Schedule 1 |
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Part 3 - Prostheses List - Part C |
3 Prostheses List - Part C |
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Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
AN011 | Animas Vibe/One Touch Vibe Plus Insulin Pump | Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability | 8.26 x 5.08 x 2.18cm | $8,502.00 |
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AN014 | t:slim X2 Insulin Pump | Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability | One size only. | $8,502.00 |
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DF002 | DANAR Insulin Pump | The DANAR Insulin Pump is a small device about the size of a pager. It holds up to 300 units of insulin, which is delivered continuously through a small tube to the patient. The DANAR Insulin Pump also has an integrated blood glucose meter and remote control via bluetooth communication. | 75 x 45 x 19mm, 60grams | $8,502.00 |
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DF003 | DANA RS Diabecare insulin pump | DANA RS insulin pump is a BLE (bluetooth low energy) insulin pump which can be connected to and controlled from a BLE Smart Phone. Smart Phone connection is via a secure (alpha-numeric) pairing code, creating a large easy to read display for set-up and control of the DANA RS insulin pump. | 75mm x 45mm x 19mm (63grams) | $8,502.00 |
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MS066 | Cellnovo Insulin Infusion System | Continuous Subcutaneous Insulin Infusion Pump | The Cellnovo Insulin Infusion System is only available in one size. | $8,502.00 |
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RB001 | Accu-Chek Combo System | Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided. | The Accu-Chek Combo System is only available in one size. | $8,502.00 |
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RB002 | ACCU-CHEK Insight System | Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided. | No variable sizes offered. Only one system provided. | $8,502.00 |
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YA001 | mylife™ YpsoPump Insulin Pump System | Battery-operated, programmable ambulatory insulin infusion pump system | One size only | $7,362.00 |
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MC839 | Medtronic MiniMed Insulin Infusion Pump | Paradigm Veo Model MMT-554. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control. | 5.1 x 7.6 x 2.0cm | $9,025.00 |
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MC840 | Medtronic MiniMed Insulin Infusion Pump | Paradigm Veo Model MMT-754. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control. | 5.1 x 9.4 x 2.0cm | $9,025.00 |
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MI150 | MiniMed 640G Insulin Pump | MiniMed 640G Insulin Pump with SmartGuard Technology and continuous glucose monitoring capability, designed to automatically suspend insulin delivery before dangerous lows occur, and automatically resume after levels recover. | 1.8ml and 3.0ml | $9,025.00 |
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MI290 | Medtronic MiniMed 670G Insulin Pump | MiniMed 670G Insulin Pump with SmartGuard Hybrid Closed Loop (HCL) technology and continuous glucose monitoring (CGM) capability which can be programmed to automatically adjust delivery of basal insulin based on CGM, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values. | One size only | $9,025.00 |
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AN015 | Autosoft, Varisoft, TruSteel Infusion Set | For use with insulin infusion pump | 6 - 17mm | $7.00 |
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Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
SJ152 | SJM Confirm Model DM2102 | Implantable cardiac monitor with atrial fibrillation monitoring. | 6.5cc, 12g | $3,120.00 |
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MC763 | Reveal XT | Reveal XT Insertable Cardiac Monitor | 61 x 19 x 8 mm with a volume of 9cc | $3,120.00 |
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SJ390 | Confirm RX | Insertable Cardiac Monitor | 5cm X 0.95cm X 0.33cm | $3,120.00 |
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BT186 | BioMonitor 2-AF Implantable Cardiac Monitor | Implantable cardiac monitor for continuous remote monitoring of patients with Atrial Fibrillation (AF) or unexplained syncope | 88.4 mm x 15.2 mm x 6.2 mm , 10.1g , 5cm3 | $3,120.00 |
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MI141 | Reveal LINQ | Insertable Cardiac Monitor | 45 x 7 x 3.5mm, 1.18cc | $3,120.00 |
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SJ369 | Merlin@Home wireless | Home cardiac monitor (RF) with landline, cellular and broadband connectivity | one size | $1,568.00 |
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SJ370 | Merlin@Home Inductive | Home cardiac monitor (inductive) with landline, cellular and broadband connectivity | one size | $1,568.00 |
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BT179 | Cardio Messenger II-S 3G | Bedside/Remote transmitter w/ ICD device life network access to Biotronik standard home monitoring data management service. | Bedside Device - 203 x 136mm x 80mm, 450 grams | $1,568.00 |
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BT187 | CardioMessenger Smart 3G | Bedside/Remote transmitter w/ pacemaker/ICD device life network access to Biotronik standard home monitoring data management service. | Length - 130mm, Width - 65mm, Height - 13mm Weight - 75g | $1,568.00 |
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BS294 | Latitude Communicator | Remote patient management system for implanted cardiac devices | One size only | $1,568.00 |
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MI180 | MyCareLink Patient Monitor | Electronic cellular patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment. | One size | $1,568.00 |
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MI196 | MyCareLink Smart Patient Reader | Electronic cellular patient reader which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment. | One size only | $1,568.00 |
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MI296 | MyCareLink Relay Home Communicator | Electronic cellular (optional wifi) patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment | One size | $1,568.00 |
