Private Health Insurance (Prostheses) Rules 2016 (No. 4)
made under item 4 of section 333-20 of the
Private Health Insurance Act 2007
Compilation No. 2
Compilation date: 20 February 2017
Includes amendments up to: F2017L00089
Registered: 20 February 2017
This compilation is in 9 volumes
Volume 1: Parts 1–3
Volume 2: Schedule, Part A (Categories 01–05)
Volume 3: Schedule, Part A (Category 06)
Volume 4: Schedule, Part A (Categories 07–08)
Volume 5: Schedule, Part A (Categories 09–10)
Volume 6: Schedule, Part A (Categories 11–13)
Volume 7: Schedule, Part B - Human Tissue List
Volume 8: Schedule, Part C - Other Prostheses
Volume 9: Endnotes
Each volume has its own contents
About this compilation
This compilation
This is a compilation of the Private Health Insurance (Prostheses) Rules 2016 (No. 4) that shows the text of the law as amended and in force on 20 February 2017 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self-repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Billing Code Product Name Description Size
7.1.1 - Mesh - Metal
7.1.1.1 - <0.2mm thick, 1-50cm²
Benefit
Benefit
Condition
KLS Martin Australia Pty Limited
KT027 Martin Level One Fixation Mesh, Titanium <0.2mm thick, 1 to 10cm² area $165.00
7.1.1.2 - <0.2mm thick, 51-100cm²
KLS Martin Australia Pty Limited
KT026 Martin Level One Fixation Mesh, Titanium <0.2mm, 51 to 100cm² area $380.00
7.1.1.3 - 0.2-0.49mm thick, 1-10cm²
KLS Martin Australia Pty Limited
KT031 Martin Level One Fixation Mesh, Titanium 0.2 to 0.49mm thick, 1 to 10cm² area $350.00
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY577 AO/ASIF Plate Titanium contourable mesh; Orbital & Pre- Shaped
KLS Martin Australia Pty Limited
<0.5mm $725.00
KT034 Martin Level One Fixation Mesh, Titanium 0.2 to 0.49mm thick, 1 to 10cm² area $725.00
7.1.1.4 - 0.2-0.49mm thick, 11-50cm²
Australian Surgical Innovations Pty Ltd
AI005 ASI Plates and Screws Mesh . $700.00
KLS Martin Australia Pty Limited
KT060 Martin Level One Fixation Mesh, Titanium 0.9-0.49mm thick, 11-50cm² $700.00
Lifehealthcare Pty Ltd
LH508 Martin Osteosynthesis 1.5mm System Mesh thin 50cm2
LMT Surgical Pty Ltd
Mesh, Titanium 0.2-0.49mm thick, 11-50cm2 $700.00
LM217 Bioplate Biomesh System Titanium cranial biomesh 0.3 to 0.45mm thickness, 32-60mm x 43-
60mm
$700.00
Billing Code Product Name Description Size
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MC889 TiMesh Square-rectangular Gridmesh Panel 11 to 25 cm2 area $700.00
MC914 TiMesh Titanium Rigid Fixation
Bone Grafting and Plating System
Surgiplas Medical
FlexMesh 1.5mm System. Composition: Titanium
26 to 50 cm2 area; 0.3mm thick $700.00
SP068 Plates Micro, Mini, Maxi Mesh 50mm x 74mm Mesh 26 to 50cm2 area $700.00
SP080 Plates Micro, Mini Mesh 50mm x 37, 36 x 50mm, Mesh 11 to 25cm2 area
SP107 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh, Mesh 11 to 25cm2 area.
$700.00
$700.00
Zimmer Biomet Pty Ltd
BI604 W Lorenz Osteosynthesis System Sheet, 1mm System. Titanium 85x50x0.2mm $700.00 BI645 W Lorenz Osteosynthesis System Mesh panel, 1.5mm System Titanium (41-83) x (39-54mm) (0.3 or 0.2mm) $700.00
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY578 AO/ASIF Plate Titanium contourable mesh; Mastoid, Cranial & Pre-Shaped
0.2mm-0.49mm $850.00
Stryker Australia Pty Ltd
HW528 Stryker Neuro Mesh Plates Titanium malleable mesh plates for cranial
reconstruction
7.1.1.5 - 0.2-0.49mm thick, 51-200cm²
0.2-0.49mm $850.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY488 AO/ASIF Plate Titanium Contourable mesh plate <0.5mm $1,400.00
KLS Martin Australia Pty Limited
KT047 Martin Level One Fixation Mesh, Titanium & 3D 0.2-0.49mm thick, 51-200cm² $1,400.00
Lifehealthcare Pty Ltd
LH512 Martin Osteosynthesis 1.5mm System 3D Mesh 200cm2
LMT Surgical Pty Ltd
3D Mesh, Titanium 0.2-0.49mm thick, 51-200cm2 $1,400.00
LM218 Bioplate Biomesh System Titanium cranial biomesh 0.45mm thickness, 85-132mm x 90-134mm $1,400.00
Medtronic Australasia Pty Ltd
MC524 TiMesh Isogrid Panel One size only $1,400.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
MC525 | TiMesh | Sugar Mesh Panel / Grid | 11 x 7.5cm | $1,400.00 | | |
MC887 | TiMesh | Titanium Mesh Panel | 51 to 100 cm2 area | $1,400.00 | | |
MC890 | TiMesh | Square-rectangular Gridmesh Panel | 51 to 100 cm2 area | $1,400.00 | | |
MI084 | TiMesh Rigid Fixation Bone Grafting and Plating System | FlexMesh 1.0 - 1.5mm system. Composition: Titanium | 51 to 100cm² area, 0.3mm thickness | $1,400.00 | | |
| Stryker Australia Pty Ltd | | | | | |
SK582 | Stryker Leibinger Plating System | Craniofacial Titanium Mesh System | 0.2 - 0.49mm thick, 51 - 200cm² | $1,400.00 | | |
| Surgiplas Medical | | | | | |
SP078 | Plates | Micro, Mini | Mesh Sheet 100mm x 74mm Mesh 51 to 100cm2 area | $1,400.00 | | |
SP109 | OsteoMed Plating & Fixation System | Plates | 90 x 90mm Osteoform Mesh, Mesh 51 to 100cm2 area. | $1,400.00 | | |
Complex
Zimmer Biomet Pty Ltd
BH024 W Lorenz Osteosynthesis System Pre-contoured Neuro Mesh, titanium 163 x 115 x 0.3mm $1,480.00
7.1.1.6 - 0.2-0.49mm thick, >200cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
JJ441 | Titanium Mesh | Titanium Mesh Sterile | 0.2mm thickness, 15cm x 15cm | $1,500.00 |
SY786 | AO/ASIF Plate | Titanium Contourable mesh, Cranial Neuro | <0.5mm | $1,500.00 |
| Medtronic Australasia Pty Ltd | | | |
MC387 | TiMesh Rigid Fixation Bone Grafting and Plating System | Titanium, Square Grid Mesh | Large $1,500.00 |
| Surgiplas Medical | | | |
SP106 | OsteoMed Plating & Fixation System | Plates | 111 x 191mm Mesh Plate, Mesh > 200cm2 area. | $1,500.00 |
Zimmer Biomet Pty Ltd
BH018 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium (203-206)mm x (123-127)mm x (0.2-0.3)mm $1,500.00
7.1.1.7 - 0.5-0.8mm thick, 1-10cm²
KLS Martin Australia Pty Limited
KT039 Martin Level One Fixation Mesh Titanium 0.5-0.8mm thick, 1-10cm² $315.00
Billing Code Product Name Description Size
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MC389 TiMesh Rigid Fixation Bone Grafting and Plating System
Stryker Australia Pty Ltd
Titanium, Square Grid Mesh Small $315.00
ST245 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 12 x 0.5mm $315.00
7.1.1.8 - 0.5-0.8mm thick, 11-50cm²
KLS Martin Australia Pty Limited
KT062 Martin Level One Fixation Mesh, Titanium 0.5-0.8mm thick, 11-50cm² $510.00
Lifehealthcare Pty Ltd
LH509 Martin Osteosynthesis 1.5mm System Mesh 50cm2
LMT Surgical Pty Ltd
Mesh, Titanium 0.5-0.8mm thick, 11-50cm2 $510.00
LM219 Bioplate Biomesh System Titanium cranial biomesh 0.6mm thickness, 36-65 x 52-65mm $510.00
Medtronic Australasia Pty Ltd
MC915 TiMesh Titanium Rigid Fixation
Bone Grafting and Plating System
Stryker Australia Pty Ltd
FlexMesh 1.5mm System. Composition: Titanium
26 to 50 cm2 area; 0.6mm thick $510.00
HW507 Stryker Leibinger Plating System Craniofacial Titanium Mesh System 0.5 - 0.8mm thick, 11 - 50cm² $510.00
Surgiplas Medical
SP093 OsteoMed Plating & Fixation System Plates - Reconstruction Mesh Malleable/Ridgid, 74 x 50mm, Mesh,
1.5 to 0.8mm thick, 26 to 50cm3 area
SP108 OsteoMed Plating & Fixation System Plates 40 x 40mm Osteoform Mesh, Mesh 11 to 25cm2 area.
$510.00
$510.00
Zimmer Biomet Pty Ltd
BH023 W Lorenz Osteosynthesis System Panel, Regular or Small Grid. Titanium (42-85) x (40-53)mm x 0.6mm $510.00
7.1.1.9 - 0.5-0.8mm thick, 51-200cm²
B Braun Australia Pty Ltd
BB315 Aesculap CranioPlate System/Plate
Neuro, 65 x 90mm, 0.6mm mesh
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 65 x 90 mm, 0.6mm Mesh $1,175.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY579 AO/ASIF Plate Titanium mesh 0.5mm-0.8mm $1,175.00
Billing Code Product Name Description Size
KLS Martin Australia Pty Limited
Benefit
Benefit
Condition
KT023 Martin Level One Fixation Mesh, Titanium 0.50 to 0.80mm thick, 51 to 100cm² area $1,175.00
Lifehealthcare Pty Ltd
LH510 Martin Osteosynthesis 1.5mm System Mesh 64cm2
LMT Surgical Pty Ltd
Mesh, Titanium 0.5-0.8mm thick, 51-200cm2 $1,175.00
LM220 BIOPLATE Biomesh Titanium cranial biomesh 0.6mm thickness, 90-127 x 92-131mm $1,175.00
Medtronic Australasia Pty Ltd
MC877 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Mesh 51 to 100 cm2 area, 0.6mm thickness $1,175.00
MI085 TiMesh Rigid Fixation Bone Grafting and Plating System
Stryker Australia Pty Ltd
FlexMesh 1.0 - 2.2mm system. Composition : Titanium
51 to 100cm² area, 0.6mm thickness $1,175.00
ST250 Leibinger Titanium Implant System Mesh: Micro, Dumbach, Dynamic Diameter 1.0mm - 2.3mm; Up to 90 x 90mm $1,175.00
Surgiplas Medical
SP110 OsteoMed Plating & Fixation System Plates 90 x 90mm Osteoform Mesh, Mesh 51 to 100cm2 area.
$1,175.00
7.1.1.10 - 0.5-0.8mm thick, >200cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY785 AO/ASIF Plate Titanium Contourable Mesh, Cranial Neuro 0.5mm-0.8mm $2,243.00
Lifehealthcare Pty Ltd
LH492 Standard Approach Mesh Pre-contoured titanium mesh implants for 11
standard approaches.
1.6 mm thick $2,243.00
LH511 Martin Osteosynthesis 1.5mm System Mesh 200cm2
LMT Surgical Pty Ltd
Mesh, Titanium 0.5-0.8mm thick, >200cm2 $2,243.00
LM221 BIOPLATE Biomesh Titanium cranial biomesh 3ME, packaged non-
sterile
20 x 20cm $2,243.00
Medtronic Australasia Pty Ltd
MI083 TiMesh Titanium rigid Fixation Bone Grafting and Plating System
FlexMesh 1.5mm - 2.2mm system. Composition: Titanium
148 - 154mm x 148 - 154mm, 0.6mm $2,243.00
Billing Code Product Name Description Size
Surgiplas Medical
Benefit
Benefit
Condition
SP112 | OsteoMed Plating & Fixation System | Plates | 125 x 180mm Mesh Plate, 150 x 300mm | $2,243.00 |
| | | Mesh Plate, Mesh >200cm2 area. | |
Zimmer Biomet Pty Ltd
BH019 W Lorenz Osteosynthesis System Sheet 1.5mm System. Titanium 206 x 123 x 0.6mm $2,243.00
7.1.2 - Mesh - Non-metal
7.1.2.1 - <0.2mm thick, 1-10cm²
Medtronic Australasia Pty Ltd
MC551 | Macropore | Protective Disc | 25mm | $165.00 |
MC554 | Macropore | CraniDisk | 23 - 28mm | $165.00 |
MC568 | Macropore | Bur Hole Cover | 25mm | $165.00 |
7.1.2.2 - <0.2mm thick, 11-25cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
JJ687 PDS Plates Absorbable synthetic (poly-p-dioxanone) plate/foil
7.1.2.3 - 0.2-0.49mm thick, 1-10cm²
KLS Martin Australia Pty Limited
0.25 x 30 x 40mm
0.5 x 30 x 40mm
0.25 x 40 x 50mm
0.5 x 40 x 50mm
0.15 x 30 x 40mm
0.15 x 40 x 50mm
$515.00
KT032 | Martin Level One Fixation Resorb x & SonicWeld | Mesh PDLLA (resorbable) | 0.20 to 0.49mm thick, 1 to 10 cm2 area | $450.00 |
| Zimmer Biomet Pty Ltd | | | |
BI399 | Lactosorb Resorbable Craniomaxillofacial Fixation System | Panel or Sheet, Solid or Holed, PGA/PLA | 0.25mm x 25x25mm $450.00 |
7.1.2.4 - 0.2-0.49mm thick, 11-25cm²
Surgical Specialties
SQ049 | Inion GTR Biodegradable System | PLGA/TMC Copolymer: membrane & tacks | a) 30 x 40mm membrane kit; b) 6 tack kit and | $680.00 |
| | | applicator | |
Billing Code Product Name Description Size
Zimmer Biomet Pty Ltd
Benefit
Benefit
Condition
BI401 Lactosorb Resorbable Craniomaxillofacial Fixation System
Cover, Solid or Holed, PGA/PLA 0.25mm x 50x50mm $680.00
7.1.2.5 - 0.2-0.49mm thick, 26-50cm²
KLS Martin Australia Pty Limited
KT013 Martin Level One Fixation Resorb x
& SonicWeld Rx
Mesh, PDLLA (resorbable) 0.20 to 0.49mm thick, 26 to 50cm² area $1,490.00
7.1.2.6 - 0.2-0.49mm thick, 51-100cm²
Zimmer Biomet Pty Ltd
BI998 Lactosorb Resorbable Craniomaxillofacial Fixation System
Panel or Sheet, Solid or Holed, PGA/PLA 0.25mmx100x100mm $1,750.00
7.1.2.7 - 0.5-0.8mm thick, 1-10cm²
KLS Martin Australia Pty Limited
KT058 Martin Level One Fixation Resorb X
& SonicWeld RX
Medtronic Australasia Pty Ltd
MC630 Macropore FRP (fast resorbing
polymer)
Mesh, PDLLA (resorbable) 0.50 to 0.80mm thick, 1 to 10cm² $600.00
Polylactide and Polyglycolide polymer 25mm x 25mm x 0.75mm $600.00
MI088 Macropore Protective Sheets 1 to 10cm² area; 0.5mm thick $600.00
Zimmer Biomet Pty Ltd
BI417 Lactosorb Resorbable Craniomaxillofacial Fixation System
Cover, Solid or Holed, PGA/PLA (0.5 or 0.8mm) x 25 x 25mm $600.00
7.1.2.8 - 0.5-0.8mm thick, 11-25cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY544 PolyMax Rapid-Resorbable Fixation System
Medtronic Australasia Pty Ltd
MC629 Macropore FRP (fast resorbing
polymer)
Mesh Plate 0.5-0.8mm $945.00
Polylactide and Polyglycolide polymer 50mm x 50mm 0.75mm $945.00
MC893 Macropore Protective Sheets 11 to 25 cm2 area, 0.5mm thick $945.00
Billing Code Product Name Description Size
Surgical Specialties
Benefit
Benefit
Condition
SQ052 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.
Polylactic Acid Trimethylene Carbonate Copolymer
1.5-2.5 mesh plate, 7 x 7 holes; 1.5mm baby
mesh plate 7 x 7 holes
$945.00
Zimmer Biomet Pty Ltd
BI418 Lactosorb Resorbable Craniomaxillofacial Fixation System
Panel, Lactosorb. 1.5mm System. PGA/PLA 25 x 50mm (5 x 10 hole) $945.00
7.1.2.9 - 0.5-0.8mm thick, 26-50cm²
KLS Martin Australia Pty Limited
KT046 Martin Level One Fixation Mesh PDLLA resorbable 0.5-0.8mm thick, 26-50cm² $1,230.00
Medtronic Australasia Pty Ltd
MC560 Macropore Protective Sheets 60 x 80 x 0.5mm - 60 x 80 x 0.8mm $1,230.00
MC628 Macropore FRP (fast resorbing
polymer)
Polylactide and Polyglycolide polymer 60mm x 80mm x 0.75mm $1,230.00
7.1.2.10 - 0.5-0.8mm thick, 51-100cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY547 PolyMax Rapid-Resorbable Fixation System
Medtronic Australasia Pty Ltd
MC627 Macropore FRP (fast resorbing
polymer)
Mesh Plate 0.5-0.8mm $1,940.00
Polylactide and Polyglycolide polymer 100mm x 100mm x 0.75mm $1,940.00
MC899 Macropore Protective Sheets 51 to 100 cm2 area; 0.5mm thick $1,940.00
Surgical Specialties
SQ066 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.
Polylactic Acid Trimethylene Carbonate Copolymer
1.5-2.5 mesh plates, 14 x 14 holes; 1.5mm baby mesh plate 14 x 14 holes
$1,940.00
Zimmer Biomet Pty Ltd
BI999 Lactosorb Resorbable Craniomaxillofacial Fixation System
Panel or Sheet, Solid or Holed, PGA/PLA (0.5 or 0.8)mm 100x100mm $1,940.00
Billing Code Product Name Description Size
7.1.2.11 - 0.5-0.8mm thick, 101-200cm²
Benefit
Benefit
Condition
KLS Martin Australia Pty Limited
KT048 Martin Level One Fixation Mesh PDLLA resorbable 0.5-0.8mm thick, 101-200cm² $2,100.00
7.1.2.12 - >0.8mm thick, 1-10cm²
KLS Martin Australia Pty Limited
KT044 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 1-10cm² $600.00
Medtronic Australasia Pty Ltd
MC896 Macropore Protective Sheets 1 to 10 cm2 area; 1.0mm thick $600.00
7.1.2.13 - >0.8mm thick, 11-25cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY545 PolyMax Rapid-Resorbable Fixation System
Mesh Plate >0.8mm $950.00
KLS Martin Australia Pty Limited
KT015 Martin Level One Fixation Resorb x
& SonicWeld Rx
Medtronic Australasia Pty Ltd
Mesh, PDLLA (resorbable) >0.80mm thick, 11 to 25cm² area $950.00
MC894 Marcropore Protective Sheets 11 to 25 cm2 area, 1.0mm thick $950.00
Zimmer Biomet Pty Ltd
BI427 Lactosorb Resorbable Craniomaxillofacial Fixation System
7.1.2.14 - >0.8mm thick, 26-50cm²
Mesh, Mandibular Lactosorb 2.5mm System. PGA/PLA
1.42mm x 42x42mm $950.00
KLS Martin Australia Pty Limited
KT045 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 26-50cm² $1,020.00
Stryker Australia Pty Ltd
ST516 Stryker Leibinger Resorbable Fixation System
ST526 Stryker Leibinger Resorbable Fixation System
Resorbable plate: blank panel Tripolymer 55x55mm $1,020.00
Resorbable Mesh Tripolymer 55x55mm $1,020.00
Billing Code Product Name Description Size
7.1.2.15 - >0.8mm thick, 51-100cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
Benefit
Benefit
Condition
SY546 PolyMax Rapid-Resorbable Fixation System
Medtronic Australasia Pty Ltd
Mesh Plate >0.8mm $1,175.00
MC900 Macropore Protective Sheets 51 to 100 cm2 area; 1.0mm thick $1,175.00
7.1.2.16 - >0.8mm thick, 101-200cm2
KLS Martin Australia Pty Limited
KT049 Martin Level One Fixation Mesh PDLLA resorbable >0.8mm thick, 101-200cm2 $2,100.00
07.01.03 - Mesh - Composite
07.01.03.01 - 0.5-0.8mm thick, 1-25cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY699 SynPOR Anatomical Porous Polyethylene with Titanium 08.mm - 1.5mm thick $900.00
Stryker Australia Pty Ltd
HW443 E-POR Biomaterial/ Panel - Porous
Polyethlene Titanium Mesh Composite
Panel - Porous Polyethylene Titanium Mesh Composite
0.5mm - 0.8mm thick, 38mm x 50mm $900.00
7.1.3.2 - 0.5-0.8mm thick, 26-50cm²
Stryker Australia Pty Ltd
HW440 | E-POR Biomaterial/ Panel - Porous Polyethlene Titanium Mesh Composite | Panel - Porous Polyethlene Titanium Mesh Composite | >0.8mm thick, 38mm x 50mm | $975.00 |
HW444 | E-POR Biomaterial/ Panel - Porous Polyethlene Titanium Mesh Composite | Panel - Porous Polyethylene Titanium Mesh Composite | 0.5mm-0.8mm thick, 76mm x 50mm | $975.00 |
7.1.3.3 - >0.8mm thick 26-50cm²
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY697 SynPOR Porous Polyethylene with Titanium > 08.mm thick $1,150.00
Billing Code Product Name Description Size
Stryker Australia Pty Ltd
Benefit
Benefit
Condition
HW441 E-POR Biomaterial/ Panel - Porous
Polyethylene Titanium Mesh Composite
7.1.4 - Non-mesh
Panel - Porous Polyethylene Titanium Mesh Composite
>0.8mm thick, 76mm x 50mm $1,150.00
Stryker Australia Pty Ltd
SK515 Nasal Sheet (Strut). Nasal Sheet (Strut). Model 9536 Nasal Sheet (Strut): 40 x 9 x 1.1mm $220.00
7.1.4.1 - Resorbable
Biomet 3i Australia Pty Ltd
NW005 OsseoGuard Resorbable Collagen
Membrane
Dental Resorbable Collagen Membrane 15mm x 20mm, 20mm x 30mm, 30mm x
40mm
$345.00
Geistlich Pharma Australia Pty Ltd
GI010 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen membranes containing porcine collagen in a bilayer structure. They are used for guided bone regeneration and peridontal tissue regeneration in oral and maxillofacial surgery.
GI011 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen membranes containing porcine collagen in a bilayer structure. They are used for guided bone regeneration and peridontal tissue regeneration in oral and maxillofacial surgery.
GI012 Bio-Gide Bio-Gide & Bio-Gide Perio are collagen membranes containing porcine collagen in a bilayer structure. They are used for guided bone regeneration and peridontal tissue regeneration in oral and maxillofacial surgery.
GI013 Bio-Gide Perio Bio-Gide & Bio-Gide Perio are collagen membranes containing porcine collagen in a bilayer structure. They are used for guided bone regeneration and peridontal tissue regeneration in oral and maxillofacial surgery.
30mm x 40mm $345.00
25mm x 25mm $345.00
13 x 25mm $345.00
Bio-Gide perio - 16mm x 22mm $345.00
GI014 Geistlich Mucograft Collagen Matrix 15mm x 20mm, 20mm x 30mm, diameter 8mm $345.00
Billing Code Product Name Description Size
KLS Martin Australia Pty Limited
Benefit
Benefit
Condition
KT033 Martin Level One Fixation Resorb x
& SonicWeld
7.1.4.2 - Polymer
Reconstruction sheet not mesh PDLLA (resorbable)
25x25mm-0.1mm $345.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
JJ303 Cranioplastic Kit (Type 1) Cranioplastic kit containing 2 complete sets.
Consists of 2 bags of sterile powder, 2 vials sterile liquid, 2 sterile matrix bags
30grams $240.00
SY696 SynPOR Porous Polyethylene 0.45mm - 3.0mm thick $240.00
SPIRAN PTY. LTD.
S2002 Biopore Ultra thin Sheet An implantable device intended to support,
contour, and provide structure for the craniofacial anatomy during reconstructive and plastic surgery procedures. Made of high- density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
38 x 50mm $240.00
Stryker Australia Pty Ltd
HW416 Micro Thin Sheet Model/s 8438, 83020, 83022, 83029 8438: 30 x 50 x 0.4mm, 83020: 38 x 50 x
0.25mm, 83022: 38 x 50 x 0.35mm, 83029: 38
x 50 x 0.45mm
$240.00
HW417 Sheet Porus Polyethylene. Models 6330, 6331, 8662, 9562. Micro single channel sheet, model 9528. Barrier microplate single channel sheet, model 9527 Medpor Titan Implant Sheets Plain, Barrier & Double Barrier, and Medpor Titan Orbital floor and wall sheets 8102
Sheets 6330: 38 x 50 x 1.5mm, 6331: 50 x 76
x 1.5mm, 8662: 76 x 127 x 1.5mm, 9862: 38 x
50 x 3mm. Microplate single channel Sheet 9528: 38 x 50 x 0.85mm. Barrier microplate
single channel Sheet 9527: 38 x 50 x 0.85mm.
Titan implant sheets 81020: 76 x 50 x
$240.00
HW418 Barrier Sheet: Barrier Sheet - Orbital Floor
Porus Polyethylene. Barrier sheet - Rectangle, models 8312 and 9312. Orbital floor implants, models 8305 and 9305
Barrier sheet - Rectangle: 50 x 76 x 1mm, 50 x 76 x 1.6mm: 50 x 76 x 1mm, 50 x 76 x 1.6mm. Orbital Floor: 38 x 50 x 1mm, 38 x 50 x 1.6mm
$240.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
HW428 | Sheet - Multi Channel, Barrier Channel. | Porus Polyethylene. Miniplate channel sheet, model 9529. Microplate channel sheet, model 9530. Barrier Miniplate and Microplate Channel Sheets, Models 9531 and 9532. | Miniplate channel: 40 x 52 x 2.3mm. Mircoplate channel: 40 x 52 x 2.3mm. Barier Miniplate and Microplate Channel Sheets: 40 x 52 x 2.3mm, 40 x 52 x 2.3mm | $240.00 | | |
HW442 | E-POR Biomaterial/ Sheet - Porous Polyethylene | Sheet - Porous Polyethylene | 30mm - 50mm x 0.4mm - 3mm | $240.00 | | |
SK513 | Ultra Thin Sheet | Porus Polyethylene. Models 7210 | 38 x 50 x 0.85mm | $240.00 | | |
SK516 | Ultra Thin Sheet | Porus Polyethylene. Model 7212 | 50 x 76 x 0.85mm | $240.00 | | |
SK517 | Sheet - Barrier Single Channel Sheet. | Porus Polyethylene. Barrier Single Channel Sheet, Model 9527. | Barrier Single Channel: 38 x 50 x 0.85mm | $240.00 | | |
7.1.4.3 - Block
SPIRAN PTY. LTD.
S2003 Bipore Flexible Block An implantable device intended to support,
contour, and provide structure for the craniofacial anatomy during reconstructive and plastic surgery procedures. Made of high density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
38 x50 x 3mm and 76 x 50 x 9mm $825.00
| Stryker Australia Pty Ltd | |
HW506 | Stryker MEDPOR Implant | Porous Polyethylene Mesh | Block | $825.00 |
SK520 | Medpor Porous Polyethylene Biomaterial Custom Made Implant | Porous Polyethylene Biomaterial Custom Made Product for ear, nose, face and Orbit reconstruction | Custom designed and made from CT scan image | $825.00 |
7.1.5 - Fracture or Reconstruction Plates
7.1.5.1 - <0.5mm thick, <4 holes
AA-Med Pty Ltd
ZZ018 | Plates for Kelyniam Customized | Anodized Titanium Plate | 0.4 mm Thick, 9-15mm Length | $65.00 |
| Implant System | | | |
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes |
SY561 | Matrix | Simple shaped plates | < 4 holes | $65.00 |
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
LM222 | LMT Surgical Pty Ltd BIOPLATE Low Profile | Low Profile 2-hole Straight Plate | 11mm - 14mm length | $65.00 | | |
Surgiplas Medical
SP076 Plates Micro, Midface & Mini Straight Plate - 2 Hole, Plate < 4 holes. $65.00
Zimmer Biomet Pty Ltd
BI949 Neurological Packs Plate & screws: Neuro pack - single plate or thinflip 2 hole plate set
1.5mm or 2mm system $65.00
7.1.5.2 - <0.5mm thick, 4-7 holes
AA-Med Pty Ltd
ZZ019 Plates for Kelyniam Customized Implant System
Anodized Titanium Plate 0.4 mm Thick, 9-18mm Length $140.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY562 Matrix Micro X, Frame plates 4 - 7 Holes $140.00
LMT Surgical Pty Ltd
LM223 Bioplate Plating System Plates of various shape 4 to 7 holes $140.00
Burr
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
MN196 Matrix Plate Burr Hole Plates 12 to 24mm $190.00
KLS Martin Australia Pty Limited
KT010 | Martin Level One Fixation | Plate, titanium | <0.5mm thick, 4 to 7 holes | $190.00 |
| Lifehealthcare Pty Ltd | | | |
LH495 | Martin Level One Fixation | Plate, titanium | <0.5mm thick, 4 to 7 holes | $190.00 |
| LMT Surgical Pty Ltd | | | |
LM224 | BIOPLATE Low Profile | Low Profile Flex Contoured Burr Hole Cover | Low profile 0.3mm, 1.5mm diam hole, 12 - 18mm diam plate | $190.00 |
7.1.5.3 - <0.5mm thick, 8-15 holes
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY563 Matrix Micor Orbital curved plate 12 hole $281.00
Lifehealthcare Pty Ltd
LH504 Martin Osteosynthesis 1.5mm System 8-15 hole plate
Plate, Titanium <0.5mm thick, 8-15 holes $281.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
LM225 | LMT Surgical Pty Ltd BIOPLATE Low Profile | Low Profile 8-hole Boxcar Plate | 10 x 24mm | $281.00 | | |
7.1.5.4 - <0.5mm thick, 16-32 holes
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY558 Matrix Micro Adaption, Strut Plates 18-20 hole $380.00
Lifehealthcare Pty Ltd
LH506 Martin Osteosynthesis 1.5mm System 16-32 hole plate
Plate, Titanium <0.5mm thick, 16-32 holes $380.00
7.1.5.5 - 0.5-0.99mm thick, <4 holes
AA-Med Pty Ltd
ZZ020 Plates for Kelyniam Customized Implant System
Anodized Titanium Plate 0.6 mm Thick, 9-15mm Length $95.00
Australian Surgical Innovations Pty Ltd
AI004 ASI Plates and Screws Plate Straight, Left, Right, X, T and Y shaped $95.00
B Braun Australia Pty Ltd
BB304 Aesculap CranioPlate System/ Plate Neuro, 2 hole straight
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates
Plate Neuro, 2 hole 11 & 16mm straight $95.00
KLS Martin Australia Pty Limited
KT024 Martin Micro Plate Osteosynthesis
System
Lifehealthcare Pty Ltd
LH502 Martin Osteosynthesis 1.5mm System 2 hole plate
LMT Surgical Pty Ltd
1.5mm system Straight Plate Titanium 2 hole, 0.6mm profile $95.00
Plate, 0.6mm thick, titanium 2-4 hole $95.00
LM226 Bioplate Plating System Plates of various shape Less than 4 holes $95.00
Medtronic Australasia Pty Ltd
MC872 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Straight Plate < 4 holes $95.00
MC908 Timesh Rigid Straight Plates < 4 holes $95.00
Stryker Australia Pty Ltd
HW497 Stryker Leibinger Plating System Fracture or reconstruction plates 0.5 - 0.99mm thick, <4 holes $95.00
Billing Code Product Name Description Size
Surgiplas Medical
Benefit
Benefit
Condition
SP075 Plates Micro, Midface & Mini Straight Plate - 2 Hole, Plate < 4 holes. $95.00
Zimmer Biomet Pty Ltd
BI677 W Lorenz Osteosynthesis System Plate, Neuro Straight, 1.5mm System, Titanium 2 hole (medium or long) $95.00
Burr
Medtronic Australasia Pty Ltd
MC867 TiMesh Rigid Fixation Bone Grafting and Plating System
Stryker Australia Pty Ltd
Titanium, Plate Ohata Tristar 8.4 10mm, < 4 hole $140.00
SK267 Leibinger Titanium Implant System Burr Hole Cover 1.0mm - 2.3mm Diameter 7, 10, 14 & 20mm $140.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY580 AO/ASIF Plate Titanium adaption plate <4 holes $140.00
Lifehealthcare Pty Ltd
LH538 Cranial Loop (Std/L) Cranial bone fixation system made of PEEK OPTIMA
Diameter: 12, 16. Thickness: 0.9mm - 1.0mm $140.00
LMT Surgical Pty Ltd
LM227 BIOPLATE Plating System Titanium cranial compression plate 2 holes $140.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY512 AO/ASIF Plate Rapid resorbable reconstruction plate <4 holes $180.00
07.01.05.06 - 0.5-0.99mm thick, 4-7 holes
AA-Med Pty Ltd
ZZ021 Plates for Kelyniam Customized Implant System
Aus Systems Pty Ltd
AU007 Aus Systems Titanium Miniplates
(Bone Plates)
B Braun Australia Pty Ltd
Anodized Titanium Plate 0.6 mm Thick, 11-19mm Length $170.00
Plate Titanium 0.7mm profile 4-7 holes $170.00
BB305 Aesculap CranioPlate System/Plate
Neuro, 6 hole rectangular
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 6 hole 10 x 17 mm rectangular $170.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
BB306 Aesculap CranioPlate System/ Plate Neuro, 4 hole square
BB307 Aesculap CranioPlate System/ Plate Neuro, 4 hole straight
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 4 hole 10mm square $170.00 Plate Neuro, 4 hole 17 & 20 mm straight $170.00
BB308 Aesculap CranioPlate System/ Plate
Neuro, 6 hole double Y
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 6 hole 15 & 17mm, double Y shape
$170.00
BB309 Aesculap CranioPlate System/ Plate
neuro, 5 hole Y
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates
Plate Neuro, 5 hole 17mm, Y shape $170.00
BB313 Aesculap CranioPlate System/ Plate
Neuro, Burr hole cover 12 & 16mm
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 6 hole x 16 & 20mm Burr hole cover
$170.00
KLS Martin Australia Pty Limited
KT057 Martin Level One Fixation Plate Titanium 0.5 to 0.99mm thick, 4 - 7 holes $170.00
Lifehealthcare Pty Ltd
LH503 Martin Osteosynthesis 1.5mm System 4-7 hole plate
LMT Surgical Pty Ltd
Plate, 0.6mm thick, Titanium 4-7 hole $170.00
LM228 Bioplate Plating System Plates of various shape 4 to 7 holes $170.00
Medtronic Australasia Pty Ltd
MC393 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Z Plate Left and Right 4 hole - 5mm, 9.5mm $170.00
MC519 TiMesh Squareplate 4 holes x 1mm - 4 holes x 2.2mm $170.00
MC520 TiMesh X Plate 4 holes x 1mm - 4 holes x 2.2mm $170.00
MC576 Timesh Double Y Plates 3 Hole - 2.5mm - 7mm $170.00
MC870 TiMesh Rigid Fixation Bone Grafting and Plating System
MC875 TiMesh Rigid Fixation Bone Grafting and Plating System
MC883 TiMesh Rigid Fixation Bone Grafting and Plating System
MC885 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Y Plate Double and Single 4 - 7 hole $170.00
Titanium, T Plate 4 - 7 hole $170.00
Titanium, L Plate (Left and right configurations) 4 to 7 holes $170.00
Titanium, H Plate 4 - 7 hole $170.00
MC891 Macropore Oblique Plates 4 to 7 holes $170.00
MC909 Timesh Rigid Straight Plates 4 - 7 holes $170.00
Stryker Australia Pty Ltd
HW498 Stryker Leibinger Plating System Craniofacial Fixation Plates 0.5 - 0.99mm thick, 4 -7 holes $170.00
Billing Code Product Name Description Size
Surgiplas Medical
SP074 Plates Micro, Midface, Mini, BSSO, TR BSSO 4 Hole BSSO Plate Short, Medium, Long; TR BSSO Plate, Short, Long; 4 & 6 Hole Straight Plate 1.0mm thick, Plate 4 to 7 holes.
Benefit
$170.00
Benefit
Condition
SP084 Plates Mini & Maxi 4 & 5 Hole compression Plates 4 to 7 Holes $170.00
SP087 Plates Mini & Maxi Zygomatic Plates, Pyriform Plates, Orthognathic, Y Plates, Y Plate, H Plate, 5 Hole straight plate, 13mm & 16mm L Plate - Left & Right, 19mm T Plate, X Plate; 10mm Square Plate; 13mm, 15mm & 22mm L Plate - Left & Right, 9mm & 11mm ZED Plate - Left
& Right
$170.00
Zimmer Biomet Pty Ltd
BH362 Lorenz Plating System Neuro Gap Plate, Titanium 25mm - 45mm $170.00 BI348 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right. Titanium 2 x 2 hole, Mini or Low Profile $170.00 BI351 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right. Titanium 2 x 2 hole, long $170.00
BI605 W Lorenz Osteosynthesis System Plate, Matrix, 1.0 or 1.5mm System, Titanium 6 hole $170.00
BI617 W Lorenz Osteosynthesis System Plate, Straight, 1mm System. Titanium 4 hole $170.00
BI620 W Lorenz Osteosynthesis System Plate, Straight, low profile, 2.0mm System,
Titanium
4 - 8 hole $170.00
BI621 W Lorenz Osteosynthesis System Plate, L , 2.5mm or 2m system, Titanium 2 x2 or 3x3 hole $170.00
BI622 W Lorenz Osteosynthesis System Z-Shape Plate, Left or Right, 1.5mm or 2mm
System. Titanium
2 x 2 hole $170.00
BI623 W Lorenz Osteosynthesis System T-Plate, Left or Right, 1.5mm System. Titanium 3x3 hole, 7x7 hole $170.00
BI624 W Lorenz Osteosynthesis System T-Plate 90 degrees, Left or Right, 2mm System.
Titanium
BI625 W Lorenz Osteosynthesis System Plate, Y, Double Y, X, 1.5mm System or
2.0mm System, Titanium
2x5hole, 3x3hole, 2x3hole $170.00
One size only $170.00
BI627 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System, Titanium 4 or 6 hole $170.00
BI638 W Lorenz Osteosynthesis System Plate, Orbital. 1mm System, Titanium One size only $170.00
BI656 W Lorenz Osteosynthesis System Plate, Orbital, 1.5mm, 2.0mm System, Titanium 6 hole $170.00 BI728 W.Lorenz Osteosynthesis System Neuro Square or Rectangular Plate, titanium 1.5mm system, 4 hole $170.00 BI988 W Lorenz Osteosynthesis System Plate Straight 2mm System 4 - 7 hole $170.00
Billing Code Product Name Description Size
Burr
Aus Systems Pty Ltd
Benefit
Benefit
Condition
AU014 Aus Systems Titanium Miniplates
(Bone Plates)
Low profile burr hole cover 10mm, 14mm, 18mm, 22mm $170.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY319 AO/ASIF Plate Low profile neurosurgical plate, burr hole 4-7 holes $170.00
Lifehealthcare Pty Ltd
LH507 Martin Osteosynthesis 1.5mm System Burr hole plate
LMT Surgical Pty Ltd
Burr Hole Plate, Titanium 0.6mm thick, 4-7 holes $170.00
LM229 Bioplate Plating System Titanium Burr Hole Covers 4 to 7 holes $170.00
Medtronic Australasia Pty Ltd
MC868 TiMesh Rigid Fixation Bone Grafting and Plating System
Stryker Australia Pty Ltd
Titanium, Plate Fan Blade 11-18mm, Mesh 11-25mm, 4 - 7 hole
$170.00
ST141 Leibinger Titanium Implant System Leibinger Burr Hole Cover: curved Titanium 7, 10, 14mm $170.00
Surgiplas Medical
SP072 Plates Micro, Mini, Maxi Burr Hole Plates, Calvarium Plate - Small & Large - Calvarium Plate, Plates 4 to 7 Holes
$170.00
| Zimmer Biomet Pty Ltd | |
BI353 | W Lorenz Osteosynthesis System | Plate, Burr Hole, 1mm, 1.5mm, 2mm system | 13mm, 17mm, 18.5mm | $170.00 |
BI721 | W Lorenz Osteosynthesis System | Plate, Burr Hole, 1.5mm System, Titanium | 22mm, 25mm | $170.00 |
BI870 | Neurological Packs | Plate & screws: Neuro pack Burr cover or multi plate set. Thinflap 4 hole plus plate sets | 1.5mm or 2mm system | $170.00 |
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY582 AO/ASIF Plate Titanium adaption plate 4-7 holes $246.00
KLS Martin Australia Pty Limited
KT014 Martin Level One Fixation Plate, titanium 0.5-0.99mm thick, 4-7 holes $246.00
Medartis
EO095 MODUS Orthognathics Indication-specific solutions for maxillary and
mandibular orthognathic surgeries
1.5mm - 2.0mm $246.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
| Surgiplas Medical | | | |
SP070 | Plates | Micro, Mini, Maxi | Gap Plates, Plates 4 to 7 holes | $246.00 |
Zimmer Biomet Pty Ltd |
BI591 | W Lorenz Osteosynthesis System | Chin Plates, Paulus, 2mm System, Titanium | 4 - 12mm $246.00 |
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY581 | AO/ASIF Plate | Titanium adaption plate | 4-7 holes | $170.00 |
HW501 | Stryker Australia Pty Ltd Stryker Leibinger Plating System | Craniofacial Fixation Plates, Compression | 0.5 - 0.9mm thick, 4 -7 holes | $170.00 |
Surgiplas Medical
SP033 OsteoMed Plating & Fixation System Compression Plates - Micro, Mini & Maxi Micro: 2 x 3 Hole Compression T Plate,
Oblique Left & Right Compression T Plate, 4 Hole Straight Compression Plate; 5 Hole Straight Plate, 13mm Left & Right L Plate, 19mm T Plate, 2 x 3 Hole Quad Plate; Mini: 4 Hole Left & Right L Plate, 4 Hole Left & Rig
$170.00
Zimmer Biomet Pty Ltd
BI349 W Lorenz Osteosynthesis System Plate, Compression Straight, 2mm System.
Titanium
4 hole $170.00
Locking
Stryker Australia Pty Ltd
HW500 Stryker Leibinger Plating System Craniofacial Fixation Plates ,Locking 0.5 - 0.9mm thick, 4 -7 holes $195.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY504 | AO/ASIF Plate | Rapid resorbable reconstruction plate | 4-7 holes | $200.00 |
Medtronic Australasia Pty Ltd |
MC550 | Macropore | Rectangle Plates | 4-8 hole | $200.00 |
MC553 | Macropore | Oblong Plates | 6 - 8 hole | $200.00 |
MC562 | Macropore | Y Plates | 7 hole | $200.00 |
MC563 | Macropore | Straight Plates | 4 hole | $200.00 |
Stryker Australia Pty Ltd |
HW499 | Delta Resorbable Fixation System | Craniofacial Resorbable Fixation Plates | 0.5 -0.99mm thick, 4 - 7 holes | $200.00 |
Billing Code Product Name Description Size
Zimmer Biomet Pty Ltd
Benefit
Benefit
Condition
BH001 Lactosorb Resorbable Craniomaxillofacial Fixation System
Lactosorb Plates, 2mm System, All shapes PGA/PLA
4 - 7 hole $200.00
BI990 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 4 - 7 hole $200.00
07.01.05.07 - 0.5-0.99mm thick, 8-32 holes
Aus Systems Pty Ltd
AU060 Aus systems titanium Miniplates
(Bone plates)
B Braun Australia Pty Ltd
titanium miniplates 8,19 hole $204.00
BB310 Aesculap CranioPlate System/ Plate
Neuro, 8 hole rectangular
BB317 Aesculap CranioPlate System/ Plate
Neuro, 16 hole straight
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates.
Plate Neuro, 8 hole 10 x 24 mm rectangular $204.00 Plate Neuro, 16 hole 63mm straight $204.00
KLS Martin Australia Pty Limited
KT037 Martin Level One Fixation Plate Titanium 0.5-0.99mm thick, 8-32 holes $204.00
Lifehealthcare Pty Ltd
LH505 Martin Osteosynthesis 1.5mm System 8-32 hole plate
LMT Surgical Pty Ltd
Plate, 0.6mm thick, Titanium 8-32 hole $204.00
LM230 Bioplate Plating System Plates of various shape 8 to 32 holes $204.00
Medtronic Australasia Pty Ltd
MC678 TiMesh Rigid Fixation Bone Grafting and Plating System
MC871 Ti Mesh Rigid Fixation Bone
Grafting and Plating System
MC876 TiMesh Rigid Fixation Bone Grafting and Plating System
MC884 TiMesh Rigid Fixation Bone Grafting and Plating System
MC886 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Universal Plate 12h $204.00
Titanium ,Straight Plate 8 - 32 holes $204.00
Titanium, T Plate 8 - 15 hole $204.00
Titanium, L Plate (Left and right configurations) 8 - 15 hole $204.00
Titanium, H Plate 8-15 hole $204.00
MC892 Macropore Oblique Plates 8 to 15 holes $204.00
MI091 TiMesh Rigid Straight Plate 8 -32 holes $204.00
Billing Code Product Name Description Size
Stryker Australia Pty Ltd
Benefit
Benefit
Condition
HW502 Stryker Leibinger Plating System Craniofacial Fixation Plates 0.5 - 0.99mm thick, 8 -32 holes $204.00
Surgiplas Medical
SP077 Plates Micro, Midface & Mini Quad Plate, Quad Plate - Short, Plate 8 to 15 holes.
SP083 Plates Mini & Maxi 16 & 18 Hole Straight Plate, 18 Hole Straight Plate, Plates 15 to 32 Holes
SP085 Plates Mini & Maxi Curved Plate, 8 Hole Straight Plate; Mini : 10 Hole Straight Plate, Extended Y Plate, Rigid 10 Hole Straight Plate, 12 Hole Straight Plate, Y Plate - 13 Hole, 12 Hole Curved Plate, 10 Hole Straight Plate; 10 Hole Curved Plate, Straight Plate 10 Hole, Y P
$204.00
$204.00
$204.00
Zimmer Biomet Pty Ltd
BI641 W Lorenz Osteosynthesis System Plate, Matrix. 1mm System, 1.5mm System.
Titanium
BI658 W Lorenz Osteosynthesis System Plate, Orbital. 1.5mm System, 2mm System.
Titanium
2 x 4 hole $204.00
8-10 hole $204.00
BI719 W Lorenz Osteosynthesis System Neuro Sub-Temporal Plate, Titanium medium $204.00
BI773 W Lorenz Osteosynthesis System Neuro sub-temporal plate, 1.5 system, titanium Small $204.00
BI985 W Lorenz Osteosynthesis System Plates Straight, 1.5, 2.0 or 1.0mm System 15 - 32 holes $204.00
BI989 W Lorenz Osteosynthesis System Plate Straight, 2mm System 8 - 15 hole $204.00
3D
Surgiplas Medical
SP071 Plates Micro, Mini, Maxi Quad Plates, Medium 2 x 4 Hole Quad Plate, Plates 8 to 15 holes
$210.00
Burr
MC869 | Medtronic Australasia Pty Ltd TiMesh Rigid Fixation Bone Grafting | Titanium, Plate | Ohata Kerf Cover, 5 - 32 hole | $430.00 |
| and Plating System | | | |
| Stryker Australia Pty Ltd | | | |
SK355 | Universal Neuro Titanium Low Profile Plate | Titanium Low Profile plates used for the fixation of cranial bone flaps | Small, large, 20mm burr hole, 16 hole without bar | $430.00 |
Billing Code Product Name Description Size
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
Benefit
Benefit
Condition
SY585 AO/ASIF Plate Titanium adaption plate 8-32 holes $280.00
Medartis
EO096 MODUS Orthognathic Indication-specific solutions for maxillary and
mandibular orthognathic surgeries
1.5mm - 2.0mm $280.00
Stryker Australia Pty Ltd
SK345 Leibinger Titanium Implant System - Universal CMF Plate
Surgiplas Medical
Le Fort 1 Plate, Right/Left 11hole, Advancement 2 - 10mm $280.00
SP082 Plates Micro, Mini Sub - Temporal Plates, Plates 8 to 15 Holes $280.00
Zimmer Biomet Pty Ltd
BI774 W Lorenz Osteosynthesis System Lefort plate, 1.5mm system, 0.6mm thickness,
titanium
Flat, 2-11mm $280.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY583 AO/ASIF Plate Titanium adaption plate 8-32 holes $200.00
Locking
Stryker Australia Pty Ltd
HW486 | Stryker Leibinger Hybrid MMF Plate | SMARTLOCK Hybrid MMF Plate, Locking | One size - 9 Hole Straight Plate, for maxilla | $312.00 |
| | System - Universal SMARTLOCK Hybrid | and Mandible | |
| | MMF | | |
| | Component - MMF Plate | | |
HW504 | Stryker Leibinger Plating System | Craniofacial Locking Fixation Plates | 0.5 - 0.99mm thick, 8 -32 holes | $312.00 |
Zimmer Biomet Pty Ltd
ZI923 OmniMax Arch Bar Arch Bar One size $312.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY397 PolyMax Resorbable Fixation System 1.5 Burr Hole Cover 8 Hole $215.00
SY584 AO/ASIF Plate Rapid resorbable reconstruction plate 8-32 holes $215.00
Medtronic Australasia Pty Ltd
MC547 Macropore Z Plates 10 hole $215.00
MC559 Macropore L Plates 8 hole, Left & Right $215.00
Billing Code Product Name | Description | Size | Benefit | Benefit | Condition |
MI089 Macropore | Straight Plates | 8 -20 hole | $215.00 | | |
Stryker Australia Pty Ltd
HW503 Delta Resorbable fixation System Craniofacial Resorbable Fixation Plates 0.5 - 0.99mm thick, 8 -32 holes $215.00
Zimmer Biomet Pty Ltd
BH002 Lactosorb Resorbable Craniomaxillofacial Fixation System
Lactosorb Plates, 2mm System, All shapes PGA/PLA
8 - 15 hole $215.00
BI991 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 8 - 15 hole $215.00
7.1.5.8 - 0.5-0.99mm thick, >32 holes
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY466 AO/ASIF Plate Titanium adaption plates >32 holes $300.00
LMT Surgical Pty Ltd
LM231 BIOPLATE Biomesh Titanium, lattice, 48 hole, packaged non-sterile 32 x 44mm $300.00
Surgiplas Medical
SP081 Plates Micro, Mini 40 Hole Straight Plate, Mesh 18 row, Plate
>32 holes.
$300.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY514 AO/ASIF Plate Rapid resorbable reconstruction plate >32 holes $380.00
Zimmer Biomet Pty Ltd
BI993 Lactosorb Resorbable CMF System Lactosorb Plates, 1.5mm System 32+ holes- $380.00
7.1.5.9 - 1.0-1.99mm thick, <4 holes
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY317 AO/ASIF Plate Titanium Plate - straight 1.6mm Profile, 2-4 holes $115.00
KLS Martin Australia Pty Limited
KT009 Martin Level One Fixation Plate, titanium 1 to 1.99mm thick, <4 holes $115.00
Stryker Australia Pty Ltd
HW505 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.99mm thick, <4 holes $115.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY506 AO/ASIF Plate Rapid resorbable reconstruction plate <4 holes $220.00
Billing Code Product Name Description Size
Surgical Specialties
Benefit
Benefit
Condition
SQ055 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.
Polylactic Acid Trimethylene Carbonate Copolymer
7.1.5.10 - 1.0-1.99mm thick, 4-7 holes
1.5-2.5mm plates:- 2-10 hole plates and extended, c-plate & x-plate 7 hole, H-plate 8 hole, orthognathic hole and L-plate L & R 7 hole
$220.00
AA-Med Pty Ltd
ZZ022 Plates for Kelyniam Customized Implant System
Aus Systems Pty Ltd
AU061 Aus Systems Titanium Miniplates
(bone Plates)
PEEK Shunt Plate 1mm Thick, 13-18mm Length $165.00
Titanium Miniplates 1.0-1.99mm thick, 4-7 holes $165.00
KLS Martin Australia Pty Limited
KT059 Martin Level One Fixation Plate Martin Level One Fixation 1.0-1.99mm thick, 4-7 holes $165.00
Lifehealthcare Pty Ltd
LH513 Martin Osteosynthesis 1.5mm System Mesh 1mm 4-7 hole plate
Medtronic Australasia Pty Ltd
Plate, Titanium 1.0-1.99mm thick, 4-7 holes $165.00
MC517 TiMesh Mandibular "J" Plate One size only $165.00
Stryker Australia Pty Ltd
HW492 Stryker Leibinger Plating System Mandible Fixation plates 1.0 - 1.99mm thick, 4 - 7 holes $165.00
Surgiplas Medical
SP073 Plates Micro, Midface, Mini, BSSO, TR BSSO 2 x 3 Hole Quad Plate, Plate 4 to 7 holes. $165.00
Zimmer Biomet Pty Ltd
BH026 Mandibular Fracture System Plates, Angled or Curved, 2.0 Mandibular
System, Titanium
BH028 Manibular Fracture System Plates, matrix shape, 2.0 mandibular system.
Titanium
BI635 W Lorenz Osteosynthesis System Plate, DoubleT, Double Y, 1mm, 2mm system,
plate thickness 0.6 or 1mm, Titanium
BI755 Mandibular Fracture System Plates, Y Shapek, 2.0 Mandibular Fracture
System, Titanium
BI764 Mandibular Fracture System Plates, 2.0 / 2.4 Mandibular Fracture System,
Titanium
4 - 7 hole $165.00
4 or 6 hole $165.00
4-7 Hole $165.00
5 hole long, 5 hole medium, 5 hole regular $165.00 4-7 hole $165.00
Billing Code Product Name Description Size
Complex
Medartis
Benefit
Benefit
Condition
EO097 MODUS Orthognathics Indication-specific solutions for maxillary and
mandibular orthognathic surgeries
2.0mm $350.00
Stryker Australia Pty Ltd
SK131 Leibinger Titanium Implant System - Universal Mandible Fracture Plate
SK132 Leibinger Titanium Implant System - Universal Mandible Fracture Plate
Surgiplas Medical
Items used for reconstruction and fixation of mandibular fractures and tumour resection.
Items used for reconstruction and fixation of mandibular fractures and tumour resection.
Universal Mandible Fracture Plate, C-shaped, 4 holes
Universal Mandible Fracture Plate, Angled Shaped, 6 holes, 115-140 deg
$350.00
$350.00
SP018 Plates Micro, Midface, Mini & Maxi Chin Plate 2, 3, 4, 6, 8, 10 & 12mm, Plates 4
to 7 holes.
$350.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY498 AO/ASIF Plate Mandible plate 4-7 holes $165.00
Stryker Australia Pty Ltd
SK129 Leibinger Titanium Implant System - Universal Mandible Compression Plate
Surgiplas Medical
Items used for reconstruction and fixation of mandibular fractures and tumour resection.
Universal Mandible Compression Plate, 4-6 Holes
$165.00
SP028 OsteoMed Plating & Fixation System Plates - Fracture 4 hole Fracture Plate 32 -37mm; EDC Plate 32mm & 34mm, 4 to 7 hole compression plate.
