Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 2)
I, Shane Porter, delegate of the Minister for Health, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.
Shane Porter
Assistant Secretary
Private Health Insurance Branch
Medical Benefits Division
Department of Health
PART 1 PRELIMINARY
3. Authority 3
SCHEDULE – AMENDMENTS 4
These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 2).
These Rules commence on 27 June 2014.
These Rules are made under the Private Health Insurance Act 2007.
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.
Schedule – Amendments
Private Health Insurance (Prostheses) Rules 2014 (No. 1)
[1] Schedule, Part A, SubGroup 06.03.04.02 - Small (2.71mm – 4.49mm), after entry for Billing Code T0113
delete the contents of item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | TO121 | CoverLoc Screws | CoverLoc Screws, stainless steel, (lag & cortical) & Pegs (threaded & unthreaded) | 2.7mm & 3.3mm x 10mm-26mm in 2mm increments | $231.00 |
[2] Schedule, Part A, SubGroup 06.03.03.22 - Periarticular anatomic – Radius ≤ 6 holes, after entry for Billing Code TO119
delete the contents of item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | TO122 | CoverLoc Volar Plate | A stainless steel volar plate system intended for fixation of fractures and osteotomies involving the distal radius. The CoverLoc feature is unique and allows both compression and lagging with fixed angle screws. | '22mm x 3, 4 & 8 hole left & right 25mm x 3 & 4 hole left & right | $915.00 |
[3] Schedule, Part A, SubGroup 06.03.04.02 - Small (2.71mm – 4.49mm), under the subheading “Device Technologies Australia Pty Ltd”
delete the contents of item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | DE366 | Low Profile Cancellous Bone Screws | Low Profile Cancellous Bone Screws | 4mm | $91.00 |
[4] Schedule, Part A, SubGroup 06.03.04.02, Small (2.71mm – 4.49mm), above the entry for Billing Code DE368
insert the contents of items 1 of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | DE366 | Low Profile Cancellous Bone Screws | Low Profile Cancellous Bone Screws | 4mm | $161.00 |
[5] Schedule, Part A, SubGroup 06.03.07.02 – Suture, small anchors (≤ 2.3mm), entry for Billing Code BH171
delete the contents of item 1 of the table from the columns indicated, substitute the contents of item 2 of the table in the columns indicated::
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | BH171 | JuggerKnot Soft Anchor | Suture Anchor , Polyester, PE | 1.0mm, 1.4mm, 1.5mm | $310.00 |
2 | BH360 | JuggerKnot Soft Anchor | Suture Anchor, Polyester, PE | 1.0mm, 1.4mm,1.45mm, 1.5mm, 2.1mm | $310.00 |
[6] Schedule, Part A, SubGroup 06.03.07.03 – Suture, Medium anchors (2.4 – 3.9mm), under the subheading “Biomet Australia Pty Ltd”
insert the contents of item 1 of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum benefit |
1 | BH361 | JuggerKnot Soft Anchor | Suture Anchor, Polyester, PE | 2.9mm | $465.00 |
[7] Schedule, Part B, Group Bone - Cancellous Crunch 15cc, entry for Billing Code NBB62
Omit “$903.00” in the column “Minimum Benefit”, substitute “$1,169.00”.
[8] Schedule, Part B, Group Bone - Cancellous Crunch 30cc, entry for Billing Code NBB61
Omit “$1,647.00” in the column “Minimum Benefit”, substitute “$2,131.00”.
[9] Schedule, Part B, Group Bone - Cancellous Crunch 60cc, entry for Billing Code NBB60
Omit “$2,498.00” in the column “Minimum Benefit”, substitute “$3,232.00”.
[10] Schedule, Part B, Group Bone - Cortico-Cancellous Crunch (40/60) 15cc, entry for Billing Code NBB65
Omit “$903.00” in the column “Minimum Benefit”, substitute “$1,169.00”.
[11] Schedule, Part B, Group Bone - Cortico-Cancellous Crunch (40/60) 30cc, entry for Billing Code NBB64
Omit “$1,647.00” in the column “Minimum Benefit”, substitute “$2,131.00”.
[12] Schedule, Part B, Group Bone - Cortico-Cancellous Crunch (40/60) 60cc, entry for Billing Code NBB63
Omit “$2,498.00” in the column “Minimum Benefit”, substitute “$3,232.00”.
[13] Schedule, Part B, heading to Group “Bone - Milled 20-29gr (22-60cc equivalent)”
Omit “(22-60cc equivalent)”, substitute “(48-58cc equivalent)”.
[14] Schedule, Part B, Group Bone - Plug/Dowel - Cancellous, entry for Billing Code NBB05
Omit “$1,224.00” in the column “Minimum Benefit”, substitute “$1,584.00.
[15] Schedule, Part B, Group Fascia Lata, entry for Billing Code NBB09
Omit “$922.00” in the column “Minimum Benefit”, substitute “$1,193.00”.
[16] Schedule, Part B, Group Femoral Hemi-condyle, entry for Billing Code NBB59
Omit “$2,271.00” in the column “Minimum Benefit”, substitute “$2,939.00”.
