Private Health Insurance (Prostheses) Rules 2007


I, ANTHONY JOHN ABBOTT, Minister for Health and Ageing, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007. 

Dated 30 March 2007

 

TONY ABBOTT

____________________________________

 

Minister for Health and Ageing


 

 

 

 

 

 

 

 

Part 1 Preliminary 

1. Name of Rules 

2. Commencement 

3. Definitions 

Part 2 Benefit requirements 

4. Listing of, and benefits, for prostheses 

5. Benefits for prostheses provided as part of hospital treatment 

6. Benefits for prostheses provided as part of hospital-substitute treatment 

7. Timing of applications to have a prosthesis listed 

8. Minister may have regard to recommendations and advice 

Schedule 

 

 

Part 1 Preliminary

1.                      Name of Rules

These Rules are the Private Health Insurance (Prostheses) Rules 2007.

2.                      Commencement

These Rules commence:

(a)                    if the Rules are registered before the Act commencesat the same time as the Act commences; or

(b)                    if the Rules are registered on or after the day on which the Act commences―on the date on which the Rules are registered,

whichever occurs first.

3.                      Definitions

Note: Terms used in these Rules have the same meaning as in the Act―see section 13 of the Legislative Instruments Act 2003.  These terms include:

 complying health insurance policy
hospital-substitute treatment
hospital treatment
medicare benefit

In these rules:

accredited podiatrist has the same meaning as in subsection 3 (1) of the Health Insurance Act 1973.

Act means the Private Health Insurance Act 2007.

gap permitted prosthesis means a prosthesis listed in the Schedule where an amount is specified for that prosthesis in the column under the heading 'Minimum Benefit' and a different amount is specified in the column under the heading 'Maximum Benefit'.

no gap prosthesis means a prosthesis listed in the Schedule where an amount is specified for that prosthesis in the column under the heading 'Minimum Benefit' and no amount is specified in the column under the heading 'Maximum Benefit'.

private hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a private hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

professional service has the same meaning as in subsection 3 (1) of the Health Insurance Act 1973.

public hospital means a hospital in respect of which there is in force a statement under subsection 121-5 (8) of the Act that the hospital is a public hospital.

Note: Section 15 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the status of certain hospitals for which a declaration had been made before the commencement of the Act.

Schedule means the Schedule in these Rules.

Part 2 Benefit requirements

4.                      Listing of, and benefits, for prostheses

For item 4 of the table in subsection 72-1 (2) of the Act:

(a)                    the Schedule lists the prostheses (listed prostheses) the Minister has listed under subsection 72-10 (5) of the Act and section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007; and

Note: Section 12 of the Private Health Insurance (Transitional Provisions and Consequential Amendments) Act 2007 deals with the listing of a prosthesis that was a no gap prosthesis or a gap permitted prosthesis for the purposes of the National Health Act 1953 immediately before the commencement of the Act.

(b)                    rule 5 sets out the method for working out the minimum benefit and maximum benefit for hospital treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis in circumstances where:

(i)                     a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis; or

(ii)                   the provision of the prosthesis is associated with podiatric treatment by an accredited podiatrist; and

(c)                    rule 6 sets out the method for working out the minimum benefit and maximum benefit for hospital-substitute treatment, covered under a complying private health insurance policy, that is the provision of a listed prosthesis in circumstances where a medicare benefit is payable in respect of the professional service associated with the provision of the prosthesis.

5.                      Benefits for prostheses provided as part of hospital treatment

(1)        For a no gap prosthesis provided as part of an episode of hospital treatment by a private hospital in the circumstances mentioned in paragraph 4 (b), the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2)        For a gap permitted prosthesis provided as part of an episode of hospital treatment by a private hospital in the circumstances mentioned in paragraph 4 (b):

(a)                    the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b)                    the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

(3)        For a no gap prosthesis provided as part of an episode of hospital treatment by a public hospital in the circumstances mentioned in paragraph 4 (b):

(a)                    the minimum benefit is the lesser of the following amounts:

(i)                     the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii)                   the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b)                    the maximum benefit is the amount for that prosthesis listed in the column under the heading 'Minimum Benefit'.

(4)        For a gap permitted prosthesis provided as part of an episode of hospital treatment by a public hospital in the circumstances mentioned in paragraph 4 (b):

(a)                    the minimum benefit is the lesser of the following amounts:

(i)                     the amount for that prosthesis listed in the column under the heading ‘Minimum Benefit’ in the Schedule; or

(ii)                   the amount of the insured person’s liability to the public hospital for that prosthesis; and

(b)                    the maximum benefit is the amount for that prosthesis listed in the column under the heading ‘Maximum Benefit’ in the Schedule.

6.                      Benefits for prostheses provided as part of hospital-substitute treatment

(1)        For a no gap prosthesis provided as part of an episode of hospital-substitute treatment in the circumstances mentioned in paragraph 4 (c) the minimum benefit and the maximum benefit are each the amount for that prosthesis listed in the column in the Schedule under the heading ‘Minimum Benefit’.

(2)        For a gap permitted prosthesis provided as part of an episode of hospital-substitute treatment in the circumstances mentioned in paragraph 4 (c):

(a)                    the minimum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Minimum Benefit’; and

(b)                    the maximum benefit is the amount for that prosthesis in the column in the Schedule under the heading ‘Maximum Benefit’.

Note: Private health insurers cannot cover, as part of hospital-substitute treatment, a service for which medicare benefit is payable unless the service is specified in the Private Health Insurance (Health Insurance Business) Rules 2007see paragraph 121-10 (3) (a) of the Act.

7.                      Timing of applications to have a prosthesis listed

As a matter of normal administrative practice, applications made under subsection 72-10 (2) of the Act will be considered after they have been received and, if the Minister decides to grant the application, the prosthesis will be listed in the Schedule the next time the Minister makes or varies the Rules.

Note 1:  Under subsection 72-10 (5) of the Act the Minister must list the kind of prosthesis, set out the minimum benefit and, if the Minister considers it appropriate, the maximum benefit for the prosthesis in these Rules on the next occasion that the Minister makes or varies the Rules after he or she grants an application and the applicant has paid to the Commonwealth any initial listing fee within 14 days of being informed of the Minister's decision to grant the application.

Note 2: Under subsection 72-15 (3) of the Act, the Minister may remove a prosthesis from the list in the Rules if the applicant fails to pay an ongoing listing fee.

8.                      Minister may have regard to recommendations and advice

(1)        In making the decision under subsection 72-10 of the Act, the Minister may have regard to a recommendation from the Prostheses and Devices Committee.

(2)        In setting the minimum and the maximum (if any) amounts for a prosthesis, the Minister may have regard to the amounts as negotiated between the Prostheses and Devices Negotiating Group and the applicant.

Note

1. All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au

 

 

Schedule

 

PART A - Prostheses  November 2006

CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Applier, Surgical, Clip, Haemostatic, Single Use

 Medtronic Australasia Pty Ltd

MC680 Spyder Proximal Anastomotic Device 6-clip assembly $590.00

Catheters, Angioplasty, Laser

 Pacing Importers Pty Ltd

PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm,  $6,800.00

 1.7mm and 2.0mm

Coronary Stents

 Drug Eluting Stents

 Boston Scientific Pty Ltd

BS074 Taxus on Express2 Coronary Stent  balloon expandable stent with conformal  Length 8 - 32mm; Diameter  $3,484.00

 System Models 38001-0822 to 0840;  polymer/drug matrix coating, pre- 2.25 - 5.0mm

 38001-1222 to 1250; 38001-1622 to  mounted on high pressure monorail

 1650;

 38001-2022 to 2050; 38001-2422 to

 2450; 38001-2827 to 2850; 38001-3227

BS099 Taxus Liberte Paclitaxel-Eluting Coronary 316L Stainless Steel Stent with Translute  2.0mm-5.0mm & 8mm-32mm $3,350.00

  Stent System Polymer and Paclitaxel

 

Prostheses List by Category, Groups and Sponsor Page 1 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Johnson & Johnson Medical Pty Ltd

JJ302 CYPHER Sirolimus-Eluting Stent &  Stainless steel coronary stent with  Diameter 2.25 - 5.0mm, length  $3,484.00

 Delivery System Model  CRS - 23300,  Rapamycin (an immunosuppressive and  8-33mm

 08225, 08250, 08275, 08300, 28225,  antiproliferative drug) bound to the stent

 28250, 28275, 28300, 33225, 33250,

 33275, 33300, 13225, 13250, 13275,

 18225, 18250, 18275, 18300, 23225,

 23250, 23275, 23350, 23400, 08350,

 08400, 28350, 28400, 33350, 33400,

 13300, 13350, 13400, 18350, 18400,

 23450, 23500, 28450, 28500, 33450,

 33500, 08450, 13450, 18450, 18500

JJ481 CYPHER SELECT Sirolimus-Eluting  Stainless steel coronary stent with  Diameter 2.25 - 5.0mm, length  $3,350.00

 Stent & Delivery System Sirolimus (an immunosuppressive and  8 - 33mm

 anti-proliferative drug) bound to the stent

 by a polymer. Model CRA-23300, 08225,

  08250, 08275, 08300, 28225, 28250,

 28275, 28300, 33225, 33250, 33275,

 33300, 13225, 13250, 13275, 18225,

 18250, 18275, 18300, 23225, 23250,

 23275, 23350, 23400, 08350, 08400,

 28350, 238400, 33350, 33400, 13300,

 13350, 13400, 18350, 18400, 23450,

 23500, 28450, 28500, 33450, 33500,

 General Purpose Bare Metal Stents

 Abbott Australasia Pty Ltd

AY013 JoStent F1 Coronary Stent Stainless Steel 9 - 26 mm x 2.5 - 4 mm $780.00

 Atrium Australia-Pacific Rim Pty Ltd

AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm $780.00 $1,508.00

 Biotronik Australia Pty Ltd

BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm,  $1,248.00

 Length 8 - 30mm

BT065 Lekton Motion Mega Amorphous silicon carbide coated Diameter 4.5 and 5 mm; Length  $1,248.00

 13 - 40 mm

Prostheses List by Category, Groups and Sponsor Page 2 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BT069 Lekton Motion Petite Amorphous silicon carbide coated Diameter 2, 2.25, 2.5mm;  $1,248.00

 Length 8-20mm

BT082 PRO-Kinetic Cobalth Chromium coronary stent system 8-40mm length 2-5mm diameter $1,200.00

 Boston Scientific Pty Ltd

BS069 Express 2/Liberte Coronary Stent  Consists of a balloon expandable stent,  Stent lengths: 8,12,16,20,24,28  $1,248.00

 pre-mounted on a Maverick 2 Monorail  & 32 mm Stent diameters: 2.25,

 delivery catheter.  2.5, 2.75, 3.0, 3.5, 4.0, 4.5 &

 Guidant Australia Pty Ltd

GU102 Stents  ACS Multilink Coronary Stent; ACS  1.5mm - 8.0mm $1,248.00

 Megalink Peripheral Stent; ACS RX

 Herculink Peripheral Stent. Stainless steel

GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm $1,248.00

GU127 Multilink Coronary Stent System - Frontier 316L Stainless steel stent Length 1.5 - 8.0mm $2,496.00

GU128 Multilink Coronary Stent System - Vision Cobalt chrome stent Length 1.5 - 8.0mm $1,248.00

 Johnson & Johnson Medical Pty Ltd

JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel,  $1,220.00

 heparin coated

JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length  $1,220.00

 8 - 33 mm

JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 -  $1,220.00

  a balloon delivery system 33mm

 Medtronic Australasia Pty Ltd

MC197 Medtronic AVE S660 Coronary Stents,  Stainless Steel S660 Coronary Stent - Diameter $1,144.00

 S670 Coronary Stents, S7 Coronary   (2.5mm-2.75mm), Length

 Stents, BeStent2, (9mm-24mm); S670 & S7

 Coronary Stent - Diameter

 (3mm-4mm), Length (9mm-

 30mm); BeStent2 - Diameter

 (2.5mm-4mm), Length (9mm-

Prostheses List by Category, Groups and Sponsor Page 3 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC329 Medtronic Driver, Micro Driver Coronary Cobalt Alloy Driver Stent: diameter (2.25 -  $1,248.00

  Stent System 4.5mm), length (8-30mm);

 Micro-Driver Stent: diameter

 (2.25 - 2.75mm), length (8 -

 Neich Medical Pty Ltd

NM002 Constant Rx Coronary Stent System Stainless Steel Balloon Expandable  Lengths  - 9-32mm; Diameters - $1,040.00

 Tubular Stent  2.5 - 4.0mm

NM003 R Stent Evolution 2 Coronary Delivery  316LVM Stainless Steel Balloon  Lengths - 9-33mm; Diameters -  $1,144.00

 System Expandable Stent (Tubular) 2.5-4.0mm

 Pacing Importers Pty Ltd

PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold  Dia 5 - 9mm  length: 20 -  $780.00

 markers

 Terumo Corporation Australia

TU001 Tsunami Gold Coronary Stent Stainless Steel mounted on balloon  Diameter 2.0mm - 4.0mm,  $1,248.00

 Length 10mm - 30mm length

 Zynergy Medical Pty Limited

ZY001 Carbostent Coronary stent - includes Carbostent  Dia 2.5mm x Length 9, 12, 15,  $780.00 $1,482.00

 Syncro & Carbostent Sirius 19, 25mm; Dia 3.0mm x Length

  9, 12, 15, 19, 25, 32mm; Dia

 3.5mm x Length 9, 12, 15, 19,

 25, 32mm; Diameter 4.0mm x

 Length 9, 12, 15, 19, 25, 32mm

 Special Purpose Stents

 Abbott Australasia Pty Ltd

AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm $3,222.00

 Boston Scientific Pty Ltd

BS067 Symbiot Covered Stent System A self-expending nitinol stent encased  Stent lengths: 20, 31 & 45 mm   $1,248.00

 within an ePTFE covering, premounted  Stent diameters: 4.0 & 5.0 mm

 on a Monorail delivery catheter

Prostheses List by Category, Groups and Sponsor Page 4 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CRT Pacemakers

 Generation 1

 Guidant Australia Pty Ltd

GU143 Contak Renewal TR CRT -P Model  Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $9,360.00

 H120, Model H125

 Medtronic Australasia Pty Ltd

MC006 InSync model 8040 Stimulator Titanium 14.4cc $9,360.00

 St. Jude Medical Australia Pty Ltd

SJ040 Frontier 3x2 Model 5510 Biventricular Stimulation Device with AF  Height 48mm, Length 52mm,  $9,360.00

 suppression Depth 6mm

 Generation 2

 Biotronik Australia Pty Ltd

BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only $12,480.00

 Guidant Australia Pty Ltd

GU142 Contak Renewal TR2 CRT - P Model  Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm $12,480.00

 H140, Model H145

 Medtronic Australasia Pty Ltd

MC226 Medtronic Insync III Triple Chamber  Titanium One size only $12,480.00

 Pacemaker Model 8042

 St. Jude Medical Australia Pty Ltd

SJ072 Frontier II - Model 5596 Biventricular Cardiac Resynchronisation  49mm(h) x 52(1) x 6(t), 25g $12,480.00

 Device with AF suppression algorithm -

 Titanum

Prostheses List by Category, Groups and Sponsor Page 5 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Dual Chamber ICDs

 Generation 2

 Medtronic Australasia Pty Ltd

MC202 Medtronic Gem III DR Model 7275  Titanium One size only, 39.5cc $38,480.00

 Implantable Cardioverter Defibrillator

 Progressive Medical

PG004 Alto II DR Dual Chamber Implantable  One size only $38,480.00

 Cardioverter Defibrillator

 St. Jude Medical Australia Pty Ltd

SJ009 Photon Micro DR Model V-232  37cc $38,480.00

 Defibrillators/Cardioverters

 Generation 3

 Biotronik Australia Pty Ltd

BT053 Lexos DR Dual chamber ICD, rate responsive  One size only. $43,680.00

BT074 Xelos DR-T High energy ICD with home monitoring Packed in one small size $44,000.00

BT075 Lumos VR-T Single Chamber ICD with home  one size only $39,000.00

 monitoring and IEGM online

 Guidant Australia Pty Ltd

GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber,  One size only $43,680.00

 adaptive rate

GU132 Vitality DR Model 1871 This device acts to defibrillate the heart  Model 1871 Vitality DR Dual  $43,680.00

 chambers when the patient enters into an  Chamber Rate Responsive

 arrhythmia or uses shocks or anti tachy  Pacemaker/Defibrillator

 pacing to revert Ventricular Tachycardia

 (VT) or Ventricular Fibrillation (VF).

 While also acting as a dual chamber

GU149 Vitality 2 DR - Model T165 Implantable Cardiac Defibrillator 30cc ; 82g $43,680.00

GU150 Vitality 2 EL DR - Model T167 Implantable cardiac Defibrillator 35cc ; 90g $43,680.00

Prostheses List by Category, Groups and Sponsor Page 6 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC245 Marquis DR Model 7274 Implantable  Titanium 36cc $43,680.00

 Cardioverter Defibrillator

MC358 Intrinsic Model 7287, Implantable Cardioverter  36cc, 75g $43,680.00

 Defibrillator

MC363 EnTrust Model D153DRG, Dual chamber, VT  33cc, 63g $43,680.00

 Therapies, 30J 33cc, 63g

 St. Jude Medical Australia Pty Ltd

SJ049 Epic Plus DR Model V-236 Implantable  Dual Chamber sensing, bradycardia  33cc $43,680.00

 Cardioverter Defibrillator pacing with atrial fibrillation suppression

SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter  33cc 70g $43,680.00

 Defibrillator

SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter  33cc 70g $43,680.00

 defibrillator

Dual Chamber ICDs with CRT

 Generation 1

 Biotronik Australia Pty Ltd

BT081 Kronos LV-T CRT ICD with home monitoring one size $39,000.00 $44,000.00

 Medtronic Australasia Pty Ltd

MC252 Medtronic InSync Marquis Implantable  Titanium Volume 38cc $40,560.00

 Cardioverter Defibrillator Model 7277

 Generation 2

 Guidant Australia Pty Ltd

GU134 Contak Renewal 2 This device acts to defibrillate the heart  One Size Only $45,760.00

 chambers when the patient enters into an

 arrhythmia or uses shocks or anti tachy

 pacing to revert Ventricular Tachycardia

 (VT) or Ventricular Fibrillation (VF).

 While also acting as a biventricular

Prostheses List by Category, Groups and Sponsor Page 7 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GU147 Contak Renewal 4 CRT-D Model H190,  Implantable dual-chamber defibrillator One size only $45,760.00

 Model H195

 Medtronic Australasia Pty Ltd

MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc $45,760.00

 St. Jude Medical Australia Pty Ltd

SJ062 Epic HF Model V-339 Implantable  Cardioverter/defibrillator with dual  One size only $45,630.00

 Cardiac Defibrillator chamber (atrial and RV) sensing and

 bradycardia pacing with ventricular

SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter  36cc / 73g $45,760.00

 defibrillator with dual chamber (atrial and

 RV) sensing and bradycardia pacing with

 ventricular resynchronisation therapy.

 Generation 3

 Biotronik Australia Pty Ltd

BT076 Lumos DR-T Dual Chamber ICD with home monitoring one size only $42,000.00 $44,000.00

Dual Chamber Pacemakers

 Generation 1

 Biotronik Australia Pty Ltd

BT026 Philos D Model 122447 Implantable  Multiprogrammable, ventricula, rate  One size only $5,200.00

 Pacemaker responsive modes, DDDC

 Guidant Australia Pty Ltd

GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1 $5,200.00

 Medtronic Australasia Pty Ltd

MC727 Adapta Pacemaker DDD Pacemaker 12.1cc $5,000.00 $6,500.00

 Models ADD01 27.1g

Prostheses List by Category, Groups and Sponsor Page 8 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 St. Jude Medical Australia Pty Ltd

SJ050 Verity ADx Model XL DC 5256 Dual -  Dual Chamber multi-programmable rate- 11cc, 23.5g $5,200.00

 Chamber pacemaker adaptive pacing devices with extended

 longevity

SJ061 Identity Adx Model XL DC 5286 Dual  Identity ADx Model XL DC Model 5286  11cc, 23.5g $5,200.00

 Chamber Pacemaker is an implantable, multi-programmable

 rate-adaptive pacing device with AF

 Generation 2

 Biotronik Australia Pty Ltd

BT027 Philos SLR Model 122456 Implantable  Single pass, multiprogrammable, rate  One size only $6,760.00

 Pacemaker responsive, VDDR

 Medtronic Australasia Pty Ltd

MC243 Medtronic Kappa KVDD 900 Model  Cardiac Pacemaker, Titanium 11.1cc $6,552.00

 KVDD 901

MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1  One size only $6,760.00

 connector.  Titanium silicone

MC713 Adapta Pacemaker VDDR Pacemaker 11.1cc $6,500.00

 Models ADVDD01 23.6g

 St. Jude Medical Australia Pty Ltd

SJ054 Identity ADx Model VDR 5480  Single Chamber multi-programmable rate- 8cc, 18g $6,760.00

 implantable pacemaker adaptive pacing device with extended

 longevity

SJ057 Verity ADx Model XL VDR 5456  Single Chamber multi-programmable rate- 11cc, 23.5g $6,760.00

 implantable pacemaker adaptive pacing device with extended

 longevity

 Generation 3

 Biotronik Australia Pty Ltd

BT024 Philos DR Model 122450 Implantable  Multiprogrammable, rate responsive,  One size only $9,360.00

 Pacemaker

Prostheses List by Category, Groups and Sponsor Page 9 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BT029 Philos DR-A Model 122600 Implantable  Multiprogrammable, rate responsive,  5mm ports, One size only $9,360.00

 Pacemaker

BT047 Protos DR/CLS Dual chamber, rate responsive, closed  One size only. $9,360.00

 loop system.

BT060 Philos II DR Multiprogrammable, rate responsive,  One size only $9,360.00

BT071 Philos II DR-T Dual Chamber Rate Responsive with  One size only $9,000.00 $10,000.00

 Home Monitoring

BT079 Cylos DR-T Dual chamber dual sensor rate responsive one size $9,000.00 $11,000.00

  with home monitoring system option

 Guidant Australia Pty Ltd

GU120 Insignia Plus DR Model 1297, Insignia  Dual Chamber Rate Responsive  One size only $9,360.00

 Plus DR Model 1298 Permanent Pacemaker

GU121 Insignia Entra DR Models  Dual Chamber Rate Responsive  One size only $9,360.00

 Permanent Pacemaker

GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only $9,360.00

GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only $9,360.00

 Medtronic Australasia Pty Ltd

MC029 Medtronic Kappa 400 pacemaker Model  Titanium 13.9cc $9,048.00

 KDR401

MC333 Medtronic Kappa Pacemaker Model KDR  Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc $9,048.00

 901, KDR921 and KDR931

 Progressive Medical

PG002 Talent II DR Pacemaker Model 233 Dula Chamber Pacemaker. 99% titanium 57.5 x 37.2 x 8mm $9,360.00

PG005 Symphony DR 2550 Active Implantable pacemaker 1 size only $9,360.00

 St. Jude Medical Australia Pty Ltd

SJ026 St Jude Medical Integrity AFX DR5346  Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm $9,360.00

 Pacemaker, Cardiac, Implantable

SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive  Volume 8cc, Weight 18gm $9,360.00

SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive  Volume 11cc, Weight 23.5gm $9,360.00

Prostheses List by Category, Groups and Sponsor Page 10 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SJ032 Identity DR 5370 Dual Chamber Rate Responsive  Volume 8cc, Weight 18gm $9,360.00

SJ051 Verity Adx Implantable Pacemaker,  Dual - Chamber, multi-programmable,  45x52x6mm,11cc, 23g, 5mm or $9,360.00

 Models XL DR 5356 and XL DR 5357M/S rate-responsive pacemaker withAF   6mm M/S

SJ056 Integrity ADx Model DR 5360 and XL  Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g,  $9,360.00

 DR 5366 responsive pacemaker with AF  Model XL DR 5366 - 11cc,

SJ059 Identity ADx Models DR 5380 and XL  Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm,  $9,360.00

 DR 5386 adaptive pacing devices with AF  18g and 8cc

 ADx XL DR 5386: 44x52x6mm,

  23.5g and 11cc

SJ089 Victory XL DR 5816 and DR 5810 Dual Chamber Rate Responsive  44x52x6mm; 23.5g; 11cc $9,000.00

 Generation 4

 Medtronic Australasia Pty Ltd

MC322 EnPulse DR Series: Model E2DR01,  EnPulse DDDR Pacemakers - with IS1  one size only $11,440.00

 Model E2DR03, Model E2DR06, Model  connector and normal battery size; with

 E2DR21, Model E2DR31, Model E2DR33 3.2mm low profile connector and normal

 battery size; with 5/6 mm connector and

 normal battery size; with IS1 connector

 and small battery size; with IS1

 connector and large battery size; with

 3.2mm low profile connector and large

 battery size. Titanium and silicone.

MC726 Adapta Pacemaker DR Pacemaker 11.1-14.2cc $11,000.00

 Models ADDR01, ADDRS1, ADDRL1,  23.6g-31.3g

 ADDR06, ADDR03

Fixation Device, Internal, Plate

 Biomet Australia Pty Ltd

BI930 Sternalock Plates - xyphoid, "L" & square 4 hole $195.00

BI931 Sternalock Plates - "X" & "T" 5-8 hole $300.00

Prostheses List by Category, Groups and Sponsor Page 11 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Fixation Device, Internal, Screw

 Biomet Australia Pty Ltd

BI929 Sternalock Screws Ti 2.4-2.7mm x 8-12mm $44.00

Grafts, Vascular, Synthetic

 Incision Pty Ltd

IP028 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are  For all diameters in 60 and  $750.00

  Grafts, Straight Grafts texturised exterior yarns for superior  100cm lengths

 tissue incorporation and healing

 characteristics, with the new Bioseal

 impregnation to make the grafts blood

IP029 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes up to 50cm in Length $920.00

 Graft, Straight, Standard Wall With  structure, Straight, Standard Wall with

 Reinforcement

IP030 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes at over 50cm in Length $1,050.00

 Graft, Straight, Standard Wall With  structure, Straight, Standard Wall with

 Reinforcement

IP031 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes up to 50cm in Length $1,100.00

 Graft, Straight, Thin Wall with  structure. Thin Wall with spiral

IP032 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes at over 50cm in Length $1,300.00

 Graft, Straight, Thin Wall with  structure. Thin Wall with spiral

IP033 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Bifurcated grafts are  45 cm length, 12x6mm,  $1,000.00

  Grafts, Bifurcated Grafts texturised exterior yarns for superior  14x7mm, 16x8mm, 18x9mm,

 tissue incorporation and healing  20x10mm, 22x11mm,

 characteristics, with the new Bioseal

 impregnation to make the grafts blood

Prostheses List by Category, Groups and Sponsor Page 12 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 1- Cardiothoracic Mechanical Valves

 Group 1a - Ball Valve, Standard

 Edwards Lifesciences Pty Ltd

EL029 SE SIL Ball Valve Aortic Models  Starr Edwards - Silastic Ball Valve.  16mm-34mm $3,850.00

 1200/1260, SE SIL Ball Valve Mitral  Composition: Stellite Alloy No. 21;

 Polytetrafluroethelyne; polypropylene

 cloth; Silicone rubber (contains 2% by

 weight barium sulphate for radiopacity)

 Group 1c - Bi-Leaflet, rotatable

 Advanced Biomedical Pty Ltd

AB002 ATS medical open pivot heart valve  Pyrolythic Carbon, Double Velour  16-33mm $5,909.00

 model 500FA standard flexi-cuff aortic  Polyester, Titanium

 valve series, ATS medical open pivot

 heart valve model 500DM standard flexi-

AB064 ATS medical open pivot heart valve  Pyrolythic Carbon, Double Velour  16-33mm $5,909.00

 model 501DA advanced performance  Polyester, Titanium

 (AP) aortic valve series, ATS medical

 open pivot heart valve model 501DM

 advanced performance (AP) mitral valve

 Medtronic Australasia Pty Ltd

MC292 Advantage Heart Valve - Aortic Model  A7760 - Pyrolytic carbon, PET Diameter 19-31 mm $5,909.00

MC324 Advantage Supra Aortic  Heart Valve Mechanical Heart Valve Pyrolite Carbon  Diameter (mm): 19 - 25 $5,909.00

 leaflets Pyrolite carbon ring

 Reid Healthcare

RH001 Aortic On-X Prosthetic Heart Valve  27-29mm, 19mm, 21mm,  $5,500.00

 Models ONXA-19; ONXA-21; ONXA- 23mm, 25mm, 25-33mm, 27-

 23; ONXA-25; ONXA-27/29; ONXM-23; 29mm, 31-33mm, 23mm,

  ONXM-25; ONXM-27/29; ONXM31/33;

 Tag Medical

TM003 Optiform Mechanical Valve 19mm to 33mm $4,950.00

Prostheses List by Category, Groups and Sponsor Page 13 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 1e - Tilting Disc, rotatable

 Hjorth Health Pty Limited

HH001 Omnicarbon 4000 4313 Aortic UPP Pure pyrolitic carbon mono-leaflet  Aortic - Sizes 19mm - 27mm;  $5,000.00

 prosthetic heart valve Mitral - Sizes 27mm - 33mm

HH002 Omnicarbon 4000 4523 Mitral UPP  Pure pyrolitic carbon mono-leaflet  Aortic - Sizes 19mm - 27mm;  $5,000.00

 SupraAnnular prosthetic heart valve Mitral - Sizes 27mm - 33mm

Group 2 - Cardiothoracic Tissue Valves

 Group 2a - Stented, porcine

 Edwards Lifesciences Pty Ltd

EL030 CE Supra Annular Aortic Valve Model  Carpentier-Edwards SAV Bioprosthesis.  19mm-33mm $4,350.00

 2650 Carpentier-Edwards S.A.V  Composition: Porcine Valve; Elgiloy

 Bioprosthesis Model 6650 Mitral Valve Alloy; Silicone Rubber,

 Medtronic Australasia Pty Ltd

MC701 Mosaic Cinch, Aortic, Mitral Models 305cxx, 310cxx 19mm - 35mm $4,350.00

 Group 2b - Stented, pericardial

 Edwards Lifesciences Pty Ltd

EL031 Carpentier-Edwards Perimount Pericardial Carpentier-Edwards Pericardial  Models 2900/6900 19-33mm,  $4,900.00 $5,144.00

  Bioprosthesis - Models 2900/6900   Bioprosthesis. Composition: Bovine  Model 6900P 25, 27, 29, 31,

 Carpentier-Edwards Perimount Plus  Pericardium; Elgiloy Alloy; Silicone

 Pericardial Bioprosthesis Mitral - Model  Rubber, Polytetrafluoroethylene

 6900P

 Group 2c - Non-Stented, porcine

 Edwards Lifesciences Pty Ltd

EL032 Baxter Edwards Prima Plus Stentless  Edwards Prima Plus. Porcine Valve;  19mm-29mm for pack of 7 items $4,600.00

 Bioprosthesis Model 2500P Prosthetic  Woven Polyester Cloth.

 Heart Valve

Prostheses List by Category, Groups and Sponsor Page 14 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC015 Freestyle bioprosthesis Models 995xx, 995MSxx 19 - 35mm $5,110.00

 St. Jude Medical Australia Pty Ltd

SJ038 St Jude Medical Toronto SPV Valve  Tissue Heart Valves, Bioimplant TSPV: 21 - 29mm, Bioimplant  $4,800.00

 Model SPA-101, St Jude Medical  Aortic: 21-27mm, Bioimplant

 Bioimplant Heart Valve Mitral: 27-32mm

Group 3 - Cardiothoracic Valve Conduits

 Group 3a - Mechanical Valve

 Advanced Biomedical Pty Ltd

AB001 ATS Medical open pivot aortic valved  Pyrolythic Carbon, Double Velour  21-33mm $6,800.00

 graft model 502AG Polyester, Titanium

 Medtronic Australasia Pty Ltd

MC198 Medtronic Hall rotatable aortic valved  Titanium, pyrolite, dacron 20 - 33mm $6,800.00

 collagen impregnated conduit Model R7700

 Tag Medical

TM002 CarboSeal Ascending Aortic Prosthesis,  Mechanical Conduit AP 21-33mm, CP 21 - 33mm $6,800.00

 sterile, CarboSeal Ascending Aortic

 Prosthesis with Handle Model AP21,

 Model AP23, Model AP25, Model AP27,

 Model AP29, Model AP31, Model AP33,

 Carboseal Valsalva

 Group 3b - Tissue Valve, stented porcine

 Medtronic Australasia Pty Ltd

MC012 Medtronic Hancock Valved Conduit  Porcine bioprosthesis, dacron 12, 14, 16, 18, 20, 22, 25,  $5,750.00

 Model 100/150

Prostheses List by Category, Groups and Sponsor Page 15 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 4 - Cardiothoracic Atrio-Ventricular Rings and Bands

 Group 4a - Ring, Standard

 Edwards Lifesciences Pty Ltd

EL028 Baxter Sterile Grafts, Implants &  Carpentier-Edwards Classic Annuloplasty  24mm-40mm $2,200.00

 Prostheses, Non-Animal Origin  Ring. Composition: Titanium Alloy;

 Annuloplasty: Ring-Mitral Ring with  Silicone Rubber; Polyester Fabric

 Holder; Mitral Cosgrove-Edwards  Carpentier-Edwards Physio Annuloplasty

 Annuloplasty System Model 4600; Classic Ring. Composition: Elgiloy Bands;

 Polyester Film Strips; Silicone Rubber;

 Polyester Cloth, Cosgrove-Edwards

 Annuloplasty Band. Composition: Silicone

  Rubber; Polyester Cloth. Carpentier-

 Edwards Tricuspid Ring. Composition:

 Titanium Alloy; Silicone Rubber;

 Medtronic Australasia Pty Ltd

MC005 Medtronic Duran Annuloplasty Ring;  Annuloplasty Devices - Models 610R &  Model 610R 25-35mm & Model $1,900.00

 Duran Ancore Ring 620R; Duran Ancore  620R Silicone / Barium Sulphate, Dacron.  620R 23-35mm

 Chordal Model 620RG

 St. Jude Medical Australia Pty Ltd

SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm $2,150.00

 Tag Medical

TM001 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm $1,600.00

 Group 4b - Band, multiplanar

 Edwards Lifesciences Pty Ltd

EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester  24mm/26mm/28mm/30mm/32m $2,350.00

 cloth/plastic template Mitral valve annular  m/34mmd

 repair device designed specifically for

 patients with Ischemic Mitral regurgitation

 St. Jude Medical Australia Pty Ltd

SJ087 St Jude Medical Rigid Saddle Ring Rigid Annuloplasty Ring 24 - 34mm $2,400.00

Prostheses List by Category, Groups and Sponsor Page 16 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 4b - Ring, multiplanar

 Edwards Lifesciences Pty Ltd

EL050 Edwards MC3 Tricuspid Annuloplasty  Annuloplasty Ring,  26mm to 36mm in 2mm  $2,350.00

 titanium/silicone/polyester velour

 cloth/plastic template

 Group 4c - Band Standard

 Medtronic Australasia Pty Ltd

MC709 Posterior Annuloplasty Band;  Colvin -  Annuloplasty - Model 610B & 620B  Model 610B: 25-35mm; Models  $1,900.00

 Galloway Future Band Model 638B;  Silicone / Barium Sulphate, Dacron.  620B & 620BG: 23-35mm,

 Duran Ancore Band 620B; Duran Ancore  Models 638B semi-regid metal alloy core,  Model 638B - 26-38mm

 Chordal Model 620BG silicone coating, polyester knit fabric, kit

 includes-band, malleable handle, template

 with suture markers, sizers

 St. Jude Medical Australia Pty Ltd

SJ088 SJM Tailor Annuloplasty Band Flexible double-velour, polyester fabric 25 - 35mm $2,150.00

Group 5 - Cardiothoracic Membranes and Patches

 Group 5a - Tissue

 Edwards Lifesciences Pty Ltd

EL033 Baxter Augmentation / Substitution  Edwards Pericardial Patch. Bovine  10cm x 16cm $740.00

 Material, Human or Animal Origin, Sterile  Pericardium.

 Pericardial Patch.

 Group 5b - Synthetic, Cardiovascular

 W L Gore & Associates

GT117 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm Thickness 2 x 9cm $233.00

GT118 Gore-Tex - Cardiovascular Patch ePTFE 0.4mm - 3 x 6cm $275.00

 0.6mm - 2.5cm x 15cm & 5cm

 x 7.5cm

Prostheses List by Category, Groups and Sponsor Page 17 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT120 Gore-Tex  Cardiovascular Patch ePTFE 0.6mm Thickness 5 x 15cm $510.00

GT121 Gore-Tex Cardiovascular Patch ePTFE 0.6mm Thickness 10 x 15cm $925.00

GT126 Acuseal Cardiovascular Patch Vascular ePTFE 0.5mm Thickness 1 x 9cm; 0.8  $217.00

 x 7.5cm

GT127 Acuseal Cardiovascular Patch Cardiac ePTFE 0.5mm Thickness 3 x 6cm & 5  $264.00

 x 7.5cm

 Group 5c - Synthetic, Non-cardiovascular

 W L Gore & Associates

GT122 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 6 x 12cm $353.00

GT123 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 8 x 16cm $630.00

GT124 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 12 x 12cm $732.00

GT125 Preclude Pericardial Membrane ePTFE 0.1mm Thickness 15 x 20cm $1,425.00

Group 7 - Cardiothoracic Assisted Fixation Devices

 Medtronic Australasia Pty Ltd

MC714 U-Clips (Valve Repair) Double Arm, Mitral Valve Repair 2-packs $500.00

ICD Leads

 Group 1 - Coronary Sinus Leads

 Medtronic Australasia Pty Ltd

MC026 Medtronic Transvene SVC Lead Model  Model 6937-35, Model 6937-52, Model  35 - 110cm x  660mm $2,340.00

 6937-58, Model 6937-110; Silicone;

Prostheses List by Category, Groups and Sponsor Page 18 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 4 - Transvenous/Non steroid/Passive Leads

 Biotronik Australia Pty Ltd

BT050 KAINOX A+ ICD Lead, Single Pass. Atrial ring spacing 15, 17cms. $7,280.00

BT057 Kentrox SL ICD Lead, Single Lead 65, 75 or 100cm length. Tip to  $7,280.00

 second shock coil 16cm or

 Progressive Medical

PG003 Swift 4040 1CT lead length 58 cm - 69 cm $7,280.00

 Group 5 - Transvenous/Steroid/Passive Leads

 Biotronik Australia Pty Ltd

BT077 Kentrox SL steriod Dual shock coil fractal steroid eluting  65, 75cm lengths $9,000.00

 passive fixation electrode

BT078 Kentrox RV Steroid single shock coil fractal steroid eluting  65, 75 cm lenghts $9,000.00

 passive fixation electrode

 Guidant Australia Pty Ltd

GU112 Endotak Reliance S Lead Model 0127 & Model 0128, defibrillation  59cm, 64cm $7,488.00

 lead, 9fr introducer (silicone coated),

 steroid eluting, high impedence

GU115 Endotak Reliance Lead Model 0147, Model 0148 & Model 0149,  59cm, 64cm, 90cm $7,488.00

 defibrillation lead, 9fr introducer (silicone

 coated), steroid eluting, high impedence

GU158 Endotak Reliance SG Passive Fixation Lead Endotak Reliance SG Passive Fixation  54cm - 90cm $7,200.00 $10,000.00

 Lead: Models 0170, 0171, 0172, and

 0173 Implantable cardioverter defibrillator

  lead with GORE ™ ePTFE covered

GU159 Endotak Reliance G Passive Fixation Lead Endotak Reliance G Passive Fixation  54cm -90cm $7,200.00 $10,000.00

 Lead: Models 0174, 0175, 0176 and

 0177. Implantable Cardioverter

 defibrillator lead with GORE ™ ePTFE

Prostheses List by Category, Groups and Sponsor Page 19 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC002 Medtronic Sprint Quattro Lead Model  Silicone and polyurethane 65-100cm $9,360.00

 6944RV/SVC 65cm; Model 6944RV/SVC

  75cm; or Model 6944RV/SVC 100cm;

 Medtronic Sprint Quattro Lead Model

 6944RV/SVC 58cm

MC018 Medtronic Sprint Lead Model 6942RV/SVC Model 6942-65, Model 6942-75, Model  65 - 100cm $7,488.00

 6942-100; Silicone

MC025 Medtronic Sprint Lead Model 6932RV Model 6932-65, Model 6932-75, Model  65 - 100cm $7,488.00

 6932-100; Silicone

MC696 Sprint Fidelis Lead Model 6948, dual-coil, tined 58-100cm $10,000.00

MC698 Sprint Fidelis Lead Model 6930, single-coil, tined 58-100cm $10,000.00

 St. Jude Medical Australia Pty Ltd

SJ016 Riata Transvenous Tachyarrhythmia Lead Quadripolar, dual-coil, steroid eluting,  One size only $10,400.00

  Model 1570, Model 1571 active fixation tachyarrhythmia leads

SJ083 Riata Transvenous Tachyarrhythmia Lead Tri-polar Passive-Fixation, Steroid  60cm, 65cm, 8F introducer $10,000.00

  Model 1572 Eluting, Single Shock Coil

SJ085 Riata iTransvenous Tachyarrhythmia  Passive Fixation, Steroid-Eluting, Dual  60cm, 65cm, 70cm, 8F  $10,000.00

 Leads Models 1560 and 1561 Shock Coil Defibrillation Lead

SJ086 Riata i Transvenous Tachyarrhythmia  Passive Fixation, Steroid Eluting, Single  60cm, 65cm, 70cm, 8F  $10,000.00

 Lead Model 1562 Shock Coil Defibrillation Lead

 Group 6 - Transvenous/ Steroid/Active Leads

 Biotronik Australia Pty Ltd

BT064 Kentrox SL-S steroid Fractal coated steroid electrode, dual  16 and 18 cms tip to second  $7,488.00

 shock coil shock coil

BT068 Kentrox RV-S steroid Fractal coated steroid electrode, single  65cm lengths $7,488.00

 shock coil

Prostheses List by Category, Groups and Sponsor Page 20 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Guidant Australia Pty Ltd

GU118 Endotak Endurance EZ Leads Model  Defibrillation lead, steroid eluting,  64, 70, 100cm $7,488.00

 0154, Model 0155, Model 0156 trilumen lead body contains one

 conductor for pacing/sensing and two

 conductors for defibrillation.  The helix is

  composed of platinum iridium.

GU145 Endotak Reliance G Lead Model 0164,  Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $11,440.00

 Model 0165, Model 0166, Model 0167

GU146 Endotak Reliance SG Lead Model 0160,  Implantable defibrillator/pacemaker lead Lead Lengths: 59 - 90cm $11,440.00

 Model 0161, Model 0162, Model 0163

GU160 Endotak Reliance Active Fixation Lead Endotak Reliance Active Fixation Lead:  54cm - 90cm $7,200.00

 Models 0157, 0158 and 0159 Implantable

 cardioverter defibrillator lead

GU161 Endotak Reliance S Active Fixation Lead Endotak Reliance S Active Fixation Lead:  54cm - 90cm $7,200.00

 Models 0137, 0138 and 0139

GU163 ENDOTAK RELIANCE G Lead 018 Series Endotak Reliance G Lead: Models 0184 to 59-90cm $7,200.00 $11,000.00

  0187.  Implantable cardioverter

 defribrillator lead.  Active fixation.

GU164 ENDOTAK RELIANCE SG Lead 018  Endotak Reliance SG Lead: Models 0180  59-90cm $7,200.00 $11,000.00

 to 0183.  Implantable cardioverter

 defibrillator lead.  Active fixation.

 Medtronic Australasia Pty Ltd

MC208 Medtronic Sprint Quattro Secure Lead  Leads, Defibrillator, Implantable, Silicone, 58-100cm $9,360.00

 Model 6947 58cm; Model 6947 65cm;   polyurethane, platinized tantalum coils,

 Model 6947 75cm; Model 6947 100cm steroid eluting tip

MC331 Medtronic Sprint Lead Model 6943 Model 6943-58, Model 6943-65, Model  58 - 100cm $7,488.00

 6943-75, Model 6943-100; Silicone

MC341 Medtronic Sprint Lead Model 6945 Model 6945-58, Model 6945-65; Silicone, 58 - 100cm $7,488.00

  Model 6945-75, Model 6945-100; Silicone

MC695 Sprint Fidelis Lead Model 6949, dual-coil, screw-in 58-100cm $10,000.00

MC697 Sprint Fidelis Lead Model 6931, single-coil, screw-in 58-100cm $10,000.00

Prostheses List by Category, Groups and Sponsor Page 21 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 St. Jude Medical Australia Pty Ltd

SJ074 Riata Transvenous tachyarrhythmia Leads Tri-polar Active - Fixation, Steroid- 60cm, 65cm, 8F introducer $10,400.00

  Model 1582 Eluting, Single shock Coil

SJ075 Riata Transvenous Tachyarrhythmia Lead Quadripolar, dual-coil, steroid eluting,  One size only $10,400.00

  Model 1580, Model 1581 active fixation tachyarrhythmia leads

SJ081 Riata i Transvenous Tachyarrhythmia  Active fixation leads, Steroid Eluting,  60cm, 65cm, 75cm, 8F  $10,000.00

 Leads Model 1590/1591 Dual Shock Coil Defibrillation Lead

SJ084 Riata i Transvenous Tachyarrhythmia  Active Fixation, Steroid Eluting, Single  60cm, 65cm, 75cm, 8F  $10,000.00

 Lead Model 1592 Shock Coil Defibrillation Lead

Limited Functionality ICDs

 Generation 2

 Biotronik Australia Pty Ltd

BT052 Cardiac Airbag Single chamber ICD rate responsive  One size only. $15,600.00

Mesh, Polymeric

 W L Gore & Associates

GT128 Helex Septal Occluder ePTFE 15-35mm $10,200.00

Occluders

 Medtel Australia Pty Ltd

ME068 Amplatzer PFO Occluder Nitinol Wire Mesh 25mm & 35mm $10,200.00

 St. Jude Medical Australia Pty Ltd

SJ091 Premere PFO Closure System Percutaneous, transcatheter, self- Left Atrial Anchor diameter  $9,820.00

 expanding, dual anchor, occlusion device 20mm and 25mm

Prostheses List by Category, Groups and Sponsor Page 22 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Occluders, Vascular

 Medtel Australia Pty Ltd

ME065 Amplatzer Duct Occluder Nitinol Wire Mesh 5 - 24mm $10,200.00

ME066 Amplatzer Septal Occluder Nitinol Wire Mesh 4mm - 40mm $10,200.00

ME067 Amplatzer Muscular VSD Occluder Nitinol Wire Mesh 4 - 24mm $10,200.00

ME074 Amplatzer Membranous VSD Occluder Nitinol wire mesh, double disc occluder  4-24mm, Length 7-10mm $10,200.00

 and delivery system

Pacemaker Lead Adapters, Implantable

 Guidant Australia Pty Ltd

GU129 LV-1 Lead Adaptor to IS-1 Connects Left ventricular leads to IS-1  One size only $500.00

 ports in pacemakers and defibrillators to

 replace abnormal cardiac excitation

GU130 Y Adaptor Connects multiple defibrillator electrodes  One size only $500.00

 to a common port, enabling the use of

 shocks to revert Ventricular Tachycardia

 and normal cardiac function to return

 Medtronic Australasia Pty Ltd

MC035 Medtronic lead Extender Kit Model:  Silicone 14 - 50cm $530.00

 6984M, 6981M, 6985M, 5866-24M,

 5866-38M, 5866-40M, 6986M, 5866-

 37M; Bipolar Lead Adaptor Kit Model 2872

MC036 Medtronic Lead End Cap Kit Model:  Silicone or Polyurethane; Plug to Seal IS- 10 - 25mm, IS-1 Pin Plug - One $80.00

 5867-3M; Medtronic Adaptor Kit Line  1 connector in a pacemaker or   Size only

 5866-23; Connector Sleeve 5866-45;    defibrillator, Silicone

 Metronic lead sleeve kit model: 5866-46;

 Medtronic Pinplug kit. Model 6719, IS-1

Prostheses List by Category, Groups and Sponsor Page 23 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC246 DF-I Y-Adaptor/Extender Model 6726  Silicone Lengths 25cm, 37cm $537.00

 25cm & 37cm

Pacemaker leads

 Group 1 - Non-transvenous, Bi-Polar, Steroid

 Medtronic Australasia Pty Ltd

MC011 Capsure EPI steroid eluting bipolar  Silicone 25 - 60cm $1,716.00

 epicardial lead Model 4968 - ventricle

 Group 11 - Transvenous, Bi-Polar, Passive, Steroid, Left Ventricular

 Guidant Australia Pty Ltd

GU138 Easytrak 2, Model 4514,4515, 4516,  The Easytrak 2 lead is a dual electrode  $6,240.00

 4517, 4518, 4519, 4520 version of the Easytrak lead.  The

 Easytrak 2 lead is a coronary sinus lead,

 steroid eluting, dual electrode, pace/sense

 lead.  The lead provides chronic pacing

 and sensing of the left ventricle by

 placement in the coronary venous

GU153 Easytrak 2 Is-1 Lead - Models 4542,  Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00

 4543 & 4544

GU156 Easytrak 3 Lead - Models 4521, 4522,  Implantable left ventricular pacemaker lead 80 to 100cm $6,240.00

 4523, 4524, 4525, 4526 and 4527

GU162 Easytrak 3 IS-1 Lead Models 4548, 4549 and 4550. Silicone  Sizes 80 to 100cm $6,240.00

 and polyurethane insulation and

 polyurethane protective sleeve

GU165 Acuity Steerable Lead Steerable IS-1 bipolar CS LV Lead 80cm, 90 cm, 100cm $6,000.00

 Models 4554, 4555, 4556

 Medtronic Australasia Pty Ltd

MC699 Attain OTW Model 4194 Lead Model 4194 78cm, 88cm $6,000.00

Prostheses List by Category, Groups and Sponsor Page 24 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 2 - Non-transvenous, Uni-Polar, Steroid

 Medtronic Australasia Pty Ltd

MC053 Capsure EPI steroid eluting unipolar  Silicone 25 - 50cm $1,544.00

 epicardial lead Model 4965 ventricle

 Group 3 - Non-Transvenous, Uni-Polar, Non-Steroid

 Guidant Australia Pty Ltd

GU037 Myocardial Pacing Lead Model 4312 and 4316 54cm and 35cm $1,144.00

 Medtronic Australasia Pty Ltd

MC009 Medtronic Epicardial Pacing Leads IS-1  Silicone 35 - 53cm $1,144.00

 Model 5071

 Group 4 - Transvenous, Uni-Polar, Passive, Steroid, Right Ventricular/Atrial

 Medtronic Australasia Pty Ltd

MC254 CapSure Sense pacemaker lead Models  Titanium Nitride 30 - 85cm $1,248.00 Also grouped in Pacemaker Lead

 Group 8

 St. Jude Medical Australia Pty Ltd

SJ078 IsoFlex S, Models 1645K, 1643K, 1635K Endocardial, Steroid Eluting, Silicone,  34cm, 40cm, 46cm, 52cm,  $1,200.00

 Passive Fixation Leads with Fast-Pass  58cm, 85cm, 7F

 Group 5 - Transvenous, Uni-Polar, Passive, Non- Steroid, Left Ventricular

 Medtronic Australasia Pty Ltd

MC037 Medtronic Attain Cardiac Vein Pacing  Polyurethane; 4 FR Polyurethane, 5 FR  58 - 75cm: 85cm/75cm/110cm  $2,735.00

 Lead Model 2187; Medtronic Coronary  Electrode Tip, Kit Includes: Stylet x 3,  or 75-110cm; 75cm/85cm

 Sinus Pacing Lead Model 2188;  Valve lifter, Attain Lead & Anchoring

 Medtronic Attain SD Model 4189;  Sleeve; 4 FR Polyurethane Body, 6.1FR

 Medtronic Attain Side-Wire Model 4191

 St. Jude Medical Australia Pty Ltd

SJ033 Aescula LV Model 1055K Left Ventricular Pacing Lead 75cm $2,735.00

Prostheses List by Category, Groups and Sponsor Page 25 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 6 - Transvenous, Uni-Polar, Passive, Steroid, Left Ventricular

 Biotronik Australia Pty Ltd

BT070 Corox OTW UP Steroid Coronary Sinus Lead 77, 87cm $3,000.00

 Guidant Australia Pty Ltd

GU056 Easytrak Lead Model 4510, Model 4511, Model 4512  65cm, 72cm, 80cm $3,120.00

 Transvenous Coronary Sinus Lead

GU152 Easytrak IS-1 Lead, Models 4535 to 4538 Implantable left ventricular pacemaker lead 80 - 90cm $3,120.00

 Medtronic Australasia Pty Ltd

MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm $3,120.00

 St. Jude Medical Australia Pty Ltd

SJ079 QuickSite Model 1056K Unipolar, Steroid Eluting, Titanium Nitride 75cm, 6F and 86cm, 6F $3,000.00

  Electrode, Guidewire/Stylet-placed Left

 Heart Lead with Fast-Pass Coating

 Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial

 St. Jude Medical Australia Pty Ltd

SJ013 Transvenous Superior Vena Cava Lead  TVL lead system models SV01, SV02,  SV01- 100cm; SV02 - 45cm;  $7,280.00

 Model SV01, Transvenous Superior Vena SV03 transvenous leads SV03 - 55cm

  Cava Lead Model SV02, Transvenous

 Superior Vena Cava Lead Model SV03

 Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial

 Biotronik Australia Pty Ltd

BT066 Selox ST Transvenous Bipolar Passive Steroid  53 and 60cm lengths $1,248.00

 Ventricular Pacing Lead, fractal coated

BT067 Selox JT Fractal coated steroid electrode 45 and 53cm lengths $1,248.00

 Guidant Australia Pty Ltd

GU009 Fineline II Sterox IROX Lead Model 4458, Model 4459 52cm, 58cm $1,248.00

Prostheses List by Category, Groups and Sponsor Page 26 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GU011 Fineline II Sterox IROX Lead Model 4456, Model 4457 52cm, 58cm $1,248.00

GU012 Fineline II Sterox IROX Lead Model 4479, Model 4480 45cm, 52cm $1,248.00

GU023 Guidant Aust Selute Picotip Steroid  Model 4033, Model 4034, Model 4035,  45cm , 52cm, 59cm $1,248.00

 Eluting Bipolar Lead Model 4063, Model 4064

 Medtronic Australasia Pty Ltd

MC010 Medtronic Capsure SP Novus Model  Silicone Polyurethane 45 -110cm $1,144.00

 5092; Capsure SP Novus Lead Model

 5592; Medtronic Capsure Model 4023

 Lead; Medtronic Capsure Model 4024

 Lead (med.dexamethasone) Medtronic

 Capsure Model 4523(MED) Medtronic

 Capsure Model 4524 Lead; Medtronic

 Capsure Model 5023M Lead; Medtronic

 Model 5024M Capsure Lead; Medtronic

 Model 5024M Capsure Lead; Medtronic

 Capsure Model 5524M SP Bipolar Lead

MC229 Medtronic Capsure SP Novus Model  Silicone, platinum 30-100cm $1,144.00

 5594 Lead 30cm

MC336 Medtronic Capsure Z Novus Model 5054  Silicone; Contents: 1 x lead with  45-58cm $1,248.00

 Pacing Lead anchoring sleeve, stylet & guide, 1 x vein

 lifter, 2 x fixation tools, extra stylets

MC337 Medtronic Capsure Z Novus Model 5554  Silicone; Contents: 1 x lead with  45-58cm $1,248.00

 Pacing Lead anchoring sleeve, stylet & guide, 1 x vein

 lifter, 2 x fixation tools, extra stylets

MC371 Medtronic Capsurefix Model 6940 Pacing Silicone Polyurethane 30 - 85cm $1,144.00

  Lead;  Medtronic Tined IS-1 Model

 4557M; Medtronic Capsurefix Model

 4067/8/4568 Pacing Leads;  Medtronic

 Capsurefix Model 5067 Pacing Leads;

 Medtronic Capsurefix Model 5068 Pacing

  Leads; Capsure SP Novus Pacing Lead

 Model 4092; Capsure SP Novus Pacing

MC372 CapSure Sense pacemaker lead Models  Titanium Nitride CapSure Sense Lead Model  $1,248.00

 4074 & 4574 4074 - 30cm to 85cm; CapSure

 Sense Lead Model 4574 - 30cm

Prostheses List by Category, Groups and Sponsor Page 27 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 St. Jude Medical Australia Pty Ltd

SJ024 PASSIVE PLUS DX 1342T, 1343K,  Single, passive fixation, steroid eluting,  46-58cm $1,248.00

 1345K, 1346T low polarisation lead; Models: Bipolar

 Atrial Lead, IS-1 Unipolar Atrial Lead, IS-

 1 Unipolar Ventricular Lead, IS-1 or

 Bipolar Ventricular Lead, IS-1

SJ082 Isoflex S, Models 1646T, 1642T and  endocardial, Steroid Eluting, Silicone,  34cm, 40cm, 46cm, 52cm,  $1,200.00

 Passive Fixation Pacing Leads with Fast- 58cm, 85cm, 7F, 120cm 8F

 Pass Coating

 Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial

 Biotronik Australia Pty Ltd

BT063 Selox SR Lead, pacemaker, implantable,  45, 53, 60cm length $1,248.00

 Guidant Australia Pty Ltd

GU013 Fineline II EZ Sterox IROX Lead Model 4472, Model 4473 & Model 4474 45cm, 52cm, 58cm $1,248.00

GU016 Fineline II EZ Sterox IROX Lead Model 4469, Model 4470 & Model 4471 45cm, 52cm, 58cm $1,248.00

GU122 Flextend Lead Models 4086, 4087 &  Bipolar, steroid eluting, transvenous  45,52,59cm $1,248.00

 silicon pace/sense leads with an

 extendable/retractable active fixation for

 implantation into the atrium or ventricle

 Medtronic Australasia Pty Ltd

MC008 Medtronic Capsurefix Model 5568 Pacing Silicone Polyurethane 30 - 85cm $1,144.00

  Leads

MC338 Medtronic Capsurefix Novus Model 5076 Silicone; Contents: 1 x lead with  45-85cm $1,248.00

  Pacing Lead anchoring sleeve, stylet & guide, 1 x vein

 lifter, 2 x fixation tools, extra stylets

 St. Jude Medical Australia Pty Ltd

SJ023 TENDRIL SDX 1488T, 1388T Single, Active Fixation, Steroid Eluting,  46cm-58cm $1,248.00

 Low Polarisation Lead, IS-1

SJ073 Tendril SDX Models 1688T and 1688TC Endocardial Steroid-Eluting Active  100cm, 25cm, 34cm, 40cm,  $1,248.00

 Fixation Pacing Lead 46cm, 52cm, 58cm, 85cm, 7F

Prostheses List by Category, Groups and Sponsor Page 28 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Cardiac Valve, Artificial

 Medtronic Australasia Pty Ltd

MC013 Medtronic Hall Heart Valve Aortic Model  A7700/M7700 Titanium. Pyrolite.  A7700 - Diameter 20-31mm,  $5,000.00

 A7700, Medtronic Hall Heart Valve Mitral  Dacron, A7700EZ/M7700EZ Titanium.  M7700 - Diameter 23-33mm,

 Model M7700, Hall Easy Fit Aortic Heart  A7700EZ - Diameter 19-29mm,

 Valve Model A7700, Hall Easy Fit Mitral  M7700EZ - Diameter 23-31mm

 Heart Valve Model M7700

MC681 Advantage Mitral Mechanical Heart Valve 23mm-33mm $5,909.00

 Group 1c - Bi-Leaflet, rotatable

 St. Jude Medical Australia Pty Ltd

SJ037 St Jude Medical Aortic Expanded Cuff  Aortic Expanded Cuff, Aortic  Aortic Expanded 19 -31mm,  $5,909.00

 Heart Valve; St Jude Medical Aortic  Hemodynamic Plus Cuff, Mitral  Aortic Hemodynamic 17 -

 Hemodynamic Plus Cuff Heart Valve; St  Hemodynamic Cuff, Aortic & Mitral  27mm, Mitral Hemodynamic 17

 Jude Medical Mitral Hemodynamic Plus  -27mm, Rotatable 17 - 33mm

 Cuff Heart Valve; St Jude Medical

 Mechanical Heart Valve Masters Series

SJ039 St Jude Medical Regent Prosthetic Heart  Standard Cuff - Model 17AGN-751 -  Standard cuff - 17-29mm, Flex  $5,909.00

 Valves 29AGN-751, Flex Cuff - Model  cuff - 17-29mm

 17AGFN-756 - 29AGFN-756

 Group 3a - Mechanical Valve

 St. Jude Medical Australia Pty Ltd

SJ036 St Jude Medical Coated Aortic Valved  Coated Aortic Valved Graft  21mm - 33mm $6,800.00

Prostheses List by Category, Groups and Sponsor Page 29 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Cardiac Valve, Biological

 Edwards Lifesciences Pty Ltd

EL039 Edwards Perimount Magna Model 3000 Carpentier-Edwards Perimount Magna  19MM Aortic Pericardial Tissue  $4,900.00 $5,690.00

 composition: Glutaraldehyde treated  Valve; 21MM Aortic Pericardial

 bovine pericardium/elgiloy wireform  Tissue Valve; 23MM Aortic

 stent/polyester band/silicone rubber  Pericardial Tissue Valve; 25MM

 suture ring/polytetrafluoroethylene  Aortic Pericardial Tissue Valve;

 cloth/polyester cloth. 27MM Aortic Pericardial Tissue

 Valve; 29MM Aortic Pericardial

 Tissue Valve

 Tag Medical

TM039 Mitroflow Pericardial Bioprosthesis 19-27mm $4,445.00 $4,950.00

 Group 2a - Stented, porcine

 St. Jude Medical Australia Pty Ltd

SJ069 St Jude Medical Biocor Porcine  St Jude Medical Biocor Porcine  Aortic Valves - Tissue Annulus  $4,350.00

 Prosthetic Heart Valve Prosthetic Heart Valve is manufactured  Diameter - 21-29mm,  Implant

 from selected porcine aortic valve cusps  Height - 11-15c;  Mitral Valves -

 that have been cross-linked with a   Tissue Annulus Diameter - 25-

 35mm, Implant Height - 8-

Recorders, Long Term, ECG, Implantable

 Medtronic Australasia Pty Ltd

MC028 Medtronic Reveal ILR Model 9525,  Titanium 8cc $3,635.00

 Implantable Cardiogram Recorder; 

 Reveal Plus Implantable Loop Recorder

Prostheses List by Category, Groups and Sponsor Page 30 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Single Chamber ICDs

 Generation 1

 St. Jude Medical Australia Pty Ltd

SJ058 St Jude Medical Australia Ventritex  Contour MD Models V - 175 AC, V-175C 57-65cc, 109 - 118g $33,462.00

 Contour MD Models V-175AC, V-175D   and V-175D Single chamber

 and V- 175C Defibrillators/Cardioverters Defibrillators/Cardioverters

 Generation 2

 Biotronik Australia Pty Ltd

BT054 Lexos VR Single chamber ICD, Rate responsive  One size only. $36,400.00

 Medtronic Australasia Pty Ltd

MC201 Medtronic A/Asia Gem III VR Model  Titanium One size only, 39.2cc $36,400.00

 7231CX

 Progressive Medical

PG001 Alto II VR Single Chamber ICD Debrillator, implantable, automatic $36,400.00

 Generation 3

 Biotronik Australia Pty Ltd

BT055 Lexos A+ Single chamber ICD, rate responsive  One size only. $40,560.00

 pricing, dual chamber sensing.

 Guidant Australia Pty Ltd

GU110 Ventak Prizm II VR Model 1860, titanium, single chamber,  One size only $40,560.00

 adaptive rate

GU133 Vitality VR Model 1870 This device acts to defibrillate the heart  Model 1870 Vitality VR Single  $40,560.00

 chambers when the patient enters into an  Chamber Rate Responsive

 arrhythmia or uses shocks or anti tachy  Pacemaker/Defibrillator

 pacing to revert Ventricular Tachycardia

 (VT) or Ventricular Fibrillation (VF).

 While also acting as a single chamber

Prostheses List by Category, Groups and Sponsor Page 31 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GU148 Vitality 2 EL VR - Model T177 Implantable Cardiac Defibrillator 35cc 90g $40,560.00

GU151 Vitality 2 VR - Model T 175 Implantable cardiac defibrillator 30cc; 82g $40,560.00

 Medtronic Australasia Pty Ltd

MC253 Medtronic Marquis VR 7230CX  Titanium, Sterile, Single Chamber Volume 36cc $40,560.00

 Implantable Cardioverter Defibrillator

MC365 EnTrust Model D153VRC, Single chamber, 30J 33cc, 63g $40,560.00

 St. Jude Medical Australia Pty Ltd

SJ010 Photon Micro VR Model V-194  36cc $40,560.00

 Defibrillators/Cardioverters

SJ048 Epic Plus VR Model V-196 Implantable  Single Chamber sensing and bradycardia  32cc $40,560.00

 Cardioverter Defibrillator pacing

Single Chamber Pacemakers

 Generation 1

 Biotronik Australia Pty Ltd

BT036 PHILOS S Implantable Cardiac Pulse  Multiprogrammable SSI One size only $4,264.00

 Generator Cat No 122 453

 St. Jude Medical Australia Pty Ltd

SJ020 REGENCY SC+ 2402L Single Chamber,  VVI,  Autocapture, IS-1 8.6cc, 18.5gm $4,264.00

SJ053 Verity Adx Model XL SC 5056  Single Chamber multi-programmable rate- 10.5cc, 23g $4,264.00

 implantable pacemaker adaptive pacing device with extended

 longevity

 Generation 2

 St. Jude Medical Australia Pty Ltd

SJ076 Verity Adx Model  XL SR 5157 M/S  Single Chamber  multi-programmable  11cc, 23g $5,928.00

 implantable pacemaker rate-adaptive pacing devices with

 extended longevity

Prostheses List by Category, Groups and Sponsor Page 32 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Generation 3

 Biotronik Australia Pty Ltd

BT028 Philos SR Model 122459 Implantable  Multiprogrammable, rate responsive,  One size only $5,928.00

 Pacemaker

BT030 Philos SR-B Model 122610 Implantable  Multiprogrammable, rate responsive,  5/6mm port, One size only $5,928.00

 Pacemaker

BT046 Protos VR/CLS Single chamber rate responsive, closed  One size only $5,928.00

 loop system.

BT062 Philos II SR Multiprogrammable, Rate Responsive,  One size only $5,928.00

 SSIR pacemaker

BT080 Cylos VR single chamber dual sensor rate responsive one size only $5,700.00

 Guidant Australia Pty Ltd

GU124 Insignia Entra SR Models 1195 & 1198 Single Chamber Rate Responsive  One size only $5,928.00

 Permanent Pacemaker

GU126 Insignia Plus SR Model 1194 Single Chamber Rate Responsive  One size only $5,928.00

 Permanent Pacemaker

GU139 Insignia Ultra SR Lodel 1190 Implantable Cardiac Pacemaker One size only $5,928.00

 Medtronic Australasia Pty Ltd

MC321 EnPulse SR Series: Model E2SR01,  EnPulse SR - Pacemakers - with IS1  One size only $6,188.00

 Model E2SR03, Model E2SR06 connector; with 3.2mm low profile

 connector; with 5mm connector.

MC728 Adapta Pacemaker SR Pacemaker 9.7 - 11.0cc $5,950.00

 Models ADSR01, ADSR06, ADSR03 21.5 - 22.5g

 Progressive Medical

PG006 Symphony SR Titanium one size only $5,928.00

 St. Jude Medical Australia Pty Ltd

SJ022 REGENCY SR+ 2400L Single Chamber, Rate Response,  8.6cc, 18.5gm $5,928.00

 Autocapture, IS-1

Prostheses List by Category, Groups and Sponsor Page 33 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SJ025 St Jude Medical Integrity SR5142  Single chamber, rate responsive  Volume 10.4cc, weight 23gm $5,928.00

 Pacemaker, Cardiac Implantable

SJ029 Integrity Micro SR 5136 Pacemaker Single Chamber Rate Responsive  Volume 8cc, weight 18gm $5,928.00

SJ030 Identity SR 5172 Single Chamber Rate Responsive  Volume 8cc, Weight 17gm $5,928.00

SJ055 Integrity ADx Model SR 5160 implantable Single Chamber multi-programmable rate- 8cc, 17g $5,928.00

  pacemaker adaptive pacing device

SJ060 Identity ADx Model SR 5180 implantable  Single Chamber multi-programmable rate- 8cc, 18g $5,928.00

 pacemaker adaptive pacing device

SJ077 Verity Adx Models XL SR 5156  Single Chamber  multi-programmable  11cc, 23g $5,928.00

 implantable pacemaker rate-adaptive pacing devices with

 extended longevity

SJ090 Victory SR 5610 single chamber rate responsive  41x44x46mm 17g 8cc $5,700.00

Special Implantable Cardioverter Defibrillator Leads

 Group 2 - Subcutaneous Leads

 Guidant Australia Pty Ltd

GU123 Endotak SQ Array XP Lead Model 0085 Endotak SQ Array XP Lead Model 0085  70 cm $4,680.00

 is used in addition to an Endotak

 endocardial leads for patients with a high

 DFT (Defibrillation Threshold)

 Medtronic Australasia Pty Ltd

MC251 Implantable Subcutaneous Defibrillator  Silicone and Platinum Alloy Lengths 41-85cm inclusive $4,680.00

 Lead Model 6996SQ 41cm, 58cm, 85cm

 Group 7 - Epicardial Patches

 Medtronic Australasia Pty Ltd

MC027 Model 6721 Unipolar Epicardial Patch  Model 6721S-50, Model 6721M-50,  370, 660, 840mm $2,340.00

 Leads S/M/L Model 6721L-50; Silicone

Prostheses List by Category, Groups and Sponsor Page 34 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Special Purpose Dual Chamber Pacemaker - Custom Header

 Generation 3

 Medtronic Australasia Pty Ltd

MC241 Medtronic Kappa Pacemaker Model KDR  Cardiac Pacemaker, Titanium 13.9cc $9,048.00

MC332 Medtronic Kappa Pacemaker KDR 903  Cardiac Pacemaker, Titanium 13cc, 14.2cc $9,048.00

 and KDR 906

MC340 Medtronic Kappa 400 pacemaker Model  Titanium 13.9cc $9,048.00

 KDR403

Special Purpose ICDs - High energy products

 Generation 1

 Medtronic Australasia Pty Ltd

MC019 Medtronic Gem DR Model 7271 Titanium  62cc $36,400.00

MC020 Medtronic Gem Model 7227Cx;  Gem  Titanium 49cc, 40cc $34,320.00

 Model 7227 Implantable Cardioverter

 Generation 2

 Guidant Australia Pty Ltd

GU107 Ventak Prizm HE DR Model 1853 & Model 1858, titanium, dual One size only $40,560.00

  chamber, adaptive rate

 Generation 3

 Medtronic Australasia Pty Ltd

MC317 Maximo VR Model 7232Cx Titanium One size only 38.5cc $42,640.00

MC318 Maximo DR Model 7278 Titanium One size only 38.9cc $45,760.00

MC362 EnTrust Model D154DRG, dual chamber, VT  35cc, 68g $45,760.00

 Therapies, 35J

Prostheses List by Category, Groups and Sponsor Page 35 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC366 EnTrust Model D154VRC,  Single chamber, 35J 35cc, 68g $42,640.00

MC722 Virtuoso VR Model 37cc, 68g $41,000.00

 Implantable Cardioverter Defibrillator,

 Single Chamber

 St. Jude Medical Australia Pty Ltd

SJ011 Atlas DR Model V-240 Dual chamber implantable cardioverter  37cc $45,630.00

 defibrillator with rate response

SJ012 Atlas VR Model V-199 Single chamber implantable cardioverter  36cc $42,588.00

 defibrillator with rate response

SJ063 Atlas DR Model V-242 ICD Implantable Dual Chamber Cardio-verter  38cc/78g $45,760.00

 Defibrillator

SJ065 Atlas + VR Model V-193 ICD Single chamber implantable cardio-verter  38cc, 77g $42,640.00

 defibrillator

SJ066 Atlas + VR - C Model V-193C ICD Single chamber implantable cardio-verter  38cc, 77g $42,640.00

 defibrillator

SJ068 Atlas + DR Model V-243 ICD Implantable Dual Chamber Cardio-verter  38cc, 78g $45,760.00

 Defibrillator

Special Purpose ICDs - With custom headers

 Generation 1

 Medtronic Australasia Pty Ltd

MC237 Gem Model 7227B Implantable  Titanium, "B" Style Connector 56cc $33,800.00

 Cardioverter Defibrillator

MC238 Gem Model 7227D Implantable  Titanium, "D" style connector 53cc $33,800.00

 Cardioverter Defibrillator

MC239 Gem Model 7227EImplantable  Titanium, "E" style connector 55cc $33,800.00

 Cardioverter Defibrillator

Prostheses List by Category, Groups and Sponsor Page 36 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Special Purpose ICDs - With therapies for Atrial Tachyarrhythmia

 Generation 2

 Medtronic Australasia Pty Ltd

MC227 Medtronic Gem III AT Model 7276  Titanium 39.5cc $40,560.00

 Implantable Cardioverter Defibrillator

 Generation 3

 Guidant Australia Pty Ltd

GU137 Vitality AVT Dual chamber defibrillator, with atrial and One size only $45,760.00

  ventricular therapy

GU157 Vitality AVT - Model A155 Implantable cardiac defibrillator with both 30cc $45,760.00

  Atrial and Ventricular tachyarrhythmia

 therapy

 Medtronic Australasia Pty Ltd

MC349 Entrust Model D 153ATG, Dual chamber, AT  33cc, 63g $45,760.00

 Therapies, 30J

MC364 EnTrust Model D154ATG, Dual chamber, AT  35cc, 68g $45,760.00

 Therapies, 35J

MC721 Virtuoso DR Model 37cc, 68g $44,000.00

 Implantable Cardioverter Defibrillator,

 Dual Chamber

Special Purpose ICDs with CRT - High energy products

 Generation 2

 Guidant Australia Pty Ltd

GU144 Contak Renewal 4 HE CRT-D Model  Implantable dual-chamber defibrillator one size only $47,840.00

 H197, Model H199

 Medtronic Australasia Pty Ltd

MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc $52,000.00

Prostheses List by Category, Groups and Sponsor Page 37 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC700 InSync Maximo Model 7304 40cc, 35J $46,000.00

MC720 Concerto CRT-D Implantable Cardioverter Defibrillator  38cc $50,000.00

 with Cardiac Resynchronisation Therapy

 St. Jude Medical Australia Pty Ltd

SJ064 Atlas + HF Model V - 341 ICD -  Atlas + HF ICD is a cardioverter  40cc/81g $47,840.00

 Defibrillator, Implantable, automatic,  defibrillator with dual chamber (atrial and

 dual-chamber RV) sensing and bradycardia Pacing with

 ventricular resynchronisation therapy.

 Generation 3

 Medtronic Australasia Pty Ltd

MC359 Intrinsic Model 7288, Implantable Cardioverter  38cc, 76g $45,760.00

 Defibrillator

Special Purpose ICDs with CRT - With therapies for Atrial

 Generation 2

 Guidant Australia Pty Ltd

GU154 Contak Renewal 4 AVT CRT -D - Model  Implantable Cardioverter Defibrillator  37cc; 89g $50,960.00

 M170 and M175 with Cardiac Resynchronisation Therapy

GU155 Contak Renewal 4 AVT HE CRT - D -  Implantable Cardioverter Defibrillator  40cc; 89g $52,000.00

 Model M177, M179 with cardiac resynchronisation Therapy

Special Purpose Pacemaker - Small size (<7cc) for pacing in infants

 Generation 3

 St. Jude Medical Australia Pty Ltd

SJ027 St Jude Medical Microny II SR+ Model  Single Chamber Rate Responsive  Volume 5.9cc, Weight 12.8gm $5,928.00

 2525T Pacemaker

Prostheses List by Category, Groups and Sponsor Page 38 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Special Purpose Pacemaker - with Therapies for Atrial

 Generation 3

 Medtronic Australasia Pty Ltd

MC200 Medtronic A/Asia AT500 DDDRP Pacing Titanium, silicone One size only, 14.9cc $11,440.00

  System Model AT501

MC360 EnRhythm Model P150 1DR, Rate Responsive dual  21g, 13cc $11,440.00

 chamber pacemaker with Anti-

 Tachycardia functions: DDDRP

Special Purpose Pacemaker Leads - Catheter Delivered

 Group 9 - Transvenous, Bi-Polar, Active, Steroid, Right Ventricular/Atrial

 Medtronic Australasia Pty Ltd

MC301 Model 3830 PACING LEADS Active fixation pacemaker lead 59 - 75 cm $2,600.00

 Composition: Insulation is polyurethane,

 Electrodes are Titanium Nitride coated

 Platinum, the screw is steriod-coated

Special Purpose Pacemaker Leads - VDD Leads

 Group 7 - Transvenous, Bi-Polar, Passive, Non-Steroid, Right Ventricular/Atrial

 Biotronik Australia Pty Ltd

BT009 SL Tripolar Lead - SL60/130,  Single pass lead 130mm, 150mm, 110mm $1,040.00

 BP,SL60/150-BP, SL60/110-BP

 Group 8 - Transvenous, Bi-Polar, Passive, Steroid, Right Ventricular/Atrial

 Guidant Australia Pty Ltd

GU028 Guidant Aust Selute Picotip VDD Lead Model 4340, Model 4341, Model 4342 &  $1,544.00

 Model 4343

Prostheses List by Category, Groups and Sponsor Page 39 of 784


CARDIO-THORACIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC052 Medtronic Capsure VDD2 Model 5038  Silicone; Contents: 1 x lead with  11.5cm, 13.5cm, 15.5cm $1,544.00

 AV Pacing Lead anchoring sleeve, stylet & guide, 1 x vein

 lifter, 2 x fixation tools, extra stylets

Special Purpose Single Chamber Pacemaker - Custom Header

 Generation 1

 St. Jude Medical Australia Pty Ltd

SJ019 REGENCY SC 2406L, SCX 2408L, SC  Single Chamber, Standard VVIC, IS-1/5- 8.6cc, 18.5-19gm $4,264.00

 2407M/S

 Generation 3

 Medtronic Australasia Pty Ltd

MC030 Medtronic Kappa 400 Pacemaker Model  Titanium 11.6cc, 11.7cc $5,616.00

 KSR401

MC242 Medtronic Kappa KSR 900 Model KSR  Cardiac Pacemaker, Titanium 9.7,10.5,11.0 cc $5,928.00

 901,903, 906

MC330 Medtronic Kappa 400 Pacemaker Model  Titanium 11.6cc, 11.7cc $5,616.00

 KSR 403

Prostheses List by Category, Groups and Sponsor Page 40 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Cannulae, Eye, Lacrimal

 Device Technologies Australia Pty Ltd

DE191 Canaliculus Intubation Sets  Silicone, SS & Nylon 17.7 x .064 x 29cm, 15.5 x .051 $165.00

  x 33cm

Caps, Bone

 Cochlear Limited

CO028 BAHA - Bone Anchored Hearing Aids Cover screw unigrip One size only $364.00

Cement

 Endotherapeutics Pty Ltd

ET031 Serenocem Cement Reaction bonded polymer composite  One size only - box of 2 $1,560.00

 formed by the neutralisation gelletation of

 a basic inorganic ionomer

ET032 Serenocem Granules Reaction bonded polymer composite  0.5 - 1mm granules, 1gm or  $1,070.00

 formed by the neutralisation gelletation of  5gm; 2 - 3mm granules, 1gm or

 a basic inorganic ionomer  5gm - 3 pouches

Prostheses List by Category, Groups and Sponsor Page 41 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Cochlear Implants

 Cochlear Limited

CO017 SPrint Speech Processor  Consists of: SPrint Speech Processor -  Processor: One Size Only,  $4,282.25

 body worn speech processor to suit  Transmit Cable, 8-28cm,

 Nucleus 24 cochlear implant system;  Headset Cable 45-100cm,

 transmit cable; headset cable; headset;  Headset: 0.5-4.0 magnet

 battery case - double; batteries - AA;  strength, Hook small and large

 microphone cover; belt clip; and hook

CO019 ESPrit 3G Speech Processor -  Includes speech processor with titanium  Cable lengths: 6, 8, 10, 20, 28cm $6,790.00

 ear hook, 6 high powered zinc air

 batteries, cleaning brush, microphone

 puffer, earmould compatible earhook,

 soft earhook cover, magnet, drying

 capsules, accessory adaptor and socket

 covers, signal check, coil/cable (x2),

CO024 Nucleus Freedom Implant with Straight  Cochlear implant with straight electrode  One size only $12,570.00

 Electrode in a titanium casing, with a removable

 magnet, banded platinum electrodes

 moulded in a silicone seal.

 Pacing Importers Pty Ltd

PI005 Combi C40+ Implantable Auditory  One Size Only $11,450.00

Ear/Nose/Throat Treatment Units

 Pacific Medical

PM065 Tympo Vent Otological ventilation tubes, short medium Length 2.2 $12.59

  term, Donaldson fluoroplastic/blue

PM066 Tympo Vent Otological ventilation tubes, straight tube Length 7.0 - 7.2mm $7.50

PM068 Tympo Vent Otological ventilation tubes, short medium Length 2.8 $20.00 $20.77

  term, star tube, silicone

Prostheses List by Category, Groups and Sponsor Page 42 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PM072 Tympo Vent Otological ventilation tubes, short medium Length 12.4 $13.32

  term, shepard with tail, silicone/blue

PM074 Tympo Vent Otological ventilation tubes,  paparella  Length 2.2mm $17.83

 with tab

PM075 Tympo Vent Otological ventilation tubes, collar button, Length 1.5mm $29.92

  tubingen type gold, gilded silver

PM079 Tympo Vent Otological ventilation tubes, t-tube Length 6 - 12mm $19.08

PM083 Tympo Vent Otological ventilation tubes, long term,  Length 1.5 $26.78

 collar button - tubingen type, titanium

PM086 Tympo Vent Otological ventilation tubes, short medium Length 1.6 $50.10

  term, reuter bobbin without holes, titanium

PM088 Tympo Vent Otological ventilation tubes, donaldson,  Length 1.5mm - 9.8mm $9.00

 reuter bobbin, shepard

PM089 Tympo Vent Otological ventilation tubes, short medium Length 1.8 $10.55

  term, bevel bobbin, fluoroplastic/blue

PM090 Tympo Vent Otological ventilation tubes, armstrong Length 3.8 - 10.0mm $13.10

PM091 Tympo Vent Otological ventilation tubes, short medium Length 2.0 $8.62

  term, collar button, fluoroplastic/blue

Grafts

 Pacific Medical

PM107 Laryngeal Keel 12-16mm Keel $251.00

Prostheses List by Category, Groups and Sponsor Page 43 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Hearing Aids

 Cochlear Limited

CO033 BAHA - Bone Anchored Hearing Aid -  The BAHA Hearing Aids (Compact  &  $6,000.00 To be claimed only for patients

 Various Models Cordelle II in various colours) are the  with deafness who have

 external hearing processors which are  problems using air conduction or

 attached to the implanted titanium fixture   conventional hearing aids which

 by a snap coupling.   This allows the  is made worse when a hearing

 sound transmission using bone

 conduction for patients where

 conventional hearing devices are not

Larynxes, Artificial

 Pacific Medical

PM057 Provox Voice Prosthesis Long term indwelling; Silicone 4.5,6,8,10,12.5mm $335.00 $356.00 Only able to be claimed once for

 the initial implant

Middle Ear Analyzers

 Medtronic Australasia Pty Ltd

MC256 Pressure Pulse Generator Meniett 20 Composition - Polycarbonate One size only $5,060.00 To be claimed only where

 medical therapy such as lifestyle

 (general health assessment and

 stress reduction) and oral

 medications (diuretics, anti-

 emetics, anti-vertigo and

Prostheses List by Category, Groups and Sponsor Page 44 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Nasal Septum Buttons

 Gyrus Australasia Pty Ltd

GY018 Septal Button Plastipore One size only $149.00

 Medtronic Australasia Pty Ltd

MC264 Septal Button  Silicone 3cm  $149.00

Plugs

 Cochlear Limited

CO025 BAHA - Bone Anchored Hearing Aids Abutment Snap Coupling 5.5mm $895.00

Prostheses, Ear

 Gyrus Australasia Pty Ltd

GY001 Canal Wall Prosthesis Grote, HA Small - Large $543.00

 Pacific Medical

PM028 Stapes Bell/Aerial/Angular Prosthesis/Piston  -  1.75 - 7.00mm $330.00 $444.00

 Gold/Titanium

PM032 K-Piston Gold/Titanium ID 0.4,0.6mm $221.75 $249.00

Prostheses List by Category, Groups and Sponsor Page 45 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Larynx

 Endotherapeutics Pty Ltd

ET040 Vox Implants Vox Implants are solid, irregularly  One size only $8,200.00

 textured, medical grade

 Polydimethylsiloxane Elastomer implants

 suspended in a hydrogel carrier

 Gyrus Australasia Pty Ltd

GY072 Vocal Cord Medialisation Implant Vocom Larynx Medial Implant -  3 - 7mm Head $675.00

 Hydroxylapatite

GY073 Vocal Cord Medialisation Implant Vocom Shim for Medial Implant -  1mm - 3mm Offset $345.00

 Hydroxylapatite

 Pacific Medical

PM033 Montgomery Thyroplasty Implant System Silicone 6,7,8,9,10,11,12 $1,172.00 $1,928.00

Prostheses, Ossicular

 BR & CT Enterprises Pty Ltd

BC001 Titanium Head To suit blue or grey implants $179.00

BC004 Titanium PORP with Fixed Bell and  Maximum lengths of 5.0mm  $360.00

 Removable Head (grey) and 5.5mm (blue) -

 adjustable in 1mm increments;

 O R Paradigm Pty Ltd

OS002 Ossicular Prostheses - PORP ALTO (adjustable Length Titanium  Head Size 2.5mm x 3.5mm;  $675.00

 Ossicular) Partial Length 2.0mm - 5.6mm; Distal

 Diameter 1.2mm (Cup)

OS004 Ossicular Prostheses - TORP/PORP OtoSil Universal Head Size 3.5mm; Length  $450.00

 8.0mm; Shaft Diameter 1.0mm

Prostheses List by Category, Groups and Sponsor Page 46 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OS005 Ossicular Prostheses - PORP OtoSil Partial Head Size 3.0mm - 4.0mm;  $450.00

 Length 6.0mm; Cannulation

 Diameter 1.12mm

OS007 Ossicular Prostheses - PORP Dense HA Partial Head Size 3.0mm - 4.0mm;  $360.00

 Length 5.0mm; Cannulation

 Diameter 1.17mm

OS008 Ossicular Prosthese - PORP Dense HA Footplate Shoe Width 2.0mm; Height 1.32mm $150.00

OS010 Ossicular Prostheses - PORP Dense HA Partial Incus Strut Length 5.0mm; Cannulation  $360.00

 Diameter 1.17mm

OS011 Ossicular Prostheses - PORP Gator Stapes Shaft Diameter 0.6mm; Length  $450.00

 3.5mm - 5.5mm

OS012 Ossicular Prostheses - PORP Titanium Bucket Shaft Diameter 0.4mm -  $490.00

 0.8mm; Length 4.0mm - 5.0mm

OS013 Ossicular Prostheses - PORP Causse Type Fluoroplastic Stapes Shaft Diameter 0.4mm -  $90.00

 0.8mm; Length 3.5mm -

 6.0mm; Loop Diameter 0.6mm

Prostheses, Ossicular, Incus and Stapes

 Gyrus Australasia Pty Ltd

GY002 Ossicular Prosthesis Malleus, Incus and  Goldenberg Footplate - HA One size only $126.00 $915.00

 Stapes

GY003 Ossicular Prosthesis Attic Defect Plate, HA 7-14mm $335.00

GY004 Ossicular Prosthesis Incus  a) Applebaum HA,  b) Goldenberg HA,   a) small - large, b) one size only, $580.00

 c) Kartusch HA , d) Grote HA, e) Wehrs   c) short, medium, long, d) 7-

 (single & double notched) HA 10mm, e) short, average,

GY005 Ossicular Prosthesis - PORP Sheehy plastipore, Drum to stapes, Grote  One size only $190.00 $360.00

 Malleus to stapes, modified, centered or

 offcentered

GY006 Ossicular Prosthesis - PORP/TORP Goldenberg Malleable/HA One Size Only $360.00 $580.00

Prostheses List by Category, Groups and Sponsor Page 47 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GY007 Ossicular Prosthesis Incus  a) Grote HA, b) Wehrs (single & double  a) one size only, b) Short,  $625.00

 notched) HA medium, long

GY008 Piston: Stapes Prosthesis a) Schuknecht Malleus att Piston.  a) 0.6x5.5mm-0.8x6.5, b)  $90.00

 Stainless steel, b) Cawthorne.  0.3x0.8x3.5-0.3x0.8x6mm, c)

 Fluoroplastic, c) Fluoroplastic, d)  0.6x0.6x3.5-0.8x0.6x6mm,

 Schuknecht. Stainless steel, e) Causse.   d) 0.4x3.5-0.5x5mm, e) one

 size only

GY012 Piston: Stapes Prosthesis a) Armstrong. Platinum, b) McGee.  a) 0.6x3.5-0.8x5mm, b)  $104.00

 Stainless steel, c) Richards.  Teflon &  0.6x3.25-0.8x5.5mm,

 c) 0.4x4-0.4x5mm

GY013 Piston: Stapes Prosthesis Fisch-Type Platinum or Stainless Steel 0.4mm  x 6mm $104.00

GY014 Piston: Stapes Prosthesis Bucket Handle Fluoroplastic and stainless  0.4 x 1 x 3.5mm - 0.6 x 1 x 5mm $104.00

 steel

GY015 Piston: Stapes Prosthesis Platinum Fluoroplastic 0.6x3.5mm - 0.8x5mm $104.00

GY016 Piston: Stapes Prosthesis Platinum Fluoroplastic 0.6x3mm - 0.8x5.75mm $104.00

GY017 Piston: Stapes Prosthesis McGee Shepherd's Crook - Stainless  0.6x3.5mm - 0.6x5.5mm $104.00

GY074 Wehrs II Stapes Prostheses Wehrs HAPEX Incus Prostheses, Single  0.6 - 1.57mm Shaft Dia $675.00

 & Double Notch

GY078 Dornhoffer Prostheses Hydroxyapetite head/HAPEX shaft PORP  0.8mm Shaft Dia TORP, 1.3mm $360.00

 and TORP  Shaft Diameter PORP

GY080 Ossicular Chain Prosthesis Micron adjustable TORP/PORP. Titanium 2-10mm, 2-5mm $360.00 $500.00

GY081 Piston: Stapes Prosthesis Smart: Nitinol/Flouroplastic 0.5, 0.6, 0.8 x 3.75-4.75mm $255.00 $535.00

 Medtronic Australasia Pty Ltd

MC258 Ossicular, Incus and Stapes Flex H/A, Dense H/A, Titanium, SS,  0.4 - 1.17mm x 0.9 - 4.0mm x  $330.00

 Fluroplastic, Polycel; Roberson Stapes  4.0 x 10.2mm; 4.0 - 4.75mm

 Prostheses & Big Easy Piston. Middle Ear

  Prostheses

MC259 Ossicular, Incus and Stapes Flex H/A, Polycel, SS Small, Medium, Large, 0.6 x 2.2 $190.00

  x 8.0mm

MC260 Ossicular, Incus and Stapes H/A, Polycel, SS 0.6 - 0.8mm x 3.0 - 4.0mm x  $236.00

 7.0 - 8.0mm

Prostheses List by Category, Groups and Sponsor Page 48 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC261 Ossicular, Incus and Stapes Polycel, SS, Fluroplastic 0.6 - 1.17mm x 0.3 - 4.0mm x  $106.00

 4.75 - 8.0mm

MC262 Ossicular, Incus and Stapes Platinum, Fluroplastic, SS, Polycel 0.4 - 1.17mm x 2.2 - 8.8mm x  $104.00

 3.5 - 10.0mm

MC263 Ossicular, Incus and Stapes SS, Fluroplastic, Polycel 0.5 - 0.6mm x 3.5 - 6.0mm and  $104.00

 One Size Only

MC266 Prostheses Ossicular Incus and Stapes H/A, Polycel, SS 0.6 - 4.0mm x 2.7 - 5.0mm x  $179.00

 1.5 - 10.0mm

Prostheses, Ossicular, Total

 BR & CT Enterprises Pty Ltd

BC007 Titanium Middle Ear Total Implant with  Maximum lengths of 7.0mm  $360.00

 Removable Shoe or Head (grey) and 7.5mm (blue) -

 adjustable in 1mm increments;

 0.3mm and 0.4mm in diameter

BC008 Titanium Middle Ear Total Implant with  Maximum lengths of 7.0mm  $360.00

 Adjustable Head (grey) and 7.5mm (blue) -

 adjustable in 1mm increments;

BC009 Titanium Shoe to suit Titanium Middle Ear Implants To suit blue or grey implants $126.00

 Gyrus Australasia Pty Ltd

GY009 Ossicular Prosthesis -TORP  a) black spanner strut HA, b) black oval  a) one size only, b) 7-10mm, c)  $360.00 $675.00

 top TORP HA, c) black oval top PORP,  0.5-0.7mm

 universal, HA/fluoroplastic

GY010 Ossicular Prosthesis -TORP  Fisch plastipore, Causse modified  One size only $360.00

 plastipore, Shea modified plastipore/

 fluoroplastic, Austin modified plastipore,

GY011 Ossicular Prosthesis -TORP  a) Shea malleable, HA/plastipore, b) Shea  a) one size only, b) 4-8mm $360.00

 plastipore

 Medtronic Australasia Pty Ltd

MC267 Ossicular, Incus and Stapes Universal Middle Ear Prosthesis, titanium  Round 2.5 x 10mm, Cam 4.0 x  $360.00

 round and cam head design 2.7 x 10.0mm

Prostheses List by Category, Groups and Sponsor Page 49 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 O R Paradigm Pty Ltd

OS001 Ossicular Prostheses - TORP ALTO (Adjustable Length Titanium  Head Size 2.5mm x 3.5mm;  $675.00

 Ossicular) Total Length 3.0mm - 8.0mm; Distal

 Diameter 0.8mm

OS003 Ossicular Prostheses - TORP OtoSil total Head Size 3.0mm - 4.0mm;  $450.00

 Length 8.0mm; Shaft Diameter

OS006 Ossicular Prostheses - TORP Dense HA Total Head Size 3.0mm - 4.0mm;  $360.00

 length 4.0mm - 8.0mm; Shaft

 Diameter 0.8mm

OS009 Ossicular Prostheses - TORP Dense HA Total Incus - Stapes Strut Length 8.0mm; Shaft Diameter  $360.00

 0.8mm

 Stryker Australia Pty Ltd

ST795 Titanium Middle Ear Prostheses Fisch Incus Prostheses: short, medium,  2x3mm, 2x4mm, 2 x 5mm $238.00

 large, Titanium

ST796 Titanium Middle Ear Prostheses Fisch Neomalleus Prostheses, Titanium 1.1x5mm $190.00

ST797 Titanium Middle Ear Prostheses Fisch Stapes Prostheses: short, medium,  0.4x7mm, 0.4x8.5mm, 0.4x10mm $238.00

 long, Titanium

ST798 Titanium Middle Ear Prostheses Fisch Total Prostheses: with foot, Titanium 0.6x10mm $360.00

Prosthesis, Internal, Tube, Tympanostomy

 Gary L Hinz and Associates Pty Ltd

GH001 NeoZoline Otological Ventilation Tubes Armstrong, Collar Button, Shepard,  1.10mm, 1.14mm, 1.27mm,  $13.00

 Reuter, Donaldson, Paparella, Shah 1.40mm, 0.76mm

Prosthesis, Internal, Valve, Speech, Tracheostomy

 Pacific Medical

PM117 Passy-Muir Speaking Valve Tracheostomy and Ventilator 15mm I.D./ 22 & 23mm O.D. $102.00

Prostheses List by Category, Groups and Sponsor Page 50 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Reconstruction Blocks, Plastic Surgery

 Medtronic Australasia Pty Ltd

MC255 Medtronic Xomed Australia Material  ePTFE - expanded polytetrafluroethyelene 0.75cm x 40cm x 0.6mm;  $1,110.00

 Implantable Sterile - Gore Thyroplasty 0.4cm x 20cm x 0.6mm; 0.6cm

  x 20cm x 0.6mm

MC265 Silicone Blocks  Netterville Phonoform Block - Right,  Right - One size only, Left -  $275.00

 Left, Wedge & Strip One size only, Wedge - One size

  only & Strip - One size only

Screws, Bone

 Cochlear Limited

CO027 BAHA - Bone Anchored Hearing Aids Flange fixture 4mm and 3mm $895.00

CO030 BAHA - Bone Anchored Hearing Aids Flange Fixture - Titanium Self Tapping 4mm and 3mm $1,035.00

CO032 BAHA - Bone Anchored Hearing Aids Flange Fixture - Titanium Self Tapping 4mm and 3mm  $2,500.00

 with BAHA Abutment

Stents

 Medical Vision Australia Pty Ltd

MF001 Endoxane Silicone tracheal and bronchial stents -  10 - 20mm diameter, 20 -  $1,000.00

 Dumon 60mm length

 William A Cook Aust Pty Ltd

WC074 SONG-Nasolacrimal Duct Stent Set  Nasolacrimal Stent Stent 6Fr, 35mm, Stent Oval or  $283.00

 Acute Angle, Radiopaque

 proximal tip 0.5mm or Entended

  proximal tip.

Prostheses List by Category, Groups and Sponsor Page 51 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stents, Bronchial

 Medical Vision Australia Pty Ltd

MF002 Tracheobronxane Silmet Nitinol wire - tracheal and bronchial  12 - 20mm diameter, 20 -  $2,500.00

 stenets - Dumon 90mm length

Stents, Tracheal

 Technology For Life Pty Ltd

TE010 Tracheal/Broncheal Stent Silicone, Dumon 10/20 to 18/80 $1,000.00 $1,317.00

TE011 Bronchial Tracheal Stent Silicone, Dumon 10/20 to 18/80 $1,000.00 $1,680.00

TE012 Harrell Y Stent Tracheal Silicone, Dumon 10/10/20 to 16/16/70 $1,240.00 $1,740.00

TE013 Westaby T Y Stent Tracheal Silicone, Dumon 10/10/20 to 16/16/90 $1,240.00 $2,160.00

 William A Cook Aust Pty Ltd

WC073 Tracheal/broncheal stent Gianturco-Rosch Trancheobronchial  Expanded Diameter 15-40 mm  $1,240.00

 Length 5cm

Stimulators, Auditory

 Cochlear Limited

CO013 Nucleus 24k Cochlear Implant Model CI24R (ST) One size only $10,600.00

CO014 Nucleus 24 Contour Advance Cochlear  Model CI24R (CA) One size only $11,600.00

 Implant

CO021 Nucleus Freedom Implant with Contour  Cochlear implant.  Titanium casing,  one size only $13,570.00

 Advance Electrode removable magnet, 22 half-banded

 platinum electrodes, moulded in a durable

CO022 Nucleus Freedom Speech Processor Speech processor, and accessories -  One size only $11,500.00

Prostheses List by Category, Groups and Sponsor Page 52 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CO023 Nucleus Freedom Speech Processor Speech processor, and accessories -  one size only $8,050.00

 REPLACEMENT

 Pacing Importers Pty Ltd

PI006 Tempo+ Auditory Implant Speech  Tempo+ Auditory  Implant Speech  One Size Only $12,450.00

Telephone Aids, Hearing-Impaired

 Cochlear Limited

CO006 Nucleus 24 Cochlear Implant System  Set of assistive listening & maintenance  Lapel Microphone: 40-150cm,  $785.00

 Accessories for SPrint Adult devices, consisting of: Lapel Microphone; Personal Audiocable - one size

  Personal Audiocable; Battery Charger;  only, Battery Charger - one size

 Pouch (adult style), Ear Hook; Battery  only, Pouch (adult style),  Ear

 case; Mic Lock; Lapel clip; TV/Hi-Fi  Hook (small and large) Battery

 Cable; Mic sleeve; Dry pack; Accessory  case - single, Mic Lock - one

 case; AC adaptor; Telecoil; and Mic clip size only, Lapel clip - one size

 only, TV/Hi-Fi Cable - one size

 only     Mic sleeve - one size

 only, Dry pack - one size only  

  Accessory case - one size only,

  AC adaptor - one size only,

 Telecoil - one size only, Mic clip

  - one size only

CO007 Nucleus 24 Cochlear Implant System  Set of assistive listening & maintenance  Lapel Microphone: 40-150cm,  $785.00

 Accessories for SPrint Child devices, consisting of: Lapel Microphone: Personal Audiocable - one size

  40-150cm, Personal Audiocable; Battery  only,Battery Charger - one size

 Charger; Pouch (adult style), Ear Hook;  only, Pouch (adult style), Ear

 Battery case; Mic Lock; Lapel clip;  Hook (small and large), Battery

 TV/Hi-Fi Cable; Mic sleeve; Dry pack;  case - single, Mic Lock - one

 Accessory case; AC adaptor; Telecoil;  size only, Lapel clip - one size

 only, TV/Hi-Fi Cable - one size

 only, Mic sleeve - one size only,

  Dry pack - one size only,

 Accessory case - one size only,

 AC adaptor - one size only,

 Telecoil - one size only, Mic clip

  - one size only,  FM Cable - to

 suit Sonic Air Easy Listener

Prostheses List by Category, Groups and Sponsor Page 53 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CO020 Nucleus Cochlear Implant Accessory Kit  Accessory set consists of accessory  Lapel microphone comes in  $500.00

 - ESPrit 3G Speech Processor adapter cable, lapel microphone & lapel  lengths of 40-150cm

 clip, battery cover set and accessory case

Tubes, Myringotomy

 BR & CT Enterprises Pty Ltd

BC010 Ventilation tube Ventilation tube - Silicone - T-tube, T- 1.1mm; 1.27mm lumen $19.00

 tube grommet

BC011 Ventilation Tubes - Collar Button Teflon, w/o wire 1.10mm, 1.25mm, 1.50mm  $12.00

BC012 Ventilation Tubes - Collar Button Teflon w/wire, and titanium w/o wire 0.76mm, 1.00mm, 1.25mm,  $15.00

 1.50mm lumen

BC013 Ventilation Tubes - Collar Button Titanium w wire 1.00mm, 1.25mm, 1.50mm  $19.00

BC014 Ventilation Tubes - Shepherd Teflon, w or w/o wire 1.15mm lumen $12.00

BC015 Ventilation Tubes - Shepherd Titanium, w/o wire 1.00mm, 1.25mm lumen $17.00

BC016 Ventilation Tubes - Shepherd Titanium with wire 1.00mm, 1.25mm lumen $19.00

BC017 Ventilation Tubes - Silicone Armstrong Grommet, Donaldson w &  1.1mm & 1.5mm lumen $15.00

 w/o Tab, Paparella 1 and Paparella 2

 Endocorp Pty Ltd

EC018 Exmoor Plastics Ear Vent Drains -   Without hole, teflon 1.14 mm lumen dia x 2.54 mm  $13.00

 Reuter Bobbin  inner flange dia x 2.54 mm outer

  flange dia x 0.76 inter flange.

 1.52mm total length

EC019 Exmoor Plastics Ear Vent Drains -  Collar Teflon  1.14 mm lumen dia x 2.24 mm  $12.00

  Button inner flange dia x 2.24 mm outer

  flange dia x 1.27 inter flange.

 1.78 mm total length

EC020 Exmoor Plastics Ear Vent Drains  -   Teflon  1.14 mm lumen dia x 3.0 mm  $14.00

 Collar Button inner flange dia x 3.0 mm outer

 flange dia x 1.27 inter flange.

 1.78 mm total length

Prostheses List by Category, Groups and Sponsor Page 54 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EC021 Exmoor Plastics Ear Vent Drains  -   Teflon  1.4 mm lumen dia x 2.55 mm  $14.00

 Collar Button inner flange dia x 2.55 mm outer

  flange dia x 0.85 inter flange.

 1.35 mm total length

EC022 Exmoor Plastics Ear Vent Drains - Collar  Teflon  1.75 mm lumen dia x 2.85 mm  $15.00

 Button  inner flange dia x 2.85 mm outer

  flange dia x 0.95 inter flange.

 1.46 mm total length

EC024 Exmoor Plastics Ear Vent Drains -  Teflon Shephards Drain 1.14 mm lumen dia x 2.36 mm  $14.00

 Shepards Drain inner flange dia x 2.36 mm outer

  flange dia x 1.42 inter flange.

 2.41 mm total length

EC026 Exmoor Plastics Ear Vent Drains - Teflon Teflon Shephards Drain with wire 0.97 mm lumen dia x 2.08 mm  $14.00

  Shephards Drain with wire grasping  inner flange dia x 2.08 mm outer

  flange dia x 1.42 inter flange.

 2.41 mm total length

EC031 Exmoor Plastics Ear Vent Drains -  With tab, silicone rubber 1.1 mm lumen dia x 2.25 mm  $20.00

 Donaldson Grommet inner flange dia x 2.25 mm outer

  flange dia x 0.76 inter flange.

 2.25 mm total length

 Enta Surgical Pty Ltd

ES001 Trocar Myringotomy Tube Myringotomy Tube with Trocar - Gold  One Size Only $20.00 $38.00

 Coated Silver; Myringotomy Tube with

 Trocar - Titanium; Myringotomy Tube

 with Trocar, with wire - Gold Coated

 Silver; Myringotomy Tube with Trocar,

 with wire - Titanium

 Gyrus Australasia Pty Ltd

GY019 Ventilation Tube Shepard grommet, fluoroplastic or  1.02 -1.14mm $20.00

 silicon, vent tube w/wire.

GY020 Ventilation Tube Shepard, fluoroplastic, w/Tab & wire 1.02 -1.14mm $20.00

GY021 Ventilation Tube Shepard, Ultrasil Silicon & Blue Poly 1.02 - 1.14mm $20.00

GY027 Ventilation Tube T-Tube Richards Silicon, Soft Silicon,  1.14mm $20.00

Prostheses List by Category, Groups and Sponsor Page 55 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GY028 Ventilation Tube T-Tube Richards Modified Silicon &  1.32mm $20.00

GY029 Ventilation Tube T-Tube Richards Modified Soft Silicon  1.32mm $20.00

GY030 Ventilation Tube Butterfly T-Tube Silicon & Ultrasil Silicon - one size only. Ultrasil -  $20.00

 one size only.

GY032 Ventilation Tube Armstrong Beveled Grommet Ultrasil  1.14mm $20.00

 Silicon w/Tab

GY033 Ventilation Tube Grommet - Sha Mini. Teflon 0.76mm $20.00

GY034 Ventilation Tube Shah. Teflon, Silicon 5.1mm $20.00

GY035 Ventilation Tube Shah. Teflon, Fluorplastic w/Wire 1.14mm $20.00

GY036 Ventilation Tube Shah. Teflon, Fluorplastic without Wire 1.14mm $20.00

GY037 Ventilation Tube Armstrong Beveled Plain End  One size only $20.00

GY038 Ventilation Tube Armstrong Beveled Plain End Silcon One size only $20.00

GY039 Ventilation Tube Bobbin - Reuter Stainless Steel 1mm   $20.00

GY040 Ventilation Tube Bobbin - Reuter Stainless Steel Without Wire 1.14-1.27mm,  $20.00

 w/wire 1mm

GY041 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F  1mm $20.00

 Without Holes

GY042 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F  1.14mm $20.00

 Without Holes

GY043 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F  1.14mm $20.00

GY044 Ventilation Tube Bobbin - Reuter Fluoroplastic 1mm I.F 1.14mm $20.00

GY045 Ventilation Tube Bobbin - Reuter Fluoroplastic 0.5mm I.F 1.27mm $20.00

GY048 Ventilation Tube Collar Bobbin Fluoroplastic  1.27mm $20.00

GY049 Ventilation Tube Collar Bobbin Fluoroplastic  0.75mm $20.00

GY050 Ventilation Tube Collar Bobbin Fluoroplastic  1.14mm $20.00

GY051 Ventilation Tube Collar Bobbin Fluoroplastic  1.27x0.5mm $20.00

GY052 Ventilation Tube Collar Button Ultrasil Silicon 1.27mm $20.00

Prostheses List by Category, Groups and Sponsor Page 56 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GY053 Ventilation Tube Collar Button Fluoroplastic Blue 1.27mm $20.00

GY054 Ventilation Tube Collar Button Fluoroplastic w/Wire 1.27mm $20.00

GY055 Ventilation Tube Collar Button Silicon 1.27mm $20.00

GY056 Ventilation Tube Collar Button Titanium 1.14mm $20.00

GY057 Ventilation Tube Collar Button Titanium 1.27mm $20.00

GY058 Ventilation Tube Donaldson Silicon 1.14mm $20.00

GY059 Ventilation Tube Donaldson Soft Silicon 1.14mm $20.00

GY060 Ventilation Tube Donaldson Silicon w/Tab 1.14mm $20.00

GY061 Ventilation Tube Donaldson Fluoroplastic 1.14mm $20.00

GY062 Ventilation Tube Donaldson Ultrasil Silicon 1.14mm $20.00

GY063 Ventilation Tube Duravent Silicon 1.27mm $20.00

GY064 Ventilation Tube Duravent Blue Ultrasil 1.27mm $20.00

GY065 Ventilation Tube Paparella w/tab Fluoroplastic, Silicon,  1.02 - 2.03mm $20.00

 Soft Silicon, Ultrasil

GY067 Ventilation Tube Shea  w/Tab - Silicone 0.76mm $20.00

GY068 Ventilation Tube Shea Parasol w/Tab Small Flange -  1.02mm $20.00

GY069 Ventilation Tube Shea Parasol w/Tab - Silicone 1.02mm $20.00

GY070 Ventilation Tube Shea Parasol w/Tab - Silicone 1.52mm $20.00

GY071 Ventilation Tube Straight Fluoroplastic or Polyethylene  0.89 x 12mm, 0.86 x 7mm,  $20.00

 1.14 x 12mm, 1.14 x 7mm

 Medtronic Australasia Pty Ltd

MC268 Activent Antimicrobial Ventilation Tube Silicone, Silver Oxide, Fluroplastic 0.76 - 1.52mm x 2.1 - 9.5mm x $20.00

  1.0 - 12.0mm

MC269 Activent Antimicrobial Ventilation Tube Silicone, Silver Oxide, Fluroplastic 1.02 - 1.27mm x 0.9 - 2.4mm $20.00

MC270 Activent Antimicrobial Ventilation Tube Silicone & Silver Oxide. Sheehy 1.27 x 2.9 x 1.3mm $20.00

MC271 Vent Tube Silicone, Fluroplastic, Titanium, SS 1.02 - 1.27mm, 1.58 - 2.7mm $20.00

Prostheses List by Category, Groups and Sponsor Page 57 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC272 Vent Tube Silicone, Fluroplastic 1.02 - 1.52mm x 0.9 - 4.45mm $16.00

MC273 Vent Tube Silcone Fluroplastic 1.02 - 1.27mm x 1.3 - 3.0mm $12.00

MC274 Vent Tube Titanium, Fluroplastic 1.02 - 1.27mm x 1.0 - 3.5mm $12.00

MC275 Vent Tube Fluroplastic, Silicone 1.14 - 1.27mm x 0.9 - 3.0mm $14.00

MC276 Vent Tube Silicone, Fluroplastic, H/C Flex 0.76 - 1.27mm x 1.0 - 7.5mm $20.00

MC277 Vent Tube Silicone, Fluroplastic, C-Flex 0.89 - 1.52mm x 2.3 - 12.0mm $18.00

MC278 Vent Tube Silicone, Fluroplastic 0.76 - 1.27mm x 1.5 - 12.0mm $20.00

MC279 Vent Tube Microgel, Titanium, SS 1.02 - 1.27mm x 2.7 - 9.1mm $20.00

MC280 Vent Tube Silicone, Fluroplastic 1.02 - 1.52mm x 1.3 - 12.0mm $20.00

 Morton Surgical Pty Ltd

MG003 Micromedics Ventilation Tubes Micromedics;Shepard;1.0mm /  $12.50

 1.14mm lumen;Fluroplastic /

 Silicone;w.tab / w.wire;box of 6

  / box of 50

MG011 Micromedics Ventilation Tubes Micromedics; Donaldson;  $19.50

 1.14mm lumen; Silicone /

 Fluroplastic; w.tab; box of 6 /

MG012 Micromedics Ventilation Tubes Micromedics; Paparella-I /  $15.50

 Paparella-II; 1.14mm / 1.42mm

 lumen; Silicone; box of 6 / box

 of 50

MG013 Micromedics Ventilation Tubes Micromedics; T-tubes;  $17.50

 (12x10)/(5x8)/(5x4)/(8x5.5);

 1.14mm / 1.27mm / 1.4mm

 lumen ; silicone; box of 6 / box

MG014 Micromedics Ventilation Tubes Micromedics;  Armstrong;  $14.50

 bevelled straight / grommit /

 w.wire;  7mm / 7.5mm /

 1.14mm; silicone / fluroplastic;

Prostheses List by Category, Groups and Sponsor Page 58 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MG015 Micromedics Ventilation Tubes Micromedics; Collar Button;  $10.50

 1.27mm lumen; fluroplastic; box

  of 6 / box of 50

MG016 Micromedics Ventilation Tubes Micromedics;Reuter  $11.50

 Bobbin;1.0mm / 1.14mm lumen;

  fluroplastic; box of 6 / box of 50

MG017 Micromedics Ventilation Tubes Micromedics; Shah with wire;  $11.50

 mini 0.76mm lumen;

 fluroplastic;  box of 6 / box of 50

 Precise Medical Supplies

PR001 Medasil Teflon Aural Grommets Teflon grommets Shepard with wire $12.00

PR002 Medasil Teflon Aural Grommets Teflon grommets Shepard without wire $12.00

PR003 Medasil Teflon Aural Grommets Teflon grommets Shah with wire $13.00

PR004 Medasil Teflon Aural Grommets Teflon grommets Shah without wire $13.00

PR005 Medasil Teflon Aural Grommets Teflon grommets Collar button $12.00

PR006 Medasil Teflon Aural Grommets Teflon grommets Reuter bobbin $16.00

Tubing

 Pacific Medical

PM102 Tracheal Cannula System Short and long term Cannula (Medical  Diameter 9-13mm; Length 37m  $298.00

 Grade Silicone) & 101mm

PM103 Tracheal Cannula System Cannula Speaking Valves (Medical Grade  4-10 $125.00 Only able to be claimed once for

 Plastic) the intial implant

PM104 Montgomery Safe-T-Tube Paediatric, Standard, Thoracic, Extra- Paediatric/Standard -  $471.00

 Long, Tapered and Hebeler in clear and  Clear/Radioplaque

PM106 Montgomery Safe-T-Tube Paediatric, Standard, Thoracic, Extra- ID 8/10, 10/13, 12, 15, 18mm;  $549.00

 Long, Tapered, Hebeler and HMS, in  Length 76, 77, 79, 159, 163mm

 clear and radiopaque

Prostheses List by Category, Groups and Sponsor Page 59 of 784


EAR, NOSE & THROAT

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PM115 Montgomery Safe-T-Tube Paediatric, Standard, Thoracic, Extra- ID 7, 9, 11mm; Length 100,  $769.00

 Long, Tapered, Hebeler and HMS

Prostheses List by Category, Groups and Sponsor Page 60 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Accessories, Endoscopes

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS045 STAT TACK* and Endoscopic Tacker  Endoscopic TACKER*; Titanium;  20 tacks; 30 tacks; 5mm; 4mm, $429.00 Temporary Approval

 Device; PROTACK* Hernia Stapling  Titanium Surgical Stapler.  4.8mm (10 staples).

 Product; ENDO UNIVERSAL*

AS073 ENDOCLIP*; Acuclip Single use  Titanium Surgical Stapler 5mm (12 clips); One size only. $412.00 Temporary Approval

 Endoscopic Multiple Clip Applier.

AS074 ENDOCLIP* Titanium Surgical Stapler 10mm (ML, M, L)-(20 clips) $415.00 Temporary Approval

 ConMed Linvatec Australia Pty Ltd

LV076 Richard Allan Endoscopic Accessories Titanium endoscopic clips with applier Medium-Large, 9mm closed. 20 $243.00 Temporary Approval

  clips

LV081 Open Clip Applier Titanium 25 medium size titanium clips $149.00 $174.00 Temporary approval

 Olympus Australia

OL001 Individual Ligating Clip Rotatable Clip Fixing Device. Pack of 50  MD-59 - 90 degree, standard;  $11.25 Temporary Approval

 MD-850 - 135 degree, standard;

  HX-600-090 - standard, sterile;

 HX-600-135 - standard, sterile

OL002 Individual Ligating Clip Rotatable Clip Fixing Device. Pack of 50  MH-858 - 90 degree, long. MH- $10.78 Temporary Approval

 859 - 90 degree, short. MAJ-

 458 - 90 degree, short. MAJ-

 459 -135 degree, short.

OL006 Individual Ligating Clip Ligating Device - loops. Pack of 10  MAJ-254-30mm loop;  MAJ- $32.69 Temporary Approval

 339- 13mm loop; MAJ-340 -20

Anchor, Fixation

 William A Cook Aust Pty Ltd

WC014 Cope Gastrointestinal Suture Anchor Set  Standard, pediatric $125.00

 (GIAS)

Prostheses List by Category, Groups and Sponsor Page 61 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Applier, Surgical Staple, Cutting

 Johnson & Johnson Medical Pty Ltd

JJ568 Echelon 60mm Endocutter Echelon 60mm Endocutter Standard Compact Long $595.00

Catheterization Kits, Central Venous

 William A Cook Aust Pty Ltd

WC195 Cook Central Venous Catheterisation Kits Long Term Drug Infusion Catheter With  Triple Lumen 12.5fr $257.00

 or Without Clamp and Cuff

Clip Appliers

 Applied Medical Australia Pty Ltd

MH008 Applied Medical Laparoscopic Clip  Disposable Clip Applier made from  Medium - large - 20 clips per  $190.00 Temporary Approval, pending

 Applier - Disposable Cartridge - CA001  polycarbonate, nylon, stainless steel,  review of product group

 liquid crystal polymer, bone wax, titanium

  clip.  The disposable cartridge is used in

 conjunction with a reuseable handle.

MH009 Applied Medical Laparoscopic Clip  Disposable Clip Applier made from  Medium - large, 20 clips per  $200.00 Temporary Approval, pending

 Applier - Disposable CA080 Box of 6 polycarbonate, nylon, stainless steel,  review of product group

 liquid crystal polymer, bone wax, titanium

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS001 Endoclip Disposable Loading Unit;  Single use loading unit with 8 titanium  One size only $69.00 Temporary Approval

 MultApplier Disposable loading unit. clips; Disposable clip cartridge with 8

 Edwards Medical Supplies

EW001 Endox Visu-Loc Clip Applier Single-use laparoscopic clip applier Medium, Large $265.00

Prostheses List by Category, Groups and Sponsor Page 62 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Johnson & Johnson Medical Pty Ltd

JJ482 LIGAMAX 5mm Endoscopic Clip Applier LIGAMAX 5mm Endoscopic Clip Applier Medium / Large $412.00

Clips

 Olympus Australia

OL009 Rotatable Clip fixing device Endoscopic Mechanical Standard or long clip length, 9  $135.00

 or 11mm jaw opening

 William A Cook Aust Pty Ltd

WC213 Endoscopic Clipping Device TriClip Endoscopic Clipping Device 7Fr - 3 Prong 12mm, 8Fr - 3  $136.00

 prong 12mm

Clips, Hemostatic

 Boston Scientific Pty Ltd

BS082 Resolution Clip Device Pre-loaded endoscopically applied clip,  7Fr, 11mm jaw opening $140.00

 radiopaque stainless steel & cobalt

Clips, Vascular

 Applied Medical Australia Pty Ltd

MH001 Clips Haemostatic Clips 10-mm, 14 med/lrg $25.00 Temporary approval

Prostheses List by Category, Groups and Sponsor Page 63 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Device Kits With Drugs

 Boston Scientific Pty Ltd

BS064 Enteryx Procedure Kit Enteryx is supplied as a kit that is made  Solution 10ml, DMSO 10ml,  $4,000.00

 up of Enteryx solution, DMSO (dimethyl  syringes 1ml (2), needles 18

 sulfoxide) a primer solution, Enteryx  gauge x 1 1/2

 injection catheters, syringes and needles

Fixation Device

 Johnson & Johnson Medical Pty Ltd

JJ435 EndoANCHOR EndoANCHOR System with Nitinal  Device Length 482; Device  $429.00

 Shaft Length 360mm; Shaft

 Diameter 5mm; Implantable

 Construct Width 6.7mm,

 Implantable Construct length

JJ564 ECHELON 60mm Endocutter Reload ECHELON 60mm Endocutter Reload 60mm $235.00

Ligators

 Olympus Australia

OL010 Ligation device Disposable pre-assembled applier and  Sheath Length 1650-2300mm $110.00

 ligating loop

Port, Infusion, Implantable

 Morton Surgical Pty Ltd

MG018 HAGA Acess Port Access Port contains Titanium and  Standard $600.00

Prostheses List by Category, Groups and Sponsor Page 64 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Bile Duct

 William A Cook Aust Pty Ltd

WC166 Cook Bile Duct Prostheses Solus Double Pigtail Stent Set with  10 fr, Length: 3, 4, 5, 7, 9, 10,  $296.00

 12, 15 cm

Prostheses, Gastroesophageal Antireflux

 Incision Pty Ltd

IP005 Durasphere GR Composition: Pyrolitically carbon coated  Syringe 1 ml $520.00

 silica bead in an aqueous gel. Injectable

 bulking agent for the treatment of GERD

 (Reflux Disease). Syringe plus needle.

IP006 Durasphere GR Composition: Pyrolitically carbon coated  Syringe 3ml $1,560.00

 silica bead in an aqueous gel. Injectable

 bulking agent for the treatment of GERD

 (Reflux disease). Syringe plus needle.

Prosthesis, Internal, Stent

 Medtel Australia Pty Ltd

ME124 Emphasys Endobronchial Valve One way valve Small, Medium, Large $6,300.00

Prosthesis, internal, stent, oesophageal

 Device Technologies Australia Pty Ltd

DE262 ALIMAXX-E Esophageal Stent System Esophageal stent, radiopaque, self  Diameter 18-22mm, Length 70- $2,500.00

 expanding nitinol covered stent,  120mm

 premounted on a delivery system

Prostheses List by Category, Groups and Sponsor Page 65 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Stent, Pancreatic

 William A Cook Aust Pty Ltd

WC212 Pancreatic Stent Sets Zimmon Pancreatic Stent without Ductal  3Fr -4,6,8,10,12cm $93.00

 Flap, Pigtail with Radiopaque Band

Staples, Tissue

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS046 Endo GIA* Universal Stapling System;  Multifire 30 disposable stapler with  12mm; One size only. $415.00 Temporary Approval

 Versafire GIA*. titanium staples; Disposable surgical

 stapling instruments or cartridges.

AS076 ENDO TA* reloading unit Titanium Surgical Stapler DLU 30mm -2.5, 30mm-3.5 $186.00 Temporary Approval

AS077 ENDO GIA* Titanium Surgical Stapler 30 - 35mm $615.00 Temporary Approval

AS081 ENDO GIA* reloading unit Titanium Surgical Stapler DLU 30 - 35mm; 45mm; 60mm. $246.00 Temporary Approval

AS092 ENDO - Herna reloading unit; VERSA  Titanium Surgical Stapler DLU 4mm, 4.8mm (10 staples). $108.00 Temporary Approval

 TACK* reloading unit.

AS095 STAT TACK*  and Endoscopic Tacker  STAT TACK* One size only $231.00 Temporary Approval

 Device

Stents

 Boston Scientific Pty Ltd

BS071 Ultraflex Precision Colonic Stent System The Ultraflex Precision Colonic Stent  Dia 25mm along body and  $3,000.00

 System consists of a self-expanding metal 30mm at flared distal section. 

  stent and a delivery catheter. Stent Length 60 - 120mm

Prostheses List by Category, Groups and Sponsor Page 66 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stents, Biliary

 Bard Australia Pty Ltd

BA124 Memotherm Biliary Stent Nitinol. Includes deployment system Sizes - Diameter 8 - 10mm,  $2,200.00

 Length 40 - 100mm

 Boston Scientific Pty Ltd

BS066 Biliary Drainage Stent, Amsterdam Biliary  The Biliary Stent is supplied with a push  French Size 7Fr to 12Fr, Length $200.00

 Stent catheter and possibly a guide catheter.  between pigtails/barbs:  5cm to

 15cm

BS070 Wallstent RX Biliary Endoprosthesis with  Self-expanding metal stent constructed  Diameter: Up to 10mm, Stent  $3,000.00

 Unistep Plus delivery System from a biomedical Cobalt-based super  Length: Up to 100mm

 alloy wire, Eligiloy, with a tantalum core.

  The stent is either bare or covered with

 silicone. The stent is mounted on a

 William A Cook Aust Pty Ltd

WC174 Zilver Stent Expandable Metal Biliary  Diameters: 6, 8, 10cm; Lengths: $2,500.00

 Stent System  4,6,8cm

WC200 Zilver Stent Expandable Metal Biliary  Zilver Biliary Stent with Fusion  6mm, 8mm & 10mm; Cm  $2,752.00

 Stent System Introducer System length: 4cm, 6cm & 8cm

WC228 Tannenbaum Biliary Stent Set preloaded  Plastic Biliary Stent 8.5 - 11.5 Fr,   5 - 15 cm $210.00

 on the OASIS Introduction System

Stents, Esophageal

 Boston Scientific Pty Ltd

BS089 WallFlex Oesophageal Metal Stent TTS, closed cell, catheter delivery  Lengths: up to 15cm $3,500.00

 system, nitinol

BS090 WallFlex Enteral Metal Stent  TTS, closed cell, catheter delivery  Lengths: up to 15cm $3,500.00

 (Duodenal/Colonic) system, nitinol

Prostheses List by Category, Groups and Sponsor Page 67 of 784


ENDOSCOPIC PRODUCTS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Endotherapeutics Pty Ltd

ET035 Sinus-Esophageal Stent Self expanding stent made of nickel -  Diameter 24-18-24mm, length  $3,000.00 $3,300.00

 titanium alloy 50,70,90,120mm; Diameter 26-

 20-26, length 50,70,90,120mm

ET045 Boubella Esophageal Stent Self expandable stainless steel wire stent  Length 90 - 195mm $4,100.00

 with anti-reflux valve

Stents, Pancreatic

 William A Cook Aust Pty Ltd

WC194 Johlin Pancreatic Wedge Stent with  Johlin Pancreatic Stent 8.5 and 10fr, 8cm - 16cm $300.00

 Wedge Stent Introduction

Stents, Vascular

 Endotherapeutics Pty Ltd

ET038 SX-Ella Biliary Stent Uncovered, self-expanding nitinol stent Dia 8-12mm, length 50-77mm $3,600.00

ET039 SX-Ella Tips Stent Uncovered, self-expanding nitinol stent Dia 10-14mm, length 52-77mm $4,000.00

Prostheses List by Category, Groups and Sponsor Page 68 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Adhesives, Aerosol

 Medical Vision Australia Pty Ltd

MF003 Steritalc Sterile granules of talc implanted in  3 grams & 4 grams $60.00

 pleural space to act as permanent

 Technology For Life Pty Ltd

TE002 Sclerosol Pleural Spray Intrapleural Patch 5gm $100.00 $140.00

Adhesives, Liquid

 Baxter Healthcare Pty Ltd

BX252 CoSeal Surgical Sealant Composition: two synthetic polyethelene  2ml $320.00 Temporary approval, pending

 glycols (PEG's), COH102 and COH206,  review of product group

 premixed and filled into one syringe, a

 dilute hydrogen chloride solution and a

 sodium phosphate/sodium carbonate

BX253 CoSeal Surgical Sealant Composition: two synthetic polyethelene  4ml $600.00 Temporary approval, pending

 glycols (PEG's), COH102 and COH206,  review of product group+

 premixed and filled into a syringe, a dilute

  hydrogen chloride solution and a sodium

 phosphate sodium carbonate solution

BX254 CoSeal Surgical Sealant Composition: two synthetic polyethelene  8ml $1,120.00 Temporary approval, pending

 glycols (PEG's), COH102 and COH206,  review of product group+

 premixed and filled into a syringe, a dilute

  hydrogen chloride solution and a sodium

 phosphate sodium carbonate solution

Prostheses List by Category, Groups and Sponsor Page 69 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Anesthesia Kits, Other

 Ultimate Medical Pty Ltd

UM001 LA Bubble Balloon based local anaesthetic infusion  One size only $180.00

 system

Appliers

 N Stenning  & Co Pty  Ltd

NG042 Weck Hem-o-lok Hem-o-lok Automatic Open Applier 15 Clips per applier $229.00 Temporary approval

NG043 Weck Hem-o-lok Hem-o-lok Automatic Endo Applier 15 Clips per applier $309.00 Temporary approval

Balloons, Gastric, Appetite-Suppressing

 Morton Surgical Pty Ltd

MG002 Heliogast Adjustable Gastric Ring Silicone and Titanium HAGM (medium) Inner  $3,264.00

 Diameter 27.5mm; HAGS

 (small) Inner Diameter 25mm;

 HAGA (advanced) Inner

Barrier Dressing, Antiadhesion

 Genzyme Australasia Pty Ltd

GE001 CV Seprafilm Cardiovascular Adhesion  Sodium hyaluronate carbomethylcellulose  One size only; 6 x 6 inch. $294.02 Temporary Approval - Funded

 Barrier; Seprafilm II. membrane; Carbomethycellulose. when clinical indications for use

 are present.

Prostheses List by Category, Groups and Sponsor Page 70 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Barrier, Absorbable, Adhesion Prevention

 Genzyme Australasia Pty Ltd

GE006 Seprafilm Adhesion Barrier Sodium hyaluronate carbomethylcellulose  13cm  x 15cm $339.00

 membrane

Brachytherapy Sources

 Global Medical Solutions Australia Pty Ltd

GL001 Advantage I-125 Seed Advantage I-125 per patient up to 120  3mm x 0.5mm silver rod within  $6,500.00

 4.5 x 0.8mm sealed titanium

GL002 Advantage I-125 Seed Advantage I-125 per seed 3mm x 0.5mm silver rod within  $55.00

 4.5 x 0.8mm sealed titanium

 Nucletron Pty. Limited

NU001 selectSeed Nucletron selectSeed Model # 130002  One size only $86.00 Only to be funded where used in

 consists of cylindrical silver rod, coated  a service for which a medicare

 with radioactive Iodine-125 layer. Active  benefit is payable (current MBS

 silver rod is encapsulated in hollow  items are 37220, 15338)

 titanium tube. Laser welding, using

 sperical shaped end welds, seals the tube.

 Oncura Pty Ltd

ON001 Iodine 125 - 'Rapid Strand' Brachytherapy Rapid Strand consists of 10 welded  One size each $6,500.00 Only to be funded where used in

  Implant, Iodine 125 - 'OncoSeeds'  titanium capsules containing iodine-125  a service for which a medicare

 Brachytherapy Implant absorbed onto a silver rod.  OncoSeeds  benefit is payable (current MBS

 consists of the loose seeds only. items are 37220, 15338)

Prostheses List by Category, Groups and Sponsor Page 71 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ON002 Iodine 125 - Rapid Strand Brachytherapy  I-125 Rapid Strand, code IMC 7000,  One size only $55.00 $65.00 Only to be funded where used in

 Implant; OncoSeeds Brachytherapy  consists of 10 welded titanium capsules  a service for which a medicare

 containing iodine 125. This assembly is  benefit is payable (current MBS

 sterile, the acitivity of the capsules  items are 37220, 15338)

 "seeds" is available from 0.18mCi to

 0.70mCi.  Individual I-125 capsules

 (seeds) are also available as OncoSeeds

 IMC6711.  To be used only if more than

 Sirtex Medical Limited

SE001 SIR-Spheres including Delivery  Biocompatible microspheres 20-60mm  One size only $7,222.00 $8,014.00 Temporary listing pending review

 (microns) in diameter containing yttrium-

 90. Delivery apparatus is PVC tubing,

 ABS stopcocks, acrylic holders and

 stainless steel needles with PE hubs

Catheter Injection Ports

 The Mayo Group International Pty Ltd

CM007 Vascular Ports - Implantable Vascular  Arrow Model No.'s VARRX AP01007,  Ports - H15.5mm x L28.6mm,  $507.00

 Access System AP06010, AP06013, AP06014, AP06015, Weight 9.2grams, Internal Vol.

  AP06018, AP06520.  Titanium Port with 0.8ml.  Catheter 75cm

  self sealing silicone septum and either

 attached or detached silicone catheters.

 Include relevant size Introducer Kit.

CM008 Vascular Ports - Implantable Vascular  Arrow Model No.'s   AP6528, AP06530,  Ports - H15.5/17.1mm x  $1,275.00

 Access System AP06535, .  Double Titanium ports with  L28.6mm, Weight 19.9grams,

 self sealing silicone septums and either  Internal Vol.  0.8 - 1.0ml each

 attached or detached dual lumen silicone  side.  Catheters 75cm

 catheters. Include relevant sized

Prostheses List by Category, Groups and Sponsor Page 72 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheterization Kits

 Medtronic Australasia Pty Ltd

MC070 Medtronic AlgoLIne Catheter System  Model 81104.  Radiopaque silicone 85cm $385.00

Catheterization Kits, Central Venous

 Medical Specialties  Australia Pty Ltd

MS008 Catheterisation kits(Horizon Medical) Central Venous Catheter - Apheresis Bone 12.5F $640.00

  Marrow Transplantation Catheter, silicone

Catheterization Kits, Intravenous

 Medtronic Australasia Pty Ltd

MC064 Implantable Drug Pump Accessories 8590-8, 8590-9 - Synchromed catheter  20cm; one size only;  38-60cm $163.00

 accessory kit -  Radiopaque silicone,

 8590RAC - Right angled connector - 

 Titanium, polyurethane,  8591-38, 8691-

 60, 8590-41 Tunnelling rods - Stainless

 Steel, 8575 Synchromed connector (40

 degree) with catheter access port, 8577

 Isomed connector (90 degree) without

 catheter access port, Right Angle

 Connectors - Models 8575 40 Deg,

 Model 8577 90 Deg;

 The Mayo Group International Pty Ltd

CM011 Arrow Peripherally Inserted Central  Model No.'s VARRC PC01351.   3Fr x 55cm $112.00

 Catheterisation Sets   Polyurethane single lumen catheters with

 stylet.

Prostheses List by Category, Groups and Sponsor Page 73 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CM012 Arrow Peripherally Inserted Central  Model No.'s VARRC PC01451, PR05041, 4Fr x 55cm $112.00

 Catheterisation Sets    Polyurethane single lumen catheters with

  or without stylet.

CM013 Arrow Peripherally Inserted Central  Model No.'s VARRC PC01552, PR05052, 5Fr x 55cm & 70cm $112.00

 Catheterisation Sets    PR07051 Polyurethane single and double

 lumen catheters with or without stylet.

Catheters, Biliary

 William A Cook Aust Pty Ltd

WC071 Nasobiliary Drainage Set Biliary/Pancreatic DRAINAGE CATHETER Fr  $250.00

 size:  5,6,7,8.5 Length:  250cm

 Sideports: 5cm WIRE GUIDE

 Diameter: .035 inch Length:

 480cm Color Connection purple

WC216 Fanelli Laparoscopic Endobiliary Stent Set Fanelli stent (double flange white  7.0 French diameter x 6cm  $585.00

 polyehtylene), tracer Hybrid  length double flange stent loaded

 .035"X150cm Guide (slippery wire), 8.5   in an 8.5 fr delivery system.

 Fr Introducer and Pusher Catheter (TFE)

 System with four radiopaque accuracy

 markers, two way terminal adapter

Catheters, Central Venous, Long Term

 Medtronic Australasia Pty Ltd

MC068 Medtronic SynchroMed vascular catheter Model 8700, 8700A, 8710.  Radiopaque  62 to 89cm $830.00

 silicone

 William A Cook Aust Pty Ltd

WC116 Cook Central Venous Long Term  Cook TPN single lumen catheter Fr 3, length 55, 65cm; Fr 4,  $142.00

 length 65cm, Fr 6.5, 9.5, length

Prostheses List by Category, Groups and Sponsor Page 74 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC117 Cook Central Venous Long Term  Cook TPN single lumen catheter set Fr 3, length 55; Fr 4, length  $202.00

 65cm, Fr 6.5 length 65, 90cm,

 Fr 9.5, length 90cm

WC118 Cook Central Venous Long Term  Cook TPN double lumen catheter Fr 5, length special; Fr 7, length $201.00

  65cm, Fr 9 length 80, 90cm, Fr

  12, length special

WC119 Cook Central Venous Long Term  Cook TPN double lumen catheter set Fr 7, length 65cm, Fr 9 length  $261.00

 90cm, Fr 12, 90, special

WC121 Cook Central Venous Long Term  Cook TPN triple lumen catheter Fr 8, length 90cm $225.00

WC122 Cook Central Venous Long Term  Cook TPN triple lumen catheter set Fr 8, length 90cm $270.00

Catheters, Epidural

 Smiths Medical Australasia Pty Ltd

SI020 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.2 mm O.D. polyurethane  $458.00

 A-CATH II Epidural Low Profile System

SI021 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 0.9 mm O.D. polyurethane  $458.00

 A-CATH II Intraspinal Low Profile

Catheters, Irrigation

 William A Cook Aust Pty Ltd

WC196 Cook Irrigation Catheter Chait Percutaneous Cecostomy Set  10fr, Set $920.31

 consisting of: Suture Anchor Set,

 Drainage Catheter, Wireguide, Cecostomy

  Catheter Set, Adapter, Connecting Tube

WC197 Cook Irrigation Catheter Chait Percutaneous Cecostomy Catheter 10fr, Standard or Extra Long $351.00

Prostheses List by Category, Groups and Sponsor Page 75 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheters, Jejunostomy

 William A Cook Aust Pty Ltd

WC098 Cook Jejeunostomy Catheters Composition - Catheter Radiopaque  12fr, length 66cm $163.00

 Stripe, includes Wireguide, Airplug,

WC099 Cook Jejunostomy Catheters Composition - Catheter Radiopaque  9fr, Length 24cm $163.00

 Stripe, includes Wireguide, Airplug,

WC198 Cook Jejunostomy Catheters Heidelberg Jejunostomy Catheter 12fr, 60cm $163.00

Catheters, Peritoneal Dialysis

 Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd

KA001 Tenckhoff Peritoneal Dialysis Catheter Adult 2 cuff, Adult 1 cuff, Adult 0 Cuff 42cm to 47cm length. All  $162.64

 Peritoneal Catheters excluding

 the Swan Neck Fast Flow

 Catheter, have an internal

 diameter of 2.67mm and an

 external diameter of 4.95 mm.

KA002 Tenckhoff Peritoneal Dialysis Catheter Paediatric 2 cuff, Paediatric 1 cuff,  31cm to 37 cm length. All  $178.22

 Neonatal 1 cuff Peritoneal Catheters excluding

 the Swan Neck Fast Flow

 Catheter, have an internal

 diameter of 2.67mm and an

 external diameter of 4.95 mm.

KA003 Fast Flow Peritoneal Dialysis Catheter  Swan Neck, 2 cuff Int.diam: 3.2mm; ext diam  $246.44

 5.49mm.All Peritoneal Catheters

  excluding the Swan Neck Fast

 Flow Catheter, have an internal

 diameter of 2.67mm and an

 external diameter of 4.95 mm.

Prostheses List by Category, Groups and Sponsor Page 76 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

KA004 Swan Neck Curl Peritoneal Dialysis  Adult 2 cuff, left 62 cm length. All Peritoneal  $294.99

 Catheters excluding the Swan

 Neck Fast Flow Catheter, have

 an internal diameter of 2.67mm

 and an external diameter of 4.95

KA005 Swan Neck or Swan neck Tenckhoff  Adult-left, Adult-right, Adult, 2 cuff-left,  20 to 25cm external segment or  $213.90

 Peritoneal Dialysis Catheter Adult, 2 cuff-right 43cm length. All Peritoneal

 Catheters excluding the Swan

 Neck Fast Flow Catheter, have

 an internal diameter of 2.67mm

 and an external diameter of 4.95

KA006 Tenckhoff Peritoneal Dialysis Catheter,  Adult, 2 cuffs 57 to 62cm length. All Peritoneal $199.36

  Catheters excluding the Swan

 Neck Fast Flow Catheter, have

 an internal diameter of 2.67mm

 and an external diameter of 4.95

Clips, Hemostatic

 N Stenning  & Co Pty  Ltd

NG025 Hem-o-Lok Polymer Non-Absorbable  Hem-o-lok Medium (M), Medium-Large  Medium, Medium-Large, Large $40.00 $48.06 Temporary Approval

 Ligating Clip (ML) and Large (L) Polymer Clips

NG044 Hem-o-lok Polymer Non-Absorbable  Hem-o-lok Extra-large (XL) Polymer  Extra-large (XL) $40.00 $70.42

 Ligating Clip

Clips, Ligating

 LMT Surgical Pty Ltd

LM042 Synovis Microclip Malleable titanium clip One size only $25.00 Temporary approval, pending

 review of product group

 N Stenning  & Co Pty  Ltd

NG006 Horizon Ligating Clips   Ligation Clips Titanium  Small (6 per cartridge)   $10.00 Temporary Approval

Prostheses List by Category, Groups and Sponsor Page 77 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NG007 Horizon Ligating Clips   Ligation Clips Titanium  Small  (24 per cartridge) $39.55 Temporary Approval

NG008 Horizon Ligating Clips   Ligation Clips Titanium  Medium (6 per cartridge), Micro $11.14 Temporary Approval

  (6 per cartridge)

NG009 Horizon Ligating Clips   Ligation Clips Titanium  Medium  (24 per cartridge) $41.02 Temporary Approval

NG010 Horizon Ligating Clips   Ligation Clips Titanium  Medium/Large (6 per cartridge) $11.00 $21.87 Temporary Approval

NG011 Horizon Ligating Clips   Ligation Clips Titanium  Medium/Large (24 per  $40.00 $90.86 Temporary Approval

NG012 Horizon Ligating Clips   Ligation Clips Titanium  Large (6 per cartridge) $11.00 $22.85 Temporary Approval

NG013 Horizon Ligating Clips   Ligation Clips Titanium  Large (24 per cartridge) $40.00 $93.50 Temporary Approval

Clips, Other

 N Stenning  & Co Pty  Ltd

NG014 Hemoclip  Titanium Clips Small, Medium (25 per  $25.00 $34.02 Temporary Approval

 cartridge); Large (15 per

NG016 Hemoclip  Titanium Clips Medium  (10 per cartridge)  $16.00 Temporary Approval

NG017 Hemoclip  Titanium Clips Small (10 per cartridge)  $15.00 Temporary Approval

NG018 Hemoclip   Titanium Clips Med-large (10 per cartridge)  $17.11 Temporary Approval

NG019 Hemoclip  Titanium Clips Large (10 per cartridge)  $17.00 $22.71 Temporary Approval

NG023 Hemoclip Plus  Ligation System Small and Medium 15 small preloaded clips and 20  $151.00 Temporary Approval

 medium preloaded clips

Clips, Tube

 Femcare Australia Pty Ltd

FE003 Filshie Clips - Sterishot With Disposable Applicator One Size $155.00 $440.00 Temporary approval, pending

 review of product group

Prostheses List by Category, Groups and Sponsor Page 78 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Clips, Vascular

 N Stenning  & Co Pty  Ltd

NG020 EZLoad Ligating Clips   Titanium Clip  Small (25 per cartridge); Med- $24.75 $28.71 Temporary Approval

 Large, Large (10 per cartridge)

NG021 EZLoad Ligating Clips   Titanium Clip  Medium (25 per cartridge)  $34.02 Temporary Approval

NG022 EZLoad Ligating Clips   Titanium Clip  Small, Medium (10 per  $17.00 $19.45 Temporary Approval

 Tag Medical

TM035 ANASTOCLIP (VCS) VCS - Small 0.9mm $390.00

TM036 ANASTOCLIP (VCS) VCS - MEDIUM 1.4mm $365.00

TM037 ANASTOCLIP (VCS) VCS - LARGE 2.0mm $365.00

TM038 ANASTOCLIP (VCS) VCS - X-LARGE 3.0mm $365.00

Delivery Kits

 Surgical Synergies Pty Ltd

SS001 PainBuster Kit includes catheter, introducer needle,  270ml volume x 2 lines x 2 ml  $450.00

 flow restrictor, filter, bolus per hour; 270ml x 2ml, 5ml

 bolus; 270ml x 1-7ml/hr

SS002 PainBuster Kit includes catheter, introducer needle,  100ml volume x 2 ml per hour $250.00

 flow restrictor, filter

SS003 PainBuster Kit includes catheter, introducer needle,  270ml volume x 2 ml per hour $300.00

 flow restrictor, filter

SS004 PainBuster Kit includes catheter, introducer needle,  270ml volume x 5 ml per hour $300.00

 flow restrictor, filter

SS005 Painbuster Kit includes catheter, introducer needle,  270ml x 4ml/hr, dual; 400ml x  $610.00

 flow restrictor, filter 4ml per hour, dual

Prostheses List by Category, Groups and Sponsor Page 79 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SS006 Painbuster Kit includes catheter, introducer needle,  400ml x 10ml/hr; 400ml x 5ml/hr $450.00

 flow restrictor, filter

Dressings, Resorbable, Antiadhesion

 Endotherapeutics Pty Ltd

ET051 Surgiwrap Bio Absorbable Antiadhesion Barrier All sizes with and without suture $495.00 Temporary approval - funded

  holes when clinical indications are

 Johnson & Johnson Medical Pty Ltd

JJ010 Interceed Absorbable Adhesion Barrier Oxidized Regenerated Cellulose 7.6cm x 10.2cm $168.00 Temporary Approval - Funded

 when clinical indications for use

 are present.

Drug Delivery System

 Biomet Australia Pty Ltd

BI280 Septopal Chain Septopal Beads PMMA, Stainless Steel 30 bead chain $555.00

Enteral Feeding Kits

 Abbott Australasia Pty Ltd

AY002 Flexiflo inverta PEG kit Basic, Flexiflo  Composition - biocompatible silicone  20F $200.00

 inverta PEG kit with snare tube.  Items included in kit/product -

 Sliding retention disc, Insertion wire,

 Gastrostomy tube with attached Dilator

 Catheter, seldinger needle 14g, magna

 port connector, scalpel, Snare (in kit with

Prostheses List by Category, Groups and Sponsor Page 80 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AY003 Durapeg kit Composition - biocompatible  16F $230.00

 Polyurethene tube.  Items included in

 kit/product - Sliding retention disc, drum

 wire dispenser, 16 french peg tube, pinch

  clamp, luer lock connector, scalpel. 

AY004 Hide-A-Port Composition - biocompatible silicone.   Size: 14 french, length: 1.5cm;  $170.00

 Items included in kit/product - 1 low  Size: 16 french, Length: 1.5,

 profile Balloon Gastrostomy tube, Straight 2.0cm; Size: 18 french, Length:

  extension tube, Extension tube with right 1.2cm, 1.5cm, 1.7cm, 2.0cm,

  angle adaptor, luer lock syringe, lubricant. 2.3cm, 2.5cm, 3.0cm, 3.5cm,

 4.0cm; Size: 20 french, Length:

 2.0cm, 2.7cm, 3.0cm, 3.5cm,

 4.0cm; Size: 24 french, Length:

 1.7cm, 2.0cm, 2.5cm, 2.7cm,

 3.5cm

 Bard Australia Pty Ltd

BA047 Gastrostomy Tube Silicone  16 - 20 French  $237.00

BA075 Gauderer Ponsky 20Fr PEG Kits  Genie PEG System 20 French $365.00

 Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd

KA015 Entristar Skin Level Gastrostomy Kits Skin level non-balloon internal retention  16fg x 1.5cm, 16fg x 1.7cm,  $226.60 Temporary approval, pending

 bolster gastrostomy kit, including  16fg x 2.0cm, 16fg x 2.7cm,  review of product group

 Entristar gastrostomy tube, accessory  16fg x 3.0cm, 16fg x 3.5cm,

 bolus and continuous feeding tubes,  20fg x 1.5cm, 20fg x 2.ocm,

 syringes for inflation and flushin. Patient  20fg x 2.5cm, 20fg x 3.0cm,

 20fg x 3.5cm, 20fg x 4.0cm,

KA016 Kangaroo Gastrostomy Feeding Tubes 100% silicone gastrostomy with internal  12fg, 14fg, 16fg, 18fg, 20fg,  $84.46

 retention balloon 22fg, 24fg

KA017 NutriPort Balloon Skin Level Gastrostomy Skin level silicone balloon gastrostomy  12fg x 0.8 - 5.0cm, 14fg x 0.8 - $195.70 Temporary approval, pending

 kit, including NutriPort gastronomy tube,   5.0cm, 16fg x 0.8 - 5.0cm review of product group

 accessory bolus and continuous feeding

 tubes, syringes for inflation and flushing,

 Patient handbook

Prostheses List by Category, Groups and Sponsor Page 81 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Kimberly-Clark Australia Pty Ltd

KI001 Kimberly-Clark Aust Pty Ltd Enteral  68914 MIC Gastrostomy Tubes Model  MIC* Percutaneous Endoscopic $200.00

 Feeding Kit 100 Series  Gastrostomy (P.E.G) Feeding

 Tubes/Kits 14, 20, 24 French

 #0630 Series PUSH (OTW)

 Method & #0640Series PULL

 Method

KI002 Kimberly-Clark Aust Pty Ltd Enteral  68914 MIC Gastrostomy Tubes Model  MIC* Percutaneous Endoscopic $161.00

 feeding kit, Mic* Percutaneous  100 Series  Gastrostomy (P.E. G) Feeding

 Endoscopic Gastrostomy (P.E.G)  BASIC Tubes/Kits 14, 20, 24

 French#0644 Series PULL

KI003 Kimberly-Clark Aust Pty Ltd Enteral  68914 MIC Gastrostomy Tubes Model  Feeding Adaptors (Universal or  $26.00

 feeding kit, Mic* Percutaneous  100 Series Bolus) for use with 14, 20 &24

 Endoscopic Gastrostomy (P.E.G)  F MIC* PEG's#0135 &#0136

KI004 Kimberly-Clark Aust Pty Ltd Enteral  68914 MIC Gastrostomy Tubes Model  MIC-KEY* Low Profile  $200.00

 feeding kit, MIC-KEY Low Profile  100 Series Gastrostomy Feeding

 Gastrostomy Feeding Tubes/Kits Tubes/Kits 14 - 24 French, 0.8

KI005 Kimberly-Clark Aust Pty Ltd Enteral  68914 MIC Gastrostomy Tubes Model  SECUR-LOK* Extension Sets & $120.00

 feeding kit, MIC-KEY Low Profile  100 Series  Bolus Feeding Sets 30.5 cm &

 Gastrostomy Feeding Tubes/Kits 60.9 cm

KI007 MIC* Gastrostomy Feeding Tube; MIC*  Medical Grade Silicone Construction.  12fr - 3-5ml balloon, 14fr - 3- $110.00

 Bolus Gastrostomy Tube Silicone Internal Inflatable Retention  5ml balloon, 16fr - 3-5ml

 Balloon, SECU-LOK* External Retention  balloon, 18fr - 7-10ml balloon,

 Ring, Universal Feeding Port Connector,  20fr - 7-10ml balloon, 22fr - 7-

 Medication Port, Dual Exit Ports, Tapered 10ml balloon, 24fr - 7-10ml

  Distal Tip, Radiopaque Strip, Sterile. balloon, 26fr - 7-10ml balloon,

 28fr - 7-10ml balloon, 30fr - 7-

 10ml balloon,

 Nutricia Australia

NF002 Flocare Percutaneous Endoscopic  The Flocare PEG set is for endoscopic  various sizes - charriere 10, 14  $135.00

 gastrostomy (PEG) set placement of a gastrostomy tube, based  and 18

 on the "Pull" technique.

 Promedica Pty Ltd

PO001 Corflo Cubby LPGD Kit Low profile gastronomy device 12 - 24fg x 1.0 - 4.5cm $210.00

Prostheses List by Category, Groups and Sponsor Page 82 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PO002 Corflo Gastronomy Replacement Device Dual and triple gastronomy tubes Dual 12 - 24fg 5 - 20cc balloon; $69.00

  Triple 16 - 24fg 20cc balloon

PO003 Corflo Max 20fg PEG Kit Complete with  Sterile enteral feeding tube with   20fg $190.00

 7fg Snare - "Pull Type"

PO004 Corflo Max 20fg PEG Kit "Pull Type" Sterile enteral feeding tube with   20fg $165.00

 Sherwood Davis & Geck T/A Tyco Healthcare Pty Ltd

SG001 Gastrostomy Tube EntriStar Single Pass PEG 16fg, 20fg $200.00

 William A Cook Aust Pty Ltd

WC070 Gastrostomy Tube PEG Balloon Replacement Tube - Single 18, 24fr $85.00

WC072 Passport Low Profile Device Enteral/Gastrostomy FEEDING TUBE French Sizes:  $200.00

 20.0, 24.0 Length:

 1.2,1.7,2.4,3.4,4.4 cm

WC184 Percutaneous Endsocopic Gastrostomy  PEG Gastrostomy Tube Pull or Push  18, 20, 24fr $200.00

 System - Single

WC185 Percutaneous Endoscopic Gastrostomy  PEG Gastrostoym Tube Pull or Push  18, 20, 24fr Pack of 1 $200.00

 system - Box of 2

Gastroplasty Bands

 Advanced ORT Pty Ltd

OA003 Adjustable Peri Gastric Belt-Midband Silicon moulded peri gastric band and  Peri gastric band - 2.2 x 17.5 x  $3,250.00

 implantable chamber 0.8cm, Implantable chamber -

 one size only

 Endotherapeutics Pty Ltd

ET042 Soft Gastric Banding System Sterile long term implant for the treatment One size only $3,264.00

  of obesity.  Supplied in kit format with

 catheter, port and huber needles

 Inamed Australia Pty Ltd

IN001 Lap-Band Adjustable Gastric Banding  - 9.75, 10 and 11cm $3,264.00

 (LAGB) System

Prostheses List by Category, Groups and Sponsor Page 83 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Incision Pty Ltd

IP010 Cousin Bioring Gastric Band Laparoscopically adjustable gastric band.  27mm diameter $3,200.00

 Silicone. Pre-shaped.

 Johnson & Johnson Medical Pty Ltd

JJ412 Swedish Adjustable Gastric Band Silicone One size only $3,264.00

 Rymed Pty Ltd

RY001 MiniMizer Adjustable Gastric Band Silicon elastomer 14mm wide, 16.6cm band two  $2,200.00

 phase closure, 1: 31mm inner

 diameter, phase 2: 26mm inner

 diameter. 40cm silicon tube

 attached

Gel, Resorbable, Antiadhesion

 Gyrus Australasia Pty Ltd

GY083 SprayGel Adhesion Barrier Polymer Kit PK-A-6010 SprayGel Polymer Kit; PK-A- One size only; PK-A-4210 - 5  $300.00 Temporary approval - funded

 4210 SprayGel Open Surgery Polymer Kit Kits/Box when clinical indications for use

  (10ml) are present.

Grafts

 Bard Australia Pty Ltd

BA160 Bard Crurasoft Patch Dual sided mesh with PTFE mesh on one 7cm x 6cm Small $540.00

  side and ePTFE mesh on the other side

BA161 Bard Crurasoft Patch Dual sided mesh with PTFE mesh on one 11cm x 8cm Large $707.00

  side and ePTFE mesh on the other side

Prostheses List by Category, Groups and Sponsor Page 84 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Grafts, Dura, Biological

 Advanced Biomedical Pty Ltd

AB012 Peri-Strips Dry Model No PSD 4506-EN One size only $342.00 Temporary Approval

AB013 Peri-Strips Dry Model No PSD 6006-UN One size only $342.00 Temporary Approval

AB014 Peri-Strips Dry Model No PSD 4506-ETSN One size only $342.00 Temporary Approval

AB016 Peri-Strips Dry Model No PSD 3006-N One size only $342.00 Temporary Approval

AB017 Peri-Strips Dry Model No PSD 10006-EN One size only $342.00 Temporary Approval

AB018 Peri-Strips Dry Model No PSD 4506-UN One size only $342.00 Temporary Approval

AB019 Peri-Strips Dry Model No PSD 9006-UN One size only $342.00 Temporary Approval

AB020 Peri-Strips Dry Model No PSD 8006-UN One size only $342.00 Temporary Approval

AB021 Peri-Strips Dry Model No PSD 7506-EN One size only $342.00 Temporary Approval

AB022 Peri-Strips Dry Model No PSD 5506-EN One size only $342.00 Temporary Approval

AB063 Peri-Strips Dry Model No PSD 3506-AN One size only $342.00 Temporary Approval

Haemostatic Materials, Animal Origin

 Bard Australia Pty Ltd

BA119 Avitene Ultrafoam Hemostatic sponge applied directly to the  12.5-7   2 cm x 6.25cm x 7mm $21.00

 source of surgical bleeding

BA120 Avitene Ultrafoam Hemostatic sponge applied directly to the  50   8cm x 6.25cm x 1cm $34.00

 source of surgical bleeding

BA121 Avitene Ultrafoam Hemostatic sponge applied directly to the  100   8cm x 12.5cm x 1cm $55.00

 source of surgical bleeding

BA122 Avitene Ultrafoam Hemostatic sponge applied directly to the  100/Thin   8cm x 12.5cm x  $58.00

 source of surgical bleeding

Prostheses List by Category, Groups and Sponsor Page 85 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA123 Avitene Ultrafoam Hemostatic sponge applied directly to the  200   8cm x 25cm x 1cm $100.00

 source of surgical bleeding

Hemorrhage Occluder Pin with Applicator

 Design for Vision Pty Ltd

DV024 Haemorrhage Occluder Pin with  Designed to control severe presacral  Pin size 7mm. $860.00

 bleeding during pelvic surgery. Application length 30cm. 2 units

  per box

Infusion Controller Administration Sets

 Baxter Healthcare Pty Ltd

BX245 Patient Control Module Sterile infusor devices, spring or  Module 0.5ml dose, Module 2  $30.00

 elastomer driven ml dose

 Roche Diagnostics Australia Pty Ltd

RO004 "Disetronic Infusion Sets" Tender II 17/30 Pack 10/10 $7.70 $22.90 The price indicated is per unit

 and there are 10 units per box

RO010 "Disetronic Infusion Sets" Tender II 17/60 Pack 10/10 $7.70 $29.90 The price indicated is per unit

 and there are 10 units per box

RO011 "Disetronic Infusion Sets" Tender II 17/80 Pack 10/10 $7.70 $29.90 The price indicated is per unit

 and there are 10 units per box

RO012 "Disetronic Infusion Sets" Tender I 17/60 Pack 10 $7.70 $21.90 The price indicated is per unit

 and there are 10 units per box

Prostheses List by Category, Groups and Sponsor Page 86 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Infusion Pump Administration Sets

 Australasian Medical & Scientific Ltd

AN002 Animas IR Insulin Infusion Cartridge 3.0ml Cartridge, sterile, indicated as  one size only $7.00

 reservoir for insulin by the Animas

 infusion pump; not intended for use with

 any other infusion device.

AN003 Animas Insulin Infusion Sets (INFUSION SET, COMFORT, 23",  one size only $7.70

 HOSP 10, INFUSION SET, COMFORT

 43", HOSP 10) Needle guard, soft

 cannula, adhesive tape, introducer needle,

  cannula housing, tubing, connector

 needle, circular protective cap and

AN004 Animas Insulin Infusion Set (INFUSION SET, COMFORT, 23", STD One size only $7.70

  5/5 AND INFUSION SET, COMFORT,

 43" STD 5/5) Needle guard, soft cannula,

  adhesive tape, introducer needle, cannula

  housing, tubing, connector needle,

 circular protective cap and disconnect

 Global Manufacturing Technology Pty Limited

GM040 Alpha Infusion Pump Alpha Infusion Pump Kit, includes Alpha  450ml $300.00 Temporary Approval, pending

 Infusion Pump, introducer needle,  review of product group

 syringe, hip pack, labels and instructions

 for use plus Alpha Cath Infusion Catheter

 Medical Specialties  Australia Pty Ltd

MS039 Medical Specialties "Deltec Cozmo  Drug Infusion Reservoir 3ml Cartridges - Box 25 $7.80

 Ancillary Equipment"

MS040 Medical Specialties/Unomedical "Deltec  Drug Infusion Set Box 10 $7.70

 Cozmo Ancillary Equipment"

 Medtronic Australasia Pty Ltd

MC058 Medtronic SynchroMed Catheter Model  Radiopaque Silicone 89cm $820.00

Prostheses List by Category, Groups and Sponsor Page 87 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC285 Medtronic MiniMed Insulin Pump  Ambulatory Insulin Infusion Pump  60-110cm $17.50

 Infusion Sets System Administration Sets and

 Accessories: Quick-set MMT-390,

 MMT-391, MMT-392, MMT-393; Sof-

 set Micro MMT-320, MMT-321; Sof-set

 Ultimate MMT-315, MMT-316 (all tubing

  with cannula for use with MMT-507C

 and MMT-508 insulin infusion pump);

 Silhouette MMT-371, MMT-372, MMT-

 373, MMT-374 (Full Set of 10 complete

 sets: 10 sites + 10 tubing, OR Combo Set:

  10 sites + 5 tubing for use with MMT-

 507C or MMT-508 insulin infusion

 pump); Serters MMT-395, MMT-300,

 MMT-385 (For use with MMT-511 or

 MMT-507C or MMT-508 insulin infusion

  pump); Polyfin MMT-106, MMT-306,

 MMT-307, Polyfin QR MMT-165,

 MMT-365, MMT-366 (bent needles with

 wings for use with MMT-507C and

MC286 Medtronic MiniMed Paradigm Insulin  Ambulatory Insulin Infusion Pump  60-110cm $18.00

 Pump Infusion Sets System Adminstration Sets and

 accessories: Quick-set MMT-396, MMT-

 398, MMT-397, MMT-399; Sof-set

 Micro MMT-324, MMT-325; Sof-set

 Ultimate MMT-317, MMT-318 (all tubing

  with cannula for use with MMT-511

 insulin infusion pump), Silhouette MMT-

 377, MMT-379, MMT-378, MMT-380

 (Full Set of 10 complete sets: 10 sites +

 10 tubing, OR Combo Set: 10 sites + 5

 tubing for use with MMT-511 insulin

MC304 Medtronic Minimed Paradigm Insulin  Reservoir Model MMT - 332A (for use  3.0 ml reservoir $5.50

 Infusion Pump Reservoir with the Paradigm Model MMT - 712).

 Polycarbonate

 Roche Diagnostics Australia Pty Ltd

RO003 Disetronic Administration Sets and  Adaptor D-Tron plus 10/box $13.00 The price indicated is per unit

 Accessories and there are 10 units per box

Prostheses List by Category, Groups and Sponsor Page 88 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

RO005 Disetronic Administration Sets and  Adaptor H-Tron  plus Grey/Blue each $15.00

 Accessories

RO006 Disetronic Administration Sets and  Plastic Cartridge (H-Tron) 3.15mL 25/box $7.80 $11.96 The price indicated is per unit

 Accessories and there are 25 units per box

RO007 Disetronic Administration Sets Plastic Cartridge (D-Tron plus) 3.0mL 5/box $13.00 The price indicated is per unit

 and there are 5 units per box

RO017 Disetronic Tender Infusion Set Tender II 13/30 Pack 20/10 13/30mm $247.92

RO018 Disetronic Tender Infusion Set Tender II 13/60 Pack 20/10 13/60mm $247.92

RO019 Disetronic Tender Infusion Set Tender II 13/80 Pack 20/10 13/80mm $247.92

 Smiths Medical Australasia Pty Ltd

SI024 Medication Cassettes (50ml & 100ml) Pump 50 mL $21.00

SI025 Medication Cassettes (50ml & 100ml) Pump 100 mL $28.00

SI026 CADD Administration Set 175cm TOTM  For use with SI036 250 mL $7.00 $18.75

 tubing

SI028 Extention Set (30" & 60") Pump 76 cm $6.00

SI029 Extention Set (30" & 60") Pump 152 cm $7.00

SI036 Flexible Medication Reservoir, 250ml  Pump 250 mL $7.00

 Model 21-6167-24

SI040 Adminstration Set Bag Spike, Integral Anti-Siphon Valve 196cm Bag Spike, Box of 12 $7.00 $18.75

SI041 Administration Set High Volume, with 0.2 Micron Filter,  Box of 15 $7.00 $18.75

 Male Luer, Add On Anti Syphon Valve

SI042 Extension Set Microbore TOTM with 0.22 Filter, M/M  152cm $6.00 The benefit amount/minimum

 Luers, for Flolan benefit amount is for and

 individual product which comes

 as a pack of six.

SI044 Administration Set High Volume, TOTM- Plasticized Blue  305cm $22.00 The benefit amount/minimum

 Striped with 1.2 Micron Filter, Male Luer, benefit amount is for an

  Add On Anti-Siphon Valve individual product which comes

 as a pack of ten.

Prostheses List by Category, Groups and Sponsor Page 89 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Infusion Pumps

 Medical Specialties  Australia Pty Ltd

MS031 Medical Specialties "Deltec Cozmo Insulin Ambulatory Insulin Infusion Pump Deltec Cozmo Insulin Pump -  $7,950.00

  Pump"

 Medtronic Australasia Pty Ltd

MC300 Medtronic MiniMed Insulin Infusion  Model MMT - 508 One Size Only $7,000.00

 Pump System

MC302 Medtronic Minimed Insulin Infusion  Paradigm Model MMT - 512.  One Size Only $7,950.00

 pump System

MC303 Medtronic Minimed Insulin Infusion  Paradigm Model MMT - 712  One Size Only $7,950.00

 Pump System

 Orthocare Pty Limited

OC003 Pain Care 2000L Pain Care 2000L System One Size Only $249.00

OC004 Pain Care 2000L "Y" Accessory Kit One Size Only $80.00

OC005 Pain Care 2000L Multiport Catheter 54" One Size Only $54.00

Infusion Pumps, Ambulatory, Insulin

 Australasian Medical & Scientific Ltd

AN001 Animas IR 1000 Insulin Infusion Pump One size only $6,500.00

AN005 Animas IR 1200 Insulin Infusion Pump  Ambulatory Insulin Infusion Pump One size only $7,750.00

 (Insulin Infusion Pump IR 1200 series),

 Animas IR1250i Insulin Infusion Pump

 (Insulin Infusion Pump IR1200 series).

AN006 Animas IR 1200 Insulin Infusion  Sterile, indicated as reservoir for insulin  Cartridge Capacity - 2.0mL or  $7.50 Temporary Approval, pending

 Cartridge (Insulin Infusion Pump IR 1200 by the Animas Infusion Pump, not  200 units review of product group

 intended for use with any other infusion

Prostheses List by Category, Groups and Sponsor Page 90 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Diacare International Pty Ltd

DI001 DANAII Insulin Pump Continuous insulin infusion pump 75mm x 45mm x 19mm $4,000.00

 Medtronic Australasia Pty Ltd

MC283 Medtronic MiniMed Paradigm Insulin  Model MMT-511- One Insulin Pump  One Size Only $7,900.00

 Infusion Pump System

MC351 Medtronic MiniMed Insulin Infusion  Paradigm Model MMT - 715 Pump Dimensions: 5.1 x 9.4 x  $7,950.00

 2.0cm

MC352 Medtronic MiniMed Insulin Infusion  Paradigm Model MMT - 515 Pump Dimensions: 5.1 x 7.6 x  $7,950.00

 2.0cm

MC353 Medtronic MiniMed Insulin Infusion  Paradigm Model MMT-722 Pump dimensions: 5.1 x 9.4 x  $7,950.00

 2.0cm

MC354 Medtronic MiniMed Insulin Infusion  Paradigm Model MMT-522 Pump Dimensions: 5.1 x 7.6 x  $7,950.00

 2.0cm

 Roche Diagnostics Australia Pty Ltd

RO001 "Disetronic Insulin Infusion Pump  D-Tron plus Large Kit Blue or Anthracite $6,700.00

RO002 "Disetronic Insulin Infusion Pump  H-Tron plus Large Kit Blue or Grey $5,700.00

RO008 "Disetronic Insulin Infusion Pump  H-Tron plus Small Kit Blue or Grey $5,400.00

RO009 "Disetronic Insulin Infusion Pump  D-Tron plus Small Kit Blue or Grey $6,400.00

RO020 Accu-chek Spirit Insulin Pump Insulin infusion pump One size only $5,000.00 Temporary listing pending review

  of product group

Infusion Pumps, Ambulatory, Other

 Smiths Medical Australasia Pty Ltd

SI027 CADD Administration Sets, 198cm, with  Pump 198 cm $17.00

 Bag Spike & Add-on Anti-siphon Valve,

 TOTM Plasticized Tubing, Model No. 21-

SI037 CADD Legacy 1 Model 6400 Ambulatory Pump One size only $4,850.00

  Infusion Pump

Prostheses List by Category, Groups and Sponsor Page 91 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SI038 CADD Legacy Plus Model 6500  Pump One size only $5,445.00

 Ambulatory Infusion Pump

Infusion Pumps, Ambulatory, Syringe

 Medical Specialties  Australia Pty Ltd

MS019 Infusa T, Infusa TS or Infusa DSLT Powered Drug Infusion System, Battery  Small, Medium, Large $2,400.00

 operated, Syringe type

 Medtronic Australasia Pty Ltd

MC282 Medtronic MiniMed Insulin Infusion  Ambulatory Insulin Infusion Pump  One Size Only $7.80

 Pump Reservoir System Administration Sets and

 Accessories; Insulin Infusion Pump

 Reservoir MMT-103A  (for use with

MC284 Medtronic MiniMed Paradigm Insulin  Paradigm Insulin Infusion Pump  One Size Only $5.50

 Infusion Pump Reservoir Reservoir MMT-326A (for use with

 Model MMT-511 insulin infusion pump)

Infusion Pumps, General-Purpose

 Medical Specialties  Australia Pty Ltd

MS021 Medical Specialties "Walkmed Infusion  Ambulatory Infusion Pump System,  Walkmed Infusion Pump  $5,445.00

 Pump System" Powered Drug Infusion  Administration Sets and Accessories

 System and Ancillary Equipment

 (McKinley, USA)

MS022 Medical Specialties "Walkmed Drug  Ambulatory Infusion Pump System,  Walkmed Drug Administration  $5.00

 Administration Reservoir" (McKinley,  Administration Sets and Accessories Reservoirs

MS023 Medical Specialties "Walkmed Drug  Ambulatory Infusion Pump System,  Walkmed Drug Administration  $61.00

 Administration Sets"  (McKinley, USA) Administration Sets and Accessories

Prostheses List by Category, Groups and Sponsor Page 92 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Nipro Asia Pte Ltd-Melbourne

NQ001 Surefuser Surefuser 50ml. Sterile infusion devices,  Volume of 50ml at 10ml/hr, or  $48.00

 spring or elastometric driven. Various  at 4.2ml/hr, or at 2.1ml/hr, or at

 flow rates  1.0ml/hr, or at 0.7ml/hr or at

 0.4ml/hr or at 0.3ml/hr

NQ002 Surefuser Surefuser 100ml. Sterile infusion devices, Volume of 100ml at 200ml/hr,  $48.00

  spring or elastometric driven. Various  or at 100ml/hr, or at 20ml/hr, or

 flow rates  at 8.3ml/hr, or at 4.2ml/hr, or

 at 2.0ml/hr, or at 0.8ml/hr or at

 0.6ml/hr

NQ003 Surefuser Surefuser 250ml. Sterile infusion devices, Volume of 250ml at 125ml/hr,  $48.00

  spring or elastometric driven. Various  or at 62.5ml/hr, or at 10ml/hr,

 flow rates or at 5ml/hr, or at 3.5ml/hr, or

 at 2.0ml/hr, or at 1.5ml/hr

Infusion Pumps, Patient-Controlled Analgesic

 B Braun Australia Pty Ltd

BB282 Easy-Pump C-Block RA Elastomeric infusion pump, latex/polymer 400ml $80.00 The benefit amount/minimum

  blend. Fixed flow rate 5ml/hr. benefit amount is for an

 indivudual product which comes

 in a pack of 10.

BB283 Easy-Pump C-Block RA Elastomeric infusion pump, latex/polymer 400ml $180.00 The benefit amount/minimum

  blend. Fixed flow rate 5ml/hr + 5ml  benefit amount is for an

 bolus.  Select-a-flow 2-14ml/hr. indivudual product which comes

 in a pack of 10.

BB284 Easy-Pump C-Block RA Elastomeric infusion pump, latex/polymer 400ml $250.00 The benefit amount/minimum

  blend.  Select-a-flow 2-14ml/hr + 5ml  benefit amount is for an

 indivudual product which comes

BB285 Easy-Pump C-Block RA Elastomeric infusion pump, latex/polymer 400ml $80.00 The benefit amount/minimum

  blend. Fixed flow rate 8ml/hr. benefit amount is for an

 indivudual product which comes

 in a pack of 10.

Prostheses List by Category, Groups and Sponsor Page 93 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB286 Easy-Pump C-Block RA Elastomeric infusion pump, latex/polymer 400ml $80.00 The benefit amount/minimum

  blend.  Fixed flow Rate 10ml/hr. benefit amount is for an

 indivudual product which comes

 in a pack of 10.

 Medtronic Australasia Pty Ltd

MC316 Personal Therapy Manager Model 8832 One Size Only $1,350.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

 National Surgical Corporation Pty Ltd

NI154 Alpha Infusion Pump System Alpha Infusion Pump Kit 200ml (includes  200ml $200.00 Temporary listing pending review

 pump, introducer needle, syringe, carry   of product group

 bag, instructions) sterile

NI155 Alpha Infusion Pump System Alpha Infusion Pump Kit 450ml (includes  450ml $260.00 Temporary listing pending review

 pump, introducer needle, syringe, carry   of product group

 bag, instructions) sterile

NI156 Alpha Infusion Pump System Alpha Infusion Pump Endhole Catheter 0.5, 1.0, 2.0, 4.0 and 5.0ml/per  $60.00 Temporary listing pending review

 hour endhole catheters  of product group

NI157 Alpha Infusion Pump System Alpha Infusion Pump Mulltidrip Catheter 2.0, 4.0ml hour, 6 or 12cm  $70.00 Temporary listing pending review

 infusion length  of product group

NI158 Alpha Infusion Pump System STA endhole catheter including  2.0, 4.0 ml per hour $110.00 Temporary listing pending review

 attachment suture  of product group

 Smiths Medical Australasia Pty Ltd

SI034 CADD-PRIZM VIP (Variable Infusion  Pump One size only $5,445.00

 Profile) Model 6100; CADD-PRIZM PCS

  Ambulatory Infusion Pump, Model 6100

SI039 CADD Legacy PCA Model 6300  Pump One size only $5,445.00

 Ambulatory Infusion Pump

Prostheses List by Category, Groups and Sponsor Page 94 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Infusion/Injection Port Tack

 Inamed Australia Pty Ltd

IN003 Rapid Port Tack Implantable acetal copolymer disk  Outside diameter for the tack  $170.00

 assembly, rotor assembly with three  30.5mm diameter by 5.6mm

 stainless steel fasteners.  The fasteners,  Height.  The wires extend 3mm

 when deployed by rotating the rotor,  below the bottom surface.

 extend about 3mm below the

Injection/Infusion Ports, Implantable

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS052 Chemosite Implantable Venous Access  Port - Single Lumen (ChemoSite*) 7-9 french; 10.5 french. $600.00 * Trademark of United States

 System Surgical Corporation

 B Braun Australia Pty Ltd

BB082 Celsite Epoxy Single Access Port Epoxy/titanium Standard/small/baby $600.00

BB083 Celsite Epoxy Dual Access Port Epoxy/titanium Standard/small/baby $884.00

BB084 Celsite MBS Single Access Port Methylbutadeine styrene Standard/small $475.00

BB086 Celsite Epoxy Peritoneal Port Epoxy/titanium 32x27x13mm $749.00

 Bard Australia Pty Ltd

BA046 The Bard Button Implantable Injection,  Silicone Replacement Gastrostomy  18 - 24 French  $293.00

 Infusion Port

BA165 X Port duo Intermediate-sized MRI port with open- Port: Base 38.5 x 28.5mm,  $715.00

 ended attachable Hickman dual lumen  Height: 12.6mm, Weight: 9.6g,

 Catheter: 10Fr

BA166 X Port duo Intermediate-sized MRI port with open- Port: Base 38.5 x 28.5mm,  $715.00

 ended attachable Chronoflex dual lumen  Height 12.6mm, Weight: 9.6g,

 Catheter: 9.5Fr

Prostheses List by Category, Groups and Sponsor Page 95 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Inamed Australia Pty Ltd

IN002 Lap-Band Access Port For use with the Lap-Band Adjustable  Standard, low profile $618.00 $660.00

 Gastric Banding System

 Johnson & Johnson Medical Pty Ltd

JJ444 Swedish Adjustable Gastric Band -  Titanium implantable infusion port &  One size only $618.00

 Injection Port & Locking Connector locking connector for the Swedish

 Adjustable Gastric Band.  Replacement

 port & locking connector to the one

 included with the Swedish Adjustable

 Smiths Medical Australasia Pty Ltd

SI001 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $459.00

 A-CATH II Trans Arterial Percuataneous

SI002 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $455.00

 A-CATH Intraspinal 501CS System

SI003 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm O.D. PolyFlow  $490.00

 A-CATH P.A.S Port T2 System Polyurethane Catheter

SI005 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $455.00

 A-CATH Peritoneal System

SI006 Injection/Infusion Ports, Sterile - PORT- Port - single lumen One size only $455.00

 A-CATH Intraspinal 500CS System

SI007 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.3 mm silicone catheter $455.00

 A-CATH Arterial Titanium System

SI008 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter & 9  $470.00

 A-CATH Titanium Venous Portal French introducer set

SI009 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $459.00

 A-CATH Implantable Venous Access

SI010 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9mm polyurethane catheter $470.00

 A-CATH Implantable Access System -

 Venous Portal, with introducer set

SI011 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $475.00

 A-CATH Low Profile Titanium Venous

Prostheses List by Category, Groups and Sponsor Page 96 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SI012 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $495.00

 A-CATH Low Profile Implantable Venous

  System, with introducer set

SI013 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter $430.00

 A-CATH II  Titanium Venous System

SI014 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.8 mm silicone catheter $450.00

 A-CATH II Titanium Venous System,

 with introducer set

SI015 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $430.00

 A-CATH II Titanium Venous System

SI016 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $450.00

 A-CATH II Titanium Venous System

 with introducer set

SI017 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 2.6 mm polyurethane catheter $459.00

 A-CATH Titanium Venous System with

 introducer set

SI018 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $420.00

 A-CATH II Low Profile Titanium Venous

  System

SI019 Injection/Infusion Ports, Sterile - PORT- Port - single lumen 1.9 mm polyurethane catheter $450.00

 A-CATH II Low Profile Titanium Venous

  System with introducer set

SI022 Injection/Infusion Ports, Sterile - PORT- Port - dual lumen 3.4 mm silicone catheter $565.00

 A-CATH II Dual Lumen Titanium Venous

  system

SI023 Injection/Infusion Ports, Sterile - PORT- Port - dual lumen 3.4 mm silicone catheter $600.00

 A-CATH II Dual Lumen Titanium Venous

  system and introducer set

Prostheses List by Category, Groups and Sponsor Page 97 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 The Mayo Group International Pty Ltd

CM009 Low Profile Ports -  Implantable Vascular Arrow Model No.'s VARRX AP01040,   Ports - H10mm, L25mm,  $604.00

  Access System AP06046, AP06016, AP06020, AP06012, Weight 9grams, Internal Vol.

  AP06022, AP06025.  Plastic low profile  0.3ml.  Catheter75cm

 ports with self sealing silicone septum

 and either attached or detached silicone

 catheters. Include relevant sized

CM010 Low Profile Ports -  Implantable Vascular Arrow Model No.'s VARRX AP06036,  Ports - H10mm, L25mm,  $594.00

  Access System AP06040, AP06042, AP06045.  Titanium  Weight 9grams, Internal Vol.

 Low Profile Ports with self sealing  0.3ml.  Catheter75cm

 silicone septum and either attached or

 detached silicone catheters.  Include

 relevant sized Introducer Kit.

Mesh

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS121 Parietene-Monofilament Polypropylene  Parietene-Monofilament Polypropylene  06 x 11cm, 15 x 10cm, 15 x  $89.00

 standard mesh / light mesh

AS122 Parietene-Monofilament Polypropylene  Parietene-Monofilament Polypropylene  20 x 20 cm $146.00

 standard mesh / light mesh

AS123 Parietene-Monofilament Polypropylene  Parietene-Monofilament Polypropylene  30 X 30 cm, 30 x 32 cm $250.00

 standard mesh / light mesh/ X-shaped

AS124 Parietene-Monofilament Polypropylene  Parietene-Monofilament Polypropylene  06 x 12 cm $155.00

 mesh Plug and Patch

AS125 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard  13 x 09 cm, 15 x 10 cm, 15 x  $200.00

 Mesh/ Bi-dimensional, Bi-dimensional

 Rigid, Three Dimensional

AS126 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester  12 x 08 cm, 14x 09 cm, 13 x 09 $200.00

 Preshaped Mesh Three-dimensional/Easy

AS127 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Standard  20 x 20 cm, 30 x 30 cm $250.00

 Mesh/ Bi-dimensional, Bi-dimensional

 Rigid, Three Dimensional

Prostheses List by Category, Groups and Sponsor Page 98 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AS128 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester  13 x 09 cm, 15 x 10 cm $205.00

 Anatomical Mesh Standard / With Slit and

  Folding / With Slit and No Touch

AS129 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Folding  14x 10 cm $185.00

 Mesh/ Bi-dimensional with integrated

 Folding System/ With Slit

AS130 Parietex-Multifilament Polyester Mesh Parietex-Multifilament Polyester Mesh Plug 6 cm, 8 cm $140.00

 Endotherapeutics Pty Ltd

ET046 Parietene Monofilament Polypropylene Surgical  6cm x 11cm to 30cm x 30cm  $265.00

ET047 Parietex Multifibre Polyester Surgical Mesh 7cm x 1.5cm to 20cm x 20cm  $240.00

 Single

ET048 Parietene Monofilament Polypropylene Surgical  6cm x 11cm to 30cm x 32cm  $380.00

 Mesh - three dimensional & X-shape (3D) Single

ET049 Parietex Multifibre Polyester Surgical Mesh 12cm x 8cm to 30cm x 32cm  $350.00

 (3D) Single

 Johnson & Johnson Medical Pty Ltd

JJ179 VYPRO Mesh Vicryl (polyglactin 910) / Prolene  30cm x 30cm $230.00

 (polypropylene) composite mesh

JJ240 VYPRO II Mesh Composition - equal part Vicryl  Small 6 x 11cm $73.67

 polyglactin yarn - non-absorbable Prolene

  polypropylene yarn.  Partly absorbable

 lightweight mesh for tension free-inguinal

JJ241 VYPRO II Mesh Composition - equal part Vicryl  Medium 12 x 10cm $94.00

 polyglactin yarn - non-absorbable Prolene

  polypropylene yarn.  Partly absorbable

 lightweight mesh for tension free-inguinal

JJ242 VYPRO II Mesh Composition - equal part Vicryl  Large 15 x 10cm $112.00

 polyglactin yarn - non-absorbable Prolene

  polypropylene yarn.  Partly absorbable

 lightweight mesh for tension free-inguinal

Prostheses List by Category, Groups and Sponsor Page 99 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ243 VYPRO II Mesh Composition - equal part Vicryl  Extra large 15 x 15cm $126.00

 polyglactin yarn - non-absorbable Prolene

  polypropylene yarn.  Partly absorbable

 lightweight mesh for tension free-inguinal

JJ434 GYNECARE GYNEMESH* PS Gynecare Gynemesh* PS is a non- 10cm x 15cm $390.00

 absorbable Prolene soft mesh indicated

 for tissue reinforcement and long lasting

 stabilisation of fascial structures of the

 pelvic floor in vaginal wall prolapse.

 Gynemesh PS* is constructed of knitted

 filaments of extruded polypropylene

 identical in composition to Prolene*

 polypropylene suture. It is packaged

 sterile, one 10 x 15cm piece per box.

JJ459 GYNECARE GYNEMESH* PS Gynecare Gynemesh* PS is a non- 25cm x 25cm $1,050.00

 absorbable Prolene soft mesh indicated

 for tissue reinforcement and long lasting

 stabilisation of fascial structures of the

 pelvic floor in vaginal wall prolapse.

 Gynemesh PS* is constructed of knitted

 filaments of extruded polypropylene

 identical in composition to Prolene*

 polypropylene suture. It is packaged

 sterile, one 25 x 25cm piece per box.

JJ477 Gynecare Prolift Pelvic Floor Repair  Pre-cut gynemesh PS and single use  PFRA01 $1,333.00

 instruments for mesh placement

 Medical Specialties  Australia Pty Ltd

MS030 TiMESH light Prosthetic warp-knitted fabric made of  10 x15 cm TiMESH light $195.00

 monofil polypropylene threads with an

 encapsulating titanic coating

MS032 TiMESH extralight Prosthetic warp-knitted fabric made of  10 x 15cm TiMESH extralight $239.00

 monfil polypropylene threads with an

 encapsulating titanic coating

MS033 TiMESH light Prosthetic warp-knitted fabric made of  15 x 15cm TiMESH light $221.00

 monofil polypropylene threads with an

 encapsulating titanic coating

Prostheses List by Category, Groups and Sponsor Page 100 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MS034 TiMESH extralight Prosthetic warp-knitted fabric made of  15 x15cm TiMESH extralight $249.00

 monofil polypropylene threads with an

 encapsulating titanic coating

MS035 TiMESH light Prosthetic warp-knitted fabric made of  20 x 15cm TiMESH light $272.00

 monofil polypropylene threads with an

 encapsulating titanic coating

MS036 TiMESH extralight Prosthetic warp-knitted fabric made of  20 x 15cm TiMESH extralight $288.00

 monofil polypropylene threads with an

 encapsulating titanic coating

MS041 TiCOVER Titanized polypropylene composite.  TiCOVER light $138.00

 Prosthetic warp-knitted fabric made of

 monofilament polypropylene threads with

 an encapsulating titanic coating.

MS042 TiCOVER Titanized polypropylene composite.  TiCOVER strong $195.00

 Prosthetic warp-knitted fabric made of

 monofilament polypropylene threads with

 an encapsulating titanic coating.

MS044 TiPLUG/TiPATCH System Titanized polypropylene composite.  TiPATCH $124.00

 Prosthetic warp-knitted fabric made of

 monofilament polypropylene threads with

 an encapsulating titanic coating.

MS049 TiGUARD Titanized polypropylene composite.  TiGUARD strong 20 x 15cm $173.00

 Prosthetic warp-knitted fabric made of

 monofilament polypropylene threads with

 an encapsulating titanic coating.

MS050 TiGUARD Titanized polypropylene composite.  TiGUARD strong 30 x 30cm $52.00

 Prosthetic warp-knitted fabric made of

 monofilament polypropylene threads with

 an encapsulating titanic coating.

Prostheses List by Category, Groups and Sponsor Page 101 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Mesh, Polyglycolic Acid

 Johnson & Johnson Medical Pty Ltd

JJ019 Vypro Mesh Vicryl/Prolene Composite Mesh Medium - 15cm x 15cm $112.00

JJ020 Vicryl Mesh 1 sheet/box Large - 30cm x 30cm $242.00

JJ173 VICRYL Mesh Polyglactin 910 - synthetic absorbable  15cm x 15cm $84.00

 Sherwood Davis & Geck T/A Tyco Healthcare Pty Ltd

SG002 Dexon Mesh Danbury 7979-00 Beige polyglycolic acid absorbable  18 x 23cm $119.48

 surgical mesh fabric

Mesh, Polymeric

 Atrium Australia-Pacific Rim Pty Ltd

AC005 Atrium polypropolene mesh - surgical  Polypropolene 7.5 x 15cm $77.00 $82.00

AC006 Atrium polypropolene mesh - surgical  Polypropolene 30 x 30cm $270.00 $282.00

AC007 Atrium polypropolene mesh - surgical  Polypropolene 15 x 15cm $87.00 $96.00

AC008 Atrium polypropolene mesh - surgical  Polypropolene 26 x 36cm $288.00 $297.00

AC009 Atrium polypropolene mesh - surgical  Polypropolene - Pre-shaped with hole 6.5 x 12.5cm $90.00 $96.00

AC010 Atrium polypropolene mesh - surgical  Polypropolene 5 x 10cm $77.00 $82.00

AC011 Atrium polypropolene mesh - surgical  Polypropolene mesh plug Small, Medium, Large and Extra $302.00 $317.00

  Large

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS055 Mesh Polyproplene; Monofilament  Multifilament Polypropylene;  7.6cm x 12.7cm Surgipro*  $52.00 * Trademark of United States

 Polyproplylene. Monofilament Polypropylene. mesh (3 x 5 inch) Surgical Corporation

AS056 Mesh Polyproplene; Monofilament  Multifilament Polypropylene;  35.6cm x 22.9cm Surgipro*  $207.00 * Trademark of United States

 Polyproplylene. Monofilament Polypropylene. mesh (14 x 9 inch). Surgical Corporation

Prostheses List by Category, Groups and Sponsor Page 102 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AS057 Mesh Polyproplene; Monofilament  Multifilament Polypropylene;  2.5cm x 10.2cm Surgipro*  $51.00 * Trademark of United States

 Polyproplylene. Monofilament Polypropylene. mesh (1 x 4 inch) Surgical Corporation

AS058 Mesh Polyproplene; Monofilament  Multifilament Polypropylene;  15.3cm x 15.3cm Surgipro*  $67.00 * Trademark of United States

 Polyproplylene; SURGIPRO* Non  Monofilament Polypropylene;  mesh (6 x 6 inch); SPMM46:  Surgical Corporation

 Absorbable Monofilament Polypropylene  SURGIPRO, Non-Asborbable  10.2cm x 15.3cm (4 x 6 inch).

 Mesh.

AS068 Surgipro Non Absorbable Polypropylene  Polypropylene Medium and Large $69.00

 Hernia Mate Plug System

 B Braun Australia Pty Ltd

BB177 Premilene Mesh Premilene Nonabsorbable Polypropylene  2.5x10cm, 5 pieces $82.00

 Surgical Suture Material Low Profile.

BB178 Premilene Mesh Premilene Nonabsorbable Polypropylene  5x10cm, 5 pieces $111.00

 Surgical Suture Material Low Profile.

BB179 Premilene Mesh Premilene Nonabsorbable Polypropylene  7.5x15cm, 5 pieces $117.00

 Surgical Suture Material Low Profile.

BB180 Premilene Mesh Premilene Nonabsorbable Polypropylene  10x15cm, 5 pieces $141.00

 Surgical Suture Material Low Profile.

BB181 Premilene Mesh Premilene Nonabsorbable Polypropylene  5x30cm, 5 pieces $142.00

 Surgical Suture Material Low Profile.

BB182 Premilene Mesh Premilene Nonabsorbable Polypropylene  26x36cm, 5 pieces $505.00

 Surgical Suture Material Low Profile.

BB183 Premilene Mesh Premilene Nonabsorbable Polypropylene  7.5x7.5cm, 5 pieces $124.00

 Surgical Suture Material Low Profile.

BB184 Premilene Mesh Premilene Nonabsorbable Polypropylene  15x15cm, 5 pieces $134.00

 Surgical Suture Material Low Profile.

BB185 Premilene Mesh Premilene Nonabsorbable Polypropylene  30x30cm, 5 pieces $345.00

 Surgical Suture Material Low Profile.

BB186 Premilene Mesh Premilene Nonabsorbable Polypropylene  4.5x9.5cm, 5 pieces $142.00

 Surgical Suture Material Low Profile.

BB187 Premilene Mesh Premilene Nonabsorbable Polypropylene  6x12.5cm, 5 pieces $147.00

 Surgical Suture Material Low Profile.

Prostheses List by Category, Groups and Sponsor Page 103 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB188 Premilene Mesh Premilene Nonabsorbable Polypropylene  4.5x10cm, 5 pieces $131.00

 Surgical Suture Material Low Profile.

BB189 Premilene Mesh Premilene Nonabsorbable Polypropylene  6x13.5cm, 5 pieces $137.00

 Surgical Suture Material Low Profile.

BB190 Premilene Mesh Premilene Nonabsorbable Polypropylene  4.5x10cm, 5 pieces $126.00

 Surgical Suture Material Low Profile.

BB191 Premilene Mesh Premilene Nonabsorbable Polypropylene  6x13.5cm, 5 pieces $138.00

 Surgical Suture Material Low Profile.

BB192 Premilene Mesh Premilene Nonabsorbable Polypropylene  Self-Forming Plug-Small, 5  $371.00

 Surgical Suture Material Low Profile.

BB193 Premilene Mesh Premilene Nonabsorbable Polypropylene  Self-Forming Plug-Medium, 5  $370.00

 Surgical Suture Material Low Profile. pieces

BB194 Premilene Mesh Premilene Nonabsorbable Polypropylene  Self-Forming Plug-Large, 5  $371.00

 Surgical Suture Material Low Profile.

BB195 Premilene Mesh Premilene Nonabsorbable Polypropylene  Self-Forming Plug-X-Large, 5  $388.00

 Surgical Suture Material Low Profile. pieces

 Bard Australia Pty Ltd

BA061 Bard Mesh  PerFix Plug Small, Medium, Large $250.00

BA062 Bard Mesh   Visilex Laparoscopic mesh 3 x 6" & 4.5 x 6" $150.00

BA063 Bard Mesh   Composix Ventral mesh 10"x14" $1,122.00

BA064 Bard Mesh   Composix Ventral mesh 12"x12" $1,300.00

BA065 Bard Mesh   Composix Ventral mesh 2" x 4" $158.00

BA066 Bard Mesh   Composix Ventral mesh 3" x 6" $300.00

BA067 Bard Mesh   Composix Ventral mesh 4" x 8" $395.00

BA068 Bard Mesh   Composix Ventral mesh 6" x 8" $560.00

BA069 Bard Mesh   Composix Ventral mesh 8" x 10" $1,003.00

BA070 Bard Mesh   Flat mesh Small - 1" x 4" / 2" x 4" / 2" x  $140.00

 12" / 3 " x 6" / Pre-shaped 1.8"

 x 4" / Pre-shaped 2.4" x 5.4"

Prostheses List by Category, Groups and Sponsor Page 104 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA071 Bard Mesh   3D Mesh  Large Left $275.00

BA072 Bard Mesh   3D Mesh  Medium Left $248.00

BA073 Bard Mesh   3D Mesh  Large Right $275.00

BA074 Bard Mesh   3D Mesh  Medium Right $248.00

BA083 Bard Mesh   Kugel Patch Small Oval 8 x 12cm $400.00

BA084 Bard Mesh   Kugel Patch Large Oval 14 x 18cm $570.00

BA085 Bard Mesh   Kugel Patch Small Circle 8 x 8cm $400.00

BA086 Bard Mesh   Kugel Patch Large Circle 12 x 12cm $550.00

BA087 Bard Mesh   Kugel Patch Medium Oval 11 x 14cm $460.00

BA096 Bard Composix Kugel Hernia Patch Small Oval w/e PTFE 8 x 12 cms $588.00

BA097 Bard Composix Kugel Hernia Patch Medium Oval w/e PTFE 11 x 14 cms $690.00

BA098 Bard Composix Kugel Hernia Patch Large Oval w/e PTFE 14 x 18 cms $799.00

BA099 Bard Composix Kugel Hernia Patch Small Circle w/e PTFE 8 x 8cms $552.00

BA100 Bard Composix Kugel Hernia Patch Large Circle w/e PTFE 12 x 12cms $715.00

BA101 Bard Composix E/X Mesh Elliptical 4" x 6" (10 x 15cm) $615.00

BA102 Bard Composix E/X Mesh Elliptical 6" x 8" (15 x 20cm) $1,055.00

BA103 Bard Composix E/X Mesh Elliptical 7" x 9" (18 x 23cm) $1,270.00

BA104 Bard Composix E/X Mesh Elliptical 8" x 10" (20 x 25 cm) $1,590.00

BA105 Bard Composix E/X Mesh Elliptical 10" x 13" (25 x 33 cm) $1,976.00

BA106 Bard Composix E/X Mesh Rectangle 10" x 14" (25 x 36 cm) $2,184.00

BA107 Bard Dulex Mesh Oval Shaped 7.5 x 10 cm, 1mm thickness $447.00

BA108 Bard Dulex Mesh Oval Shaped 8 x 12cm, 1mm thickness $573.00

BA109 Bard Dulex Mesh Oval Shaped 10 x 15 cm, 1mm thickness $812.00

BA110 Bard Dulex Mesh Oval Shaped 15 x 19 cm, 1mm thickness $1,248.00

BA111 Bard Dulex Mesh Oval Shaped 18 x 24 cm, 1mm thickness $1,723.00

Prostheses List by Category, Groups and Sponsor Page 105 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA112 Bard Dulex Mesh Oval Shaped 20 x 30cm, 1mm thickness $2,432.00

BA113 Bard Dulex Mesh Oval Shaped 26 x 34 cm, 1mm thickness $2,939.00

BA114 Bard Dulex Mesh Oval Shaped 10 x 15 cm, 2 mm thickness $1,320.00

BA115 Bard Dulex Mesh Oval Shaped 15 x 19 cm, 2 mm thickness $2,030.00

BA116 Bard Dulex Mesh Oval Shaped 18 x 24 cm, 2 mm thickness $3,120.00

BA117 Bard Dulex Mesh Oval Shaped 20 x 30 cm, 2 mm thickness $4,060.00

BA118 Bard Dulex Mesh Oval Shaped 26 x 34 cm, 2 mm thickness $5,075.00

BA127 Composix Kugel Hernia Patch Extra large oval - w/e PTFE 20cm X 25cm $1,600.00

BA128 Composix Kugel Hernia Patch Extra large oval - w/ePTFE 25cm X 33cm $1,976.00

BA131 Bard Composix Kugel Hernia Patch The Bard Composix Kugel Hernia Patch is Extra Large Oval w/e PTFE  $1,270.00

  a self-expanding, non-absorbable, sterile  18cm x 23cm

 prosthesis. Two layers of monofilament,

 polypropylene mesh are stitched to an

 ePTFE sheet; an extruded monofilament

 PET polymer "ring" provides memory,

 adds stability to the device.

BA132 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is  7.5 cm (3") diameter $415.00

 a self-expanding, non-absorbable, sterile

 prosthesis.  It consists of two layers of

 monofilament, polypropylene mesh; an

 extruded monofilament PET polymer

 "ring" provides memory, adds stability to

 the device.  The positioning strap

 facilitates placement, positioning and

 suturing of the device.

Prostheses List by Category, Groups and Sponsor Page 106 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA133 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is  10 cm (4") diameter $475.00

 a self-expanding, non-absorbable, sterile

 prosthesis.  It consists of two layers of

 monofilament, polypropylene mesh; an

 extruded monofilament PET polymer

 "ring" provides memory, adds stability to

 the device.  The positioning strap

 facilitates placement, positioning and

 suturing of the device.

BA134 Bard Modified Kugel Hernia Patch The Bard Modified Kugel Hernia Patch is  11.5 cm (4.5") diameter $550.00

 a self-expanding, non-absorbable, sterile

 prosthesis.  It consists of two layers of

 monofilament, polypropylene mesh; an

 extruded monofilament PET polymer

 "ring" provides memory, adds stability to

 the device.  The positioning strap

 facilitates placement, positioning and

 suturing of the device.

BA135 Bard Composix Kugel Hernia Patch The Bard Composix Kugel Hernia Patch is Oval w/e PTFE 16cm x 31.2cm $1,560.00

  a self-expanding, non-absorbable, sterile

 prosthesis. Two layers of monofilament,

 polypropylene mesh are stitched to an

 ePTFE sheet; an extruded monofilament

 PET polymer "ring" provides memory,

 adds stability to the device.

BA136 Bard Ventralex Hernia Patch The Bard Ventralex Patch is a self- 4.3 cm x 4.3 cm (1.7" x 1.7") $365.00

 expanding, non-absorbable, sterile

 prosthesis. Two layers of monofilament,

 polypropylene mesh are stitched to an

 ePTFE sheet; an extruded monofilament

 PET polymer "ring" provides memory,

 adds stability to the device. The

 positioning strap facilitates placement,

Prostheses List by Category, Groups and Sponsor Page 107 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA137 Bard Ventralex Hernia Patch The Bard Ventralex Patch is a self- 6.4 cm x 6.4 cm (2.5" x  2.5") $470.00

 expanding, non-absorbable, sterile

 prosthesis. Two layers of monofilament,

 polypropylene mesh are stitched to an

 ePTFE sheet; an extruded monofilament

 PET polymer "ring" provides memory,

 adds stability to the device. The

 positioning strap facilitates placement,

BA138 Bard 3DMax Mesh The Bard 3DMax Mesh is a sterile  Extra Large Left 5" x 7" $300.00

 prosthesis constructed of monofilament

 polypropylene mesh. 3DMax mesh is a

 three-dimensional, anatomically formed

 prosthesis for use in laparoscopic hernia

BA139 Bard 3DMax Mesh The Bard 3DMax Mesh is a sterile  Extra Large Right 5" x 7" $300.00

 prosthesis constructed of monofilament

 polypropylene mesh. 3DMax mesh is a

 three-dimensional, anatomically formed

 prosthesis for use in laparoscopic hernia

BA157 Bard Mesh Flat Mesh Medium - 6" x 6" $220.00

BA158 Bard Mesh Flat Mesh Large - 10" x 14" $300.00

BA162 Bard CK Parastomal Patch Bard CK Parastomal Patch 12.5 x 15.5cm, 15.5 x 20.5cm $1,185.00

 EMT Healthcare Pty Ltd

EM004 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh  2.5 x 10cm; 8 x 13cm; 15 x 15cm $49.00

 for laproscopic and open surgical

EM005 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh  5 x 10cm; 7 x 15cm, 10c x 15cm $52.00

 for laproscopic and open surgical

EM006 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh  5cm x 30cm, 6cm x 30cm $110.00

 for laproscopic and open surgical

EM007 Biomesh P1/P3 Reinforcement Mesh Macro porous 100% polypropylene mesh  25 x 36cm; 30 x 30cm $112.00

 for laproscopic and open surgical

EM008 Intramesh Reinforcement Mesh Reinforcement mesh made from two  20 x 20cm $801.00

 surfaces for intra-peritoneal visceral

 surgery (Polypropylene/ePTFE or

Prostheses List by Category, Groups and Sponsor Page 108 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EM009 Intramesh Reinforcement Mesh Reinforcement mesh made from two  15 x 15cm $555.00

 surfaces for intra-peritoneal visceral

 surgery (Polypropylene/ePTFE or

EM010 Intramesh Reinforcement Mesh Reinforcement mesh made from two  30 x 30cm $997.00

 surfaces for intra-peritoneal visceral

 surgery (Polypropylene/ePTFE or

EM015 Biomesh Hernia Reinforcing Mesh Kit Polypropylene Mesh Hernia Repair Kit -  EMT-KIT2BT2PMX2 - 2x15cm $475.00

 includes Balloons (various) , Disposable   x 15cm Mesh, 1 x Distension

 Valve and EMT Ports Balloon, 1 x Balloon Trocar, 2 x

 Ports, 1 x Disposable Valve

EM016 BIOMESH HERNIA REINFORCING  Polypropylene Mesh Hernia Repair Kit -  EMT -KIT2NM - 1 x 15cm x  $425.00

 MESH KIT includes Balloons (various) , Disposable  15cm Mesh, 1 x Distension

 Valve and EMT Ports Balloon, 1 x Balloon Trocar, 1 x

 Disposable Valve

EM018 Abdominal Wall Reinforcement Implant Polyester combined with polymerised  12cm x 14cm & 12cm x 16cm $190.00

 Jecoli Pty Ltd

JO006 Herniamesh Polypropylene Mesh Hertra Polypropylene Mesh  4.5cm x 10cm $178.00

JO008 Hertra Oval & Round Patch Pre-Shrunk Polypropylene Mesh for  Ovals in 8cm x 12cm, 11cm x  $410.00

 Inguinal, Laproscopic & Open Hernia  14cm, 14cm x 18cm, & 10cm

 Johnson & Johnson Medical Pty Ltd

JJ172 Mersilene Mesh Non-absorbable polyester mesh 30cm x 30cm $76.00

JJ174 Prolene Mesh  Small polypropylene monofilament non  2.5cm x 10cm $55.00

 absorbable mesh

JJ175 Prolene Mesh Medium polypropylene monofilament non 7.6cm x 15cm $59.56

  absorbable mesh

JJ176 Prolene Mesh Large polypropylene monofilament non  30cm x 30cm $220.00

 absorbable mesh

JJ177 Prolene Mesh Small keyhole polypropylene  4.6cm x 10.2cm $133.00

 monofilament non absorbable mesh

JJ178 Prolene Mesh Large keyhole polypropylene  6cm  x 13.7cm $95.00

 monofilament non absorbable mesh

Prostheses List by Category, Groups and Sponsor Page 109 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ180 Prolene Hernia System Bilayer polypropylene non absorbable  Onlay 4.5-5.5cm x 10cm;  $193.00

 synthetic mesh with connector Connector 1.91 x 1.27cm;

 Underlay 7.5-10cm diameter

JJ222 Prolene Mesh - medium Constructed of knitted filaments of  Medium - 6" x 6" $97.00

 extruded polypropylene identical to that

 used in Prolene suture.  Material is

 approx. 0.027mm thick.  Non-absorbable

 mesh for tension free-inguinal hernia

JJ413 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device  5.49cm x 12.50cm 3DPatch  $260.00

 consisting of a flat mesh onlay patch  large with preshaped overlay

 secured to a formed expandable diamond-

 shaped mesh patch component.

JJ414 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device  5.49cm x 12.50cm 3D Patch  $260.00

 consisting of a flat mesh onlay patch  with medium preshaped overlay

 secured to a formed expandable diamond-

 shaped mesh patch component.

JJ415 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device  5.49cm x 12.50cm 3D Patch  $250.00

 consisting of a flat mesh onlay patch  medium with extended overlay

 secured to a formed expandable diamond-

 shaped mesh patch component.

JJ416 Prolene *3D Patch Polypropylene Mesh Sterile Three-dimensional device  5.49cm x 12.50cm 3D Patch  $250.00

 consisting of a flat mesh onlay patch  large with extended overlay

 secured to a formed expandable diamond-

 shaped mesh patch component.

JJ446 PROCEED Surgical Mesh PROCEED Surgical Mesh B1 2x4 (inches) $247.00

JJ447 PROCEED Surgical Mesh PROCEED Surgical Mesh R1 3x6 inches $309.00

JJ448 PROCEED Surgical Mesh PROCEED Surgical Mesh N1 4x6 inches oval $490.00

JJ449 PROCEED Surgical Mesh PROCEED Surgical Mesh D1 4x8 inches $505.00

JJ450 PROCEED Surgical Mesh PROCEED Surgical Mesh M1 6x6 inches $715.00

JJ451 PROCEED Surgical Mesh PROCEED Surgical Mesh G1 6x8 inches oval $935.00

JJ452 PROCEED Surgical Mesh PROCEED Surgical Mesh H1 8x10 inches oval $1,575.00

JJ453 PROCEED Surgical Mesh PROCEED Surgical Mesh J1 8x12 inches $1,750.00

Prostheses List by Category, Groups and Sponsor Page 110 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ454 PROCEED Surgical Mesh PROCEED Surgical Mesh T1 10x13 inches oval $2,300.00

JJ455 PROCEED Surgical Mesh PROCEED Surgical Mesh W1 10x14 inches $2,165.00

JJ456 PROCEED Surgical Mesh PROCEED Surgical Mesh L1 12x12 inches $2,184.00

JJ465 ULTRAPRO Mesh ULTRAPRO Mesh S3 6 x 11cm $84.66

JJ466 ULTRAPRO Mesh ULTRAPRO Mesh P3 10 x 12cm $109.00

JJ467 ULTRAPRO Mesh ULTRAPRO Mesh N3 10 x 15cm $136.59

JJ468 ULTRAPRO Mesh ULTRAPRO Mesh M3 15 x 15cm $149.00

JJ469 ULTRAPRO Mesh ULTRAPRO Mesh T1 15x30cm $192.00

JJ470 ULTRAPRO Mesh ULTRAPRO Mesh L1 30x30cm $269.58

JJ565 ULTRAPRO Mesh Composite Mesh 7.6cm x 15cm $99.00

JJ566 PROLENE Mesh Polypropylene Mesh 10 x 15cm $75.00

 Morton Surgical Pty Ltd

MG019 Surgimesh WN / Surgimesh WN non- Surgimesh WN non-adherent 14x15cm Tintra S 14x15cm $985.00

 W L Gore & Associates

GT084 Gore-Tex MycroMesh Plus  ePTFE 1mm Thickness 20cm x 30 $1,926.00

GT087 Gore-Tex MycroMesh Plus  ePTFE 1mm thickness Oval 26 x 34cm $2,536.00

GT104 Gore-Tex DualMesh PLUS   ePTFE 1mm Thickness 7.5 x 10cm $350.00

GT107 Gore-Tex DualMesh PLUS   ePTFE 15.0 x 19.0cm x 1mm Oval $1,167.00

GT201 Dualmesh Plus Biomaterial ePTFE 8cm x 12cm x 1mm $446.00

GT202 Dualmesh Plus Biomaterial ePTFE, oval 10cm x 15cm x 1mm $633.00

GT203 Dualmesh Plus Biomaterial ePTFE 18cm x 24cm x 1mm $1,823.00

GT204 Dualmesh Plus Biomaterial ePTFE 20cm x 30cm x 1mm $2,544.00

GT205 Dualmesh Plus Biomaterial ePTFE, oval 26cm x 34cm x 1mm $3,373.00

GT206 Dualmesh Plus Biomaterial ePTFE, oval 10cm x 15cm x 2mm $1,020.00

GT207 Dualmesh Plus Biomaterial ePTFE, oval 15cm x 19cm x 2mm $2,029.00

Prostheses List by Category, Groups and Sponsor Page 111 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT208 Dualmesh Plus Biomaterial ePTFE, 18cm x 24cm x 2mm $2,952.00

GT209 Dualmesh Plus Biomaterial ePTFE, 20cm x 30cm x 2mm $3,986.00

GT210 Dualmesh Plus Biomaterial ePTFE, oval 26cm x 34cm x 2mm $5,192.00

Port/Catheter, Internal, Subcutaneous

 Bard Australia Pty Ltd

BA163 X Port isp Intermediate-sized MRI port with open- Port: Base 22.6 x 28.2mm.   $640.00

 ended pre-attached or attachable Hickman Height: 11.7mm.  Weight: 5.2g.

  single lumen catheter  Catheter: 9.6Fr

BA164 X Port isp Intermediate-sized MRI port with open- Port: Base 22.6 x 28.2mm.   $640.00

 ended pre-attached or attachable  Height: 11.7mm.  Weight: 5.2g.

 Chronoflex single lumen catheter  Catheter: 6 & 8Fr

Procedure Trays, Surgical

 Abbott Australasia Pty Ltd

AY001 Flexiflo Stomate - low profile  Composition - biocompatible silicone.   Size: 18 french, length: 2, 2.8,  $200.00

 Items included in kit/product - 1 low  4.3cm; Size 22 french. Length:

 profile stomate gastronomy tube,  1.7, 2.8, 4.3cm

 Obturator, Y port connector with right

AY005 Flexiflo balloon gastrostomy tube Composition - biocompatible silicone.   16 french, 18 french, 20 french $85.00

 Items included in kit/product - sliding

 retention disc and opened edged feeding

Prostheses, Bile Duct

 William A Cook Aust Pty Ltd

WC001 Cotton-Huibregste Biliary Stent Set 7 - 11.5Fr, Length 5 - 15cm $210.00

Prostheses List by Category, Groups and Sponsor Page 112 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC006 Cotton-Leung Biliary Stent Only 6 - 11.5Fr, Length 3 - 20cm $80.00

WC008 Cotton-Huibregste Biliary Stent Only 7 - 11.5Fr, Length 5 - 21cm $80.00

WC010 Zimmon Pancreatic Stent Only 5, 7Fr, Length 6, 10, 12cm $80.00

WC012 Zimmon Biliary Stent Only 5 - 11.5Fr, Length 3 - 15cm $80.00

WC013 Zimmon Biliary Stent Set 5 - 11.5Fr, Length 4 - 30cm $205.00

WC017 Cotton-Leung Biliary Stent Set 7 - 11.5Fr, Length 5 - 18cm $205.00

WC064 Biliary Stents Tannenbaum and Oasis Introducer Stent: 8.5,10,11.5 Fr. Length  $150.00

 Between Flaps: 5 -->15 cm

WC079 Cook Bile Duct Prostheses Includes Protective Sleeve for  French 5.0, length 2, 2.5, 4, 6,  $80.00

 Introduction through the Scope 8, 10, 12cm; French 6.0,

 Length 2, 2.5, 4, 6, 8, 10,

 12cm; French 7.0, Length 2,

WC080 Cook Bile Duct Prostheses Includes Protective Sleeve for  French 5.0, length 1, 2, 4, 6, 8,  $80.00

 Introduction through the Scope 10, 12cm; French 7.0, Length

 2, 4, 6, 8, 10, 12cm

WC106 Cook Bile Duct Prostheses Cotton Leung Biliary Radiopaque  Diameter 10mm, length 5, 7, 9,  $205.00

 Polyethylene Stent preloaded in an Oasis  12, 15cm

 Introduction System

WC107 Cook Bile Duct Prostheses - Geenan  Radiopaque Polyethylene Stent Includes  Diameter 5, 7mm, length 3, 5,  $227.00

 Pancreatic Stent Set Stent, Wireguide and Catheter 7, 9, 12cm

WC108 Cook Bile Duct Prostheses - Geenan  Radiopaque Polyethylene Stent Set  Diameter 5mm, length 3, 5, 7,  $227.00

 Pancreatic Stent Set without Flap includes Stent, Wirreguide and Catheter

WC123 Prostheses, Bile Duct Geenen pancreatic stent French 3 - 7, length 3 -12cm $85.00

WC124 Cook Bile Duct Prostheses Za-Stent endoscopic biliary stent only Dia 10mm, length 4 - 8cm $1,833.00

Prostheses, Esophageal

 William A Cook Aust Pty Ltd

WC007 Cook Esophageal Prostheses Esophageal Z-Stent with uncoated flanges Stent length 8 -14mm,  $2,300.00

 introducer length 70, 100cm

Prostheses List by Category, Groups and Sponsor Page 113 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC068 Esophageal Z Stent Anti-Reflux STENT Flared End Diameter:  $2,435.00

 25mm Shaft Diameter: 18mm

 Length: 8,10,12,14cm

 INTRODUCER French Size:

 31.0 (10 mm) Length: 70 cm

Prostheses, Nerve Sheath

 LMT Surgical Pty Ltd

LM017 Neurotube Bioabsorbable nerve conduit made of  2.3mm - 8mm $1,430.00

 polyglycolic acid

Prosthesis, Bowel Sphincter

 Endotherapeutics Pty Ltd

ET041 PTP Implants PTP Implants are solid, irregularly  One size only $9,200.00

 textured medical grade

 Polydimethyisiloxane Elastomer implants

 suspended in a hydrogel carrier

Prosthesis, Internal, Stent

 ev3 Australia Pty Ltd

EE001 Protégé GPS Self-Expanding Nitinol Stent Nitinol self-expanding stent, disposable  20 - 150mm length, 6 - 12mm  $1,365.00

  with Starport Delivery System delivery catheter diameter

Prostheses List by Category, Groups and Sponsor Page 114 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Shunts, Peritoneovenous

 Endocorp Pty Ltd

EC007 Denver Peritoneo-Venous Shunt Pleural Effusion Shunt PAK Pump length 7.5 cm  Pump  $1,624.00 $1,642.00

 Height 1.0 cm  Pump Width 1.7

 cm (not including suture pad) 

 Tubing Size: inside diameter

 0.27 cm  Outside diameter 0.51

Shunts, Pleuroperitoneal

 Endocorp Pty Ltd

EC002 Denver Pleuro-Peritoneal Shunt Ascites - Single Valved High Flow Rate  Pump length 7.5 cm  Pump  $1,190.00 $1,642.00

 (36-48ml/min) Height 1.0 cm Pump Width 1.7

 cm (not including suture pad) 

 Tubing Size: inside diameter

 0.27 cm  Outside diameter 0.51

EC003 Denver Pleuro-Peritoneal Shunt Ascites - Single Valved Extra High Flow  Pump length 7.5 cm  Pump  $1,642.00

 Rate (48ml/min) Height 1.0 cm  Pump Width 1.7

 cm (not including suture pad) 

 Tubing Size: inside diameter

 0.27 cm  Outside diameter 0.51

EC004 Denver Pleuro-Peritoneal Shunt Ascites - Double Valved Standard Flow  Pump length 7.5 cm  Pump  $1,642.00

 Rate (25-40ml/min) Height 1.0 cm  Pump Width 1.7

 cm (not including suture pad) 

 Tubing Size: inside diameter

 0.27 cm  Outside diameter 0.51

EC005 Denver Pleuro-Peritoneal Shunt Double Valved Shunt PAK.  Flow Rate  Pump length 7.5 cm  Pump  $2,038.00

 (20-35ml/min) Height 1.0 cm  Pump Width 1.7

 cm (not including suture pad) 

 Tubing Size: inside diameter

 0.27 cm  Outside diameter 0.51

Prostheses List by Category, Groups and Sponsor Page 115 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Sponges, Hemostatic, Absorbable

 Johnson & Johnson Medical Pty Ltd

JJ003 Spongostan Absorbable Haemostat Standard (Box of 20) 70 x 50 x 10mm $10.00

JJ004 Spongostan Absorbable Haemostat Film (Box of 20) 200 x 70 x 0.5mm $20.87

JJ005 Spongostan Absorbable Haemostat Special (Box of 20) 70 x 50 x 1mm $9.00

JJ006 Spongostan Absorbable Haemostat Anal 20s (Box of 20) 80 x 30mm $17.00

JJ007 Spongostan Absorbable Haemostat Anal 5s (Box of 5) 80 x 30mm $23.00

JJ008 Surgicel Nu-Knit Absorbable Haemostat Large (Box of 24) 7.5 x 10cm $33.00

JJ009 Surgicel Fibrillar Absorbable Haemostat Small (Box of 24) 2.5 x 5.1cm $33.00

JJ012 Surgicel Absorbable Haemostat Large (Box of 24) 5 x 35cm or 10 x 20cm $30.00

JJ013 Surgicel Absorbable Haemostat Medium (Box of 24) 5 x 7.5cm $18.00

JJ014 Surgicel Absorbable Haemostat Small (Box of 24) 1.2 x 5cm $10.00

JJ015 Spongostan Absorbable Haemostat Dental (Box of 24) 10 x 10 x 10mm $3.00

JJ023 Surgicel Nu-Knit Absorbable Haemostat Small (Box of 24) 2.5 x 2.5cm $17.35

JJ029 Surgicel Fibrillar Absorbable Haemostat Large (Box of 24) 10.2 x 10.2cm $96.00

JJ030 Surgicel Fibrillar Absorbable Haemostat Medium (Box of 24) 5.1 x 10.2cm $64.00

JJ432 SURGICEL Nu knit Absorbable Haemostat High density , oxidised regenerated  1in x 3.5in (2.5cm x 8.75cm) $28.40

 cellulose, the material is biocompatible

 and also bactericidal. Box of 10.

JJ433 SURGICEL Nu knit Absorbable Haemostat High density , oxidised regenerated  6in x 9in (15cm x 22.5cm) $101.00

 cellulose, the material is biocompatible

 and also bactericidal. Box of 10.

Prostheses List by Category, Groups and Sponsor Page 116 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Pharmacia Australia Pty Ltd

PU056 Gelfoam Sterile Sponge Sterile, pliable, nonantigenic surgical  Size 12 - 20mm x 60mm x  $4.00 $35.62

 sponge prepared from specially treated  7mm, packet of 4; Size 100 -

 purified gelatin solution 80mm x 125mm x 10mm in

 individual packet

 Taylor Bryant Pty Ltd

TB134 Curaspon Absorbable Gelatin Sponge Dental Cubes, Ster, Gel Sponge 10 x 10 x 10mm, Bx /50.  $1.00

 Benefit amount per item

TB135 Curaspon Absorbable Gelatin Sponge CUR-D-101010-60  Dental Cubes, Ster,  10 x 10 x 10mm, Bx 2/30.  $2.00

 Gel Sponge Benefit amount per item.

TB136 Curaspon Absorbable Gelatin Sponge CUR-SP-805001-20 Special 20, Ster, Gel  80 x 50 x 1mm, Bx /20 $8.00

 Sponges

TB137 Curaspon Absorbable Gelatin Sponge CUR-ST-1258001-10C Absorb Sterile  100mm, Bx /10 $41.00

 Gelatin Sponges

TB138 Curaspon Absorbable Gelatin Sponge CUR-ST-1258010-10 Absorb Sterile  100mm, Bx /10 $41.00

 Gelatin Sponges

TB139 Curaspon Absorbable Gelatin Sponge Sterile Gel Sponges 60 x 20 x 7mm, Bx /10 $7.00

TB140 Curaspon Absorbable Gelatin Sponge CUR-ST-602007-10NSHS Special Paper  Bx /10 $7.00

 Peel Pack

TB141 Curaspon Absorbable Gelatin Sponge Sterile Gel Sponges 80 x 50 x 10mm, Bx /10 $8.00

TB142 Curaspon Absorbable Gelatin Sponge CUR-ST-805010-10-NSHS Special Paper Bx /10 $12.00

  Peel Pack

TB143 Curaspon Absorbable Gelatin Sponge CUR-T-8030-05 Tampon 5, Anal Ster,  80 x 30mm, Bx /5 $9.00

 Gel Sponge

TB314 Curaspon Absorbable Gelatin Powder Curaspon Powder 1 Gram Fluffy 1 gram $47.00

TB359 Curaspon Absorbable Gelatin Sponge Absorb Sterile Gelatin Sponges 200mm, Bx/10 $55.00

Prostheses List by Category, Groups and Sponsor Page 117 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Spring Infusor, Ambulatory

 Baxter Healthcare Pty Ltd

BX246 Infusor Sterile infusor devices, spring or  SV Half day, 5ml/hr, 60ml vol.  $80.00

 elastomer driven LV 10, 10ml/hr, 240ml vol. SV

 Single day, 2ml/hr, 48ml vol. LV

  5, 5ml/hr, 240ml vol.

BX247 Intermate Sterile infusor devices, spring or  SV 200 - 200ml/hr, 100ml vol.  $60.00

 elastomeric driven SV 100 - 100ml/hr, 100ml vol.

 LV 250, 250ml/hr, 275ml vol.

 SV 50 - 50ml/hr, 100ml vol.  LV

  100  - 100ml/hr, 275ml vol. LV

  50, 50ml/hr, 275ml vol

BX248 Infusor Sterile infusor devices, spring or  LV 2, 2ml/hr, 275 ml vol; LV  $105.00

 elastomer driven 1.5, 1.5ml/hr, 275ml vol; SV

 Multi day, 0.5ml/hr. 60ml vol;

 SV Seven day, 0.5ml/hr, 96ml

BX249 Multirate with PCM Sterile infusor devices, spring or  Multirate 5, 7 or 12 ml/hr with  $250.00

 elastomer driven PCM

BX250 Basal/Bolus and Multirate Infusors Sterile infusor devices, spring or  Basal/Bolus 60, Basal 0.5ml/hr,  $125.00

 elastomer driven Bolus 0.5ml/hr x 65ml;

 Basal/Bolus 15, Basal 0.5ml/hr,

 Bolus 2ml/hr x 65ml;

 Basal/Bolus infusor, Basal

 2ml/hr, Bolus 2ml/hr x 65ml;

 Multirate 5, 7 or 12 ml/hr x 300

 ml; Multirate 2, 4, or 6 ml/hr x

 300 ml; Multirate 2, 3, or 5

 ml/hr x 300 ml; Multirate 1, 2 or

  3 ml/hr x 100 ml

 Orthocare Pty Limited

OC001 Pain Care 2000 Pain Care 2000 System One size only $229.00

OC002 Pain Care 2000 "Y" Accessory Kit One size only $80.00

Prostheses List by Category, Groups and Sponsor Page 118 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OC006 Breg Paincare 3000 100ml Continuous Infusion device  100cc reservoir $370.00

 (delivers 2ml/hr) with additional 4ml  L=10.4cm, D=3.0cm,

 bolus.  Code # 10314

OC007 Breg Paincare 3200 200ml Continuous Infusion device  200cc reservoir $265.00 $395.00

 (delivers 4ml/hr) with additional 4ml  L=10.4cm, D=6.5cm,

 bolus Code # 11030

OC008 Breg Paincare 4200 200ml Continuous Infusion device  200cc reservoir $265.00 $395.00

 (delivers 2ml/hr) with additional 4ml  L=10.4cm, D=6.0cm,

 bolus Code # 11090

 Orthotech Pty Ltd

OH065 PC2000 Pain Control Infusion Pump Plastic spring loaded drug delivery device 0.5 ml - 4 ml $310.00

OH122 PC2000 Pain Control Infusion Pump  Plastic spring loaded drug delivery device 0.5ml - 4ml $130.00

 Connector

 Stryker Australia Pty Ltd (2)

SK120 Stryker PainPump Vacuum operated pump providing  120ml Unit Base Infusion Kits $230.00

 controlled infusion of a Local Anaesthetic

  directly into a surgical site for post-

 operative pain management.

SK121 Stryker PainPump Vacuum operated pump providing  120ml unit 1-7 Day Infusion  $258.00

 controlled infusion of a Local Anaesthetic

  directly into a surgical site for post-

 operative pain management.

SK122 Stryker PainPump Vacuum operated pump providing  120ml unit Two Pump 2-4 Day  $370.00

 controlled infusion of a Local Anaesthetic Infusion Kits

  directly into a surgical site for post-

 operative pain management.

SK123 Stryker PainPump Vacuum operated pump providing  270ml unit 1-7 Day Infusion  $300.00

 controlled infusion of a Local Anaesthetic

  directly into a surgical site for post-

 operative pain management.

SK124 Stryker PainPump Vacuum operated pump providing  270ml unit Base Infusion Kits $265.00

 controlled infusion of a Local Anaesthetic

  directly into a surgical site for post-

 operative pain management.

Prostheses List by Category, Groups and Sponsor Page 119 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK125 Stryker PainPump Vacuum operated pump providing  75-150mm Extra Fenestration  $62.50

 controlled infusion of a Local Anaesthetic Infusion Catheters

  directly into a surgical site for post-

 operative pain management.

Staples, Tissue

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS091 VERSA TACK* stapler Titanium Surgical Stapler 4, 4.8mm (10 staples) $272.00 Temporary Approval

Stents

 Bard Australia Pty Ltd

BA088 Memotherm Stents  Colorectal, Nitinol, Self-expanding 25-30mm D, 60-100mm Length $2,200.00

 Boston Scientific Pty Ltd

BS053 Wallstent Enteral Endoprosthesis  Enteral Endoprosthesis Wallstent with  18mm x 60mm, 18mm x  $2,600.00

 Delivery System:Monofilament wire, self- 90mm, 20mm x 60mm, 20mm

 expanding x 90mm, 22mm x 60mm,

 Olympus Australia

OL008 Olympus Biliary Stent Set Radio-opaque Polyethglare Stent Set 7Fr 3cm - 15cm, 8Fr 3cm -  $195.00

 15cm, 10Fr 3cm - 15cm

 William A Cook Aust Pty Ltd

WC100 Colonic Z Stent with Introduction System Composition of Stent Stainless Steel,  Dia 25mm, length 4, 6, 8, 10,  $1,833.00

 includes Stent Introducer Set

Stents, Biliary

 Boston Scientific Pty Ltd

BS050 Stent (Billiary Wallstent) Wallstent (Non-covered): Monofilament  10mm x 56 to 62 mm, 10mm x  $2,200.00

 wire, self-expanding 78 to 86 mm, 10mm x 101 to

Prostheses List by Category, Groups and Sponsor Page 120 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BS055 Rapid Exchange Biliary Stent System Flexima Polyurethane with Glidex  Diameter 7 FR - 11.5 FR, length $200.00

 Hydrophilic Coating, System includes   5 - 15cm

 Stent, Guide Catheter and Push Catheter

 Endotherapeutics Pty Ltd

ET018 Optimed Biliary Sinus Stent Nickel Titanium Alloy 4-12 x 30-100mm $2,500.00

ET019 Sinus-Flex Vascular-Biliary Stent Nickel Titanium Alloy 4-12 x 40-80mm $1,888.00 $2,000.00

ET020 Sinus-Endoflex-Biliary Sinus Stent Nickel Titanium Alloy 40 x 7,8,9,10 mm; 60 x  $2,500.00

 7,8,9,10 mm; 80 x 7,8,9,10 mm

 ev3 Australia Pty Ltd

EE002 Primus Balloon Expandable Biliary Stent  Stainless steel stent premounted on a  Stent Diameter - 5, 6, 7, 8mm;  $1,525.00

 and Delivery System balloon catheter. Stent Length - 12, 17, 27,

EE003 Paramount Balloon Expandable Biliary  Stainless steel with radiopaque tantalum  Paramount Mini - Diameters 5,  $1,525.00

 Stent and Delivery System spheres.  Dual lumen tubing. Proximal  6, 7mm  Length 14, 18, 21mm;

 end incorporates a luer lock hub to  Paramount XS - Diameter 5, 6,

 provide access for guidewire insertion  7, 8mm Length 12, 17mm:

 and a second luer lock for attachment of  Paramount - Diameter 3.8, 5, 6,

 an inflation device for balloon inflation 7, 8mm Length 16, 26, 36, 56,

 Olympus Australia

OL003 Bile Duct Stent Polyethylene Stents 7FR - 12FR 3cm - 15cm $63.00

OL004 Bile Duct Stent Polyethylene Stents 7FR - 10FR 3cm - 15cm $80.00 $179.75

OL005 Bile Duct Stent Fluorinated Ethylene Propylene 10FR - 14FR 3cm -15cm $38.00

 W L Gore & Associates

GT116 Gore Biliary Endoprostheses ePTFE Short or Long Catheter 8- $3,605.00

 10mmx4-8cm

 William A Cook Aust Pty Ltd

WC016 Cook Biliary Stents Gianturco-Rösch Biliary Design Single, triple and five body $1,050.00

WC062 Biliary Stents Miller Set (UBSS-MLR). Double Pigtail  Stent: 10,12,14 Fr Stent Length: $165.00

 Stent for Drainage of bile from the   2.5,5,7.5 cm Positioner Length:

 Common Duct into the Duodenum  25cm.

