Knee - Augments	Augment, Femoral or Coned Tibial 	(63-79)mm x 20mm, small or 	$1,283.00
	Augments	std x (10-30)mm
BI183	Maxim Complete Knee System 	Tibial and femoral half wedges and 	55-80mm	$1,283.00
	Femoral and Tibial Augments 	half blocks, Titanium
BI952	Vanguard Total Knee System	Femoralor Tibial Augments, anatomic, 	5-15mm x 55-80mm	$1,283.00
	distal or posterior, Ti alloy
Prostheses List by Category, Groups and Sponsor	Page 913 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Exactech Australia
EX025	Optetrak Total Knee System Tibial 	Tibial Augments for CCK femoral 	Size 1 - 6	$1,283.00
	Augments	component, half and third blocks, 
	titanium, screw fixation 
EX026	Optetrak Total Knee System Femoral	Femoral Augments for CCK femoral 	Size 1-6	$1,283.00
	 Augments 	component, distal and posterior 
	blocks, titanium, screw fixation 
	Global Orthopaedic Technology
GO116	RBK Total Knee System Tibial 	Tibial hemi blocks and wedges, CoCr, 	4mm and 10mm thick	$1,283.00
	Augments 	Titanium 
GO118	RBK Total Knee System Femoral 	Distal and posterior femoral blocks, 	4mm and 10mm thick	$1,283.00
	Augments 	titanium
GO254	SHiVA Modular Knee Hinge 	SHiVA Modular Knee Hinge 	Size 2,3 and 4 x 5mm and 	$1,283.00
	Prosthesis	Prosthesis - Tibial Spacer	10mm thick
GO260	Apex Revision Knee	Apex Revision Knee Femoral and 	5mm to 10mm	$1,283.00
	Tibial Augments
	Johnson & Johnson Medical Pty Ltd
DP158	PFC Sigma Knee System femoral  	Distal and posterior femoral augments,	Sizes  1 - 6.  4-16mm	$1,283.00
	augments 	 CoCr , with screws
DP161	PFC Sigma Knee System tibial 	Tibial wedges (full and hemi) and  	Size 1-6	$1,283.00
	augments 	hemi blocks, CoCr, with screw
DP269	SROM Noiles Knee System femoral 	Distal or posterior and combined 	Sizes xxsmall - xlarge.  5-	$1,283.00
	augments 	distal and posterior femoral augments	10mm
DY153	LCS Complete Knee System 	Femoral distal and posterior 	Sizes small to large+.  5-15mm	$1,283.00
	Augments 	augments, CoCr, with screws
DY159	MBT Knee System tibial augments 	Tibial blocks, with screws, CoCr 	Sizes 1-7. 5-15mm	$1,283.00
	Mathys Orthopaedics Pty Ltd
MA508	Balansys Revision Knee, Augments	Revision Femoral/Tibial Augments, 	5 and 10mm	$1,283.00
	complete with screws
	Medacta Australia Pty Ltd
MU085	GMK Revision femoral distal wedge	Screwed femoral distal augmentation	Size 1 to 6, each one 	$1,283.00
	available in 3 thicknesses: 
	4mm, 8mm, 12mm
MU087	GMK Revision femoral posterior 	Screwed femoral posterior 	Size 1 to 6, each one 	$1,283.00
	wedge	augmentation	available in 2 thicknesses: 
	5mm, 10mm
Prostheses List by Category, Groups and Sponsor	Page 914 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MU094	GMK Revision tibial wedge	Cemented tibial baseplate 	Size 0 to 6, each one 	$1,283.00
	available in 2 thicknesses: 
	5, 10mm
	Oceania Orthopaedics
OO026	ACS Knee System-ACS spacer 	ACS tibial and femoral augments for 	Left and Right, medial, 	$1,283.00
	(tibial and femoral)	use with mobile bearing and Revision	lateral, posterior and distal.
	 FB tibial base plates
	Orthotech Pty Ltd
OH026	Optetrak Total Knee System Tibial 	Tibial Augments for CCK femoral 	Size 1 - 6	$1,283.00
	Augments	component, half and third blocks, 
	titanium, screw fixation 
OH029	Optetrak Total Knee System Femoral	Femoral Augments for CCK femoral 	Size 1-6	$1,283.00
	 Augments 	component, distal and posterior 
	blocks, titanium, screw fixation 
OH416	Samo TCK Revision Knee System	Tibial and femoral augments	T1-T5 5-10mm	$1,283.00
	Smith & Nephew Surgical Pty Ltd
SM088	RT (Rotating Hinge) PLUS Knee 	Femoral Augment Distal and posterior	5-15mm	$1,283.00
	System Femoral Augment	 blocks, CoCr, includes screws for 
	fixation
SM089	RT (Rotating Hinge) PLUS Knee 	Tibial Augment Half blocks, CoCr, 	5-10mm	$1,283.00
	System Tibial Augment	includes screws for fixation
SM153	Legion Hinge Femoral Wedge	A distal femoral Wedge for use with 	Size 2 to 7 5,10,15,20mm	$1,283.00
	the Legion Hinge system.
SN330	Genesis II Knee System Tibial and 	Tibial Augments, half blocks and half 	1-8	$1,283.00
	Femoral Augments	wedges, (CoCr) and Femoral 
	Augments, distal and posterior or 
	distal and posterior combined 
SN381	Profix Knee System Tibial and 	Tibial Augments, Half wedges and 	1-7. Small - Large 	$1,283.00
	Femoral Augment	half blocks, uncemented beaded 
	includes screws for fixation, Titanium. 
	 Femoral Augments, Posterior, Distal 
	and Posterior and distal combined, 
	uncemented beaded, includes screws 
	for fixation, Titanium
Prostheses List by Category, Groups and Sponsor	Page 915 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN384	Profix Knee System Tibial and 	Tibial Augments, Half wedges and 	1-7	$1,283.00
	Femoral Augment	half blocks, cement fixation, Titanium. 
	 Femoral Augments, Posterior, Distal 
	and Posterior and distal combined, 
	includes screws for fixation, Titanium
SN821	Legion Knee System Femoral 	Femoral Augment, posterior, distal 	5-15mm	$1,283.00
	Augement	and combined posterior and distal, 
	Titanium, includes screws for fixation
SN822	Legion Knee System Tibial 	Tibial Augments, half blocks and half 	5-15mm	$1,283.00
	wedges, full blocks and full wedges, 
	Titanium includes screws for fixation
	Stryker Australia Pty Ltd
HW099	Duracon Knee System Tibial 	Tibial Augments Full wedge (angled) 	Left & right, full & angled, 	$1,283.00
	Augments 	& Full block (flat), CoCr (Vitallium), 	5mm & 10mm
	cemented
HW153	Kinemax Knee System & Modular 	Distal & posterior femoral blocks & 	Kinemax: Full, Distal & 	$1,283.00
	Rotating Hinge Distal & Posterior 	spacers, CoCr (Vitallium), cemented	Posterior Augments: xs-xl; 
	Femoral Augments & Spacers	5mm /10mm         MRH 
	Distal Femoral Augments 
	xs-xl; 5mm / 10mm
HW168	Kinemax Knee System Full Tibial 	Full Tibial Block, CoCr (Vitallium), 	xs-xl, 10mm thickness	$1,283.00
	Augment	cemented
HW169	Kinemax Knee System Hemi Tibial 	Half block, CoCr (Vitallium), 	 LM/RL & LL/RM xs-xl in 5	$1,283.00
	Augment	 & 10mm thickness
SK441	Triathlon Knee System Femoral 	Femoral blocks distal & posterior, 	Left & Right 5mm size 1-8	$1,283.00
	Augments	CoCr, mechanical attachment	10mm size 1-815mm size 
	1-8
SR036	Triathlon Knee System Hemi 	Half (hemi) tibial blocks, CoCr, 	LM/RL & LL/RM, 1 to 8, 	$1,283.00
	Augments	mechanical attachment 	5mm and 10mm
ST018	Scorpio Knee System Femoral & 	Femoral & tibial blocks distal, 	5mm & 10mm for all sizes of 	$1,283.00
	Tibial Augment	posterior and full, CoCr, cemented	femur and tibia. 5 degrees for
	 all tibia sizes
ST604	Duracon Knee System Tibial 	Tibial Augments Half (hemi) wedge 	LM/RL & LL/RM in 5mm, 	$1,283.00
	Augments 	(angled) & Half (hemi) block (flat), 	10mm thicknesses
	CoCr (Vitallium), cemented
	Tornier Pty Ltd
TO022	HLS Noetos Revision Knee 	Distal and Posterior Femoral and 	1 to 6 Thickness 4, 8 and 12	$1,283.00
	tibial Wedges and blocks, CoCr
Prostheses List by Category, Groups and Sponsor	Page 916 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
TO027	HLS Noetos  Revision Tibial 	Tibial Spacer (including 2 screws) 	1 to 6 thickness 4, 8 and 	$1,283.00
	12mm
	Wright Medical Australia
WR178	Medial Pivot Knee System	Offset tibial block augments, screw 	1, 2/1, 3/2, 4/3, 5/4, 6/5, All	$1,283.00
	fixation for use with offset stemmed 	 in 5mm, 10mm, 15mm
	tibial component 
WR193	Medial Pivot Knee System	Femoral Augments titanium, separate 	1 - 5, 5mm thick, 10mm 	$1,283.00
	distal and posterior with screw 	thick, posterior and distal
	attachment 
WR197	Medial Pivot Knee System	Tibial augments, wedges and blocks, 	15 degree, sizes 1, 2/1+, 	$1,283.00
	screw attachment 	3/2+, 4/3+, 5/4+, 6/5+, 
	Blocks 5mm, 10mm, 15mm
	Zimmer Pty Ltd
ZI140	NexGen Tibial Augments	Tibial Augments, wedges, hemi and 	1 - 10	$1,283.00
	one third and tibial blocks hemi, 
	titanium
ZI141	NexGen Tibial Augment	Tibial Augment, Full Wedge, 	1 - 10	$1,283.00
ZI142	NexGen Knee Tibial Augments	One Third Wedge - Ti	1 - 10	$1,283.00
ZI143	NexGen Knee Tibial Augments	NexGen Tibial Blocks - half and full, 	1 - 10	$1,283.00
	Titanium
ZI144	NexGen  Femoral Augments	Femoral blocks, posterior, distal and 	A - H	$1,283.00
	anterior, titanium 
ZI145	NexGen  Femoral Augments	Femoral blocks, combined posterior 	A - H	$1,283.00
	distal block 
ZI404	Natural Knee Tibial Augments 	Tibial hemi blocks, titanium, lug 	4 to 8mm  Size 00 to 5	$1,283.00
	fixation 
	Global Orthopaedic Technology
GO264	SHiVA Hinge Knee Revision 	SHiVA Hinge Knee Revision  Spacer 	Size 2 -4, Thickness 5 and 	$1,283.00
	System - Spacer	including locking screws	10 mm for Distal Femoral 
	and Posterior Femoral 
	Reference
	Size 2-5 , Thickness 5 and 
	10 mm for Tibial Reference
Prostheses List by Category, Groups and Sponsor	Page 917 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.02 - Axles for hinged prostheses
	Johnson & Johnson Medical Pty Ltd
JJ705	LPS & SROM Systems - Hinge Pin	Rotating Hinge Axle - uncemented, 	xxsmall - medium	$728.00
	CoCr
	Oceania Orthopaedics
OO089	MUTARS - Genux Locking screw 	Locking screw, axel, for Genux hinge 	1 Size	$728.00
	for locking mechanism	locking mechanism
	Smith & Nephew Surgical Pty Ltd
SN901	Legion Hinge Axle	Is used to secure the Legion Hinge 	Sizes 2-7	$728.00
	femoral component to baseplate.
	Stryker Australia Pty Ltd
HW201	HMRS (Howmedica Modular 	HMRS Fixed Hinged Knee Axle Pin, 	One size only	$728.00
	Replacement System) Fixed Hinged 	CrCo, (Vitallium), uncemented, Fixed
	Knee Axle Pin 
12.11.03 - Bolts
	Global Orthopaedic Technology
GO158	RBK Universal Knee System Insert 	Insert bolt for RBK universal pegged 	10mm - 20mm	$305.00
	Bolt 	and non pegged inserts
GO190	Apex Knee, Locking Bolt	Tibial Insert Locking Bolt	One size	$305.00
	Johnson & Johnson Medical Pty Ltd
DP155	PFC Sigma Knee System femoral 	Bolts to connect femoral stem, straight	Neutral +/- 2mm	$305.00
	stem bolts	 and offset 
	Oceania Orthopaedics
OO090	MUTARS - Genux Locking screws	Locking screws for augments	Various	$305.00
Prostheses List by Category, Groups and Sponsor	Page 918 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.04 - Connectors for hinged prostheses
	Biomet Australia Pty Ltd
BH136	Orthopaedic Salvage System	Femoral/Tibial Interlocking 	One size only except srew - 	$3,453.00
	devices:locking pin, femoral and 	small or large, Tibial 
	tibial bushings, tibial bearing. Axle, 	bearing 12-22mm
	reinforced Yoke, locking screws 
	CoCr, Ti
	Global Orthopaedic Technology
GO119	RBK Total Knee System Rotating 	Rotating Hinge Bushing Mechansim	Complete mechanism	$3,453.00
	hinge bushing mechanism 
	Johnson & Johnson Medical Pty Ltd
DY196	Limb Preservation System	Tibial Hinge Insert	XX Small - Large, 12 - 31mm	$3,453.00
	Link Orthopaedics  Australia
LO163	LINK Endo Model M Modular 	Hinge components	Extra Small - Extra Large	$3,453.00
	Knee Prostheses System
LO174	Link Endo Rotational and Hinge 	Hinge Component	Extra small - Extra large	$3,453.00
	Knee Prostheses
	Oceania Orthopaedics
OO098	MUTARS Genux Hinge locking 	Connecting piece; connecting distal 	Genux Hinge Component	$3,453.00
	mechanism	femoral and proximal tibial 
	replacement.
	Smith & Nephew Surgical Pty Ltd
SM154	Legion Hinge Sleeve and Bolt	Is used to secure the Legion Hinge 	Sizes 2-7	$3,453.00
	femoral component to the hinge 
	mechanism attached to the baseplate.
	Stryker Australia Pty Ltd
HW144	KRH (Kinematic Rotating Hinge) 	KRH Rotating Hinge Tibial bearing 	Small and Medium 	$3,453.00
	Tibial Bearing Component	component, CoCr, Mobile	11mm/15mm by 
	110mm/180mm
Prostheses List by Category, Groups and Sponsor	Page 919 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HW145	GMRS (Global Modular 	GMRS, MRH, KRH Rotating Hinge 	Small & standard	$3,453.00
	Replacement System) MRH 	Femoral Bushings & Bumpers 
	(Modular Rotating Hinge) 	UHMWPE, (Duration) 
	Kinematic Rotating Hinge (KRH) 
	Femoral Bushings & Bumpers 
HW228	HMRS (Howmedica Modular 	HMRS Rotating Hinge Axle - 	One size only	$3,453.00
	Replacement System) Rotating 	uncemented, CoCr (Vitallium)
	Hinge Axle
HW229	HMRS (Howmedica Modular 	HMRS Rotating Hinge Femoral 	One size only	$3,453.00
	Replacement System) Rotating 	Bushing - UHMWPE, (Duration) 
	Hinge Femoral Bushing
HW230	HMRS (Howmedica Modular 	HMRS & MRH Rotating Hinge 	HMRS: 0°, 3°, 5°       MRH: 	$3,453.00
	Replacement System) & MRH 	Bumper - (Duration) UHMWPE	0°, 3°
	(Modular Rotating Hinge) Rotating 
	Hinge Bumper
HW231	GMRS (Global Modular 	GMRS & MRH Tibial Rotating Hinge	GMRS-small  	$3,453.00
	Replacement System) & MRH 	 component (not baseplate) separated 	MRH/crossover                      
	(Modular Rotating Hinge) Tibial 	from femoral component by bumper 	MRH - xs-xl  & l-xl
	Rotating Component	and rotates on top of tibial insert , 
SK331	MRH (Modular Rotating Hinge) 	MRH Assembly pack consists of: 	1 Tibial Sleeve, 1  Bumper 	$3,453.00
	Rotating Hinge Assembly Pack	Tibial sleeve, Bumper insert & 	Insert, 2 Femoral Bushing 
	Femoral Bushing components 	Components
	UHMWPE (Duration)
	Wright Medical Australia
WR149	Guardian Limb Salvage System	Tibial Hinge Assembly with 	One Size only	$3,453.00
	polyethylene bearing, with/ without 
	rotational stop pin - CoCR 
WR157	Guardian Limb Salvage System	Quick Snap Axial Pin, CoCr, Titanium	1, 2, 3, 4	$3,453.00
	Zimmer Pty Ltd
ZI309	Nexgen Rotating Hinge 	Rotating hinge replacement which 	B-F	$3,453.00
	includes metal rotating hinge plus 
	Polyethylene bushing and fixation 
ZI560	Nexgen complete knee solution	Rotating hinge knee cement shield 	B, C, D, E & F	$3,453.00
	servicing kit
ZI571	Zimmer segmental system - 	Segmental poly insert	B & C	$3,453.00
	segmental poly insert
ZI573	Zimmer segmental system - hinge 	Segmental femoral hinge servicing kit	B & C	$3,453.00
	servicing kit
Prostheses List by Category, Groups and Sponsor	Page 920 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.05 - Conversion modules
	Smith & Nephew Surgical Pty Ltd
SN314	Genesis II Knee System Femoral 	Femoral Conversion Module, for 	Left/Right size 1-8	$1,185.00
	Conversion Module	Genesis II CR or PS femoral 
	component, includes screws for fixation
	Stryker Australia Pty Ltd
HW085	Duracon Knee System Modular 	Modular Stabilizer Box, CoCr 	Small, Medium, Medium-	$1,185.00
	Stabilizer Box	(Vitallium)	Large, Large, Extra-Large
12.11.06 - End caps
	B Braun Australia Pty Ltd
BB210	Columbus Total Knee System (TKS) 	Tibial Stem (cap), cemented or 	Small & Large D: 12mm & 	$725.00
	Tibial Stems	uncemented, short (mini) (obturator 	D: 14mm
	stem) CoCr, usually required when 
	stem not used
BB241	Emotion Total Knee System (TKS) 	Tibial Stem (cap), cemented or 	12mm, 14mm & 16mm in 	$725.00
	Tibial Stem	uncemented, short (mini) (obturator 	cemented and uncemented
	stem) CoCr, usually required when 
	stem not used
	Oceania Orthopaedics
OO110	Mutars – end piece	Mutars – end piece	1 size	$725.00
	Wright Medical Australia
WR251	Advance Medial Pivot Stem Cap	Modular Tibial Base Stem Cap	N/A	$725.00
12.11.07 - Offset couplers/adaptors
	Amplitude Australia
LI067	Score Knee System Offset Connector	Connector for stems to alter stem offset	2mm, 4mm, 6mm	$1,350.00
	 morse taper but also including screw 
	for additional fixation, titanium
Prostheses List by Category, Groups and Sponsor	Page 921 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BI956	Offset Tibial Tray System 	Offset Adapter for connection to tibial	0mm, 2.5mm, 5mm, 7.5mm 	$1,350.00
	 stems and baseplate, titanium 	Offset
	Johnson & Johnson Medical Pty Ltd
JJ654	PFC Sigma - Femoral Adaptor	Offset Adaptor	5 and 7 degree	$1,350.00
	Medacta Australia Pty Ltd
MU088	GMK Revision offset adaptor	Offset adaptor for tibial and femoral 	3mm and 5mm offset	$1,350.00
	revision extension stem
	Oceania Orthopaedics
OO027	ACS Knee System - ACS double 	ACS offset adapters for use with ACS 	0, +2mm, +4mm, +6mm.	$1,350.00
	taper adapter	FB, MB tibial and femoral components
	 and stems
OO093	MUTARS - Genux offset adapter	Offset Adapter	0, 2.5mm, 5mm, 7.5mm	$1,350.00
	Orthotech Pty Ltd
OH414	Samo TCK Revision Knee System	TCK femoral, tibial offsets	Straight, posterior, lateral, 	$1,350.00
	medial 2-6mm
	Stryker Australia Pty Ltd
SK435	Triathlon Knee System Tibial / 	Tibial & femral offset adaptor, CoCr	2,4,6,8mm	$1,350.00
	Femoral Offset Adaptor 
ST603	Duracon Knee System Tibial / 	Tibial / Femoral Offset Adaptor, CoCr, 	2mm, 4mm, 6mm, 8mm	$1,350.00
	Femoral Offset Adaptor 	(Vitallium)
	Smith & Nephew Surgical Pty Ltd
SN885	Genesis II/Legion Knee System 	Offset Coupler, titanium	2-6	$1,350.00
	Offset Couplers
12.11.08 - Pegs, lugs, etc
	Biomet Australia Pty Ltd
BI173	Maxim Complete Knee System Tibial	Insert locking pin, Titanium	One size only	$140.00
	 Locking Bar
Prostheses List by Category, Groups and Sponsor	Page 922 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO262	Apex Revision Knee - Tibial Insert 	Tibial Insert Locking Peg/Bolt	10; 11; 12; 14; 16; 18; 20; 	$140.00
	Locking Peg/Bolt	24 and 28mm
	Johnson & Johnson Medical Pty Ltd
DP255	SROM Noiles Knee System bumper 	Replacements for UHMWPE axis 	Sizes xxsmall - medium.	$140.00
	and hinge bearing replacements 	bearings and bumpers, for hinged 
	prosthesis 
DP267	SROM Noiles Knee System femoral 	Cap and bolt for end of femoral 	One size only	$140.00
	metaphyseal sleeve cap 	metaphyseal sleeve if stem not used 
DP384	AMK primary locking pin and clip	Normally supplied with insert, this 	One size only	$140.00
	covers separate provision
DY460	SROM Noiles Knee System tibial 	Cap and bolt for end of tibial 	One size only	$140.00
	metaphyseal sleeve cap 	metaphyseal sleeve if stem not used 
JJ659	LCS Complete Knee System APG arm	APG arm for use with APG mobile 	Sizes small to large+	$140.00
	tibial insert only
	Link Orthopaedics  Australia
LO043	LINK Endo Model Rotational and 	Full tibial blocks made of UHMWPE 	Small, Medium, Large	$140.00
	Hinge Knee Prosthesis System
LO159	LINK Endo Model M Modular 	Centering Stars	Small, medium, large	$140.00
	Knee Prostheses System
	Mathys Orthopaedics Pty Ltd
MA511	Balansys Revision Knee, Sealing Cap	Sealing cap	61	$140.00
	Smith & Nephew Surgical Pty Ltd
SN318	Genesis II 	Lug	One size only	$140.00
SN342	Genesis	Custom Flex Lock Peg	Left & right	$140.00
	Stryker Australia Pty Ltd
HW167	Kinemax Knee System Tibial 	Tibial Fixation Peg, CoCr (Vitallium), 	20mm	$140.00
	Fixation Peg
	Zimmer Pty Ltd
ZI406	Natural Knee Tibial Augment 	Tibial Augment Fixation peg and 	One size only	$140.00
	Fixation 	screws  
ZI422	Natural Knee	Femoral Spacer Lug - Ti alloy	4 to 12mm	$140.00
ZI741	Zimmer Segmental System - TM Tibia	Zimmer Segmental System - TM Tibia 	one size only	$140.00
	 Washer Kit	Washer Kit
Prostheses List by Category, Groups and Sponsor	Page 923 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.09 - Screws
	Endotec Australia Pty Ltd
EA024	Buechel-Pappas Ultracoat Total 	Screws used for augmentation of bone 	BP Rebar screws 15mm-	$140.00
	Knee Replacement System Rebar 	defects and reinforcement of PMMA, 	50mm (inc)
	TiNi surface treatment
	Euros Orthopaedics Australia Pty Ltd
EU012	Europ knee cancellous screw	Knee cancellous screws	diameter: 6.5mm lengths 	$140.00
	25,30,35,40,45,50mm
	Exactech Australia
EX030	Optetrak Total Knee System Tibial 	Tibial Stem Screw for Tibial stem 	One size only	$140.00
	Stem Extension Screw 	fixation 
	Global Orthopaedic Technology
GO120	RBK Total Knee System	Screw, Ti	5mm to 5.7mm x 5mm to 	$140.00
	17.5mm long
GO192	Apex Knee, Bone Screw	6.5mm Bone Screw	20mm, 25mm, 30mm, 35mm, 	$140.00
	40mm, 45mm, 50mm, 55mm, 
	60mm, 65mm & 70mm.
GO259	Apex Revision Knee - Femoral and 	Femoral and Tibial Locking 	Femoral Augment Locking 	$140.00
	Tibial Augment Locking 	Screw/Bolt - one size only
	Tibial Augment Locking 
	Screw/Bolt - 4mm, 8mm, 12mm
	Medacta Australia Pty Ltd
MU036	Evolis Knee System Fixation Screw 	Tibial screw for baseplate fixation to 	20/25/30/35/40/45mm 	$140.00
	bone, titanium, optional 	(6.5mm diameter)
	Oceania Orthopaedics
OO029	ACS Knee System - ACS Screws	Screw for spacers and augments	2 sizes	$140.00
	Orthotech Pty Ltd
OH056	Optetrak Total Knee System Tibial 	Tibial Stem Screw for Tibial stem 	One size only	$140.00
	Stem Extension Screw 	fixation 
Prostheses List by Category, Groups and Sponsor	Page 924 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Smith & Nephew Surgical Pty Ltd
SM091	RT (Rotating Hinge) PLUS Knee 	Insert clip and screws for stem 	0-10	$140.00
	System Clip and Screw	fixation, packed together as emergency
SN329	Genesis II 	Tibial screws 	15-50mm	$140.00
SN367	Mobile Bearing Knee System Insert 	Insert Locking Screw, used to lock 	One size only	$140.00
	Locking Screw	AP translation of Mobile insert
SN393	Profix Knee System Tibial Screws	Tibial Screws, Titanium for fixation of 	15-50mm	$140.00
	baseplate to bone (optional)
	Stryker Australia Pty Ltd
HW084	Duracon Knee System Augment 	Augment Locking Screw, CoCr 	5mm, 10mm	$140.00
	Locking Screw	(Vitallium)
HW097	Duracon Knee System Tibial 	Tibial baseplate screw, CoCr 	6.2mm diameter in 15mm, 	$140.00
	Baseplate Screw	(Vitallium)	20mm, 25mm, 30mm, 35mm, 
	40mm, 50mm, 55mm, 60mm 
	lengths
HW192	HMRS (Howmedica Modular 	HMRS Hex Head Cortical Bone 	16-30mm in 2mm increments	$140.00
	Replacement System) Hex Head 	Screw, Self Tapping, CoCr (Vitallium) 	 and 35-70mm in 5m 
	Cortical Bone Screw, Self Tapping	for prosthesis fixation 	increments
HW195	HMRS (Howmedica Modular 	HMRS Plug Screw Axis, UHMWPE, 	One size only	$140.00
	Replacement System) Plug screw 	(Duration) for fixation of HMRS Axis 
	within HMRS bearing component of 
	HMRS Distal Femur / Proximal Tibia 
	and HMRS Femoral / Tibial Joint. 
	Wright Medical Australia
WR179	Advantim Total Knee System	Cortical Bone Screws, to fix femoral 	4.5mm x 2.0 - 7.5cm in 0.5cm	$140.00
	component to bone, Titanium optional	 increments long
WR200	Medial Pivot Knee System	Option bone screw for tibial 	6.5mm x 1.5 - 6cm in 0.5cm 	$140.00
	increments long
	Zimmer Pty Ltd
ZI089	Miller Galante II	Bone Screw - Ti	20 - 80mm	$140.00
Prostheses List by Category, Groups and Sponsor	Page 925 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.10 - Stems - straight or offset
	Amplitude Australia
LI066	Score Knee System Femoral and 	Femoral and Tibial Stems, Titanium, 	4 diameters, 3 lengths	$1,258.00
	Tibial Stems	cemented
	B Braun Australia Pty Ltd
BB200	Emotion Total Knee System (TKS) 	Tibial and femoral stems, CoCr, 	Short, D: 10mm to 16mm , 	$1,258.00
	Tibial and Femoral Stems	cemented or uncemented	Medium, D: 10mm to 16mm, 
	Long, D: 10mm to 16mm
BB242	Columbus Total Knee System (TKS) 	Tibial Stem, cemented or uncemented, 	12mm & 14mm,  in 	$1,258.00
	Tibial Stem	CoCr	uncemented, 12mm & 14mm 
	in cemented. 
	Biomet Australia Pty Ltd
BI171	Maxim Complete Knee System 	Femoral and Tibial Stems, Titanium, 	40mm 80mm	$1,258.00
	Femoral and Tibial Stems 	curved and straight, cemented 
BI184	Biomet Universal Tibial and femoral 	Tibial and Femoral Stems, Titanium, 	55-80mm	$1,258.00
	stems 	curved and straight, cemented
BI978	Regenerex Tibial Tray	Stem, PressFit, Ti Alloy	40, 80mm	$1,258.00
	Endotec Australia Pty Ltd
EA023	Buechel-Pappas Ultracoat Total 	Femoral and Tibial stems, titanium, 	BP TKR Revision stems 	$1,258.00
	Knee Replacement System Femoral 	TiNi surface treatment, uncemented	9mm -20mm (inc)
	and Tibial Stems
	Exactech Australia
EX027	Optetrak Total Knee System Femoral	Femoral and Tibial Stems for Optetrak 	Size 1 - 6	$1,258.00
	 and Tibial Stems 	Knee System, titanium, cemented or 
	uncemented, femoral stem requires 
	stem extension adapter on every 
	occasion, tibial stem requires screw 
	fixation 
	Global Orthopaedic Technology
GO114	RBK Total Knee System Stems 	Tibial and Femoral Stems, cemented, 	10mm to 24mm thick x 80mm	$1,258.00
	Titanium including locking bolt	 to 170mm long
Prostheses List by Category, Groups and Sponsor	Page 926 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
GO258	Apex Revision Knee Stems	Apex revision Knee Femoral and 	Straight stem 9mm-25mm x 	$1,258.00
	Tibial Stems	75mm -150mm
	Offset 9mm-25mm x 75mm-
	150mm x 2mm-4mm
	angled stem 9mm
	Johnson & Johnson Medical Pty Ltd
DP143	PFC Sigma Knee System tibial stems 	Tibial stems cemented and fluted 	Sizes 30-150mm	$1,258.00
	uncemented, titanium
DP153	PFC Sigma Knee System femoral 	Femoral stems cemented and fluted 	5-7degree, 125-175mm 	$1,258.00
	stems 	uncemented, titanium with variable 
	angulation  
DP272	SROM Noiles Knee System stems	Femoral and tibial stems, uncemented, 	Sizes 100-150mm	$1,258.00
	fluted and slotted including 
	attachment bolt
JJ655	PFC Knee System - Universal 	Tibial/Femoral Stem-Titanium	Lengths 75, 115, 150mm; 	$1,258.00
	Slotted Stem	widths 10 to 24mm
	Link Orthopaedics  Australia
LO173	Link Endo Model Rotational and 	Stems	Extra small - Extra large	$1,258.00
	Hinge Knee Prostheses
	Mathys Orthopaedics Pty Ltd
MA507	Balansys Revision Knee, Stems	Ti uncemented Stem, straight and 	80 to 200mm, straight and 	$1,258.00
	offset, complete with locking screw	offset 4mm
	Medacta Australia Pty Ltd
MU035	Evolis Knee System Tibial Stem 	Tibial stems, titanium, cemented	30/60mm length (12mm 	$1,258.00
	diameter)
MU069	GMK Tibial Extension Stem	Tibial Baseplate extension stem	diameter 11mm, length 	$1,258.00
MU082	GMK Revision cemented extension 	Cemented tibia and femur extension 	Diameters 11, 13 and 16mm, 	$1,258.00
	stem	stem	available in 2 or 3 lengths 
	(65, 105, 150mm)
MU086	GMK Revision uncemented 	Uncemented tibia and femur extension 	Multiple diameters (10, 11, 	$1,258.00
	extension stem	stem	12, 13, 14, 15, 16, 18, 19, 
	20, 22mm) each one 
	available in 3 lengths (65, 
	105, 150mm)
Prostheses List by Category, Groups and Sponsor	Page 927 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Oceania Orthopaedics
OO094	MUTARS - Genux stems	Genux cemented. Press fit stems	130-240mm length, 11, 12, 	$1,258.00
	13, 14, 15, 16, 17, 18, 19, 
	20mm wide
OO122	ACS Knee system, ACS stems, 	ACS tibial and femoral stems	12/14/16/18/201/22mm dia 	$1,258.00
	straight and offset	stems, 
	25/50/75/100/150/200mm 
	length
	Orthotech Pty Ltd
OH027	Optetrak Total Knee System Femoral	Femoral and Tibial Stems for Optetrak 	Size 1 - 6	$1,258.00
	 and Tibial Stems 	Knee System, titanium, cemented or 
	uncemented, femoral stem requires 
	stem extension adapter on every 
	occasion, tibial stem requires screw 
	fixation 
OH418	Samo TCK Revision Knee System	Femoral and tibial stems.	40-120mmL x Dia 10-23mm	$1,258.00
	Smith & Nephew Surgical Pty Ltd
SM077	RT (Rotating Hinge) PLUS Knee 	Femoral and Tibial Stems, Titanium, 	95 -120	$1,258.00
	System Femoral and Tibial Stems	uncemented
SM084	RT (Rotating Hinge) PLUS Knee 	Femoral and Tibial Stems, CoCr, 	95-160	$1,258.00
	System Femoral and Tibial Stems	Cemented
SM086	RT (Rotating Hinge) PLUS Knee 	Femoral and Tibial Stems, Titanium, 	95 - 160	$1,258.00
	System Femoral and Tibial Stems	uncemented
SM087	RT (Rotating Hinge) PLUS Knee 	Femoral and Tibial Stems, Titanium, 	200	$1,258.00
	System Femoral and Tibial Stems	uncemented (longer stems)
SN316	Genesis II Knee System Tibial and 	Tibial and Femoral Stems, titanium, 	10-24x100mm, 10-20 x 	$1,258.00
	Femoral Stems	cemented or press fit 	150mm 10-16x 200mm
SN319	Genesis II 	Metaphyseal Stem	1-8	$1,258.00
SN347	Genesis	I/M Peg: Femoral and Tibial: Titanium	10-16mm Diameter x  40-	$1,258.00
	200mm Length
SN376	Profix Knee System Femoral and 	Femoral and Tibial stems, Titanium, 	10-20mm x 100mm. 10-	$1,258.00
	Tibial Stems	Cemented or press fit,	20x150mm 10-20 x 200mm
SN377	Profix	Metaphyseal Tibial Stem	14-20mm	$1,258.00
SN715	Genesis II Knee System Femoral and	Tibial and Femoral Stems, Titanium, 	18 - 24mm x 200mm	$1,258.00
	 Tibial Stems	cemented or press fit (larger diameter 
	range for 200mm length)
Prostheses List by Category, Groups and Sponsor	Page 928 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SN823	Legion Knee System Femoral and 	Femoral and Tibial stems, Titanium, 	120-220mm	$1,258.00
	Tibial Stems	Cemented or press fit
	Stryker Australia Pty Ltd
HW098	Duracon Knee System Stems	TS (Total Stabilizer) Stems, CoCr 	40mm, 80mm, 155mm 	$1,258.00
	(Vitallium), uncemented	lengths
HW171	Duracon Knee System / Kinemax 	Stem, femoral & tbial, CoCr, 	40mm, 80mm, 155mm for 	$1,258.00
	Knee System stem	(Vitallium), cemented	each size
SK434	Triathlon Knee System TS Titanium 	Stem, Titanium, uncemented	10-25 (100mm) 10-25 	$1,258.00
	stem	(150mm)
SR035	Triathlon Knee System TS stem	Tibial stem, Titanium, cemented	9x50mm, 9x100mm, 	$1,258.00
	9x150mm, 12x50mm, 
	12x100mm, 12x150mm, 
	15x50mm, 15x100mm, 
	15x150mm
SR037	Triathlon Knee System Femoral 	Modular Femoral Distal Fixation Peg 	one size	$1,258.00
	Distal Fixation Peg	CoCr
ST606	Duracon Knee System Tibial & 	Stem, femoral & tibial, titanium, 	10mm-19mm, 21mm, 23mm 	$1,258.00
	Femoral stem	cemented	in 80mm and 155mm lengths
	Tornier Pty Ltd
TO028	HLS Noetos Revision Stems	Femoral and Tibial extension stems 	1 to 6 Length 75 and 	$1,258.00
	CoCr
	Wright Medical Australia
WR148	Advantim Total Knee System	Tibial Primary Smooth/Finned 	3" Length in Small-Xlarge	$1,258.00
	Titanium CoCr short stem. This stem is
	 required for primary prosthesis.
WR171	Advantim / Ortholoc Revision Knee	Tibial Revision Smooth/Finned 	6" Length in varying 	$1,258.00
	Titanium	diameters 
WR186	Advantim / Ortholoc Revision Knee	Femoral stems titanium	5 Degree Size 4 10mm5 	$1,258.00
	Degree Size 6 10mm7 
	Degree Size 4 10mm7 
	Degree Size 6 10mm
WR195	Medial Pivot Knee System	Uncemented stems, femoral and tibial 	11 - 22mm in 1mm 	$1,258.00
	increments, 100 & 140mm 
	lengths
WR196	Advantim Total Knee System	Tibial Primary Smooth/Finned 	6" Length in Small-Xlarge	$1,258.00
	Titanium CoCr long stem. This stem is 
	required for primary prosthesis.