[17] Schedule, Part B, Group Femoral Rings, entry for Billing Code NBB17
Omit “$1,606.00” in the column “Minimum Benefit”, substitute “$2,078.00”.
[18] Schedule, Part B, Group Femoral Shaft - Half, entry for Billing Code NBB57
Omit “$2,778.00” in the column “Minimum Benefit”, substitute “$3,595.00”.
[19] Schedule, Part B, Group Femoral Shaft - Middle Third, entry for Billing Code NBB13
Omit “$2,507.00” in the column “Minimum Benefit”, substitute “$3,244.00”.
[20] Schedule, Part B, Group Femoral Shaft - Segment, entry for Billing Code NBB56
Omit “$1,687.00” in the column “Minimum Benefit”, substitute “$2,183.00”.
[21] Schedule, Part B, Group Femoral Shaft - Third, entry for Billing Code NBB55
Omit “$1,687.00” in the column “Minimum Benefit”, substitute “$2,183.00”.
[22] Schedule, Part B, Group Femur - Distal Half, entry for Billing Code NBB10
Omit “$2,778.00” in the column “Minimum Benefit”, substitute “$3,595.00”.
[23] Schedule, Part B, Group Femur - Distal third, entry for Billing Code NBB11
Omit “$2,606.00” in the column “Minimum Benefit”, substitute “$3,372.00”.
[24] Schedule, Part B, Group Femur - Entire, entry for Billing Code NBB12
Omit “$6,200.00” in the column “Minimum Benefit”, substitute “$8,023.00”.
[25] Schedule, Part B, Group Femur - Proximal half, entry for Billing Code NBB15
Omit “$2,921.00” in the column “Minimum Benefit”, substitute “$3,780.00”.
[26] Schedule, Part B, Group Femur - Proximal third, entry for Billing Code NBB14
Omit “$1,306.00” in the column “Minimum Benefit”, substitute “$1,690.00”.
[27] Schedule, Part B, Group Fibula - Entire, entry for Billing Code NBB18
Omit “$6,041.00” in the column “Minimum Benefit”, substitute “$7,817.00”.
[28] Schedule, Part B, Group Fibula - Segment, entry for Billing Code NBB54
Omit “$2,359.00” in the column “Minimum Benefit”, substitute “$3,053.00”.
[29] Schedule, Part B, Group, Hemipelvis - Acetabulum, entry for Billing Code NBB21
Omit “$2,905.00” in the column “Minimum Benefit”, substitute “$3,759.00”.
[30] Schedule, Part B, Group Hemipelvis - Complete, entry for Billing Code NBB24
Omit “$6,500.00” in the column “Minimum Benefit”, substitute “$8,411.00”.
[31] Schedule, Part B, Group Hemipelvis - iliac crest, entry for Billing Code NBB22
Omit “$2,705.00” in the column “Minimum Benefit”, substitute “$3,500.00”.
[32] Schedule, Part B, Group Hemipelvis - Tricortical iliac wedge, entry for Billing Code NBB23
Omit “$1,195.00” in the column “Minimum Benefit”, substitute “$1,546.00”.
[33] Schedule, Part B, Group Humeral Head Addition, entry for Billing Code NBB26
Omit “$1,545.00” in the column “Minimum Benefit”, substitute “$1,999.00”.
[34] Schedule, Part B, Group Humeral Shaft, entry for Billing Code NBB50
Omit “$3,090.00” in the column “Minimum Benefit”, substitute “$3,998.00”.
[35] Schedule, Part B, Group Humeral Shaft - Half, entry for Billing Code NBB51
Omit “$1,671.00” in the column “Minimum Benefit”, substitute “$2,162.00”.
[36] Schedule, Part B, Group Humerus - Distal, entry for Billing Code NBB25
Omit “$2,359.00” in the column “Minimum Benefit”, substitute “$3,053.00”.
[37] Schedule, Part B, Group Humerus - Entire, entry for Billing Code NBB29
Omit “$3,142.00” in the column “Minimum Benefit”, substitute “$4,066.00”.
[38] Schedule, Part B, Group Humerus - Entire with rotator cuff, entry for NBB30
Omit “$3,182.00” in the column “Minimum Benefit”, substitute “$4,118.00”.
[39] Schedule, Part B, Group Humerus - Proximal, entry for Billing Code NBB27
Omit “$2,769.00” in the column “Minimum Benefit”, substitute “$3,583.00”.
[40] Schedule, Part B, Group Humerus - Proximal half with rotator cuff, entry for Billing Code NBB28
Omit “$2,778.00” in the column “Minimum Benefit”, substitute “$3,595.00”.
[41] Schedule, Part B, Group Humerus - Ring, entry for Billing Code NBB53
Omit “$1,448.00” in the column “Minimum Benefit”, substitute “$1,874.00”.
[42] Schedule, Part B, Group Ligament - Medial, entry for Billing Code NBB31
Omit “$1,781.00” in the column “Minimum Benefit”, substitute “$2,305.00”.
[43] Schedule, Part B, Group Radius, entry for Billing Code NBB06
Omit “$3,024.00” in the column “Minimum Benefit”, substitute “$3,913.00”.
[44] Schedule, Part B, Group Radius - Ring, entry for Billing Code NBB49
Omit “$1,854.00” in the column “Minimum Benefit”, substitute “$2,399.00”.
[45] Schedule, Part B, Group Radius - Shaft, entry for Billing Code NBB47
Omit “$2,975.00” in the column “Minimum Benefit”, substitute “$3,850.00”.
[46] Schedule, Part B, Group Tendon - Achilles, entry for Billing Code NBB01
Omit “$1,922.00” in the column “Minimum Benefit”, substitute “$2,487.00”.
[47] Schedule, Part B, Group, Tendon - Achilles with bone block, entry for Billing Code NBB02
Omit “$2,228.00” in the column “Minimum Benefit”, substitute “$2,883.00”.
[48] Schedule, Part B, Group Tendon - Achilles with machined conical bone block, entry for Billling Code NBB69
Omit “$2,728.00” in the column “Minimum Benefit”, substitute “$3,530.00”.
[49] Schedule, Part B, Group Tendon - Patellar with bone plugs, entry for Billing Code NBB33
Omit “$2,147.00” in the column “Minimum Benefit”, substitute “$2,778.00”.
[50] Schedule, Part B, Group Tendon - Patellar with machined conical bone plug, entry for Billing Code NBB68
Omit “$2,647.00” in the column “Minimum Benefit”, substitute “$3,425.00”.
[51] Schedule, Part B, Group, Patellar with Quads, entry for Billing Code NBB72
Omit “$2,184.00” in the column “Minimum Benefit”, substitute “$2,826.00”.
[52] Schedule, Part B, Group Tendon - Peroneus Longus, entry for Billing Code NBB73
Omit “$2,184.00” in the column “Minimum Benefit”, substitute “$2,826.00”.
[53] Schedule, Part B, Group, Tendon - Semi tendinosis, entry for Billing Code NBB70
Omit “$2,185.00” in the column “Minimum Benefit”, substitute “$2,827.00”.
[54] Schedule, Part B, Group Tendon - Tibialis Anterior, entry for Billing Code NBB67
Omit “$2,184.00” in the column “Minimum Benefit”, substitute “$2,826.00”.
[55] Schedule, Part B, Group Tendon - Tibialis Posterior, entry for Billing Code NBB71
Omit “$2,184.00” in the column “Minimum Benefit”, substitute “$2,826.00”.
[56] Schedule, Part B, Group, Tibia - Plateau (prox 1/3), entry for Billing Code NBB35
Omit “$2,518.00” in the column “Minimum Benefit”, substitute $3,258.00”.
[57] Schedule, Part B, Group Tibia - Proximal, entry for Billing Code NBB36
Omit “$2,551.00” in the column “Minimum Benefit”, substitute “$3,301.00”.
[58] Schedule, Part B, Group Tibia - Proximal with Patellar Tendon, entry for Billing Code NBB46
Omit “$3,986.00” in the column “Minimum Benefit”, substitute “$5,158.00”.
[59] Schedule, Part B, Group Tibia - Ring, entry for Billing Code NBB45
Omit “$1,448.00” in the column “Minimum Benefit”, substitute “$1,874.00”.
[60] Schedule, Part B, Group Tibia - Whole, entry for Billing Code NBB37
Omit “$4,065.00” in the column “Minimum Benefit”, substitute “$5,260.00”.
[61] Schedule, Part B, Group Tibia - Whole with Patellar Tendon, entry for Billing Code NBB44
Omit “$5,455.00” in the column “Minimum Benefit”, substitute “$7,059.00”.
[62] Schedule, Part B, Group Tibial Shaft, entry for Billing Code NBB41
Omit “$3,747.00” in the column “Minimum Benefit”, substitute “$4,849.00”.
[63] Schedule, Part B, Group Tibial Shaft - half, entry for Billing Code NBB43
Omit “$2,450.00” in the column “Minimum Benefit”, substitute “$3,170.00”.
[64] Schedule, Part B, Group Tibial Shaft - third, entry for Billing Code NBB42
Omit “$2,645.00” in the column “Minimum Benefit”, substitute “$3,423.00”.
[65] Schedule, Part B, Group Tri Cortical Osteotomy, entry for Billing Code NBB66
Omit “$1,208.00” in the column “Minimum Benefit”, substitute “$1,563.00”.
[66] Schedule, Part B, Group Ulna, entry for Billing Code NBB07
Omit “$2,787.00” in the column “Minimum Benefit”, substitute “$3,606.00”.
[67] Schedule, Part B, Group Ulna - Ring, entry for Billing Code NBB40
Omit “$1,854.00” in the column “Minimum Benefit”, substitute “$2,399.00”.
[68] Schedule, Part B, Group Ulna - Shaft, entry for Billing Code NBB38
Omit “$2,450.00” in the column “Minimum Benefit”, substitute “$3,170.00”.