$165.00
SP034 OsteoMed Plating & Fixation System Compression Plates - Maxi Maxi: 4, 5 & 6 Hole Straight Plate $165.00
Zimmer Biomet Pty Ltd
BI754 Mandibular Fracture System Plates, Compression, 2.0 Mandibular Fracture
System, Titanium
BI756 Mandibular Fracture System Plates, Compression, 2.0 Mandibular Fracture
System, Titanium
4 hole $165.00
4-6 hole $165.00
Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY587 AO/ASIF Plate Titanium mandible locking plate, complex shape 4-7 holes $470.00
KLS Martin Australia Pty Limited
KT043 Martin Level One Fixation Plate Titanium locking 1.0 to 1.99 mm thick, 4 - 7 holes $470.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
HW493 | Stryker Australia Pty Ltd Stryker Leibinger Plating System | Mandible Locking Fixation Plates | 1.0 -1.9mm thick, 4 - 7 holes | $470.00 | | |
Surgiplas Medical
SP027 OsteoMed Plating & Fixation System Plates - Fracture 8 Hole Fracture Plate, 4 & 6 hole locking fracture plate, 4 to 7 hole locking plate.
$470.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY507 AO/ASIF Plate Rapid resorbable reconstruction plate 4-7 holes $260.00
KLS Martin Australia Pty Limited
KT012 Martin Level One Fixation Resorb x
& SonicWeld Rx
Medtronic Australasia Pty Ltd
Mesh, PDLLA (resorbable) 1.0 to 1.99mm thick, 4 to 7 holes $260.00
MC567 Macropore Clover Leaf Plates 4 hole $260.00
Stryker Australia Pty Ltd
ST519 Stryker Leibinger Resorbable Fixation System
Surgical Specialties
Resorbable plate: L-shape plate, 110 deg, right/left Tripoymer
7 holes $260.00
SQ054 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.
Polylactic Acid Trimethylene Carbonate Copolymer
07.01.05.11 - 1.0-1.99mm thick, 8-15 holes
1.5mm plates:- 20 holes, c-plate & x-plate 7 hole, L-plate 7 hole L & R. burrhole
$260.00
KLS Martin Australia Pty Limited
KT056 Martin Level One Fixation Plate ,Titanium 1.0 to 1.99mm thick, 8 -15 holes $420.00
Lifehealthcare Pty Ltd
LH514 Martin Osteosynthesis 1.5mm System 1mm 8-15 hole plate
Medartis
Plate, Titanium 1.0-1.99mm thick, 8-15 holes $420.00
EO099 MODUS Orthognathics Indication-specific solutions for maxillary and
mandibular orthognathic surgeries
2.0mm $420.00
Medtronic Australasia Pty Ltd
MC522 TiMesh Curved Plate: Standard, Rigid, Left, Right 1mm x 12 holes $420.00
Stryker Australia Pty Ltd
HW508 Stryker Leibinger Plating System Mandible Locking Fixation Plates 1.0 - 1.99mm thick, 8 - 15 holes $420.00
Billing Code Product Name Description Size
Surgiplas Medical
SP086 Plates Mini & Maxi 12 Hole Straight Plate 1.0 mm thick, 8 Hole Straight Plate 1.0 mm thick, Plates 8 to 15 holes
Benefit
$420.00
Benefit
Condition
Zimmer Biomet Pty Ltd
BH027 Mandibular Fracture System Plates, Angled or Curved, 2.0 Mandibular
System, Titanium
BH029 Mandibular Fracture System Plates, matrix shape, 2.0 mandibular system.
Titanium
BI767 Mandibular Fracture System Plates, Straight, 2.0 Mandibular Fracture
System, Titanium
8 hole $420.00
8 to 16 hole $420.00
8-15 hole $420.00
Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY588 AO/ASIF Plate Titanium mandible locking plate, complex shape 8-15 holes $645.00
Medartis
EO098 MODUS Orthognathics Indication-specific solutions for maxillary and
mandibular orthognathic surgeries
2.0mm $645.00
Stryker Australia Pty Ltd
HW494 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.99mm thick, 8 -15 holes $645.00
Surgiplas Medical
SP117 OsteoMed Plating & Fixation System Mandible Locking plates 8-15 Hole Plates, 1.0-1.99 mm thick $645.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY508 AO/ASIF Plate Rapid resorbable reconstruction plate 8-15 holes $420.00
KLS Martin Australia Pty Limited
KT036 Martin Level One Fixation Resorb x
& Sonic Weld
Medtronic Australasia Pty Ltd
Plate PDLLA (resorbable) 1.0 to 1.99mm thick, 8 to 15 holes $420.00
MC566 Macropore C Plates 8 hole $420.00
Surgical Specialties
SQ062 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC copolymer Plates 6 & 8 hole $420.00
Billing Code Product Name Description Size
7.1.5.12 - 1.0-1.99mm thick, 16-32 holes
Benefit
Benefit
Condition
Aus Systems Pty Ltd
AU019 Aus Systems Titanium Miniplates
(Bone Plates)
Plate Titanium 1mm & 1.2mm profile 16 & 19 hole $204.00
KLS Martin Australia Pty Limited
KT030 Martin Level One Fixation Plate Titanium 1.0 to 1.99mm thick, 16 to 32 holes $204.00
Lifehealthcare Pty Ltd
LH515 Martin Osteosynthesis 1.5mm System 1mm 16-32 hole plate
Stryker Australia Pty Ltd
Plate, Titanium 1.0-1.99mm thick, 16-32 holes $204.00
HW495 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 - 1.9mm thick, 16- 32 holes $204.00
Surgiplas Medical
SP067 Plates Micro, Mini, Maxi 16 Hole Straight Plate, 1.0mm thick, Plate 15 to 32 holes
$204.00
Zimmer Biomet Pty Ltd
BI762 Mandibular Fracture System Plates, 2.4 Mandibular Fracture System,
Titanium
16 - 24 Hole $204.00
3D
KLS Martin Australia Pty Limited
KT029 Martin Level One Fixation Plate, titanium 1.0 to 1.99mm thick, 16 to 32 holes $818.00
Locking
Stryker Australia Pty Ltd
HW496 Stryker Leibinger Plating System Mandible Fixation Plates 1.0 -1.9mm thick, 16 - 32 holes $818.00
Surgiplas Medical
SP118 OsteoMed Plating & Fixation System Mandible Locking Plates 16-32 Hole Plates, 1.0-1.99 mm thick $818.00
Locking, Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY493 AO/ASIF Plate Titanium Mandibular locking plate, complex shape
16-32 holes $1,400.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY589 AO/ASIF Plate Rapid resorbable reconstruction plate 16-32 holes $420.00
Billing Code Product Name Description Size
KLS Martin Australia Pty Limited
Benefit
Benefit
Condition
KT028 Martin Level One Fixation Resorb x
& SonicWeld Rx
Surgical Specialties
Plate, PDLLA (resorbable) 1.0 to 1.99mm thick, 16 to 32 holes $420.00
SQ053 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.
Polylactic Acid Trimethylene Carbonate Copolymer
7.1.5.13 - 1.0-1.99mm thick, >32 holes
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
1.5mm baby plates:- 20 hole, c-plate & x-plate 7 hole, 2 hole
$420.00
SY700 AO/ASIF Plate Titanium Mandibular locking plate, complex shape
>32 holes $840.00
Resorbable
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY511 AO/ASIF Plate Rapid resorbable reconstruction plate >32 holes $420.00
7.1.5.14 - 2.0-2.99mm thick, 4-7 holes
Surgiplas Medical
SP120 OsteoMed Plating & Fixation System Mandible locking plates 4-7 Holes, 2.0-2.99 mm thick $620.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY499 AO/ASIF Plate Titanium mandible plate 4-7 holes $720.00
7.1.5.15 - 2.0-2.99mm thick, 8-15 holes
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY497 AO/ASIF Plate Titanium mandible plate 8-15 holes $780.00
Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY599 AO/ASIF Plates Titanium mandible locking plate 8-15 holes $950.00
Stryker Australia Pty Ltd
SK140 Leibinger Titanium Implant System - Universal Mandible Reconstruction Plate
Items used for reconstruction and fixation of mandibular fractures and tumour resection.
Universal Mandible Reconstruction Plate, 11 - 17 holes, straight with template
$950.00
Billing Code Product Name Description Size
Zimmer Biomet Pty Ltd
Benefit
Benefit
Condition
BI987 Lorenz 2.4mm Locking Reconstruction System
Plates Plate, Angled 2.4mm System, Ti 5 x 11 hole $950.00
7.1.5.16 - 2.0-2.99mm thick, 16-32 holes
Complex, Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY780 AO/ASIF Plate Anatomical Preformed Complex Locking Reconstruction Plates
Small, Medium, Large $1,320.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY500 AO/ASIF Plate Titanium mandible plate 15-32 holes $900.00
Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY600 AO/ASIF Plate Titanium mandible locking plate 16-32 holes $1,100.00
KLS Martin Australia Pty Limited
KT055 KLS Martin Plating System Preshaped reconstruction plates, in left and
right options
2.0mm and 2.5mm thickness with 26 holes $1,100.00
SK138 | Stryker Australia Pty Ltd Leibinger Titanium Implant System - | Items used for reconstruction and fixation of | Universal Mandible Reconstruction Plate, | $1,100.00 |
| Universal Mandible Reconstruction | mandibular fractures and tumour resection. | (Full), 6 + 13 + 6 holes, with template | |
| Plate | | | |
SK141 | Leibinger Titanium Implant System - | Items used for reconstruction and fixation of | Universal Mandible Reconstruction Plate, | $1,100.00 |
| Universal Mandible Reconstruction | mandibular fractures and tumour resection | (Hemi), Right and Left, 6 + 17 holes with | |
| Plate | | template | |
SK142 | Leibinger Titanium Implant System - | Items used for reconstruction and fixation of | Universal Mandible Reconstruction Plate, | $1,100.00 |
| Universal Mandible Reconstruction | mandibular fractures and tumour resection | (Full), 6 + 17 + 6 holes, with template | |
| Plate | | | |
Surgiplas Medical
SP026 OsteoMed Plating & Fixation System Plates - Fracture Rigid Comminuted Fracture Plate $1,100.00
Zimmer Biomet Pty Ltd
ZI938 Lorenz Locking Reconstruction System
Locking plates 2.0 and 2.4 mm, 16-32 holes $1,100.00
Billing Code Product Name Description Size
7.1.5.17 - 2.0-2.99mm thick, >32 holes
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
Benefit
Benefit
Condition
SY472 AO/ASIF Plate Titanium mandible locking plate, complex shape >32 holes $1,450.00
7.1.5.18 - ≥3mm thick, 4-7 holes
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY550 Titanium Sternal Fixation System Locking Plate - Star Star: 6 holes $1,480.00
7.1.5.19 - ≥3mm thick, 8-15 holes
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY551 Titanium Sternal Fixation System Locking Plate - Straight , H or Star Straight: 12holes, H: small & large, Star: 12
holes
$1,480.00
Lifehealthcare Pty Ltd
LH500 Martin Sternal Talon® An advanced system for rigid sternal fixation
made of titanium alloy. Single sternal talon ( Two legs)
Widths: XS, S, M, L,
Foot plate lengths: 11, 14 ,17 ,20mm
$1,480.00
Locking
KLS Martin Australia Pty Limited
KT007 Martin Level One Fixation Plate, titanium =>3mm thick, 8 to 15 holes $630.00
7.1.5.20 - ≥3mm thick, 16-32 holes
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY347 Titanium Sternal Fixation System Locking Plate - straight 20 or 30 holes $1,800.00
Lifehealthcare Pty Ltd
LH501 Martin Sternal Talon® an advanced system of rigid sternal fixation
made of titanium alloy. Double sternal talon (4 legs)
Widths: S, M; Four foot plate depths: 11, 14, 17, 20mm
$1,800.00
Compression
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY501 AO/ASIF Plate Titanium mandible plate 16-32 holes $1,350.00
Billing Code Product Name Description Size
Locking
KLS Martin Australia Pty Limited
Benefit
Benefit
Condition
KT061 Martin Level One Fixation Plate, Titanium ≥3mm thick, 16 to 32 Holes $1,420.00
07.01.06 - Screws
07.01.06.01 - Diameter ≤1.24mm
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY559 AO/ASIF Screw CMF screw; cortex, cortical, emergency, self- tapping,self-drilling
KLS Martin Australia Pty Limited
1.0mm-1.20mm various lengths $70.00
KT025 Martin Level One Fixation Screw Titanium diameter <1.24mm $70.00
Medtronic Australasia Pty Ltd
MC574 Timesh X-Drive Screws 2 - 15mm $70.00
MC879 TiMesh Rigid Fixation Bone Grafting and Plating System
Stryker Australia Pty Ltd
Titanium, Screw - Cruciate Head, 12 point Flat Head
Diameter <1.24mm $70.00
HW511 Stryker Leibinger Plating System Micro Screws 1.0 - 1.2mm diameter, 3 - 15mm length $70.00
Surgiplas Medical
SP088 Screws Micro, Maxi & Self Drilling "Size1.2mm self-drilling screws, 1.2mm x (2 - 14)mm, Screws diameter < 1.24mm"
$70.00
Compression Surgiplas Medical
SP031 OsteoMed Plating & Fixation System Lag Screws - Micro, Mini 1.2mm x (6 - 16)mm; 1.6mm x (10-12)mm;
2.0mm x (8 - 22)mm;
$80.00
07.01.06.02 - Diameter 1.25-3.24mm
Aus Systems Pty Ltd
AU059 Aus systems titanium bone screws titanium bone screws 1.5mm diameter - 2.3mm diameter, 3mm length to 15mm length
$43.00
Australian Surgical Innovations Pty Ltd
AI007 ASI Plates and Screws Screw Width 1.0 - 3.0mm. Length 3.0 - 25mm $43.00
Billing Code Product Name Description Size
B Braun Australia Pty Ltd
Benefit
Benefit
Condition
BB314 | Aesculap CranioPlate System/ Screws Neuro Emergency, self tapping, 1.8mm x 3 & 5mm | Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates. | Screws Neuro, Emergency, self tapping, magazine of 8, 1.8mm x 3 & 5mm lengths | $43.00 |
BB316 | Aesculap CranioPlate System/Screws Neuro, self-drilling, 1.5 x 3, 4 & 5mm | Cranial fixation system, internal fracture, non biodegradable. Consists of screws, plates. | screws neuro, self drilling, magazine of 8, 1.5mm x 3, 4 & 5 mm lengths | $43.00 |
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY590 AO/ASIF Screw Cortex, Cortical, Emergency, Self-tapping, Self- drilling; Low Profile Screws
KLS Martin Australia Pty Limited
1.25-3.24mm $43.00
KT038 Martin Level One Fixation Screw Titanium Diameter 1.25 to 3.24mm $43.00
Lifehealthcare Pty Ltd
LH516 Martin Osteosynthesis 1.5mm System Screw
LMT Surgical Pty Ltd
Self retaining, Titanium 3-7mm length, 1.5-1.8mm diam $43.00
LM232 Bioplate Plating System Titanium Screws 1.25 to 3.24mm Diameter $43.00
Medtronic Australasia Pty Ltd
MC571 Timesh 12 Point Screws 3 - 20mm $43.00
MC880 TiMesh Rigid Fixation Bone Grafting and Plating System
Titanium, Screw - Cruciate Head, 12 point Flat Head
Diameter 1.25 - 1.74mm $43.00
MI092 TiMesh Internal Drive Screws Diameter: 1.5 - 1.8mm $43.00
MI093 TiMesh Rescue Screws Diameter: 1.8 - 2.4mm $43.00
Signature Orthopaedics
SF127 Melbourne TMJ Prosthesis TMJ Mandibular Component - Screws (2.7-3.2mm Diameter) x (8-12mm Length) $43.00
Stryker Australia Pty Ltd
HW491 Stryker Leibinger Plating System Craniofacial Fixation Screws 1.5 - 2.7mm diameter, 3 - 20mm length $43.00
Surgiplas Medical
SP089 Screws Micro, Maxi & Self Drilling "Size1.6mm x (4-8)mm self-drilling screws,1.5mm Safety ,Screws diameter 1.25- 1.75mm"
SP090 Screws Micro, Maxi & Self Drilling "Size2.0mm x (4-8)mm self-drilling screws,1.9mm Safety ,Screws diameter 1.75- 2.24mm"
$43.00
$43.00
Billing Code Product Name Description Size
SP091 Screws Micro, Maxi & Self Drilling 2.4mm x (4-22)mm self-drilling screws, 2.7mm x (8-20)mm; 2.7mm Safety Screws, diameter 2.25-2.74mm
Benefit
$43.00
Benefit
Condition
Zimmer Biomet Pty Ltd
BH016 TMJ System Screw, Cross Drive, Fossa. Titanium 2.0mm dia x (5 - 13)mm $43.00 BH017 TMJ System Screw, Cross Drive, Fossa. Titanium 2.3mm Dia x (5 - 13)mm $43.00
BH020 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre Drive.
Titanium
BH021 W Lorenz Osteosynthesis System Bone Screw, Cross Drive or Centre Drive.
Titanium
BI360 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive, Std or Self
Drilling; Titanium
1.5mm dia x (3.5 - 17)mm $43.00
1.8mm dia x (3.5 - 17)mm $43.00
2.0mm x (4 - 7) mm $43.00
BI365 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive; Titanium 2.0mm x (9 - 19) mm $43.00
BI723 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular
Fracture, Titanium
2.7 x (6-20)mm $43.00
BI726 Mandibular Fracture System Screw, High Torque (HT), Emergency, 2.0/2.4
Mandibular Fracture System, Titanium
Dia 2.3mm x 4.0, 5.0, 7.0, 9.0, 11.0, 13.0,
15.0mm Lengths
$43.00
BI733 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive,
Titanium
BI734 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive,
Titanium
1.5 mm (dia) x 6.0, 7.0mm [lengths] $43.00 1.5 mm (dia) x 3.5, 4.0, 5.0mm, [lengths] $43.00
BI735 W.Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive; Titanium 2.3mm x (5 - 9) mm $43.00
BI742 TMJ System Screw, Cross Drive Mandibular Component, Titanium
BI744 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular
Fracture, Titanium
(2.7 - 3.2mm) x (8 - 12mm) $43.00
2.0 x (9-17)mm $43.00
BI748 Mandibular Fracture System Screw, High Torque (HT), 2.0/2.4 Mandibular
Fracture System, Titanium
Dia 2.4 x 6.0mm, 8.0, 10.0, 12.0, 14.0, 16.0,
18.0mm Lengths
$43.00
ZI924 OmniMax Screws IMF screws 2.0 diameter, 7-11mm $43.00
ZI925 OmniMax Screws MMF Screws 2.0 diameter, 7mm-11mm $43.00
Compression
Stryker Australia Pty Ltd
SK152 | Leibinger Screw - Universal | Items used for reconstruction and fixation of | Universal Mandible Lag Screws, 2.0mm | $121.00 |
| Mandibular Screws | mandibular fractures and tumour resection | Diameter, 24mm-42mm Length | |
Billing Code Product Name Description Size
Distractor
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
Benefit
Benefit
Condition
SY591 External Midface Distractor System Fixation; Set - Screws 1.25-3.24mm $85.00
Locking
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY592 AO/ASIF Screw Cortex, Cortical, Emergency, Self-tapping, Self- drilling; Locking Screws
KLS Martin Australia Pty Limited
1.25-3.24mm $90.00
KT035 Martin Level One Fixation Screw, titanium Diameter 2.25 - 2.74mm $90.00
Stryker Australia Pty Ltd
HW487 Stryker Leibinger Hybrid MMF
Screws
SMARTLock Hybrid MMF Screws, Locking System - Universal SMARTLock Hybrid MMF Component - MMF Screws
Two Sizes -
2.0mm Diameter, 6mm Length 2.0mm Diameter, 8mm Length
$90.00
HW509 Stryker Leibinger Plating System Universal Mandibular Locking Screws 2.0 - 2.7mm diameter, 3 - 24mm length $90.00
Surgiplas Medical
SP094 OsteoMed Plating & Fixation System Screws 2.4mm x (6-22)mm Locking Screws, Screws 2.25-2.74mm
$90.00
SP116 OsteoMed Plating & Fixation System Locking Screws Diameter 2.0mm, length 4-18mm $90.00
Zimmer Biomet Pty Ltd
BI457 Lorenz 2.4mm Locking Reconstruction System
Resorbable
Screw, Locking Reconstruction Modular. Titanium
2.4 x (6-18)mm $90.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY593 PolyMax Rapid-Resorbable Fixation System
Polyactide Resorbable Screw/Tack 1.25-3.24mm $141.00
KLS Martin Australia Pty Limited
KT040 Martin Level One Fixation Resorb x
& Sonic Weld
Medtronic Australasia Pty Ltd
MC626 Macropore FRP (fast resorbing
polymer)
Sonic Pin PDDLA (resorbable) Diameter 1.25 - 3.24mm $141.00
Polylactide and Polyglycolide polymer 1.8mm x 3-8mm $141.00
MI090 Macropore Screws 1.75 - 2.75 x 2.24 - 3.24mm $141.00
Stryker Australia Pty Ltd
HW510 Delta Resorbable Fixation System Resorbable Screws 1.7mm diameter, 3 -6mm length $141.00
Billing Code Product Name Description Size
Surgical Specialties
Benefit
Benefit
Condition
SQ060 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC copolymer Screws 2 x 9-19mm, 2.5 x 10-23mm and 2.8 x
10 - 23mm
$141.00
Zimmer Biomet Pty Ltd
BI415 Lactosorb Resorbable Craniomaxillofacial Fixation System
BI994 Lactosorb Resorbable Craniomaxillofacial Fixation System
BI995 Lactosorb Resorbable Craniomaxillofacial Fixation System
BI996 Lactosorb Resorbable Craniomaxillofacial Fixation System
BI997 Lactosorb Resorbable Craniomaxillofacial Fixation System
07.01.06.03 - Diameter ≥3.25mm
Resorbable
Surgical Specialties
Bone Screw, 2 Pack, Endobrow, Lactosorb. PGA/PLA
Bone Screw Lactosorb, single screw (multiple screws per pack) PGA/PLA
Bone Screw Lactosorb, single screw (multiple screws per pack) PGA/PLA
Bone Screw Lactosorb,single screw (multiple screws per pack) PGA/PLA
Bone Screw Lactosorb, single screw (multiple screws per pack) PGA/PLA
2 x 5mm $141.00
1.5mm dia $141.00
2.0mm dia $141.00
2.5mm dia $141.00
2.8mm dia $141.00
SQ059 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC copolymer Screws 4.5 x 20-55mm, 3.1 x 40mm $310.00
7.1.7 - Ancillary Components
7.1.7.1 - Pin
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY345 Titanium Sternal Fixation System Titanium Emergency Release Pin One Size only $95.00
7.1.7.2 - Tack
Medtronic Australasia Pty Ltd
MC570 Macropore Tacks 1.5 x 4mm - 2.0 x 6mm $52.00
Surgical Specialties
SQ050 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane & tacks 6 tack kit $52.00
Billing Code Product Name Description Size
7.1.7.3 - Washer
Benefit
Benefit
Condition
Stryker Australia Pty Ltd
SK146 Leibinger Titanium Implant System - Universal Mandible Biconcave Washer
Items used for reconstruction and fixation of mandibular fractures and tumour resection
Universal Mandible Bi-concave Washer $30.00
7.1.7.4 - Wedges and Burr Hole Covers
AA-Med Pty Ltd
ZZ023 Burr Hole Covers for Kelyniam
Customized Implant System
Lifehealthcare Pty Ltd
PEEK and Anodized Titanium Burr Hole Covers
13mm - 22mm Diammeter $385.00
LH539 Cranial Loop (XL) Burr Hole Cranial bone fixation system made of PEEK
OPTIMA
Diameter: 22mm ; Thickness: 0.9mm - 1.0mm thick
$385.00
Stryker Australia Pty Ltd
HW435 E-POR Biomaterial/ Craniotomy Gap Wedge Porous Polyethylene
HW439 E-POR Biomaterial/ Burr Hole
Cover, Porous Polyethylene
7.1.7.5 - Anchor Bone
Craniotomy Gap Wedge Porous Polyethylene One Size - V and T shape $385.00 Burr Hole Cover, Porous Polyethylene 15mm x 3mm x 5mm; 29mm x 7mm x 14mm $385.00
Surgiplas Medical
SP096 OsteoMed Plating & Fixation System Screws MMF / Anchorage Screws 1.2/1.6/2.0mm Anchor, Bone
$140.00
7.1.7.6 - Clamps
B Braun Australia Pty Ltd
BB072 Craniofix Titanium Clamps Titanium 11mm $95.00
BB073 Craniofix Titanium Clamps Titanium 16mm $95.00
BB168 Craniofix Titanium skull fixation clamp 20mm $95.00
BB289 CranioFix Absorbable Double sided Cranial clamp, absorbable
polyester
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
11mm, 16mm $95.00
SY252 AO/ASIF Facio-Maxillary Plates Flapfix - Plates for fixation of cranial bone flaps 10 - 20mm $95.00
Billing Code Product Name Description Size
LMT Surgical Pty Ltd
Benefit
Benefit
Condition
LM233 Bioplate ZIP Titanium Clamp 11 to 20 mm $95.00
Medtronic Australasia Pty Ltd
MI094 Invisx Locks Invisx polymer cranial fixation system One size $95.00
Zimmer Biomet Pty Ltd
BI714 RapidFlap Cranial Clamp Clamp, Burr Hole or Craniotomy Line, Titanium 12, 16, 20mm $95.00
7.1.7.7 - Screws
AA-Med Pty Ltd
ZZ007 HND Screws for OBL PSI System Osteosynthesis screws for cranio-maxillo-facial
patient specific implants
Width – 1.5mm-3mm Length 3.5mm-18mm $140.00
ZZ024 Screws for Kelyniam Customized Implant System
Self-drilling Titanium Screws 1.5mm diameter, 3mm-6mm length $140.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY784 SynPOR Chin Connector One Size $140.00
Surgiplas Medical
SP095 OsteoMed Plating & Fixation System Screws Locking Screw Inserts, Other ancillary $140.00
7.1.7.8 - Locks
Medtronic Australasia Pty Ltd
MC580 Macropore Locks 2 - 20mm $700.00
7.1.7.9 - Probe
WILLIAM A COOK AUSTRALIA PTY LTD
WC264 SYSTEM- Doppler Blood Flow
Monitoring System. COMPONENT - Cook-Swartz Implantable Doppler Flow Probe
The Cook-Swartz Implantable Doppler Flow Probe is an implantable 20MHz Probe with epoxy-coated Crystal and patented Silicone Cuff which provides continuous direct vessel monitoring of microvascular anastomoses. A 30cm wire with external Retention Tabs is attached to the 1mm diameter Crystal.
Cuff Lengths: 17.4 and 32mm $390.00
Billing Code Product Name Description Size
7.1.8 - Non-mesh, non-resorbable
7.1.8.1 - <6cm2
Benefit
Benefit
Condition
Neoss Australia Pty Ltd
NJ010 Neoss Ti Reinforced Membrane - S I, Neoss Ti Reinforced Membrane - M I, Neoss Non- Reinforced Membra
7.1.8.2 - >6cm2 - <8cm2
Neoss Australia Pty Ltd
NJ011 Neoss Ti Reinforced Membrane - L I, Neoss Ti Reinforced Membrane - M
7.1.8.3 - >8cm2
Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.
Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.
28.7mm x 18mm, 0.3mm thick (Reinforced S I)
30.4mm x 19.4mm, 0.3 thick (Reinforced M I)
29mm x 14mm, 0.3mm thick (Non-reinforced)
35.9mm x 21.2mm, 0.3mm thick (L I) 32.2mm x 22mm, 0.3mm thick (M)
$185.00
$250.00
Neoss Australia Pty Ltd
NJ012 Neoss Non-Reinforced Membrane,
Neoss Ti Reinforced Membrane - L
Neoss Ti Reinforced membrane NeoGen is an implantable temporary non-resorbable device (membrane) for use as a spacer creation barrier in the treatment of local defects in the oral cavity in conjunction with tissue regeneration or augmentation. Neoss membranes are intended to be submerged and clinically implanted more than 30 days with an expected duration of implantation up of 6 months.
34.2mm x 24.8mm, 0.3mm thick $330.00
Billing Code Product Name Description Size
7.2.1 - Chin
Device Technologies Australia Pty Ltd
Benefit
Benefit
Condition
DE320 | Facial Implant Chin | Anotomical chin | Small, medium, large/left, right | $286.00 |
DE321 | Facial Implant Chin | Chin | Small, medium, large/left, right | $286.00 |
SPIRAN PTY. LTD.
S2001 Biopore Chin Two Piece Anatomical contour.
Stryker Australia Pty Ltd
An implantable device intended to support, contour, and provide structure for the chin. Made of high density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
78 x 9mm $286.00
HW412 Chins Extended chin implants: Round RZ (Models 8313 - 8315) and extended square RZ (Models 8316, 8318). Two piece chin design (Models 8320 - 8322). Single piece chin design, contoured (Models 7520 - 7522). Additional chin shapes (Models 6341 - 6344) Contoured t
Surgiplas Medical
Extended chin Implants design RZ round small: 45 x 47 x 3mm, medium 45 x 47 x 5mm, large 45 x 47 x 7mm; Extneded Chin Implants square small 45 x 47 x3mm; Medium 45 x 47 x 5mm; Large 45 x 47 x 7mm; Two piece design small 46 x 33 x 5mm; Medium 56 x 36 x 7mm
$286.00
SP004 Facial Prosthesis Silicone elastomer Small / Medium / Large / X-Large $286.00
Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY782 SynPOR Porous Polyethylene Chin Implant 4-9mm $950.00
7.2.2 - Cranium
Medtronic Australasia Pty Ltd
MC548 Macropore Cranial Recon 29 - 165mm $481.00
Billing Code Product Name Description Size
7.2.2.1 - Complex
Benefit
Benefit
Condition
Australian Surgical Innovations Pty Ltd
AI006 ASI Plates and Screws Custom Mesh . $6,700.00
Biomodelled
AA-Med Pty Ltd
ZZ001 OBL PorousiTi® Patient Specific Implant - Cranium
Patient specific implant for the cranium constructed of PourousTi®
The implant is custom made so the size is variable
$9,930.00
ZZ014 Kelyniam Customized Cranial Implant PEEK-OPTIMA Customised Cranial Implant The implant is custom made so the size will be
variable
$9,930.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY772 PSI Biomodelled Patient Specific Craniofacial implant, PEEK Titanium
Custom $9,930.00
SY834 OBL PorousiTi® Patient Specific Implant - Cranium
Patient specific implant for the cranium constructed of PourousTi®
The implant is custom made so the size is variable
$9,930.00
KLS Martin Australia Pty Limited
KT003 UNIQOS Custom Patient Specific
Craniofacial Implant, PEEK Titanium
Medtronic Australasia Pty Ltd
UNIQOS Custom Patient Specific Craniofacial Implant, PEEK Titanium
Custom - Patient Specific $9,930.00
MC528 TiMesh Cranial Custom Mesh 121mm x 72mm - 152 x 152mm $9,930.00
Stryker Australia Pty Ltd
HW547 Stryker Biomodelled Patient Specific PEEK Implant
Biomodelled Three Piece
Biomodelled Patient Specific Craniofacial Implant PEEK
Custom $9,930.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY774 PSI Biomodelled Patient Specific Craniofacial implant, PEEK Titanium, 3 Piece
Custom $10,930.00
Biomodelled Two Piece
AA-Med Pty Ltd
ZZ002 OBL PorousiTi® Cranial Patient
Specific Implant – Two piece
Patient specific two piece implant for the cranium constructed of PourousTi®
The implant is custom made so the size is variable
$10,430.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY773 PSI Biomodelled Patient Specific Craniofacial Implant, Titanium, 2 Piece
Custom $10,430.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
SY826 | OBL PorousiTi® Cranial Patient Specific Implant – Two piece | Patient specific two piece implant for the cranium constructed of PourousTi® | The implant is custom made so the size is variable | $10,430.00 | | |
Biomodelled, Dual Mesh Medtronic Australasia Pty Ltd
MC625 Modified Dual TiMesh TiMesh Surgical Mesh Modified, includes two
cranial plates. Composition: Titanium
121mm x 77mm - 152mm x 152mm. $10,500.00
Stryker Australia Pty Ltd
HW437 E-POR Biomaterial/ Mastoid,
Pterional, Contourable Porous Polyethylene
Complex
SPIRAN PTY. LTD.
Mastoid, Pterional, Contourable Porous Polyethylene
Left, Right, 43mm - 57mm x 0.6mm, 1.5mm $1,300.00
S2007 Biopore Custom Made Implant An implantable device made of high-density
polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is custom made/biomodelled from individual patient's CT scan, on doctors prescription, used for correction and reconstruction of any facial, head or any non weight bearing bone structure.
Custom designed and biomodelled from patient's CT scan image.
$9,930.00
Surgiplas Medical
SP113 OsteoMed Plating & Fixation System Plates 90 x 90mm, 95 x 165mm, & Large Pre-formed Osteoform Mesh, Cranium.
$2,600.00
7.2.2.4 - Surgical Guide
Biomodelled
AA-Med Pty Ltd
ZZ004 Surgical Guide for OBL PSI System - Cranium
Patient specific surgical guide for cranial implant
The device is custom made so sizes will vary $2,650.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY777 ProPlan Patient Specific Cranical Surgical Guides, Implants
Custom $2,650.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
SY825 | Surgical Guide for OBL PSI System - Cranium | Patient specific surgical guide for cranial implant | The device is custom made so sizes will vary | $2,650.00 | | |
7.2.3 - Ear
7.2.3.1 - Helical Rim
Stryker Australia Pty Ltd
HW420 Ear Reconstruction Porus Polyethylene. Helical rim, models 8328 and 8329
Helical rim: 37 x 62mm $420.00
Stryker Australia Pty Ltd
HW432 Ear Reconstruction Porus Polyethylene. Ear base left and right, models 7542 and 7525 - 7527. Ear base extended left and right, models 8330 and 8331.
Ear base: 29 x 55 x 13mm, 32 x 65 x 16mm. Ear base extended: 30 x 60mm.
$600.00
7.2.4 - Malar
Device Technologies Australia Pty Ltd
DE333 Facial Implant Malar Malar Anatomical Small, medium, large/left or right $330.00
Stryker Australia Pty Ltd
HW413 Genioplasty Wedge Porus Polyethylene. Genioplasty wedges, models 8340 - 8343
Small 60 x 25 x 5mm, medium 60 x 25 x 7.5mm, large 60 x 25 x 10mm
$330.00
HW414 Prejowl Shape Porus Polyethylene. Model 8319 45 x 41 x 4mm $330.00
SK512 Malar Shape Porus Polyethylene. Design RZ malar shapes, super petite and petite, left and right (Models 9501 - 9504). Design M malar shapes, left and right (Models 9507 - 9512). Additional malar shapes, extended contoured left and right (Models 9513 - 9518) Contoured
Design RZ malar shapes: super petite left and right 50 x 19 x 3mm, Design RZ malar shapes petite left and right 50 x 19 x 5mm. Design malar shapes: small left and right 64 x 19 x 3mm, left and right medium 64 x 19 x 4.5mm, Left and right large 64 x 19 x
$330.00
7.2.4.1 - Complex
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY783 SynPOR Porous Polyethylene Malar Implant 3-5 mm $1,150.00
Billing Code Product Name Description Size
Stryker Australia Pty Ltd
Benefit
Benefit
Condition
HW434 E-POR Biomaterial/ Midface Contour Porous Polyethylene
HW438 E-POR Biomaterial/ Temporal Fossa Implant Porous Polyethylene
7.2.4.2 - Polymer
Midface Contour Porous Polyethylene One size $1,150.00 Temporal Fossa Implant Porous Polyethylene 61mm - 105mm x 18mm - 20mm $1,150.00
SPIRAN PTY. LTD.
S2004 Biopore Malar Implant An implantable device intended to support,
contour and provide structure for the face including the cheeks and eye sockets. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
Left and Right (47mm x 24mm x 4mm) $430.00
Stryker Australia Pty Ltd
HW436 E-POR Biomaterial/ Transsphenoidal Sellar Contourable Porous Polyethylene
Transphenoidal Sellar Contourable Porous Polyethylene
2.5mm x 20mm - 40mm $500.00
7.2.5 - Mandible, Maxilla and Temperomandibular Joint (TMJ)
7.2.5.1 - Mandible, Full
Medtronic Australasia Pty Ltd
MC513 TiMesh Full Mandible One size only $1,520.00
Surgiplas Medical
SP092 Osteo Plating & Fixation System Plates - Reconstruction 5 x 20 x 5 Hole Full Mandible Plate; 5 x 16 x
5 Hole Full Mandible Plate; Mandible, Full
$1,520.00
Biomodelled
AA-Med Pty Ltd
ZZ025 OBL PorousiTi Patient Specific
Implant - Mandible
Patient specific implant for mandible constructed of PourousiTi
The model is custom made so size will vary $8,500.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY824 OBL PorousiTi Patient Specific
Implant - Mandible
Patient specific implant for mandible constructed of PourousiTi
The model is custom made so size will vary $8,500.00
Billing Code Product Name Description Size
7.2.5.2 - Fossa Replacement
Benefit
Benefit
Condition
OMX SOLUTIONS PTY LTD
OG003 OMX Solutions Melbourne TMJ
Glenoid Fossa Component
Signature Orthopaedics
Universal glenoid fossa component constructed of UHMWP
The device is custom made so the size will vary.
$5,850.00
SF131 Melbourne TMJ Prosthesis TMJ Fossa component One Size $5,850.00
Zimmer Biomet Pty Ltd
BI569 TMJ System Fossa Component, Left or Right; Titanium, UHMWPE
Small, Medium Large $5,850.00
7.2.5.3 - Mandibular Angle
Compression
Stryker Australia Pty Ltd
ST369 Luhr Fixation System Luhr Mandibular Compression System: curved,
straight, metacarpal plate Vitallium
Curved: 30,38, 45mm, Straight: 30, 40, 50,
60, 80mm, metacarpal: 41, 45mm
$152.00
Surgiplas Medical
SP069 Plates Micro, Mini, Maxi Angled EDC Plate, Angled Long EDC Plate, 40mm 6 Hole Fracture Plate, 6 Hole Curved EDC Plate, 33mm & 38mm 4 Hole EDC Plate, 48mm 6 Hole EDC Plate, Mandible, Mandible/Reduction, Mandible Angle
$152.00
Polymer
SPIRAN PTY. LTD.
S2009 Biopore Mandible (Left / Right) An implantable device intended to support,
contour, and provide structure for the mandible. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device can be cut by the surgeon to meet the patient's specific needs.
74 x 33 x5mm $1,485.00
Stryker Australia Pty Ltd
HW422 Mandibular angle Porus Polyethylene. RZ mandibular angles left and right (Models 9955 - 9960); Porus Polyethylene. Contoured mandibular angles left and right (Models 88037 - 88038)
RZ mandibular angles: 65 x 35 x 3 x 6.5 x 3 x
3mm, 65 x 35 x 7 x 6.5 x 3 x 3mm, 65 x 35 x
11 x 6.5 x 3 x 3mm. Contoured mandibular angles left and right:59 x 29 x 7 x 11mm.
$1,485.00
Billing Code Product Name Description Size
7.2.5.4 - Condylar Device
Benefit
Benefit
Condition
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY694 Condylar Head Add-On System Condylar Head - Left, Right One Size $1,545.00
KLS Martin Australia Pty Limited
KT008 Martin Level One Fixation Temporary condylar impant, titanium 5cm $1,545.00
Stryker Australia Pty Ltd
SK218 Leibinger Titanium Implant System - Universal Mandible Condylar Device
Zimmer Biomet Pty Ltd
Items used for reconstruction following trauma or tumor resection of the mandible. Included are 2x cross pin fixation screw.
Universal Mandible Condylar Device Left and Right
$1,545.00
BI792 Lorenz 2.4mm Locking Reconstruction System
Fixation Plate
Condyle left or right, chrome cobalt (CoCr) One size only $1,545.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY695 Condylar Head Add-On System Fixation Plate 0-6mm positions 2 Holes $645.00
7.2.5.5 - Plate
OMX SOLUTIONS PTY LTD
OG002 OMX Solutions Melbourne TMJ Mandibular Ramus
Signature Orthopaedics
Custom 3D printed mandible component constructed of titanium alloy
The device is custom made so the size will vary.
$6,875.00
SF128 Melbourne TMJ Prosthesis TMJ Mandibular Component S, M, L (Left & Right) $6,875.00
Zimmer Biomet Pty Ltd
BI559 TMJ System Mandibular Component, Left or Right, Titanium (40 - 60mm), 5-13 hole $6,875.00
Biomodelled
AA-Med Pty Ltd
ZZ009 Custom made plates (including
Megaplates)
Patient specific plates for the mandible and maxilla
The model is custom made so size will vary $4,200.00
ZZ011 SynpliciTi System - Plates Patient specific plates for the mandible, maxilla
and TMJ
The model is custom made so size will vary $4,200.00
Billing Code Product Name Description Size
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
Benefit
Benefit
Condition
SY776 ProPlan Biomodelled Patient specific Mandible Complex Locking Reconstruction Plate
SY832 SynpliciTi System - Plates Patient specific plates for the mandible, maxilla
and TMJ
Custom $4,200.00
The model is custom made so size will vary $4,200.00
SY836 Custom made plates (including
Megaplates)
Patient specific plates for the mandible and maxilla
The model is custom made so size will vary $4,200.00
KLS Martin Australia Pty Limited
KT002 UNIQOS custom Threadlock TS
Mandible Reconstruction Plates
Stryker Australia Pty Ltd
HW545 Stryker Biomodelled Patient Specific Mandible Reconstruction Plate
Hemimandible
Medtronic Australasia Pty Ltd
UNIQOS Custom Threadlock TS Mandible Reconstruction Plates
Biomodelled Patient Specific Mandible Complex Locking Reconstruction Plate
Custom-Patient Specific $4,200.00
Custom $4,200.00
MC515 TiMesh Hemimandible, Left/Right One size only $645.00
Surgiplas Medical
SP024 OsteoMed Plating & Fixation System Plates - Reconstruction 5 x 16 Hole plate Right & Left $645.00
Maxilla
Medtronic Australasia Pty Ltd
MC512 TiMesh Maxillary Prosthesis One size only $2,124.00
Symphsis
Medtronic Australasia Pty Ltd
MC516 TiMesh Mandibular Symphysis One size only $1,294.00
7.2.5.6 - External Midface System
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY594 Mandible External Fixator Hemi, 3/4, Full and Ramus Various $1,460.00
7.2.5.7 - Surgical Guide
Biomodelled
AA-Med Pty Ltd
ZZ005 Surgical Guide for OBL PorousiTi®
PSI System – Mandible & Maxilla
Patient specific surgical guide for mandible and maxilla
The model is custom made so size will vary $2,650.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
ZZ010 Custom made plates (including
Megaplates) – Surgical Guides
Surgical Guides for patient specific plates for the mandible and maxilla
The model is custom made so size will vary $2,650.00
ZZ012 SynpliciTi System – Surgical Guides Patient specific surgical guides for the
mandible, maxilla and TMJ
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY778 ProPlan Pateint specific Maxillofacial Surgical Guides, Implants
SY827 SynpliciTi System – Surgical Guides Patient specific surgical guides for the
mandible, maxilla and TMJ
The model is custom made so size will vary $2,650.00
Custom $2,650.00
The model is custom made so size will vary $2,650.00
SY829 Custom made plates (including
Megaplates) – Surgical Guides
SY835 Surgical Guide for OBL PorousiTi®
PSI System – Mandible & Maxilla
Surgical Guides for patient specific plates for the mandible and maxilla
Patient specific surgical guide for mandible and maxilla
The model is custom made so size will vary $2,650.00 The model is custom made so size will vary $2,650.00
KLS Martin Australia Pty Limited
KT005 UNIQOS Patient Specific Surgical
guides
OMX SOLUTIONS PTY LTD
OG001 OMX Solutions patient Optimized
Guide system
7.2.5.8 - Maxilla
Biomodelled
AA-Med Pty Ltd
UNIQOS Patient Specific Surgical guides Custom - Patient specific $2,650.00
CT Based Patient Specific Surgical Guide The device is patient specific so size will vary $2,650.00
ZZ026 OBL PorousiTi Patient Specific Implant - Maxilla
Patient specific implant for maxilla constructed of PorousiTi
The model is custom made so size will vary $6,500.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY828 OBL PorousiTi Patient Specific Implant - Maxilla
7.2.6 - Nose and Zygoma
7.2.6.1 - Nasal Dorsum
Patient specific implant for maxilla constructed of PorousiTi
The model is custom made so size will vary $6,500.00
Device Technologies Australia Pty Ltd
DE322 Facial Implant Nasal Zygomatic Right, left $279.00
Billing Code Product Name Description Size
SPIRAN PTY. LTD.
Benefit
Benefit
Condition
S2010 Biopore Nasal Dorsum Shape An implantable device intended to support,
contour, and provide structure for the nose and zygoma. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
53 x 5mm, 66 x 6 mm, 76 x 15mm, 40 x 9mm $279.00
Stryker Australia Pty Ltd
HW423 Nasal Shape. Petite Nasal Dorsum. Porus Polyethylene. Petite Nasal Dorsum (
Models 84000 - 84004).
7.2.6.2 - Nasal Arch
Stryker Australia Pty Ltd
HW415 Nasal Shape or Rhinoplasty Shape Porus Polyethylene. Nasal Arch shapes, nasal
arch and nasal sheet (Models 9533 - 9536). Nasal dorsum shapes, design A and design B (Models 7516 - 7518). Nasal valve support, lateral nasal valve support and ext.
7.2.6.3 - Nasal Shell Shape
Stryker Australia Pty Ltd
HW425 Nasal Shell Shapes. Nasal Shell Shapes, Regular and Large with Inserts Small and Large (included). Models 9553 - 9554. Thin Nasal Shell 84006
7.2.6.4 - Nasal Valve Support
Stryker Australia Pty Ltd
HW424 Nasal Valve Support. Lateral Nasal Valve, Model 7545. External Nasal Valve Batten, Model 7546. External Nasal Valve Batten - Thin, Model 7167
Petite Nasal Dorsum: 4 x 4 x 45mm, 4 x 4 x
55mm, 5 x 5 x 45mm, 5 x 5 x 55mm, 6 x 9 x 55mm.
Nasal arch shapes: small 70 x 13 x 2mm, medium 70 x 15 x 2mm, large 70 x 15 x 2mm, sheet 40 x 9 x 1.1mm. Nasal dorsum shapes: design A small 53 x 5mm, design A large 66 x 8mm, design B 67 x 6.5mm. Nasal valve support: lateral nasal valve 13 x 0.85 x 3.5mm
Regular: 38 x 21 x 17mm, Insert Small 30 x 4 x 9mm, Insert Large 38 x 2.5 x 9mm. Large: 40 x 20 x 18mm, Insert Small 32 x 4 x 9mm, Insert Large 41 x 3 x 9mm. Thin Nasal Dorsal Shell 42.7mm x 16.4mm x 21.8mm
Lateral Nasal Valve:13 x 3.5 x 0.85mm, External Nasal Valve Batten: 25 x 11 x 0.85mm, External Nasal Valve Batten - Thin: 24 x 11.5 x 0.6mm.
$279.00
$350.00
$490.00
$227.00
Billing Code Product Name Description Size
7.2.6.5 - Naso-orbital Ethmoid Implant
Complex
Medtronic Australasia Pty Ltd
MC521 TiMesh Naso-Orbital-Ethmoid 1mm - 2.2mm; Complex 1, Complex 2, Complex 3
Benefit
$541.00
Benefit
Condition
7.2.6.6 - Surgical Guide
Biomodelled
AA-Med Pty Ltd
ZZ013 SynpliciTi System – Surgical Guides Surgical Guide for the zygoma The model is custom made so size will vary $2,650.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY823 SynpliciTi System – Surgical Guides Surgical Guide for the zygoma The model is custom made so size will vary $2,650.00
7.2.6.7 - Zygoma Plate
Biomodelled
AA-Med Pty Ltd
ZZ027 SynpliciTi System - Plates Patient specific plates for zygoma The model is custom made so size will vary $4,200.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY831 SynpliciTi System - Plates Patient specific plates for zygoma The model is custom made so size will vary $4,200.00
7.2.7 - Orbit
7.2.7.1 - Complete Orbital Shape
Stryker Australia Pty Ltd
HW411 Complete Orbital Shape Porus Polyethylene. Complete and 2 / 3 orbit
shapes. Inferior 2 / 3 left and right. Models 9567, 9568
Inferior: 83 x 78mm $1,940.00
HW421 Complete Orbital Shape Complete left and right. Models 9569, 9570 Complete 61 x 76mm $1,940.00
7.2.7.2 - Orbital Floor
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY391 | Orbital Fixation System | Orbital Floor Plate | S, M, L | $890.00 |
SY698 | SynPOR | Anatomical Porous Polyethylene | 0.8mm - 1.5mm thick | $890.00 |
Billing Code Product Name Description Size
Stryker Australia Pty Ltd
Benefit
Benefit
Condition
HW522 Stryker Leibinger 3D Orbital Floor
Plate
Surgiplas Medical
Stryker Leibinger 3D Orbital Floor Plate Small, Right
Small, Left Large, Right Large, Left
$890.00
SP079 Plates Micro, Mini Orbital Plate, Orbital Plate Large $890.00
Zimmer Biomet Pty Ltd
BH363 Lorenz Plating System Orbital Floor Plate, Titanium Small to Large $890.00
BI924 Lactosorb Resorbable Craniomaxillofacial Fixation System
Biomodelled
AA-Med Pty Ltd
Orbital Floor Plate, 1.5mm System, PGA/PLA Left or right $890.00
ZZ003 OBL PorousiTi® Patient Specific
Implant – Orbital Floor
Patient specific implant for the orbital floor constructed of PourousTi®
The model is custom made so size will vary $4,200.00
ZZ015 Kelyniam Customized Orbital Floor
Implant
PEEK-OPTIMA Customised Orbital Floor Implant
The implant is custom made so the size will be variable
$4,200.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY833 OBL PorousiTi® Patient Specific
Implant – Orbital Floor
Patient specific implant for the orbital floor constructed of PourousTi®
The model is custom made so size will vary $4,200.00
KLS Martin Australia Pty Limited
KT001 UNIQOS Biomodelled Customised Orbital Floor Mesh
Coated
Stryker Australia Pty Ltd
HW433 E-POR Biomaterial/ Orbital Wall and Floor Porous Polyethylene Titanium Mesh Composite (large)
UNIQOS Biomodelled Customised Orbital Floor Mesh
Orbital Wall and Floor Porous Polyethylene Titanium Mesh Composite
Customised - patient specific $4,200.00
41 x 42 x 0.6-1.0mm $985.00
Billing Code Product Name Description Size
7.2.7.3 - Rim
Benefit
Benefit
Condition
SPIRAN PTY. LTD.
S2006 Biopore Orbital Rim, Extended An implantable device intended to support,
contour, and provide structure for the face including the cheeks and eye socket. Made of high-density polyethylene material with an interconnecting pore structure that supports tissue ingrowth. The device is available in various shapes and can be cut by the surgeon to meet the patient's specific needs.
Left and Right (44mm x 38mm) $395.00
Stryker Australia Pty Ltd
SK511 Orbital Rim Orbital rims, left and right extended. Models 9539, 9540 Orbital Rim Onlay Implants 81001,
81002
Left & right extended models 47 x 40mm Oribtal Rim Onlay Implants left & right 40 x 40mm
$395.00
Biomodelled
AA-Med Pty Ltd
ZZ016 Kelyniam Customized Orbital Rim
Implant
7.2.7.4 - Wedge for Orbit
PEEK-OPTIMA Customised Orbital Rim Implant
The implant is custom made so the size will be variable
$4,200.00
Stryker Australia Pty Ltd
HW410 Enophthalmos Wedge Regular left and right. Large left and right.
(Models 9541 - 9544)
Regular: 22 x 31 x 7mm. Large: 28 x 40 x 7.5mm
$460.00
7.2.7.5 - Surgical Guide
Biomodelled
AA-Med Pty Ltd
ZZ006 Surgical Guide for OBL PorousiTi®
PSI System – Orbital Floor
Patient specific surgical guide for orbital floor implant
The model is custom made so size will vary $2,650.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY830 Surgical Guide for OBL PorousiTi®
PSI System – Orbital Floor
Patient specific surgical guide for orbital floor implant
The model is custom made so size will vary $2,650.00
Billing Code Product Name Description Size
7.2.8 - External Prostheses, Bone Attachment
7.2.8.1 - Endosseous Implant
Benefit
Benefit
Condition
Cochlear Limited
CO042 Vistafix™ Fixture ST Titanium self-tapping fixtures for the retention
of midface and orbital prostheses.
3mm and 4mm $635.00
Concave
Cochlear Limited
CO058 Cochlear Vistafix 3 VXI300 Implants Titanium implant with TiOblast™ for Vistafix
one-stage or two-stage surgery
3 mm and 4 mm $1,082.00
Flanged
Cochlear Limited
CO030 Flange fixture ST 3mm and 4mm Self tapping titanium flange fixture pre-
mounted with a disposable fixture mount. Available in two sizes: 3mm and 4mm. Used in two stage surgical procedures.
Self Tapping 4mm and 3mm $1,035.00
7.2.8.2 - Abutment, Permanent
Cochlear Limited
CO036 Standard Abutments Abutment Complete - Titanium 3.0mm - 90780, 4.0mm - 90778, 5.5mm -
90776, 7.0mm - 90774
$412.00
Angled/Offset
Cochlear Limited
CO037 Face to Face Console Abutment Unigrip - Titanium 30, 60, 90, 110 Degrees $895.00
Concave
Cochlear Limited
CO061 Cochlear Vistafix 3 VXA300 Abutments
Titanium abutment for Vistafix one-stage and two-stage surgery. VXA Abutments are only compatible with VXI300 Implants
3.5 mm, 4.5 mm, 6 mm, 7.5 mm $936.00
7.2.8.3 - Abutment, Temporary or Healing
Cochlear Limited
CO038 Face to Face Healing Abutment Unigrip - Titanium 7mm $285.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
CO059 | Cochlear Vistafix 3 VXA300 Healing | Titanium healing abutment can be used during | 9 mm | $285.00 |
| Abutment | healing to avoid having to select the abutment | |
| | length during surgery. The markings can be | |
| | used to indicate thickness of the soft tissue. The | |
| | healing abutment is mounted on the implant | |
| | and is only compatible with theVXI300 | |
| | implants | |
7.2.8.4 - Abutment Fixtures
Cochlear Limited
CO035 Face to Face Cover Screw with Internal Hexagon One Size Only $142.00
CO060 Cochlear Vistafix 3 Cover screw
conical
7.2.9 - Anatomical Biomodel
Cover screw conical for Vistafix VXI300 implant. The Cover screw is only compatible with VXI300 implants
One size $142.00
AA-Med Pty Ltd
ZZ008 Anatomical Model for OBL PSI
System
ZZ017 Anatomical Biomodel for Kelyniam
Customized Implant System
3D anatomical biomodel The model is custom made so size will vary $2,000.00 Patient Specific Anatomical Biomodel Custom $2,000.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY775 PSI Patient specific Craniofacial Anatomical Biomodel
SY779 ProPlan Patient Specific Craniofacial Anatomical Biomodel
KLS Martin Australia Pty Limited
Custom $2,000.00
Custom $2,000.00
KT004 UNIQOS Patient Specific Anatomical Biomodel
OMX SOLUTIONS PTY LTD
Patient specific antomical biomodel Custom-Patient Specific $2,000.00
OG004 The OMX Solutions Biomodel CT Based Patient Specific Anatomical
Biomodel
The device is patient specific so size will vary $2,000.00
Stryker Australia Pty Ltd
HW544 Stryker Anatomical Biomodel for
Mandible
Patient Specific Craniofacial Anatomical Biomodel
Custom $2,000.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
HW546 | Stryker Anatomical Biomodel for PEEK | Patient Specific Craniofacial Anatomical Biomodel | Custom | $2,000.00 | | |
7.3.1 - Abutment
7.3.1.1 - Permanent
Biomet 3i Australia Pty Ltd
NW001 3i Abutment Complete Titanium 3.25 - 6mm diameter $175.00
DENTSPLY IH Pty Ltd
DH007 Ankylos Permanent Abutments Permanent Abutments Diameter range: 3.3mm - 5.7mm, height range: 7.5mm - 11.1mm
$175.00
MV005 | More Group Pty Ltd MIS Abutments | Abutments | Height: 1mm - 5mm, Crown height: 4 - 11mm, | $175.00 |
| | | Platform: Narrow, Standard or Wide | |
| Neoss Australia Pty Ltd | | | |
NJ003 | Neoss Titanium Abutment | Neoss Abutment Titanium | Universal | $175.00 |
NJ004 | Neoss Gold Abutment | Neoss Abutment Gold | Universal | $175.00 |
Nobel Biocare Australia Pty Ltd
NR001 Nobel Biocare Abutments Abutment, complete Np, RP, WP 6.0mm $175.00
7.3.1.2 - Temporary
DENTSPLY IH Pty Ltd
DH003 Astra Tech Implant System Healing
Abutments
Healing Abutments Implant Diameter: Range 3.0 - 5.4mm Healing Abutment Diameter Range from 3.5 - 6.5
$70.00
DH004 Astra Tech Implant System Abutments Temporary Abutment Diameter range: 3.3 - 7.0mm $70.00 DH006 Ankylos Temporary Abutments Temporary and healing abutments Diameter 3.3mm - 7mm $70.00
Neoss Australia Pty Ltd
NJ009 Neoss Implant System Healing Abutment with Screw Universal $70.00
Nobel Biocare Australia Pty Ltd
NR004 Nobel Biocare Abutments Abutment, temporary or healing, complete NP, RP, WP, 6.0mm $70.00
Straumann Pty Ltd
SB004 Straumann Bone Level Implant
Healing Abutment
Straumann Healing Abutment NC/RC Height 0 - 6 mm $70.00
Billing Code Product Name Description Size
7.3.1.3 - Cover Screw/Cap
Benefit
Benefit
Condition
DENTSPLY IH Pty Ltd
DH001 Astra Tech Implant System Cover
Screws
More Group Pty Ltd
Cover Screw Diameter range 3.0 - 5.4 $52.00
MV006 MIS Cover Screws and Healing Caps Cover screws and healing caps (Biocom, Seven,
Mistral)
1.5mm - 6mm height, 4mm - 6.3mm diameter $52.00
Nobel Biocare Australia Pty Ltd
NR002 Nobel Biocare Cover Screws Cover screw NP, RP, WP, 6.0mm $52.00
Straumann Pty Ltd
SB002 Straumann Pty Ltd Straumann Healing Cap NNC/NNI/RN/WN Height 1.5 - 4.5 mm $52.00
7.3.2 - Zygomatic Bone Implant
Nobel Biocare Australia Pty Ltd
NR007 Branemark Titanium Fixture Zygomaticus Fixture 30, 35, 42.5, 40, 45, 47.5, 50, 52.5mm Length $800.00
Southern Implants Australia Pty Ltd
IC002 Southern Zygomatic and Oncology
Implants
7.3.3 - Endosseous Implant
07.03.03.01 - Screws
Zygomatic Titanium dental implants with 45 or 55 degree angulation
4 to 6mm diameter, 27 to 52.5mm length $800.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY750 Orthodontic Bone Anchor System Anchor Screw, Self Drilling, Self Tapping 1.5mm - 1.8mm $78.00
KLS Martin Australia Pty Limited
KT064 Martin Level 1 Fixation Orthodontic Screw 1.5 - 2.0mm $78.00
Stryker Australia Pty Ltd
SK422 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary
Fixation Screw, Self-Drilling
SK423 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary
Fixation Screw, Self-Drilling
1.7mm $78.00
2.0mm $78.00
Billing Code Product Name Description Size
7.3.3.2 - Plates
Benefit
Benefit
Condition
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY749 Orthodontic Bone Anchor System Anchor Plate, Various Designs 4-5 Holes $226.00
KLS Martin Australia Pty Limited
KT063 Martin Level One Fixation Orthodontic skeletal anchorage plate 0.5 to 0.99mm thick, 2 to 7 holes $226.00
Stryker Australia Pty Ltd
SK420 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate, Standard 1.7mm $226.00
Locking
Stryker Australia Pty Ltd
SK421 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate Locking 1.7mm $320.00
7.3.3.3 - Implants and Fixtures
Biomet 3i Australia Pty Ltd
NW002 3i Self Tapping Threaded Implants and 3i Coverscrew
DENTSPLY IH Pty Ltd
Osseotite/Ice 3.25 - 6mm diameter $360.00
DH002 Astra Tech Implant System Fixtures
Tx/EV
Titanium fixture with microthreaded cervical neck
Diameter 3.0 - 5.7mm, Length 6-17mm $360.00
DH005 Ankylos C/X Implants Screw implant with cover screw (included) and
pre-mounted placement head
Diameter range 3.5 - 7.0 mm, Length 8-17mm $360.00
More Group Pty Ltd
MV004 MIS Implants Titanium implants (Biocom, Seven, Mistral) 3mm - 6mm Diameter, 6mm - 16mm length $360.00
Neoss Australia Pty Ltd
NJ001 NEOSS IMPLANT SYSTEM TITANIUM DENTAL IMPLANT DIAMETERS 3.25, 3.5, 4.0, 4.5, 5.0, 5.5mm
in Lengths: 7, 9, 11, 13, 15, 17mm
$360.00
Nobel Biocare Australia Pty Ltd
NR003 Branemark Fixtures Titanium Fixture 3, 4, 5mm $360.00 NR010 Replace Implant Dental Implant Endosseous, Titanium 10mm, 13mm, 16mm $360.00
NR012 Groovy Implants (NobelReplace
Straight Groovy, NobelReplace Tapered Groovy, NobelSpeedy Replace, Branemark System Mk III Groovy, NobelSpeedy Groovy)
Dental Implants, endosseous Diameter 3.5 - 6.0mm; Length 8.0 - 18.0mm $360.00
Billing Code Product Name | Description | Size | Benefit | Benefit | Condition |
NR013 NobelActive implants | Dental implants, endosseous | Diameter 3.5 - 5.0mm; Length 8.5 - 18.0mm | $360.00 | | |
Southern Implants Australia Pty Ltd
IC001 Southern Dental Implants Titanium dental implants in External-Hex, Tri-
Nex or Internal Octagon (IT) connection
3.25 to 6.0mm diameter, 6.0 to 52.5mm length $360.00
Straumann Pty Ltd
SB008 Straumann Dental Implant Straumann Dental Implant 4 - 16mm $360.00
Summit Healthcare Solutions
HS011 Periosave Z1-M Transgingival dental implant.
Hydrophilic Coating
Straumann Pty Ltd
Periosave Z1-M Zirconia-titanium Transgingival hybrid dental implant.
All Ø3.2mm transgingival implants have a zirconia platform of 4.4mm, all Ø3.90mm transgingival implants have zirconia platform of 5.0mm, all Ø4.7mm transgingival implants have a zirconia platform of 6.0mm.
Zirconia gingival collar height of all implants
= 1.5mm. All above implant diameters are available in lengths of 8mm, 10.0mm, 11.5mm, 13.0mm, 15mm
$360.00
SB009 Straumann SLActive Straumann Bone Level Implants with SLActive
Hydrophillic Surface
3.1mm-4.8mm diameter, 6mm-16mm height $420.00
7.3.3.4 - Graft Material <0.5ml
Straumann Pty Ltd
SB005 Straumann Bone Ceramic 070.203 Straumann Bone Ceramic 400 -700 070.203 Straumann Bone Ceramic 400 -700,
Granule size 400 - 700 microns, Unit size 0.25 g, Volume: approx 0.3 ml
$98.00
7.3.3.5 - Graft Material 0.5ml-<1.0ml
Biomet 3i Australia Pty Ltd
NW006 Endobon Xenograft Granules Hydroxyapatite granules, 0.5-1mm diameter 0.5ml $300.00
Geistlich Pharma Australia Pty Ltd
GI007 Bio-Oss Pen Pen applicator with natural bone mineral derived from bovine bone
0.25 to 1mm; 0.25g (0.5125cc) $300.00
Billing Code Product Name Description Size
Straumann Pty Ltd
SB006 Straumann Bone Ceramic 070.204 Straumann Bone Ceramic 500 -1000 070.204 Straumann Bone Ceramic 500 -1000,
Granule size: 500 -1000 microns, Unit size:
0.5 g, Volume: approx 0.95 ml
Benefit
$300.00
Benefit
Condition
07.03.03.06 - Graft Material ≥1.0ml
Biomet 3i Australia Pty Ltd
NW007 Endobon Xenograft Granules Hydroxyapatite granules, 0.5-1mm diameter or
1-2mm diameter
Geistlich Pharma Australia Pty Ltd
2 - 8ml $300.00
GI006 Bio-Oss Natural bone mineral derived from bovine bone 1 to 2mm: 0.5g (1.5cc) $300.00
GI008 Bio-Oss Pen Pen applicator with natural bone mineral derived from bovine bone
GI009 Bio-Oss Pen Pen applicator with natural bone mineral derived from bovine bone
0.25 to 1mm; 0.5g (1.025cc) $300.00
1 to 2mm; 0.5g (1.5cc) $300.00
Straumann Pty Ltd
SB007 Straumann Bone Ceramic 070.205 Straumann Bone Ceramic 500 -1000 070.205 Straumann Bone Ceramic 500 -1000,
Granule size: 500 -1000 microns, Unit Size 1g, Volume approx 1.9 ml
$300.00
7.4.1 - Complete
7.4.1.1 - External Midface System
Multivector
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY401 External Midface Distractor System Head Frame Assembly, Carbon Fibre Rods One size only $8,100.00
KLS Martin Australia Pty Limited
KT018 Martin Distraction Osteogenesis
Rigid External Distraction (Polley RED II)
Single Vector
Distractor System, Complete, External, Midface, Aluminium, Carbon Fibre
one size only $8,100.00
KLS Martin Australia Pty Limited
KT016 Martin Distraction Osteogenesis Distractor System, Complete, other, titanium 1.5mm $7,100.00
Billing Code Product Name Description Size
7.4.1.2 - External Set
Multivector
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY349 Multi Vector Distractor Set Titanium Multi Vector Distractor MVD Arms:15mm-85mm. Pin holding clamps-
ramus,body,universal,limited bone stock ramus and body. Assembly left & right 35mm. K wires 2.0mm 150mm length. Connecting bar 4.0mm 100mm-200mm length
Benefit
$1,955.00
Benefit
Condition
7.4.1.3 - Internal/Intraoral
Multivector
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY753 Curvilinear Distraction System Curvilinear Distraction, Right Left 30mm - 100mm radius $3,100.00
KLS Martin Australia Pty Limited
KT019 Martin Distraction Osteogenesis Distractor System, Complete, other, titanium 15-60 mm distraction length $3,100.00
Stryker Australia Pty Ltd
SK183 Leibinger Intraoral Distractor (Multiguide II)
Surgiplas Medical
Manufactured from stainless steel, allows gradual, independent, and simultaneous distraction of the mandible in 3 planes.
Frame 20mm - 35mm, 2.0mm diameter, 50 - 90 mm length Auto - Pilot Pins
$3,100.00
SP045 Logic Distraction System Distractor, spacers & activation set Straight, Curved 18-52mm $3,100.00
Single Vector
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY399 Alveolar Distractor Vertical mandibular, maxilla alveolar ridge distractor
KLS Martin Australia Pty Limited
KT011 Martin Distraction Osteogenesis Distractor System, Complete, internal/intraoral,
titanium
8-16mm $1,955.00
10 to 20 mm $1,955.00
Zimmer Biomet Pty Ltd
BI823 Alveolar Ridge Distraction System -
titanium
BI824 Alveolar Ridge Distraction System -
titanium
distraction device, single tooth 10-20mm $1,955.00
distraction device, multi tooth 10-20mm $1,955.00
Billing Code Product Name Description Size
Single Vector, Resorbable Zimmer Biomet Pty Ltd
Benefit
Benefit
Condition
BI934 Lactosorb Distraction System Plate, drive screw and distractor, PGA/PLLA, Ti Small, Medium, Large $3,500.00
7.4.2 - Component
7.4.2.1 - Distractor Body
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY515 Midface Distractor System Distractor System, Distractor Body 10-40mm distraction length $2,200.00
KLS Martin Australia Pty Limited
KT053 KLS Martin Distractor Zurich II distractor bodies 15mm - 30mm distraction length $2,200.00
7.4.2.2 - Footplate
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY406 External Midface Distractor System Titanium Zygomatic, Maxxilary Footplate 3 holes, 40mm $156.00
KLS Martin Australia Pty Limited
KT021 Martin Distraction Osteogenesis
Rigid External Distraction (Polley RED II)
Assembly
Distractor System, Component, Footplate, titanium
1.5mm $156.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY595 External Midface Distractor Distractor Footplate Various $480.00
Dual Plate
KLS Martin Australia Pty Limited
KT006 Zurich II Modular Distractors Distractor System, Component, Dual fixation
plates, pair
Mesh-large and small design; Cloverleaf design
$1,312.00
7.4.2.3 - Cross Bar/Rod
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY402 External Midface Distractor System Horizontal Rod Assembly One size only $990.00
KLS Martin Australia Pty Limited
KT022 Martin Distraction Osteogenesis
Rigid External Distraction (Polley RED II)
Distractor System, Component, Cross Bar, aluminium.carbon fibre
one size only $990.00
Billing Code Product Name Description Size
7.4.2.4 - Shim Plate
Benefit
Benefit
Condition
Zimmer Biomet Pty Ltd
BI825 Alveolar Ridge Distraction System -
titanium
7.4.2.5 - Pin
Shim plate, titanium 1-3mm $100.00
KLS Martin Australia Pty Limited
KT017 Martin Distraction Osteogenesis
Rigid External Distraction (Polley RED II)
7.4.2.6 - Screws
Distractor System, Component, Screws/Pins (other than bone screws), titanium
45-55mm $148.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY517 Midface Distractor System Distractor System, Screw 4-10mm $75.00
7.4.2.7 - External Distractor Component
KLS Martin Australia Pty Limited
KT020 Martin Distraction Osteogenesis
Rigid External Distraction (Polley RED II)
7.4.2.8 - Body Extension
Distractor System, Component, Other, titanium, aluminium
1.5-1.58mm $1,461.00
Johnson & Johnson Medical Pty Ltd t/a DePuy Synthes
SY518 Midface Distractor System Distractor System , Body extensions 20-40mm $500.00
KLS Martin Australia Pty Limited
KT054 KLS Martin Distractors Zurich II remote release activators 20mm - 50mm $500.00
7.5.1 - Muscular
7.5.1.1 - Calf Implant
Device Technologies Australia Pty Ltd
DE316 Calf Implants Asymmetrical shape, silicone gel smooth surface
85-180cc $517.00
Billing Code Product Name | Description | Size | Benefit | Benefit | Condition |
DE325 Calf Implants | Symmetrical shape, silicone gel | 12-140cc | $517.00 | | |
Precise Medical Supplies
PR007 ContourFlex Calf Implant Calf implant 70-170cc $517.00
7.5.1.2 - Gluteal
Device Technologies Australia Pty Ltd
DE327 | Gluteal Implants filled with Gel | Oval Shape, Silicone Gel, Textured Surface | 200-400cc | $620.00 |
DE328 | Gluteal Implants filled with Gel | Round Shape, Silicone Gel, Smooth Surface | 200-300cc | $620.00 |
PR008 | Precise Medical Supplies ContourFlex Gluteal Implant | Gluteal Implant | 280-460cc, Round and Anatomical | $620.00 |
7.5.1.3 - Pectoral
Precise Medical Supplies
PR009 PowerFlex Pectoralis Implant Pectoralis Implant Length: 14.2-17.6cm, Width: 9.0-13.5cm, Depth: 1.6-3.2cm,Shape: Symetrical or Asymetrical.
$950.00
7.5.2 - Tissue Expanders
7.5.2.1 - Skin or Mammary
Device Technologies Australia Pty Ltd
DE336 | Silimed Tissue Expander | various shapes, textured, magnetic port | 150ml-1000ml | $670.00 |
| J T Medical Pty Ltd | | | |
JT005 | Polytech Smooth Tissue Expander with integrated or remote magnetic valve | Smooth with integrated or remote valve | The tissue expanders vary in maximum volume from 100 - 960mls | $670.00 |
Johnson & Johnson Medical Pty Ltd
MN001 Mentor Radovan Tissue Expander Tissue Expander Volume 25cc - 1000cc $670.00
Surgiplas Medical
SP010 Nagor Tissue Expander Two Stage, Valved 10 to 2000cc $670.00
Expander Implant
Allergan Australia Pty Limited
AW012 Natrelle® 150, 1-Stage BioDimensional™ Tissue Expander
Full height, Short Height, textured 9.6 -16cm width x 8 - 17cm height x 4.2 -
7.1cm projection
$2,040.00
Billing Code Product Name Description Size
Expander Implant, Textured
Johnson & Johnson Medical Pty Ltd
Benefit
Benefit
Condition
MN013 Mentor Siltex Becker Expander/Mammary Implant
Multiple Chamber
Textured Becker Expander/Mammary Implant 145 to 800cc $2,040.00
Device Technologies Australia Pty Ltd
DE335 Silimed Tissue Expander Double chamber, textured, magnetic, with
suture tabs. Catalogue number: 20799
470mm-780mm $1,250.00
Self Expanding Spectrum Surgical
SO042 Osmed Tissue Expanders Self inflating, Hydrogel 0.24ml-650ml $1,250.00
Textured
Allergan Australia Pty Limited
AW013 Natrelle® 133, 2-Stage BioDimensional™ Tissue Expander
Silicone Elastomer. Saline filled. 150-950 cm3 $1,050.00
Device Technologies Australia Pty Ltd
DE337 Silimed Tissue Expander Anatomical superior-pole/inferior-pole shape,
textured, magnetic
200ml-840ml $1,050.00
Emergo Asia Pacific Pty Ltd
ER198 Aeroform Patient Controlled Tissue
Expander
J T Medical Pty Ltd
Aeroform Patient Controlled Tissue Expander; Multichamber, textured, CO2 filled
width (12.5, 14, 15.5 cm) x height (11, 12.5,
14 cm) x projection (8, 9.5, 10.5 cm); volume
400, 600 and 800 cc
$1,050.00
JT006 Polytech Textured Mammary or
Tissue Expander with integrated or remote magnetic valve
Textured with integrated or remote valve. The tissue expanders vary in maximum
volume from 100 - 960mls
$1,050.00
JT007 Polytech Textured Mammary Expander with integrated or remote magnetic valve
Textured with integrated or remote magnetic valve. Anatomically shaped with reinforced inner base
The mammary expanders vary in maximum volume from 200 - 960mls
$1,050.00
Johnson & Johnson Medical Pty Ltd
MN002 Mentor Siltex Contour Profile Breast Tissue Expander
Siltex Contour Tissue Expander Volume 250cc - 850cc $1,050.00
MN042 Mentor Siltex Contour Breast Tissue Expander
Siltex Contour Tissue Expander with suture tab (CPX3)
250-850cc $1,050.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
MN176 | Mentor Siltex Contour Profile Breast Tissue Expander | Siltex Contour Profile Breast Tissue Expander (CPX4) | 250-850cc | $1,050.00 | | |
MN177 | Mentor Siltex Contour Profile Breast Tissue Expander | Siltex Contour Profile Breast Tissue Expander (CPX4) with suture tabs | 250-850cc | $1,050.00 | | |
Textured, Multiple Chamber SPIRAN PTY. LTD.
S2008 PMT Integra tissue expander Tissue/skin Expander 5cc to 1400cc $1,250.00
7.5.2.2 - Orbital
Self Expanding
Spectrum Surgical
SO041 | Osmed Sphere / Hemisphere tissue expander | Self inflating, Hydrogel | 6mm, 8mm, 9mm, 10mm | $865.00 | The provision of the prosthesis is for a child who is under 18 years of age. |
| | | | | See rule 5B for effect of Condition. |
7.5.2.3 - External Component
Patient Controller
Emergo Asia Pacific Pty Ltd
ER199 AeroForm Tissue Expander System Dosage Controller
7.5.3 - Skin, Artificial
7.5.3.1 - <50cm²
Integra Neurosciences Pty Ltd
IG034 Integra Artificial Skin (IDRT) Terminally Sterile
AeroForm Tissue Expander System Dosage Controller
INTEGRA Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross- linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.
N/A $1,400.00
5cm x 5cm $900.00
Billing Code Product Name Description Size
7.5.3.2 - 50-149cm²
Benefit
Benefit
Condition
Integra Neurosciences Pty Ltd
IG035 Integra Artificial Skin (IDRT) Terminally Sterile
7.5.3.3 - 150-400cm²
Integra Neurosciences Pty Ltd
IG036 Integra Artificial Skin (IDRT) Terminally Sterile
7.5.3.4 - >400cm²
Integra Neurosciences Pty Ltd
IG037 Integra Artificial Skin (IDRT) Terminally Sterile
7.5.4 - Coupler
INTEGRA Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross- linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.
INTEGRA Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross- linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.
INTEGRA Dermal Regeneration Template is a bilayer membrane system for skin replacement made of a porous matrix of fibers of cross- linked bovine tendon collagen and glycosaminoglycan and polysiloxane layer.
10cm x 12.5cm $1,140.00
10cm x 25cm $1,740.00
20cm x 25cm $3,380.00
LMT Surgical Pty Ltd
LM030 Synovis Coupler High Density polyethylene (ring); Stainless Steel (pins)
Diameter 1-3mm $625.00
with Doppler probe
LMT Surgical Pty Ltd
LM274 FlowCOUPLER High Density polyethylene (ring); Stainless Steel (pins) with preattached probe
2.0mm, 2.5mm, 3.0mm, 3.5mm, 4.0mm $1,015.00
Billing Code Product Name Description Size
7.6.1 - Saline Filled
7.6.1.1 - <500cc
Textured
Johnson & Johnson Medical Pty Ltd
Benefit
Benefit
Condition
MN053 Mentor Siltex Round Saline Implant Textured, round implant <500cc $685.00
Valved
Johnson & Johnson Medical Pty Ltd
MN045 Mentor Spectrum Saline Tissue
Expander/Adjustable Implant
Smooth, round adjustable implant with posterior spectrum valve
<500cc $715.00
MN118 Mentor Smooth Round Saline Implant Smooth Round implant with Anterior
Diaphragm Valve
<500cc $715.00
Surgiplas Medical
SP011 Nagosil SFS-LP-Saline Filled Low
Profile Smooth Surface Breast Prostheses, Nagosil SFS-HP-Saline Filled High Profile Smooth Surface Breast Prostheses
Valved, Textured
Smooth surface 100 to 600cc $715.00
Johnson & Johnson Medical Pty Ltd
MN049 Mentor Spectrum Saline Tissue
Expander/Adjustable Implant
Surgiplas Medical
Textured, round adjustable implant with posterior spectrum valve
105 to 475cc $715.00
SP012 Nagotex SFX-LP-Saline Filled Low
Profile Textured Surface, Nagotex SFX-HP-Saline Filled High Profile Textured Surface Breast Prostheseses
Valved, Textured, Pre-shaped
Textured surface 100 to 600cc $715.00
Johnson & Johnson Medical Pty Ltd
MN047 Mentor Spectrum Saline Tissue
Expander/Adjustable Implant
MN120 Mentor Siltex Contour Profile Saline Implant
Textured, Contour Profile adjustable implant with posterior spectrum valve
Textured, Contour Profile implant with Anterior Diaphragm Valve
<500cc $715.00
<500cc $715.00
Billing Code Product Name Description Size
7.6.1.2 - ≥500cc
Valved
Johnson & Johnson Medical Pty Ltd
Benefit
Benefit
Condition
MN046 Mentor Spectrum Saline Tissue
Expander/Adjustable Implant
Smooth, round adjustable implant with posterior spectrum valve
≥500cc $640.00
MN119 Mentor Smooth Round Saline Implant Smooth Round implant with Anterior
Diaphragm Valve
≥500cc $640.00
Valved, Textured, Pre-shaped
Johnson & Johnson Medical Pty Ltd
MN048 Mentor Spectrum Saline Tissue
Expander / Adjustable Implant
MN121 Mentor Siltex Contour Profile Saline Implant
7.6.2 - Gel Filled
7.6.2.1 - <500cc
Allergan Australia Pty Limited
AW008 Natrelle® INSPIRA® TruForm™
Smooth Mammary Implant
Textured, Contour Profile adjustable implant with posterior spectrum valve
Textured, Contour Profile implant with Anterior Diaphragm Valve
Round implants with smooth surface. Available in four projections: low, moderate, full and extra-full; and two cohesive gel types: TruForm™ 1 Responsive Gel and TruForm™ 2 Soft-Touch™ Gel.
≥500cc $685.00
≥500cc $685.00
110 - 800 grams $610.00
Johnson & Johnson Medical Pty Ltd
MN122 Mentor Smooth Round Gel Implant Smooth, Round, Cohesive l Gel Implant <500cc $610.00
Surgical Supplies Australia Pty Ltd
ZW002 Eurosilicone Breast Implants Round Cohesive Gel Breast Implants for Plastic
and Reconstructive Surgery
100cc to 900cc $610.00
Surgiplas Medical
SP048 Gel Filled Mammary Prosthesis
Models RGI-D, RGI-DH and RGI- DEH
Smooth Round 80 to 800ml $610.00
Billing Code Product Name Description Size
Pre-shaped
J T Medical Pty Ltd
Benefit
Benefit
Condition
JT003 Sublime Line Mammary Implant Smooth, Microthane or textured surface. Round
or oval based with anatomical or central projection.
Surgical Supplies Australia Pty Ltd
Low Profile, Moderate Profile, High Profile and Extra High Profile. Sizes 45-495cc.
$1,000.00
ZW003 Eurosilicone Breast Implants Anatomical Cohesive Gel Breast Implants for
Plastic and Reconstructrive Surgery
100cc to 500cc $1,000.00
Textured
Allergan Australia Pty Limited
AW005 Natrelle® INSPIRA® TruForm
Textured Mammary Implant
Round implants with textured surface. Available in four projections: low, moderate, full and extra-full; and two cohesive gel types: TruForm™ 1 Responsive Gel and TruForm™ 2 Soft-Touch™ Gel.
110 - 800 grams $760.00
Device Technologies Australia Pty Ltd
DE362 Silimed Textured Mammary Implant Silimed Textured Mammary Implant 40cc - 499cc $760.00
Johnson & Johnson Medical Pty Ltd
MN124 Mentor Siltex Round Gel Implant Textured, Round Cohesive l Gel implant <500cc $760.00
MN128 Mentor Perthese Sensitive Gel Breast Implants
Perthese Sensitive Textured, Round Implants <500cc $760.00
MN130 Mentor Siltex Round Gel Implant Textured, Round Cohesive Gel ll Implant <500cc $760.00
Surgical Supplies Australia Pty Ltd
ZW001 Eurosilicone Breast Implants Textured Cohesive Gel Breast Implants for
Plastic and Reconstructive Surgery
100cc to 900cc $760.00
Surgiplas Medical
SP047 Gel Filled Mammary Prosthesis
Models GFX-LP, GFX and GFX-EHP
Textured Round 80 to 800ml $760.00
SP114 Nagor Breast Implants Silicone Firm and Stable Gel Breast Implants 150 - 620cc $760.00
Textured, Pre-shaped
Device Technologies Australia Pty Ltd
DE338 Silimed Anatomical Textured
Mammary Implant
Anatomical shape, textured surface, silicone gel filled mammary implant
115cc to 600cc $1,000.00
Billing Code Product Name Description Size
Johnson & Johnson Medical Pty Ltd
Benefit
Benefit
Condition
MN126 Mentor Contour Profile Gel Implant Textured, Contour Profile, Cohesive lll, Gel
implant
<500cc $1,000.00
7.6.2.2 - ≥500cc
Johnson & Johnson Medical Pty Ltd
MN123 Mentor Smooth Round Gel Implant Smooth, Round Cohesive l Gel Implant ≥500cc $685.00
Pre-shaped
Allergan Australia Pty Limited
AW004 Natrelle® 510 TruForm™ Dual Gel
Breast Prosthesis
Anatomical textured implant with dual gel for projection of nipple/areola complex, concave base and tapered edges for minimisation of edge/thoracic wall palpability.
LX sizes from 130-575 grams, MX sizes from 145-600 grams, FX sizes from 165-630 grams
$1,200.00
AW007 Natrelle® 410 BioDIMENSIONAL™ TruForm™ 2 Soft-Touch™ Gel and
TruForm™ 3 Cohesive Gel Textured Mammary Implants.