Prostheses List by Category, Groups and Sponsor	Page 929 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
WR199	Medial Pivot Knee System	Cemented stems, femoral and tibial	10, 12,14, 16, 18 x 65mm, 15	$1,258.00
	 x 30mm
	Zimmer Pty Ltd
ZI146	NexGen Femoral and Tibial Stems 	Femoral and Tibial Stems, straight and	Length - 35 - 155mm, 	$1,258.00
	 offset, cemented 	Diameters - 10 - 24 mm
ZI417	Natural Knee Tibial Stem 	Tibial Stem, Titanium, cemented 	60 to 215mm	$1,258.00
	including locking bolt 
	Global Orthopaedic Technology
GO263	SHiVA Hinge Knee Revision 	Knee revision Extension Stem	Straight 10 - 18mm 	$1,258.00
	System - Stems	Diameter; 50 to 150mm 
	Length
	Offset 10 - 16 mm Diameter; 
	75mm Length
12.11.11 - Stem Extenders, Sleeves and other couplings
	B Braun Australia Pty Ltd
BB319	Emotion Total Knee System Femoral	Revision nut for Femur Extension 	One size only	$780.00
	 Stem Extension
	Exactech Australia
EX029	Opetrak Total Knee System Femoral 	Femoral Stem Extension Adapter that 	One size only	$780.00
	Stem Extension Adpater 	provides for set changes in angulation
	 of stem needs to be used on every 
	occasion 
	Orthotech Pty Ltd
OH057	Opetrak Total Knee System Femoral 	Femoral Stem Extension Adapter that 	One size only	$780.00
	Stem Extension Adpater 	provides for set changes in angulation
	 of stem needs to be used on every 
	occasion 
	Stryker Australia Pty Ltd
HW233	KRH (Kinemax Knee System 	KRH & MRH Rotating Hinge Tibial 	One size only	$780.00
	Rotating Hinge) & MRH (Modular 	Sleeve, UHMWPE, (Duration) houses
	Rotating Hinge) Rotating Hinge 	 Rotating Hinge Tibial Rotating 
	Sleeve	component sHydroxyapatiteft
Prostheses List by Category, Groups and Sponsor	Page 930 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SK442	Triathlon Knee System Stem 	Stem extender, cemented, CoCr 	25mm & 50mm	$780.00
	Tornier Pty Ltd
TO024	HLS Noetos Revision Stem 	Stem Adaptor (Femoral Sledge) CoCr	5, 7 and 9 degrees	$780.00
	Extender, Sleeve and other 
TO025	HLS Hoetos Revision Knee	Sleeve stem adaptor (flange piece) 	5, 7 and 9 degrees, right and	$780.00
	 left
	Metaphyseal
	Biomet Australia Pty Ltd
BH063	Regenerex Sleeve Augment	Augment, cone or finned sleeve, 	(25mm to 40mm, Type A or 	$2,700.00
	SSK/OSS Systems, Ti	B) x Extra small/Large
	Johnson & Johnson Medical Pty Ltd
DP261	SROM Noiles Knee System tibial 	Tibial metaphyseal sleeve, porous 	37-61mm	$2,700.00
	sleeves	coated, for proximal bone replacement 
DP271	SROM Noiles Knee System femoral 	Femoral metaphyseal sleeve, porous 	Size 31-46mm	$2,700.00
	sleeves	coated, for distal bone replacement 
DY156	LCS, PFC and SROM  Knee 	Universal femoral metaphyseal sleeve, 	20 - 46mm	$2,700.00
	Systems, femoral metaphyseal sleeve	Porocoat, smaller size cemented, larger
	 sizes uncemented, titanium
DY157	MBT  Knee Systems tibial 	Universal tibial metaphyseal sleeve, 	29 - 61mm	$2,700.00
	metaphyseal sleeve	Porocoat, smaller size cemented or 
	uncemented, larger sizes uncemented, 
	titanium
JJ706	LCS, PFC & SROM Knee System - 	Universal Fully Beaded (Porocoat) 	31-46mm	$2,700.00
	Universal Fully Porous Femoral 	Femoral Metaphyseal Titanium Sleeve
	Metaphyseal Sleeve
	Zimmer Pty Ltd
ZI485	Trabecular Metal Tibial Cone	Trabecular Metal Tibial void filling 	31-67mm	$2,700.00
	cone for proximal metaphyseal bone 
	surrounding stem, full or stepped
ZI516	Trabecular Metal Femoral Cone 	Trabecular Metal femoral void filling 	Small, Medium, Large	$2,700.00
	cone for distal metaphyseal bone 
	surrounding stem
Prostheses List by Category, Groups and Sponsor	Page 931 of 1059

12 - KNEE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
12.11.12 - Temporary Spacers
	Zimmer Pty Ltd
ZI313	Spacer-K	Temporary implantable device for the 	Small, Medium, Large	$2,079.00
	treatment of infected total knee 
	replacement, Composition - stainless 
	steel core surrounded by PMMA 
	impregnated with Gentamicin
12.12.01 - Articulating Component
	Advanced Surgical Design & Manufacture Ltd
AE133	HemiCAP Contoured Articular 	Articular resurfacing component - 	Articular Component 15mm 	$2,300.00
	Knee System Resurfacing 	CoCr with titanium plasma spray 	- 0.5mm x 0.5mm to 2.0mm x 
	2.0mm offset;  Articular 
	Component 20mm - 1.0mm x 
	1.0mm to 4.0mm x 4.0mm 
	offset; 6 x 2mm to 10 x 3mm 
	Offset
AE137	HemiCAP Patello-Femoral 	A distal femoral trochlear surface 	20mm, 35mm	$2,300.00
	Resurfacing System - Femoral 	articular component comprised of 
	Trochlear Component Articular	cobalt-chromium alloy which mates to
	 a fixation stud
12.12.02 - Fixation Component
	Advanced Surgical Design & Manufacture Ltd
AE134	HemiCAP Contoured Articular 	Proximal Morse taper, fully 	Component for 15mm & 	$700.00
	Knee System Fixation component 	cannulated, tapered, threaded fixation 	20mm Articular 
	component - Titanium with titanium 	Components Screw 9.5mm 
	Dia x 20mm; 11mm x 22mm
AE135	HemiCAP Patello-Femoral 	A titanium-alloy fixation stud	8.5mm x 17.0mm	$700.00
	Resurfacing System - Fixation Stud
Prostheses List by Category, Groups and Sponsor	Page 932 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.01.01 - Pedicle, Monoaxial
	Advanced Surgical Design & Manufacture Ltd
AE141	Firebird mono axial screws	Firebird mono axial pedicle screws in 	4.0, 4.5, 5.5, 6.5, 7.5. 8.5; 	$930.00
	various diameters and lengths. 	25mm-100mm in 5mm 
	Titanium.	increments
	B Braun Australia Pty Ltd
BB226	S4 Spinal System	Monoaxial Screw - titanium various 	Diameter 4.5mm & 5mm  - all	$930.00
	sizes	 lengths 25 - 60mm
BB227	S4 Spinal System	Monoaxial Screw - titanium various 	Diameter 6.0mm, 7.0mm & 	$930.00
	sizes	8.0mm - all lengths 25 - 60mm
	Biomet Australia Pty Ltd
BH070	Synergy/Polaris Spinal System	Open/Closed Screws	5.5 to 8.0mm dia	$930.00
BH083	Synergy Spinal System	Iliac Screw	6.0 - 10.0mm	$930.00
BH097	Array Spinal System	Titanium Alloy Modular Spinal 	5.5 - 7.5mm x 30 - 55mm	$930.00
	System - fixed screw
	Device Technologies Australia Pty Ltd
DE356	EasySpine - Standard Pedicle Screws	The standard Pedicle screws allow for 	Diametres 4.25 to 7mm; 	$930.00
	20 degrees of angular variation 	lengths 30 to 50mm
	between the screw axis and the rod in 
	the axial plane; EasySPine is a spinal 
	fusion system.
DE380	SpineTune TL - Monoaxial Screws	These components are monoaxial 	Diameters 4.5mm to 9.5mm 	$930.00
	pedicle screws	in steps of 0.5mm
	Lengths 30mm to 100mm in 
	steps of 5mm
	Emergo Asia Pacific Pty Ltd
ER108	Novel/Zenius Mono screw	Mono axial pedicle screw	4.0-8.5	$930.00
Prostheses List by Category, Groups and Sponsor	Page 933 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Manufacturing Technology Pty Ltd
GM159	SOCORE Spinal System - 	Pedicle Screw - Monoaxial	Diameter 45mm 25mm to 	$930.00
	40mm Length. Diameter 
	5mm 30mm to 50mm Length.
	 Diameter 6mm 30mm to 
	55mm Length. Diameter 
	7mm 30mm to 50mm Length.
	 Diameter 8mm 40mm
	Global Orthopaedic Technology
GO203	Malibu Spinal System Monoaxial 	Monoaxial Bone Screw	4.5mm x 25mm - 9.5mm x 	$930.00
	Screw	80mm
	Johnson & Johnson Medical Pty Ltd
DY309	Frontier Anterior Scoliosis System 	Bone Screws	5.5 x 25-40mm, 6.5 x 25-	$930.00
	(Titanium)	60mm, 7.5 x 35-60mm
DY401	Monarch Monoaxial Pedicle Screw	Monarch Monoaxial Pedicle Screw	4.75mm - 8.5mm x 25 to 	$930.00
	80mm length
JJ772	Anterior Isola System	Open Monoaxial Screw	20-60mm	$930.00
JJ936	Expedium Spine System	Monoaxial Screw	4 - 10mm Diameter	$930.00
JJ938	Isola System	Monoaxial Screw	4.75 - 7.0mm	$930.00
JJ941	Moss Miami Spinal System	Monoaxial Screw	5-8mm Diameter	$930.00
	KH NXGEN (AUS) Pty Limited
KH032	G5 Monoaxial Pedicle Screws	Monoaxial pedicle screw, titanium 	Diameter: 4.5 - 7.5mm	$930.00
	Length: 25- 55mm
	Lifehealthcare Pty Ltd
LH450	DSS Pedicle Screw	The DSS Pedicle Screw is a mono-	5.0mm diameter x 30, 35, 40, 	$930.00
	axial pedicle screw designed for 	45, 50, 55, 60mm length
	implantation in the posterior 	6.0mm diameter x 30, 35, 40, 
	throacolumbar spine for skeletally 	45, 50, 55, 60mm length
	mature patients	7.0mm diameter x 30, 35, 40, 
	45, 50, 55, 60mm length
	8.0mm diameter x 30, 35, 40, 
	45, 50, 55, 60mm length
	Medtronic Australasia Pty Ltd
MC402	CD Horizon	Pedicle Screws	Diameter 4.5 - 7.5mm  	$930.00
	Length 25 - 80mm
Prostheses List by Category, Groups and Sponsor	Page 934 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC503	CD Horizon	Fixed Angle Screw	25 - 90mm	$930.00
MC860	Silo	Fixed Screw	4.5 - 8.5mm Diameter	$930.00
MC967	CD HORIZON Spinal System - 	CD HORIZON SOLERA Fixed Angle	Diameter: 4.0mm - 10.5mm	$930.00
	Fixed Angle Screw	 Screw	Length:  15mm - 110mm
	Nuvasive Australia and NZ  Pty Ltd
NV001	SpheRx	Cannulated Fixed Axis Screw	4.5 - 8.5mm diameter25 - 	$930.00
	65mm length
NV051	SpheRx II Anterior (Fixed Screw)	Fixed screw	5.5/6.5/7.5mm x (45-55mm)	$930.00
NV056	Armada (Fixed Screw)	Fixed screw	4.0/4.5/5.0/5.5/6.5/7.5 x 25-	$930.00
	55mm
	Orthotech Pty Ltd
OH357	Novel/Zenius Mono screw	Mono axial pedicle screw	4.0-8.5	$930.00
	Prism Surgical Designs Pty Ltd
PZ012	Centaur Monoaxial Screw	Monoaxial screw	Diameter 4mm-10mm, 	$930.00
	lengths 20mm-110mm
	Scient'x Australia
SX032	Isobar TTL Monoaxial Screw	In Module Monoaxial Pedicle Screw	Diameter 4.5mm; 5.5mm; 	$930.00
	6.2mm; 7mm - Length 25mm;
	 30mm; 35mm; 40mm; 45mm;
	 50mm; 55mm
SX046	Zodiac Spinal Fixation System - 	Open monoaxial screw	Diameter: 4.0mm, 4.5mm, 	$930.00
	monoaxial screw, open	5.5mm, 6.5mm, 7.5mm, 
	8.5mm. Length: 20mm, 
	25mm, 30mm, 35mm, 40mm, 
	45mm, 50mm, 55mm, 60mm, 
	70mm, 75mm, 80mm.
SX047	Zodiac Spinal Fixation System - 	Closed monoaxial screw	Diameter: 7.5mm, 8.5mm. 	$930.00
	monoaxial screw, closed	Length: 25mm, 30mm, 
	35mm, 40mm, 45mm, 50mm, 
	55mm, 60mm, 70mm, 75mm, 
	80mm.
	Signature Orthopaedics
SF009	Centaur Monoaxial Screw	Monoaxial screw	Diameter 4mm-10mm, 	$930.00
	lengths 20mm-110mm
Prostheses List by Category, Groups and Sponsor	Page 935 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Signature Spine
SV011	Romeo Monoaxial Pedicle Screws	Titanium alloy	5mm diameter: 30, 35, 40 	$930.00
	and 45mm lengths.  6mm and
	 7mm diameter: 30, 35, 40, 
	45 and 50mm lengths
	Stryker Australia Pty Ltd
HW385	Xia Spine System	Monoaxial Screw	Dia 4.5 - 8.5mm Length 25 - 	$930.00
	60mm
	Synthes Australia Pty Ltd
SY549	Pangea Spinal System	Preassembled Monoaxial Pedicle 	Diameter, 4.0mm to 10mm, 	$930.00
	Screw - Thoracic, Lumbar and Sacral 	Length, 20mm to 120mm
	Spine
SY597	Universal Spine System	Pedicle screw	25mm - 140mm	$930.00
SY707	Spinal Fixation System	Matrix Preassembled Monoaxial 	4.00mm - 9.00mm; 20mm - 	$930.00
	Pedicle Screw	100mm Length
	Zimmer Pty Ltd
ZI476	Silhouette Spinal System Implants	Fixed Screw with Tab Extensions	5.5 x 25mm to 8.5 x 60mm	$930.00
ZI513	Optima Spinal System - Monoaxial 	Monoaxial Pedicle screw system	Dia 4-8mm, length 20-60mm	$930.00
	Pedicle Screw System
ZI684	NexLink	Occipital Cervical Plating System	Closed Screw 4mm	$930.00
	Cannulated
	Emergo Asia Pacific Pty Ltd
ER109	Novel/Zenius Cannulated Mono 	Monoaxial cannulated pedicle screw	5.5-8.5	$960.00
	Johnson & Johnson Medical Pty Ltd
JJ820	Viper Spinal System - monoaxial 	Monoaxial screw	30 - 80mm	$960.00
	screw
	Orthotech Pty Ltd
OH355	Novel/Zenius Cannulated Mono 	Monoaxial cannulated pedicle screw	5.5-8.5	$960.00
OH410	Ulrich Spine System cannulated 	Cannulated monoaxial screw	4.5-10mm x 25-60mm	$960.00
	monoaxial screws
	Synthes Australia Pty Ltd
SY708	Spinal Fixation System	Matrix Preassembled Monoaxial 	5.00mm - 8.00mm; 20mm - 	$960.00
	Pedicle Screw, Cannulated	65mm Length
Prostheses List by Category, Groups and Sponsor	Page 936 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI687	NexLink	Occipital Cervical Plating System	Bone Screw 3.5 - 4.0mm	$960.00
ZI725	DTL Pedicle Screw	HA coated, Monaxial	D: 5.2mm, 6.00mm, 6.4mm, 	$960.00
	7.2mm, 8.00mm. L: 35mm - 
	55mm
	Closed
	Advanced Surgical Design & Manufacture Ltd
AE164	Blackstone - Spinal Fixation System	Composition - Titanium	5.5mm x 40mm, 5.5mm x 	$930.00
	 - Mono Axial Screws	45mm, 6.5mm x 40mm and 
	6.5mm x 45mm
	Johnson & Johnson Medical Pty Ltd
JJ773	Anterior Isola System	Closed Monoaxial Screw	20-80mm	$930.00
	Medtronic Australasia Pty Ltd
MC823	CD Horizon	Legacy Fixed Iliac Screw	5.5mm to 8.5mm Diameter	$930.00
	Complex
	Medtronic Australasia Pty Ltd
MC636	CD Horizon	Eclipse Dual Head Screws	20-60mm	$1,037.00
MC862	Silo	Sagittal Screw	4.5 - 8.5mm Diameter	$1,037.00
	With Cap/Cover Plate
	Emergo Asia Pacific Pty Ltd
ER110	Novel/Zenius Reduction Mono screw	Monoaxial Reduction pedicle screw	5.5-8.5	$990.00
	Orthotech Pty Ltd
OH354	Novel/Zenius Reduction Mono screw	Monoaxial Reduction pedicle screw	5.5-8.5	$990.00
	Scient'x Australia
SX001	Isobar TTL	Monoaxial Screw	D: 4.5 - 8mm, L: 25 - 50mm	$990.00
Prostheses List by Category, Groups and Sponsor	Page 937 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Globus Medical Australia
LB083	REVERE Monoaxial Screw	Monoaxial Screw	4.0mm x 20mm in 5mm 	$930.00
	increments
	4.5mm x 20mm - 45 in 5mm 
	increments
	5.0mm x 25mm - 55mm in 
	5mm increments
	5.5mm x 27mm - 55mm in 
	5mm increments and 25mm -
	6mm in 5mm increments
	6.5mm x 27 - 55mm in 5mm 
	in 5mm increments and 
	25mm -65mm in 5mm 
	increments
	7.5mm x 27mm - 55mm in 
	5mm increments and 25mm -
	65mm in 5mm increments
	8.5mm x 25mm - 65mm in 
	5mm increments
LB084	REVERE TRANSITION HA Coated	Monoaxial Screw HA Coated	6.5mm - 8.5mm x 35mm - 65mm	$930.00
	 Monoaxial Screw
	Medacta Australia Pty Ltd
MU126	M.U.S.T Monoaxial Pedicle Screws	Monoaxial Screws	4.5 - 8mm; Length 25-90 mm.	$930.00
	Signature Spine
SV019	AnyPlus Pedicle Screw System - 	The screws are not cannulated and are 	Diameters 4.5mm to 8.5mm 	$930.00
	Monoaxial Screws	part of the AnyPlus Pedicle Screw 	with length from 25mm to 
	System. A posterior pedicle screw 	70mm
	fixation system intended to provide 
	immobilization and stabilization of 
	spinal vertebrae in the thoracic, 
	lumbar and sacral regions.
Prostheses List by Category, Groups and Sponsor	Page 938 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI881	APEX Spine System - Monoaxial 	Monoaxial pedicle Screws Titanium	4.75mm x 25mm - 85mm in 	$930.00
	Pedicle Screws	5mm increments; 5.5mm x 
	25mm - 85mm in 5mm 
	increments; 6.25mm x 25mm 
	- 85mm in 5mm increments; 
	7.0mm x 25mm - 100mm; 
	7.75mm x 25mm - 100mm; 
	8.5mm x 40mm - 100mm
	Cannulated
	Medacta Australia Pty Ltd
MU125	M.U.S.T Monoaxial Pedicle Screws 	Monoaxial screws cannulated	5 - 7 mm: Length 40 - 60 mm	$960.00
	Cannulated
13.01.02 - Pedicle, Polyaxial
	Advanced Surgical Design & Manufacture Ltd
AE146	Firebird multi axial screws	Firebird multiaxial pedicle screws in 	4.0, 4.5, 5.5, 6.5, 7.5, 8.5; 	$1,330.00
	various diameters and lengths. 	25mm-100mm in 5mm 
	Titanium.	increments
AE160	Spinal Fixation System	Multi screw - Titanium	5.5 x 35mm up to 55mm in 	$1,330.00
	5mm increments; 6.5 x 35mm
	 up to 60mm in 5mm 
	increments; 7.5 x 35mm up 
	to 60mm in 5mm increments
AE178	Blackstone - Posterior Cervical 	Mini-Multi-Axial Screw	3.5-4mmx10-30mm (2mm 	$1,330.00
	System	increments)
	B Braun Australia Pty Ltd
BB224	S4 Spinal System	Polyaxial Screw - titanium various 	All sizes	$1,330.00
BB225	S4 Spinal System	Polyaxial Screw - Titanium various 	Diameter 6.0mm, 7.0mm & 	$1,330.00
	sizes	8.0mm - all lengths 25 - 60mm
	Biomet Australia Pty Ltd
BH094	Altius Occipito-Cervico-Thoracic 	Screws	8mm to 32mm	$1,330.00
	(OCT) System
Prostheses List by Category, Groups and Sponsor	Page 939 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BH098	Array/Ballista Spinal System	Titanium Alloy Modular Spinal 	5.5 - 7.5mm x 30 - 55mm	$1,330.00
	System - multiaxial screw
BH116	Polaris Spine System	Polaris, Polyaxial screw, Titanium	(4.75-8.5)mm dia x (30-55) 	$1,330.00
	mm length
	Device Technologies Australia Pty Ltd
DE353	EasySpine - Alpha Pedicle Screws	Side-entry pedicle screws for 	Diameters 4.25 to 8mm; 	$1,330.00
	EasySpine system allowing +/- 	lengths 30mm to 70mm
	degrees of angular variation in the 
	axial and sagital plane
DE354	EasySpine - LP Multiaxial Pedicle 	Pedicle screws with 10mm of offset 	Packs of 1 only: 5, 6 and 	$1,330.00
	Screws	and allow 70 degrees of head motion 	7mm; lengths 30mm to 
	and +/-20 degrees of screw motion in a	55mm.
	 360 degrees arc.
DE381	SpineTune TL - Polyaxial Screws	These components are Polyaxial 	Length 30mm to 100mm in 	$1,330.00
	Screws that insert into the pedicles of 	steps of 5mm
	the spine.  The polyaxial heads allow 	Diameter 4.5mm to 8.5mm in 
	a rod to connect to the screw in at 	steps of 0.5mm
	angles varying up to +/- 30 degrees 
	from neutral alignment (60 degree 
	Emergo Asia Pacific Pty Ltd
ER014	Denali Spinal System / Polyaxial 	Polyaxial Pedicle Screw	Diameter:  4.5, 5.5, 6.5, 7.5, 	$1,330.00
	Pedicle Screw	8.5mm and Length: 
	25,30,35,40,45,50,55,60,65
	mm
ER017	Mesa Spinal System / Polyaxial 	Polyaxial Pedicle Screw	3.5. 4.0. 4.5. 5.0. 5.5. 6.5. 	$1,330.00
	Pedicle Screw	7.5. 8.5. 9.5. 10.5. diameter 
	with lengths from 5mm to 
	120mm
ER026	Capsian OCT Spinal  System -  Mini 	cervico-thoracic posterior rigid 	Diameter: 3.5mm and 4.0mm 	$1,330.00
	Mesa Polyaxial Screw	fixation system	screwsLength: 10mm - 
	20mm (2mm increments)
	25mm - 50mm (5mm 
	increments)
ER049	Everest Spinal System Pedicle 	Pedicle Screw	diameter: 5.5mm, 6.5mm, 	$1,330.00
	7.5mm, 8.5mm,
	
	Length: 30mm, 35mm, 
	40mm, 45mm, 50mm, 55mm
ER111	Novel/Zenius Reduction Poly 	Polyaxial Reduction pedicle screw	5.5-8.5	$1,330.00
Prostheses List by Category, Groups and Sponsor	Page 940 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ER112	Novel/Zenius Poly screw	Poly axial pedicle screw	4.0-8.5	$1,330.00
	Euros Orthopaedics Australia Pty Ltd
EU001	e.Spine PEDICULAR SCREW	spine Pedicular Screw for sacral-	Diameter 4.35 Length 25, 	$1,330.00
	thoraco-lumbar osteosynthesis	Diameter 4.35 Length 30, 
	Diameter 4.35 Length 35, 
	Diameter 5 Length 35, 
	Diameter 5 Length 40, 
	Diameter 5 Length 45, 
	Diameter 6 Length 40, 
	Diameter 6 Length 45, 
	Diameter 6.5 Length 40, 
	Diameter 6.5 Length 45, 
	Diameter 6.5 Length 50, 
	Diameter 7 Length 35, 
	Diameter 7 Length 40, 
	Diameter 7 Length 45, 
	Diameter 7 Length 50, 
	Diameter 7 Length 55, 
	Diameter 7 Length 60, 
	Diameter 7 Length 65, 
	Diameter 7 Length 70, 
	Diameter 7 Length 75, 
	Diameter 7 Length 80, 
	Diameter 7 Length 85, 
	Diameter 7 Length 90, 
	Diameter 7 Length 95, 
	Diameter 7 Length 100, 
	Diameter 7 Length 105, 
	Diameter 7 Length 110, 
	Diameter 7 Length 115, 
	Diameter 7 Length 120.
	Global Manufacturing Technology Pty Ltd
GM154	SOCORE Spinal System - Pedicle 	Pedicle Screw- Polyaxial. Pedicle 	Diameter 4mm 25mm to 	$1,330.00
	Screws	Screw - Reduction	40mm Length. Diameter 
	5mm 30mm to 50mm Length.
	 Diameter 6mm 30mm to 
	55mm length. Diameter 7mm 
	30mm to 50mm Length. 
	Diameter 8mm 40mm
Prostheses List by Category, Groups and Sponsor	Page 941 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO202	Malibu Spinal System Polyaxial 	Polyaxial screw	4.5mm x 20mm - 8.5mm x 	$1,330.00
	Screw	110mm in 5mm increments
GO214	Sierra Spinal System, Polyaxial 	Polyaxial bone screw	3.5mm - 4.5mm diameter 	$1,330.00
	10mm 50mm Length
	Globus Medical Australia
LB043	ELLIPSE Stabilization System, 	Polyaxial Bone Screw	3.5mm - 4.5mm diameter 8mm	$1,330.00
	Polyaxial Screw	 x 50mm length
	Health Care Surgical Pty Ltd
HC008	S14 Biospine Screw	Polyaxial Screw	3.5-7mm, 25-50mm	$1,330.00
	Johnson & Johnson Medical Pty Ltd
DY171	Monarch Spinal System	Pedicle Screws - Polyaxial	4.75 - 8.5 mm x 25 - 80mm	$1,330.00
JJ593	Mountaineer OCT Spinal System	CT Minipolyaxial Screw - Favoured 	3.5-4.35mm x 10 - 50mm	$1,330.00
	Angle and Medial/Lateral
JJ937	Summit Spinal system	Polyaxial Screws	3.5 to 4mm	$1,330.00
JJ940	Moss Miami Spinal System	Polyaxial Screw	4.35 to 8mm diameter	$1,330.00
JJ944	Expedium Spine System	Polyaxial screws	4.0 - 11mm diameter	$1,330.00
	KH NXGEN (AUS) Pty Limited
KH023	Cobra Multiaxial Pedicle Screw	Multiaxial Pedicle Screw	Diam: 3.5 and 4.0mm	$1,330.00
	length: 12-32mm
KH033	G5 Polyaxial Pedicle Screw	Polyaxial Pedicle Screw, Titanium 	Diameter: 4.0 -7.5	$1,330.00
	Alloy	Length: 25 -55mm
	Matrix Medical Innovations
BF006	Smartloc Spinal Fixation 	Polyaxial Pedicle Screw and 	Length 30mm - 50mm 	$1,330.00
	System/Polyaxial Pedicle Screw & 	Reduction screw	Diameter 4.5mm, 5.5mm, 
	Reduction Screw	6.5mm, 7.0mm, 8.0mm
	Medtronic Australasia Pty Ltd
MC501	CD Horizon	Multi-Axial screw (Stainless Steel)	25 - 80mm	$1,330.00
MC502	CD Horizon	Multi-axial screw (Titanium)	25 - 80mm	$1,330.00
MC545	Vertex Spinal System	Screws	Diameter 3.5 - 4.5mm 	$1,330.00
	Length 6 - 52mm
MC579	CD Horizon	Spondylolisthesis Screw	Diameter: 4.5 - 7.5, Length: 	$1,330.00
	25mm - 50mm
MC675	CD Horizon	Legacy Screw	Diameter 4.0 - 10.5mm	$1,330.00
Prostheses List by Category, Groups and Sponsor	Page 942 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC749	Legacy HA Coated Screw	Hydroxyapatite coated pedicle screw	4.5mm - 8.5mm	$1,330.00
MC822	CD Horizon	Legacy Multiaxial Iliac Screw	5.5mm to 8.5mm Diameter	$1,330.00
MC861	Silo	Mutliaxial Screw	4.5 - 8.5mm Diameter	$1,330.00
MC969	CD HORIZON Spinal System - 	CD HORIZON SOLERA Multi-Axial 	Diameter:  4.5mm - 10.5mm	$1,330.00
	Multi-Axial Screw	Screw, HA coated Multi-Axial Screw'	Length:  15mm - 110mm
	National Surgical Pty Ltd
NK002	SteriSpine PS - Mutli-Axial Screw	Pedicle bone screw (including seat) 	5.5 x 35mm, 5.5 x 40mm, 6.5 	$1,330.00
	for use with SteriSpine PS system	x 40mm, 6.5 x 45mm6.5 x 
	50mm, 7.5 x 35mm, 7.5 x 
	40mm, 7.5 x 45mm
NK006	Fortex Pedicle Screw system - 	Polyaxial pedicle screw	4.75, 5.5, 6.5, 7.5, 8.25mm 	$1,330.00
	Pedicle Screw	diameter. 30, 35, 40, 45, 50, 
	55mm lengths
NK016	X90 Pedicle Screw	Capless, Polyaxial pedicle screw	Diameter 4.75 - 8.25mm	$1,330.00
	Length 30 -55mm
	Nuvasive Australia and NZ  Pty Ltd
NV024	VuePoint screw (multi axial)	Screw (mulit-axial)	3.5mm x (10-34mm)3.5mm 	$1,330.00
	x (24-36mm)4.0mm x (10-
	40mm)4.5mm x (10-40mm)
NV057	Armada (Reduction Screw)	Reduction Screw	4.5-8.5mm x 20-120mm	$1,330.00
NV062	SpheRx II Anterior (Polyaxial Screw)	Polyaxial screw	5.5/6.5/7.5mm x (25-50mm)	$1,330.00
NV067	Armada (Polyaxial Screws)	Polyaxial screw	Polyaxial Screw 4.5-	$1,330.00
	10.0mm x 25-120mmlliac 
	Screw6.5/7.5/8.5/9.5mm
	(60/70/80/90/100mm)
	Provisional locking screw 
	size ranges from 
	4.0mmx25-45mm,
	4.5mmx25-45mm,
	5.0mmx25-50mm,
	5.5mmx25-55mm,
	6.5mmx30-55mm
	Uniplanar Screw 
	5.0/5.5/6.5mm x 
	25/30/35/40/45/5
Prostheses List by Category, Groups and Sponsor	Page 943 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH353	Novel/Zenius Reduction Poly 	Polyaxial Reduction pedicle screw	5.5-8.5	$1,330.00
OH358	Novel/Zenius Poly screw	Poly axial pedicle screw	4.0-8.5	$1,330.00
	Scient'x Australia
SX002	Isobar TTL	Polyaxial Screw	D: 4.5 - 8mm, L: 30 - 55mm	$1,330.00
SX031	Isobar TTL Polyaxial Screw	In Module Polyaxial Pedicle Screw	Diameter 4.5mm; 5.5mm; 	$1,330.00
	6.2mm; 7mm - Length 25mm;
	 30mm; 35mm; 40mm; 45mm;
	 50mm; 55mm
SX044	Zodiac Spinal Fixation System - 	Non-cannulated polyaxial screw, 	Diameter: 4.0mm, 4.5mm, 	$1,330.00
	polyaxial screw, non-cannulated	including uniplanar, high top and 	5.0mm, 5.5mm, 6.5mm, 
	7.5mm, 8.5mm. Length: 
	20mm, 25mm, 30mm, 35mm, 
	40mm, 45mm, 50mm, 55mm, 
	60mm, 65mm, 70mm, 75mm, 
	80mm, 85mm, 90mm, 95mm, 
	100mm.
SX063	Solanas Posterior Cervico-thoracic 	Poly-axial Screw	Thread diameter: 3.5mm, 	$1,330.00
	Fixation System - Poly-axial Screw	4.0mm, 4.35mm; Thread 
	length: 8 to 60mm by 
	increments or 2 or 4mm
	Signature Spine
SV003	Romeo Polyaxial Pedicle and 	Available in standard and reduction 	Standard - 5mm diameter: 	$1,330.00
	Reduction Screws	screw variants. Titanium alloy	30, 35, 40, 45mm length. 6 
	and 7mm diameter: 30, 35, 
	40, 45 and 50mm length.  
	Reduction - 6mm diameter: 
	35, 40 and 45mm.
	Stryker Australia Pty Ltd
HW384	Xia Spine System	Polyaxial Screw	Dia: 4mm - 10.5mm Length: 	$1,330.00
	20mm - 100mm
SK225	Oasys-Occipito Cervico Thoracic 	Multiaxial Screw	3.5mm x 10mm - 40mm	$1,330.00
	System	4.0mm x 10mm - 50mm
	4.5mm x 20mm - 52mm
	Synthes Australia Pty Ltd
SY007	Click'X Spinal Fixation System	Pedicle Screw: Preassembled	Length 25-80mm	$1,330.00
Prostheses List by Category, Groups and Sponsor	Page 944 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY289	USS llio-Sacral Fixation system	Polyaxial screw	20mm to 140mm	$1,330.00
SY309	Axon Spinal System	Variable axis screw	3.0mm - 4.5mm diameter, 	$1,330.00
	4mm to 60mm length
SY337	Universal Spinal System (USS)	Polyaxial Pedicle Screw, titanium	4.0mm to 9.00mm	$1,330.00
SY441	Synapse	Posterior Cervical Polyaxial Screw 	3.5mm-4.5mm Diameter; 	$1,330.00
	System	8mm-50mm Length
SY447	Spinal Fixation System	Universal Reduction Screw	4.0mm - 9.0mm Diameter; 	$1,330.00
	20mm-100mm Length
SY548	Pangea Spinal System	Preassembled Polyaxial Pedicle 	Diameter, 4.0mm to 10mm, 	$1,330.00
	Screw - Thoracic, Lumbar and Sacral 	Length, 20mm to 120mm
	Spine
SY566	Spinal Fixation System	Matrix Reduction Screw	4.0mm - 8.00mm; 20mm - 	$1,330.00
	65mm Length
SY705	Spinal Fixation System	Matrix Preassembled Polyaxial 	4.00mm - 9.00mm; 20mm  - 	$1,330.00
	Pedicle Screw	100mm Length
	Zimmer Pty Ltd
ZI475	Silhouette Spinal System Implants	Polyaxial Screw Assembly with Tabs	5.5 x 25mm to 8.5 x 60mm	$1,330.00
ZI514	Optima Spinal System - Polyaxial 	Polyaxial Pedicle Screw System	Diameter 4-8mm, length 20-	$1,330.00
	Pedicle Screw System	60mm
ZI616	SEQUOIA PEDICLE SCREW 	Polyaxial Screw	4.5mm - 8.5mm dia, 25mm-	$1,330.00
	SYSTEM	60mm length
ZI660	Nex-Link	Spinal Fixation System, Polyaxial 	3.5mmx10mm - 	$1,330.00
	Screws	4.00mmx22mm; 4.5 x 20-
	40mm(5mm increments); 
	5.5mm x 20-45mm (5mm 
	increments)
ZI668	Incompass	Thoracolumbar Fixation System, 	5.5 - 7.5	$1,330.00
	Polyaxial Screw Open
	Cannulated
	Advanced Surgical Design & Manufacture Ltd
AE143	Firebird cannulated multi axial 	cannulated multiaxial pedicle screws 	4.0, 4.5, 5.5, 6.5, 7..5, 8.5; 	$1,390.00
	in various diameters and lengths. 	25-100mm in 5mm increments
	Titanium.
Prostheses List by Category, Groups and Sponsor	Page 945 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE382	SpineTune Tl - Cannulated 	These products are cannulated 	Length 30mm to 100mm in 	$1,390.00
	Polyaxial Screws	Polyaxial Screws that insert into the 	steps of 5mm
	pedicles of the spine.  The polyaxial 	Diameter 5.5mm to 8.5mm in 
	heads allow a rod to connect to the 	steps of 0.5mm
	screw in at angles varying up to +/-30
	 degrees from neutral alignment (60 
	degree range) and the cannulation 
	allows the screws to be placed into 
	minimally-invasive incisions along a 
	guide wire.
	Emergo Asia Pacific Pty Ltd
ER025	Denali cannulated polyaxial screw	Cannulated polyaxial pedicle screw	Diameter:  5.5mm, 6.5mm 	$1,390.00
	and 7.5mm  Length:  35 to 
	55mm
ER113	Novel/Zenius Cannulated poly 	Poly axial cannulated pedicle screw	5.5-8.5	$1,390.00
	Global Orthopaedic Technology
GO240	Newport MIS Spinal System - 	Double Lead Screw	Diameter 5.5-7.5mm Length 	$1,390.00
	Double Lead Screws	25-110mm
GO241	Newport MIS Spinal System-MIS 	Cannulted, polyaxial, extended tab	Diameter 5.5-7.5mm Length 	$1,390.00
	Screw	25-55mm
GO242	Newport MIS Spinal System - 	Cannulated Polyaxial Reduction Screw	Diameter 5.5-7.5mm Length 	$1,390.00
	Polyaxial Reduction Screws	25-110mm
GO244	Newport MIS Spinal System - 	DLTA Cannulated Polyaxial Screw	Diameter 5.5-7.5mm, length 	$1,390.00
	DLTA Polyaxial Screws	25-110mm
	Globus Medical Australia
LB018	REVOLVE Stabilization System 	Polyaxial, cannulated pedicale screw	5.5mm - 8.5mm diameter 	$1,390.00
	Poliaxial Screw	30mm - 90mm length
LB060	REVLOK Fenestrated Screw System	Fenestrated Screw	5.5mm x 30mm - 8.5mm x 	$1,390.00
	 Screw	90mm
	Johnson & Johnson Medical Pty Ltd
DY556	Expedium Spine System	Si Polyaxial Screw	4.35 - 11mm x 20 - 100mm	$1,390.00
JJ835	Viper Spine System	Polyaxial and Uniplanar Screw, with 	20-130mm	$1,390.00
	and without tab
MN156	Viper Spinal System	F2 Transfacet Pedicular Screw	5 to 7mm	$1,390.00
Prostheses List by Category, Groups and Sponsor	Page 946 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH484	DSS HP Spinal System - Pedicle 	Cannulated Pedicle Screw	Diameter: 5mm, 6mm, 7mm, 	$1,390.00
	Screw	8mm, 9mm, 10mm
	Length: 30mm-110mm (5mm
	 increments)
	Medacta Australia Pty Ltd
MU106	M.U.S.T Polyaxial Pedicle Screws 	Polyaxial Cannulated Screws	5-7mm; Length 25 -90mm	$1,390.00
	Cannulated
	Medtronic Australasia Pty Ltd
MC439	CD Horizon	Cannulated Pedicle Screw	20mm - 80mm	$1,390.00
MC586	CD Horizon Sextant Percutaneous 	Cannulated titanium percutaneous 	Dia 3.5 to 9.5mm, Length 15	$1,390.00
	Cannulated Multi Axial Screw	multi axial screw	 to 65mm
MC736	Vertex Max Cannulated Screw	Posterior cannulated cervical screw	Diameter 3.5 - 4.5mm	$1,390.00
	Length 20 - 60mm
MC968	CD HORIZON Spinal System - 	CD HORIZON SOLERA Cannulated 	Diameter: 4.5mm - 10.5mm	$1,390.00
	Cannulated Multi-Axial Screw	Multi-Axial Screw	Length:  15mm - 110mm
MI036	CD HORIZON Fenestrated Screw	Fenestrated multi-axial screw	Diameter: 5.5 - 7.5mm, 	$1,390.00
	Length: 30 - 55mm
	National Surgical Pty Ltd
NK003	SteriSpine PS - Multi-Axial Screw - 	Cannulated pedicle bone screw 	5.5 x 35mm, 5.5 x 40mm, 6.5 	$1,390.00
	Cannulated	(including seat) for use with 	x 40mm, 6.5 x 45mm, 6.5 x 
	SteriSpine PS system	50mm, 7.5 x 35mm, 7.5 x 
	40mm, 7.5 x 45mm
	Nuvasive Australia and NZ  Pty Ltd
NV019	System:  SphRX Component: 	Cannulated Polyaxial Screw, Fixation 	45-7.5mm Diameter; 25-	$1,390.00
	Cannulated Polyaxial Screw	Bone Screws	80mm Length
NV087	Precept (Polyaxial Screw)	Polyaxial Screw	4.5 x 25-45mm, 5.5-8.5 x 30-	$1,390.00
	100mm
NV089	Armada (Fenestrated Screw)	Fenestrated Screw	5.5 - 8.5 x 30-65mm	$1,390.00
	Orthotech Pty Ltd
OH356	Novel/Zenius Cannulated poly 	Poly axial cannulated pedicle screw	5.5-8.5	$1,390.00
OH409	Ulrich Spine System cannulated 	Cannulated Polyaxial screw	4.5-10mm x 25-60mm	$1,390.00
	Polyaxial screws
Prostheses List by Category, Groups and Sponsor	Page 947 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX045	Zodiac Spinal Fixation System - 	Cannulated polyaxial screw, 	Diameter: 4.5mm, 5.5mm, 	$1,390.00
	polyaxial screw, cannulated	including high top and sacral	6.5mm, 7.5mm. Length: 
	30mm, 35mm, 40mm, 45mm, 
	50mm, 55mm, 60mm.
SX050	Illico MIS Posterior Fixation 	Cannulated polyaxial screw, 	Diameter: 4.5mm, 5.5mm, 	$1,390.00
	System - screw	including sacral and high top	6.5mm, 7.5mm. Length: 
	30mm, 35mm, 40mm, 45mm, 
	50mm, 55mm, 60mm.
	Stryker Australia Pty Ltd
HW484	ES2 Spinal System, Screw	Polyaxial cannulated screw with 	Diam 4.5mm to 8.5mm, 	$1,390.00
	integrated blades	Length 25mm to 90mm
HW521	Mantis Augmentable Screw	Augmentable Pedicle Screw	5.5-8.5mm diameter, 40-	$1,390.00
	65mm Length
SR042	MANTIS	Screw, Cannulated, Multiaxial, Ti	4.5mm - 7.5mm x 25mm - 60mm	$1,390.00
	Synthes Australia Pty Ltd
SY336	Click'x Spinal System	Cannulated Screws	4.0mm to 9.0mm	$1,390.00
SY461	Pangea Spinal System	Preassembled Polyaxial Pedicle 	Diameter, 4.0mm to 10mm.	$1,390.00
	Screw - Thoracic, Lumbar and Sacral 	Length, 20mm to 120mm
	Spine, Cannulated
SY706	Spinal Fixation System	Matrix Preassembled Pedicle Screw, 	5.00mm - 9.00mm; 20mm - 	$1,390.00
	Cannulated	65mm Length
	Zimmer Pty Ltd
ZI681	Pathfinder	Minimally invasive pedicle fixation 	Cannulated Polyaxial 	$1,390.00
	system	Screws 4.5mm, 5.5mm, 6.5, 
	Complex
	Johnson & Johnson Medical Pty Ltd
JJ738	Expedium Spine System	DI Favoured Angle Reduction Tab 	4.35-10mm Diameter 20 - 	$1,330.00
	Polyaxial Screw	100mm Length
	Shank
	Advanced Surgical Design & Manufacture Ltd
AE140	Firebird Modular cannulated screws	Modular cannulated pedicle screws 	4.5, 5.5, 6.5, 7.5, 8.5, 9.5, 	$665.00
	(screw only) in various lengths and 	10.5mm diameters; 25-
	diameters	100mm lengths in 5mm 
	increments
Prostheses List by Category, Groups and Sponsor	Page 948 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AE183	ICON Modular Spinal Fixation 	Screw	4.5mm - 8.5mm x 25-80mm	$665.00
	System
	B Braun Australia Pty Ltd
BB011	Spine System Evolution	Screw	Dia 5 - 8mm, length 30 - 	$665.00
	55mm
	Biomet Australia Pty Ltd
BH079	Synergy/Polaris Spinal System	Variable Locking Screws	4.75-8.5mm	$665.00
	Johnson & Johnson Medical Pty Ltd
DY170	Monarch Spinal System	Bolts - Pedicle & Reduction	4.75 - 8.5 mm x 30 - 55mm	$665.00
JJ911	VSP System	Polyaxial screw	4.75 - 8.5mm	$665.00
	Medtronic Australasia Pty Ltd
MC384	Colorado 2	Pedicle Screw	Diameter 4.5 - 8.5mm 	$665.00
	Length 30 - 80mm
MC458	TSRH 3D 	Screw	4.5 -8.5mm diameter	$665.00
MC459	TSRH 3D 	Extended Post Screw	30 - 60mm	$665.00
MC986	Vertex Spinal System	Posted Screws	Diameter 3.5 - 4.5mm	$665.00
	Length 10 - 52mm
	Nuvasive Australia and NZ  Pty Ltd
NV048	SpheRx PPS (Screw Shank)	Screw shank	4.5/5.5/6.5/7.5/8.5mm x (25-	$665.00
	50mm)
NV084	Precept (Screw Shank)	Screw shank	4.8-8.5mm x (25-50mm)	$665.00
	Synthes Australia Pty Ltd
SY598	Spinal Fixation System	Pedicle: Screw, Head	4mm - 9mm D	$665.00
	Corin Australia Pty Ltd
CR207	3 Lock - Dual Lead Multiaxial 	Polyaxial screws for posterior lumbar 	Diameter: 4.5, 5.5, 6.0, 7.0, 	$1,330.00
	stabilisation	8.0mm
	Length: 35-60mm, (5mm 
	increments)
	Emergo Asia Pacific Pty Ltd
ER143	Signus MonoPoly Pedicle Screw 	Signus MonoPoly Pedicle Screw 	4.5 - 7.5mm x 30 - 70mm	$1,330.00
	System-Pedicle Screw Polyaxial 
Prostheses List by Category, Groups and Sponsor	Page 949 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO211	Malibu Spinal System Polyaxial 	Malibu Spinal System Polyaxial or 	4.5mm x 25mm - 40mm in 	$1,330.00
	Reduction Screw	Uni Planar Reduction Screw	5mm increments5.5mm x 
	25mm - 50mm in 5mm 
	increments6.5mm x 35mm -
	 55mm in 5mm increments
	7.5mm x 35mm - 55mm in 
	5mm increments
	Globus Medical Australia
LB079	REVERE Polyaxial Screw	Polyaxial screw	5.5 Titanium Alloy and 	$1,330.00
	Stainless Steel - 4.0mm -
	8.5mm x 20mm to 90mm in 
	5mm increments
	5.5 Reduction screws - 
	5.5mm - 7.5mm x 30mm - 
	90mm in 5mm increments
	6.35 Titanium Alloy and 
	Stainless Steel - 5.5mm - 
	90mm x 25mm to 120mm in 
	5mm increments
	5.5 Dual Diameter Screw 
	Titanium Alloy and 
	Stainless Steel - 5.5mm, 
	6.0mm 7.0mm, 7.5mm x 30mm
	 to 100mm in 5mm 
	increments
	6.35 Dual Diameter Screws 
	Titanium Alloy and 
	Stainless Steel - 5.5mm, 
	6.0mm, 7.0mm, 7.5mm x 
	30mm to 65mm in 5mm 
LB080	REVERE TRANSITION HA coated 	Polyaxial Screw HA Coated, Dual 	5.5mm-8.5mm x 35mm - 	$1,330.00
	Pedicle Screw	Outer Diameter, Prefered Angle	100mm
	Health Care Surgical Pty Ltd
HC016	KM POLYAXIAL	Polyaxial Screw	W:3.5-7.5mm L:10-55mm	$1,330.00
	Implament
IB005	Vertefix II Poly-Axial Screw	Multi/ Poly-Axial Pedicle Screw	Diameters: 5.5, 6.5, 7.5mm 	$1,330.00
	length: 35, 40, 45, 50mm
Prostheses List by Category, Groups and Sponsor	Page 950 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Medacta Australia Pty Ltd
MU109	M.U.S.T. Polyaxial Pedicle Screws	Polyaxial Screws	4.5 -10mm; length 20 -100mm	$1,330.00
	Prism Surgical Designs Pty Ltd
PZ013	Centaur Screw System	Polyaxial Screw	Diameter 4mm-13mm, 	$1,330.00
	lengths 20mm-140mm
	Signature Orthopaedics
SF008	Centaur Screw System	Polyaxial Screw	Diameter 4mm-13mm, 	$1,330.00
	lengths 20mm-140mm
	Signature Spine
SV017	Sky Spinal Fixation System-	The Poly axial screw is part of the Sky	3.5 x 8mm to 4.0 x 40mm	$1,330.00
	Polyaxial Screw	 Spinal Fixation System, indicated for 
	intrumentation of the occipital, 
	posterior cervical and upper thoracic 
	spine.
SV025	AnyPlus Pedicle Screw System-	The screws are not cannulated and are 	Diameters 4.5mm to 7.5mm 	$1,330.00
	Polyaxial Screws	part of the AnyPlus Pedicle Screw 	with length from 25mm to 
	Systems. A posterior pedicle screw 	70mm
	fixation system intended to provide 
	immobilization and stabilization of 
	spinal vertebrae in the thoracic, 
	lumbar and sacral regions.
	Zimmer Pty Ltd
ZI882	APEX Spine System - Polyaxial 	Polyaxial Pedicle Screws Titanium	4.75mm x 25mm - 85mm in 5 	$1,330.00
	Pedicle Screws	mm increments; 5.5mm x 
	25mm - 85mm in 5mm 
	increments; 6.25mm x 25mm 
	- 85mm in 5mm increments; 
	7.0mm x 25mm 0 100mm; 
	7.75mm xx25mm - 
	100mm;8.5mm x 40mm - 
	100mm
	Cannulated
	Emergo Asia Pacific Pty Ltd
ER144	Signus Pedicle Screw System-	Signus Pedicle Screw System-Pedicle 	4.5 - 7.5mm x 30 - 70mm	$1,390.00
	Pedicle Screw Polyaxial Cannulated	Screw Polyaxial Cannulated
Prostheses List by Category, Groups and Sponsor	Page 951 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Globus Medical Australia
LB081	REVERE Cannulated Polyaxial Screw	Cannulated Polyaxial Screw	5.5mm x 25 - 8.5 x 65mm	$1,390.00
LB082	REVERE TRANSITION HA Coated	Polyaxial Screw HA Coated, 	6.5mm - 8.5mm x 35mm - 	$1,390.00
	 Cannulated Polyaxial Screw	Cannulated	6mm
	Johnson & Johnson Medical Pty Ltd
JJ836	Viper Spine System	Polyaxial screw with cortical fixation	20-120mm	$1,390.00
	Signature Spine
SV018	MIS Percutaneous Pedicle Screw 	The MIS Screw System-Screw is part 	5.0x2.5mm to 8.5 X100 mm 	$1,390.00
	System-Screws	of the MIS Percutaneous Pedicle 	and 10.6 x4.7 for the Set 
	Screw System, intended to provide 	Screw
	immobilization and stabilization of 
	spinal vertebrae in the thoracic, 
	lumbar and sacral regions. The poly 
	axial capability provides 20 degrees 
	of freedom in any direction.
	Shank
	Globus Medical Australia
LB069	BEACON™ Stabilization System 	Posted Screw and Reduction Screw	4.5mm - 9.5mm diameter 	$665.00
	Posted Screw	25mm - 90mm length
13.01.03 - Standard
	Advanced Surgical Design & Manufacture Ltd
AE158	Blackstone Medical Inc Anterior 	Bone Screw, Primary/Rescue Screw	12, 14, 16mm	$200.00
	Cervical Plate System
AE173	Blackstone - Posterior Cervical 	Occipital Screw	6, 8, 10, 12, 14mm	$200.00
	System
AE189	Unity Lumbar Plate	Unity Bone Screw	6-7mm	$200.00
AE197	Pillar SA	The Pillar SA PEEK Spacer system is 	5.0x25, 30, 35mm screws	$200.00
	comprised of a variety of implants 
	manufactured from PEEK-OPTIMA 
	LT as described by ASTM F-2026, 
	with tantalum markers as described by
	 ASTM F-560. The implants are 
	available in multiple footprint sizes a 
	variety of heig
Prostheses List by Category, Groups and Sponsor	Page 952 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AE200	Blackstone Medical ACP Bone Screw	Titanium Alloy Bone Screw	4.1mm x 10mm - 18mm. 	$200.00
	4.5mm x 10mm - 18mm
	B Braun Australia Pty Ltd
BB068	Caspar Screws	Stainless Steel	10mm-28mm	$200.00
BB069	Caspar Screws	Titanium	10mm-28mm	$200.00
	Biomet Australia Pty Ltd
BH101	Interpore Bone Plate System	TPS Screw	14 - 22mm	$200.00
BH108	Anterior Cervical Plate System	Titanium Cancellous Bone Screw	4 - 20mm	$200.00
	Device Technologies Australia Pty Ltd
DE387	C-Plate - Fixed and Variable Screws	C-Plate Anterior Cervical Plates are 	Diameters: 3.5mm and 	$200.00
	inserted via an anterior approach to 	4.0mm, with lengths 
	the cervical spine, in order to fix one 	ranging from 10mm to 20mm 
	or two levels of vertebrae together.  	in 1 mm increments
	Such fixation is performed to cause 
	bony fusion between the levels and is 
	done in order to address pain, 
	instability, and/or a range of other 
	indications. The C-Plate system 
	consists of low-profile (1.6mm thick) 
	pre-contoured plates of varying sizes 
	and a full range of screws. The plates 
	themselves contain an innovative 
	screw-loking mechanism utlising an 
	elastic locking ring which allows the 
	surgeon choice between semi-fixed or 
	variable-angle self-tapping screws.
	Emergo Asia Pacific Pty Ltd
ER053	Blue Ridge Hybrid Cervical Plate 	Variable screws in Self-starting and 	4.0mm and 4.3mm Diameters	$200.00
	System - Screw	Self-tapping options. Fixed screws in 	
	Self-Tapping	12mm, 14mm, 16mm, 18mm 
	Euros Orthopaedics Australia Pty Ltd
EU007	SENEGAS SELF-TAPPING 	Titanium self-tapping cancellous 	Diameter: 4mm - Length: 10,	$200.00
	CANCELLOUS SCREW	 12, 14, 16, 18, 20, 22, 24, 
	26, 28, 30 and 32mm
EU009	E.C.P. Cervical Screw	Titanium Cervical Screw	Diameter: 3.5 and 4mm - 	$200.00
	Length 12, 15, 18 and 21mm
Prostheses List by Category, Groups and Sponsor	Page 953 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO223	Sierra Spinal System Occipital 	Occipital Screw	6mm x 14mm	$200.00
GO230	Zuma bone screw	Bone screw	5.5mm - 6.0mm x 20mm - 30mm	$200.00
GO249	Balboa Anterior Buttress Plate 	Bone Screw	5.5mm x 20mm, 5.5mm x 25mm	$200.00
	Globus Medical Australia
LB002	Independence Variable Angled 	Variable Angled Bone Screw	5.5mm x 20mm - 40mm	$200.00
LB003	Independence Fixed Angled Screw	Fixed Angled Bone Screw	5.5mm x 20mm - 40mm	$200.00
LB010	TRUSS® Thoracolumbar Variable 	Variable Angle screw	5.5m and 6.5mm diameter x 	$200.00
	Angle Screws	22mm - 57mm length
LB011	TRUSS® Thoracolumbar Fixed 	Fixed Angle screw	5.5m and 6.5mm diameter x 	$200.00
	Angle Screws	22mm - 57mm length
LB013	CITADEL® Anterior Variable 	Variable Angle screw	22m - 57mm length	$200.00
	Angled Bone Screws
LB014	CITADEL® Anterior Fixed Angles 	Fixed Angle screw	22mm - 57mm length	$200.00
	Bone Screws
LB016	VIP Anterior Cervical Fixed Angle 	Anterior Cervical Fixed Angle Bone 	4.6mm - 5.1mm Diameter, 	$200.00
	Screws	Screws	12mm - 20mm length
LB017	VIP Anterior Cervical Variable 	Anterior Cervical Variable Bone 	4.6mm - 5.1mm Diameter, 	$200.00
	Angle Screws	12mm - 20mm length
LB033	REVERE Bone Screw, Anterior Plate	Bone Screw	5.5mm - 7.5mm Diameter x 	$200.00
	25mm - 50mm Length
LB036	Coalition Variable Angled Screw	Bone screw Variable angle	3.6mm and 4.2mm diameter, 	$200.00
	12mm - 20mm length
LB037	Coalition Fixed Angled Screw	Bone screw, Fixed Angle	3.6mm and 4.2mm diameter, 	$200.00
	12mm - 20 mm length
LB041	XTEND Variable Angled Screws	Variable Angled Bone Screws	4.2, 4.6 and 5.1mm diameter 	$200.00
	x 10mm - 20mm length
LB042	XTEND Fixed Angled Screws	Fixed Angled Bone Screws	4.2, 4.6 and 5.1mm diameter 	$200.00
	x 10mm - 20mm length
LB052	ELLIPSE® Stabilization System 	Bone Screw	4.0mm to 4.5mm Diameter x 	$200.00
	Occipital Screw	6mm - 16mm Length
LB054	CORRIDOR Fixation System Screw 	Bone Screws	3.5mm - 4.5mm diameter, 	$200.00
	Non Cannulated Screws	30mm - 60mm Length
Prostheses List by Category, Groups and Sponsor	Page 954 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DP830	Profile Anterior Thoracolumbar 	Cancellous Screw	6mm x 20 - 60mm	$200.00
	Plate System
DP831	Profile Anterior Thoracolumbar 	Cancellous Bolt	7mm x 25 - 60mm	$200.00
	Plate System
DP833	Profile Anterior Thoracolumbar 	Graft Screw	15 - 30mm  	$200.00
	Plate System
DY110	Carbon Fibre Cages	Stackable Cage Titanium Interface 	M4 / M5	$200.00
	Screws
DY300	Slim-loc Anterior Cervical Plate 	Screws self tapping	4.5 x 12 - 26mm	$200.00
	System
DY301	Slim-loc Anterior Cervical Plate 	Screws - Large Diameter	4.8 x 12-16mm	$200.00
	System
DY302	Slim-loc Anterior Cervical Plate 	Screws - Self Drilling	4.5 x 12-18mm	$200.00
	System
DY333	Summit Cervical Rod System	Occipital Bone Screw	4.5 - 5.25 Dia x 6 -16mm 	$200.00
	length
DY338	Summit Cervical Rod System	Cortical, Cancellous and Rescue 	3.5-4.5mm x 12-48mm	$200.00
DY452	Swift Spine System	Titanium Anterior Cervical Plate 	10 - 18mm	$200.00
	System - 3.8mm Self-Drilling/Tapping 
	Screw
DY453	Swift/Eagle Anterior Cervical System	Titanium Self Drilling/Self Tapping 	4.2mm x 10-18mm	$200.00
	Screw
DY454	Swift Spine System	Titanium Anterior Cervical Plate 	10 - 28mm	$200.00
	System - 3.8mm Bicortical Screw
DY455	Swift Spine System	Titanium Anterior Cervical Plate 	10mm	$200.00
	System - Graft Screw
DY478	Uniplate ACP System	Rescue Screw	12-18mm	$200.00
DY479	Uniplate ACP System	Primary Screw	12-18mm	$200.00
JJ512	Skyline Cervical Plate System	Skyline anterior cervical screw, 	Self drilling 3.8mm, 10-	$200.00
	18mm
JJ513	Skyline Cervical Plate System	Skyline anterior cervical screw. 	Self tapping 3.8mm, 10-	$200.00
	Titanium	26mm
JJ514	Skyline Cervical Plate System	Skyline anterior cervical screw.  	Self Tapping 4.3mm, 10-18mm	$200.00
	Titanium
Prostheses List by Category, Groups and Sponsor	Page 955 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ515	Skyline Cervical Plate System	Skyline anterior cervical screw.  	Bi-cortical 10-18mm	$200.00
	Titanium
JJ519	AEGIS ALP	AEGIS ALP Bone Screws, Titanium	24-36mm	$200.00
JJ528	Eagle/Eagle Plus Anterior Cervical 	Cervical Screw Titanium	3.8mm x 10-20mm	$200.00
	Plate
JJ529	Eagle/Eagle Plus Anterior Cervical 	Cervical Screw Titanium	3.8mm x 10-26mm	$200.00
	Plate
JJ530	Eagle/Eagle Plus Anterior Cervical 	Cervical Screw Titanium	4.3mm x 10-20mm	$200.00
	Plate
JJ531	Eagle/Eagle Plus Anterior Cervical 	Cervical Screw Titanium	Self drilling 4.3mm 10 - 18mm	$200.00
	Plate
JJ603	McGuire Bone Screw	Cancellous Bone Screw	3.5mm x 8 - 60mm	$200.00
JJ690	Mountaineer OCT Spinal System - 	Occipital - titanium bone screw	4.5 - 5.25 x 6 - 16	$200.00
	OC screw
	KH NXGEN (AUS) Pty Limited
KH020	Ceres - Bone Screw - Self-tapping	Bone Screw - Self-tapping	Diam: 405mm	$200.00
	Length:12-16mm
KH021	Ceres - Bone Screw - Large Diameter	Bone Screw - Large Diameter	Diam: 4.8mm	$200.00
	Length: 12- 16mm
KH022	Ceres - Bone Screw - Self drilling	Bone Screw - Self drilling	Diam: 5.5mm	$200.00
	Length:12-16mm
KH027	Cobra Occipital Screws	Occipital bone screw	Dianeter:4.0 -4.5mm	$200.00
	length: 6 -10mm
	Lifehealthcare Pty Ltd
LH325	Lumbar Screw	ECF in PEEK optima	32, 36, 40, 44, 48, 52, 56, 	$200.00
	60, 65mm
LH398	Blackstone Medical ACP Bone Screw	Titanium Alloy Bone Screw	4.1mm x 10mm - 18mm. 	$200.00
	4.5mm x 10mm - 18mm
	Medtronic Australasia Pty Ltd
MC296	Vertex Spinal System	Occipital Screws	 3.0 - 5.0 mm diameter, 4 - 30	$200.00
	 mm length
MC310	Centerpiece	TiMesh LP	Screw	$200.00
MC343	Venture Self Drilling Screws	single or multi level plate construct, 	4.0mm x 8mm - 21mm ; 	$200.00
	titanium alloy	4.5mm x 8mm -21mm 
	variable Angled
Prostheses List by Category, Groups and Sponsor	Page 956 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC344	Venture Self Drilling Screws	single or multi level plate construct, 	4.0mm x 8mm - 21mm, 4.5mm 	$200.00
	titanium alloy	x 8mm - 21mm Fixed Angled
MC347	Venture Self tapping Screws	Single or multi level plate construct, 	4.0mm x 8mm - 21mm; 4.5mm	$200.00
	titanium alloy.	 x 8mm - 21mm Variable 
	Angled
MC348	Venture Self tapping Screws	Single or multi level plate construct, 	4.0mm x 8mm - 21mm; 4.5mm	$200.00
	titanium alloy.	 x 8mm - 21mm Fixed Angled
MC482	Axis Cervical Plating System	Screw: Cancellous	6 - 24mm	$200.00
MC483	Axis Cervical Plating System	Screw: Cortical	26 - 54mm	$200.00
MC511	Premier Anterior Cervical Plate 	Screws	10 20mm	$200.00
	System
MC611	Vantage	Vantage Plates and Screws; Thoracic 	5.5 x 15-50mm	$200.00
	Screw
MC613	Vantage	Vantage Plates and Screws; ATL Screw	6.5 x 30-55mm	$200.00
MC656	Pyramid	Pyramid Bone Screws	6.5mm Diameter, 20 -60mm 	$200.00
	length in 5mm increments
MC988	Sovereign Spinal System - Screws	Sovereign Spinal System - Screws	20 - 35mm	$200.00
MI057	Atlantis Anterior Cervical Plate 	Screws - Self-Tapping / Self-Drilling 	Diameter: 4.0mm - 4.5mm; 	$200.00
	System - Bone Screw	and Fixed / Variable Angle	Length 11mm - 17mm
	National Surgical Pty Ltd
NK007	Spider Cervical Plating System - 	Titanium, Self Tapping and Self 	4.0 - 4.25mm, lengths 12-	$200.00
	Spider Screw	Drilling	16mm
NK020	Easy Plate - Bone Screw	Bone screw	12mm to 20mm	$200.00
	Nuvasive Australia and NZ  Pty Ltd
NV007	Gradient Cervical Plates	Bone Screw	4.0 - 4.7mm diameter10 - 	$200.00
	20mm length
NV023	VuePoint Screw (occipital bone)	The VuePoint system, of which the 	4.5mm x (6/8/10/12/14mm)	$200.00
	VuePoint screw (occipital bone) is a 	5.0mm x 
	component, is intended to promote 	(6/8/10/12/14mm)
	fusion of the cervical spine and 
	occipito-thoracic junction (occiput-
	T3) and is indicated for degenerative 
	disc disease (as defined by back pain 
Prostheses List by Category, Groups and Sponsor	Page 957 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NV031	Traverse Bolt	The Traverse system, of which the 	6.5mm x 	$200.00
	Traverse bolt is a component, is 	(25/30/35/40/45/50/55/60/
	indicated for use as an adjunct to 	65mm)7.5mm x 
	fusion via a lateral or anterolateral 	(25/30/35/40/45/50/55/60/
	surgical approach, above the 	65mm)
	bifurcation of the great vessels, in the 
	treatment of thoracic and 
NV034	Traverse Bone Screw	The Traverse system, of which the 	5.5mm x 	$200.00
	Traverse bone screw is a component, 	(25/30/35/40/45/50/55/60/
	is indicated for use as an adjunct to 	65mm)6.5mm x 
	fusion via a lateral or anterolateral 	(25/30/35/40/45/50/55/60/
	surgical approach, above the 	65mm)
	bifurcation of the great vessels, in the 
	treatment of thoracic and 
NV036	XLP bolt	The XLP system, of which the XLP 	5.5mm x 	$200.00
	bolt  is a component, is indicated for 	(25/30/35/40/45/50/55/60/
	use via a lateral or anterolateral 	65mm)6.5mm x 
	surgical approach, above the 	(25/30/35/40/45/50/55/60/
	bifurcation of the great vessels in the 	65mm)
	treatment of thoracic and 
	thoracolumbar (T1-L5) spine 
	instability or via the an
NV039	Halo Bone Screw	The Halo System, of which the Halo 	5.5mm x 	$200.00
	bone screw  is a component, is 	(20/22/24/26/28/30/32/34
	indicated for use via a lateral or 	mm)6.5mm x 
	anterolateral surgical approach above 	(20/22/24/26/28/30/32/34
	the bifurcation of the great vessels in 	mm)
	the treatment of thoracic and 
	thoracolumbar (T1-L5) spine 
	instability or via
NV041	Helix Mini bone screw	The Helix Mini system, of which the 	4.0mm x (11/13/15mm)	$200.00
	Helix Mini bone screw is a 	4.5mm x (11/13/15mm)
	component, is intended for anterior 
	screw fixation of the cervical spine. 
	These implants have been designed to 
	provide stabilisation as an adjunct to 
	cervical fusion. Indications for the use
Prostheses List by Category, Groups and Sponsor	Page 958 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NV044	Helix Bone Screw	The Helix system, of which the Helix 	4.0mm x 	$200.00
	bone screw is a component, is 	(11/13/15/17/19mm)
	intended for anterior screw fixation  of 	4.5mm x (13/15/17/19mm)
	the cervical spine. These implants 
	have been designed to provide 
	stabilisation as an adjunct to cervical 
	fusion. Indications for the use of this im
NV052	Leverage LFS (Bone Screw)	The Leverage LFS, of which the bone 	2.6/3mm x 5-8mm	$200.00
	screw is a component, is intended for 
	use in the lower cervical and upper 
	thoracic spine (C3 to T3) in 
	laminoplasty procedures. Leverage 
	LFS is used to hold allograft material 
	in place in order to prevent the 
NV070	Helix-Revolution (screw)	Bone Screw	4 x 11-19mm; 4.5 x 11-19mm	$200.00
NV072	Brigade standalone ALIF (screw)	Bone screw	4.5 x 20-35mm; 5.5 x 20-	$200.00
	35mm
NV082	Long Lateral Fixation System 	Bone Screw	5.5-12.5mm x 20-65mm	$200.00
NV093	Helix-T (Bone Screw)	Anterior cervical plate bone screw	4/4.5x11-19mm	$200.00
NV096	Brigade Bone Screw	Anterior plate bone screw	5.5/6.5 x 20-35mm	$200.00
	Orthotech Pty Ltd
OH053	Interpore Bone Plate System	TPS Screw	14 - 22mm	$200.00
OH064	Anterior Cervical Plate System	Titanium Cancellous Bone Screw	4 - 20mm	$200.00
OH253	Intext Cervical Plate/Intext Screws	Intext cervical plate, including (2 - 	Screws/ Revision Screws - 	$200.00
	part) fixation screws	dia 4.4mm, length 11 - 18mm
OH255	Hartshill	Cancellous bone screws for 	6.5mm diam - 25 - 30mm 	$200.00
	Horseshoes/STALIF each	length, 5.5mm diam - 25 - 
	30mm length
OH256	Cancellous Screws	For use with Stalif Implants	5.5mm x 25mm (for use with 	$200.00
	37mm Stalif), 6.5mm x 30mm 
	(for use with 41/45mm 
	Stalif), 6.5mm x 25mm (for 
	use with 41/45mm Stalif). 
	Pack of 4 screws.
Prostheses List by Category, Groups and Sponsor	Page 959 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OH304	ADD / ADDplus	Cancellous bone screw, titanium. The 	length = 	$200.00
	cancellous bone screw is used for the 	12,14,16,18,20,24,26mm
	biocortical fixation. The outer 
	diameter is 4mm.
OH400	Ulrich Neon Cortical screw	Cortical screws	8-18mm	$200.00
	Prism Surgical Designs Pty Ltd
PZ014	Aquila Plate System, Aquila screw	Bone Screw	4.0mm Diameter (length 10, 	$200.00
	12, 14, 16, 18, 20mm) and 
	4.5mm Diameter (Length 10,
	 12, 14, 16, 18, 20mm)
	Scient'x Australia
SX012	Stella	Screw	D: 4-4.5mm, L: 12-20mm	$200.00
SX054	Trestle Anterior Cervical Plating 	Titanium allow self drilling screws, 	Diameter: 4.0mm, 4.5mm. 	$200.00
	System - screw	self tapping screws, self tapping 	Length: 10mm - 20mm (1mm 
	rescue screws; fixed and variable 	increments)
SX076	Trestle Luxe Anterior Cervical 	Self-tapping screws, self-drilling 	Diameters: 4.0mm, 4.5mm. 	$200.00
	Plating System - screw	screws; fixed and variable angle	Lengths of self-drilling 
	screws: 10, 11, 12, 13, 14, 
	15, 16, 17, 18, 19, 20mm. 
	Lengths of self-tapping 
	screws: 10, 11, 12, 13, 14, 
	15, 16, 17, 18, 19, 20, 21, 
	22, 23, 24, 25, 26mm
SX078	Avalon Occipital Fixation System - 	Bone screw	Diameters: 4.5mm, 5.0mm. 	$200.00
	screw	Lengths: 6mm, 8mm, 10mm, 
	12mm, 14mm, 16mm
	Signature Orthopaedics
SF053	Aquila Plate System, Aquila screw	Bone Screw	4.0mm Diameter (length 10, 	$200.00
	12, 14, 16, 18, 20mm) and 
	4.5mm Diameter (Length 10,
	 12, 14, 16, 18, 20mm)
	Signature Spine
SV006	Tryptik Anterior Cervical Plate 	Tryptik Anterior Cervical Plate bone 	The produc is available in 2 	$200.00
	bone screw	screws are designed to have a low 	diameters, namely 3.8 and 
	profile and lock into the plate on 	4.5mm. The 3.8mm screw is 
	insertion to prevent back out. The 	available in 4 lenghts: 12, 
	screw is made o Titanium	14, 16 and 18mm while the 
	4.5mm screw is available in 
	3 lenghts, 14, 16 and 18mm
Prostheses List by Category, Groups and Sponsor	Page 960 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW393	Xia Spine System	Bone Screw	One size only	$200.00
HW409	Aviator Anterior Cervical Plating 	Anterior Cervical Plate System - 	4 - 4.35mm diameter, 10 - 	$200.00
	System - Screw	18mm length
HW513	Anchor-L Lumbar cage System, 	Bone Screw	Dia 5mm- 6mm, Length 	$200.00
	Bone Screw	20mm- 30mm
HW519	AVS Anchor C Cervical Cage 	Screw for use with Anchor C Cervical 	Diameter 3.5-4mm Length 8-	$200.00
	Cage	14mm
SK223	Oasys-Occipito Cervico Thoracic 	Cortical Screws	3.5mm x 6mm - 24mm	$200.00
	System	4.0mm x 6mm - 54mm
	4.5mm x 6mm - 16mm
SK489	THOR Anterior  Screw	Anterior Plate Screw: Stardard and 	Dia: 6 - 6.5mm	$200.00
	Compression
SK502	Trio Spinal Fixation System	Screw	Diameter: 4.5 - 8.5mm	$200.00
	Length: 25 - 60mm
	Standard and Long Post
SR039	Techtonix System	Screw, titanium	5-6mm x 25mm-60mm	$200.00
ST914	REFLEX  Anterior Cervical Plating 	Screw	Diameter 4 - 4.5mm lengths 	$200.00
	System	10mm - 20mm
	Synthes Australia Pty Ltd
SY149	Universal Spine System (USS)	Schanz Screws	 5-7mm dia 	$200.00
SY187	Cervifix Posterior Cervical  System	Screw	Dia 3.2 - 4.5mm, Length 6 - 	$200.00
	55mm
SY299	Spinal Fixation System	Locking Screw	10mm to 26mm	$200.00
SY334	Arch Fixation System	Screws, titanium	2.0mm - 2.4mm screws, 4 to 	$200.00
	12mm
SY362	Universal Spine System (USS)	Pedicle Hook Screw	Length 20 - 40mm	$200.00
SY381	Axon Occipital Fusion System	Occipital Screws 4.5mm / 5.0mm 	Length 4 - 18mm	$200.00
	diameterTitanium Alloy
	Zimmer Pty Ltd
ZI487	Trinica Screw	Titanium Screws, fixed and variable 	4.2mm x 12/14/16/18mm; 	$200.00
	angle.	4.6mm x 12/14/16/18mm
Prostheses List by Category, Groups and Sponsor	Page 961 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI517	Trinica Anterior Lumbar/Sacral Screw	Screw, Titanium, Fixed or Variable 	22 to 34mm lengths	$200.00
	Axis
ZI686	NexLink	Occipital Cervical Plating System	Primary Bone Screw 3.5mm 	$200.00
	and 4mm
	Cannulated
	Globus Medical Australia
LB053	CORRIDOR Fixation System Screw 	Bone Screws	3.5mm - 4.5 diameter. 3	$210.00
	Cannulated Screws	0mm - 60mm length
LB058	ZYFUSE Facet Fixation System 	Facet Screw	5.0 - 6.0mm diameter x 30 - 	$210.00
	Screw with washer	60mm length
LB059	ZYFUSE Facet Fixation System Screw	Facet Screw	5.0 - 6.0mm diameter x 30 - 	$210.00
	60mm length
LB062	SI-LOK™ Stabilization System 	Cannulated Dual Thread Screw	8.0-12.0mm diameter x 25-	$210.00
	60mm length
	Medtronic Australasia Pty Ltd
MC447	UCSS	Cortical Screws 	30 - 50mm	$210.00
MC448	UCSS	Cortical Lag Screws	36 - 50mm	$210.00
	National Surgical Pty Ltd
NK021	Fixcet Spinal Facet Screw	Spinal facet screw	25mm - 45mm	$210.00
	Nuvasive Australia and NZ  Pty Ltd
NV005	Triad Facet Screw	Cannulated	3.5 - 4.5mm diameter20-	$210.00
	70mm length
NV073	Radian Facet Screw System, (Facet 	Cannulated Facet Screw	Fully threaded 4.5-6.0mm x 	$210.00
	Screw)	20-55mmPartially 
	Threaded 4.5-6.0mm x 20-
	55mm
	Orthotech Pty Ltd
OH254	Intext Cervical Plate/Intext Screws	Intext cervical plate, including (2-	Screws/Revision Screws - 	$210.00
	part) fixation screws	dia 4.4mm, length 11 - 18mm
	 - Pack of 3
OH365	AxiaLIF Facet Screw	Percutaneous 360 degree fusion at L5 	4/5mm x 25-40mm	$210.00
	- S1
	Synthes Australia Pty Ltd
SY141	Spinal Plate/Plate System AO/ASIF	Cannulated/self tapping screw 	3.5mm dia, 36-50mm length	$210.00
	 Spinal Implants	(odontoid)
Prostheses List by Category, Groups and Sponsor	Page 962 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY302	TeleFix Spinal System	Posterior Screw	20mm to 70mm in length	$210.00
SY303	TeleFix Spinal System	Anterior Screw	20mm to 70mm in length	$210.00
	Closed
	Johnson & Johnson Medical Pty Ltd
JJ935	Kaneda Spine system	Monoaxial Screw	25 to 60mm	$210.00
	Medtronic Australasia Pty Ltd
MC462	Zephir	Cancellous Screw	13-17mm	$210.00
	Nuvasive Australia and NZ  Pty Ltd
NV099	Archon Plate (Bone Screw)	The Archon system, of which the bone	4/4.5 x 10-23mm	$210.00
	 screw is a component, is intended for 
	anterior screw fixation of the cervical 
	spine. These implants have been 
	designed to provide stabilisation as 
	an adjunct to cervical fusion.
	Scient'x Australia
SX009	Antelys	Screw	D: 5mm, L: 32.5 to 50mm	$210.00
	Synthes Australia Pty Ltd
SY148	Universal Spine System (USS)	Pedicle Hook Screw	Length 20- 40mm	$210.00
	Complex
	Johnson & Johnson Medical Pty Ltd
JJ939	Kaneda Spine System	Closed Monoaxial Screw	25 to 60mm	$260.00
	Orthotech Pty Ltd
OH405	Ulrich Neon Toggle system	Toggle system consisting of toggle, 	one size	$260.00
	Locking plate and hex nut.
	Dual Thread
	Biomet Australia Pty Ltd
BH115	Solitare Anterior Spinal System	Fixation screw	20-35mm	$480.00
	Emergo Asia Pacific Pty Ltd
ER016	Pyrenees Cervical Plate System / 	Self-drilling, self-tapping and bone 	Diameter: 4.0, 4.35 and 	$480.00
	bone Screw	reduction screws for fixating the 	4.5mm.  Length: 10,12,14 
	Pyrenees plate to bone	and 16mm
Prostheses List by Category, Groups and Sponsor	Page 963 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ER023	Cayman Thoracolumbar Plate 	Self tapping screw that lags plate to 	Length: 20mm to 54mm  	$480.00
	System / Bone Screw	bone and forms an autogenic lock 	Diameter:  6mm and 7mm
	with plate.  Available in two 
	diameters and a variety of lengths
ER035	Caspian OC screw	The Caspian OC screw is used to 	4.5mm diameter. 6-16mm 	$480.00
	fixate the Caspian OC plate to the 	length in 1mm increments
	5.25mm diameter. 6-16mm 
	length in 1mm increments
ER047	Chesapeake Spinal System - 	Locking screw for the Chesapeake 	Diameter: 3.5mm, 3.85mm. 	$480.00
	Fixation Screw	Spinal System	5.5mm
	Lengths: 12mm to 35mm
	National Surgical Pty Ltd
NK017	Fixcet Spinal Facet Screw	Spinal facet screw	30mm - 45mm	$480.00
	Orthotech Pty Ltd
OH441	AxiaLif Rod	Integral fixated spacer for lumbar 	25-65mm	$480.00
	Prism Surgical Designs Pty Ltd
PZ015	Pegasus Plate System, Pegasus Screw	Bone Screw	4.6mm diameter - 12, 13, 14, 	$480.00
	15, 16, 17, 18, 26mm
PZ016	Aurora Screw	Bone screw	20mm - 36mm	$480.00
	Scient'x Australia
SX062	Aspida Anterior Lumbar Plating 	Screw	Diameter: 6.0mm, 7.0mm; 	$480.00
	System - Screw	Length: 25, 30, 35mm
	Signature Orthopaedics
SF018	Pegasus Plate System, Pegasus Screw	Bone Screw	4.6mm diameter - 12, 13, 14, 	$480.00
	15, 16, 17, 18, 26mm
SF021	Aurora Screw	Bone screw	20mm - 36mm	$480.00
	Synthes Australia Pty Ltd
SY140	AO/ASIF Spinal Implants	Locking Screws	Length 12 - 55mm	$480.00
SY251	Ventrofix - MIS	Screw	25-65mm	$480.00
SY291	Anterior Tension Band	Locking Screw	22mm to 36mm	$480.00
SY297	SynFix Spinal system	Locking Screw	10mm to 40mm, 4.0mm 	$480.00
	diameter
Prostheses List by Category, Groups and Sponsor	Page 964 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Expansion Head/Screw
	B Braun Australia Pty Ltd
BB158	Aesculap Cervical System	Titanium with locking mechanism	Dia 4 - 4.5mm, length 10 - 	$300.00
	28mm
	Emergo Asia Pacific Pty Ltd
ER163	Signus Anterior Cervical Plate - 	Provides stability in patients 	4.0 & 4.5mm diameter x 12-	$300.00
	Bone Screws	undergoing anterior cervical spine 	16mm length
	fusion procedures. It consists of a pre-
	contoured titanium plate, secured 
	onto the spinal vertebrae by either 
	fixed or variable angle colour coded 
	screws. These screws have an integral 
	Orthotech Pty Ltd
OH305	ADD / ADDplus	Osmium Screw including bolt, 	length = 14, 16, 18mm with 	$300.00
	titanium. The osmium screw is a two-	outer diameter of 5mm
	component system consisting of a 
	screw and a bolt. Expansion of the 
	screw is achieved by inserting the 
	bolt. Hyper-expansion of the screw is 
	not possible.
	Synthes Australia Pty Ltd
SY181	Cervical Spine Locking Plate 	Expansion Head Screw	Dia 3.5 - 4.5mm,  Length 12 	$300.00
	(CSLP) System	- 25mm
SY449	Cervical Spine Locking Plate 	QuickLock Screw	4.0 or 4.5mm Diameter, 12-	$300.00
	(CSLP) System	20mm Length
	Expansion Screw / Expansion head screw
	Global Orthopaedic Technology
GO224	Sonoma Vaiable Bone Screw	Vaiable Bone Screw	4.0mm x 10mm - 20mm	$300.00
	4.5mm x 10mm - 18mm
GO225	Sonoma Limited Angle Bone Screw	Limited Angle Bone Screw	4.0mm x 10mm - 18mm	$300.00
	4.5mm x 10mm - 18mm
Prostheses List by Category, Groups and Sponsor	Page 965 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Lifehealthcare Pty Ltd
LH488	Slimfuse Cervical Plate System - 	Self-tappind and self-drilling screws 	4.5mm and 5.0mm diameter	$300.00
	Bone Screw	screw options with expandable heads 
	and expandable tips. The screw has a 
	unique locking mechanism whereby 
	the screw head expands locking into 
	the plate
	Australian Pacific Medical Pty Ltd
PB004	Bone Screws	Bone Screws	Diameter: 4.0-4.35mm, 	$200.00
	Length: 12-18mm
	Health Care Surgical Pty Ltd
HC014	Origin Screw	Origin Screw	6-26mm	$200.00
HC018	KM Bone screw	Bone Screw	W:3.5-5.0mm  L:6-22mm	$200.00
	Implament
IB006	STACC Cervical Screw	Cervical  Screw	4mm x 14,16 and 18mm	$200.00
	Medacta Australia Pty Ltd
MU123	MectaLIF Anterior Stand-Alone 	Bone Screws	Dimeter: 5 & 5.5mm. 	$200.00
	Screws	Length: 25, 30, & 35mm.
	Medtronic Australasia Pty Ltd
MC423	Atlantis	Fixed Angle Cancellous Screw	10-20mm	$200.00
MC424	Atlantis	Variable Angle Cancellous Screw	10-20mm	$200.00
	Nuvasive Australia and NZ  Pty Ltd
NV104	CoRoent Small Interlock (screw)	The CoRoent Small Interlock System 	10-20mm	$200.00
	is a stand-alone anterior cervical 
	interbody fusion system indicated for 
	use in skeletally mature patients with 
	degenerative disc disease (DDD) at 
	one level from C2 - T1.
	Orthofix Australia Pty Limited
OF002	Azure Anterior Cervical Plate System	Bone Screws	4.0 & 4.5mm diameter	$200.00
	12, 14, 16, 18mm length
	Orthotech Pty Ltd
OH479	Stalif C	Stalif Screws	14-16	$200.00
Prostheses List by Category, Groups and Sponsor	Page 966 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI879	V2F Screws	Dual-lead cortical/cancellous screws	Diameter 6mm and 7mm, 30-	$200.00
	60mm in 5mm increments
	Dual Thread
	Signature Orthopaedics
SF056	Australis Spine System	Bone Screw	15mm-45mm	$480.00
	Expansion Screw / Expansion Head Screw
	Nuvasive Australia and NZ  Pty Ltd
NV106	Decade Lateral Plate System (screw)	The Nuvasive Decade Lateral Plate 	5.5/6.5mm diameter, length 	$300.00
	System is indicated for use in the 	15-75mm
	treatment of lumbar and lumbosacral 
	(L1-S1) spine instability.
13.02.01 - Nut/Set Screw/Locking Screw
	Advanced Surgical Design & Manufacture Ltd
AE163	Spinal Fixation System	Set screw spinal system	One size only	$170.00
AE179	Blackstone Set Screw	Titanium	One size only	$170.00
AE181	Blackstone - Standard Ring Screw	Titanium	One size only	$170.00
AE186	ICON Modular Spinal Fixation 	Set Screw	one size only	$170.00
	System
	B Braun Australia Pty Ltd
BB230	S4 Spinal System	Set Screw - titanium	one size	$170.00
	Biomet Australia Pty Ltd
BH069	Synergy/Polaris Spinal System	Hex Nut / Cap Nut	3mm	$170.00
BH076	Synergy Spinal System	Point/Double Hex Set Screw	4.75 - 6.35mm	$170.00
BH081	Synergy/Polaris Spinal System	Variable Locking Screw Nut	13.8mm	$170.00
BH087	Array/Ballista Spinal System	Titanium Alloy Modular Spinal 	one size	$170.00
	System - set screws
BH091	Altius Occipito-Cervico-Thoracic 	Locking and CAP Nuts	one size only	$170.00
	(OCT) System
BH102	Interpore Bone Plate System	TPS Locked Nut	3mm	$170.00
Prostheses List by Category, Groups and Sponsor	Page 967 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE378	SpineTune TL - Set Screw	This component is a screw set that is 	One size only	$170.00
	inserted within the rod housing of the
	 monoaxial and polyaxial screws to 
	secure the rod to the screw.
	Emergo Asia Pacific Pty Ltd
ER015	Denali Spinal System / ATR Set Screw	Set Screw	8mm diameter and 4mm 	$170.00
	height
ER029	Caspian OCT Spinal System - Set 	cervico-thoracic posterior rigid 	one size only	$170.00
	Screw	fixation system
ER048	Everest Spinal System Set Screw	Set Screw	one size only	$170.00
ER114	Novel/Zenius set screw	Set screw	4-10mm	$170.00
	Euros Orthopaedics Australia Pty Ltd
EU017	e.Spine locking screw	Titanium locking screw for e.Spine 	One size	$170.00
	hooks and e.Spine pedicular screws
	Global Manufacturing Technology Pty Ltd
GM158	SOCORE Spinal System- Locking 	Locking Screw	Standard & Mini	$170.00
	Screw
	Global Orthopaedic Technology
GO213	Sierra Spinal System Set Screw	Set Screw	3.5mm	$170.00
GO239	Newport MIS Spinal System - Cap	Locking Cap	One size only	$170.00
	Globus Medical Australia
LB019	REVOLVE Stabilization Locking 	Locking Cap	One Size	$170.00
LB023	REVERE Locking Cap	Locking Cap	5.5 and 6.35mm	$170.00
LB048	ELLIPSE Stabilization System, 	Locking Cap	One Size	$170.00
	Locking Cap
LB061	REVLOK Fenestrated Screw System	Locking Cap	One Size	$170.00
	 Locking Cap
	Health Care Surgical Pty Ltd
HC009	S14 Biospine Nut	Nut	One Size Only	$170.00
	Johnson & Johnson Medical Pty Ltd
DY107	Carbon Fibre Cages	Stackable Cage Titanium Interface 	One size only	$170.00
	Screw Nuts
DY293	Crossover System (Titanium)	Crossover Nut or Ball Screw	One size only	$170.00
Prostheses List by Category, Groups and Sponsor	Page 968 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DY568	Monarch Spinal System	Domed Nuts	One size only	$170.00
DY569	Monarch Spinal System	Typhoon Cap and Domed Nuts	One size only	$170.00
JJ524	VIPER Spine System	Viper Single Innie Set Screw	One size	$170.00
JJ656	SI Set Screw - Expedium Anterior 	Single Innie Set Screw - Titanium	one size only	$170.00
	Spine System
JJ913	Summit Spinal System	Screws and nuts	One size	$170.00
JJ914	Profile Anterior Thoracolumbar 	Locking inner screw and outer nut	One size only	$170.00
	Plate System
JJ915	Expedium Spine System	Si and Unitised Screw Set	4.35 -7.5mm	$170.00
JJ916	Mountaineer Spinal System	Inner screws and out nuts	One size only	$170.00
JJ942	Moss Miami Spinal System	Inner and outer screw, nuts and set 	3 - 6.5mm	$170.00
	screws
JJ943	Isola Spine System	Nuts, Set screws and locking screws	3/8, 5/16 and 1/4 inch, 	$170.00
	6.35-120mm
	KH NXGEN (AUS) Pty Limited
KH029	Cobra Locking Screw	Locking Screw	one size only	$170.00
KH034	G5 Locking Cap/Screw	setscrew, titanium alloy	one size only	$170.00
	Lifehealthcare Pty Ltd
LH452	DSS Breaking Nut	The DSS Breaking Nut is a set screw 	One size only	$170.00
	that locks the DSS pedicle screw for 
	final tightening. It is an integral part 
	of the DSS pedicle screw system, is 
	used every time and can not be used 
	on its own.
LH456	DSS Fusion Coupler Set Screw	The DSS Fusion Coupler set screw 	DIA700-04 for 20mm - 	$170.00
	locks the telescoping fusion couplers 	22mm fusion coupler
	rigidly in place. This set screw can 	DIA70022-04 for 22mm - 
	only be used for this purpose, is used 	25mm / 25mm - 31mm / 
	every case and can not be used for any 	31mm - 43mm fusion couplers
	other purpose.
LH486	DSS HP Spinal System - Set Screw	Set Screw	One size only	$170.00
LH491	Jazz Posterior Fixation System - 	A locking screw that ensures a perfect 	10mm	$170.00
	Screw Connector	two-in-one bond of the braid and 
	connector.
Prostheses List by Category, Groups and Sponsor	Page 969 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Matrix Medical Innovations
BF004	A-Mesh Spinal Titanium Mesh Set 	A-Mesh® Spinal Titanium Mesh is 	Diameter 3mm and Length 	$170.00
	Screw	designed to restore biomechanical 	9mm
	integrity throughout the thoracic and 
	lumbar spine following vertebrectomy
	 or corpectomy for patients with spine 
	tumors or fractures.
BF008	Smartloc Spinal Fixation System / 	Set screw for poyaxial pedicle screw	8mm diameter, 5mm height	$170.00
	Set Screw
	Medacta Australia Pty Ltd
MU107	M.U.S.T. Set Screw	Set Screw	One Size	$170.00
	Medtronic Australasia Pty Ltd
MC394	CD Horizon	Set screw	Each in one size	$170.00
MC399	TSRH Spinal Implant System	3D - Nut, Eyebolt locknot, locknut 	Each in one size	$170.00
	1/2 inch, locking screws, double hex, 
	flush break, universal breakoff
MC435	Colorado Spinal System	Break off Nut	One size only	$170.00
MC504	CD Horizon	Breakoff Set Screw	25 - 55mm	$170.00
MC546	Vertex Spinal System	Set screw	One size only	$170.00
MC609	CD Horizon Spinal System	Percutaneous Set Screw	25 - 60mm	$170.00
MC615	Vantage	Vantage Plates and Screws; Lock Nut	One Size Only	$170.00
MC654	Engage	Breakoff Set Screw	one size only	$170.00
MC667	SiLo	Set Screw	One Size only	$170.00
MC674	CD HORIZON Spinal System - Set 	Set Screw	3.5mm - 6.35mm	$170.00
	Screw
	National Surgical Pty Ltd
NK005	SteriSpine PS - Setscrew	Locking screw for use with SteriSpine	Diameter: 9mm	$170.00
	 PS system	Length: 4mm
NK010	Fortex Pedicle Screw Set Screw	Pedicle Screw Set	3.1mm height	$170.00
	Nuvasive Australia and NZ  Pty Ltd
NV002	SpheRx	Cannulated Lock Screw	one size	$170.00
Prostheses List by Category, Groups and Sponsor	Page 970 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NV022	VuePoint screw (inner set)	The VuePoint system, of which the 	Tulip & Laminar Hook - 	$170.00
	VuePoint screw (inner set) is a 	One SizeOffset & 
	component, is intended to promote 	Occipital Connector - One 
	fusion of the cervical spine and 	SizeParallel Rod 
	occipito-thoracic junction (occiput-	Connector - One Size
	T3) and is indicated for degenerative 	Inline Rod Connector - One 
	disc disease (as defined by back pain 	SizeCross Connector - 
	of discoge	One Size
NV032	Traverse Lock Nut	The Traverse system, of which the 	One Size	$170.00
	Traverse lock nut  is a component, is 
	indicated for use as an adjunct to 
	fusion via a lateral or anterolateral 
	surgical approach, above the 
	bifurcation of the great vessels, in the 
	treatment of thoracic and 
NV037	XLP Lock Nut	The XLP system, of which the XLP 	One size	$170.00
	lock nut is a component, is indicated 
	for use via a lateral or anterolateral 
	surgical approach, above the 
	bifurcation of the great vessels in the 
	treatment of thoracic and 
	thoracolumbar (T1-L5) spine 
	instability or via the
NV045	SpheRx PPS (Lock Screw)	Lock screw	5.5mm/6.25mm	$170.00
NV061	Armada (Lock Screw)	Lock screw	One Size	$170.00
NV077	X-CORE (Lock Screw)	Lock screw	Small and Large	$170.00
NV085	Precept (Lock Screw)	Lock Screw	one size	$170.00
	Orthotech Pty Ltd
OH054	Interpore Bone Plate System	TPS Locked Nut	3mm	$170.00
OH309	Cosmic implant system	Cosmic Locking Screw - titanium	one size	$170.00
OH351	Novel/Zenius set screw	Set screw	4-10mm	$170.00
OH399	Ulrich Neon Hex nut	Hex nut	one size	$170.00
OH411	Ulrich Spine System Locking Screws	Locking screw	one size	$170.00
	Prism Surgical Designs Pty Ltd
PZ024	Centaur Set Screw, Centaur Screw 	Set Screw	small and standard	$170.00
	System
Prostheses List by Category, Groups and Sponsor	Page 971 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX004	Isobar TTL	Nut	Blocker, Hemispherical	$170.00
SX034	Isobar TTL Inner nut	Inner Locking Nut	One size only	$170.00
SX048	Zodiac Spinal Fixation System - set 	Set screw	Diameter: 9.5mm, 10.8mm.	$170.00
	screw
SX064	Solanas Posterior Cervico-thoracic 	Set Screw	5.3mm	$170.00
	Fixation System - Set Screw
SX079	Avalon Occipital Fixation System - 	Hexalobe set screw	Diameter: 6.5mm; Length: 	$170.00
	Set screw	3.4mm
	Signature Orthopaedics
SF010	Centaur Set Screw, Centaur Screw 	Set Screw	small and standard	$170.00
	System
	Signature Spine
SV001	Romeo Set Screws	Titanium alloy	One size	$170.00
	Stryker Australia Pty Ltd
SK112	XIA/Oasys Spine System	Buttress thread locking nut	3.5mm - 6mm	$170.00
	Synthes Australia Pty Ltd
SY010	VentroFix	Set screw	One size only	$170.00
SY135	Cervical Spine Locking Plate 	Locking Screw	One size only	$170.00
	(CSLP) System
SY152	Universal Spine System (USS)	Set Screw	Standard	$170.00
SY174	Universal Spine System (USS)	Nut	Standard, SS	$170.00
SY186	Posterior Cervical System	Nut	One size only	$170.00
SY286	USS llio-Sacral Fixation system	Locking Screw	one size only	$170.00
SY304	TeleFix Spinal System	Posterior Locking Screw	One size only	$170.00
SY308	Axon Spinal System	Locking Set screw	One size only	$170.00
SY383	Synmesh	Locking Screw, Low Profile, For 	Small, Large	$170.00
	Synmesh End Rings
SY440	Synapse	Locking Screw	One size	$170.00
	Zimmer Pty Ltd
ZI511	Optima Spinal System - Set Screw	Screw set	One size only	$170.00
Prostheses List by Category, Groups and Sponsor	Page 972 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI659	Nex-Link	Spinal Fixation System, Closed Screw 	4.0mm	$170.00
	Set Screw
ZI699	Universal Clamp	Locking Screw	.	$170.00
ZI706	Nex-Link	Spinal Fixation System, Open Screw 	4.00mm	$170.00
	Closure
	Emergo Asia Pacific Pty Ltd
ER141	Signus MonoPoly Pedicle Screw 	Set Screw - as part of Pedicle Screw 	N/A	$170.00
	System-Set Screw	System Construct
	Global Orthopaedic Technology
GO204	Malibu Spinal System Locking Cap	Locking cap with integral set screw	5.5mm and 6.35mm	$170.00
	Health Care Surgical Pty Ltd
HC017	KM Nut	Nut	One size	$170.00
	Implament
IB003	Vertefix II Locking Screw	Set/Locking Screw	One size only	$170.00
	Synthes Australia Pty Ltd
SY796	Vertebral Body Replacement System	Endplate Screw	One Size	$170.00
	Zimmer Pty Ltd
ZI880	V2F Cap Screws	Cap Screws (fixed or variable)	One size	$170.00
13.02.02 - Collar/Sleeve
	Johnson & Johnson Medical Pty Ltd
DY109	Carbon Fibre Cages	Stackable Cage Titanium Protective 	5-15mm	$225.00
	Sleeve
Prostheses List by Category, Groups and Sponsor	Page 973 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Stryker Australia Pty Ltd
HW445	Oasys-Occipito Cervico Thoracic 	The Saddle Connector is available to 	one size only	$225.00
	System (Saddle)	connect the OASYS® Occipital-
	Cervico-Thoracic System to a 
	construct with Xiz®II or Xia®3 
	Polyaxial screws. *The Saddle 
	Connector is to allow the use of a 
	larger size bone screw in the thoracic 
	area of T1 to T3 per the current 
	OASYS® indications.
	Synthes Australia Pty Ltd
SY151	Universal Spine System (USS)	Sleeve	3.5 - 6mm	$225.00
SY363	Universal Spine System (USS)	Sleeve	3.5 - 6mm	$225.00
13.02.03 - Cap/Cover Plate
	Advanced Surgical Design & Manufacture Ltd
AE157	Blackstone Top Locking Plate	Holds bone screws and anterior 	One size only	$424.00
	cervical plate in place
AE190	Unity Lumbar Plate	Unity Cover Plate	17-28mm	$424.00
AE198	Pillar SA	The Pillar SA PEEK Spacer system is 	37W, 40W, 43W, cover 	$424.00
	comprised of a variety of implants 	plates
	manufactured from PEEK-OPTIMA 
	LT as described by ASTM F-2026, 
	with tantalum markers as described by
	 ASTM F-560. The implants are 
	available in multiple footprint sizes a 
	variety of heig
	B Braun Australia Pty Ltd
BB064	Socon Spinal System	Socon Clamps	One size only	$424.00
	Biomet Australia Pty Ltd
BH068	Synergy/Polaris Spinal System	Sliders	4.75 - 6.35mm dia	$424.00
	Global Orthopaedic Technology
GO217	Sierra Spinal System Locking Cap	Locking Cap	3.5mm	$424.00
GO232	Zuma Spinal System Locking Cover	Locking Cover	10mm - 20mm	$424.00
Prostheses List by Category, Groups and Sponsor	Page 974 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
DP580	Kaneda Anterior Scoliosis System  	Radiused Caps for Open Screws	3/16" 	$424.00
	S/S
	Nuvasive Australia and NZ  Pty Ltd
NV009	Gradient Cervical Plates	Slotted Hole/Round Cover assembly	one size	$424.00
	Orthotech Pty Ltd
OH310	Cosmic implant system	Cosmic Cap - titanium	one size	$424.00
	Stryker Australia Pty Ltd
HW514	Anchor-L Lumbar Cage System, 	Final Locking plate	One Size	$424.00
	Locking Plate
	Synthes Australia Pty Ltd
SY701	Spinal Fixation System	Cap	One size	$424.00
	Zimmer Pty Ltd
ZI625	SEQUOIA PEDICLE SCREW 	Closure Top	One size only	$424.00
	SYSTEM
ZI682	Pathfinder	Minimally invasive pedicle fixation 	Open Implant Closure Top 	$424.00
	system	5.5mm
13.02.04 - Cap/Cover Plate, Complex
	Johnson & Johnson Medical Pty Ltd
DY311	Frontier Anterior Scoliosis System 	Twist on Internal Cap	One size only	$605.00
	(Titanium)
JJ647	Expedium Spine System - Dual Innie	DI Set Screw	one size only	$605.00
	 Set Screw
	KH NXGEN (AUS) Pty Limited
KH040	G5 Double Locking Cap	Double locking set screw	One size only	$605.00
	Medtronic Australasia Pty Ltd
MC657	Pyramid	Pyramid Cover Plate and Set Screw	17mm - 35mm length in 2 	$605.00
	mm increments
	Nuvasive Australia and NZ  Pty Ltd
NV083	Long Lateral Fixation System 	Locking Cap	Single/Dual	$605.00
	(Locking Cap)
Prostheses List by Category, Groups and Sponsor	Page 975 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Synthes Australia Pty Ltd
SY448	Spinal Fixation System	Locking Cap	One Size	$605.00
	Corin Australia Pty Ltd
CR213	3 Lock - Locking Cap	Locking mechanism for the rods, 	one size	$605.00
	screws and hooks of the posterior 
	lumbar stabilisation system
	Zimmer Pty Ltd
ZI883	APEX Spine System - Set Screws	Apex Spine System - set screws	9.5mm, 11mm	$605.00
13.02.05 - Block/Screw head
	Advanced Surgical Design & Manufacture Ltd
AE145	Firebird Phoenix screw heads	Modular screw heads; various sizes 	Various 8-14mm	$760.00
	including reduction heads
AE147	Firebird modular pedicle screws	Modular pedicle screws (screw only) 	4.5, 5.5, 6.5, 7.5, 8.5 9.5, 	$760.00
	in various lengths and diameters. 	10.5mm; 25-100mm lengths 
	Titanium.	in 5mm increments
AE184	ICON Modular Spinal Fixation 	Multi-axial body assembly	5.5mm	$760.00
	System
	Biomet Australia Pty Ltd
BH080	Synergy/Polaris Spinal System	Variable Locking Screw Seat	5.5-6.35mm	$760.00
BH082	Synergy/Polaris Spinal System	Variable Locking Screw Reduction 	4.75-6.35mm	$760.00
	Global Orthopaedic Technology
GO235	Sierra Spinal System Occipital Clip	Occipital Clip	One size only	$760.00
	Johnson & Johnson Medical Pty Ltd
DP453	Isola Paediatric System (Stainless 	Threadless TRC - Closed  or Open 	3/16"	$760.00
	Steel)	Body without or with Rod 
DY337	Summit Cervical Rod System	Open Cable Connector	One size only	$760.00
	Medtronic Australasia Pty Ltd
MC294	Vertex Spinal System	Occipital Buttons	Bolt 6 - 30 mm Length	$760.00
MC307	Vertex Spinal System	Occipital Buttons	Nut 12mm Diameter	$760.00
Prostheses List by Category, Groups and Sponsor	Page 976 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC377	Colorado Spinal System	Colorado 2 Clamp	.	$760.00
MC434	Colorado Spinal System	Connector for Sacral & Ilio-Sacral 	One size only	$760.00
MC608	TSRH	Connector	Small, Medium, Large	$760.00
MC985	Vertex Spinal System	Connectors	Small, medium, large	$760.00
	Nuvasive Australia and NZ  Pty Ltd
NV065	SpheRx PPS (Tulip Screw)	Tulip screw	5.5mm/6.25mm	$760.00
NV086	Precept (Tulip)	Tulip screw	5.5mm/6.25mm	$760.00
	Scient'x Australia
SX005	Isobar TTL	Clamp	Snap-on, Short, Long and 	$760.00
	Monobloc
SX016	Easys	Straddler - titanium alloy	one size	$760.00
	Synthes Australia Pty Ltd
SY008	VentroFix	Clamp	Single, Double, Fracture, 	$760.00
	Left, Right
SY178	Spinal Fixation System	Pedicle screw head	5 - 6mm	$760.00
	Globus Medical Australia
LB067	BEACON™ Stabilization System 	Clamp	5.5mm and 6.35mm small, 	$760.00
	Clamp	medium, large
LB068	BEACON™ Stabilizer System 	Connector	5.5mm and 6.35mm small, 	$760.00
	Connector	medium, large, offset
13.02.06 - Cross Link Rod
	Scient'x Australia
SX015	Easys	Connector Bar - titanium	L: 40-100mm	$400.00
	Synthes Australia Pty Ltd
SY146	Universal Spine System (USS)	Cross Link Rod	40-80mm length 	$400.00
SY361	Universal Spine System (USS)	Cross Link Rod	40 - 80mm Length	$400.00
SY415	USS Micro-Crosslink	Crosslink Clamp Rod	One size only	$400.00
Prostheses List by Category, Groups and Sponsor	Page 977 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.02.07 - Hook/Clamp/Plate
	Johnson & Johnson Medical Pty Ltd
JJ921	Isola Spinal System	Jaw Clamp	1/4" & 3/16"	$400.00
	Synthes Australia Pty Ltd
SY144	Universal Spine System (USS)	Fracture Clamps	Cranial, Standard, Low 	$400.00
	Profile
SY326	Spinal Plate/Plate System AO/ASIF	Internal fixator - cross link clamp	One size only	$400.00
	 Spinal Implants
SY357	ECD - Expandable Corpectomy 	Locking clip, PEEK/Titanium	Universal	$400.00
	Device
SY359	Universal Spine System (USS)	Fracture Clamps	Cranial, Standard, Low 	$400.00
	Profile
SY382	Axon Occipital Fusion System	Occipital Clamp Titanium Alloy	1 or 2 holes	$400.00
SY414	USS Micro-Crosslink	Crosslink Clamp	One size only	$400.00
13.02.08 - Sublaminar Cable
	Zimmer Pty Ltd
ZI708	Universal Clamp	Construct consisting of hook, band 	5.5mm and 6.0mm	$820.00
	and screw which serves as a bone 
13.03.01 - In-Line
	Biomet Australia Pty Ltd
BH092	Altius Occipito-Cervico-Thoracic 	Domino Adjustable CC Left & Right	One size only	$760.00
	(OCT) System
BH144	Polaris Domino	Parallel and axial, rod to rod 	(3.5 - 6.35mm) x (3.5 - 	$760.00
	connectors, titanium alloy	6.35mm)
Prostheses List by Category, Groups and Sponsor	Page 978 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE359	EasySpine - Axial Rod Connector	A connector to join two rods together	One size only	$760.00
	 end-to-end
	Emergo Asia Pacific Pty Ltd
ER011	Denali Spinal System / In-Line 	In-line connector for linking rods	Varied	$760.00
	Fixation Connector
	Euros Orthopaedics Australia Pty Ltd
EU006	e.Spine connector	Titanium connector for rods of 	Straight (axial connexion), 	$760.00
	diameter 5.5 mm	Open domino (parallel 
	connexion), Closed domino 
	(parallel connexion)
	Global Orthopaedic Technology
GO206	Malibu Spinal System In-line 	In-line Connector	5.5mm and 6.35mm	$760.00
	Connector
GO216	Sierra Spinal System Parallel 	In-line connector	3.5-3.5 - 6.35mm	$760.00
	Connector
	Globus Medical Australia
LB028	REVERE ADDITION In-line 	Connector, in-line	5.5mm and 6.35mm	$760.00
	Connectors
LB056	REVERE ADDITION In-line Rod 	IN-line Connector with integral rod	5.5mm-6.5mm 160-200mm 	$760.00
	Connectors with Integral Rod	length
	Johnson & Johnson Medical Pty Ltd
DY184	Monarch Spinal System	Dual Rod Connectors End to End or 	4.75 to 6.35mm	$760.00
	Side by Side
DY575	Summit Sl System	Connectors - wedding bands and axial	Various	$760.00
JJ635	Expedium Spine System – Dual Rod 	Dual Rod Connector	4.75, 5.5 & 6.35mm	$760.00
	Connector
JJ917	Mountaineer Spinal System	Connectors	3.5 to 6.35mm	$760.00
JJ918	Isola Spinal System	Wedding band and domino connector	1/4" & 3/16"	$760.00
JJ920	Moss Miami Spinal System	Axial Connector	4/4mm to 5/7mm	$760.00
	Medtronic Australasia Pty Ltd
MC407	CD Horizon	Domino	3.2mm, 3.5mm, 4.5mm, 	$760.00
	5,5mm, 6.35mm
MC409	CD Horizon	Domino & Axial Connector	4.5mm, 5.5mm and 6.35mm	$760.00
Prostheses List by Category, Groups and Sponsor	Page 979 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC542	Vertex Spinal System	Connector	Length 10 - 13mm; diameter 	$760.00
	3.2 - 6.35mm
MC635	CD Horizon	Legacy In-Line Connector	Length 40-110mm	$760.00
	Nuvasive Australia and NZ  Pty Ltd
NV021	VuePoint inline connector	In-line connector	3.5mm x (3.5/4.5/6.5)mm	$760.00
NV066	Armada	In-line connector	3.5/5.5/6.25 x 5.5mm	$760.00
	Scient'x Australia
SX040	Zodiac Spinal Fixation System - 	In-line rod connector	Length: 31.75mm	$760.00
	Axial Domino rod connector
SX065	Solanas Posterior Cervico-thoracic 	Axial and parallel rod-to-rod 	For 3.3mm to 3.mm rods; For	$760.00
	Fixation System - Rod-to-Rod 	 3.3mm to 5.5mm rods
	Connector
	Stryker Australia Pty Ltd
HW386	Xia Spine System	Rod Clamp - Parallel, Axial	One size only	$760.00
	Synthes Australia Pty Ltd
SY011	VentroFix	Parallel connector	6.0/6.0mm	$760.00
SY015	CerviFix Posterior Cervical System	Parallel connector	3.5/3.5, 3.5/5.0, 3.5/6.0	$760.00
SY147	Universal Spine System (USS)	Connectors	Parallel, In-line, Transverse,	$760.00
	 SS, 15 - 25mm
SY442	Synapse	Parallel Connector	3.5/3.5-6.0mm	$760.00
	Zimmer Pty Ltd
ZI609	Optima Spinal Fixation System	Optima Spinal Fixation System - Rod 	Small, Large, 2 Hole, 3 	$760.00
	Connectors	Hole, 4 Hole
	Complex
	Johnson & Johnson Medical Pty Ltd
DP495	Isola Paediatric System (Stainless 	Growth/Tandem Connector	3/16"	$1,060.00
	Steel)
JJ792	Expedium 4.5 System Tandem 	Expedium extended growth Tandem 	40 - 80mm	$1,060.00
	Connectors	Connectors
Prostheses List by Category, Groups and Sponsor	Page 980 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR210	3 Lock - Connection element in-line	Offers a longitudinal connection 	Longitudinal	$760.00
	between rods used in posterior lumbar
	 stabilisation.
	Globus Medical Australia
LB073	ELLIPSE Stabilization System In-	Connector	3.5mm - 6.35mm	$760.00
	line Connector
LB075	ELLIPSE® Stabilization System 	Connector	3.5mm to 10.0mm - 3.5mm - 	$760.00
	Lateral Connector	6.5mm Rod
	Prism Surgical Designs Pty Ltd
PZ025	Centaur Screw System	In Line Connectors	5.5/6.35mm	$760.00
	Signature Orthopaedics
SF014	Centaur Screw System	In Line Connectors	5.5/6.35mm	$760.00
	Signature Spine
SV022	Sky Spinal Fixation System-	The connectors are part of the Sky 	3.5 x 35mm to 3.5 x 63mm for	$760.00
	Connectors	Spinal Fixation System, indicated for 	 the Axial connectors and 
	posterior intrumentation of the 	10 to 50 mm for the Lateral 
	occipital, posterior cervical and upper	connectors
	 thoracic spine.
SV026	AnyPlus Pedicle Screw System- 	The connectors are part of the 	16-29mm	$760.00
	Connectors	AnyPlus Screw Systems, intended to 
	provide immobilzation and 
	stabilization of spinal vertebrae in the
	 thoracic, lumbar and sacral regions.
	Zimmer Pty Ltd
ZI887	APEX Spine system - Rod 	Tandem rod connectors	5.5mm to 6mm diameter	$760.00
13.03.02 - Offset
	Advanced Surgical Design & Manufacture Ltd
AE142	Firebird lateral offsets	lateral offsets in lengths from 8mm-	15, 20, 25, 30, 35, 80mm; 	$760.00
	80mm. Titanium.	8mm-35mm in 3mm 
	increments
Prostheses List by Category, Groups and Sponsor	Page 981 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AE185	ICON Modular Spinal Fixation 	Offset body assembly	8, 11, 14mm	$760.00
	System
	Biomet Australia Pty Ltd
BH075	Synergy/Polaris Spinal System	Lateral Connectors (Closed Rod)	4.75 - 6.35mm	$760.00
	Device Technologies Australia Pty Ltd
DE360	EasySpine - Lateral Connector	A connector to connect the pedicle 	1 size only	$760.00
	screw and a rod in an offset position
	Emergo Asia Pacific Pty Ltd
ER010	Denali Spinal System / Offset 	Offset connector for linking rods	Varied	$760.00
	Fixation Connector
ER115	Novel/Zenius cross link	Cross Link	16-56mm	$760.00
	Global Orthopaedic Technology
GO218	Sierra Spinal System Lateral 	lateral connector	3.5mm	$760.00
	Connector
	Globus Medical Australia
LB027	REVERE ADDITION Offset 	Connector, offset	5.5mm and 6.35mm Diameter	$760.00
	Connectors	 15mm - 150mm Length
LB029	REVERE ADDITION Offset Rod 	Offset Connector with integral rod	5.5mm - 6.5 mm, 20mm - 	$760.00
	Connectors with Integral Rod	160mm length
	Johnson & Johnson Medical Pty Ltd
DP454	Isola System (Titanium)	Slotted Connectors Standard or 	1/4" & 3/16"	$760.00
	Extended or Offset or Angled or Open 
	or Twister
DP469	Isola System (Stainless Steel)	Slotted Connectors  - Standard or 	1/4" & 3/16"	$760.00
	Extended or Offset or Angled or Open 
	or Twister
DP842	Moss Miami (Stainless Steel)	Sacral Extender	5mm x 5 - 20mm length	$760.00
DP843	Moss Miami (Titanium)	Sacral Extender	5.5mm x 5 - 20mm in length	$760.00
DY094	Isola Paediatric System	Stainless Steel, Slotted Connector 	3/16"	$760.00
	Downsized
DY186	Monarch Spinal System	Band Clamp Connector	6.35 & 5.5mm	$760.00
DY342	Summit Cervical Rod System	Connectors Left or Right or Neutral	One size only	$760.00
DY519	Isola System (Stainless Steel)	Offset Connector	1/4" & 3/16"	$760.00
Prostheses List by Category, Groups and Sponsor	Page 982 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DY544	Monarch Spinal System	Slotted Connectors 	One size only	$760.00
	(Straight/Extended/Offset/Twister/Mi
	ni Offset)
DY574	Summit Sl System	Connectors	Various	$760.00
JJ607	Expedium Spine System	Lateral Connector, Open or Closed 	4.5-6.35mm x 20 -500mm 	$760.00
	with/without rod	length
JJ692	Mountaineer OCT Spinal System - 	Lateral Offset, Cable and J Hook 	One size only	$760.00
	Lateral Offset, Cable and J Hook 	Connector
	Connector
JJ739	Expedium Spine system	Open and closed Polyaxial 	5.5 x 6.35 x 20-200mm	$760.00
	connectors with or without end tab
JJ919	VSP Spinal System	Sacral Connector - Left & Right Offset	One size	$760.00
	KH NXGEN (AUS) Pty Limited
KH028	Cobra Lateral Offset Connector	Lateral Offset Connector	one size only	$760.00
	Medtronic Australasia Pty Ltd
MC376	Colorado Spinal System	Colorado 2 Connector	For 5mm rod and 5.5mm rod	$760.00
MC665	Engage	Connector	Small, Medium, Large	$760.00
MC668	CD HORIZON Spinal System - Iliac 	Iliac Lateral Connector	10mm - 60mm	$760.00
	Lateral Connector
MC676	SiLo	Lateral Connector	10-40mm	$760.00
	Nuvasive Australia and NZ  Pty Ltd
NV029	VuePoint offset connector	Offset connector	11mm, 25mm, 30mm - Offset 	$760.00
	Lateral Connector3.5mm x 
	(3.5/4.5/5.5/6.25mm) - 
	Offset Rod-to-Rod 
	connectorEyelet 
	Connector (Occipital) - One
	 Size
NV049	Armada (Offset Connectors)	Offset connector	5.5mm x 20-120mm	$760.00
	Orthotech Pty Ltd
OH350	Novel/Zenius cross link	Cross Link	16-56mm	$760.00
OH402	Ulrich Neon	Connector, including locking screw	15, 17, 19mm	$760.00
	Prism Surgical Designs Pty Ltd
PZ026	Centaur Lateral Connector, Centaur 	Cross Connector - Rod to Rod	20-500mm	$760.00
	Screw System
Prostheses List by Category, Groups and Sponsor	Page 983 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX041	Zodiac Sponal Fixation System - rod	Offset rod connector	Length: 9.2mm, 15.75mm	$760.00
	 connector, offset
SX042	Zodiac Spinal Fixation System - 	Offset connector	10mm, 15mm, 20mm, 30mm, 	$760.00
	offset connector	45mm, 60mm.