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SJ409 | FlexAbility Ablation Catheter | Sensor Enabled and Non-Sensor Enabled | D, F, J, D-F, F-J, D-D, F-F, J-J | $3,500.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ410 | TactiCath™ Contact Force Ablation Catheter | Sensor Enabled and Non-Sensor Enabled catheter | DD, DF, FF, FJ, JJ, D, F. | $3,500.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BT221 | AlCath Force | Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection with Optical Contact Force Sensor | 7F, 110cm , 3.5mm tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BT222 | AlCath G FullCircle | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Standard or Long Tip. | 7F, 110cm , 4 mm Tip Gold (G) and 8mm (LT) Long Tip Gold(G) | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BT223 | AlCath Flux G eXtra | Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection | 7F , 110cm , 3.5mm irrigated gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BT224 | AlCath Flutter Flux G eXtra | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, Advanced 3D irrigation (eXtra), FullCircle Deflection, Optimised stability,control & length for flutter | 7F ,95cm , 3.5mm Gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BT225 | AlCath Flutter LT G | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Long 8mm Tip (LT), Optimised stability,control & length for flutter | 7F , 95cm , 8mm(LT) gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BS361 | IntellaNav™ MiFi™ Open-Irrigated Ablation Catheter | IntellaNav™ Open-Irrigated, MiFi™ Mini-electrode Technology, Nav-abled | 110cm, shaft size 7.5F | $2,700.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MN238 | CARTO: SMARTTOUCH/ SMARTTOUCH SF | Contact Force Sensing Catheter: with/without Porous Tip | One size only | $3,700.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI300 | PVAC Gold Phased RF catheter | The Pulmonary Vein Ablation Catheter (PVAC) Gold is a three-dimensional, anatomically designed, multi-electrode phased RF catheter used to map, pace, and ablate the pulmonary veins. | 9Fr | $6,399.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ408 | EnSite Patch | Surface Electrodes | Patch/Kit | $350.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BS360 | Rhythmia™ Location Reference Patch Kit | Rhythmia™ Location Reference Patch Kit (Box of 1) | 50mm diameter | $299.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MN239 | CARTO Reference | External Reference | One size only | $499.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ404 | Inquiry Optima Diagnostic Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ405 | Reflexion Spiral Variable Radius Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ406 | Advisor mapping catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
SJ407 | Afocus II EB Inquiry Steerable Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
BS359 | IntellaMap Orion High Resolution Mapping Catheter | High resolution 64-electrode steerable mapping catheter | 8.5F, 115cm | $3,400.00 | The prosthesis is only to be used in a surgical procedure described in item 38920 in Group t8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MN240 | LASSO/ PENTARAY | Circular/High Density | Various | $2,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI301 | Arctic Front Advance Cardiac CryoAblation Catheter | A flexible, over-the-wire balloon catheter used to ablate cardiac tissue | 23mm, 28mm | $5,100.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI302 | Achieve / Achieve Advance Mapping Catheter | Intra-cardiac electrophysiology circular mapping catheter | 15mm, 20mm, 25mm | $1,299.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
MI309 | Cardioblate® Surgical Ablation Pen XL | The Cardioblate® Surgical Ablation Pen XL facilitates cardiac ablation in areas that are difficult to ablate with a bipolar device. | One size only | $2,876.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
ZZ055 | ATRICURE ISOLATOR SYNERGY RF CLAMPS | Surgical Radio Frequency (RF) Clamps for Atrial Fibrillation surgery | Short, Long | $4,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
ZZ056 | Isolator Synergy Access | Articulating Surgical Radio Frequency (RF) Clamp for Atrial Fibrillation Surgery | One size only | $4,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI308 | Cardioblate BP2 RF Surgical Ablation Device | The Cardioblate BP2 RF Surgical Ablation devices feature dual electrodes for the delivery of irrigated RF energy. iRF technology combines saline to facilitate treatment | Standard, Low Profile | $3,523.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI312 | Cardioblate® BP2 RF Surgical Ablation System | The Cardioblate® BP2 RF Surgical Ablation system features dual electrodes for the delivery of irrigated RF energy. iRF technology combines saline to facilitate treatment | One size only | $4,614.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI310 | Cardioblate® Gemini® Surgical Ablation System | The Cardioblate® Gemini® Surgical Ablation System is designed for minimally invasive ablation procedures. Gemini-s combines the efficacy of irrigated RF energy through a bipolar jaw, to facilitate deeper energy penetration, with real time measured customised energy delivery for greater confidence in achieving transmural cardiac lesions. | One size only | $6,040.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
ZZ057 | cryoICE Cryoablation Surgical Probes | Surgical Cryoablation probes for atrial fibrillation surgery | One size only | $3,800.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI311 | CryoFlex™ Surgical Ablation Probe | The CryoFlex™ Surgical Ablation Probe utilises a gas for freezing cells in the surgical treatment of cardiac arrhythmias. | One size only | $4,695.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI307 | SurgiFrost 10 | SurgiFrost 10 is a malleable, single-use cryosurgical device developed to treat cardiac arrhythmias during heart surgery. Freezing preserves tissue integrity. SurgiFrost10 features a malleable shaft and flexible tip with adjustable insulation sleeve. | One size ony | $4,095.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
MI306 | CryoFlex™ Surgical Clamp and Probe | The CryoFlex™ Surgical Clamp and Probe combines the utility of the CryoFlex™ Probe with the delivery of a clamp. | One size only | $5,095.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |