Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1)
I, Lyndall Moore, 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.
Lyndall Moore
Lyndall Moore
Acting 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 2015 (No. 1).
These Rules commence on 1 May 2015.
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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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 2015 (No. 1)
[1] Schedule, Part A, Group 01.09.06 – Intraocular Silicone Oils, after entry for Billing Code SO053
insert the heading “01.10.01 – Foldable”
under that heading insert the subheading “Spectrum Surgical”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | SO076 | HumanOptics Artificial Iris
| One sterile, foldable Artificial Iris made of silicone, with or without fibre and custom made specific to the patient.
| Custom made
| $6,213.00 |
[2] Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, entry for Billing Code CO073
delete the contents of Item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | CO073 | Cochlear™ Baha® 4 Sound Processor | The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction | One size. | $6,500.00 |
[3] Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, after entry for Billing Code OI029
insert the subheading “Programmable, Wireless enabled”
under that subheading insert the subheading “Cochlear Limited”
under that subheading insert the contents of Item 1of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | CO073 | Cochlear™ Baha® 4 Sound | The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction | One size | $6,825.00 |
[4] Schedule, Part A, Group 05.04.01.02 - ≥ 500 sq cm, after entry for CT020
insert the subheading “Johnson & Johnson Medical Medical Pty Ltd”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | JJ789 | GYNECARE GYNEMESH | Pelvic floor reconstructive material, lightweight mesh | 25 x 25 cm | $677.00 |
[5] Schedule, Part A, Group 06.03.15.03 – Ceramic, >10cc – 20cc, after entry for Billing Code ER159
delete the subheading “Eupharma”
delete the contents of Item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | EH004 | ELIZ Bone Graft Substitute | Synthetic HA / TCP Bone graft Substitute | Granules (1.0 - 4.0 mm) (0.8 - 1.5mm) (0.5 - 1.0mm) Volume / Vial ( 15.0 cc to 20.0cc) | $1,500.00 |
[6] Schedule, Part A, SubGroup 06.03.15.04 – Ceramic, >20cc, after entry for Billing Code ER160
delete the subheading “Eupharma”
delete the contents of Item 1 of the table from the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | EH005 | ELIZ Bone Graft Substitute | Synthetic HA / TCP Bone Graft | Granules (1.0 - 4.0 mm) (0.8 - 1.5mm)(0.5 - 1.0mm) Volume / Vial (25.0 cc to 30.0cc) | $1,560.00 |
[7] Schedule, Part A, Group 09.02.03 – Non-Stented, after entry for Billing Code MC015
insert the heading “09.02.04 - Rapid Deployment Aortic Valve with dedicated single use tools”
under that heading insert the subheading “b”
under that subheading insert the subheading “Sorin Group Australia Pty Ltd”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item | Billing Code | Product | Description | Size | Minimum Benefit |
1 | SA170 | Perceval S Sutureless Aortic Heart Valve
| Sutureless Aortic Pericardial Heart Valve
| S (19-21mm), M (21-23mm), L (23-25mm), XL (25-27mm)
| $9,450.00 |