Full, moderate or low height;
Extra full,full, moderate or low projection
125 - 775 grams $1,200.00
J T Medical Pty Ltd
JT004 Sublime Line Mammary Implant Smooth, Microthane or textured surface. Round
or oval based with anatomical or central projection
Low Profile, Moderate Profile, High Profile and Extra High Profile. Sizes 500-1035cc.
$1,200.00
Surgiplas Medical
SP049 Gel Filled Mammary Prosthesis
Models CoGel-XR, CoGel-XRH, CoGel-XL, CoGel- XM and CoGel XF
Textured
CoGel High Cohesive 100 to 790gm $1,200.00
Device Technologies Australia Pty Ltd
DE340 Silimed Polyurethane Breast Implant Polyurethane coated silicone gel breast implant 40cc to 695cc $760.00
DE363 Silimed Textured Mammary Implant Silimed Textured Mammary Implant 500cc - 695cc $760.00
Johnson & Johnson Medical Pty Ltd
MN125 Mentor Siltex Round Gel Implant Textured, Round Cohesive l Gel implant ≥500cc $760.00
MN129 Mentor Perthese Sensitive Gel Breast Implants
Perthese Sensitive Textured, Round Implants ≥500cc $760.00
MN131 Mentor Siltex Round Gel Implant Textured, Round Cohesive Gel ll Implant ≥500cc $760.00
Billing Code Product Name Description Size
Textured, Pre-shaped
Device Technologies Australia Pty Ltd
Benefit
Benefit
Condition
DE341 Silimed Anatomical Polyurethane
Breast Implant
Polyurethane coated silicone gel breast implant 115cc to 640cc $1,200.00
Johnson & Johnson Medical Pty Ltd
MN127 Mentor Contour Profile Gel Implant Textured, Contour Profile, Cohesive lll, Gel
implant
≥500cc $1,200.00
7.6.2.3 - Pectoral Implant
Device Technologies Australia Pty Ltd
DE334 Pectoral Implants Gel - Smooth surface 190cc - 300cc $950.00
7.6.2.4 - Adjustable
Johnson & Johnson Medical Pty Ltd
MN028 Mentor Spectra Adjustable Gel Breast Implants
MN029 Mentor Spectra Adjustable Gel Breast Implants
Smooth Round Spectra Adjustable Gel Implant 190cc-760cc $1,050.00
Textured Round Spectra Adjustable Gel Implant 190cc - 760cc $1,050.00
Billing Code Product Name Description Size
8.1.1 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex arrhyth
Benefit
Benefit
Condition
a
Livanova Australia Pty Limited
SA149 PARADYM VR 8250 Single Chamber implantable cardioverter
defibrillator with rate response
St Jude Medical Australia Pty Ltd
Dimensions: 58.4 x 73.4 x 11mm; Weight: 90 grams; Volume: 32.6cc
$38,376.00
SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter
defibrillator
38cc, 77g $38,376.00
a, d
Boston Scientific Australia Pty Ltd
BS208 INCEPTA VR ICD High energy single chamber ICD with DF-1 RV connector
31.5cc, 9.9mm, 72g $38,376.00
a,d
Boston Scientific Australia Pty Ltd
BS282 DYNAGEN ICD VR DF-1 Single Chamber implantable cardioverter
defibrillation, 4IJ, DF-1 RV connector
28.5cc - 31.5cc, 61.9g - 70.7g, 9.9mm $38,376.00
a,d,e
Boston Scientific Australia Pty Ltd
BS280 DYNAGEN ICD VR DF-4 Single Chamber implantable cardioverter
defibrillation, 4IJ, DF-4 RV connector
26.5cc - 29.5cc, 60g - 68.9g, 9.9mm $39,051.00
8.1.2 - Features of 8.1.1 plus auto test sensing parameters, auto captu
a, d
St Jude Medical Australia Pty Ltd
SJ296 | Ellipse VR CD1277-36 | Single chamber cardioverter defibrillator with 36J delivered energy and ST segment monitoring | 66g, 31cc | $39,528.00 |
SJ299 | Fortify Assura VR CD1259-40 | Single chamber cardioverter defribrillator with 40J delivered energy and ST segment monitoring | 76g, 35cc | $39,528.00 |
Billing Code Product Name Description Size
a, d, e
St Jude Medical Australia Pty Ltd
Benefit
Benefit
Condition
SJ309 Fortify Assura VR CD1259-40Q Single chamber cardioverter defribrillator with
40J delivered energy and ST segment monitoring and DF4 connector
SJ311 Ellipse VR CD1277-36Q Single chamber cardioverter defibrillator with
36J delivered energy and ST segment monitoring and DF4 connector
35cc, 75g $40,203.00
67g, 30cc $40,203.00
a,d
Biotronik Australia Pty Ltd
BT143 Ilesto 7 VR-T Single Chamber ICD, rate adaptive pacing, max. 40J shock energy, Home Monitoring, MRI conditional, IS-1/DF-1 connector
BT144 Ilesto 7 VR-T DX Single Chamber ICD, rate adaptive, additional atrial detection, max. 40J shock energy, Home Monitoring, MRI conditional, IS-1/DF-1 connector
W x H x D (mm) 65 x 55 x 11, Volume: 31cc, Mass: 80g
W x H x D (mm) 65 x 55 x 11, Volume: 31cc, Mass: 80g
$39,528.00
$39,528.00
Livanova Australia Pty Limited
SA157 PARADYM™ RF VR 9250 Single Chamber, High Energy, Implantable
Cardioverter Defibrillator with rate response and remote monitoring.
69.5 x 73.4 x 11mm 38.6cc 95g $39,528.00
Medtronic Australasia Pty Ltd
MI112 Evera XT VR DF1 Single Chamber Implantable Cardioverter Defibrillator with PhysionCurve Design, Optimised Battery Chemistry, SmartShock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management. DF1
MI114 Evera S VR DF1 Single Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF1
St Jude Medical Australia Pty Ltd
33cm³ 77g $39,528.00
33cm³ 77g $39,528.00
SJ326 Ellipse VR CD1377-36/CD1377-36C Single Chamber Cardioverter Defribrillator 31cc, 66g $39,528.00
SJ333 Fortify Assura VR CD1359- 40/CD1359-40C
Single Chamber Cardioverter Defibrillator with 40J delivered energy
76g , 35cc $39,528.00
Billing Code Product Name Description Size
a,d,e
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MI111 Evera XT VR DF4 Single Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management. DF4
MI113 Evera S VR DF4 Single Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF4
St Jude Medical Australia Pty Ltd
33cm³ 77g $40,203.00
33cm³ 77g $40,203.00
SJ318 Fortify Assura VR CD1359- 40Q/CD1359-40QC
Single Chamber Cardioverter Defibrillator 75g, 35cc $40,203.00
SJ332 Ellipse VR CD1377-36Q/CD1377-
36QC
Single Chamber Cardioverter Defibrillator with 36 J delivered energy
67g, 30cc $40,203.00
a,d
Biotronik Australia Pty Ltd
BT170 Itrevia 7 VR-T Single Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, DF-1, IS-1 connector
BT171 Itrevia 7 VR-T DX Single Chamber ICD, ventricular capture control, physiological rate adaption, additional atrial detection (DX),automatic event (IEGM)
& trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, DF-1, IS-1 connector
Boston Scientific Australia Pty Ltd
BS278 AUTOGEN ICD VR DF-1 Single Chamber implantable cardioverter
defibrillation, 4IJ, DF-1 RV connector
65mm x 55mm x 11 mm, 33cm3, 80grams $39,528.00
65mm x 55mm x 11mm, 33cm3, 81grams $39,528.00
28.5cc -31.5cc, 61.9g - 70.7g, 9.9mm $39,528.00
Billing Code Product Name Description Size
a,d,e
Biotronik Australia Pty Ltd
Benefit
Benefit
Condition
BT150 | Ilesto 7 VR-T DF-4 | Single Chamber ICD, rate adaptive, max. 40J shock energy, Home Monitoring, MR conditional, IS-1/DF4 connector | W x H x D (mm) 65 x 55 x 11, Volume: 31cc, Mass: 80g | $40,203.00 |
BT167 | Iperia 7 VR-T | Single Chamber ICD, ventricular capture | 65mm x 52mm x 11mm, 31cm3, 80grams | $40,203.00 |
| | control, physiological rate adaption, automatic | | |
| | event (IEGM) & trend triggered transmission. | | |
| | Wandless telemetry, Home Monitoring, MRI | | |
| | conditional, DF-4, IS-1 connector | | |
Boston Scientific Australia Pty Ltd
BS276 AUTOGEN ICD VR DF-4 Single Chamber implantable cardioverter
defibrillation, 4IJ, DF-4 RV connector
26.5cc - 29.5cc, 60.0g - 68.9g, 9.9mm $40,203.00
Livanova Australia Pty Limited
SA167 INTENSIA VR MODEL 124 INTENSIA VR MODEL 124 is a Single
Chamber ICD with 39J output, RF, Home Monitoring, DF-4 connectivity
61.9 x 73.4 x 11mm $40,203.00
Medtronic Australasia Pty Ltd
MI160 Evera MRI XT VR ICD/ Evera MRI
S VR ICD
Single chamber implantable cardioverter defibrillators with SureScan MRI Technology
33cm3 77g $40,203.00
8.1.3 - Single Chamber, Subcutaneous
Boston Scientific Australia Pty Ltd
BS297 EMBLEM S-ICD Pulse Generator Subcutaneous Implantable Cardioverter
Defibrillator
59.5cc: (W) 83.1mm x (H) 69.1mm x (D)12.7mm
$38,376.00
8.2.1 - 29-42cc, 5-7 yrs longevity, Lead perf trends, Complex arrhyth
a
Livanova Australia Pty Limited
SA147 Paradym DR 8550 Dual Chamber, High Energy, Implantable Cardioverter Defibrillator with rate response
Weight: 90 grams; Volume: 32.6cc; Dimensions: 58.4 x 73.4 x 11mm
$41,184.00
Billing Code Product Name Description Size
a, d
Boston Scientific Australia Pty Ltd
Benefit
Benefit
Condition
BS206 INCEPTA DR ICD Hight energy dual chamber ICD with DF-1 RV connector
31.5cc, 9.9mm, 72g $41,184.00
a,d
Boston Scientific Australia Pty Ltd
BS283 DYNAGEN ICD DR DF-1 Dual Chamber implantable cardioverter
defibrillation, 4IJ, DF-1 RV connector
28.5cc - 31.5cc, 62.3g - 71g, 9.9mm $41,184.00
a,d,e
Boston Scientific Australia Pty Ltd
BS281 DYNAGEN ICD DR DF-4 Dual Chamber implantable cardioverter
defibrillation, 4IJ, DF-4 RV connector
28.0cc - 31.0cc, 62.5g - 71.4g, 9.9mm $41,859.00
8.2.2 - Features of 8.2.1 plus auto test sensing parameters, auto captu
a, d
St Jude Medical Australia Pty Ltd
SJ297 | Fortify Assura DR CD2259-40 | Dual chamber cardioverter defibrillator with 40J delivered energy and ST segment monitoring | 35cc, 76g | $42,417.00 |
SJ300 | Ellipse DR CD2277-36 | Dual chamber cardioverter defibrillator with 36J delivered energy and ST segment monitoring | 66g, 31cc | $42,417.00 |
a, d, e
St Jude Medical Australia Pty Ltd
SJ310 | Fortify Assura DR CD2259-40Q | Dual Chamber cardioverter defrillator with 40J delivered energy and ST segment monitoring with DF4 connector | 35cc, 75g | $43,092.00 |
SJ313 | Ellipse DR CD2277-36Q | Dual chamber cardioverter defibrillator with 36J delivered energy and ST segment monitoring with DF4 connector | 68g, 31cc | $43,092.00 |
Billing Code Product Name Description Size
a,c,d
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MI116 | Evera XT DR IS1/DF1 | Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. DF1 | 34cm³ 78g | $42,417.00 |
MI118 | Evera S DR IS1/DF1 | Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF1 | 34cm³ 78g | $42,417.00 |
a,c,d,e
Medtronic Australasia Pty Ltd
MI115 | Evera XT DR IS1/DF4 | Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. DF4 | 34cm³ 78g | $43,092.00 |
MI117 | Evera S DR IS1/DF4 | Dual Chamber Implantable Cardioverter Defibrillator with PhysioCurve Design, Optimised Battery Chemistry, Smart Shock Technology 2.0, DF4 | 34cm³ 78g | $43,092.00 |
a,d
Biotronik Australia Pty Ltd
BT145 Ilesto 7 DR-T Dual Chamber ICD, rate adaptive, Max. 40J shock energy, Home Monitoring, MRI conditional, IS-1/DF-1 connector
W x H x D (mm) 65 x 55 x 11, Volume: 31cc, Mass: 80g
$42,417.00
Livanova Australia Pty Limited
SA156 PARADYM™ RF DR 9550 Dual Chamber Implantable Cardioverter
Defibrillator with rate response, high output extended longevity and remote monitoring.
St Jude Medical Australia Pty Ltd
69.5 x 73.4 x 11mm 38.6cc 95g $42,417.00
SJ324 Fortify Assura DR CD2359- 40/CD2359-40C
Dual Chamber Cardioverter Defibrillator
75g, 35cc $42,417.00
SJ327 Ellipse DR CD2377-36/CD2377-36C Dual Chamber ICD 66g, 31cc $42,417.00
Billing Code Product Name Description Size
a,d,e
St Jude Medical Australia Pty Ltd
Benefit
Benefit
Condition
SJ325 Fortify Assura DR CD2359- 40Q/CD2359-40QC
SJ331 Ellipse DR CD2377-36Q/CD2377-
36QC
Dual Chamber Cardioverter Defibrillator with 40J delivered energy
Dual Chamber Cardioverter Defibrillator with 36J delivered energy
75g, 35cc $43,092.00
68g, 31cc $43,092.00
a,c,d,e
Medtronic Australasia Pty Ltd
MI158 Evera MRI XT DR ICD/ Evera MRI
S DR ICD
Dual chamber implantable cardioverter defibrillator with SureScan MRI Technology
34cm3 78g $43,092.00
a,d
Biotronik Australia Pty Ltd
BT172 Itrevia 7 DR-T Dual Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, DF-1, IS-1 connector
Boston Scientific Australia Pty Ltd
BS279 AUTOGEN ICD DR DF-1 Dual Chamber implantable cardioverter
defibrillation, 4IJ, DF-1 RV connector
65mm x 55mm x 11mm, 33cm3, 81grams $42,417.00
28.5cc - 31.5cc, 62.3g - 71g, 9.9mm $42,417.00
a,d,e
Biotronik Australia Pty Ltd
BT151 | Ilesto 7 DR-T DF-4 | Dual chamber ICD, rate adaptive, max. 40J shock energy, Home Monitoring, MR conditional, IS-1/DF4 connector | W x H x D (mm) 65 x 55 x 11, Volume: 31 cc, Mass: 80g | $43,092.00 |
BT168 | Iperia 7 DR-T | Dual Chamber ICD, ventricular capture control, | 65mm x 56mm x 11mm, 32cm3, 82grams | $43,092.00 |
| | physiological rate adaption, automatic event | | |
| | (IEGM) & trend triggered transmission. | | |
| | Wandless telemetry, Home Monitoring, MRI | | |
| | conditional, DF-4, IS-1 connector | | |
Boston Scientific Australia Pty Ltd
BS277 AUTOGEN ICD DR DF-4 Dual Chamber implantable cardioverter
defibrillation, 4IJ, DF-4 RV connector
28.0cc - 31.0cc, 62.5g - 71.4g, 9.9mm $43,092.00
Billing Code Product Name Description Size
Livanova Australia Pty Limited
Benefit
Benefit
Condition
SA166 INTENSIA DR MODEL 154 INTENSIA DR MODEL 154 is a Dual
Chamber ICD with 39J output, RF, Home Monitoring, DF-4 connectivity.
68.4 x 73.4 x 11mm $43,092.00
08.03.01 - Dual Chamber, Bivent pacing, Vent tachyarrhythmia treatme
a
Livanova Australia Pty Limited
SA145 PARADYM CRT-D 8750 Implantable Cardioverter Defibrillator with
Cardiac Resynchronisation therapy, High Energy
34cc, 94 grams; 61.8 x 73.4 x 11mm $43,056.00
a, d
Boston Scientific Australia Pty Ltd
BS209 INCEPTA CRT-D High energy CRT-D with DF-1 RV connector
& lS-1 (N163) or LV-1 (N165) LV connector
32.5cc, 9.9mm, 72g $43,056.00
a, d, e
Boston Scientific Australia Pty Ltd
BS205 INCEPTA DF-4 CRT-D High energy CRT-D with DF-4 RV connector
and lS-1 LV connector
32cc, 9.9mm. 72g $43,731.00
a,d
Boston Scientific Australia Pty Ltd
BS275 DYNAGEN CRT-D DF-1 High energy CRT-D with DF-1 RV connector
& lS-1 (G156) or LV-1 (G151) LV connector.
32.0cc, 9.9mm $43,056.00
a,d,e
Boston Scientific Australia Pty Ltd
BS274 DYNAGEN CRT-D DF-4 ICD with cardiac resynchronization therapy. 32.5cc, 9.9mm $43,731.00
Billing Code Product Name Description Size
08.03.02 - Features of 8.3.1 plus auto test sensing parameters, auto captu
Benefit
Benefit
Condition
a, c, d, e
Medtronic Australasia Pty Ltd
MI070 VIVA XT CRT-D DTBA2D4 Implantable Cardioverter Defibrillator with
Cardiac Resynchronisation therapy, SmartShock Technology, OptiVol 2.0 Fluid Status Monitoring, Complete Capture Management Specifications (DF4), and AdaptivCRT
35cc, 82g $47,475.00
a, d
St Jude Medical Australia Pty Ltd
SJ281 Promote Quadra CRT CD3237-40 Cardiac Resynchronisation Therapy
Defibrillator with 40J delivered energy, VectSelect Quartet Programmable LV pulse configuration and Multisite Pacing
SJ298 Quadra Assura CD3267-40 Cardiac Resynchronisation Therapy
Defibrillator with 40J delivered and Multisite Left Ventricular Pacing and Quadripolar pacing
SJ301 Unify Assura CD3261-40 Cardiac Resynchronisation Therapy
Defribrillator with 40J delivered energy
46cc, 88g $46,800.00
40cc, 83g $46,800.00
36cc, 78g $46,800.00
a, d, e
St Jude Medical Australia Pty Ltd
SJ312 | Quadra Assura CD3267-40Q | Cardiac Resynchronisation Therapy Defribrillator with 40J delivered energy, Multisite Left Ventricular Pacing plus Quadripolar pacing and SJ4 connector | 38cc, 81g | $47,475.00 |
SJ314 | Unify Assura CD3261-40Q | Cardiac Resynchronisation Therapy Defribrillator with 40J delivered energy and SJ4 connector | 36cc, 77g | $47,475.00 |
Billing Code Product Name Description Size
a,c,d
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MI069 | VIVA XT CRT-D DTBA2D1 | Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, SmartShock Technology, OptiVol 2.0 Fluid Status Monitoring, Complete Capture Management Specifications (DF1), and AdaptivCRT | 35cc, 82g | $46,800.00 |
MI071 | VIVA S CRT-D DTBB2D1 | Implantable Cardioverter Defibrillator with Cardiac Resynchronisation therapy, SmartShock Tehnology, OptiVol 2.0 Fluid Status Monitoring and Complete Capture Management Specifications (DF1) | 35cc, 82g | $46,800.00 |
a,c,d,e
Medtronic Australasia Pty Ltd
MI072 VIVA S CRT-D DTBB2D4 Implantable Cardioverter Defibrillator with
Cardiac Resynchronisation therapy, SmartShock Tehnology, OptiVol 2.0 Fluid Status Monitoring and Complete Capture Management Specifications (DF4)
35cc, 82G $47,475.00
a,d
Biotronik Australia Pty Ltd
BT146 Ilesto 7 HF-T Triple Chamber CRT-D device, rate adaptive, max. 40J shock energy, Home Monitoring, MRI conditional, IS-1/DF-1 connector
W x H x D (mm) 65 x 58.5 x 11, Volume: 33 cc, Mass: 80g
$46,800.00
Livanova Australia Pty Limited
SA158 | PARADYM™ RF CRT-D 9750 | Implantable Cardioverter Defibrillator, for resyncronisation of heart failure, high output extended longevity and home monitoring. | 69.5 x 73.4 x 11mm 38.6cc 95g | $46,800.00 |
SA159 | PARADYM™ RF CRT-D SonR 9770 | Implantable Cardioverter Defibrillator for | 69.5 x 73.4 x 11mm 38.6cc 95g | $46,800.00 |
| | resyncronisation of heart failure, high output, | | |
| | extended longevity and home monitoring, and | | |
| | in conjunction with a dedicated atrial lead with | | |
| | SonR sensor provides automatic adjustment of | | |
| | AV/VV delays for optimisation of | | |
| | resynchronisation therapy. | | |
St Jude Medical Australia Pty Ltd
SJ319 Quadra Assura MP CD3371- 40/CD3371/40C
Cardiac Resynchronisation Therapy Cardioverter Defibrillator
83g, 40cc $46,800.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
SJ320 | Unify Assura CD3361-40/CD3361- 40C | Cardiac Resynchronisation Therapy Cardioverter Defibrillator | 78g, 36cc | $46,800.00 | | |
SJ323 | Quadra Assura CD3367-40/CD3367- 40C | Cardiac Resynchronisation Therapy Defibrillator with 40J delivered energy | 83g, 40cc | $46,800.00 | | |
a,d,e
Medtronic Australasia Pty Ltd
MI109 VIVA QUAD XT CRT-D IS4/DF4 ICD with CRT. PhysioCurve Design,
AdaptivCRT Algorithm, CardioSync Optimisation, VextorExpress, LV Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. IS4 DF4
MI110 VIVA QUAD S CRT-D IS4/DF4 ICD with CRT. PhysioCurve Design,
CardioSync Optimisation, VectorExpress, V Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0. Complete Capture management. IS4 DF4
St Jude Medical Australia Pty Ltd
SJ282 Promote Quadra CD3237-40Q Cardiac Resynchronisation Therapy
Defibrillator with 40J delivered energy and VectSelect Quartet Programmable LV pulse configuration plus Multisite Left Ventricular Pacing and SJ4 connector.
35cm³ 81g $47,475.00
35cm³ 81g $47,475.00
44cc, 87g $47,475.00
SJ321 Quadra Assura MP CD3371- 40Q/CD3371-40QC
SJ329 Unify Assura CD3361-40Q/CD3361- 40QC
SJ330 Quadra Assura CD3367- 40Q/CD3367-40QC
Cardiac Resynchronisation Therapy Defibrillator
Cardiac Resynchronisation Therapy Cardioverter Defibrillator
Cardiac Resynchronisation Therapy Defibrillator with 40J delivered energy
80gm, 38cc $47,475.00
77g, 36cc $47,475.00
80g, 38cc $47,475.00
a,d
Biotronik Australia Pty Ltd
BT173 Itrevia 7 HF-T Triple Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, DF-1, IS-1 connector
65mm x 58.5mm x 11mm, 34cm3, 83grams $52,000.00
Billing Code Product Name Description Size
Boston Scientific Australia Pty Ltd
Benefit
Benefit
Condition
BS286 AUTOGEN CRT-D DF-1 High energy CRT-D with DF-1 RV connector
& lS-1 (G173) or LV-1 (G175) LV connector. PaceSafe RV, RA, and LV auto threshold.
32.0cc, 72.8g, 9.9mm $46,800.00
BS287 AUTOGEN X4 CRT-D DF-1 High energy CRT-D with DF-1 RV connector
& lS4 LV connector
32.0cc, 73.4g, 9.9mm $46,800.00
Medtronic Australasia Pty Ltd
MI130 | VIVA QUAD XT CRT-D IS4/DF1 | ICD with CRT. PhysioCurve Design, Adaptiv CRT Algorithm, CardioSync Optimisation, VectorExpress, LV Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0, Optivol 2.0 Fluid Status Monitoring, Complete Capture Management and Atrial Therapies. IS4 DF1 | 35cm³ 81g | $46,800.00 |
MI131 | VIVA QUAD S CRT-D IS4/DF1 | ICD with CRT. PhysioCurve Design, CardioSync Optimisation, VectorExpress, LV Automated Test, Optimised Battery Chemistry, Smart Shock Technology 2.0. Complete capture management. IS4 DF1 | 35cm³ 81g | $46,800.00 |
a,d,e
Biotronik Australia Pty Ltd
BT152 | Ilesto 7 HF-T DF-4 | Triple Chamber CRT-D device, rate adaptive, max. 40J shock energy, Home Monitoring, MR conditional, lS-1/DF4 connector. | W x H x D (mm) 65 x 56 x 11, Volume: 33 cc, Mass: 80g | $47,475.00 |
BT169 | Iperia 7 HF-T | Triple Chamber ICD, ventricular capture | 65mm x56mm x 11 mm, 33cm3, 82grams | $47,475.00 |
| | control, physiological rate adaption, automatic | | |
| | event (IEGM) & trend triggered transmission. | | |
| | Wandless telemetry, Home Monitoring, MRI | | |
| | conditional, DF-4, IS-1 connector | | |
BT177 | Inventra 7 HF-T QP | Triple Chamber ICD, ventricular capture | 65mm x 58.5mm x 12.5mm, 38cm3, 91grams | $47,475.00 |
| | control, physiological rate adaption, automatic | | |
| | event (IEGM) & trend triggered transmission. | | |
| | Wandless telemetry, Home Monitoring, MRI | | |
| | conditional, DF-4, IS-4 quadripolar connector | | |
Billing Code Product Name Description Size
Benefit
Benefit
Condition
BT184 Iperia 7 HF-T QP Triple Chamber ICD, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, DF-4,IS-1, IS-4 quadripolar connector
Boston Scientific Australia Pty Ltd
BS284 AUTOGEN CRT-D DF-4 ICD with cardiac resynchronization therapy.
PaceSafe RV, RA, and LV auto threshold.
65mm x 58.5mm x 11mm, 36cm3, 87grams $47,475.00
32.5cc, 73.6g, 9.9mm $47,475.00
BS285 AUTOGEN X4 CRT-D DF-4 ICD with cardiac resynchronization therapy. 32.5cc, 73.8g, 9.9mm $47,475.00
Livanova Australia Pty Limited
SA168 INTENSIA SonR CRT-D MODEL
184
INTENSIA SonR CRT-D MODEL 184 is a
Cardiac Resynchronisation Therapy Defibrillator, Automatic SonR optimisation, 39J output, RF, Home Monitoring, DF-4 connectivity
68.4 x 73.4 x 11mm $47,475.00
SA169 INTENSIA CRT-D MODEL 174 INTENSIA CRT-D MODEL 174 is a Cardiac
Resynchronisation Therapy Defibrillator, Automatic SonR optimisation, 39J output, RF, Home Monitoring, DF-4 connectivity
8.4.2 - SSIR pacemakers with rate responsive feature
St Jude Medical Australia Pty Ltd
68.4 x 73.4 x 11mm $47,475.00
SJ076 Verity Adx Model XL SR 5157 M/S implantable pacemaker
Single Chamber multi-programmable rate- adaptive pacing devices with extended longevity
11cc, 23g $5,335.00
8.4.3 - SSIR with small/compact size, multi-programmability & longe
Livanova Australia Pty Limited
SA142 | Reply™ SR | Single chamber permenent pacemaker with rate response modulation | 37 x 41.5 x 6.1mm 19 Grams 7.5 cm3 | $5,335.00 |
SA143 | ESPRIT SR | Single Chamber Permanent Pacemaker with Rate Response Modulation | Dimensions: 37.4 x 41.5 x 6.1mm Weight : 19grams. Volume: 7.5 cm3 | $5,335.00 |
Medtronic Australasia Pty Ltd |
MC728 | | Adapta Pacemaker | SR PacemakerModels ADSR01, ADSR06, ADSR03 | 9.7 - 11.0cc21.5 - 22.5g | $5,335.00 |
St Jude Medical Australia Pty Ltd |
SJ105 | | Zephyr SR 5620 | Single Chamber Rate-Responsive Pacemaker | 8cc, 17g | $5,335.00 |
SJ131 | | Zephyr XL SR 5626 | Single-Chamber Rate-Responsive Pacemaker | 23.5g and 10.4cc | $5,335.00 |
SJ205 | | Accent SR PM 1110 | Single Chamber Rate Responsive Pacemaker | 18g, 9.5cc | $5,335.00 |
SJ255 | | Accent ST PM1122 | Single Chamber Pacemaker with ST segment monitoring | 21g, 9.5cc | $5,335.00 |
SJ294 | | Accent MRI SR PM1124 | Single Chamber Pacemaker with MRI testing capability | 23g, 13.1cc | $5,335.00 |
| f | | | | |
St Jude Medical Australia Pty Ltd |
SJ027 | | St Jude Medical Microny II SR+ Model 2525T Pacemaker | Single Chamber Rate Responsive Pacemaker | Volume 5.9cc, Weight 12.8gm | $5,335.00 |
| i | | | | |
| | Biotronik Australia Pty Ltd | | | |
BT108 | | Entovis SR-T | Fully automatic, single chamber pacemaker with Closed Loop Stimulation, Home Monitoring and extended longevity | Size: 53mm x 39mm x 6.5mm (W x H x D), Volume: 11cc, Mass: 24g | $5,335.00 |
BT110 | | Evia SR-T | Fully automatic, single chamber pacemaker with Closed Loop Stimulation, Home Monitoring and extended longevity | Size: 53mm x 39mm x 6.5mm (W x H x D), Volume: 11cc, Mass: 24g | $5,335.00 |
Boston Scientific Australia Pty Ltd |
BS236 | | INGENIO MRI SR | Single Chamber Pacemaker, MRI Compatible | 11.5cc $5,335.00 |
St Jude Medical Australia Pty Ltd |
SJ200 | | Accent SR RF PM1210 | Single Chamber Pacemaker with RF telemetry | 23g, 12.8cc | $5,335.00 |
SJ257 | | Accent ST RF PM1222 | Single Chamber Pacemaker with ST Segment Monitoring and RF Telemetry | 12.8g, 23g | $5,335.00 |
SJ259 | | Accent MRI SR RF PM1224 | Single Chamber Pacemaker with RF Telemetry and MRI testing capability | 23g, 13.1cc | $5,335.00 |
Livanova Australia Pty Limited
SA161 REPLY 200™ SR REPLY 200™ SR is a Single Chamber rate- responsive pacemaker.
SA172 KORA 100 SR KORA 100 SR is a Single Chamber MRI conditional rate-responsive pacemaker.
Medtronic Australasia Pty Ltd
Dimensions 37.4 x 41.5 x 6.1mm, Weight 19g, Volume 7.5cm3. Connector IS-1, Sensors Minute Ventilation (MV) and Accelerometer (G).
Dimensions 37.4 x 41.5 x 6.1mm, Weight 19g. Volume 7.5cm3. Connector IS-1. Sensors Minute Ventilation (MV) and Accelerometer (G).
$5,335.00
$5,335.00
MI161 Advisa SR MRI SureScan pacemaker A3SR01
Single chamber pacemaker with SureScan MRI Technology
11.9cm3 21g $5,335.00
St Jude Medical Australia Pty Ltd
SJ335 Endurity PM1160 Single Chamber Rate Responsive Pacemaker 10.5cc, 19g $5,335.00
SJ367 Endurity PM1162 MR Conditional Single Chamber Pacing System 19g , 9.7cc $5,335.00
i
Biotronik Australia Pty Ltd
BT180 Eluna 8 SR-T Single Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, IS-1 connector
BT182 Etrinsa 8 SR-T Single Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, IS-1 connector
Boston Scientific Australia Pty Ltd
53 x 39 x 6.5 mm, 11cm3 , 24grams $5,335.00
53 x 39 x 6.5 mm, 11cm3, 24grams $5,335.00
BS271 VITALIO MRI SR Single Chamber Pacemaker, MRI Compatible 11.5cc $5,335.00
St Jude Medical Australia Pty Ltd
SJ334 Assurity PM1240 Single Chamber Rate-Responsive Pacemaker with RF Telemetry
SJ340 Assurity+ PM1260 Single Chamber Rate-Responsive Pacemaker with RF Telemetry
10.4cc, 20g $5,335.00
10.4cc. 20g $5,335.00
SJ363 | Assurity MRI PM1272 | MRI Conditional RF Single Chamber Rate | 10.4cc, 20g | $5,335.00 |
| | Responsive Pacemaker | | |
SJ365 | Endurity MRI PM1172 | MR Conditional Single Chamber Pacing System | 9.7cc, 19g | $5,335.00 |
8.5.2 - DDDR/VDDR including rate responsive feature
Medtronic Australasia Pty Ltd
MC713 Adapta Pacemaker VDDR PacemakerModels ADVDD01 11.1cc23.6g $6,084.00
8.5.3 - DDDR with four or more advanced features
Boston Scientific Australia Pty Ltd
BS151 Altrua 60 DR Dual chamber rate responsive pacemaker 10cc - 15cc $8,424.00
Livanova Australia Pty Limited
SA141 Reply™ DR Dual Chamber permanent Pacemaker with Rate Response Modulation
SA144 ESPRIT DR Dual Chamber Permanent Pacemaker with Rate Response Modulation
St Jude Medical Australia Pty Ltd
8cc, Weight: 20grams, Dimensions:41.2 x
41.5 x 6.1mm
8cc, Weight: 20grams, Dimensions:41.2 x
41.5 x 6.1mm
$8,424.00
$8,424.00
SJ051 Verity ADX XL DR 5357 M/S Dual - Chamber, multi-programmable, rate-
responsive pacemaker withAF suppression
45x52x6mm,11cc, 23g, 5mm or 6mm M/S $8,424.00
i
Boston Scientific Australia Pty Ltd
BS234 INGENIO MRI EL DR Dual Chamber Pacemaker, Extended Life, MRI
Compatible
14cc $10,296.00
BS235 INGENIO MRI DR Dual Chamber Pacemaker, MRI Compatible 12cc $10,296.00
Livanova Australia Pty Limited
SA160 REPLY™ 200 DR REPLY™ 200 DR is a DDDR-type dual chamber rate-responsive pacemaker. It is equipped with a physiological sensor (minute ventilation) and an accelerometer to allow adaption of pacing to suit the patients activity.
Dimensions 41.2 x 41.5 x 6.1mm, Weight 20g, Volume 8cm3.
$8,424.00
Billing Code Product Name Description Size
08.05.04 - DDDR with continuous threshold monitoring in atrium + vent
Benefit
Benefit
Condition
MC726 | | Medtronic Australasia Pty Ltd Adapta Pacemaker | DR PacemakerModels ADDR01, ADDRS1, | 11.1-14.2cc23.6g-31.3g | $10,296.00 |
| | | ADDRL1, ADDR06, ADDR03 | | |
St Jude Medical Australia Pty Ltd |
SJ103 | | Zephyr XL DR 5826 and DR 5820 | Dual Chamber Rate-Responsive Pacemaker | 5826 - 23.5g, 11cc and 5820 - 18g, 8.5cc | $10,296.00 |
SJ193 | | Accent DR PM 2112 | Dual Chamber Pacemaker | 19g, 10.5cc | $10,296.00 |
SJ256 | | Accent ST PM2122 | Dual Chamber Pacemaker with ST segment monitoring | 10.5cc, 19g | $10,296.00 |
SJ295 | | Accent MRI DR PM2124 | Dual Chamber Pacemaker with MRI testing capability | 24g, 13.1cc | $10,296.00 |
| g | | | | |
| | Medtronic Australasia Pty Ltd | | | |
MC933 | | Advisa DR MRI SureScan | Model A3DR01 Digital dual chamber pacemaker with SureScan Technology (OAE- DDDR) MR Conditional with MVP Mode, Complete Capture Management Diagnostic (ACM, RVCM), AT/AF Suite Diagnostics and Therapies, OptiVol Fluid Status Monitoring, and Therapy Guide Fea | 13cc, 22g | $10,602.00 |
MC934 | | Advisa DR | Model A5DR01 Digital dual chamber pacemaker (OAE-DDDR) MVP mode with Complete Capture Management Diagnostic (ACM, RVCM) AT/AF Suite Diagnostics and Therapies, OptiVol Fluid Status Monitoring, and Therapy Guide Feature | 13cc, 22g | $10,602.00 |
| i | | | | |
| | Biotronik Australia Pty Ltd | | | |
BT114 | | Evia DR-T | Fully automatic, dual chamber pacemaker with Closed Loop Stimulation, Home Monitoring, Vp suppression and extended longevity | Size: 53mm x 43mm x 6.5mm (W x H x D), Volume: 11cc, Mass: 26g | $10,296.00 |
BT115 | | Entovis DR-T | Fully automatic, dual chamber pacemaker with Closed Loop Stimulation, Home Monitoring, Vp suppression and extended longevity | Size: 53mm x 43mm x 6.5mm (W x H x D), Volume: 11cc, Mass: 26g | $10,296.00 |
Billing Code Product Name Description Size
St Jude Medical Australia Pty Ltd
Benefit
Benefit
Condition
SJ196 Accent DR RF PM2212 Dual chamber Pacemaker with RF telemetry 236, 12.8cc $10,296.00
SJ254 Accent ST RF PM2222 Dual Chamber Pacemeker with ST Segment
Monitoring and RF Telemetry
SJ258 Accent MRI DR RF PM2224 Dual Chamber Pacemaker with RF Telemetry
and MRI testing capability
23g, 12.9cc $10,296.00
24g, 13.1cc $10,296.00
Livanova Australia Pty Limited
SA171 KORA 100 DR KORA 100 DR is a Dual Chamber MRI conditional, Rate Responsive Pacemaker
St Jude Medical Australia Pty Ltd
41.2 x 41.5 x 6.1mm $10,296.00
SJ336 Endurity PM2160 Dual Chamber Rate Responsive Pacemaker 10.4cc, 19g $10,296.00
SJ368 Endurity PM2162 Dual Chamber MR Conditional Rate Responsive Pacemaker
20g,10.4cc $10,296.00
i
Biotronik Australia Pty Ltd
BT181 Eluna 8 DR-T Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, IS-1 connector
BT183 Etrinsa 8 DR-T Dual Chamber Pacemaker, ventricular capture control, physiological rate adaption, automatic event (IEGM) & trend triggered transmission. Wandless telemetry, Home Monitoring, MRI conditional, IS-1 connector
Boston Scientific Australia Pty Ltd
53 x 44.5 x 6.5 mm, 12cm3, 25grams $10,296.00
53 x 44.5 x 6.5 mm, 12cm3, 25grams $10,296.00
BS268 FORMIO MRI DR Dual Chamber Pacemaker, MRI Compatible 12cc $10,296.00
BS269 VITALIO MRI EL DR Dual Chamber Pacemaker, extended life MRI
Compatible
St Jude Medical Australia Pty Ltd
SJ339 Assurity PM2240 Dual Chamber Rate Responsive Pacemaker with RF Telemetry
SJ341 Assurity+ PM2260 Dual Chamber Rate Responsive Pacemaker with RF Telemetry
14cc $10,296.00
10.4cc, 20g $10,296.00
10.4cc, 20g $10,296.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
SJ364 | Assurity MRI PM2272 | MR Conditional RF Dual Chamber Rate Responsive Pacemaker | 10.4cc, 20g | $10,296.00 | | |
SJ366 | Endurity MRI PM2172 | Dual Chamber MR Conditional Rate Responsive Pacemaker | 10.4cc, 20g | $10,296.00 | | |
08.06.02 - Features of 8.6.1 plus continuous threshold monitoring in atriu
St Jude Medical Australia Pty Ltd
SJ194 Anthem PM3112 CRT Pacemaker Cardiac Resynchronisation Therapy Pacemaker 21g, 11.5cc $12,168.00
g
Medtronic Australasia Pty Ltd
MI012 Consulta CRT-P Cardiac Resynchronisation Therapy Pacemaker, Model C3TR01
One size only $12,168.00
i
Biotronik Australia Pty Ltd
BT147 Evia HF-T MRI conditional Multiprogrammable biventricular pacemaker with Home Monitoring
St Jude Medical Australia Pty Ltd
53mm x 49mm x 6.5mm (W x H x D), Volume: 14cm3 Mass: 26 grams
$12,168.00
SJ207 Anthem RF PM3212 CRT Pacemaker with RF telemetry 25g, 13.7cc $12,168.00
g
Medtronic Australasia Pty Ltd
MI159 Viva CRT-P Fully automatic digital pacemaker with CRT, atrial therapy and aCRT
15cm3 26g $12,168.00
i
Boston Scientific Australia Pty Ltd
BS262 INLIVEN IS-1 Cardiac Resynchronization therapy pacemaker 15cc $12,168.00
BS263 INLIVEN LV-1 Cardiac Resynchronization therapy pacemaker 15cc $12,168.00
St Jude Medical Australia Pty Ltd
SJ337 Allure RF PM3222 CRT Rate Responsive Pacemaker with RF Telemetry
SJ338 Allure Quadra RF PM3242 CRT Quadripolar, Rate Responsive Pacemaker
with RF Telemetry
14cc, 24g $12,168.00
15cc, 27g $12,168.00
Billing Code Product Name | Description | Size | Benefit | Benefit | Condition |
SJ353 Quadra Allure MP RF PM 3262 | Quadra Allure MP RF Biventricular Pacemaker | 27g, 15cc | $12,168.00 | |
8.7.1 - Coronary Sinus
Medtronic Australasia Pty Ltd
MC026 Medtronic Transvene SVC Lead
Model 6937;
8.7.2 - Subcutaneous
Model 6937-35, Model 6937-52, Model 6937-
58, Model 6937-110; Silicone;
35 - 110cm x 660mm $2,106.00
Guidant Australia Pty Ltd
GU123 Endotak SQ Array XP Lead Model
0085
Medtronic Australasia Pty Ltd
MC251 Implantable Subcutaneous
Defibrillator Lead Model 6996SQ 41cm, 58cm, 85cm
Sub-Q Array for high DFT 70cm $4,212.00
Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,212.00
8.7.5 - Transvenous/Steroid/Passive
Biotronik Australia Pty Ltd
BT119 Linox SMART TD Dual-shock coil ICD lead with passive fixation and hydrophilic coating on lead body.
BT149 Linox Smart T Single-shock coil ICD lead with passive fixation, and SilGlide technology
Lengths: 65, 75 cm, Diameter: 7.8Fr $8,100.00
65 cm length $8,100.00
Guidant Australia Pty Ltd
GU115 Endotak Reliance Lead Passive Dual Coil 59cm, 64cm, 90cm $8,100.00
GU158 Endotak Reliance SG Passive Passive Single Coil wih GORE ePTFE covered
coils
GU159 Endotak Reliance G Passive Passive Dual Coil with GORE ePTFE covered
coils
54cm - 90cm $8,100.00
54cm - 90cm $8,100.00
Billing Code Product Name Description Size
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MC002 Medtronic Sprint Quattro Lead
Model 6944RV/SVC 65cm; Model 6944RV/SVC 75cm; or Model 6944RV/SVC 100cm; Medtronic Sprint Quattro Lead Model 6944RV/SVC 58cm
Silicone and polyurethane 65-100cm $8,100.00
St Jude Medical Australia Pty Ltd
SJ158 Durata 7170, 7171 Passive fixation, true bipolar, dual coil, steroid eluting, endocardial defibrillation leads with Optium insulation overlay
60, 65 and 70cm $8,100.00
e
Boston Scientific Australia Pty Ltd
BS170 Endotak Reliance S 4-SITE Passive fixation single coil defibrillation leads
& 4-SITE connector.
BS180 Endotak Reliance G 4-SITE Passive fixation dual coil defibrillation leads
with ePTFE covered coils & 4-SITE connector
BS181 Endotak Reliance SG 4-SITE Passive fixation single coil defibrillation leads
with ePTFE covered coil & 4-SITE connector
BS183 Endotak Reliance 4-SITE Passive fixation dual coil defibrillation leads
with 4-SITE connector
St Jude Medical Australia Pty Ltd
SJ245 Durata 7170Q, 7171Q and 7172Q 7170Q/7171Q - passive fixation, bipolar, dual
coil, 7172Q - passive fixation, bipolar - single coil steroid eluting endocardial defibrillation leads with Optim insulation overlay and SJ4 quadripolar lead connector
50-70cm $8,100.00
50-70cm $8,100.00
50-70 $8,100.00
50-70cm $8,100.00
52, 58 and 65cm, 7F introducer $8,100.00
Biotronik Australia Pty Ltd
BT154 Volta 1 CT Singe-shock coil ICD lead with passive fixation, and SilGlide technology
St Jude Medical Australia Pty Ltd
65cm length $8,100.00
SJ345 Optisure ICD Lead LDP 220/230 Passive fixation ICD lead with DF-1 connector 60cm-75cm $8,100.00
Billing Code Product Name Description Size
e
Benefit
Benefit
Condition
Biotronik Australia Pty Ltd
BT176 Protego T & TD T - Quadripolar Single Coil ICD lead with passive fixation, fractal/steroid coating, Silglide and DF4 connector
TD - Quadripolar Dual Coil ICD lead with passive fixation, fractal/steroid coating, Silglide and DF4 connector
Boston Scientific Australia Pty Ltd
T - Length: 65cm, Electrode spacing 15mm, 7.8F
TD - Length: 65cm, 75cm; Electrode spacing 16mm & 65cm, 18mm @ 65cm & 75cm, 7.8 F
$8,100.00
BS261 RELIANCE 4-FRONT Passive, single/dual coil, defibrillation lead Length: 59cm - 70cm $8,100.00
St Jude Medical Australia Pty Ltd
SJ346 Optisure ICD Lead LDP210Q/220Q/230Q
Passive fixation ICD lead with DF-4 connector. 52cm-65cm $8,100.00
8.7.6 - Transvenous/Steroid/Active
Biotronik Australia Pty Ltd
BT120 Linox SMART SD Dual-shock coil ICD lead with active fixation helix and hydrophilic coating on lead body.
Lengths: 60, 65, 75 cm, Diameter: 7.8Fr $8,100.00
BT125 Linox SMART SD X LinoxSmart S DX pentapolar, single-coil ICD
lead with floating atrial dipole. Permanent, transvenous implantation in the right ventricle.
Length: 65cm. Distance of dipole from tip: Linox Smart SD X 65/15: 15 (cm), Linox Smart SD X 65/17: 17 (CM)
$8,100.00
BT148 Linox Smart S Single shock coil ICD lead with active fixation, fractal coating and steroid elution. Coated in SilGlide silicone based coating for improved gliding
Lengths; 60, 65, 75 cm $8,100.00
Guidant Australia Pty Ltd
GU163 ENDOTAK RELIANCE G Active Active Dual Coil with GORE ePTFE covered
coils
GU164 ENDOTAK RELIANCE SG Active Active Single coil with GORE ePTFE covered
coils
59-90cm $8,100.00
59-90cm $8,100.00
Medtronic Australasia Pty Ltd
MC208 Medtronic Sprint Quattro Secure
Lead Model 6947 58cm; Model 6947 65cm; Model 6947 75cm; Model 6947 100cm
Leads, Defibrillator, Implantable, Silicone, polyurethane, platinized tantalum coils, steroid eluting tip
58-100cm $8,100.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
MC834 Sprint Quattro Secure S Model 6935, Active Fixation Single Coil
Defibrillation Lead
St Jude Medical Australia Pty Ltd
SJ157 Durata 7120, 7121, 7122, 7130, 7131 Active fixation bipolar, dual-coil/single coil
Steroid-eluting Endocardial Defibrillation Leads
52 - 100cm $8,100.00
60, 65, 75cm $8,100.00
e
Boston Scientific Australia Pty Ltd
BS174 Endotak Reliance SG 4-SITE Active fixation single coil defibrillation leads
with ePTFE covered coil & 4-SITE connector.
BS178 Endotak Reliance 4-SITE Active fixation dual coil defibrillation leads
with 4-SITE connector
BS179 Endotak Reliance S 4-SITE Active fixation single coil defibrillation leads &
4-SITE connector
BS182 Endotak Reliance G 4-SITE Active fixation dual coil defibrillation leads
with ePTFE covered coils & 4-SITE connector.
St Jude Medical Australia Pty Ltd
SJ230 Durata 7120Q, 7121Q and 7122Q 7120/1Q - Adtive fixation, true bipolar;
7122Q - Active fixation true bipolar - single coil steroid eluting endocardial defibrillation leads with Optim insulation overlay and SJ4 quadripolar lead connector.
50-70cm $8,100.00
50-70cm $8,100.00
50-70mm $8,100.00
50-70cm $8,100.00
52cm, 58cm and 65cm $8,100.00
Biotronik Australia Pty Ltd
BT155 VOLTA 2 CR Fractal coated and steroid electrode, active fixation quadrapolar
60, 65, 75cm length, 16, 18mm electrode spacing
$8,100.00
BT157 Volta 1CR Single shock coil ICD lead with active fixation, fractal coating and steroid elution. Coated in SilGlide silicone based coating for improved gliding
BT158 Volta 2 CT Fractal coated and steriod electrode, active fixation, quadrapolar
BT159 Linox Smart ProMRI SD Dual-shock coil ICD lead with active fixation
helix and hydrophilic coating on lead body. MRI conditional use
Lengths: 60, 65 and 75 cm $8,100.00
Lengths: 65, 75 cm, Diameter: 7.8Fr $8,100.00 LENGTHS: 65, 75CM; Diameter: 7.8Fr $8,100.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
BT160 | Linox Smart ProMRI S | Single shock coil ICD lead with active fixation, | Lengths: 65cm, 75cm | $8,100.00 | | |
| | fractal coating and steroid elution. Coated in | | | | |
| | SilGlide coating for improved gliding. MRI | | | | |
| | condional use | | | | |
BT161 | Linox Smart ProMRI S DX | Pentapolar, single-coil ICD lead with floating | Length: 65cm. Distance of dipole from tip: | $8,100.00 | | |
| | atrial dipole. Permanent, transvenous | 15cm or 17cm | | | |
| | implantation in the right ventricle. MRI | | | | |
| | conditional use | | | | |
St Jude Medical Australia Pty Ltd
SJ343 Optisure ICD Lead - LDA210/220/230
Active fixation ICD lead with DF-1 connector 60cm-75cm $8,100.00
e
Biotronik Australia Pty Ltd
BT165 Protego ProMRI SD Dual-shock coil ICD lead with active fixation helix and DF4 connector, MRI conditional
BT166 Protego SD Dual-shock coil ICD lead with active fixation helix and DF4 connector
Length: 65, 75cm; 16mm, 18mm electrode spacing
Length: 61cm, 65cm, 75cm; 16mm, 18mm electrode spacing
$8,100.00
$8,100.00
BT175 Protego S Tripolar ICD lead with active fixation Length: 61cm, 65cm, 75cm $8,100.00
Boston Scientific Australia Pty Ltd
BS260 RELIANCE 4-FRONT Active, Single/Dual coil, defibrillation lead Length: 59cm -70cm $8,100.00
Medtronic Australasia Pty Ltd
MI033 | Sprint Quattro Secure 6947M Lead | Active fixation, true bipolar, dual coil defibrillation leads with silicone backfill and DF-4 connector | 45-110cm | $8,100.00 |
MI108 | Sprint Quattro Secure S DF4 | Dexamethasone acetate and dexamethasone sodium phosphate steroid-eluting, tripolar, screw-in, ventricular lead with RV defibrillation coil electrode | 49 - 97 cm | $8,100.00 |
St Jude Medical Australia Pty Ltd
SJ344 Optisure ICD Lead LDA210Q/220Q/230Q
Active fixation ICD lead with DF-4 connector 52cm-65cm $8,100.00
Billing Code Product Name Description Size
8.7.7 - Epicardial Patches
Benefit
Benefit
Condition
Medtronic Australasia Pty Ltd
MC027 Model 6721 Unipolar Epicardial Patch Leads S/M/L
Model 6721S-50, Model 6721M-50, Model 6721L-50; Silicone
370, 660, 840mm $2,106.00
8.8.1 - Non-transvenous, Bi-Polar, Steroid
Boston Scientific Australia Pty Ltd
BS153 Myopore Bipolar sutureless myocardial pacing lead 25-54cm $1,544.00
Medtronic Australasia Pty Ltd
MC011 Capsure EPI steroid eluting bipolar
epicardial lead Model 4968 - ventricle
Silicone 25 - 60cm $1,544.00
St Jude Medical Australia Pty Ltd
SJ132 Myodex 1084T Steroid-Eluting Bipolar Sutureless Myocardial Pacing Lead with Titanium Nitride Electrodes
35cm and 54cm $1,544.00
SJ140 Myodex 1084T and FasTac Flex Lead Implant Tool
Steroid -Eluting Bipolar Sutureless Myocardial Pacing Lead with Titanium Nitride Electrodes and Lead implant tool with articulating distal end.
35cm and 54cm, Lead implant tool - 44cm $1,544.00
8.8.2 - Non-transvenous, Uni-Polar, Steroid
Medtronic Australasia Pty Ltd
MC053 Capsure EPI steroid eluting unipolar
epicardial lead Model 4965 ventricle
Silicone 25 - 50cm $1,390.00
8.8.3 - Non-transvenous, Uni-Polar, Non-Steroid
Medtronic Australasia Pty Ltd
MC009 Medtronic Epicardial Pacing Leads IS-1 Model 5071
Silicone 35 - 53cm $1,030.00
Billing Code Product Name Description Size
8.8.4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/A
Benefit
Benefit
Condition
Medtronic Australasia Pty Ltd
MC254 CapSure Sense pacemaker lead Models 4073
Titanium Nitride 30 - 85cm $1,123.00
08.08.06 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular
Boston Scientific Australia Pty Ltd
BS133 Acuity Spiral Unipolar passive fixation 80, 90 & 100cm $2,808.00
Medtronic Australasia Pty Ltd
MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $2,808.00
Biotronik Australia Pty Ltd
BT156 Sentus OTW UP H 4.8F Unipolar, steroid eluting coronary sinus pacing lead
overall length 77, 87, 97 cm, 4.8F $2,808.00
8.8.8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atr
Biotronik Australia Pty Ltd
BT066 Selox ST Transvenous Bipolar Passive Steroid Ventricular Pacing Lead, fractal coated
BT067 Selox JT Bipolar, passive fixation, steroid eluting pacing lead with fractal coating and J-shape
BT117 Siello JT Sub 6F, steroid-eluting, transvenous, endocardial, bipolar passive-fixation lead that carries a J-shaped distal end.
BT118 Siello T Sub 6F, steroid-eluting, transvenous, endocardial, bipolar passive-fixation lead
BT138 TILDA T Bipolar, passive fixation, steroid eluting pacing lead with fractal coating
53 and 60cm lengths $1,123.00
Lengths: 45, 53 cm $1,123.00
Lengths: 45, 53 cm; Diameter: 5.6Fr $1,123.00
Lengths: 53, 60 cm; Diameter: 5.6Fr $1,123.00
53, 60cm length $1,123.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
BT141 TILDA JT Bipolar, passive fixation, steroid eluting pacing lead with fractal coating and J-shape
Length 45, 53cm $1,123.00
Guidant Australia Pty Ltd
GU009 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,123.00
GU011 Fineline II Sterox IROX Lead Bipolar passive fixation 52cm, 58cm $1,123.00
GU012 Fineline II Sterox IROX Lead Bipolar, passive fixation 45cm, 52cm $1,123.00
Livanova Australia Pty Limited
SA152 Refino ER Series Steroid eluting passive fixation pacing lead.
Permanent pacing lead, Model Refino ER, is indicated for the pacing and sensing of the ventricle. This permanent pacing lead is used in conjunction with an IS-1 compatible implantable pulse generator (pacema
SA154 Petite ER Series Steroid eluting passive fixation pacing lead.
Permanent pacing lead, Petite ER series, is indicated for the pacing and sensing of the ventricle. This permanent pacing lead is used in conjunction with an IS-1 compatible implantable pulse generator (pacema
The lead comes in 44, 48, 52 and 58cm lengths and has a 6.0F (polyurethane 6.3F (silicone) lead body
The lead comes in 44, 48, 52, 58, 70 and 78cm lengths and has a 4.8 F lead body.
$1,123.00
$1,123.00
Medtronic Australasia Pty Ltd
MC010 Medtronic Capsure SP Novus Model 5092
MC229 Medtronic Capsure SP Novus Model 5594 Lead
Bipolar, steroid, pasive fixation pacing lead 45 -110cm $1,123.00
Bipolar, steroid, passive fixation pacing lead 30-100cm $1,123.00
MC336 Medtronic Capsure Z Novus Model 5054 Pacing Lead
MC337 Medtronic Capsure Z Novus Model 5554 Pacing Lead
Silicone; Contents: 1 x lead with anchoring sleeve, stylet & guide, 1 x vein lifter, 2 x fixation tools, extra stylets
Silicone; Contents: 1 x lead with anchoring sleeve, stylet & guide, 1 x vein lifter, 2 x fixation tools, extra stylets
45-58cm $1,123.00
45-58cm $1,123.00
MC372 CapSure Sense MRI SureScan
pacemaker leads Models 4074 & 4574
Bipolar, steroid, passive fixation pacing lead Model 4074: 52 - 58cm; Model 4574: 45 -
53cm
$1,123.00
St Jude Medical Australia Pty Ltd
SJ146 Isoflex 1944T & 1948T Passive-Fixation, Bipolar, Steriod Eluting,
Endocardial Pacing Lead with Optim insulation
46cm, 52cm, 58cm $1,123.00
Billing Code Product Name Description Size
k
Benefit
Benefit
Condition
Medtronic Australasia Pty Ltd
MC052 Medtronic Capsure VDD2 Model
5038 AV Pacing Lead
Silicone; Contents: 1 x lead with anchoring sleeve, stylet & guide, 1 x vein lifter, 2 x fixation tools, extra stylets
11.5cm, 13.5cm, 15.5cm $1,390.00
Biotronik Australia Pty Ltd
BT163 Solia T Sub 6F, steoid-eluting transvenous, endocardial, bipolar passive-fixation lead MRI conditional
Boston Scientific Australia Pty Ltd
Lengths: 53, 60cm; Diameter: 5.6Fr $1,123.00
BS295 Ingevity Passive MR conditional pacing lead 45cm to 59cm $1,123.00
8.8.9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atri
Biotronik Australia Pty Ltd
BT083 Setrox S Bipolar active fixation lead with fractal coated and steroid eluting electrode
length 45, 53, 60cm $1,123.00
BT097 Dextrus (marketed by Boston
Scientific)
Bipolar, silicone, active fixation, steroid eluting, pacing lead
Lengths: 45, 53 and 60 cm, Diameter: 7Fr $1,123.00
BT116 Siello S Sub 6F, steroid-eluting, trasvenous, endocardial, bipolar active-fixation lead with an extendable/retractable, electrically active screw.
BT123 Safio S Steroid eluting active fixation pacemaker lead with an electrically active extendable/ retractable screw for fixating the lead in the myocardium. The lead body is insulated in Silicone. The entire lead is conditionally safe to be used in a MRI system.
BT139 TILDA R Bipolar active fixation lead with fractal coated and steroid eluting electrode
Lengths: 45, 53, 60 cm; Diameter: 5.6Fr $1,123.00
Length: 53, 60cm; Diameter: 6.6F $1,123.00
length 45, 53, 60cm $1,123.00
Guidant Australia Pty Ltd
GU013 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,123.00 GU016 Fineline II EZ Sterox IROX Lead Bipolar, active fixation 45cm, 52cm, 58cm $1,123.00
Billing Code Product Name Description Size
Livanova Australia Pty Limited
Benefit
Benefit
Condition
SA151 Physique ER Series Steroid eluting active fixation pacing lead.
Permanent pacing lead, Model Physique ER is indicated for the pacing and sensing of the ventricle or atrium. This permanent pacing lead is used in conjunction with a compatible implantable pulse generator. P
SA153 PY2-ER Series Steroid eluting active fixation pacing lead.
Permanent pacing lead PY2-ER series, is indicated for pacing and sensing of the ventricle and/or atrium of the heart. This lead is used in conjunction with a compatible implantable pulse generator (Pacemaker)
The lead comes in 44, 48, 52 and 58cm lengths and has a 4.8F lead body
The lead comes in 44, 48, 52, 58cm lengths and has a 6.3F lead body
$1,123.00
$1,123.00
Medtronic Australasia Pty Ltd
MC008 Medtronic Capsurefix Model 5568
Pacing Leads
MC833 CapSureFix Novus Model 4076
Pacing Lead
Bipolar, steroid, active fixation pacing lead 30 - 85cm $1,123.00
Active fixation pacemaker lead 45 - 85cm $1,123.00
MC936 CapSure Fix MRI Pacing Lead Model 5086, MRI Conditional 42, 52, 58 cm $1,123.00
St Jude Medical Australia Pty Ltd
SJ073 Tendril SDX 1688TC Endocardial Steroid-Eluting Active Fixation
Pacing Lead
100cm, 25cm, 34cm, 40cm, 46cm, 52cm, 58cm, 85cm, 7F
$1,123.00
SJ129 Tendril ST 1888TC and 1882TC Endocardial Bi-polar Steroid-Eluting Active
Fixation Pacing Leads
SJ151 OptiSense Model 1999 Active-Fixation Bipolar, Steroid Eluting,
endocardial, atrial pacing lead with Optim insulation
SJ238 Tendril STS 2088TC Endocardial Bi-polar Steroid-Eluting Active Fixation Pacing Leads
SJ270 Tendril MRI LPA 1200M The Tendril MRI™ lead, Model LPA1200M, is
an MR Conditional, bipolar, steroid-eluting, active fixation implantable pacing lead with Optim™ insulation.
46-65cm $1,123.00
40, 46 & 52cm $1,123.00
34cm-100cm $1,123.00
46cm, 52cm and 58cm $1,123.00
Billing Code Product Name Description Size
j
Benefit
Benefit
Condition
Medtronic Australasia Pty Ltd
MC301 Model 3830 PACING LEADS Active fixation pacemaker leadComposition:
Insulation is polyurethane, Electrodes are Titanium Nitride coated Platinum, the screw is steriod-coated
59 - 75 cm $2,340.00
Biotronik Australia Pty Ltd
BT164 Solia S Sub 6F, steroid-eluting, transvenous, endocardial, bipolar active fixation lead with an extendable/retractable, electrically active screw. MRI conditional
Boston Scientific Australia Pty Ltd
Lengths: 45, 53, 60cm; Diameter: 5.6Fr $1,123.00
BS296 Ingevity Active MR conditional pacing lead 45cm to 59cm $1,123.00
Medtronic Australasia Pty Ltd
MC338 Medtronic Capsurefix Novus Model 5076 Pacing Lead
Silicone; Contents: 1 x lead with anchoring sleeve, stylet & guide, 1 x vein lifter, 2 x fixation tools, extra stylets
45-85cm $1,123.00
08.08.11 - Transvenous, Multi-Polar, Passive, Steroid, Left Ventricular
Biotronik Australia Pty Ltd
BT095 | Corox OTW BP; Corox OTW-S BP; | Bipolar, steroid eluting coronary sinus pacing lead with fractal coating | Lengths: 77, 87 cm | $5,616.00 |
BT121 | Corox OTW-L BP | Corox OTW-L BP is a bipolar coronary sinus | Length: 75, 85cm; Diameter: 5.4F | $5,616.00 |
| | lead, intended for permanent implantation in | | |
| | the venous system and left ventricular pacing | | |
| | with appropriate single or multi chamber | | |
| | cardiac pacemakers or ICDs as part of cardiac | | |
| | resynchornisation therapy (CRT). The lead | | |
| | body is insulated with silicone and coated with | | |
| | polyurethane. | | |
BT135 | CELERITY PILOT | Bipolar, steroid eluting coronary sinus pacing | Lengths: 77, 87cm (in model number as 75 | $5,616.00 |
| | lead with fractal coating | and 85 for simplicity) | |
Billing Code Product Name Description Size
Benefit
Benefit
Condition
BT136 CELERITY 2D, CELERITY 3D Bipolar, steroid eluting coronary sinus pacing
lead with fractal coating. 2D preshaped curved distal end; 3D - preshaped helix distal end
Lengths: 77, 87cm (model shows 75 and 85 for simplicity)
$5,616.00
Guidant Australia Pty Ltd
GU138 Easytrak 2, Model 4514, 4515, 4516,
4517, 4518, 4519, 4520
GU153 Easytrak 2 Is-1 Lead - Models 4542,
4543 & 4544
GU156 Easytrak 3 Lead - Models 4521,
4522, 4523, 4524, 4525, 4526 and
4527
Bipolar, passive fixation . $5,616.00
Bipolar, passive fixation 80 to 100cm $5,616.00
Bipolar, passive fixation 80 to 100cm $5,616.00
GU162 Easytrak 3 IS-1 Lead Bipolar, passive fixation Sizes 80 to 100cm $5,616.00 GU165 Acuity Steerable Lead Bipolar, passive fixation 80cm, 90cm ,100cm $5,616.00
Medtronic Australasia Pty Ltd
MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $5,616.00 MC811 Attain Ability 4196 LV Lead Over the wire dual electrode left ventricular lead 78, 88, and 103 cm $5,616.00 MI013 Attain Ability Plus 4296 Over the wire electrode left ventricular lead 78cm, 88cm $5,616.00
MI014 Attain Ability Straight 4396 Over the wire dual left ventricular lead 78cm, 88cm $5,616.00
St Jude Medical Australia Pty Ltd
SJ243 Quartet 1458Q Quadripolar, Left Ventricular Pacing Lead with Optim Lead Insulation
75, 86 and 92cm, 5 French introducer $5,616.00
j
St Jude Medical Australia Pty Ltd
SJ208 Quick Flex µ 1258T 4F Bipolar Left Ventricular Pacing Lead 75cm, 86cm, 92cm $5,616.00
Biotronik Australia Pty Ltd
BT162 Corox ProMRI OTW (-S) (-L) BP Bipolar, steroid eluting coronary sinus pacing
lead with fractal coating
BT174 Sentus OTW BP L Bipolar, steroid eluting coronary sinus pacing lead with fractal coating
BT185 Sentus ProMRI OTW QP L & S Quadripolar, steroid eluting left ventricular lead
with fractal coating. IS4 Connector & MRI Conditional for CRT
Lengths: 77, 87cm $5,616.00
Lengths: 77cm, 87 cm, 97cm 4.8F $5,616.00
Lengths: 77cm, 87 cm, 97cm 4.8F $5,616.00
Billing Code Product Name Description Size
Medtronic Australasia Pty Ltd
Benefit
Benefit
Condition
MI129 Attain Perfoma Leads LV lead family with four electrodes and an IS4
connector for LV pacing w/premium and standard IS4 CRT-D devices. The Attain Perfoma™ Lead provides LV pacing options to avoid the following: phrenic nerve stimulation, high pacing thresholds, and ischemic tissue
78, 88cm $5,616.00
j
Boston Scientific Australia Pty Ltd
BS292 ACUITY X4 Left ventricular family of quad leads with four pacing and sensing electrodes. Three lead configurations offered to assist in LV lead placement and avoid phrenic nerve stimulation and high thresholds.
08.08.13 - Transvenous, Active, Steroid, Left Ventricular
86cm, 95cm $5,616.00
Medtronic Australasia Pty Ltd
MC730 Attain StarFix LV Lead Over the wire left Ventricular Lead 78, 88, 103cm $4,500.00
08.09.01 - Pacemaker/ICD Adaptors
Medtronic Australasia Pty Ltd
MC246 DF-I Y-Adaptor/Extender Model 6726 25cm & 37cm
Silicone Lengths 25cm, 37cm $450.00
MC778 Oscor Adaptor Adaptor for LV-1 lead to unipolar and bipolar IS-1
10cm, 17cm and 40cm $450.00
MI045 Adaptor Kit Model 5866-24M, 5866- 40M, 5866-37M
5866-24M: 5mm Bifurcated Bipolar Lead or Two 5mm Unipolar Leads to IS-1 Bipolar IPG; 5866-40M: 3.2mm BI Lead to IS-1 BI IPG;
5866-37M: 5mm UNI Lead to IS-1 UNI IPG
14cm $450.00
MI046 Bipolar Lead Adaptor Kit Model 2872 Two IS-1 BI Leads to IS-1 BI IPG One size only $450.00
MI053 5019 Adaptor Adapts DF-4 lead to enable use of additional leads for high defibrillation thresholds
One size $450.00
Billing Code Product Name Description Size
08.10.01 - Pacemaker/ICD Adaptors
Benefit
Benefit
Condition
Medtronic Australasia Pty Ltd
MC831 Medtronic Lead Extender Kit Model: 6984M, 6981M, 6985M,6986M
6984M: IS-1 BI Lead to IS-1 BI IPG; 6981M: IS-1 UNI Lead to IS-1 UNI IPG; 6986M: 3.2mm BI Lead to IS-1 BI IPG; 6985M: IS-1
UNI Lead to EPG
37 - 50cm $477.00
08.11.01 - Pacemaker/Lead Accessories
Boston Scientific Australia Pty Ltd
BS212 Pacemaker/Defibrillator port safety
plug
Pacemaker/Defibrillator Plug that seals unused IS-1 and DF-1 port
3.2mm x 38mm $72.00
BS213 Lead Cap Kit Caps used to protect lead terminal connector pin 4.75mm and 3.2mm $72.00
Medtronic Australasia Pty Ltd
MI042 Medtronic Lead End Cap Kit Model: 5867-3M
Lead End Cap Kit One size only $72.00
MI043 Medtronic DF-1 Port Pin Plug Kit:
Model 6719; Medtronic IS-1 Port Pin Plug Kit: Model 6725
MI044 Medtronic Upsizing Sleeve: Model
5866-45, Model 5866-46
08.11.02 - Antibacterial Envelope
No SubGroup
No Suffix
Medtronic Australasia Pty Ltd
MI195 TYRX Absorbable Antibacterial
Envelope
DF-1 unipolar connector port pin plug, one per kit
IS1 UNI Lead to 5/6mm UNI IPG;
IS1 UNI Lead to 5mm UNI IPG or
5mm Bifurcated BI IPG
Antibacterial surgically implanted mesh envelope which stabilises CIED placement and prevents infection
One size per model $72.00
18-25mm $72.00
6.3 x 6.9cm, 7.4 x 8.5cm $1,116.00
Billing Code Product Name Description Size
8.12.1 - Drug Eluting
8.12.1.1 - General Purpose
Benefit
Benefit
Condition
Abbott Australasia Pty Ltd
AY023 Xience Everolimus Eluting Stent
System
AY037 Xience PRIME LL Everolimus
Eluting Coronary Stent; Xience PRIME Everolimus Eluting Coronary Stent; Xience PRIME SV Everolimus Eluting Coronary Stent
AY040 XIENCE Xpedition Everolimus
Eluting Coronary Stent System
AY044 XIENCE Alpine Everolimus Eluting Coronary Stent System
Biotronik Australia Pty Ltd
Everolimus Eluting Stent System 2.25mm to 4.0mm widths, 8mm to 28mm lengths
Coronary Artery Stent, Drug Eluting XIENCE PRIME LL 2.50; 2.75; 3.00; 3.50;
4.0 x 33MM; XIENCE PRIME LL 2.50;
2.75; 3.00; 3.50; 4.0 x 38MM; XIENCE
PRIME SV 2.25 x 08; 12; 15; 18; 23; 28MM;
XIENCE PRIME 2.50 x 08; 12; 15; 18; 23;
28MM; XIENCE PRIME 2.75 x 08; 12; 15;
18; 23; 28MM; XIENCE PRIME 3.00 x 08;
12; 15; 18; 23; 28MM; XIENCE PRIME 3.50
x 08; 12; 15; 18; 23; 28MM; XIENCE
PRIME 4.00 x 08; 12; 15; 18; 23; 28MM
Coronary Artery Stent, Drug Eluting Xience Xpedition DES - 2.25 x
(8,12,15,18,23,28) RX CE, 2.50 x
(8,12,15,18,23,28,33,38,48) RX CE; 2.75 x
(8,12,15,18,23,28,33,38,48) RX CE; 3.00 x
(8,12,15,18,23,28,33,38,48) RX CE; 3.25 x
(8,12,15,18,23,28,33,38) RX CE; 3.50 x
(8,12,15,18,23,28,33,38,48) RX CE; 4.00 x
(8,12,15,18,23,28,33,38) RX CE;
Drug eluting coronary artery stent 2.00 mm x (08, 12, 15, 18, 23, 28) mm
2.25 mm x (08, 12, 15, 18, 23, 28) mm
2.50 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
2.75 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
3.00 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
3.25 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
3.50 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
4.00 mm x (08, 12, 15, 18, 23, 28, 33, 38) mm
$3,105.00
$3,105.00
$3,105.00
$3,105.00
BT178 Orsiro Sirolimus Coronary Artery Stent, Drug Eluting Co/Cr Alloy coated in PLLA
Boston Scientific Australia Pty Ltd
BS272 SYNERGY Everolimus-Eluting Platinum Chromium Coronary Stent System with Bioabsorbable Polymer
Stent diameters ø 2.25 -4.0mm Lengths: 9- 40mm
8mm to 38mm in length, diameter of 2.25 mm - 4.0 mm
$3,105.00
$3,105.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
BS273 | PROMUS PREMIER | Platinum chromium alloy stent coated with a blended polymer mixed with everolimus. | 8mm to 38mm in length, diameter of 2.25 mm - 4.0 mm | $3,105.00 | | |
HELEX-A PTY. LTD.
HE001 BioMatrix Flex Drug Eluting
Coronary Stent System
Medtronic Australasia Pty Ltd
Coronary Artery Stent, Drug Eluting (8 - 38)mm length x (2.25 - 4.0)mm diameter $3,105.00
MC732 Endeavour Drug Eluting Coronary
Stent System
MC769 Endeavor Sprint Drug Eluting Stent
System
MC816 Endeavor Resolute Drug Eluting
Coronary Stent System
MI037 Resolute Integrity Zotarolimus-
Eluting Coronary Stent System
MI189 Resolute Onyx Zotarolimus-Eluting
Coronary Stent System
Reid Healthcare
Cobalt Alloy, ABT - 578 Diameter: 2.25mm-4.5mm; Length: 8.00mm- 38.0mm
Cobals Alloym ABT - 578 Diameter: 2.25mm-4.0mm; Length: 8.0mm- 30.0mm
Cobalt Alloy, ABT - 578, BioLinx Polymer Diameter:2.25mm-4.0mm; Length: 8.00mm-
30.0mm
Cobalt-alloy, ABT-578, BioLinx Polymer Small Vessel - Diameter: 2.25mm-2.75mm;
Length: 8.0mm-30.0mm
Medium Vessel - Diameter: 3.0mm-4.0mm;
Length: 9.0mm-38.0mm
coronary stent system; drug eluting diameter: 2.25 to 5.00 mm; length: 8.00 to
38.00 mm
$3,105.00
$3,105.00
$3,105.00
$3,105.00
$3,105.00
RH015 CRE8 Coronary Stent Coronary Artery Drug Eluting Stent The stent is available in 6 diameters: 2.5mm;
2.75mm; 3.0mm; 3.5mm; 4.0mm; 4.5mm and 5 lengths: 12mm; 16mm; 20mm; 25mm and 31mm.
$3,105.00
Bioabsorbable
Abbott Australasia Pty Ltd
AY045 Absorb Bioresorbable Vascular Scaffold System
8.12.2 - Bare Metal
8.12.2.1 - General Purpose
Abbott Australasia Pty Ltd
AY028 Multilink Coronary Stent System -
Vision
Drug eluting coronary artery stent 2.5 mm x (8, 12, 18, 23, 28) mm
3.0 mm x (8, 12, 18, 23, 28) mm
3.5 mm x (12, 18, 23, 28) m
Cobalt chrome stent 2.25mm to 4.0mm widths, 8mm to 38mm lengths
$3,105.00
$1,123.00
Billing Code | Product Name | Description | Size | Benefit | Benefit | Condition |
AY039 | MULTI-LINK 8 Coronary Stent | The MULTI-LINK 8, MULTI-LINK 8 SV, | MULTI-LINK 8: Diam: 2.5, 2.75, 3.0, 3.5, | $1,123.00 | | |
| System, MULTI-LINK 8 SV | MULTI-LINK 8 LL Coronary Stent System | 4.0mm, Stent Length: 8, 12, 15, 18, 23, | | | |
| Coronary Stent System and MULTI- | (CSS) is comprised of two main components: | 28mm; MULTI-LINK 8 SV CSS: Diam: | | | |
| LINK 8 LL Coronary Stent System | the cobalt chromium (CoCr) stent and the | 2.25mm, Stent Length: 8, 12, 15, 18, 23, | | | |
| | balloon expandable delivery system. | 28mm; MULTI-LINK 8 LL CSS: Diam: 2.5, | | | |
| | | 2.75, 3.0, 3.5, 4.0mm, Stent Length: 33 and | | | |
| | | 38mm | | | |
Biotronik Australia Pty Ltd
BT107 PRO-Kinetic Energy Balloon-expandable cobalt chromium (CoCr) stent. The stent surface is fully coated with amorphous hydrogen-rich silicon carbide (aSiC:H).
Boston Scientific Australia Pty Ltd
Lengths: 8 - 40mm, Diameters: 2.0 - 5.0mm. $1,123.00
BS069 Liberte Coronary Stent System Consists of a balloon expandable stent, pre-
mounted on a Maverick 2 Monorail delivery catheter.
Stent lengths: 8,12,16,20,24,28 & 32 mm
Stent diameters: 2.25, 2.5, 2.75, 3.0, 3.5, 4.0,
4.5 & 5.0 mm
$1,123.00
BS211 OMEGA Bare Metal Stent Platinum Chromium Bare Metal Stent 2.25mm to 4.50mm Diameter. 8mm to 38mm
Length.
$1,123.00
BS291 REBEL REBEL is a balloon expandable platinum chromium (PtCr) alloy stent pre-mounted on a monorail catheter.
8mm to 32mm in length, diameter of 2.25mm to 4.50mm
$1,123.00
Medtronic Australasia Pty Ltd
MC329 Medtronic Driver, Micro Driver
Coronary Stent System
Cobalt Alloy Driver Stent: diameter (2.25 - 4.5mm), length (8-30mm); Micro-Driver Stent: diameter
(2.25 - 2.75mm), length (8 - 24mm)
$1,123.00
MC932 Driver Sprint Coronary Stent System Cobalt Alloy Diameter: 2.25 - 4.5 mm; Length: 8-30mm $1,123.00 MC956 Integrity Coronary Stent System Cobalt Alloy Coronary Stent Diameter: 2.25 - 4.5mm; Length: 8 - 30mm $1,123.00
OrbusNeich Medical Pty Ltd
NM004 Azule Coronary Stent Delivery
System
L605 Cobalt Chromium alloy balloon expandable vascular prosthesis
Expanded Stent Diameter 2.5 to 4.0mm, Stent Length 9 to 33mm
$1,123.00
Billing Code Product Name Description Size
Reid Healthcare
Benefit
Benefit
Condition
RH010 Avantgarde Chrono Carbostent The Avantgarde Chrono Carbostent device
consists of a coronary stent firmly held on the distal end of a semi compliant balloon catheter. The coronary stent is a flexible implantable deivce that can be expanded using a PTCA catheter. The stent is made of cobalt chronmium alloy coated with Carbofilm. Two radio-opaque platinum markers are located at either end of the stent.
Lengths: from 7mm to 31 mm; Sizes: from 2.25mm to 4.5mm
$1,123.00
Terumo Australia
TU001 | Tsunami Gold | Stainless Steel mounted on balloon catheter | Diameter 2.0mm - 4.0mm, Length 8mm - 30mm length | $1,123.00 |
TU044 | Kaname Coronary Stent System | BMS Coronary Stent | Diameter: 2.5mm; 2.75mm; 3.0mm; 3.5mm; 4.0mm x Lengths : 9mm; 12mm; 15mm; 18mm; 24mm; 28mm. | $1,123.00 |
08.12.02.02 - Special Purpose for specific indications
l, m
Abbott Australasia Pty Ltd
AY012 GRAFTMASTER RX Coronary Stent Graft
Stainless Steel/PTFE 16-26 mm x 2.8 - 4.8 mm $2,900.00
08.13.01 - Cardiac Defect Occluders
St Jude Medical Australia Pty Ltd
SJ280 Amplatzer Duct Occluder II Additional Sizes
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Single use implantable transcatheter device for minimally invasive closure of Patent Ductus Arterious
0.2cm-0.6cm $9,180.00
Getz Healthcare Pty Ltd
ME196 Figulla Flex II ASD Occluder Occlutech Flexx II ASD Occlusion device Figulla Flex II ASD Waist Ø (mm): Size
4,5,6,7.5,9,10.5,12,13.5,15,16.5,18,21,24,27,3
0,33,36,39,40
$9,180.00
Billing Code Product Name Description Size
Benefit
Benefit
Condition
ME197 Figulla Flex II PFO Occluder The Figulla® Flex II PFO is an implant for
closure of a patent foramen ovale (PFO) defect in the heart and is deployed via a minimally invasive catheter delivery system. The Figulla® Flex PFO is intended for patients with substantiated Right-Left-Shunt in the contrast agent echocardiography under Valsalva maneuver and presence of a "cryptogenic", paradoxical thromboembolism.
St Jude Medical Australia Pty Ltd
Figulla Flex II PFO Disc Ø (mm): 23/25, 16/18, 27/30, 31/35
$9,180.00
SJ260 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $9,180.00
SJ261 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $9,180.00
SJ262 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $9,180.00 SJ263 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $9,180.00
SJ264 Amplatzer Membranous VSD Occluder
Nitinol wire mesh, double disc occluder and delivery system
4-24mm, Length 7-10mm $9,180.00
SJ267 AMPLATZER Duct Occluder II Self expandable multiple Nitinol wire mesh
PDA occlusion device
Waist diameter 3-6mm, Nominal length 4-6mm $9,180.00
GT270 GORE® CARDIOFORM Septal
Occluder
The GORE® CARDIOFORM Septal Occluder consists of an implantable occluder comprised of a platinum-filled nickel-titanium (Nitinol) wire frame covered with expanded polytetrafluoroethylene (ePTFE). The occluder is available in sizes of 15, 20, 25, and 30 mm.
15mm Nominal Disc Diameter; 20mm Nominal Disc Diameter; 25mm Nominal Disc Diameter; 30mm Nominal Disc Diameter
$9,180.00
Billing Code Product Name Description Size
08.13.02 - Vascular Occlusion Devices
WILLIAM A COOK AUSTRALIA PTY LTD
Benefit
Benefit
Condition
WC294 | Flipper PDA Closure Detachable Coil Delivery System and Mreye Flipper PDA Detachable Embolization Coil | Delivery system and one coil: the Flipper PDA Closure Detachable Coil Delivery System is a TFE coated stainless steel delivery wire with a straightening mandril and a pin vise handle for detachment. The Mreye Flipper PDA Closure Detachable Coil is made from Iconel material with synthetic fibers. | Delivery system: Length 80cm and 110cm. Extended embolus lengths of: 3cm, 5cm, 6.5cm, 8cm, 10cm, 12cm. Coiled embolus diameters: 3mm, 5mm, 6.5mm, 8mm. Configuration loops of deployed coil: 3,4 or 5 loops | $600.00 |
WC295 | Mreye Flipper PDA Detachable Embolization Coil | Coil only: the Mreye Flipper PDA Closure Detachable Coil is made from Iconel material with synthetic fibers. | Extended embolus lengths of: 3cm, 5cm, 6.5cm, 8cm, 10cm, 12cm. Coiled embolus diameters: 3mm, 5mm, 6.5mm, 8mm. Configuration loops of deployed coil: 3,4 or 5 loops | $250.00 |
8.15.1 - Uncovered
Medical Vision Australia Cardiology Thoracic Pty Ltd
MY004 | CP Stent | CP Stent Uncovered | 16, 22, 28, 24, 39 & 45mm length | $1,620.00 |
MY006 | CP Stent | CP Stent Uncovered, mounted on BIB balloon | 16, 22, 28, 24, 39 & 45mm length | $1,620.00 |
8.15.2 - Covered
Medical Vision Australia Cardiology Thoracic Pty Ltd
MY005 | CP Stent | CP Stent Covered | 16, 22, 28, 24, 39 & 45mm length | $2,700.00 |
MY007 | CP Stent | CP Stent Covered, mounted on BIB balloon | 16, 22, 28, 24, 39 & 45mm length | $2,700.00 |