SX066	Solanas Posterior Cervico-thoracic 	Open lateral rod connector	One size only	$760.00
	Fixation System - Open Lateral Rod 
	Connector
SX067	Solanas Posterior Cervico-thoracic 	Closed Lateral Rod Connector	One size only	$760.00
	Fixation System - Closed Lateral 
	Rod Connector
	Signature Orthopaedics
SF013	Centaur Lateral Connector, Centaur 	Cross Connector - Rod to Rod	20-500mm	$760.00
	Screw System
	Stryker Australia Pty Ltd
HW391	Xia Spine System	Connector - Axial, Dual, Offset	4.5mm - 6mm	$760.00
HW392	Xia Spine System	Sacral Block	One size only	$760.00
SK250	Trio Spinal Fixation System	Titanium - Offset Connector, Two Step	Offset Connector - Small, 	$760.00
	 Locking Connector, Variable Offset 	Medium, Large
	Connector
	Synthes Australia Pty Ltd
SY012	CerviFix Posterior Cervical System	Clamp	Left, Right, Medial, Lateral, 	$760.00
	Pedicle, Lamina
SY287	USS llio-Sacral Fixation system	Transconnecting bar	One size only	$760.00
SY288	USS llio-Sacral Fixation system	Sacral clamp	One size only	$760.00
SY310	Axon Spinal System	transverse bar	one size only	$760.00
SY366	Axon Spinal System	transverse bar	one size only	$760.00
	Zimmer Pty Ltd
ZI610	Optima Spinal Fixation System	Optima Spinal Fixation System - Rod 	Various Sizes - Open & 	$760.00
	Connectors	Closed
ZI685	NexLink	Occipital Cervical Plating System	Screw Offset Connector	$760.00
Prostheses List by Category, Groups and Sponsor	Page 984 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Corin Australia Pty Ltd
CR215	3 Lock - Connection Element offset	Offers a lateral connection between 	Lateral	$760.00
	rods used in posterior lumbar 
	stabilization.
	Globus Medical Australia
LB072	ELLIPSE Stabilization System 	Connector	3.5mm to 4.0 - 6.5mm Rod	$760.00
	Parallel Connector
LB074	ELLIPSE® Stabilization System 	Connector	Std, Short, medium, long	$760.00
	Lateral Connector
	Zimmer Pty Ltd
ZI884	APEX Spine System - Closed Iliac 	Closed Iliac Lateral Connector	16mm, 21mm, 26mm, 31mm, 	$760.00
	Lateral Connector	36mm
13.03.03 - Transverse (Rod-to-Rod)
	13.03.03.01 - Fixed
	B Braun Australia Pty Ltd
BB228	S4 Spinal System	S4 Cross & Lateral Offset Connector	Rigid 7 - 41mm	$400.00
	Biomet Australia Pty Ltd
BH074	Synergy/Polaris Spinal System	Fixed Transverse Connectors	10.5 - 31.5mm	$400.00
BH093	Altius Occipito-Cervico-Thoracic 	Connector	15, 30,  45 L&R	$400.00
	(OCT) System
	Corin Australia Pty Ltd
CR212	3 Lock - CrossLink Rigid	Offers a rigid transversal connection 	15-48mm (3mm increments)	$420.00
	between rods used in posterior lumbar
	 stabilisation.
	Emergo Asia Pacific Pty Ltd
ER140	Signus MonoPoly Pedical Screw 	Cross Link-as part of Signus 	MP 0150-0038-38 mm; MP-	$420.00
	System-Cross Link	MonoPoly Pedicle Screw System 	0150-0042-42 mm;MP-
	0150-0050-50 mm
	Euros Orthopaedics Australia Pty Ltd
EU004	e.Spine Transverse Link	Titanium spine transverse link	Lengths 35, 46, 60, 70 mm	$400.00
Prostheses List by Category, Groups and Sponsor	Page 985 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO205	Malibu Spinal System Lateral 	Lateral Connector	30mm - 60mm	$400.00
	Connector
	Globus Medical Australia
LB051	ELLIPSE Occipito Cervico 	T-Connector and Locking Nut	21mm - 63mm	$400.00
	Thoracic Stabilization System
	Health Care Surgical Pty Ltd
HC010	S14 Biospine Connector	Transverse Telescopic Connector	30 - 75mm	$400.00
	Johnson & Johnson Medical Pty Ltd
DP072	Isola System (Titanium)	Modular Cross Connector  J-Hooks	4.7-6.35mm	$400.00
DP073	Isola System (Titanium)	Modular Cross Connector Plates	0 - 70mm	$400.00
DP075	Isola System (Stainless Steel)	Modular Cross Connector Plates	0 - 70mm	$400.00
DP076	Isola System (Stainless Steel)	Modular Cross Connector J-Hooks	1/4 & 3/16"	$400.00
DP450	Kaneda SR (Smooth Rod)  Anterior  	Plates	Small/Large -  Caudal or 	$400.00
	(TI)	Rostral
DP451	Kaneda SR (Smooth Rod)  Anterior  	Transverse Coupler	1/4" x 13 - 16mm	$400.00
	(TI)
DP470	Isola System (Stainless Steel)	Transverse Rod Connector or Dual 	1/4" & 3/16"	$400.00
	Rod Connector
DP499	Isola System (Titanium)	Transverse Connector or Dual Rod 	1/4" & 3/16"	$400.00
	Connector
DY100	Isola System (Stainless Steel)	Threadless TRC - Closed or Open 	1/4" & 3/16"	$400.00
	Body with or without Rod
DY306	Isola System (Titanium)	Threadless TRC - open body with or 	1/4" & 3/16"	$400.00
	without rod
DY336	Summit Cervical Rod System	Cross Connector	One size only	$400.00
DY545	Monarch Spinal System	Threaded Connector	One size only	$400.00
JJ599	Mountaineer OCT Spinal System	Transverse Connector Plate	21 - 56mm	$400.00
JJ652	Cross Connector - Expedium 	Drop and Lock One Piece Connector-	13 to 20mm	$400.00
	Anterior Spine System	Titanium
	KH NXGEN (AUS) Pty Limited
KH024	Cobra Crosslink Connector	Transverse rod connector	one size only	$420.00
KH037	G5 Crosslink Fixed	Fixed crosslink, Titanium alloy	Span 16 -26 mm	$420.00
Prostheses List by Category, Groups and Sponsor	Page 986 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	National Surgical Pty Ltd
NK011	Capless LI  Pedicle screw system - X	Titanium, lowprofile transverse 	low profile, multiple sizes, 	$400.00
	 Link cross connector - Fixed	crossconnector	25-35mm
	Nuvasive Australia and NZ  Pty Ltd
NV020	VuePoint Fixed Cross Connector	Fixed cross connector	26mm-50mm	$400.00
NV055	SpheRx II Anterior (Fixed 	Fixed connector	12-22mm	$400.00
NV063	Armada (Fixed cross connector)	Fixed cross connector	5.5mm x 20-60mm5.5mm, 	$400.00
	5.5mm-6.35mm5.5, 15mm-
	40mm x 200mm
NV100	Vuepoint (Adjustable Cross 	The VuePoint OCT System is 	One size only	$420.00
	Connector)	intended to promote fusion of the 
	cervical spine and occipito-thoracic 
	junction (Occiput-T3), and is 
	indicated for; 1: Degenerative disc 
	disease (as defined by back pain of 
	discogenic origin with degeneration 
	of the disc confimred by patient 
	history and radiographic studies), 2: 
	Degenerative spondylolisthesis with 
	objective evidence of neurologic 
	impairment, 3: Fractur/Dislocation, 4: 
	Spinal Stenosis, 5: Atlantaxial 
	fracture with instability, 6; 
	Occipitocervical dislocation, 7: 
	Spinal tumor and/or 8: revision of 
	previous cervical spine surgery
	Orthotech Pty Ltd
OH308	Cosmic implant system	Cosmic Cross Links - titanium Bonit 	cosmic transversal 	$400.00
	coating	stabilizer, drop on left
	cosmic transversal 
	stabilizer, drop on right
	Stryker Australia Pty Ltd
SK227	Oasys-Occipito Cervico Thoracic 	Ti-6A1-4V	Transverse Connector; 	$400.00
	System	Offset Connector; Rod to 
	Rod Connector
SK241	Xia Spinal System	Titanium or Stainless Steel Cross 	15-20mm	$400.00
	Connector
Prostheses List by Category, Groups and Sponsor	Page 987 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI661	Nex-Link	Spinal Fixation System, Transverse 	4.00mm Rod x 25mm - 45 	$400.00
	Connectors	length; 4.00mm Rod x 
	4.00mm & 5.5mm (band), 
	4.00mm Rod x 4.00 &5.5mm 
	(inline)
ZI885	APEX Spine System - Fixed Cross 	Fixed length cross connector, titanium	16mm, 19mm, 22mm, 25mm, 	$420.00
	Connector	28mm
	13.03.03.02 - Adjustable
	Advanced Surgical Design & Manufacture Ltd
AE159	Spinal Fixation System	Multi Axial Cross Connector 	30mm - 75mm in 5mm 	$1,350.00
	Assembly - Titanium/Lateral Offset	increments
AE176	Blackstone - Posterior Cervical 	Cross-Connector	20, 25, 30, 35, 40, 45, 50mm	$1,350.00
	System
	B Braun Australia Pty Ltd
BB229	S4 Spinal System	S4 Cross, Rod & Cable Connector - 	Variable 28 - 75mm	$1,350.00
	Titanium
	Biomet Australia Pty Ltd
BH073	Synergy/Polaris Spinal System	Adjustable Transverse Connector 	3 - 6cm	$1,350.00
	With Rod/Clamp
BH088	Array Spinal System	Titanium Alloy Modular Spinal 	Large, Medium, Small, 	$1,350.00
	System - cross connector	Xsmall, 24mm, 22mm, 20mm, 
	18mm, 16mm
	Corin Australia Pty Ltd
CR211	3 Lock - Crosslink Modular	Offers a modular transversal 	30-38mm; 37-52mm; 50-	$1,350.00
	connection between rods used in 	70mm
	posterior lumbar stabilisation.
	Device Technologies Australia Pty Ltd
DE358	EasySpine - Transverse 	Connectors with open or closed ends 	Transverse connection, 	$1,350.00
	connecting two rods together; can 	open; transverse connection
	slide for full adjustability
DE361	EasySpine - Transverse 	Transverse connections that are 	30-49mm; 50-69mm; 70-	$1,350.00
	Connections, Evolution	adjustable and connect two rods 	89mm
	together
Prostheses List by Category, Groups and Sponsor	Page 988 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE379	Spine Tune TL - Cross Connector	This component is a connector that 	Cross Connector - 33-40mm	$1,350.00
	links/fixates two rods together.	
	Cross Connector - 40-50mm
	
	Cross Connector - 50-60mm
	Emergo Asia Pacific Pty Ltd
ER019	Mesa Spinal System / Natural 	Transverse Connector	Mini: 14mm-22mm, Small: 	$1,350.00
	Bridge Transverse Connector	38mm-43mm, Medium: 
	43mm-53mm, Large: 53mm-
	73mm, X-Large: 73mm-
	93mm
	Global Manufacturing Technology Pty Ltd
GM155	SOCORE Spinal System - Crosslink	Crosslink	45mm, 55mm, 65mm	$1,350.00
	Global Orthopaedic Technology
GO210	Malibu Spinal System CrossBar	CrossBar	5.5mm and 6.35mm diameter 	$1,350.00
	rods 23mm - 75mm length 
	options
GO222	Sierra Spinal System CrosBar	CrossBar	Small, medium, large, x-large	$1,350.00
	Globus Medical Australia
LB026	REVERE Cross Connectors	Cross Connectors	5.5mm 29mm-91mm	$1,350.00
	6.35mm 29mm-90mm
LB030	REVERE H-LINK	Transverse Connector with integral 	5.5mm - 6.35mm Rod with 	$1,350.00
	Rods	38mm - 71mm transverse 
	connector and 40 - 45mm 
LB057	ELLIPSE Stabilization System, Top	T-Connector	21mm - 56mm	$1,350.00
	 Loading T-Connector
	Health Care Surgical Pty Ltd
HC012	S14 Biospine Connector Bar and 	Connector Bar and Blocker	40mm, 60mm, 80mm	$1,350.00
	Blocker
	Implament
IB002	Vertefix ll Locking screw	Transverse connector rod system	One size only	$1,350.00
	Johnson & Johnson Medical Pty Ltd
DP301	Moss Miami (Stainless Steel)	Transverse Connector - Complete	One size only	$1,350.00
DP412	Moss Miami (Titanium)	Transverse Connector - Complete	One size only	$1,350.00
JJ766	Expedium SFX Cross Connector 	Fixed Length Cross Connector	15mm - 36mm Length, 4.5, 	$1,350.00
	System	5.5, 6.35mm rod diameter
Prostheses List by Category, Groups and Sponsor	Page 989 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ767	Expedium SFX Cross Connector 	Variable Length Cross Connector	26mm - 100 mm Length, 4.5, 	$1,350.00
	System	5.5, 6.35mm rod diameter
MN044	Crossover System (Titanium)	Crossover connector	Size 1 - 12, 18 - 107mm	$1,350.00
	KH NXGEN (AUS) Pty Limited
KH036	G5 Crosslink Adjustable	Adjustable crosslink (Straight or 	Straight or curved; Span 28 	$1,350.00
	curved), titanium alloy	-70mm
	Lifehealthcare Pty Ltd
LH517	DSS HPS Cross Connector	Complete system of clamps, set screws 	40 - 66mm gap	$1,350.00
	and connector bar, Titanium
	Matrix Medical Innovations
BF007	Smartloc Spinal Fixation 	Cross link for Smartloc Spinal 	Telescopes to 70mm	$1,350.00
	System/Transverse Link	Fixation System
	Medacta Australia Pty Ltd
MU124	M.U.S.T LINK - Cross Connector	Cross Connector	35-98 mm	$1,350.00
	Medtronic Australasia Pty Ltd
MC408	CD Horizon	Crosslink, Plate, Multi-span late, 	60 - 200mm	$1,350.00
	Offset plate, Transverse links
MC496	Tenor	Transverse Links - Titanium	40-100mm	$1,350.00
MC590	Vertex Reconstruction System 	Composition -  titanium alloy. The 	One size only	$1,350.00
	Crosslink Bar	system allows for the adaptation of 
	components from other Sofamor Danek
	 systems to provide for constructs 
	tailor made for individual cases.
MC634	CD HORIZON Spinal System - X10 	X10 CROSSLINK Plate	Multi-Span Plate: 25-81mm	$1,350.00
	CROSSLINK
MC708	CD HORIZON Spinal System - X10 	X10 CROSSLINK Plate	Fixed Plate: 16mm - 40mm	$1,350.00
	CROSSLINK
	National Surgical Pty Ltd
NK012	Capless LI  Pedicle screw system - X	Titanium, lowprofile transverse dual 	Low profile, Multiple sizes, 	$1,350.00
	 Link cross connector - Variable	articulation crossconnector	37-80mm
	Nuvasive Australia and NZ  Pty Ltd
NV003	SpheRx	Transverse X-Connector	45 - 100mm	$1,350.00
NV047	Armada	Arch, adjustable transverse connector	20-70mm	$1,350.00
Prostheses List by Category, Groups and Sponsor	Page 990 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH407	Ulrich Neon Cross link system	Cross link system, consisting of 	one size	$1,350.00
	xplate, hook and locking plate
OH412	Ulrich Spine System Cross Link	Cross Link	50-105mm	$1,350.00
	Prism Surgical Designs Pty Ltd
PZ027	Centaur Cross Connector, Centaur 	Cross Connector - rod to rod - 	10mm - 90mm	$1,350.00
	Screw System	Adjustable
	Scient'x Australia
SX038	Zodiac Spinal Fixation System - 	Crosslink: adjustable bridge	xx-small, x-small, small, 	$1,350.00
	adjustable bridge	medium, large.Diameter: 
	5.5mm; Length: 23-75mm
SX068	Solanas Posterior Cervico-thoracic 	Adjustable bridge	26mm: adjustable length 	$1,350.00
	Fixation System - Adjustable Bridge	from 22mm to 26mm; 37mm: 
	adjustable length from 
	27mm to 39mm; 60mm: 
	adjustable length from 
	40mm to 60mm
	Signature Orthopaedics
SF015	Centaur Cross Connector, Centaur 	Cross Connector - rod to rod - 	10mm - 90mm	$1,350.00
	Screw System	Adjustable
	Signature Spine
SV023	Sky Spinal Fixation System -	Crosslink is part of the Sky Spinal 	3.5 x 30mm to 3.5 x70mm	$1,350.00
	Fixation System, indicated for 
	posterior intrumetation of the 
	occipital, posterior cervical and upper
	Stryker Australia Pty Ltd
HW390	XIA Spine System	Cross Link	Length 20mm - 99mm	$1,350.00
	Synthes Australia Pty Ltd
SY250	Universal Spine System	Low Profile Transconnector	18-83mm length	$1,350.00
SY398	Axon Spinal System - 	Axon Transconnector	60mm - 75mm	$1,350.00
SY569	Spinal Fixation System	Matrix Snap-on Transconnector	21mm - 90mm Length	$1,350.00
	Zimmer Pty Ltd
ZI510	Optima Spinal System - Transverse 	Transverse Link Assembly	Small, Medium, Large	$1,350.00
	Link Assembly
Prostheses List by Category, Groups and Sponsor	Page 991 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI623	SEQUOIA PEDICLE SCREW 	SpeedLink II Ti	Small, Medium, Large	$1,350.00
	SYSTEM
ZI886	APEX Spine System - Multi-Span 	Adjustable length cross connector, 	24-28mm, 28-33mm, 31-	$1,350.00
	Cross Connector	titanium	39mm, 37-50mm, 48-71mm
13.04.01 - Hook
	Advanced Surgical Design & Manufacture Ltd
AE168	Blackstone - Posterior Hook	Titanium	Large/Angled/Offset/Left/R	$820.00
	ight/Narrow/Wide/Thoracic
	Laminar/Lumbar Laminar
	B Braun Australia Pty Ltd
BB002	Aesculap Hook System	Laminar Hook, Left & Right	Thick & Thin	$820.00
	Biomet Australia Pty Ltd
BH071	Synergy Spinal System	Open/Closed Offset Hooks	4mm	$820.00
BH072	Synergy Spinal System	Open/Closed Hooks Pedicle/Laminar	4.75 - 6.35mm dia	$820.00
BH089	Array Spinal System	Titanium Alloy Modular Spinal 	one size	$820.00
	System - laminar hook and pedicle 
BH095	Altius Occipito-Cervico-Thoracic 	Hook and OC Screws	Hook:  12mm to 14mm 	$820.00
	(OCT) System	(L&R), OC Screws: 6mm to 
	20mm
BH099	Synergy Spinal System	Infant Hooks	4.75mm	$820.00
	Device Technologies Australia Pty Ltd
DE352	EasySpine - Laminar and Pedicle 	Right under laminar hook, left under 	1 size only for Right under 	$820.00
	Hooks	laminar hook, right alpha pedicle 	laminar hook, left under 
	hook and left alpha pedicle hook for 	laminar hook, right alpha 
	EasySpine spinal fusion system.	pedicle hook and left alpha 
	pedicle hook
	Emergo Asia Pacific Pty Ltd
ER012	Denali Spinal System / Closed 	Thoracic and Lumbar Closed Hooks	Various blade and throat 	$820.00
	sizes
ER013	Denali Spinal System / Open Hook	Thoracic and Lumbar Open Hooks	Various blade and throat 	$820.00
	sizes
ER028	Caspian OCT Spinal System - Hook	cervico-thoracic posterior rigid 	3.5mm Posterior Cervical 	$820.00
	fixation system	hook
Prostheses List by Category, Groups and Sponsor	Page 992 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Euros Orthopaedics Australia Pty Ltd
EU003	e.Spine Hook	Titanium Spine hook	Transverse process. 	$820.00
	Pedicular, Lumbar laminar, 
	Thoracic laminar, Right 
	offset lumbar laminar, Left 
	offset lumbar laminar and 
	raised body lumbar laminar 
	hook, Progressive blade 
	(small, medium, large), 
	Pedicle (small, medium, 
	large), Reduced blade 
	(small, medium, large), Large
	 blade (small, medium, 
	large), and Laminar (Left 
	offset - Reduced, Right offset
	 - Reduced)
	Global Manufacturing Technology Pty Ltd
GM153	SOCORE Spinal Spinal - Hooks, 	Hooks, Pedicle/Laminar	Standard, Medium and 	$820.00
	Pedicle/Laminar
	Global Orthopaedic Technology
GO207	Malibu Spinal System Hooks	Hook	5.5mm x 5.5mm - 9.0mm x 	$820.00
	9.5mm
GO221	Sierra Spinal System, Hooks	Hooks	4.0mm and 6.0mm	$820.00
	Globus Medical Australia
LB025	REVERE Hooks	Hook - various	small, medium, large	$820.00
LB049	ELLIPSE® Stabilization System 	Hooks	5 - 7mm	$820.00
	Hooks
	Johnson & Johnson Medical Pty Ltd
DP299	Moss Miami (Stainless Steel)	Hooks - Pedicle	One size only	$820.00
DP300	Moss Miami (Stainless Steel)	Hooks - Laminar as Wide or Narrow 	Various Sizes	$820.00
	or Angled or Reduced Distance 
	Supra-laminar or Offset or Extended 
DP329	Moss Miami (Stainless Steel)	Hooks - Translation 	One size only	$820.00
	(Pedicle/Reduced 
DP410	Moss Miami (Titanium)	Hooks - Pedicle	3-5 mm	$820.00
Prostheses List by Category, Groups and Sponsor	Page 993 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DP411	Moss Miami (Titanium)	Hooks - Laminar as Wide or Narrow 	One size only	$820.00
	or Angled or Reduced Distance 
	Supra-laminar or Offset or Extended 
DP418	Moss Miami (Titanium)	Hooks - Translation	One size only	$820.00
DP464	Isola System (Titanium)	Closed Hooks	1/4" x 3/16" x 5-11mm	$820.00
DP465	Isola System (Titanium)	Open Hook and / or Cap	1/4" & 3/16" x 3.5-11mm	$820.00
DP471	Isola System (Stainless Steel)	Closed Hooks	1/4" & 3/16" x 3.5-11mm	$820.00
DP472	Isola System (Stainless Steel)	Open Hook Cap or Open	1/4" & 3/16" x 5-11mm	$820.00
DP487	Isola Paediatric System (Stainless 	Side Tightening Hook - 	3/16" x 3.5mm - 11mm	$820.00
	Steel)
DP845	Moss Miami 4mm Anterior System 	Hooks	4mm	$820.00
	(SS)
DY178	Monarch Spinal System	Hooks - Closed (Narrow Tapered / 	5 - 11 mm	$820.00
	wide Blade)
DY185	Monarch Spinal System	Plate J-Hooks	3.5 - 11 mm	$820.00
DY304	Monarch Spinal System	Hooks - Open (Pedicle/Narrow 	5-11mm	$820.00
	Tapered/Wide Blade)
DY344	Summit Cervical Rod System	Transverse Connector Hook	One size only	$820.00
DY438	Expedium Spine System	Hooks, Right, Left, Angled, Offset, 	4.25 - 12mm including 	$820.00
	Extended, Reduced Bladed	narrow - wide
JJ595	Mountaineer OCT Spinal System	CT Hook	3.5mm - Small, Medium, 	$820.00
	Large
JJ761	Moss Miami (Titanium)	Slotted Hook	One Size	$820.00
JJ765	Moss Miami (Stainless Steel)	Slotted Hook	One Size	$820.00
	KH NXGEN (AUS) Pty Limited
KH031	Cobra Laminar Hook	Laminar Hook	Standard size extended	$820.00
	Medtronic Australasia Pty Ltd
MC375	Colorado Spinal System	Open Hooks	5.5mm - 6.35mm	$820.00
MC397	TSRH Spinal Implant System	3D - Hook, Offset, left, right, laminar, 	Large - small	$820.00
	pedicle, Stainless steel, Titanium
MC406	CD HORIZON Spinal System - 	Hook - various	Extra Small - Large	$820.00
MC591	Vertex Reconstructive System 	Composition -  titanium alloy	4.5 - 6.0mm	$820.00
	Laminar Hook
Prostheses List by Category, Groups and Sponsor	Page 994 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC677	SiLo	Hook	Right, left, front	$820.00
MC724	Colorado Spinal System	Closed Hooks	5.5mm-6.35mm	$820.00
	Nuvasive Australia and NZ  Pty Ltd
NV004	SpheRx	Hooks	one size	$820.00
NV030	VuePoint hook (laminar)	Hook (laminar)	5.0mm, 7.0mm	$820.00
NV058	Armada (Hook - Various)	Hook	Pedicle - Small/Medium, 	$820.00
	5.5mmLamina - 
	6/8/10mm x 5.5mm
	Angled - 5.5mmOffset - 
	5.5mm
	Orthotech Pty Ltd
OH403	Ulrich Neon Atlas claw	Atlas claw - consisting of hook, 	One size	$820.00
	counter part and locking screw.
	Prism Surgical Designs Pty Ltd
PZ028	Centaur Hook, Centaur Screw 	Open hook	various	$820.00
	Scient'x Australia
SX006	Isobar TTL	Hooks	Small, Large, offset	$820.00
SX039	Zodiac Spinal Fixation System - hook	Hooks: laminar, thoracic, pedicle; 	Small, large	$820.00
	offset and angled; narrow and elevated
SX069	Solanas Posterior Cervico-thoracic 	Hook	Depth of hook throat: 	$820.00
	Fixation System - Hook	4.5mm and 6.00mm
	Signature Orthopaedics
SF012	Centaur Hook, Centaur Screw 	Open hook	various	$820.00
	Signature Spine
SV004	Romeo Pedicle System Hooks	Titanium alloy	One size	$820.00
	Stryker Australia Pty Ltd
HW405	Xia Spine System	Hooks	Laminar and Pedicle Hooks	$820.00
SK222	Oasys-Occipito Cervico Thoracic 	Ti-6A1-4V	Hook, Standard Short; 	$820.00
	System	Hook, Standard Tall; Hook, 
	Offset, Right; Hook Offset, 
	Synthes Australia Pty Ltd
SY013	CerviFix Posterior Cervical System	Hook	Small, Large, Left, Right	$820.00
SY039	Spinal Plate/Plate System AO/ASIF	Spondylolysis hook screw (complete)	Screw 45 - 60mm	$820.00
	 Spinal Implants	 small & large
Prostheses List by Category, Groups and Sponsor	Page 995 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY306	Pangea Spinal System	Pedicle and Lamina Hooks	Extra small to Extra Large	$820.00
SY325	Universal Spine System	Hook	Small, Medium, Large, 	$820.00
	Lamina, Thoracic, Pedicle
SY443	Synapse	Lamina Hook, Top Loading	right, left, straight, short, 	$820.00
SY568	Spinal Fixation System	Pedicle and Lamina Hooks, straight, 	Small, Medium, Large	$820.00
	angled, off-set
	Zimmer Pty Ltd
ZI527	Optima Spinal Fixation System - 	Titanium Alloy	Various	$820.00
	Hooks
ZI662	Nex-Link	Spinal Fixation System, Cervical 	5 & 7mm	$820.00
	Corin Australia Pty Ltd
CR209	3 Lock - Hook	Various sized hooks for the posterior 	thoracic, lumbar wide-blade,	$820.00
	lumbar stabilisation	 lumbar narrow-blade, 
	angled-blade, pedicle, 
	extended body, angled right

	angled left, offset right, 
	Zimmer Pty Ltd
ZI888	APEX Spine System - Hooks	Laminar and Offset titanium hooks	5.0mm - 9.5mm	$820.00
13.05.01 - Integral Fixation
	13.05.01.01 - Cervical
	Advanced Surgical Design & Manufacture Ltd
AE195	Blackstome Medical Inc Anterior 	Titanium alloy plate L1-L2	22mm - 54mm	$1,400.00
	Cervical Plate System
AE201	Blackstone Medical ACP - Level 1 	Titanium Alloy ACP L1-L2	22mm - 54mm	$1,400.00
	& 2
	Australian Pacific Medical Pty Ltd
PB003	Delta Plate	Anterior cervical plate	Length: 16-22mm	$1,400.00
	Biomet Australia Pty Ltd
BH107	Anterior Cervical Plate System	Titanium Locking Plate	20 - 140mm	$1,400.00
Prostheses List by Category, Groups and Sponsor	Page 996 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE385	C-Plate Cervical Plates 22-54mm	C-Plate Anterior Cervical Plates are 	Lengths 22 to 54mm in 	$1,400.00
	inserted via an anterior approach to 	increments of 2mm
	the cervical spine, in order to fix one 
	or two levels of verterbrae together. 
	Such fixation is performed to cause 
	bony fusion between levels and is 
	done in order to address pain, 
	instability, and/or a range of other 
	indications. The C-Plate System 
	consists of low-profile (1.6mm thick) 
	pre-contoured plates of varying sizes 
	and a full range of screws. The plates 
	themselves contain an innovative 
	screw-locking mechanism utilising an
	 elastic locking ring which allows the
	 surgeon choice between semi-fixed or 
	variable-angle self-tapping screws.
	Euros Orthopaedics Australia Pty Ltd
EU008	E.C.P. anterior cervical plate	Titanium anterior cervical plate	15 lengths of plates from 	$1,400.00
	24mm to 94mm
	24mm 4 holes
	26mm 4 holes
	29mm 4 holes
	32mm 4 holes
	35mm 6 holes
	39mm 6 holes
	43mm 6 holes
	49mm 6 holes
	55mm 6 holes
	60mm 8 holes
	66mm 8 holes
	69mm 8 holes
	77mm 10 holes
	89mm 10 holes
	94mm 12 holes
	Globus Medical Australia
LB015	VIP Anterior Cervical Plate	Anterior Cervical Plate	13mm - 46mm	$1,400.00
LB038	XTEND Anterior Cervical Plate	Anterior Cervical Plate	10mm - 54mm	$1,400.00
LB039	XTEND Anterior Cervical Plate 	Anterior Cervical Plate >55mm	57mm - 104mm	$1,400.00
	>55mm
Prostheses List by Category, Groups and Sponsor	Page 997 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LB040	XTEND Anterior Cervical Extender 	Anterior Cervical Extender Plate	10mm - 46mm	$1,400.00
	Plate
	Health Care Surgical Pty Ltd
HC013	Origin System	Cervical Plate	L:22-72mm	$1,400.00
	Johnson & Johnson Medical Pty Ltd
DY522	Slim-loc Anterior Cervical Plate 	Plates - various levels	22-55mm	$1,400.00
	System
DY523	Swift Spine System	Titanium Anterior Cervical Plate 	15 - 55mm	$1,400.00
	System - Various size plates
DY524	Uniplate Spinal System	Titanium Anterior Cervical Plate	13-55mm	$1,400.00
DY525	Swift Spine System	Titanium Anterior Cervical Plate 	46-55mm	$1,400.00
	System - Corpectomy Plate
JJ793	Eagle/Eagle Plus Anterior Cervical 	Anterior Cervical Plate	12-55mm	$1,400.00
	Plate
JJ800	Skyline Cervical Plate System	Skyline anterior cervical plate. 	12-55mm	$1,400.00
	Various size plates, Titanium
	KH NXGEN (AUS) Pty Limited
KH018	Ceres Anterior Cervical Plate 	Anterior Cervical Plate<55mm	22 -54mm	$1,400.00
	Lifehealthcare Pty Ltd
LH430	Blackstone Medical ACP - Level 1 	Titanium Alloy ACP L1-L2	22mm - 54mm	$1,400.00
	& 2
LH487	Slimfuse Cervical Plate System - 	Low profile, narrow, scalloped, 	Length: 10mm to 44mm	$1,400.00
	anterior cervical titanium plate
	Medtronic Australasia Pty Ltd
MC346	Venture Anterior Cervical Plate	Single or multi level plate, titanium 	20mm - 50mm	$1,400.00
	alloy and Nitinol
MC418	Atlantis Anterior Cervical Plate	Plate	19.0mm -  47.5mm	$1,400.00
MC419	Atlantis Anterior Cervical Plate	Anterior Cervical Plate	50mm - 55mm	$1,400.00
MC706	Venture Anterior Cervical Plate	Single or multi level plate, titanium 	52.5mm - 55mm	$1,400.00
	alloy and Nitinol
MC863	Zephir Anterior Cervical Plate	Anterior Cervical Plate	22.5mm - 55mm	$1,400.00
MC865	Premier Anterior Cervical Plate	Anterior Cervical Plate	23mm - 55mm	$1,400.00
MC999	Atlantis Anterior Cervical Plate 	Translational Anterior Cervical Plate	19mm - 55mm	$1,400.00
	System - Plate
Prostheses List by Category, Groups and Sponsor	Page 998 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	National Surgical Pty Ltd
NK013	Spider Cervical Plating System - 	Titanium, Anterior Cervical Plate 	22-54mm	$1,400.00
	Spider Plate	System -
NK018	Easy Plate - anterior Cervical Plate 	Anterior cervical plate	17mm to 50mm	$1,400.00
	<55mm
	Nuvasive Australia and NZ  Pty Ltd
NV008	Gradient Cervical Plates	Titanium Anterior Plate	11 - 110mm	$1,400.00
NV068	Helix-Revolution (Plate 20-54mm)	Anterior Cervical Plate	20-54mm	$1,400.00
NV091	Helix-T (Plate 20-54mm)	Anterior cervical plate	20-54mm	$1,400.00
NV097	Archon Plate (18 -55mm) plus 	The Archon ACP system, of which the	Plate 18-55mm plus 	$1,400.00
	Locking Cover	 plate (18-55mm) and locking cover 	Locking Cover standard, 
	are components, is intended for 
	anterior screw fixation of the cervical 
	spine. These implants have been 
	designed to provide stabilisation as 
	an adjunct to cervical fusion.
	Orthofix Australia Pty Limited
OF003	Azure Anterior Cervical Plate	Anterior Cervical Plate <55mm	18-54mm length	$1,400.00
	Orthotech Pty Ltd
OH063	Anterior Cervical Plate System	Titanium Locking Plate	20 - 140mm	$1,400.00
	Prism Surgical Designs Pty Ltd
PZ029	Pegasus Plate System, Pegasus 	Anterior Cervical Plate	1 level plate (13mm-22mm), 	$1,400.00
	2 level plate (28mm-40mm)
PZ030	Aquila Plate System	Anterior Cervical Plate	1 level and 2 level plates 	$1,400.00
	(21 - 55mm Length)
	Scient'x Australia
SX008	Antelys	Plate	H: 19-23mm	$1,400.00
SX011	Stella	Anterior cervical plate - titanium	L: 21-121mm	$1,400.00
SX052	Trestle Anterior Cervical Plating 	Titanium alloy anterior cervical plate	12mm - 54mm	$1,400.00
	System - Plate
SX074	Trestle Luxe Anterior Cervical 	Anterior cervical plate	1 level plates: 10, 12, 14, 	$1,400.00
	Plating System - Plate	16, 20, 22, 24, 26mm; 2 
	level plates: 24, 26, 28, 30, 
	32, 34, 37, 40, 43, 46mm; 3 
	level plates: 39, 42, 45mm
Prostheses List by Category, Groups and Sponsor	Page 999 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Signature Orthopaedics
SF017	Pegasus Plate System, Pegasus 	Anterior Cervical Plate	1 level plate (13mm-22mm), 	$1,400.00
	2 level plate (28mm-40mm)
SF051	Aquila Plate System	Anterior Cervical Plate	1 level and 2 level plates 	$1,400.00
	(21 - 55mm Length)
	Stryker Australia Pty Ltd
HW408	Aviator Anterior Cervical Plating 	Anterior Cervical Plate - Integral 	One, two and three level up 	$1,400.00
	System - Plate	Locking	to 55mm in length
SR085	Reflex Anterior Cervical Plate System	Plate	≤55mm	$1,400.00
	Synthes Australia Pty Ltd
SY459	Vectra T Anterior Spinal System	Titanium	≤55	$1,400.00
SY520	Vectra Anterior Spinal System	Cervical Plate	≤55	$1,400.00
	Zimmer Pty Ltd
ZI489	Trinica Select Anterior Cervical Plate	Titanium plate for anterior cervical 	Plates for 1 or 2 levels are 	$1,400.00
	spine. Used to assist spinal fusion.  	from 22 to 52mm long in 
	Attached to the bone using screws.	2mm increments; Plates for 3
	 levels are from 51-72mm 
	long in 3mm increments
	>55m
	Nuvasive Australia and NZ  Pty Ltd
NV092	Helix-T (Plate 56 - 110mm)	Anterior cervical plate	56-110mm	$1,700.00
	>55mm
	Advanced Surgical Design & Manufacture Ltd
AE156	Blackstone Medical Inc Anterior 	Titanium alloy plate L3	56mm - 90mm	$1,700.00
	Cervical Plate System
AE199	Blackstone Medical ACP - 3 Level	Titanium Alloy Anterior Cervical 	56mm - 90mm	$1,700.00
	Plate - 3 Level
Prostheses List by Category, Groups and Sponsor	Page 1000 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Device Technologies Australia Pty Ltd
DE386	C-Plate - Cervical Plates 56-70mm	C-Plate Anterior Cervical Plates are 	Lengths: 56 to 70mm in 	$1,700.00
	inserted via an anterior approach to 	increments of 2mm
	the cervical spine, in order to fix one 
	or two levels of vertebrae together. 
	Such fixation is performed to cause 
	bony fusion between levels and is 
	done in order to address pain, 
	instability, and/or a range of other 
	indications. The C-Plate System 
	consists of low-profile (1.6mm thick) 
	pre-contoured plates of varying sizes 
	and a full range of screws. The plates 
	themselves contain an innovative 
	screw-locking mechanism utilising an
	 elastic locking ring which allows the
	 surgeon choice between semi-fixed or 
	variable-angle self-tapping screws.
	Johnson & Johnson Medical Pty Ltd
DY299	Slim-loc Anterior Cervical Plate 	Plates - three level	56-78mm	$1,700.00
	System
DY529	Swift Spine System	Titanium Anterior Cervical Plate 	56 - 115mm	$1,700.00
	System - Corpectomy Plate
JJ527	Eagle/Eagle Plus Anterior Cervical 	Anterior Cervical Plate	56-100mm	$1,700.00
	Plate
JJ801	Skyline Cervical Plate System	Skyline anterior cervical plate. 	56-105mm	$1,700.00
	Various size plates. Titanium
	KH NXGEN (AUS) Pty Limited
KH019	Ceres Anterior Cervical Plate 	Anterior Cervical Plate >55mm	57-78mm	$1,700.00
	Lifehealthcare Pty Ltd
LH386	Blackstone Medical ACP - 3 Level	Titanium Alloy Anterior Cervical 	56mm - 90mm	$1,700.00
	Plate - 3 Level
	Medtronic Australasia Pty Ltd
MC858	Atlantis Anterior Cervical Plate	Anterior Cervical Plate	57.5mm - 110mm	$1,700.00
MC859	Venture Anterior Cervical Plate	Single or multi level plate, titanium 	57.5mm - 150mm	$1,700.00
	alloy and Nitinol
MC864	Zephir Anteior Cervical Plate	Anterior Cervical Plate	57.5mm - 70mm	$1,700.00
Prostheses List by Category, Groups and Sponsor	Page 1001 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC866	Premier Anterior Cervical Plate	Anterior Cervical Plate	57.5mm - 90mm	$1,700.00
MI056	Atlantis Anterior Cervical Plate 	Translational Anterior Cervical Plate	57.5mm - 85mm	$1,700.00
	System - Plate
	National Surgical Pty Ltd
NK014	Spider Cervical Plating System - 	Titanium, anterior cervical plate 	56-77mm	$1,700.00
	Spider Plate
NK019	Easy Plate - Anterior Cervical Plate 	Anterior cervical plate	60mm to 90mm	$1,700.00
	>55mm
	Nuvasive Australia and NZ  Pty Ltd
NV069	Helix-Revolution (plate 56-110mm)	Anterior Cervical Plate	56-110mm	$1,700.00
NV098	Archon Plate (56 - 110mm) plus 	The Archon system, of which the plate	Plate 56-110mm plus 	$1,700.00
	Locking Cover	 (56-110mm) and locking cover are 	Locking Cover standard, 
	components, is intended for anterior 	wide
	screw fixation of the cervical spine. 
	These implants have been designed to 
	provide stabilisation as an adjunct to 
	cervical fusion.
	Orthofix Australia Pty Limited
OF004	Azure Anterior Cervical Plate System	Anterior Cervical Plate > 55mm	56-120mm length	$1,700.00
	Prism Surgical Designs Pty Ltd
PZ031	Aquila Plate System	Anterior Cervical Plate	2, 3 and 4 level cervical 	$1,700.00
	plates (55m - 109mm length)
	Scient'x Australia
SX053	Trestle Anterior Cervical Plating 	Titanium alloy anterior cervical plate	57mm - 100mm	$1,700.00
	System - plate >55mm
SX075	Trestle Luxe Anterior Cervical 	Anterior cervical plate	3 level plates: 48, 51, 54, 	$1,700.00
	Plating System - plate, >55mm	57, 60, 63, 66, 69mm. 4 level
	 plates: 60, 64, 68, 72, 76, 
	80, 84mm. 5 level plates: 85,
	 90, 95, 100mm
	Signature Orthopaedics
SF052	Aquila Plate System	Anterior Cervical Plate	2, 3 and 4 level cervical 	$1,700.00
	plates (55m - 109mm length)
	Stryker Australia Pty Ltd
HW407	Aviator Anterior Cervical Plating 	Anterior Cervical Plate - Integral 	Three and four level greater 	$1,700.00
	System - Plate longer than 55mm	Locking	than 55mm in length
Prostheses List by Category, Groups and Sponsor	Page 1002 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SR084	Reflex Anterior Cervical Plate System	Plate	>55mm	$1,700.00
	Synthes Australia Pty Ltd
SY458	Vectra T Anterior Spinal System	Titanium	>55	$1,700.00
SY519	Vectra Anterior Spinal System	Cervical Plate	>55	$1,700.00
	13.05.01.02 - ThoracoLumbar / Lumbar / Lumbosacral
	Advanced Surgical Design & Manufacture Ltd
AE188	Unity Lumbar Plate	Unity Plate	17-28mm	$2,200.00
	Emergo Asia Pacific Pty Ltd
ER024	Cayman Thoracolumbar Plate 	A thoracolumbar plate system 	22mm to 109mm	$2,200.00
	System / Plate	consisting of plates of various lengths
	 and sizes and a range of fixation 
	Global Orthopaedic Technology
GO248	Balboa Anterior Buttress Plate	An anterior intravertebral screw 	Two sizes. 19mm x 15mm or 	$2,200.00
	fixation device	15mm x 24mm. Thickness 
	tapers from 3.1mm at the top 
	to 2.2mm at the bottom end 
	of the plate.
	Globus Medical Australia
LB008	TRUSS® Thoracolumbar Plate with 	Thoracolumbar plate	45mm-99.5mm	$2,200.00
	slider
LB009	TRUSS® Thoracolumbar Plate	Thoracolumbar plate	22mm - 55mm	$2,200.00
LB012	CITADEL® Anterior Lumbar Plate	Anterior Lumbar plate	20mm - 99mm length	$2,200.00
	Johnson & Johnson Medical Pty Ltd
DP828	Profile Anterior Thoracolumbar 	Plates - Thoracolumbar	50 - 120mm	$2,200.00
	Plate System
DP829	Profile Anterior Thoracolumbar 	Plates - High Thoracic	40 - 110mm 	$2,200.00
	Plate System
JJ518	AEGIS ALP	Curved anterior lumbar plate	4-25mm	$2,200.00
	Medtronic Australasia Pty Ltd
MC610	Vantage	Vantage plates and Screws; Thoracic 	3.5 - 8cm	$2,200.00
	Plate
MC612	Vantage	Vantage Plates and Screws; ATL 	4 - 10cm	$2,200.00
MC661	Pyramid	Pyramid Plate	17mm - 35mm	$2,200.00
Prostheses List by Category, Groups and Sponsor	Page 1003 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC819	Pyramid +4	Anterior Plate	Height: 33mm - 45mm	$2,200.00
	Nuvasive Australia and NZ  Pty Ltd
NV105	Decade Lateral Plate System (plate)	The NuVasive Decade Plate System is 	2-4 Hole Static, 2-4 Hole 	$2,200.00
	indicated for use in the treatment of 	Translating, Lengths 6-20
	lumbar and lumbarsacral (L1-S1) 
	spine instability.
	Prism Surgical Designs Pty Ltd
PZ032	Aurora SPINE System	Thoracolumbar plate	15mm-51mm	$2,200.00
	Scient'x Australia
SX061	Aspida Anterior Lumbar Plating 	Lumbar, sacral plate	Height: 8 to 18mm with 	$2,200.00
	System - Plate	2mm increments; Width: 26,
	 30mm
	Signature Orthopaedics
SF020	Aurora SPINE System	Thoracolumbar plate	15mm-51mm	$2,200.00
	Stryker Australia Pty Ltd
SK488	THOR Anterior Plate	Anterior Plate,	22mm to 100mm	$2,200.00
	Synthes Australia Pty Ltd
SY139	Spinal Plate/Plate System AO/ASIF	Anterior thoracolumbar plate - 	40mm - 109mm	$2,200.00
	 Spinal Implants
SY290	Anterior Tension Band	Plate	30mm to 110mm	$2,200.00
SY301	TeleFix Spinal System	Rod/Plate construct	40mm to 140mm in length	$2,200.00
	Zimmer Pty Ltd
ZI518	Trinica Anterior Lumbar Plate	Lumbar Plate, Titanium	37-51mm lengths	$2,200.00
ZI519	Trinica Anterior Lumbar Plate	Sacral Plate, Titanium	33-51mm lengths	$2,200.00
13.05.02 - No Integral Fixation
	13.05.02.01 - Cervical
	B Braun Australia Pty Ltd
BB067	Caspar Cervical Plate	Titanium and Steel	24mm-90mm	$1,300.00
BB135	Aesculap Cervical System	Titanium, rigid	Medium 34 - 64mm length	$1,300.00
BB153	Aesculap Cervical System	Titanium, rigid	Small 20 - 32mm Length	$1,300.00
Prostheses List by Category, Groups and Sponsor	Page 1004 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER030	Pyrenees Cervical Plate	1 and 2 level cervical plate	18mm to 54mm	$1,300.00
ER051	Blue Ridge Hybrid Cervical Plate 	Low profile, anterior cervical titanium	22mm, 24mm, 26mm, 28mm, 	$1,300.00
	System - Plate	 plate. Lock engages as screw is 	30mm, 32mm, 34mm, 36mm, 
	inserted, eliminating any extra 	39mm, 42mm, 45mm, 48mm, 
	locking steps	51mm, 54mm, 53mm,
ER166	Signus Anterior Cervical Plate - L1-	Pre-contoured titanium plate, secured 	22mm - 54mm	$1,300.00
	L2	onto the spinal vertebrae by either 
	fixed or variable angle colour coded 
	Global Orthopaedic Technology
GO226	Sonoma Anterior Cervic Plate	Anterior Cervic Plate	<55	$1,300.00
	Health Care Surgical Pty Ltd
HC021	Butterfly Plate	Cervical Plate	L : 21-55mm	$1,300.00
	Nuvasive Australia and NZ  Pty Ltd
NV040	Helix Mini Plate	Anterior cervical plate	20mm-50mm (2mm 	$1,300.00
	increments)
NV043	Helix Plate	Anterior cervical plate	18-54mm	$1,300.00
	Orthotech Pty Ltd
OH263	Intext Cervical Plate/Intext Screws	Intext cervical plate, including (2 - 	Plates - width 13mm, 	$1,300.00
	part) fixation screws	Height 4mm - 9mm, width 
	17mm, height 4mm - 9mm
	Signature Spine
SV007	Tryptik Anterior Cervical Plate	Tryptik Anterior Cervical Plate is 	The product is available in 	$1,300.00
	designed to have low profile with 	8 lengths, 20, 25, 30, 35, 40,
	screw holes that allow for up to 20 	 45, 50, 55mm
	degree angulations. The plate is made 
	of Titanium
	Synthes Australia Pty Ltd
SY365	Cervical Spine Locking Plate 	VA Plate	Length 23 - 109mm	$1,300.00
	(CSLP) System
SY455	Cervical Spine Locking Plate 	Plate - Special Manuf.	≤55	$1,300.00
	(CSLP) System
SY457	Cervical Spine Locking Plate 	Small Stature Plate	≤55	$1,300.00
	(CSLP) System
SY462	Posterior Cervical Plate System	Cervical Spine Reconstruction Plate	≤55	$1,300.00
Prostheses List by Category, Groups and Sponsor	Page 1005 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY464	Cervical Spine Locking Plate 	VA Plate	≤55	$1,300.00
	(CSLP) System
	> 55mm
	Emergo Asia Pacific Pty Ltd
ER031	Pyrenees Cervical Plate	3, 4 and 5 level cervical plate	57mm to 110mm	$1,700.00
	Global Orthopaedic Technology
GO227	Sonoma Anterior Cervical Plate	Anterior Cervical Plate	>55	$1,700.00
	>55mm
	B Braun Australia Pty Ltd
BB140	Aesculap Cervical System	Titanium, rigid	Large 67 - 103mm length	$1,700.00
	Emergo Asia Pacific Pty Ltd
ER052	Blue Ridge Hybrid Cervical Plate 	Low profile, anterior cervical titanium	56mm, 59mm, 62mm, 65mm, 	$1,700.00
	System - Plate	 plate. Lock engages as screw is 	68mm, 71mm, 74mm, 77mm
	inserted, eliminating any extra 
	locking steps
ER167	Signus Anterior Cervical Plate - L3-	Pre-contoured titanium plate, secured 	56mm - 100mm	$1,700.00
	L4	onto the spinal vertebrae by either 
	fixed or variable angle colour coded 
	Health Care Surgical Pty Ltd
HC023	Butterfly Plate	Cervical Plate	L:55-86mm	$1,700.00
	Nuvasive Australia and NZ  Pty Ltd
NV042	Helix Plate	Anterior cervical plate	56mm-90mm	$1,700.00
	Signature Spine
SV002	Tryptik Anterior Cervical Plate 	Tryptik Anterior Cervical Plate is 	The product is available in 	$1,700.00
	(>55mm)	designed to have a low profile with 	5 lenghts, 60, 65, 70, 80 and
	screw holes that allow for up to 20 	 90mm
	degree angulations. The plate is made 
	of Titanium
	Synthes Australia Pty Ltd
SY183	Posterior Cervical Plate System	Plate	22-33 holes	$1,700.00
SY454	Cervical Spine Locking Plate 	Plate - Special Manuf.	>55	$1,700.00
	(CSLP) System
SY456	Cervical Spine Locking Plate 	Small Stature Plate	>55	$1,700.00
	(CSLP) System
Prostheses List by Category, Groups and Sponsor	Page 1006 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY463	Posterior Cervical Plate System	Cervical Spine Reconstruction Plate	>55	$1,700.00
SY465	Cervical Spine Locking Plate 	VA Plate	>55	$1,700.00
	(CSLP) System
	13.05.02.02 - ThoracoLumbar
	B Braun Australia Pty Ltd
BB167	MACS Stabilisation Plates	Titanium, rigid	Length 45 - 100mm	$2,200.00
BB248	PACH Plate	Titanium	28 & 32mm	$2,200.00
	Johnson & Johnson Medical Pty Ltd
DY174	Monarch Spinal System	Bone Plate	½ to 1½ or 2 - 3 or 3½	$2,200.00
	Nuvasive Australia and NZ  Pty Ltd
NV033	Traverse Plate	Plate	Fixed Plate - Size 	$2,200.00
	15/20/25/30/35/40/45/50/
	55/60/65/70/80/90mm
	Compression Plate - Size 
	45/50/55/60/65/70/75/80/
	85/95/105mm
NV035	XLP Lateral Plate	Lateral plate	6-20mm	$2,200.00
NV038	Halo Plate	Anterior Plate	Lumbar Plate (32mm-46mm)	$2,200.00
	Sacral Plate (32mm-46mm)
	2-level Plate (76mm-
	100mm)
NV095	Brigade Anterior Plate	Anterior plate	26-42mm	$2,200.00
	Zimmer Pty Ltd
ZI878	V2F Plates	Thoracolumbar Plate made from a 	30-130mm in 5mm increments	$2,200.00
	titanium ally (Ti-6Al-4V)
	13.05.02.03 - Occipital
	Advanced Surgical Design & Manufacture Ltd
AE174	Blackstone - Posterior Cervical 	Occipital Anchor	31, 37, 45, 50mm	$2,250.00
	System
	Biomet Australia Pty Ltd
BH096	Altius Occipito-Cervico-Thoracic 	TI Occipital Plate	35-45mm, 40-50mm, 45-55mm	$2,250.00
	(OCT) System
Prostheses List by Category, Groups and Sponsor	Page 1007 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Emergo Asia Pacific Pty Ltd
ER034	Caspian OC Plate	Occipital Plate for posterior 	40mm & 50mm	$2,250.00
	occipital/cervical/thoracic fixation
	Global Orthopaedic Technology
GO212	Sierra Spinal System Occipital Plate	Occipital Plate	25mm-35mm30mm-40mm	$2,250.00
	40mm-50mm45mm-55mm
	32mm-40mm
	Globus Medical Australia
LB050	ELLIPSE® Stabilization System 	Occipital Plate	Small to Large	$2,250.00
	Occipital Plate
	Johnson & Johnson Medical Pty Ltd
DY332	Summit Cervical Rod System	Occipital Plates "Y" or "T" or transoral	31-45mm, small - large	$2,250.00
JJ694	Mountaineer OCT Spinal System -	Titanium Occipital - Lateral Washer 	One size only	$2,250.00
	Lateral washer plate	Plate
JJ695	Mountaineer OCT Spinal System - 	Titanium Occipital Plate	31 - 45mm	$2,250.00
	OC Plate
	KH NXGEN (AUS) Pty Limited
KH025	Cobra Occipital Plate	Occipital Plate	32 and 37mm	$2,250.00
	Medtronic Australasia Pty Ltd
MC293	Vertex Spinal System	Occipital Plate	24 - 40 mm length	$2,250.00
	Nuvasive Australia and NZ  Pty Ltd
NV027	VuePoint Keel Plate (occipital)	Plate (occipital)	35/40/45mm	$2,250.00
	Scient'x Australia
SX077	Avalon Occipital Fixation System - 	Occipital plate assembly	56mm, 66mm	$2,250.00
	Plate
	Stryker Australia Pty Ltd
SK226	Oasys-Occipito Cervico Thoracic 	Occipital Plate	Mini, SML, MED, LGE, 	$2,250.00
	System	LGE Long, 100 deg, 130 deg
	Synthes Australia Pty Ltd
SY380	Axon Occipital Fusion System	Occipital Plate Medial / Lateral, Pure 	50mm / 60mm width, 3 or 4 	$2,250.00
	titanium	holes
Prostheses List by Category, Groups and Sponsor	Page 1008 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	13.05.02.04 - Lumbosacral / Sacral
	Johnson & Johnson Medical Pty Ltd
DY543	VSP System (Stainless Steel)	VSP Bone Plate	1/2 to five slot, single, 	$1,670.00
	double or triple
MN043	VSP System (Titanium)	VSP Bone Plate	1/2 to five slot, single, 	$1,670.00
	double or triple
	Medtronic Australasia Pty Ltd
MC403	Colorado Spinal System	Colorado 2 Plate	Range length 20 - 60mm	$1,670.00
MC432	Colorado Spinal System	Sacral Plate 	Left/right	$1,670.00
MC433	Colorado Spinal System	Ilio-Sacral Plate	Left/right	$1,670.00
	Stryker Australia Pty Ltd
SR038	Techtonix	Plate, titanium	22mm-58mm	$1,670.00
	13.05.02.05 - Laminoplasty Plate
	Medtronic Australasia Pty Ltd
MC299	Centerpiece	TiMesh LP	Open Door (OD) Plate	$750.00
MC309	Centerpiece	TiMesh LP	French Door (FD) Plate	$750.00
MC947	Centrepiece	TiMesh LP	Open Door Graft (GP) Plate	$750.00
MC948	Centrepiece	TiMesh LP	Trough Plate	$750.00
	Nuvasive Australia and NZ  Pty Ltd
NV054	Leverage LFS (Traditional Plate)	Laminoplasty plate	8/9.5/11/12.5mm	$750.00
	Synthes Australia Pty Ltd
SY335	Arch Fixation System	Pre contoured mini titanium plates	4 to 16mm	$750.00
13.06.01 - Standard
	Advanced Surgical Design & Manufacture Ltd
AE144	Firebird Phoenix Rods	Titanium rods, straight and lordotic 	35-450mm	$443.00
	with hex end. CoCr 450mm
Prostheses List by Category, Groups and Sponsor	Page 1009 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
AE161	Spinal Fixation System	Rod - Titanium	40mm to 100mm in 10mm 	$443.00
	increments
AE162	Spinal Fixation System	Rod - Titanium	110 to 450mm (110, 120, 	$443.00
	140, 160, 180, 200, 450mm)
AE175	Blackstone - Posterior Cervical 	Occipital Rod	One size only	$443.00
	System
AE177	Blackstone - Posterior Cervical 	Rods - Titanium	3.0mmx70, 120, 200mm	$443.00
	System
AE187	Spinal Fixation System	Pre Lordosed Rods	40mm to 100mm in 10mm 	$443.00
	increments
	B Braun Australia Pty Ltd
BB219	S4 Spinal System	S4 Straight Rod - Titanium	30 - 60mm	$443.00
BB220	S4 Spinal System	S4 Straight Rod - Titanium	70mm - 180mm	$443.00
BB221	S4 Spinal System	S4 Straight Rod - Titanium	200mm - 500mm	$443.00
BB222	S4 Spinal System	S4 Pre-bent Rod - Titanium	35mm - 55mm	$443.00
BB223	S4 Spinal System	S4 Pre-bent Rod - Titanium	60 - 240mm	$443.00
	Biomet Australia Pty Ltd
BH066	Synergy/Polaris Spinal System	Rods	5cm - 14cm	$443.00
BH067	Synergy/Polaris Spinal System	Rods	30 - 60cm	$443.00
BH085	Array Spinal System	Titanium Alloy Modular Spinal 	5.5mm x 510mm	$443.00
	System - Alloy rod
BH086	Array/Ballista Spinal System	Titanium Alloy Modular Spinal 	5.5mm x 30 - 100mm	$443.00
	System - Pre-Bent Rod
BH090	Altius Occipito-Cervico-Thoracic 	Rod	8 to 24cm x 3.5mm Occipital	$443.00
	(OCT) System	 and  Curved Rod
	Device Technologies Australia Pty Ltd
DE357	EasySpine - LDR Rods	Rods in 3 cross-sectional profiles: 	small, medium and regular; 	$443.00
	regular, medium and small	lengths 35mm to 500mm
DE383	SpineTune TL - Rod	This component is a rod that is 	Straight Rods: Diameter 	$443.00
	inserted within the rod housing of the	6mm
	 monoaxial and polyaxial screws in 
	each pedicle, linking and fixing the 
	vertebrae together.  This group of 
	components includes pre-curved rods.
Prostheses List by Category, Groups and Sponsor	Page 1010 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DE384	SpineTune TL - Curved Rod	This component is a pre-curved rod 	Diameter 6mm	$443.00
	that is inserted within the rod 	Lengths 30 to 150mm
	housing of the monoaxial and 
	polyaxial screws in each pedicle, 
	linking and fixing the vertebrae 
	Emergo Asia Pacific Pty Ltd
ER018	Mesa Spinal System / Rod	Straight and contoured 3.5, 4.5, 5.5, 	Straight: 30mm - 500mm and	$443.00
	6.0mm diameter rods	 Contoured: 35mm - 150mm
	
	Diameter - 3.5, 4.5, 5.5, & 
	6.0mm
ER027	Caspian OCT Spinal System - Rod	cervico-thoracic posterior rigid 	Diameter: 3.5mmLength: 	$443.00
	fixation system - Rod	1.80mm - 240mm
ER116	Novel/Zenius Rods	Rod	5.5, 6.0, 6.5	$443.00
	Euros Orthopaedics Australia Pty Ltd
EU002	e.Spine Rod	Titanium spine straight or pre-bent 	Diameter 5.5mm; Legths: 	$443.00
	straight rods 40,50, 60, 70, 
	80, 90, 100, 130, 160, 220, 
	440, 500, 600mm; pre-bent 
	rods: 40, 50,60, 70, 80, 90mm
	Global Manufacturing Technology Pty Ltd
GM160	SOCORE Spinal System - Standard 	Standard and Pre-Bent Rod	Diameter 5.5mm 40mm to 	$443.00
	and Pre-Bent Rod	500mm Length.
	Global Orthopaedic Technology
GO208	Malibu Spinal System Rods	Rod	5.5mm x 30mm - 600mm	$443.00
	6.35mm x 100mm
GO209	Malibu Spinal System ESS CoNiCr 	Rod CoNiCr Precontored	5.5mm x 100mm - 600mm	$443.00
	Rods
GO215	Sierra Spinal System Occipital Rod	Occipital Rod	60, 75, 90 degrees	$443.00
GO219	Sierra Spinal System Rod	Precurved Rod	3.5mm x 20mm - 100m	$443.00
GO220	Sierra Spinal System Transitional 	Transitional Rod	3.5mm diameter / 5.5mm or 	$443.00
	6.35mm
GO238	Newport MIS Spinal System - Cap 	Bulleted rod with an attached cap	Diameter 5.5mm Length 	$443.00
	and Rod Assembly	30mm-110mm
GO243	Newport MIS Spinal System - MIS 	Precontoured MIS Rod	30-130mm	$443.00
	Rod
Prostheses List by Category, Groups and Sponsor	Page 1011 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Globus Medical Australia
LB020	REVOLVE Stabilization System 	Rod	5.5mm diameter 40mm - 	$443.00
	300mm length
LB046	ELLIPSE Stabilization System, Rod	Rod	3.5mm Diameter x 40mm - 	$443.00
	240mm
	Health Care Surgical Pty Ltd
HC007	S14 Biospine Rod	Rod	40 - 150mm	$443.00
	Johnson & Johnson Medical Pty Ltd
DP315	Moss Miami (Stainless Steel)	Pre-Cut Rod	5mm x 30 - 600mm	$443.00
DP394	Moss Miami (Titanium)	Pre-Cut Rod	5.5mm x 30 - 90mm	$443.00
DP400	Moss Miami (Titanium)	Rod - Standard	5.5mm x 12 - 48cm	$443.00
DP452	Kaneda SR (Smooth Rod)  Anterior  	Pre Cut Rod	1/4" x 45 - 150mm	$443.00
	(TI)
DP461	Isola System (Titanium)	Spinal Rod	1/4" & 3/16" x 18" & 24"	$443.00
DP476	Isola System (Stainless Steel)	Eye Rod	1/4" & 3/16" x 18" - 24"	$443.00
DP477	Isola System (Stainless Steel)	Spinal Rod Standard	1/4" & 3/16" x 18" & 24"	$443.00
DP485	Isola System (Stainless Steel)	Dual Diameter Rod	3/16" to 1/4" x 18 - 24"	$443.00
DP488	Isola Paediatric System (Stainless 	Pre-Bent Rod	3/16 "	$443.00
	Steel)
DP494	Isola Paediatric System (Stainless 	Wedding Band	3/16"	$443.00
	Steel)
DP505	Anterior Isola System (SS)	Rod with Hex End	1/4" x 18"	$443.00
DP846	Moss Miami 4mm Anterior System 	Rods	4.0mm x 30 - 48cm	$443.00
	(SS)
DY105	Isola System (Titanium)	Eye Rod	1/4" x 18"	$443.00
DY182	Monarch Spinal System	Rods	6.35 & 5.5mm x 35-600mm	$443.00
DY310	Frontier Anterior Scoliosis System 	Spinal Rod	4.75 x 200-450mm	$443.00
	(Titanium)
DY313	Monarch Spinal System	Rods - Pre Cut/Lordosed	6.35 & 5.5mm x 45 - 95mm	$443.00
DY318	Isola System (Stainless Steel)	Pre-Cut Rod	3/16" x 35 - 90mm	$443.00
DY343	Summit Cervical Rod System	Rod	3mm x 70-200mm	$443.00
DY436	Expedium Spine System	Rod - Pre - lordosed or straight	5.5 - 6.35mm diameter x 30-	$443.00
	95mm
Prostheses List by Category, Groups and Sponsor	Page 1012 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
DY554	Expedium Spine System	Rod	4.5 - 7.5 Diameter x 120 - 	$443.00
	600mm
JJ597	Mountaineer Spinal System	CT Rod	3.5mm x 60 - 400mm	$443.00
JJ644	Extra long rod - Expendium 	Rod - Titanium	5.5mm x 450mm	$443.00
	Anterior Spine System
JJ648	Pre-cut rod - Expedium Anterior 	Rod - Titanium	Diameter 5.5mm x lengths 	$443.00
	Spine System	45-150mm
JJ693	Mountaineer OCT Spinal System - 	Pre-bent Titanium Rod	3.5 x 200 - 85mm or 3.5 x 	$443.00
	Pre-bent Rod	120 - 85 mm
JJ760	Moss Miami (Titanium)	Swedge Rod	One Size	$443.00
JJ764	Moss Miami (Stainless Steel)	Swedge Rod	One Size	$443.00
JJ809	Viper 2 Spine System - Cobalt 	Cobalt Chrome Rod	100-600mm	$443.00
	Chrome Rods
MN113	Mountaineer Spine System	OC Adjustable Rod	3.5mm	$443.00
MN169	VIPER Spinal System	Spinal Rods	30-480mm	$443.00
	KH NXGEN (AUS) Pty Limited
KH030	Cobra Rod	Rod	Diameter: 3mm	$443.00
	Length: 70 -200mm
KH035	G5 Rod	Rod, titanium alloy	50 - 550mm	$443.00
	Lifehealthcare Pty Ltd
LH485	DSS HP Spinal System - Rod	Pre Lordosed Rods	5.5mm diameter rod	$443.00
	Length: 20mm to 300mm 
	(10mm increments)
	Matrix Medical Innovations
BF005	Smartloc Spinal Fixation System / 	Fixation Rod for Smartloc Spinal 	40mm - 80mm	$443.00
	Fixation Rod	Fixation System
	Medacta Australia Pty Ltd
MU108	M.U.S.T. Rods	Straight and Pre-Bent Rods	5.5; length 35 - 480mm	$443.00
	Medtronic Australasia Pty Ltd
MC295	Vertex Spinal System	Pre - curved rod	150 - 300 mm length	$443.00
MC382	Colorado Spinal System	Colorado 2 Rod	5.0mm and 5.5mm, length 	$443.00
	range 50 - 600mm
MC396	TSRH Spinal Implant System	3D - Rod	Diam 4.75 - 6.35mm, Length	$443.00
	 25mm - 80cm
Prostheses List by Category, Groups and Sponsor	Page 1013 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC404	CD HORIZON Spinal System - Rod	Rod	30mm - 600mm	$443.00
MC440	CD Horizon	Eclipse:  4.5mm Rod	40 - 600mm	$443.00
MC497	Tenor	Rod (5.5mm) - Titanium 	40 - 240mm	$443.00
MC544	Vertex Spinal System	Rod	80 - 240mm	$443.00
MC587	CD Horizon Spinal System	Percutaneous Rod	5.5 x 25mm to 5.5 x 350mm	$443.00
	National Surgical Pty Ltd
NK004	SteriSpine PS - Rod	Rods for use with SteriSpine PS system	35 - 120mm	$443.00
NK015	Capless Li Pedicle screw system - rod	Titanium rod. Straight and pre- bent	Straight and pre- bent, 	$443.00
	multiple sizes, 40-300mm
	Nuvasive Australia and NZ  Pty Ltd
NV018	System: SpheRX. Component: Rods 	Rods - Dual/Pre Bent Ball	17.5 - 500mm	$443.00
	- Dual/Pre Bent Ball
NV025	VuePoint rod	Rod	60mm x 3.5mm, 120mm x 	$443.00
	3.5mm, 240mm x 3.5mm
NV028	VuePoint rod (pre-bent)	Pre-bent rod	240mm	$443.00
NV059	SpheRx II Anterior (Rod)	Rod	25-150mm	$443.00
NV060	Armada (Rod)	Rod	5.5mm x 	$443.00
	(25/30/35/40/45/50/55/60/
	65/70/75/80/85/90/100/12
	0)300/500mm
NV080	Long Lateral Fixation System (Rod)	Rod	5.5mm x 50-500mm	$443.00
NV088	Precept (Rod)	Rod	15-600mm	$443.00
	Orthotech Pty Ltd
OH311	Cosmic implant system	Cosmic Rod (40,50,60,70,80mm) - 	diameter - 6.25mm, length - 	$443.00
	titanium	40mmdiameter - 6.25mm, 
	length - 50mmdiameter - 
	6.25mm, length - 60mm
	diameter - 6.25mm, length - 
	70mmdiameter - 6.25mm, 
	length - 80mm
Prostheses List by Category, Groups and Sponsor	Page 1014 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OH312	Cosmic implant system	Cosmic Rod (100, 120, 200mm)- 	diameter - 6.25mm, length - 	$443.00
	titanium	100mmdiameter - 6.25mm, 
	length - 120mmdiameter - 
	6.25mm, length - 200mm
	diameter - 6.25mm, length - 
	70mmdiameter - 6.25mm, 
	length - 80mm
OH352	Novel/Zenius Rods	Rod	5.5, 6.0, 6.5	$443.00
OH401	Ulrich Neon Rod	Rods	20-230mm	$443.00
OH413	Ulrich Spine System Rods	Rods	30-144mm	$443.00
	Scient'x Australia
SX003	Isobar TTL	Rod	L: 45-450mm	$443.00
SX043	Zodiac Spinal Fixation System - rod	Rods: straight and pre-bent; Pure 	Diameter: 5.5mm. Length: 	$443.00
	Titanium, Alloyed Titanium (TA6V 	3cm, 3.5cm, 4cm, 4.5cm, 5cm,
	ELI) or Colbalt Chromium	 5.5cm, 6cm, 6.5cm, 7cm, 
	7.5cm, 8cm, 8.5cm, 9cm, 
	9.5cm, 10cm, 11cm 12cm, 
	13cm, 17cm, 20cm, 25cm, 
	30cm, 45cm, 50cm, 60cm.
SX049	Illico MIS Posterior Fixation 	Titanium rods: straight and pre-bent	Diameter: 5.5mm. Length: 	$443.00
	System - rod	3cm, 3.5cm, 4cm, 4.5cm, 5cm,
	 5.5cm, 6cm, 6.5cm, 7cm, 
	7.5cm, 8cm, 8.5cm, 9cm, 
	9.5cm, 10cm, 11cm, 12cm, 
	13cm, 14cm, 15cm, 16cm, 
	17cm, 20cm, 21cm, 22cm, 
	23cm, 24cm, 25cm, 26cm, 
	27cm, 28cm, 29cm, 30cm.
SX070	Solanas Posterior Cervico-thoracic 	Rod	Diameter: 3.3mm; Length: 	$443.00
	Fixation System - Rod	40 to 240mm with 
	increments of 10mm, except 
	110mm
	Signature Spine
SV008	Romeo Pedicle System Transverse 	Titanium alloy rods for connection 	5.4mm diameter.  4 lengths.	$443.00
	Rod	between hooks (TR) in transverse 
	connector assemblies.
Prostheses List by Category, Groups and Sponsor	Page 1015 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SV009	Romeo Pedicle System Rod	Supplied non-sterile. Pre-bend for 	5.4mm diameter: 30, 40, 50, 	$443.00
	lengths up to 80mm. Titanium alloy.	60, 70, 80, 90, 100, 110, 
	120, 140, 160, 180, 200, 
	220, 240 and 350mm 
	Stryker Australia Pty Ltd
HW483	ES2 Spinal System, Rod	Hex end rods	5.5mm x 20 - 600mm	$443.00
SK224	Oasys-Occipito Cervico Thoracic 	Rods - Ti-6A1-4V or Vitallium	Diameter 3.5mm, Length 	$443.00
	System	25mm-350mm
	Synthes Australia Pty Ltd
SY143	Universal Spine System (USS)	Rods	Length 40 - 500mm	$443.00
SY444	CerviFix Posterior Cervical System	Rod: Straight or pre bent	3.5mm diameter, 120-250mm	$443.00
	 length
SY564	Spinal Fixation System	Matrix Rods	20mm - 500mm length	$443.00
	Zimmer Pty Ltd
ZI512	Optima Spinal System - Rod	Rod	Dia 5-7mm, length 40-400mm	$443.00
ZI624	SEQUOIA PEDICLE SCREW 	Sequoia Rod CP Ti	30mm - 510mm length	$443.00
	SYSTEM
ZI639	BacFix (Thoracolumbar System)	Spinal rod, rigid/flex - Titanium alloy	5.5 - 6mm x 50 - 125mm	$443.00
ZI663	Nex-Link	Spinal Fixation System, Spinal Rod	120 & 240mm	$443.00
	Dual Diameter
	Globus Medical Australia
LB045	ELLIPSE Stabilization System, 	Dual Diameter Rod	3.5mm ti 4.0mm - 6.5mm x 	$550.00
	Tapered Rod	350mm - 500mm length
	Johnson & Johnson Medical Pty Ltd
DY334	Summit Cervical Rod System	Transition Rod	3.0/4.0/3.0mm	$550.00
DY335	Summit Cervical Rod System	Dual Diameter Rod	3.0/4.75-5.5mm x 150-600mm	$550.00
JJ596	Mountaineer Spinal System	CT Dual Diameter Rod	3.5 - 6.35mm x 420 - 600mm	$550.00
	KH NXGEN (AUS) Pty Limited
KH026	Cobra Rod - Dual Diameter	Dual diameter rod for use with 	Diameter: 3/4/3mm	$550.00
	occipital plate	Length: 160mm
	Nuvasive Australia and NZ  Pty Ltd
NV026	VuePoint rod (transition)	Transition Rod	3.5mm to 5.5mm	$550.00
Prostheses List by Category, Groups and Sponsor	Page 1016 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX071	Solanas Posterior Cervico-thoracic 	Transitional Rod	Diameter: 3.3mm and 5.5mm	$550.00
	Fixation System - Transitional Rod
	Synthes Australia Pty Ltd
SY446	CerviFix Posterior Cervical System	Rod: Tapered	3.5/5.0 - 3.5/6.0 dual 	$550.00
	diameter, 300 -500mm
	Shaped
	Johnson & Johnson Medical Pty Ltd
DY555	Expedium Spine System	Contoured Scoliosis Rod	4.5 - 7.5 Diameter x - 320 - 	$600.00
	455mm
MN114	EXPEDIUM Spinal System	Pre-Shaped Rod	4.5 - 7.5mm Diameter	$600.00
	Medtronic Australasia Pty Ltd
MC505	Orfil	L-Shaped Rods	5-510mm	$600.00
	Stryker Australia Pty Ltd
HW389	XIA Spine System	Rod - Titanium alloy, Stainless Steel	30 - 600mm	$600.00
	Synthes Australia Pty Ltd
SY385	Speciality Rods	Scoliosis / J/S Rod, Precontoured, 	5mm, 6mm diameter. Left / 	$600.00
	Titanium / Stainless Steel	Right50mm - 500mm length
	Corin Australia Pty Ltd
CR208	3 Lock - Rod	The Rod is inserted in pedicle screw 	Diameter: 5.5mm	$443.00
	head	Length; 40-100 (10mm 
	increments), 120,150, 250, 
	350, 450, 500 
	Straight, pre-curved
	Emergo Asia Pacific Pty Ltd
ER139	Signus MonoPoly Pedicle Screw 	Titanium Rod- as part of the 	6.0mm x 30mm - 100mm in 	$443.00
	System-Rod	Monopoly Pedicle Screw Construct	5mm increments
	6.0mm x 108mm - 204mm in 
	12 mm increments
	Globus Medical Australia
LB076	REVERE Rods	Rod, precurved and straight	30mm - 150mm in 5.5mm and	$443.00
	 6.35mm diameter
Prostheses List by Category, Groups and Sponsor	Page 1017 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Health Care Surgical Pty Ltd
HC020	KM Rod	Rod	40-400mm	$443.00
	Implament
IB004	Vertefix II Alignment Rod	Alignment Rod	Diameters: 5.5 Length: 50, 	$443.00
	75, 100, 125, 150, 200, 
	300mm
	KH NXGEN (AUS) Pty Limited
KH004	L8 Spine System - Rod	Rod, titanium alloy	40 - 420mm	$443.00
	Prism Surgical Designs Pty Ltd
PZ033	Centaur Rod	Standard	30-480mm	$443.00
	Signature Orthopaedics
SF011	Centaur Rod	Standard	30-480mm	$443.00
	Signature Spine
SV020	Sky Spinal Fixation System-Rod	The rod is part of the Sky Spinal 	3.3 x 40mm to 3.5 x 250mm	$443.00
	System, indicated for posterior 
	intrumentation of the occipital, 
	posterior cervical and upper thoracic 
	spine.
SV021	MIS Percutaneous Pedicle Screw 	The MIS Screw System-Rod is part of 	5.5x40 to 5.5x300	$443.00
	System - Rods	the MIS Percutaneous Screw System, 
	intended to provide immobilization 
	and stabilization of spinal vertebrae 
	in the thoracic, lumbar and sacral 
	regions. The poly axial capability 
	provides 20 degree of freedom in any 
SV024	AnyPlus Pedicle Screw System- 	The AnyPlus MIS Screw System-Rod 	40mm to 600mm for the 	$443.00
	is part of the AnyPlus MIS Screw 	straight rods
	Systems, intended to provide 	40mm to 150mm for the pre-
	immobilization and stabilization of 	bent rods
	spinal vertebrae in the thoracic, 
	lumbar and sacral regions.
Prostheses List by Category, Groups and Sponsor	Page 1018 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI889	APEX Spine System - Rods	Straight and contoured rods titanium 	Straight: 5.5mm x 30mm-	$443.00
	and CoCR	90mm in 10mm increments, 
	5.5 x 300, 450, 600mm, 6mm 
	x 30mm-90mm in 10mm 
	increments, 6mm x 300, 350, 
	450, 600; Curved: 5.5mm x 
	30 - 90 and 6mm x 30-100 in
	 10mm increments
	Shaped
	Globus Medical Australia
LB077	REVERE Rods Preshaped	Pre-shaped Rods	5.5mm - 6.35mm	$600.00
13.06.02 - Telescoping
	Biomet Australia Pty Ltd
BH084	Synergy Spinal System	Growth Rod	30 - 60cm	$1,350.00
	Lifehealthcare Pty Ltd
LH457	DSS Fusion Coupler	The DSS Fusion Coupler is a 	20mm - 22mm22mm - 	$1,350.00
	telescoping coupler that rigidly joins 	25mm25mm - 31mm
	the DSS pedicle screws.	31mm - 43mm
13.06.03 - Dual Unit
	13.06.03.01 - Thoracolumbar
	Globus Medical Australia
LB078	REVERE Rods, Dual Unit	Scoliosis Rods	5.5mm - 6.35mm 450mm - 	$1,460.00
	500mm
	Medtronic Australasia Pty Ltd
MC537	Danek Unit Rod System	Scoliosis Rods	Widths 3/16", 5.5mm or 	$1,460.00
	6.35mm; lengths 25 x 45cm
MC707	Danek Unit Rod System	Scoliosis S-Rods	Widths 5.5 - 6.35mm; left 	$1,460.00
	and right
Prostheses List by Category, Groups and Sponsor	Page 1019 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthotech Pty Ltd
OH266	Hartshill Rectangle	Stainless steel posterior lumbar fusion	5mm diam 3-5cm length	$1,460.00
	 system
OH270	Hartshill Rectangle	Stainless steel posterior 	6mm diam 15 - 19cm length	$1,460.00
	thoracic/thoracolumbar fusion system
	Synthes Australia Pty Ltd
SY384	Speciality Rods	Unit Rod, Titanium / Stainless Steel	5mm, 6mm diameter250mm 	$1,460.00
	- 500mm length
	13.06.03.02 - Occipital
	Health Care Surgical Pty Ltd
HC019	KM Occipital Plate	Occipital Plate Rod	3-5mm	$2,250.00
	Nuvasive Australia and NZ  Pty Ltd
NV101	Vuepoint (Hinged Rod)	The VuePoint OCT System is 	one size only	$2,250.00
	intended to promote fusion of the 
	cervical spine and occipito-thoracic 
	junction (Occiput-T3), and is 
	indicated for; 1: Degenerative disc 
	disease (as defined by back pain of 
	discogenic origin with degeneration 
	of the disc confimred by patient 
	history and radiographic studies), 2: 
	Degenerative spondylolisthesis with 
	objective evidence of neurologic 
	impairment, 3: Fractur/Dislocation, 4: 
	Spinal Stenosis, 5: Atlantaxial 
	fracture with instability, 6; 
	Occipitocervical dislocation, 7: 
	Spinal tumor and/or 8: revision of 
	previous cervical spine surgery
	Orthotech Pty Ltd
OH264	Hartshill: Ransford	Occipito-cervical - Titanium loop	100 degree 9mm - 20mm	$2,250.00
OH265	Hartshill: Ransford	Extra long cross linked - titanium 	100 degree 45cm x 15mm	$2,250.00
	Scient'x Australia
SX080	Avalon Occipital Fixation System - 	Occipital pre-contoured transition 	Length: 280mm	$2,250.00
	Rod
Prostheses List by Category, Groups and Sponsor	Page 1020 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.07.01 - Plate Rod
	Medtronic Australasia Pty Ltd
MC509	CD Occipital-Cervical  Loop	CD Occipital-Cervical  Loop	One size only	$3,020.00
MC543	Vertex Spinal System	Plate/rod	80 - 240mm	$3,020.00
	Orthotech Pty Ltd
OH406	Ulrich Neon M plate	M plate for OC stabilisation and OC 	one size	$3,020.00
	Synthes Australia Pty Ltd
SY184	Posterior Cervical Plate System	Plate - rod	Special Manufacture - One 	$3,020.00
	size only
SY445	CerviFix Posterior Cervical System	Occipital Plate Rod	one size	$3,020.00
	Zimmer Pty Ltd
ZI683	NexLink	Occipital Cervical Plating System	Occipital Plate	$3,020.00
13.08.01 - Washer
	Advanced Surgical Design & Manufacture Ltd
AE165	Blackstone - Fixed System Washer	Titanium	One Size Only	$235.00
AE166	Blackstone - Washer	Titanium	2/4/6mm	$235.00
AE167	Blackstone - Spacer	Titanium	3/5mm	$235.00
	Biomet Australia Pty Ltd
BH078	Synergy Spinal System	Washers Single/Double	16mm - 21mm	$235.00
	Device Technologies Australia Pty Ltd
DE355	EasySpine - Spacers	Spacers that work to stabilise/take up 	Single packs: diameters 5,6 	$235.00
	length of the screw to enable secure 	and 7mm, lengths 5 to 10mm
	fixation -  EasySpien is a spinal fusion
	 system
	Emergo Asia Pacific Pty Ltd
ER033	ARI Anterior Staple System - Washer	The ARI Anterior Staple System - 	One size only	$235.00
	washer
Prostheses List by Category, Groups and Sponsor	Page 1021 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Globus Medical Australia
LB032	REVERE Blocking Plate, Anterior 	Blocking Plate	One Size	$235.00
	Screw
	Johnson & Johnson Medical Pty Ltd
DP049	VSP System (Titanium)	Washers - Standard / Tapered	3 & 5mm	$235.00
DP430	Moss Miami (Stainless Steel)	Washers - slotted, angled	Slotted/Angled or 3-5mm	$235.00
DY127	VSP System (Stainless Steel)	Washers - Standard / Tapered	3 & 5mm	$235.00
DY176	Monarch Spinal System	Washer	One size only	$235.00
JJ649	Washer & Single Hole Staple - 	Washer and Single Hole Staple - 	One size only	$235.00
	Expedium Anterior Spine System	Titanium
JJ758	Anterior Isola System	Washer	One Size only	$235.00
JJ768	Frontier Anterior Scoliosis System	Washer	One size only	$235.00
JJ770	Expedium Spine System	Washer	Various	$235.00
JJ830	Moss Miami (Titanium)	Washers - slotted / angled	One size only	$235.00
	Lifehealthcare Pty Ltd
LH451	DSS Spacer	The DSS Spacer is an integral 	One size only	$235.00
	component of the DSS pedicle screw 
	construct. It is used on the mono-axial
	 DSS screw and is used each time a 
	screw is placed. It can not be used on 
	its own.
LH453	DSS Washer	The DSS Washer is a washer that is an	One size only	$235.00
	 integral part of the DSS construct. 
	The DSS construct can  not be used 
	without the washer nor can the 
	washer be used as a separate implant.
	Nuvasive Australia and NZ  Pty Ltd
NV006	Triad Facet Screw	Washer	One size	$235.00
NV053	SpheRx II Anterior (Washer)	Washer	Small, Medium & Large	$235.00
NV074	Radian Facet Screw System 	Washer	one size	$235.00
	Orthotech Pty Ltd
OH404	Ulrich Neon Spacer	Neon spacer	2-4mm	$235.00
Prostheses List by Category, Groups and Sponsor	Page 1022 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Prism Surgical Designs Pty Ltd
PZ034	Centaur Screw System, Centaur 	Washer	1 size	$235.00
	Washer
	Synthes Australia Pty Ltd
SY150	Universal Spine System (USS)	Washers	Pointed, Flat, 4.2 - 7mm	$235.00
	Signature Orthopaedics
SF058	Centaur Screw System, Centaur 	Washer	1 size	$235.00
	Washer
	Zimmer Pty Ltd
ZI890	APEX Spine System - Screw Washers	2mm Washers (closed and open) for 	2mm	$235.00
	pedicle screws
13.08.02 - Staple
	Advanced Surgical Design & Manufacture Ltd
AE169	Blackstone - Staple	Titanium	2/4/6mm	$410.00
	Emergo Asia Pacific Pty Ltd
ER032	ARI Anterior Staple System - Staple	A non-cervical anterolateral 	Single Hole Design and 	$410.00
	thoracolumbar screw stabilization as 	Dual Hole Design: 13mm, 
	an adjunct to fusion.	Left & Right; 16mm, Left & 
	Right; 18mm, Left & Right.
	Globus Medical Australia
LB031	REVERE Integrated Staple Head 	Integrated Staple Head Plate	small, medium, large, x-large	$410.00
	Plate
	Johnson & Johnson Medical Pty Ltd
DP581	Kaneda Anterior Scoliosis System  	Staple Single or Double Hole	Small - Large	$410.00
	S/S
JJ643	Dual Hole Staple - Expendium 	Dual Hole Staple - Titanium	Small to Xlarge - 4 sizes	$410.00
	Anterior Spine System
JJ657	Single Hole Staple - Expedium 	Single Hole Staple - Titanium	One Size Only	$410.00
	Anterior Spine System
JJ759	Anterior Isola System	Single hole staple	16 - 22mm	$410.00
Prostheses List by Category, Groups and Sponsor	Page 1023 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
JJ769	Frontier Anterior Scoliosis System	Staple	Single and dual hole	$410.00
JJ771	Expedium Spine System	Staple	Various	$410.00
JJ829	Moss Miami (Titanium)	Staple Washer	One size only	$410.00
	Medtronic Australasia Pty Ltd
MC431	Colorado Spinal System	Staple	One size only	$410.00
MC437	CD-Horizon	Staples	10 - 30mm	$410.00
MC614	Vantage	Vantage Plates and Screws; Staple 	One Size Only	$410.00
	(rostral/caudal)
	Nuvasive Australia and NZ  Pty Ltd
NV046	SpheRx II Anterior (Staple - 	Staple	Small, Medium & Large	$410.00
NV050	SpheRx II Anterior (Staple - Single 	Staple (single hole)	Small, Medium & Large	$410.00
	Hole)
NV081	Long Lateral Fixation System 	Staple	Single/Dual	$410.00
	Orthotech Pty Ltd
OH408	C Jaws	Cervical compressive staple	12-17mm	$410.00
	Stryker Australia Pty Ltd
SK242	Xia Spinal System	Titanium or Stainless Steel	Single Hole Staple; Dual 	$410.00
	Hole Staples 
	(Caudal/Rostral) - Small, 
	Medium, Large
	Complex
	Johnson & Johnson Medical Pty Ltd
MN157	Viper Spinal System	Polyaxial washer with barb	13 to 19mm	$1,240.00
	Medtronic Australasia Pty Ltd
MC592	CD Horizon System	SMA Staple	Length 4-10mm	$1,240.00
MC593	CD Horizon System	SMA Staple	Length 12-18mm	$1,240.00
	Signature Orthopaedics
SF059	Centaur Screw System, Centaur 	Staple	small - extra large	$410.00
Prostheses List by Category, Groups and Sponsor	Page 1024 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.09.01 - C-Ring
	Biomet Australia Pty Ltd
BH077	Synergy Spinal System	C-Ring	4.75 - 6.35mm	$365.00
	Medtronic Australasia Pty Ltd
MC436	CD-Horizon	C-ring	One size only	$365.00
	Synthes Australia Pty Ltd
SY145	Universal Spine System (USS)	Half Ring	SS, Standard, Self-Holding	$365.00
SY360	Universal Spine System (USS)	Half Ring	SS, Standard, Self-Holding	$365.00
13.10.01 - Interbody, Integral Fixation
	13.10.01.01 - Cervical
	Emergo Asia Pacific Pty Ltd
ER137	Chesapeake Cervical-Ti 	A Multi-screw construct providing 	12 x 17mm & 13 x 18mm. 	$4,550.00
	Stabilization System	stablity to the anterior colm while 	Footprints available in 
	producing the need for supplemental 	7deg Lordotic Options. 
	fixation in the cervical spine.	Heights: 5 - 10mm in 1mm 
	Globus Medical Australia
LB065	COALITION Spacer	ACDF Spacer	12mm x 14mm, 14mm x 16mm	$4,550.00
	 and 15mm x 18mm , 6mm - 
	12mm height
	Implament
IB001	STACC Cervical Cage	PEEK Stand alone interbody fusion 	5.5, 6.5, 7.5, 8.5 (Height) x 	$4,550.00
	cage	14mm (Width)
	Medtronic Australasia Pty Ltd
MI120	PEEK PREVAIL Cervical 	Cervical intervertebral body fusion 	Height : 5mm-9mm	$4,550.00
	Interbody Device	device
Prostheses List by Category, Groups and Sponsor	Page 1025 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Nuvasive Australia and NZ  Pty Ltd
NV103	CoRoent Small Interlock (cage)	The CoRoent Small Interlock System 	Width 14-18mm x length 	$4,550.00
	is a stand-alone anterior cervical 	10-14mm x Height 5-16mm x
	interbody fusion system indicated for 	 Lordosis 0-10˚
	use in skeletally mature patients with 
	degenerative disc disease (DDD) at 
	one level from C2-T1.
	Orthotech Pty Ltd
OH478	Stalif C	Interbody fusion cage	5.5-9.5	$4,550.00
	Signature Orthopaedics
SF054	VerteLoc Spine System	Cervical Cage IF	Extra small - extra large	$4,550.00
	Stryker Australia Pty Ltd
HW518	AVS Anchor C Cervical Cage 	Standalone Cervical Cage	12 x 14mm, 14 x 16mm, 	$4,550.00
	height range ;  6mm-12 mm.) 
	0, 4 and 8 degree angulation
	Synthes Australia Pty Ltd
SY752	Zero-P	Anterior Cervical Interbody Fusion 	5-12mm Height	$4,550.00
	System
	13.10.01.02 - ThoracoLumbar / Lumbar
	Advanced Surgical Design & Manufacture Ltd
AE196	Pillar SA	The Pillar SA PEEK Spacer system is 	37Wx28Dx7º 12.5, 14, 16, 	$6,500.00
	comprised of a variety of implants 	18mmH37Wx28Dx12º 12.5,
	manufactured from PEEK-OPTIMA 	 14, 16, 18mmH
	LT as described by ASTM F-2026, 	40Wx28Dx7º 12.5, 14, 16, 
	with tantalum markers as described by	18mmH40Wx28Dx12º 12.5,
	 ASTM F-560. The implants are 	 14, 16, 18mmH
	available in multiple footprint sizes a 	43Wx28Dx7º 12.5, 14, 16, 
	variety of heig	18mmH43Wx28Dx12º 12.5,
	 14, 16, 18mmH
	37Wx32Dx7º 12.5, 14, 16, 
	18mmH37Wx32Dx12º 12.5,
	 14, 16, 18mmH40W
Prostheses List by Category, Groups and Sponsor	Page 1026 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Biomet Australia Pty Ltd
BH114	Solitare Anterior Spinal System	Interbody fusion cage	Narrow (28mm), medium 	$6,500.00
	(34mm), and wide (40mm) 
	12 to 20mm heights. 6 deg 
	and 12 deg angles
	Emergo Asia Pacific Pty Ltd
ER046	Chesapeake Spinal System	The Chesapeake Spinal System is a 	Footprint 24 x 30mm, 	$6,500.00
	multi-screw construct providing 	Lordosis 5, 10 and 15 
	stability to the anterior column in 	degrees, Height 11-21 mm 
	order to facilitate solid bony fusion	length in 2mm increments
	Footprint 28 x 36mm, 
	Lordosis 5, 10 and 15 
	degrees, Height 11-21 mm 
	length in 2mm increments
	Footprint 30 x 40mm, 
	Lordosis 5, 10 and 15 
	degrees, Height 11-21 mm 
	length in 2mm increments
	Global Orthopaedic Technology
GO231	Zuma implant with integral plate	PEEK Interbody cage with integral 	26mm x 24mm, 32mm x 25mm	$6,500.00
	plate	 Height 10mm - 18mm
	Globus Medical Australia
LB001	Independence Spacer	Spacer with integral plate	small, medium, large 8 deg 	$6,500.00
	and 15 deg 11mm – 21mm 
	height
	Medacta Australia Pty Ltd
MU121	MectaLIF Anterior Stand-Alone 	TiPEEK Anterior Interbody cage 	24mm x 31mm, 27mm x 	$6,500.00
	TiPEEK Cages.	with integral plate.	35mm. Height 12-18 in 2mm
	 increments.
MU122	MectaLIF Anterior Stand-Alone 	PEEK Anterior Stand-Alone PEEK 	24mm x 31mm, 27mm x 	$6,500.00
	PEEK Cages	Cage	35mm. Height: 12-18mm in 
	2mm increments
	Medtronic Australasia Pty Ltd
MC987	Sovereign Spinal System - 	Sovereign Spinal System - Interbody 	Small - 32mm x 23mm, 	$6,500.00
	Interbody Spacer	Spacer with Coverplate	Medium - 37mm x 27mm, 
	Large - 42mm x 30mm
Prostheses List by Category, Groups and Sponsor	Page 1027 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Nuvasive Australia and NZ  Pty Ltd
NV071	Brigade (implant)	Interbody fusion implant	10-20mm x 34/38/42 x 	$6,500.00
	24/28/32/30mm
	Orthotech Pty Ltd
OH257	Stalif	Interbody Fusion Cage	36/39/42/45 x 	$6,500.00
	11/13/15/17mm
	Signature Orthopaedics
SF055	Australis Spine System	Thoracolumbar Cage IF	extra small - extra large	$6,500.00
	Stryker Australia Pty Ltd
HW512	Anchor-L Lumbar Cage System, 	Anterior Lumbar Interbody Cage	Footprints; 22x30mm, 	$6,500.00
	Anterior Lumbar Interbody Cage	25x35mm, 28x40mm
	Heights 10-20mm (2mm 
	incr.)
	Lordosis 4°,8°,12°,16°
	Synthes Australia Pty Ltd
SY298	SynFix Spinal System	Interbody fusion cage prefilled or 	5mm to 19mm	$6,500.00
	unfilled
13.10.02 - Interbody, No Integral Fixation
	13.10.02.01 - Cervical
	Advanced Surgical Design & Manufacture Ltd
AE191	Blackstone Construx Mini PEEK 	The Construx Mini is an anterior 	12mm x 12mm 5 degrees 	$2,503.00
	VBR System	Cervical Interbody PEEK Cage	lordotic. 5mm-12mm in 1mm 
	increments. 12mm x 12mm, 
	Parallel. 5mm - 12mm in 
	1mm increments. 15mm x 
	12mm, 5 degrees lordotic. 
	5mm - 12mm in 1mm 
	increments. 15mm x 12mm, 
	Parallel. 5mm-12mm in 1mm 
	increments
	Australian Pacific Medical Pty Ltd
PB001	Anterior Cervical PEEK Cage	Interbody fusion cage	Height: 6 -10 mm in 1 mm 	$2,503.00
	increments
Prostheses List by Category, Groups and Sponsor	Page 1028 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Austspine Pty Ltd
AJ009	Kasios KAGE	Cervical interbody PEEK cage for 	Height 4mm - 10mm	$2,503.00
	anterior cervical surgery
	Biomet Australia Pty Ltd
BH110	C-Thru Anterior Spine System	Cervical Cage - PEEK	Lordotic 5-12mm, Parallel 	$2,503.00
	5-12mm, Convex 5-12mm
	Device Technologies Australia Pty Ltd
DE350	ROI-C Cervical Cage	A cervical cage for anterior 	Footprints 12x14, 12x15.5, 	$2,503.00
	approaches to cervical spine	14x14, 14x15.5; Heights 
	4.5mm to 10mm
	Emergo Asia Pacific Pty Ltd
ER142	Aleutian Cervical Interbody System	Cage, Convex, or Lordotic. PEEK	[(11x11) or (11x14) or 	$2,503.00
	(13x16)] footprint  x (5 
	to14) mm height
ER148	Rabea Peek Vertebral Body Fusion 	Composition - peek, spinal implant	4, 5, 6, 7 x 12 x 14mm, 8 x 12	$2,503.00
	Implant	 x 16mm
ER151	Nubic	Cervical Fusion Implant in interbody 	4x13x14mm, 5x13x14mm, 	$2,503.00
	fusion of the Cervical Spine	6x13x14mm, 7x13x14mm, 
	8x13x14mm
	Euros Orthopaedics Australia Pty Ltd
EU005	Cervical Interbody Cage E.C.C	PEEK cervical interbody cage	7 cage sizes:	$2,503.00
	-3 possible heights: 5, 6 
	and 7mm
	-2 possible widths: 16 and 
	19mm
	-2 possible depths: 12 and 
	14mm
	Global Orthopaedic Technology
GO201	Cambria Interbody Cage	PEEK Cervical Interbody Cage	13mm x 12mm, 15mm x 	$2,503.00
	13mm, 17mm x 13mm height 
	- 5mm - 12mm
	Globus Medical Australia
LB034	Colonial Spacers	Anterior Cervical Interbody Cage	12x11 mm, 14x12mm, 	$2,503.00
	16x14mm, 18x15mm 0deg 
	and 7deg lordosis
	Health Care Surgical Pty Ltd
HC006	Squale	Cervical Cage	4-10mm	$2,503.00
Prostheses List by Category, Groups and Sponsor	Page 1029 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
HC022	PM cage	Cervical cage	L :4-11mm	$2,503.00
	Johnson & Johnson Medical Pty Ltd
DP514	Brantigan I/F Cage	Cervical Brantigan Cage	Standard/Large 4-10mm	$2,503.00
	Lifehealthcare Pty Ltd
LH489	NanOss Cervical Interbody	Cervical Cage with 6 degree of 	Height 5mm, 6mm, 7mm, 	$2,503.00
	9mm, 11mm
	Footprints: 14mm Wide & 
	12mm Depth, 17mm Wide & 
	14.5mm Depth
	Medacta Australia Pty Ltd
MU102	Mecta-C	Cervical Interbody Fusion Device 	Width: 12,14,and 15mm. 	$2,503.00
	made with PEEK	Length: 14,16 and 18 mm. 
	Height: from 4 to 9 mm. Flat 
	Dome Shaped versions
	Medtronic Australasia Pty Ltd
MC413	Cornerstone Cage	Sterile and Non-sterile	4 - 14mm	$2,503.00
MC589	Affinity Anterior cervical cage System	The Affinity Cage is constructed of 	6mm to 14mm	$2,503.00
	titanium alloy - kit includes trials, 
	reamers and inserters.
	National Surgical Pty Ltd
NK001	Zoe Cervical Cage	The ZOE anterior cervical cage is an 	Length: 12 - 14mm, Width: 	$2,503.00
	implant intended for the surgical 	14 - 16mm, Height: 4.5 - 
	treatment of the cervical vertebrae.  It 	10mm
	is designed for stabilisation and 
	arthrodesis between the cervical 
	verterbrae by the anterior approach, to
	 optimize bone fusion from C3 to C7 
	levels.
NK008	Calix Interbody Spacer	Cervical cage, PEEK	Heights 5-12mm. Lordotic 	$2,503.00
	and Convex
	Nuvasive Australia and NZ  Pty Ltd
NV010	CoRoent	Cervical Cage	small	$2,503.00
Prostheses List by Category, Groups and Sponsor	Page 1030 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Orthofix Australia Pty Limited
OF001	Construx Mini PTC	Anterior  cervical cage	12x12mm, 15x12mm, 	$2,503.00
	15x15mm 5 degree lordotic. 
	6-14mm height in 1mm 
	increnebts 12x12mm, 
	15x12mm, 15x15mm 
	Parallel, 6-14mm height in 
	1mm increments
	Orthotech Pty Ltd
OH131	Anterior Cervical Cage	Peek	12 x 15, 12 x 17, 14 x 17, 14 	$2,503.00
	x 19
OH316	Impix-C+ - Cervical Cage	Impix-C+ Pre-filled Cervical Cage	12.5mm x 14mm x 5mm, 	$2,503.00
	12.5mm x 14mm x 6mm, 
	12.5mm x 14mm x 7mm, 
	14.5mm x 16mm x5mm, 
	14.5mm x 16mm x 6mm, 
	14.5mm x 16mm x 7mm, 
	14.5mm x 16mm x 8mm, 
	14.5mm x 16mm x 9mm
	Prism Surgical Designs Pty Ltd
PZ017	VerteLoc Spine System	Cervical Cage	extra small - extra large	$2,503.00
	Scient'x Australia
SX014	CBK Cage	PEEK	L: 15mm, W: 13mm, H: 4.5-	$2,503.00
	9mm
SX056	Novel Cervical Spacer System	PEEK Vertebral body replacement, 	Small: 12mm width x 12mm 	$2,503.00
	cervical	depth; heaight: 12mm (1mm 
	increments)Medium: 
	12mm width x 14mm depth; 
	heaight: 12mm (1mm 
	increments)Large: 14mm 
	width x 16mm depth; 
	heaight: 12mm (1mm 
	increments)
SX088	Samarys Anterior Cervical Cage 	Anterior Cervical Cage - PEEK	L15 x w17 x h5mm, L15 x 	$2,503.00
	System	w17 x h6mm, L15 x w17 x 
	h7mm, L15 x w17 x h8mm, 
	L13 x w17 x h5mm, L13 x 
	w17 x h6mm, L15 x w20 x 
	h5mm, L15 x w20 x h6mm
Prostheses List by Category, Groups and Sponsor	Page 1031 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Signature Orthopaedics
SF007	VerteLoc Spine System	Cervical Cage	extra small - extra large	$2,503.00
	Signature Spine
SV013	Tryptik Anterior Cervical Cage	Tryptik Anterior Cervical Cages are 	The product is available in 	$2,503.00
	manufactured from PEEK and are 	2 sizes, the 12mm cage is 
	anatomically shaped to fit between 	available in 3 thicknesses, 
	vertebral bodies. The cages have large 	while the 14mm cage is 
	graft windows for graft to increase the 	available in 4 thicknesses 5,
	rate of fusion. The cage also features 4 	 6, 7, and 8mm
	stabilising spikes that provide s
	Stryker Australia Pty Ltd
ST712	Solis Cervical Cage	PEEK Cervical Interbody Cage	12/4-12/9 and 14/4-14/9	$2,503.00
	Synthes Australia Pty Ltd
SY273	Cervios IBF Cage	Interbody Fusion Cage	Height 5-10mm (1mm 	$2,503.00
	increments)
SY792	ACIS	Anterior Cervical Interbody Spacer	Small to large	$2,503.00
	Zimmer Pty Ltd
ZI330	Trabecular Metal Spinal Devices	Composition - Trabecular Metal	Various heights, sizes and 	$2,503.00
	diameters
ZI482	Spine-Tech BAK Cervical Implant	Cervical Cage	6 x 12mm, 8 x 12mm, 10 x 	$2,503.00
	12mm, 12 x 12mm
ZI536	Trabecular Metal Spinal Devices	Composition Trabecular Metal	Various heights, diameters 	$2,503.00
	and sizes
ZI691	Fortitude Peek-Optima (sterile)	Vue Radiolucent Implant	12mm	$2,503.00
ZI696	Fidji Cervical Cage	Fidji anterior interbody cage	12 x 15, 12 x 17, 14 x 17, 14 	$2,503.00
	x 19
	Complex
	Scient'x Australia
SX010	PCB Plate-Cage	Titanium cervical plate-cage	L: 14-16mm, W: 12-15mm, 	$2,700.00
	Cage Height: 4.5-8mm, 
	Plate Height: 23-29mm
SX072	Samarys RF - PEEK Cage	Pre-filled cervical cage	Depty x width: 12 x 15mm, 	$2,700.00
	13 x 17mm, 15 x 17mm, 15 x 
	20mm; Height: 4.5, 5, 6, 7, 
	8, 9, 10mm
Prostheses List by Category, Groups and Sponsor	Page 1032 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	13.10.02.02 - ThoracoLumbar / Lumbar
	Advanced Surgical Design & Manufacture Ltd
AE151	Forza PLIF	PEEK PLIF cages in various sizes	9x23/27mm	$3,600.00
	11x23/27mm
	0 and 8 degree
	6-16mm height in 1mm 
	increments
AE152	FORZA TLIF	PEEK TLIF cages in various sizes	9x27/31	$3,600.00
	11x27/31/33
	6-16mm length in 1mm 
	increments 
	0 - 8 degree
AE192	Blackstone Medical Pillar AL	Anterior Lumbar Interbody Fusion 	26mm x 20mm, 7 degrees 	$3,600.00
	PEEK cage	(lordotic). 8-20mm height in
	 2mm increments. 30mm x 
	24mm, 0 degrees (parallel). 
	8mm 18mm height in 2mm 
	increments. 30mm x 24mm, 7 
	degrees (lorotic). 10-22mm 
	height in 2mm increments. 
	30mm x 24mm, 12 degrees 
	(lordotic). 12-24mm heigh
AE194	Blackstone Medical Pillar TL	Transforaminal Lumbar Interbody 	9mm x 27mm, 0 degrees 	$3,600.00
	Fusion PEEK cage	(parallel). 8mm -16mm 
	height in 1mm increments. 
	9mm x 27mm, 8 degrees 
	(lordotic). 8mm -16mm 
	height in 1mm increments
	Australian Pacific Medical Pty Ltd
PB005	TLIF (D-REX) Cage	Interbody fusion cage.	Height: 7-15 mm.	$3,600.00
	B Braun Australia Pty Ltd
BB070	Prospace Block	Titanium	9mm-11mm	$3,600.00
BB211	KLA Anterior Lumbar Cage System	Anterior Lumbar Cage - PEEK	9mm x 5 degrees, 11mm x 5 	$3,600.00
	degrees, 13mm x 5 degrees, 
	11mm x 9 degrees, 13mm x 9 
	degrees, 15mm x 9 degrees, 
	13mm X 13 degrees, 15mm X
	 13 degrees
Prostheses List by Category, Groups and Sponsor	Page 1033 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB252	T. Lif Intervertebral Cage System	T.Lif PEEK Intervertebral Cage	All sizes	$3,600.00
BB278	Aesculap Interbody Cage	Interbody cage	All sizes	$3,600.00
	Biomet Australia Pty Ltd
BH143	Zyston Curved Interbody Spacer	Transformaminal Lumbar Interbody 	(7 to 18)mm height to 	$3,600.00
	Spacer, PEEK	(27x32)mm length, Parallel, 
	Lordotic
	Device Technologies Australia Pty Ltd
DE349	ROI-A ALIF Cage	The ROI-A implant is an ALIF 	Footprints 23x26mm, 	$3,600.00
	interbody/fusion cage manufactured 	30x33mm, 33x36mm. 
	from PEEK-Optima.	Lordosis angles 2, 6, 10, 14 
	If the surgeon so chooses, additional 	degrees. Heights 9-19mm. 1 
	stability can be added to the construct	cage per pack.
	 by inserting optional self-guided, 
	locking anchoring plates into the 
	cage and the adjacent vertebral 
	bodies.
DE377	ROI-T TLIF Cage	ROI-T is a TLIF (Transforaminal 	Lordotic angles 0, 5 and 9 	$3,600.00
	Lumbar Interbody Fusion) interbody 	degrees. Length 30mm. 
	fusion cage manufactured from PPEK-	Heights: 8 to 16mm in 
	Optima, designed for ease of insertion 	increments of 1 mm.
	and graft maximisation. The 
	transforaminal approach allows for 
	exposure of the disc space by 
	removing the facet joints and 
	protecting the nerve roots. The disc 
	space is entered and disc material is 
	removed. The ROI-T cage is filled with
	 bone graft material and is placed into 
	the cage space to maintain the disc 
	height and impart additional stability 
	to the construct. Note that ROI-T 
	cages must be used in conjunction 
	with a posterior screw and rod system 
	to properly stabilise the segments and
	 enable fusion to occur.
	Emergo Asia Pacific Pty Ltd
ER021	Aleutian ALIF	Anterior lumbar interbody spacer, 	(30-60)mm wide x (18-	$3,600.00
	PEEK	24)mm long x (8-21)mm 
	height
Prostheses List by Category, Groups and Sponsor	Page 1034 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ER022	Aleutian TLIF	Transforaminal Posterior Interbody 	(8.5-12)mm wide x (24-	$3,600.00
	spacer, PEEK	32)mm long x (7-17)mm 
	height x (6-18) degree 
	lordotic angle
ER045	Aleutian Lateral	Lateral Interbody Spacer, Coronal 	(18-22)mm width x (45-	$3,600.00
	Taper, PEEK	55)mm length x (8-18)mm 
	height, (8-16) degreee 
	Lordotic Angle
ER150	Signus - Semial	Composition - PEEK	Height (ant) 7.80, 10.40, 	$3,600.00
	13.20; Diameter 38, 43, 48; 
	Height (post) 5.4, 8.0, 8.1, 
	10.8; Angle 5.00, 10.40
ER152	Magerl/Kimba Cage	Endless Carbon Fibre (ECF) in 	7, 8, 9, 11, 13, 15mm	$3,600.00
	PEEK-Optima
ER162	Signus Mobis Lumbar TLIF Cage	Peek-Optima Lumbar intervertebral 	6, 7, 8, 9, 10, 11, 12, 13, 14, 	$3,600.00
	TLIF cage	16, 18mm heights
	Global Orthopaedic Technology
GO229	Ventura Interbody Cage	PEEK Lumbar Interbody Cage	Medial Lateral 9mm - 1mm x 	$3,600.00
	A/P 28mm. Height 7mm - 
	17mm
GO236	Redondo Spinal System	An ALIF Spacer manufactured from 	Width 26-55mm, Depth 18-	$3,600.00
	PEEK Optima	24mm, Height 8-18mm 0-12 
	degrees lordosis
GO237	Hollywood Spinal Posterior 	A TLIF implant manufactured from 	11mm x 27mm x 7 to 18mm 	$3,600.00
	PEEK Optima	Lordotic in 1mm increments
	
	11mm x 27mm x 7 70 18mm 
	Globus Medical Australia
LB004	TransContinental Spacer	PEEK Interbody cages	X-small, small, medium, 	$3,600.00
	large, x-large 0 deg and 
	6deg 7 - 17mm Height
LB005	TransContinental M Spacer	PEEK Interbody cages	X-small, small, medium, 	$3,600.00
	large, x-large 0 deg and 
	6deg 7mm - 17mm Height. 
	20mm x 35mm - 60mm, 8mm -
	 17mm height
LB006	Signature Spacer	PEEK Interbody spacer	small, medium, large. 7mm - 	$3,600.00
	17mm Height
Prostheses List by Category, Groups and Sponsor	Page 1035 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
LB007	Continental Spacer	PEEK Interbody spacer	x-small, small, medium, 	$3,600.00
	large. 0deg, 8deg, 15deg. 
	9mm - 21mm Height
LB071	SUSTAIN Spacer	TLIF Cage	8mm-17mm height, 8mm-	$3,600.00
	12mm width, 26-30mm length
	Johnson & Johnson Medical Pty Ltd
DP511	Brantigan I/F Cage	ALIF C/F Cage	Small - Large, 21.5 - 29mm	$3,600.00
DY406	Leopard 5 Lodotic Carbon Fibre 	Carbon Fibre cage	7 - 18mm	$3,600.00
	Body Fusion Device
DY407	Leopard Parallel Carbon Fibre Body	Carbon Fibre Cage	7 - 18mm	$3,600.00
	 Fusion Device
JJ520	CONCORDE Spine System	Parallel Carbon Fibre Interbody 	7 - 18mm	$3,600.00
	Fusion Device
JJ569	Cougar Spine System	Anterior/lateral Lumbar Interbody 	Small - Large, 10 -65mm	$3,600.00
	Fusion Cage, Carbon Fibre Reinforced
	 Polymer (CFRP)
JJ899	CONCORDE Spine System	Lordotic Carbon Fibre Interbody 	7-18mm	$3,600.00
	Fusion Device
	Medacta Australia Pty Ltd
MU103	Mectalif Oblique	Oblique Transforaminal Interbody 	Width: 12mm. Length 32,36	$3,600.00
	Fusion Device made with PEEK	 and 40 mm. Height: from 7 
	to 15 mm
MU105	Mectalif Transforaminal	Transforaminal Interbody Fusion 	Width: 12 and 14 mm. 	$3,600.00
	Device _ Banana Shape - made with 	Length: 30 and 34 mm. 
	PEEK	Height from 8 to 15 mm
	Medtronic Australasia Pty Ltd
MC602	Union	Verte-Stack	8 - 20mm	$3,600.00
MC673	Verte-Stack	Perimeter Cage	Extra Small, Small, Medium, 	$3,600.00
	Large, Extra Large
MC685	Verte-Stack Crescent	PEEK	Height 6 - 18mm	$3,600.00
MC974	Capstone Cage	TLIF Vertebral Body Spacer	Length: 32mm - 36mm	$3,600.00
MC975	Capstone Cage	DLIF Vertebral Body Spacer	Length: 40mm - 60mm	$3,600.00
MI062	Capstone Control	TLIF vertebral Body Spacer	Length: 27-32mm	$3,600.00
MI064	Crescent Spinal System	Titanium	height: 7-16mm	$3,600.00
Prostheses List by Category, Groups and Sponsor	Page 1036 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MI065	Clydesdale Spinal System	DLIF Vertebral Body Spacer	Length: 40mm - 60mm	$3,600.00
MI068	Loop Spinal System	TLIF Vertebral Body Spacer	Length: 32.5mm -37.5mm	$3,600.00
	National Surgical Pty Ltd
NK028	SteriSpine LC - Lumbar Cage	Lumbar Cage	Height: 7-14mm, Width: 	$3,600.00
	10-12mm, Length: 28mm
	Nuvasive Australia and NZ  Pty Ltd
NV012	CoRoent	TLIF cage	LW, LC	$3,600.00
NV013	CoRoent	XLIF cage	XL	$3,600.00
NV014	CoRoent	ALIF cage	XLR	$3,600.00
NV094	Brigade Ti System	Interbody fusion implant	10-20mm x 34-42mm	$3,600.00
	Orthotech Pty Ltd
OH128	Anterior Lumbar Cage	Titanium or PEEK	Height 2 - 20mm	$3,600.00
	Prism Surgical Designs Pty Ltd
PZ018	VerteLoc™ Spine System	Interbody Fusion Device	7mm - 18mm	$3,600.00
PZ019	Australis Spine System	Thoracolumbar Cage	small to extra large	$3,600.00
	Scient'x Australia
SX007	Antelys	Cage	H: 9-15mm	$3,600.00
SX033	Olys	PEEK TLIF Cage	Length 28mm, 35mm: 	$3,600.00
	Height 7mm, 9mm, 11mm, 
	13mm
SX055	Novel Anterior Lumbar Interbody 	PEEK lumbar fusion cage	Small: 26mm wide x 23mm 	$3,600.00
	Spinal Spacer System	depth; height: 8mm - 20mm 
	(2mm increments); 7° or 12° 
	lordoticMedium: 32mm 
	wide x 26mm depth; height: 
	8mm - 20mm (2mm 
	increments); 7° or 12° 
	lordoticLarge: 36mm wide
	 x 30mm depth; height: 
	10mm - 20mm (2mm 
	increments); 7° or 12° l
Prostheses List by Category, Groups and Sponsor	Page 1037 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SX059	Novel TL Spinal Spacer System	PEEK fusion cage	Standard design:Small: 	$3,600.00
	22mm width x 10mm depth; 
	height: 7mm - 14mm (1mm 
	increments); 0° or 5° 
	lordosisMedium: 24mm 
	width x 10mm depth; 
	height: 7mm - 17mm (1mm 
	increments); 0° or 5° 
	lordosisLarge: 28mm 
	width x 10mm depth; 
	height: 7mm - 17mm (1mm 
	increme
SX060	Guided Lumbar Interbody Fusion 	Spinal spacer	Length: 40, 50, 60mm; 	$3,600.00
	spinal spacer	Height: 8, 10, 12, 14, 16, 
	18mm; Lordosis: 0 degrees, 
	7 degrees
SX082	Novel TL Spinal Spacer System 	PEEK thoracolumbar fusion cage - 	Medium: 24mm width x 	$3,600.00
	(Sterile)	Tapered design (Sterile)	10mm depth; height: 6mm-
	15 mm (1mm increments); 5° 
	lordosis
	Large: 28mm width x 10mm 
	depth; height: 6mm -15mm 
	(1mm increments); 5° 
	lordosis
	Extra Large : 30mm width x 
	10mm depth; height: 6mm-
	15mm (1mm increments) 5° 
	lordosis
SX083	Novel ALS Spinal Spacer System 	PEEK lumbar fusion cage (Sterile)	Small: 26mm wide x 23mm 	$3,600.00
	(Sterile)	depth; height: 8mm-18mm 
	(2mm increments) 7° or 12°
	Medium: 32mm wide x 
	26mm depth; height 8mm-
	18mm (2mm increments); 7° 
	or 12° lordotic
	Large: 36mm wide x 30mm 
	depth; height 10mm-18mm 
	(2mm increments) 7° or 12° 
	lordotic
	Signature Orthopaedics
SF002	VerteLoc™ Spine System	Interbody Fusion Device	7mm - 18mm	$3,600.00
SF022	Australis Spine System	Thoracolumbar Cage	small to extra large	$3,600.00
Prostheses List by Category, Groups and Sponsor	Page 1038 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Signature Spine
SV005	Juliet TLIF Cage	PEEK cage with built in anatomical 	4 thicknesses - 8, 10, 12 and	$3,600.00
	angulations	 14mm
SV010	Juliet Anterior Lumbar Cage	PEEK cage with built in anatomical 	All 26 mm length. 10, 12, 14	$3,600.00
	shape. The cage has built in 	 and 16mm height.  5 or 10 
	stabilising Titanium spike to stabilise	degree slope.
	 the implant in the disc space.
	Stryker Australia Pty Ltd
HW406	Aria Spinal System / Peek DLIF 	PEEK DLIF Interbody Spacer	H: 8-18mm L: 40-60mm W: 	$3,600.00
	Interbody Spacer	18-22mm 0-8 degree lordosis
HW520	AVS Navigator	Steerable TLIF Cage	L 26-31mm, H6-15mm, 0 	$3,600.00
	and 4 degree anglulation
SR050	AVS TL Peek Spacer System	Transforaminal Lumbar Interbody 	7-18mm x 25--30mm. 0-4 	$3,600.00
	Fusion cage, PEEK	degree
SR066	AVS AL PEEK Spacer System	Anterior Lumbar Interbody Fusion 	22mm deep x 28mm wide x 	$3,600.00
	10mm - 50mm height and 
	28mm deep x 33mm wide x 
	10mm-50mm height.  Both 
	base sizes come in 4 degree 
	and 8 degree angulations
SR082	UniLIF	PEEK Unilateral Lumbar Interbody 	Width 11mm, Height 6mm 	$3,600.00
	Fusion Cage	to 13mm, Length 30mm - 
	33mm
	Synthes Australia Pty Ltd
SY137	Syncage	Interbody fusion cage	9-19mm	$3,600.00
SY300	Travios	Interbody fusion cage, prefilled or 	5mm to 19mm	$3,600.00
	unfilled
SY439	OPAL	Cage Spacer	7-177mm, 10 x 28-32mm	$3,600.00
SY453	Oracle	Lumbar Interbody Fusion Cage	40-55mm M/L x 22mm A/P, 	$3,600.00
	9-17mm Height
SY570	T-PAL	Interbody Fusion Cage System - 	7-17mm	$3,600.00
	Lumbar
	Zimmer Pty Ltd
ZI537	Trabecular Metal Spinal Device	Composition Trabecular Metal	Various heights, sizes and 	$3,600.00
	diameters
ZI658	Traxis Peek-Optima (sterile)	Vue Radiolucent Implant	12mm	$3,600.00
Prostheses List by Category, Groups and Sponsor	Page 1039 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
ZI679	InFix Interbody Fusion System	Strut	Small - Large	$3,600.00
ZI689	Cadence Peek - Optima (sterile)	Vue Radiolucent Implant	9-13mm	$3,600.00
ZI693	InFix Interbody Fusion System	Strut	Small - Large	$3,600.00
ZI695	Anterior Lumbar Cage	Titanium or PEEK	Height 2 - 20mm	$3,600.00
ZI869	TM (Trabecular metal) Ardis 	Fenestrated and non-fenestrated 	Length  26mm x Width 9 & 	$3,600.00
	Interbody System	intervertebral body fusion device - for 	11mm x Height - 8-16mm 
	single insertion	(1mm increments, excludes 
	15mm) Total  16 sizes
	Length 30mm x Width x 9 &
	 11mm x Height - 8-16mm 
	(1mm increments, excludes 
	15mm) Total  16 sizes
	Length – 34mm x Width – 
	11mm  x Height - 8-16mm 
	(1mm increments, excludes 
	15mm) Total 8 sizes
	There are 40 sizes as above. 
	The implant comes in both 
	Fenestrated and un-
	fenestrated types, therefore 
	there are 80 options in total.
	Paired
	Advanced Surgical Design & Manufacture Ltd
AE193	Blackstone Medical Pillar PL	Posterior Lumbar Interbody Fusion 	9mm x 23mm, 0 degrees 	$3,000.00
	PEEK Cage	(parallel). 8mm - 16mm 
	height in 1mm increments. 
	9mm x 23mm, 8 degrees 
	(lordotic). 8mm-16mm 
	height in 1mm increments
	Australian Pacific Medical Pty Ltd
PB002	Thoracic-lumbar PEEK cage	Interbody fusion cage	Height: 6 - 15mm	$3,000.00
	B Braun Australia Pty Ltd
BB215	Adonys Posterior Lumbar Cage 	Posterior Lumbar Cage - PEEK - 	8mm x 4 degrees, 12mm x 4 	$3,000.00
	System	Standard	degrees, 8mm x 10 degrees, 
	12mm x 10 degrees
Prostheses List by Category, Groups and Sponsor	Page 1040 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
BB216	Adonys Posterior Lumbar Cage 	Posterior Lumbar Cage - Short	8mm x 4 degrees, 10mm x 4 	$3,000.00
	System	degrees, 12mm x 4 degrees, 
	8mm x 10 degrees, 10mm x 
	10 degrees, 12mm x 10 
	degrees
	Biomet Australia Pty Ltd
BH170	Zyston Straight Interbody Spacer	Posterior Lumbar Interbody Spacer, 	(7mm x 20mm) to (18mm x 	$3,000.00
	PEEK	30mm), Convex, Lordotic
	Device Technologies Australia Pty Ltd
DE351	ROI PLIF Cages	The ROI PLIF cages are manufactured 	Lordotic angles, 0, 5 & 8 	$3,000.00
	from PEEK-Optima and are implanted 	degrees, posterior heights 6 
	from the posterior approach for 	to 11mm, anterior heights 7 
	interbody fusion. The cages are 	to 13mm.
	supplied in pairs (2 per pack) as is 
	standard for this procedure.
	Emergo Asia Pacific Pty Ltd
ER020	Aleutian AN PLIF	Posterior lumbar spacer, PEEK	(22-28)mm long x (8.5-	$3,000.00
	10)mm wide x (4-17)mm 
	high x (0-18) degree lordosis
ER050	LP Cage	The LP Cage is a lumbar interbody 	Length: 25mm, 27mm, 	$3,000.00
	fusion device	30mm, 32mm
	Height: 8mm~14mm, in 1m 
	increments
	Width: 11mm
ER149	Tetris Lumbar Fusion Implant 	Titanium or peek, spinal implant	Footprint:9 x 24mm, 9 x 	$3,000.00
	20mm 
	Heights: 7mm to 15mm
	Lordosis: 0, 4 and 8
	Euros Orthopaedics Australia Pty Ltd
EU010	Posterior Interbody Cage PIC	PEEK posterior interbody cage	6 thickness available: 8, 9, 	$3,000.00
	10, 11, 12 and 13mm
	3 type of angulation: 0, 4, 
	8°
	2 lengths available: 20 and 
	Global Orthopaedic Technology
GO228	Pacifica Interbody Cage	PEEK Lumbar Interbody cages std 	Medium Lateral 9mm - 11mm	$3,000.00
	and lordotic	 x A/P 20mm - 24mm. Height
	 7mm - 17mm
Prostheses List by Category, Groups and Sponsor	Page 1041 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Globus Medical Australia
LB070	SUSTAIN spacer	PLIF cage	8mm-17mm height, 8mm-	$3,000.00
	12mm width, 22mm length
	Health Care Surgical Pty Ltd
HC005	Swingo	Lumbar Cage	7-14mm	$3,000.00
HC015	SHARK CAGE	Lumbar cage	L:8-16mm	$3,000.00
	Johnson & Johnson Medical Pty Ltd
DP510	Brantigan I/F Cage	PLIF C/F Cage 	Straight / Wedge	$3,000.00
DP515	I/F Ramp	PLIF C/F Ramp	7-15 x 9-17 x 21 - 25 mm	$3,000.00
DP851	Surgical Titanium Mesh System	Standard & Trapezoidal	10-16mm x 8-17mm Hgt	$3,000.00
DY422	Saber Cage	PLIF Cage	Parallel/Wedge	$3,000.00
JJ699	Iriom ramp	Carbon fibre fusion ramp	5 degrees and 7.5 degree 	$3,000.00
	lordosis, 9-17 mm anterior 
	heights
JJ900	CONCORDE Spine System	Lordotic Carbon Fibre Interbody 	7-18mm	$3,000.00
	Fusion Device for paired insertion
	Matrix Medical Innovations
BF001	Vigor/X'Plo PEEK Interbody 	Rotatable posterior lumbar interbody 	Heights: 7mm, 8mm, 9mm, 	$3,000.00
	Fusion Cage	fusion cage	10mm, 11mm, 12mm, 14mm, 
	16mm and Lengths: 24mm, 
	26mm, 32mm
	Medacta Australia Pty Ltd
MU104	Mectalif Posterior	Posterior Interbody Fusion Device 	Width: 11mm. Length: 22 	$3,000.00
	made with PEEK	and 25 mm. Height: from 7 
	to 15 mm
	Medtronic Australasia Pty Ltd
MC456	Interfix 	Titanium Cage	12 x 20mm - 24 x 50mm	$3,000.00
MC457	LordoTec Cage (LT-Cage)	Titanium,  PEEK	18-28mm	$3,000.00
MC577	R90 Spacer	Spinal Implant (Peek)	Height 7 - 16mmLordosis 	$3,000.00
	6 - 18 degrees
MC976	Capstone Cage	PLIF Vertebral Body Spacer	Length: 22mm - 26mm	$3,000.00
MI063	Capstone Control	PLIF Vertebral Body Spacer	Length: 22-26mm	$3,000.00
MI066	Fuse Spinal system	PLIF Vertebral Body Spacer	Length: 24.5mm	$3,000.00
Prostheses List by Category, Groups and Sponsor	Page 1042 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	National Surgical Pty Ltd
Prostheses List by Category, Groups and Sponsor	Page 1043 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
NK009	Calix Peek Lumbar System	Peek lumbar interbody spacer for 	36mm x 24mm x 8mm x 8 deg	$3,000.00
	fusion of the lumbar spine using an 	
	anterior, posterior or transverse 	36mm x 24mm x 10mm x 8 
	approach.	deg
	36mm x 24mm x 12mm x 8 
	deg
	36mm x 24mm x 14mm x 8 
	deg
	36mm x 24mm x 16mm x 8 
	deg
	36mm x 24mm x 18mm x 8 
	deg
	36mm x 24mm x 20mm x 8 
	deg
	36mm x 24mm x 8mm x 12 
	deg
	36mm x 24mm x 10mm x 12 
	deg
	36mm x 24mm x 12mm x 12 
	deg
	36mm x 24mm x 14mm x 12 
	deg
	36mm x 24mm x 16mm x 12 
	deg
	36mm x 24mm x 18mm x 12 
	deg
	36mm x 24mm x 20mm x 12 
	deg
	28mm x 10mm x 6mm
	28mm x 10mm x 7mm
	28mm x 10mm x 8mm
	28mm x 10mm x 9mm
	28mm x 10mm x 10mm
	28mm x 10mm x 11mm
	28mm x 10mm x 12mm
	28mm x 10mm x 13mm
	28mm x 10mm x 14mm
	28mm x 10mm x 15mm
	28mm x 10mm x 16mm
	22mm x 10mm x 6mm
	22mm x 10mm x 7mm
	22mm x 10mm x 8mm
	22mm x 10mm x 9mm
	22mm x 10mm x 10mm
	22mm x 10mm x 11mm
	22mm x 10mm x 12mm
Prostheses List by Category, Groups and Sponsor	Page 1044 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	22mm x 10mm x 13mm
	22mm x 10mm x 14mm
	22mm x 10mm x 15mm
	22mm x 10mm x 16mm
	26mm x 10mm x 6mm
	26mm x 10mm x 8mm
	26mm x 10mm x 10mm
	26mm x 10mm x 12mm
	26mm x 10mm x 14mm
	26mm x 10mm x 6mm x 5o
	26mm x 10mm x 8mm x 5o
	26mm x 10mm x 10mm x 5o
	26mm x 10mm x 12mm x 5o
	26mm x 10mm x 14mm x 5o
	Nuvasive Australia and NZ  Pty Ltd
NV011	CoRoent	PLIF cage	LN, LT	$3,000.00
	Orthotech Pty Ltd
OH129	Posterior Lumbar Cage	Titanium or PEEK	Height 7 - 20mm	$3,000.00
OH317	IMPIX-LR	IMPIX - lr Lumbar Ramp	8x20x0DEG, 	$3,000.00
	13X20X0DEG, 
	14X20X0DEG, 
	9X20X4DEG, 
	10X20X4DEG, 
	11X20X4DEG, 
	12X20X4DEG, 
	13X20X4DEG, 
	14X20X4DEG, 
	10X20X8DEG, 
	11X20X8DEG, 
	12X20X8DEG, 
	13X20X8DEG, 
	14X20X8DEG, 
	12X20X12DEG, 
	13X20X12DEG, 
	14X20X12DEG, 
	8X25X0DEG, 
	9X25X0DEG, 
	10X25X0DEG, 
	11X25X0DEG, 12X2
Prostheses List by Category, Groups and Sponsor	Page 1045 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX013	CC-CO Cages	PEEK Polymer	L: 23.5mm, W: 10-13.5mm, 	$3,000.00
	H: 8-14mm
SX058	Novel SD Spinal Spacer System	Self-distracting PEEK fusion cage	Small:9mm width x 22mm 	$3,000.00
	depth; height: 8mm - 20mm 
	(1mm increments)11mm 
	width x 22mm depth; 
	height: 8mm - 20mm (1mm 
	increments)Medium:
	9mm width x 25mm depth; 
	height: 8mm - 20mm (1mm 
	increments)11mm width x 
	25mm depth; height: 8mm - 
	20mm (1mm increment
SX081	Novel SD Spinal Spacer System 	Self-distracting PEEK fusion cage 	Small 9mm width x 22mm 	$3,000.00
	(Sterile)	(Sterile)	depth; height 8mm-20mm 
	(1mm increments)
	Medium 9mm width x 25mm 
	depth; height 8mm-20mm 
	(1mm increments)
	Large 9mm width x 28mm 
	depth; height 8mm-20mm 
	(1mm increments)
	Signature Spine
SV012	Juliet Posterior Lumbar Interbody 	PEEK cage built in anatomical slope.	All 22mm length. 8, 10, 12 	$3,000.00
	Cage	and 14mm heights. 0 or 5 
	degrees anatomical slope.
	Stryker Australia Pty Ltd
ST711	PEEK Interbody Cages	Peek lumbar cages poly ether ether 	Size 7-18mm	$3,000.00
	ketone 0, 4 & 8 degree
	Synthes Australia Pty Ltd
SY088	Plif Cage: Cage	Contact fusion cage - bone 	Width 8 - 11mm / height 9 - 	$3,000.00
	compression screw for PLIF cage	15mm
SY274	Plivios IBF Cage	Interbody Fusion Cage	Height  7-17mm	$3,000.00
SY340	PlivioPore	Ti PLIF cage	Height 7 - 17mm / width 7 - 	$3,000.00
	13mm
Prostheses List by Category, Groups and Sponsor	Page 1046 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Zimmer Pty Ltd
ZI483	Spine-Tech BAK "L" Cage	Lumbar Cage	9 x 20mm, 9 x 24mm, 11 x 	$3,000.00
	20mm, 13 x 20mm, 13 x 
	24mm, 15 x 20mm, 15 x 
	24mm, 17 x 24mm, 17 x 
	28mm
ZI615	ARDIS LUMBAR INTERBODY 	A lumbar interbody fusion cage	H 8 to 16mm; W 9 & 11mm; 	$3,000.00
	SPINAL CAGE	L 22 to 34mm
ZI694	Posterior Lumbar Cage	Titanium or PEEK	Height 7 - 20mm	$3,000.00
ZI868	TM (Trabecular Metal) Ardis 	Fenestrated and non-fenestrated 	Length  22mm x Width  - 	$3,000.00
	Interbody System	intervertebral body fusion device	9mm x Height – 8-16mm 
	(1mm increments, excludes 
	15mm)
	Total      8 sizes.
	The implant comes in both 
	Fenestrated and un-
	fenestrated types, therefore 
	there are 16 options in total.
13.10.03 - Facet Joint
	Prism Surgical Designs Pty Ltd
PZ020	ZygoLoc	Facet Fusion Cage	3-15mm	$1,500.00
	Signature Orthopaedics
SF004	ZygoLoc	Facet Fusion Cage	3-15mm	$1,500.00
13.11.01 - System
	13.11.01.01 - Cervical
	Device Technologies Australia Pty Ltd
DE411	Mobi-C Cervical Disc Prosthesis	A cervical intervertebral disc 	Depth (13-19mm) x width 	$6,500.00
	replacement consisting of superior 	(15-19mm) x height (4.5-
	and inferior spinal plates and a mobile	7mm)
	 bearing insert.
Prostheses List by Category, Groups and Sponsor	Page 1047 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Johnson & Johnson Medical Pty Ltd
MN155	Discover Artificial Disc Replacement	Artificial Cervical Disc	Small to large including 	$6,500.00
	extra wide
	Lifehealthcare Pty Ltd
LH490	M6C Artificial Cervical Disc	The M6 artificial cervical disc is an 	Footprints:	$6,500.00
	intervertebral disc prosthesis 	12.5mm x 15mm
	designed to maintain motion of a 	15mm x 15mm
	functional spinal unit when the native	14mm x 17mm
	 disc is diseased.	16mm x 17mm
	Heights: 
	6mm & 7mm
	Medtronic Australasia Pty Ltd
MI058	Bryan Cervical Disc	Cervical intervertebral disc prosthesis	14mm-18mm	$6,500.00
	 consisting of a polyurethane nucleus 
	designed to fit between two titanium 
	alloy shells
MI059	Prestige Cervical Disc	Cervical intervertebral disc prosthesis	5mm - 8mm x 12mm - 18mm	$6,500.00
	 with ball-and-trough designed 
	articulation
	Nuvasive Australia and NZ  Pty Ltd
NV090	PCM Cervical Disc	Total disc replacement system	5.7-8.0mm	$6,500.00
	Scient'x Australia
SX084	Discocerv Cervical Disc	Cervical disc prosthesis, also 	Length x Depth:17mm x 	$6,500.00
	supplied pre-loaded on single-use 	13mm,20mm x15mm; 
	Height: 5.25mm, 6mm 
	6.7mm, 7.5mm, 8.25mm
	Synthes Australia Pty Ltd
SY751	Prodisc-C	Cervical Intervertebral Disc	5-7mm Height; 15-19mm 	$6,500.00
	Width; 12-18mm Depth
	13.11.01.02 - Lumbar
	Medtronic Australasia Pty Ltd
MC585	Maverick Artificial Disc	Cobalt Chrome	8mm - 14mm	$9,550.00
	Orthotech Pty Ltd
OH467	LP-ESP® Intervertebral Disc 	Lumbar disc prosthesis	10-12mm thickness, 7/9/11 	$9,550.00
	Prosthesis	degrees
Prostheses List by Category, Groups and Sponsor	Page 1048 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.11.02 - End Plate
	Johnson & Johnson Medical Pty Ltd
DY356	In Motion Lumbar Artificial Disc	End Plates Parallel & Oblique	Small, medium, large	$4,200.00
	Synthes Australia Pty Ltd
SY327	Spine Solutions Prodisc	Artificial mechanical disc, superior 	3 Degree, 6 Degree, 11 	$4,200.00
	plate component	Degree, Medium, Large
SY329	Spine Solutions Prodisc	Artificial mechanical disc, inferior 	0 Degree, 3 Degree, 8 	$4,200.00
	plate component	Degree,Medium, Large
13.11.03 - Core
	Johnson & Johnson Medical Pty Ltd
DY359	In Motion Lumbar Artificial Disc	Sliding Core	7.5mm,  8.5mm, 9.5mm, 	$1,150.00
	10.5mm
	Synthes Australia Pty Ltd
SY328	Spine Solutions Prodisc	Artificial mechanical disc, 	10,12,14mm, Medium, Large	$1,150.00
	polyethylene inlay
13.11.04 - Replacement Nucleus
	Medtronic Australasia Pty Ltd
MC617	Nucleus Replacement	Spinal Disc	Thickness 5-25mm, 	$5,900.00
	Diameter 10-50mm
13.12.01 - Telescoping Cage
	13.12.01.01 - Integral Fixation
	Biomet Australia Pty Ltd
BH100	Interpore Bone Plate System	TPS Bone Plate	20 - 56cm	$2,300.00
	Orthotech Pty Ltd
OH052	Interpore Bone Plate System	TPS Bone Plate	20 - 56cm	$2,300.00
Prostheses List by Category, Groups and Sponsor	Page 1049 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
OH303	ADD / ADDplus	Addplus is a winged anterior 	ADDplus, diameter 12mm, 	$2,300.00
	distraction device and is also used for 	height 13-18mm. 6°
	vertebral column replacement which 	ADDplus, diameter 12mm, 
	can be used for the anterior cervical 	height 17-26mm. 6°
	column and for the cervico-thoracic 	ADDplus, diameter 12mm, 
	transition. The Adplus effects the 	height 25-41mm. 6°
	reconstruction, support and 	ADDplus, diameter 12mm, 
	stabilization 	height 40-65mm. 6°
	13.12.01.02 - No Integral Fixation
	Cervical
	Globus Medical Australia
LB066	XP and R Corpectomy Spacer 	Expandable Corpectomy spacer	Small, Medium,15-88mm in 	$3,100.00
	varying lordotic/kyphotic 
	angles
	Nuvasive Australia and NZ  Pty Ltd
NV102	X-Core Mini	the NuVasive X-CORE Mini 	15-80mm	$3,100.00
	expandable VBR System is a vertebral 
	body repalcement device for use in the
	 spine (C3 to L5) to replace a diseased
	 or damaged vertebral body caused by 
	tumor or fracure, to restore height of a 
	collapsed vertebral body, and to 
	achieve decompression of the spinal 
	cord and neural tissues,
	Scient'x Australia
SX035	TeCorp Vertebral Body Replacement	TeCorp Cervical	All sizes	$3,100.00
	 System
	Synthes Australia Pty Ltd
SY356	ECD - Expandable Corpectomy 	Vertebral body replacement system, 	Angle 4.5Deg/7Deg, 	$3,100.00
	Device	PEEK/Titanium	Height 17mm - 70mm
	ThoracoLumba
	Globus Medical Australia
LB055	Xpand Corpectomy Spacer System	Expandable corpectomy spacer	small, Medium, Large. 15-	$4,300.00
	120mm in varying 
	lordotic/kyphotic angles
Prostheses List by Category, Groups and Sponsor	Page 1050 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	ThoracoLumbar
	B Braun Australia Pty Ltd
BB288	Aesculap Vertebral Body System	Vertebral Body System, Titanium Alloy	All sizes	$4,300.00
	Johnson & Johnson Medical Pty Ltd
JJ782	X-MESH - Expandable Cage System	Telescoping, vertebral body 	Footprint/diameter 10-	$4,300.00
	replacement device	40mm, variable height range
	Medtronic Australasia Pty Ltd
MC507	LIFT/VERTE-SPAN	Vertebral Body Cages	Short - Extra Long	$4,300.00
MC820	T2	Expandable vertebral body 	Diameters: 13 - 31mm	$4,300.00
	replacement cage
	Nuvasive Australia and NZ  Pty Ltd
NV078	X-CORE (Expandable  cage)	Expandable VBR Cage	Diameter: 12-22mm	$4,300.00
	Height: 15-121mm
	Orthotech Pty Ltd
OH301	Obelisc vertebral body replacement	Centre PieceMade from titanium.	diameter - 20mm, height 20-	$4,300.00
	28mmdiameter - 20mm, 
	height 25-37mmdiameter - 
	20mm, height 32-47mm
	diameter - 20mm, height 40-
	62mmdiameter - 20mm, 
	height 53-87mmdiameter - 
	20mm, height 76-132mm
	Scient'x Australia
SX036	TeCorp Vertebral Body Replacement	TeCorp Thoracic	All sizes	$4,300.00
	 System
SX037	TeCorp Vertebral Body Replacement	TeCorp Lumbar	All sizes	$4,300.00
	 System
	Stryker Australia Pty Ltd
HW515	GIZA vertebral Body Replacement 	A Titanium expandable Vertebral 	14mm diameter, 18mm -	$4,300.00
	System	Body Replacement System with 	54mm length, 2 deg to 
	integral variable angled endplates	10deg angulation.
SK448	VLIFT	Vertebral Body Replacement System, 	Diameters 12 to 22mm	$4,300.00
	DIS Implant
	Synthes Australia Pty Ltd
SY341	Expandable Cage Titanium	Synex II, Titanium	Height 14mm-123mm	$4,300.00
Prostheses List by Category, Groups and Sponsor	Page 1051 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
SY343	Expandable Cage Titanium	Synex, Titanium, with endplates	Height 14mm - 93mm, Angle	$4,300.00
	 0 - 40 degree
SY794	XRL	Expandable Vertebral Body	22 - 121mm Height	$4,300.00
	13.12.01.03 - End Plate
	Medtronic Australasia Pty Ltd
MC540	LIFT/ VERTE-SPAN	End plates (caps)	Angulation: -8 - 7 degrees; 	$1,200.00
	left and right
	Nuvasive Australia and NZ  Pty Ltd
NV079	X-CORE (End Cap)	End plate	18 x 30-50mm; 22 x 40-6-	$1,200.00
	mm
	Orthotech Pty Ltd
OH302	Obelisc vertebral body replacement	End PieceMade from titanium.	diameter - 20mm, angle 0°	$1,200.00
	diameter - 20mm, angle 5°
	diameter - 20mm, angle 10°
	diameter - 24mm, angle 0°
	diameter - 24mm, angle 5°
	diameter - 24mm, angle 10°
	diameter - 26mm, angle 0°
	diameter - 26mm, angle 5°
	diameter - 26mm, angle 10°
	Stryker Australia Pty Ltd
SK339	VLIFT	End cap	Diameters 12 to 22mm	$1,200.00
	Synthes Australia Pty Ltd
SY342	Expandable Cage Titanium	Synex II, Titanium endplate	Angle 0 - 40 degree. 	$1,200.00
	Endplate Size 19x20, 
	22x25, 26x30
SY795	XRL	Endplate	-10˚/+15˚ Degrees	$1,200.00
	Zimmer Pty Ltd
ZI678	InFix Interbody Fusion System	Endplate	Small - Large	$1,200.00
ZI680	InFix Interbody Fusion System	Endcap	8-10mm	$1,200.00
Prostheses List by Category, Groups and Sponsor	Page 1052 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.12.02 - Stackable Cage
	Emergo Asia Pacific Pty Ltd
ER164	Signus Athlet VBR System - Main 	Peek Vertebral Body Replacement 	12, 18, 24, 30, 36 and 42mm 	$4,400.00
	Body	System (Main body)	lengths
ER165	Signus Athlet VBR System - End 	Peek Vertebral Body Replacement 	4, 6, 8mm heights	$4,400.00
	Body	System (End body)
	Johnson & Johnson Medical Pty Ltd
DP513	Stackable Corpectomy CFRP Cage 	Stackable Cage	Xsmall-Xlarge	$4,400.00
	System
DY322	Carbon Fibre Interbody Fusion 	Stackable C/F Cage System Wedges	11 Degree Small-Large	$4,400.00
	Medtronic Australasia Pty Ltd
MC603	Union	Verte-Stack	8 - 20mm	$4,400.00
MC606	Union	Verte-Stack	Centre Piece 5-40mm	$4,400.00
MC632	Verte-Stack	XS Centre Piece. Stackable 	Height 5-50mm	$4,400.00
	Corpectomy Device.
	Prism Surgical Designs Pty Ltd
PZ021	VerteLoc Spine System	Locking Screw	20mm - 150mm	$4,400.00
PZ022	VerteLoc Spine System	Stackable Cage	Extra Small- Extra large	$4,400.00
PZ023	VerteLoc Spine System	Locking Nut	one size only	$4,400.00
	Signature Orthopaedics
SF048	VerteLoc Spine System	Locking Screw	20mm - 150mm	$4,400.00
SF049	VerteLoc Spine System	Stackable Cage	Extra Small- Extra large	$4,400.00
SF050	VerteLoc Spine System	Locking Nut	one size only	$4,400.00
Prostheses List by Category, Groups and Sponsor	Page 1053 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
13.12.03 - Mesh
	Advanced Surgical Design & Manufacture Ltd
AE182	Blackstone - Surgical Mesh	4 lobe, 6 lobe	4 lobe: 12 x 15mm, 8mm - 17	$3,605.00
	 x 22, 15mm, 6 lobe: 
	(diameter x height) 10 - 16 x 
	10 - 16mm (2mm 
	increments), 7 - 70mm
	Johnson & Johnson Medical Pty Ltd
DP427	Surgical Titanium Mesh System	Various shapes	10- 26 x 15 -150mm	$3,605.00
DP438	Surgical Titanium Mesh System	Mesh  - Oblong	12 - 13 x 15 -17mm x 10 - 	$3,605.00
	20mm
	Matrix Medical Innovations
BF002	A-Mesh Spinal Titanium Mesh 	A-Mesh® Spinal Titanium Mesh is 	Diameter: 14mm, length: 	$3,605.00
	designed to restore biomechanical 	20mm, 50mm. 70mm
	integrity throughout the thoracic and 	Diameter: 20mm, Length: 
	lumbar spine following vertebrectomy	20mm, 50mm, 70mm, 90mm
	 or corpectomy for patients with spine 	Diameter: 25mm, Length: 
	tumors or fractures.	20mm, 50mm, 90mm
	Diameter: 30mm, Length: 
	20mm, 50mm, 90mm
	Medtronic Australasia Pty Ltd
MC378	Pyramesh	Titanium Surgical Mesh	51 - 500mm	$3,605.00
MC379	Pyramesh	Titanium Surgical Mesh	5 - 50mm	$3,605.00
MC449	Pyramesh	Angled	25 - 150mm	$3,605.00
MC450	Pyramesh	Curved / Round	20 - 150mm	$3,605.00
MC451	Pyramesh	Ovoid	8 - 130mm	$3,605.00
	Nuvasive Australia and NZ  Pty Ltd
NV015	Titanium Mesh	Oval/Flat/Long/Round	10mm - 16mm Diameter, 6mm	$3,605.00
	 - 14mm Length
NV016	Titanium Mesh	Oval/Flat/Long/Round	10mm - 16mm Diameter, 	$3,605.00
	15mm - 90mm Length
NV017	Titanium Mesh	Oval/Flat/Long/Round	20mm + Diameter, 30mm - 	$3,605.00
	90mm Length
Prostheses List by Category, Groups and Sponsor	Page 1054 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Scient'x Australia
SX057	Novel CP Corpectomy Spinal 	PEEK vertebral body replacement, 	Small: 14mm width x 12mm 	$3,605.00
	Spacer System	thoracolumbar	depth; height: 10mm - 50mm
	 (2mm increments)
	Medium: 17mm width x 
	15mm depth; height: 10mm -
	 50mm (2mm increments)
	Stryker Australia Pty Ltd
SK338	VBOSS/VLIFT	Titanium	Available from 10 to 25mm 	$3,605.00
	in Diameter and from 8 to 
	120mm in Length
	Synthes Australia Pty Ltd
SY293	Synmesh	Mesh, Oblong	6mm - 88mm	$3,605.00
SY294	Synmesh	Mesh, Round	6mm - 88mm	$3,605.00
13.12.04 - Mesh, End Plate
	Advanced Surgical Design & Manufacture Ltd
AE180	Blackstone - End Ring	Surgical Mesh	[Surgical mesh X Angle] 10-	$1,325.00
	16mm (2mm increments) X 0-
	2.5 degrees
	Johnson & Johnson Medical Pty Ltd
DY087	Surgical Titanium Mesh System	End Plate or Screws or End Cap 	10-33mm	$1,325.00
	(Round / Oblong / Trapezoidal)
DY088	Surgical Titanium Mesh System	Rings (Standard and Angled)	17-26mm x 22-33mm	$1,325.00
	Matrix Medical Innovations
BF003	A-Mesh Spinal Titanium Mesh Plate	A-Mesh® Spinal Titanium Mesh is 	Diameter: 14, 20 or 25mm	$1,325.00
	designed to restore biomechanical 
	integrity throughout the thoracic and 
	lumbar spine following vertebrectomy
	 or corpectomy for patients with spine 
	tumors or fractures
	Medtronic Australasia Pty Ltd
MC539	Pyramesh	End ring/cap	10 - 25mm	$1,325.00
Prostheses List by Category, Groups and Sponsor	Page 1055 of 1059

13 - SPINAL
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
MC821	T2	End Cap	13-31 mm, 0, 4, 8, 15 degree 	$1,325.00
	lordosis
	Stryker Australia Pty Ltd
SK424	VBOSS	End cap	Sizes 10 to 25mm	$1,325.00
	Synthes Australia Pty Ltd
SY295	Synmesh	End rings	round/oblong	$1,325.00
13.12.05 - Non Stackable Cage, other
	Emergo Asia Pacific Pty Ltd
ER138	Santorini Solid Corpectomy Cage 	Cage, fixed height, Peek	(12x14) or (16x20) mm 	$3,605.00
	System	footprint x (18-62) mm 
13.13.01 - Interspinous Fixation Device
	Lifehealthcare Pty Ltd
LH483	Coflex-F	Interspinous fusion device	8, 10, 12, 14, 16mm	$1,425.00
	Medtronic Australasia Pty Ltd
MC637	CD Horizon	Spire Plate	35-41mm	$1,425.00
	National Surgical Pty Ltd
NK027	Axle Interspinous fusion System	Interspinous fusion plate system	Plates : 36mm to 40 mm	$1,425.00
	Inserts: 8mm-18mm
	Nuvasive Australia and NZ  Pty Ltd
NV064	Affix Plate	Spinous process plate with an 	25mm - 55mm	$1,425.00
	integrated canted-coil locking 
	mechanism.
Prostheses List by Category, Groups and Sponsor	Page 1056 of 1059

ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
6.7.5 Orthopaedic reconstruction, general
	Baxter Healthcare Pty Ltd
BX308	Actifuse ABX MIS	Actifuse ABX MIS, Refill Cartridge, 	7.5ml	$1,560.00
	7.5ml
BX309	Actifuse ABX MIS	Actifuse ABX MIS, Applicator and 	7.5ml	$2,300.00
	Cartridge, 7.5ml
	Global Orthopaedic Technology
GO183	Actifuse ABX MIS	Actifuse ABX MIS, Applicator and 	7.5ml	$2,300.00
	Cartridge, 7.5ml
GO184	Actifuse ABX MIS	Actifuse ABX MIS, Refill Cartridge, 	7.5ml	$1,560.00
	7.5ml
	6.7.5.2.2 Bone Substitute, >1cc or 1gm, to <= 5cc or 5gm
	Baxter Healthcare Pty Ltd
BX313	Actifuse ABX Easyfill Putty	Actifuse ABX Easyfill Putty - A 	5ml	$1,300.00	$1,540.00
	silicate substituted synthetic bone 
	Global Orthopaedic Technology
GO162	Actifuse ABX Easyfill Putty	Actifuse ABX Easyfill Putty - A 	5ml	$1,300.00	$1,540.00
	silicate substituted synthetic bone 
	< = 3cc
	Baxter Healthcare Pty Ltd
BX310	Actifuse ABX Easyfill	Actifuse ABX Easyfill - A silicate 	1.5mL to 4mL	$1,080.00	$1,200.00
	substituted synthetic bone graft
	Global Orthopaedic Technology
GO161	Actifuse ABX Easyfill	Actifuse ABX Easyfill - A silicate 	1.5mL to 4mL	$1,080.00	$1,200.00
	substituted synthetic bone graft
	6.7.5.2.3 Bone Substitute, >5cc or 5gm, <=12cc or 12gm
	Baxter Healthcare Pty Ltd
BX312	Actifuse ABX Easyfill Putty	Actifuse ABX Easyfill Putty - A 	10ml	$2,300.00
	silicate substituted synthetic bone 
Prostheses List by Category, Groups and Sponsor	Page 1057 of 1059

ORTHOPAEDIC
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
	Global Orthopaedic Technology
GO163	Actifuse ABX Easyfill Putty	Actifuse ABX Easyfill Putty - A 	10ml	$2,300.00
	silicate substituted synthetic bone 
6.7.7 Limb preservation, resection and lengthening systems
	6.7.7.2.2 Limb preservation and lengthening, proximal femur
	cementless
	Johnson & Johnson Medical Pty Ltd
DY187	Limb Preservation System	Beaded, 'Porocoat' Standard & 	Neutral, 15deg Left & Right	$6,990.00
	Trochanter Replacement	 in both styles
Bone matrix implant, artificial
	Baxter Healthcare Pty Ltd
BX311	ACTIFUSE ABX Putty	Actifuse AVX Putty - A silicated 	20ml	$4,600.00
	substituted synthetic bone graft.
	Global Orthopaedic Technology
GO177	ACTIFUSE ABX Putty	Actifuse AVX Putty - A silicated 	20ml	$4,600.00
	substituted synthetic bone graft.
Grafts, Bone
	Zimmer Pty Ltd
ZI265	Continuum hip system	Hedrocel AVN Rod	3mm - 12mm block	$3,208.00
Prostheses List by Category, Groups and Sponsor	Page 1058 of 1059

PLASTIC AND RECONSTRUCTIVE
	Minimum 	Maximum 
Billing Code	Product 	Description	Size	Benefit	Benefit	Condition
Bone Matrix Implants, Artificial
	Biomet Australia Pty Ltd
BI487	Mimix Calcium Phosphate Bone 	Calcium Phosphate	5 grams	$1,004.00
	Void Filler
BI488	Mimix Calcium Phosphate Bone 	Calcium Phosphate	10 grams	$1,900.00
	Void Filler
BI489	Mimix Calcium Phosphate Bone 	Calcium Phosphate	20 grams	$2,300.00
	Void Filler
	Grand Total:	10053 Records
Prostheses List by Category, Groups and Sponsor	Page 1059 of 1059