WC078 Cook Biliary Stents Composition Plastic, includes Stent,  French 7.0, length 4cm $245.00

 Wireguide & Positioner

Prostheses List by Category, Groups and Sponsor Page 121 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stents, Bronchial

 Boston Scientific Pty Ltd

BS047 Ultraflex Tracheobronchial Stent Self expanding, nitinol metallic stent,  Diameter 8mm - 20mm, Length  $3,000.00

 covered and non-covered 20mm - 80mm

 Device Technologies Australia Pty Ltd

DE259 AERO Tracheobronchial Stent System Radiopaque self-expanding nitinol stent  Diameter 10-18mm, length 20- $3,000.00

 and delivery system 80mm

 N Stenning  & Co Pty  Ltd

NG034 Dynamic Stent Silicone and stainless steel tracheo- 11, 13, 15 tracheal limb 11.5,  $3,000.00 $3,781.60

 bronchial stent 13.5, 15.5mm; 11, 13, 15

 bronchial limb 8, 10, 12mm

Stents, Esophageal

 Boston Scientific Pty Ltd

BS046 Microvasive Ultraflex Oesophageal Stents Self expanding, nitinol metallic stent Stent Outer Diameter - Distal  $2,500.00

  (covered and non-covered) Release: 17mm to 22mm, 18mm

  to 23mm, 23mm to 28mm

 Proximal Release: 17mm to

 22mm, 18mm to 23mm, 23mm

BS048 Covered Oesophageal Wallstent Wallstent Esophageal II Endoprosthesis:  (Lengths up to 11cm): 100mm,  $3,000.00

 Monofilament wire, self-expanding Diameter: 20-28mm

BS049 Covered Oesophageal Wallstent Flamingo Wallstent, Wallstent Esophageal (Lengths over 11cm): Flamingo: $3,500.00

  II Endoprosthesis: Monofilament wire,   120mm x 16-24mm

 self-expanding  (Diameter), 140mm x 20-30mm

  (diameter), Wallstent

 Esophageal II Endoprosthesis:

 150mm x 20-28mm (diameter)

Prostheses List by Category, Groups and Sponsor Page 122 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BS051 Stent (Non-Vascular) Wallstent (Non-covered): Monofilament  8mm x 40mm, 8mm x 60mm,  $2,700.00

 wire, self-expanding 8mm x 80mm, 10mm x 42mm,

 10mm x 68mm, 10mm x 80mm

BS052 Stent (Non-Vascular) Wallstent (Covered): Monofilament wire,  10mm x 40mm, 10mm x  $2,750.00

 self-expanding 60mm, 10mm x 80mm

 Endotherapeutics Pty Ltd

ET001 Ferx Ella Esophageal Stent Kit includes esophageal stent, introducer,  Diam 20mm, Length 80 -  $3,500.00

 balloon catheter

 William A Cook Aust Pty Ltd

WC182 Esophageal EZS Stents Polyurethane  Uncoated Flange Esophageal Stent with  8, 10, 12, 14cm $2,350.00

 Z-Speed TM Introducer

Stents, Tracheal

 Boston Scientific Pty Ltd

BS101 Polyflex Airway Stent Poylester braided material encapsulated  Stent inner diameters up to  $2,040.00

 with silicone, self expanding stent 22mm, stent lengths up to

BS102 Polyflex Oesophageal Stent Poylester braided material encapsulated  Stent inner diameters up to  $2,040.00

 with silicone, self expanding stent 22mm, stent lengths up to

Stents, Ureteral

 Boston Scientific Pty Ltd

BS054 Flexima Biliary Stent System Flexima Polyurethane with Glidex  Dia 7 FR - 11.5 FR, length 5 -  $200.00

 Hydrophilic Coating, System includes

 Stent, Guide Catheter and Push Catheter

Prostheses List by Category, Groups and Sponsor Page 123 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Sutures, Polypropylene Monofilament

 B Braun Australia Pty Ltd

BB088 Premilene Mesh Polypropylene 2.5x10cm $40.00

BB089 Premilene Mesh Polypropylene 4.5x9.5cm $77.00

BB090 Premilene Mesh Polypropylene 4.5x10cm $75.00

BB091 Premilene Mesh Polypropylene 5x10 cm $57.00

BB092 Premilene Mesh Polypropylene 5x30cm $85.00

BB093 Premilene Mesh Polypropylene 6x12.5cm $83.00

BB094 Premilene Mesh Polypropylene 6x13.5cm $80.00

BB095 Premilene Mesh Polypropylene 7.5x7.5cm $90.00

BB096 Premilene Mesh Polypropylene 7.5x12.5cm $93.00

BB097 Premilene Mesh Polypropylene 7.5x15cm $75.00

BB098 Premilene Mesh Polypropylene 10x10cm $85.00

BB099 Premilene Mesh Polypropylene 10x12.5cm $78.00

BB100 Premilene Mesh Polypropylene 10x15cm $75.00

BB101 Premilene Mesh Polypropylene 15x15cm $83.00

BB102 Premilene Mesh Polypropylene 26x36cm $265.00

BB103 Premilene Mesh Polypropylene 30x30cm $270.00

BB104 Premilene Mesh Self Forming Plug One size only $226.00

Prostheses List by Category, Groups and Sponsor Page 124 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Tissue Reconstructive Materials

 Advanced Biomedical Pty Ltd

AB003 Bioglue Surgical Adhesive - 5ml Starter Kit Model No BG 3005 S (Bioglue Surgical  One size only $665.00 Temporary Approval

 Adhesive)

AB004 Bioglue Surgical Adhesive - 10ml Starter  Model No BG 3010 S (Bioglue Surgical  One size only $1,030.00 Temporary Approval

 Adhesive)

AB005 Bioglue Surgical Adhesive - 5ml Solutions Model No BG 3005-5 (Bioglue Surgical  One size only $478.00 The benefit amount/minimum

  Cartridge 5 Per pack Adhesive) benefit amount is for an

 individual product which comes

 as a pack of five, Temporary

AB006 Bioglue Surgical Adhesive - Applicator  Model No BGAT-20  (Bioglue Surgical  One size only $31.00 Temporary Approval

 Tip Extender Adhesive)

AB007 Bioglue Surgical Adhesive - 10ml  Model No BG 3010-5 (Bioglue Surgical  One size only $841.00 The benefit amount/minimum

 Solutions Cartridge 5 per pack Adhesive) benefit amount is for an

 individual product which comes

 as a pack of five, Temporary

AB008 Bioglue Surgical Adhesive - Standard  Model No BGAT (Bioglue Surgical  One size only $26.00 Temporary Approval

 Applicator Tip

AB009 Bioglue Surgical Adhesive - Applicator  Model No BGAT-10 (Bioglue Surgical  One size only $31.00 Temporary Approval

 Tip Extender Adhesive)

AB010 Bioglue Surgical Adhesive - Applicator  Model No BGAT-27 (Bioglue Surgical  One size only $31.00 Temporary Approval

 Tip Extender Adhesive)

AB011 Bioglue Surgical Adhesive - 2ml Solutions Model No BG3002-5 (Bioglue Surgical  One size only $394.00 The benefit amount/minimum

  Cartridge  5 per pack Adhesive) benefit amount is for an

 individual product which comes

 as a pack of five, Temporary

 Baxter Healthcare Pty Ltd

BX214 TISSEEL Duo 500 Two Component  Active ingedients:Sealer Protein Solution  1.0 ml (containing 1.0 ml of  $371.00 Temporary approval

 Fibrin Sealant Syringe & Thrombin Solution - deep-frozen,  Sealer Protein Solution and 1.0

 steam treated ml of Thrombin Solution)

Prostheses List by Category, Groups and Sponsor Page 125 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BX215 TISSEEL Duo 500 Two Component  Active ingedients:Sealer Protein Solution  2.0 ml (containing 2.0 ml of  $700.00 Temporary approval

 Fibrin Sealant Syringe & Thrombin Solution - deep-frozen,  Sealer Protein Solution and 2.0

 steam treated ml of Thrombin Solution)

BX216 TISSEEL Duo 500 Two Component  Active ingedients:Sealer Protein Solution  5.0 ml (containing 5.0 ml of  $1,762.00 Temporary approval

 Fibrin Sealant Syringe & Thrombin Solution - deep-frozen,  Sealer Protein Solution and 5.0

 steam treated ml of Thrombin Solution)

 Genzyme Australasia Pty Ltd

GE002 SepraMesh Biosurgical Composite SMBC-360 3 x 6 inch $377.00

GE003 SepraMesh Biosurgical Composite SMBC-480 4 x 8 inch $672.00

GE004 SepraMesh Biosurgical Composite SMBC-680 6 x 8 inch $1,001.00

GE005 SepraMesh Biosurgical Composite SMBC-812 8 x 12 inch $2,003.00

 Incision Pty Ltd

IP007 Durasphere FL Composition: Pyrolitically carbon coated  Syringe 1ml $520.00

 silica bead in an aqueous gel. Injectable

 bulking agent for the treatment of Faecal

 Incontinence. Syringe plus needle.

IP008 Durasphere FL Composition: Pyrolitically carbon coated  Syringe 3ml $1,560.00

 silica bead in an aqueous gel. Injectable

 bulking agent for the treatment of Faecal

 Incontinence. Syringe plus needle.

Tissue Reconstructive Materials, Solid

 W L Gore & Associates

GT001 GORE - Seamguard Staple Line  1pair of sleeves ePTFE One Size Only $206.00 Temporary Approval

 Reinforcement Material

GT065 Gore-Tex ePTFE Mycro-Mesh  ePTFE 1mm Thickness 2.5 x 10cm $92.00

GT066 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 5 x 10cm  $172.00

 (Rectangle), 5 x 10cm (Key

Prostheses List by Category, Groups and Sponsor Page 126 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT067 Gore-Tex Mycro-Mesh ePTFE 1mm Thickness 5 x 13cm  $217.00

 (Configured for Vaginal

 Prolapse), 5 x 15cm

GT068 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 18 x 24cm $1,288.00

GT069 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness 20 x 30cm $1,777.00

GT070 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 26 x  $2,333.00

GT071 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 10 x  $436.00

GT072 Gore-Tex Mycro-Mesh Biomaterial ePTFE 1mm Thickness Oval 15 x  $881.00

GT074 Gore-Tex  Mycro-Mesh Biomaterial Configured for Inguinal Hernia repair  1mm Thickness 6cm x 12cm $188.00

GT092 Gore-Tex Dual Mesh ePTFE 1mm Thickness 7.5 x 10cm $313.00

GT093 Gore-Tex Dual Mesh ePTFE 1mm Thickness 8 x 12cm $403.00

GT094 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 10 x  $556.00

GT095 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 15.0 x  $1,040.00

GT096 Gore-Tex Dual Mesh ePTFE 1mm Thickness 18 x 24cm $1,622.00

GT097 Gore-Tex Dual Mesh ePTFE 1mm Thickness 20 x 30cm $2,271.00

GT098 Gore-Tex Dual Mesh ePTFE 1mm Thickness Oval 26 x  $2,960.00

GT099 Gore-Tex Dual Mesh  ePTFE 2mm Thickness Oval 10 x  $923.00

GT100 Gore-Tex Dual Mesh  ePTFE 2mm Thickness Oval 15 x  $1,846.00

GT101 Gore-Tex Dual Mesh  ePTFE 2mm Thickness 18 x 24cm $2,668.00

GT102 Gore-Tex Dual Mesh  ePTFE 2mm Thickness 20 x 30cm $3,543.00

GT103 Gore-Tex Dual Mesh  ePTFE 2mm Thickness Oval 26 x  $4,563.00

GT217 Seamguard Staple Line Reinforcement  1 pair of sleeves ePTFE with self- Ethicon Endo-Surgery ETS45,  $2,210.00 Temporary approval

 Material adhesive loading and pre-trimmed sizes USS Endo GIA II 45-4.8, USS

 Endo GIA II 60-4.8

Prostheses List by Category, Groups and Sponsor Page 127 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Tubes, Gastrointestinal

 Boston Scientific Pty Ltd

BS075 Initial Enteral Feeding Kits (EndoVive):  Composition: silicone.  Kits include Stoma Initial Enteral Feeding Kit: 18 to  $200.00

 Gastrodome Initial Gastrostomy Kit; One-  devices, Gastrostomy/Jejunostomy tube  24 Fr

 Step Button Initial Placement  and patient care devices

 Gastrostomy Kit; Thru-The-Peg J Tube

BS076 Replacement Enteral Feeding Devices  Composition: silicone. Replacement Enteral Feeding  $180.00

 (EndoVive): Button Low-Profile  Devices: 12 to 28 Fr

 Replacement Gastrostomy Tube, Mini

Tubes, Gastrostomy, Other

 Kimberly-Clark Australia Pty Ltd

KI006 Kimberly-Clark MIC* Transgastric- Medical Grade Silicone Construction,  16-22 French - 45cm jejunal  $520.00 $720.00

 Jejunal Feeding Tubes (Surgical  Silicone Internal Retention Balloon,  length - 7-10ml balloon

 SECUR-LOK* External Retention ring,

 Universal Jejunal Feeding Port Connector,

  Gastric Decompression Port, Multiple

 Gastric & Jejunal Exit Ports, Tungsten

 Weighted Jejunal Portion, Tapered Distal

 Tip, Radiopaque Stripe, Sterile

KI008 MIC-KEY Low Profile Transgastric- 100% medical grade silicone tube. 40/60  16, 18 and 22Fr, 1.0 to 3.5cm  $520.00

 Jejunal Feeding Tube tungsten weighted jejunal post pyloric  stomal length, 15 to 45cm

 feeding tube. Gastric drainage ports,  jejunal length

 jejunal feeding ports

KI009 MIC Transgastric-Jejunal Feeding Tube 100% medical grade silicone tube. 40/60  16, 18, 22Fr, 15 to 45cm jejunal $485.00

 tungsten weighted jejunal post pyloric   length, 7-10ml balloon volume

 feeding tube. Gastric drainage ports,

 jejunal feeding ports

Prostheses List by Category, Groups and Sponsor Page 128 of 784


GENERAL/MISCELLANEOUS

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Nutricia Australia

NF001 Flocare Gastrostomy tube (G-tube) The Flocare Gastrostomy tube can be  Ch10, 14, 18, 20 $60.00

 used as a replacement of an existing

 gastrostomy tube (PEG or G-tube) or as

 an initial gastrostomy tube during a

 surgical intervention. This balloon tube is

 made of Carbothane, which ensures a

 longer life than tubing made of PUR or

 William A Cook Aust Pty Ltd

WC199 Cook Gastronomy Tubes Russell Gastronomy Set 14fr, 17cm $284.98

Tubing, Other

 Gyrus Australasia Pty Ltd

GY082 SprayGel Air Assisted Sprayer SK-A-6001 SprayGel Sprayer Kit; AK-A- One size only;  AK-A-4210 - 5  $135.00 Temporary approval - funded

 4210  SprayGel Open Surgery Applicator Applicators/Box when clinical indications for use

 are present.

Prostheses List by Category, Groups and Sponsor Page 129 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Applicators, Clip

 Johnson & Johnson Medical Pty Ltd

JJ186 Ligaclip Endoscopic Multiclip Applier Metal/plastic stapler with titanium clips 10-12mm shaft diameter $452.00 Temporary Approval

JJ187 Ligaclip Allport 5mm Clip Applier Metal/plastic stapler with titanium clips 5mm shaft diameter $398.00 Temporary Approval

Appliers

 Johnson & Johnson Medical Pty Ltd

JJ474 Proximate Contour Curved Cutter/Stapler Contour Curved Cutter/Stapler 30 & 40 30mm &, 40mm $618.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

JJ475 Proximate Contour Curved Cutter/Stapler Contour Curved Cutter/Stapler 30 &  30mm & 40mm $253.00 Only to be funded where used in

 40mm reload cartridges a service for which a Medicare

 Benefit is payable

Clip Appliers

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS006 Ligation Clips - Disposable clip applier  Premium Surgiclip* Small, medium & large clips $218.00 Temporary Approval

 and ligating clips

 Johnson & Johnson Medical Pty Ltd

JJ037 Ligaclip* Multiple Clip Applier  Metal/plastic applier preloaded with  3-12 mm; 20 clips per applier $246.00 Temporary Approval

 titanium clips

JJ038 Ligaclip* Multiple Clip Applier  Metal/plastic applier preloaded with  3-12 mm; 30 clips per applier $285.00 Temporary Approval

 titanium clips

JJ039 Ligaclip* Multiple Clip Applier  Metal/plastic applier preloaded with  5; 20 clips per applier $203.00 Temporary Approval

 titanium clips; reloadable

Prostheses List by Category, Groups and Sponsor Page 130 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Clips, Hemostatic

 Device Technologies Australia Pty Ltd

DE004 SLS Clips  Titanium Small - Large $41.00 The benefit amount/minimum

 benefit amount is for one pouch

 of 4 cartridges of  24 clips. 

 Temporary Approval

DE005 SLS Clips  Titanium composition Small, Medium, Large;   Height  $11.00 The benefit amount/minimum

 3.6 - 9mm, Width 4.2 - 8.4mm benefit amount is per cartridge. 

 Temporary Approval

DE098 SLS Clips Titanium Clips Medium to large $11.00 $16.00 The benefit amount/minimum

 benefit amount is per cartridge. 

 Temporary Approval

DE206 SLS Clips Titanium Micro, Height 2.6mm, Width  $20.00 The benefit amount/minimum

 3.1mm benefit amount is per cartridge. 

 Temporary Approval

 Johnson & Johnson Medical Pty Ltd

JJ033 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic  3-5mm; 6 clips per cartridge $10.20 Temporary Approval

JJ034 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic  9-12 mm; 6 clips per cartage $11.00 $16.75 Temporary Approval

JJ035 Ligaclip* Ligating Clips - titanium Titanium clips contained in a plastic  3-5 mm; 15 clips per cartage $25.00 $31.60 Temporary Approval

JJ036 Absolok* Extra Absorbable Ligating Clips Polydioxanone clips contained in a plastic  3-12 mm $90.20 Temporary Approval

 cartridge

JJ040 Ligaclip* 20/20 Reload Unit Metal reload cartridge containing titanium  5 mm; 20 clips $100.00 Temporary Approval

 clips

Clips, Ligating

 ConMed Linvatec Australia Pty Ltd

LV086 Reflex 5mm Automatic Clip Applier Autofeeding disposable clip applier.  medium/large $309.00 $338.00 Temporary Approval, pending

 Contains 15 non absorbable polymer  review of product group

Prostheses List by Category, Groups and Sponsor Page 131 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Cutters

 Johnson & Johnson Medical Pty Ltd

JJ188 Endopath Linear Cutter  Metal/plastic cutter-stapler with titanium  45mm; short shaft $685.00 Temporary Approval

 staples

JJ189 Endopath Linear Cutter  Metal/plastic cutter-stapler with titanium  45mm; long shaft $740.00 Temporary Approval

 staples

JJ191 Endopath Linear Cutter Metal/plastic cutter-stapler with titanium  35mm $670.00 Temporary Approval

 staples

Mesh, Polymeric

 Morton Surgical Pty Ltd

MG001 Aspide Surgimesh Monofilament polypropylene AS 59611p - 6 x 11cm Thread  $40.00

 0.14mm Box/5

MG004 Aspide Surgimesh Monofilament polypropylene AS 2812p - 8 x 12cm Thread  $48.50

 0.14mm Box/5

MG005 Aspide Surgimesh Monofilament polypropylene AS 31013p - 10 x 13cm Thread  $78.50

 0.14mm Box/5

MG006 Aspide Surgimesh Monofilament polypropylene AS 511015p - 10 x 15cm  $55.50

 Thread 0.14mm Box/5

MG007 Aspide Surgimesh Monofilament polypropylene AS 41515p - 15 x 15cm Thread  $51.50

 0.14mm Box/5

MG008 Aspide Surgimesh Monofilament polypropylene E33Lg - Easyplug Large Box/5 $144.00

MG009 Aspide Surgimesh Monofilament polypropylene E33mg - Easyplug Medium Box/5 $144.00

MG010 Aspide Surgimesh Monofilament polypropylene E33Sgp - Easyplug Small Box/5 $144.00

Prostheses List by Category, Groups and Sponsor Page 132 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Staples, Tissue

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS010 GIA*, ILA* Staplers Titanium 50 - 60mm (2.5mm, 3.8mm) $328.00 Temporary Approval

AS011 GIA*, ILA* Staplers Titanium 75mm (3.8mm, 4.8mm) $294.00 Temporary Approval

AS012 GIA* Reloading Unit  Titanium. Multifire 60 Cartridge, 90  50-60mm (2.5, 3.8mm) $233.00 Temporary Approval

 Premium Disposable Loading Unit with

 Titanium Staples,  50 Premium

 Disposable Loading Unit with Titanium

 Staples, Inverted Linear Anastomosis

 Cartridges 3944, 3943, 3978, 3946, 3945,

AS013 ILA* 52 Reloading Unit Titanium. Multifire 60 Cartridge 90  50 - 60mm (2.5mm, 3.8mm) $158.00 Temporary Approval

 Premium Disposable Loading Unit with

 Titanium Staples,  50 Premium

 Disposable Loading Unit with Titanium

 Staple,  Inverted Linear Anastomosis

 Cartridges 3944, 3943, 3978, 3946, 3945,

AS014 GIA*, ILA* Reloading Unit  Inverted Linear Anastomosis Cartridges  75mm (3.8mm, 4.8mm) $191.00 Temporary Approval

 3944, 3943, 3978, 3946, 3945, 3976,

 3977. Titanium. Multifire 60 Cartridge

AS015 GIA*, ILA* Reloading Unit  Inverted Linear Anastomosis Cartridges  80mm (3.8, 4.8mm) $367.00 Temporary Approval

 3944, 3943, 3978, 3946, 3945, 3976,

 3977, Titanium. Multifire 60 Cartridge

AS016 GIA*, ILA* Reloading Unit  Titanium. Multifire 60 Cartridge,   90mm (3.8, 4.8mm) $503.00 Temporary Approval

 Inverted Linear Anastomosis Cartridges

 3944, 3943, 3978, 3946, 3945, 3976, 3977

AS017 GIA*, ILA* Reloading Unit  Titanium. Multifire 60 Cartridge, Inverted 100mm (3.8,4.8mm) $392.00 Temporary Approval

  Linear Anastomosis Cartridges 3944,

 3943, 3978, 3946, 3945, 3976, 3977

Prostheses List by Category, Groups and Sponsor Page 133 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AS018 TA* Stapler; DST Series* Linear Staplers Premium Multifire TA* Disposable  30mm (2.5, 3.5, 4.8mm); DST  $330.00 Temporary Approval

 Surgical Stapler and Loading Unit;  TA45-3.5; DST TA45-4.8; DST

 Titanium staples used for hemostatic   TA60-3.5; DST TA60-4.8;

 closure of specific organs and blood  DST TA30-3.5; DST TA30-4.8;

 vessels (ex bowel, stomach and lung).  DST TA30V3.

AS019 PI*, Stapler Premium Multifire TA* Disposable  30mm (2.5, 3.5, 4.8mm) $264.00 Temporary Approval

 Surgical Stapler and Loading Unit

AS025 TA* Reloading Units; DST Series* Linear Premium Multifire TA* Disposable  30mm (2.5, 3.5, 4.8mm); DST  $243.49 Temporary Approval

  Stapler Disposable Loading Units Surgical Stapler and Loading Unit;  TA90-3.5 DLU; DST TA90-4.8

 Titanium staples used for hemostatic  DLU; DST TA45-3.5 DLU;

 closure of specific organs and blood  DST TA45-4.8 DLU; DST

 vessels (ex bowel, stomach and lung) TA60-3.5 DLU; DST TA60-4.8

 DLU; DST TA30-3.5 DLU;

 DST TA30-4.8 DLU; DST

AS026 PI*, Reloading Unit Premium Multifire TA* Disposable  30mm (2.5, 3.5, 4.8mm) $144.00 Temporary Approval

 Surgical Stapler and Loading Unit

AS030 TA* Reloading Units Premium Multifire TA* Disposable  90mm (3.5mm, 4.8mm) $724.00 Temporary Approval

 Surgical Stapler and Loading Unit

AS033 Power Stapler and Staples (Powered  LDS Instrument & Cartridges  One size only $343.00 Temporary Approval

 (Disposable Loading Unit)

AS035 Roticulator* Roticulator 30 30mm (3.5, 4.8mm) $715.00 Temporary Approval

AS036 Roticulator* Roticulator 55 55mm (3.5, 4.8mm) $839.00 Temporary Approval

AS037 ROTICULATOR* Polysorb 55 Disposable Loading Unit 55mm (3.5, 4.8mm) $715.00 Temporary Approval

AS072 Staples and Disposable Stapler Applier  Titanium, curved, PPCEEA*; Titanium  21-34mm; 21, 25, 28, 31,  $769.00 Temporary Approval

 and staples; PPCEEA*. Surgical Stapler.

AS075 ENDO TA* Titanium Surgical Stapler 30mm $606.00 Temporary Approval

AS094 GIA*, ILA* Staplers Titanium 80mm (3.8mm, 4.8mm) $451.00 Temporary Approval.  *

 Trademark of United States

 Surgical Corporation

AS102 DST Series* Linear Staplers Titanium staples used for hemostatic  DST TA90-3.5; DST TA90-4.8 $398.00 Temporary approval

 closure of specific organs and blod

 vessels (ex bowel, stomach and lung)

Prostheses List by Category, Groups and Sponsor Page 134 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AS110 DFS Disposable Fascia Stapler Stainless Steel One Size Only $183.00 Temporary Approval

AS113 DST Series* GIA* Linear Cutter Stapler  single use, reloadable stapler 60mm length: sizes 2.5mm,  $354.00 Temporary approval, pending

 and single use loading units 3.8mm, 4.8mm review of product group

AS114 DST Series* GIA* Linear Cutter Stapler  Single Use Loading Units 60mm length: Sizes 2.5mm,  $240.00 Temporary approval, pending

 and single use loading units 3.8mm, 4.8mm review of product group

AS115 DST Series* GIA* Linear Cutter Stapler  Single use, reloadable stapler 80mm length; Sizes 3.8 and  $470.00 Temporary approval, pending

 and single use loading units review of product group

AS116 DST Series* GIA* Linear Cutter Stapler  Single Use Loading Units 80mm length: Sizes 3.8 and  $367.00 Temporary approval, pending

 and single use loading units review of product group

AS117 DST Series* GIA* Linear Cutter Stapler  Single use, reloadable stapler 100mm length: Sizes 3.8 and  $460.00 Temporary approval, pending

 and single use loading units 4.8mm review of product group

AS118 DST Series* GIA* Linear Cutter Stapler  Single use loading units 100mm length: Size 3.8 and  $335.00 Temporary approval, pending

 and single use loading units review of product group

AS119 DST Series* EEA* Circular Stapler Circular staplers 21mm to 33mm $780.00 Temporary approval, pending

 review of product group

 Johnson & Johnson Medical Pty Ltd

JJ056 Proximate Articulating Linear Stapler Articulating linear stapler preloaded with  55mm $830.00 Temporary Approval

 titanium staples

JJ190 Endopath ETS Linear Cutter reload Titanium staple cartridge 45mm $243.49 Temporary Approval

JJ192 Endopath ETS Linear Cutter reload Titanium staple cartridge 35mm $220.00 Temporary Approval

Surgical Procedure Kit

 Johnson & Johnson Medical Pty Ltd

JJ443 Proximate Intraluminal Stapler PPH Proximate Hemorrhoidal Circular Stapler  One Size Only $725.00

Prostheses List by Category, Groups and Sponsor Page 135 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Suture Units, Automatic

 Johnson & Johnson Medical Pty Ltd

JJ041 Proximate* Intraluminal Stapler Metal/plastic circular straight stapler  21 - 33 mm $671.00 Temporary Approval

 preloaded with titanium staples

JJ042 Proximate* Intraluminal Stapler Metal/plastic circular curved stapler  21 - 33mm $768.02 Temporary Approval

 preloaded with titanium staples

JJ043 Proximate* Linear Cutter with Staples  Metal/Plastic linear cutter preloaded with  50 - 60mm $350.00 Temporary Approval

 titanium staples

JJ044 Proximate* Linear Cutter with Staples  Metal/Plastic linear cutter preloaded with  75 - 80mm $470.00 Temporary Approval

 titanium staples

JJ045 Proximate* Linear Cutter with Staples  Metal/Plastic linear cutter preloaded with  100mm $460.00 Temporary Approval

 titanium staples

JJ046 Proximate* Linear Cutter  Staple Reload  Plastic linear cutter reload cartridge  50 - 60mm $233.00 Temporary Approval

 containing titanium staples

JJ047 Proximate* Linear Cutter  Staple Reload  Plastic linear cutter reload cartridge  75 - 80mm $328.00 Temporary Approval

 containing titanium staples

JJ048 Proximate* Linear Cutter Staple Reload  Plastic linear cutter reload cartridge  100mm $335.00 Temporary Approval

 containing titanium staples

JJ049 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with  30mm $370.00 Temporary Approval

 titanium staples

JJ050 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with  55 - 60mm $315.00 Temporary Approval

 titanium staples, manual closure

JJ051 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with  55 - 60mm $315.00 Temporary Approval

 titanium staples, automatic closure

JJ052 Proximate* Linear Stapler Metal/Plastic linear stapler preloaded with  90mm $398.00 Temporary Approval

 titanium staples

JJ053 Proximate* Linear Stapler Reload Unit  Plastic linear stapler reload cartridge  30mm $233.00 Temporary Approval

 containing titanium staples

Prostheses List by Category, Groups and Sponsor Page 136 of 784


MECHANICAL INTERNAL WOUND

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ054 Proximate* Linear Stapler Reload Unit  Plastic linear stapler reload cartridge  55 - 60mm $235.00 Temporary Approval

 containing titanium staples

JJ055 Proximate* Linear Stapler Reload Unit  Plastic linear stapler reload cartridge  90mm $248.00 Temporary Approval

 containing titanium staples

JJ184 Endopath Multi Stapler Endoscopic titanium stapler with staples 11mm shaft diameter $530.00 Temporary Approval

Prostheses List by Category, Groups and Sponsor Page 137 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Anchor, Fixation

 Medtronic Australasia Pty Ltd

MC094 Stimulator Accessory Kit - Pisces Quad;  Model 3550-10 revision kit. 1 x boot, 1 x  One size only $545.00 When used in pain therapy - to

 Pisces Z Lead Revision Kit; Pisces Quad  twistlock anchor, 2 x silicone anchors, 1  be funded when the patient has

 Revision Kit; Octad Revision Kit x hex wrench, 1 x epidural needle 15  undergone a multi-disciplinary

 gauge, 1 x percutaneous extension (inline) assessment and trial of

  with set screws, 1 x ball-tipped (bent)

 28cm stylet for Pisces-Quad lead, 1 x

 ball-tipped (straight) 28cm stylet for

 Pisces-Quad lead, 1 x screening cable, 1

 x short stylet, 1 x tunnelling guide, 1 x

 tunnelling guide tip. Silicone,

 polycarbonate, polyurethane, titanium,

 stainless steel; 3550-22 & 3550-23

 Curved steering stylets, Epidural Needle,

 Guide Wire, Straight Steering Stylets,

 Torque Wrench, Percutaneous Extension,

  Connector Boot, PERCUPASS II

 Tunneling Tool & Tunneling Tip, Short

 Stylet, Twist-Lock Screening Cable,

 Passing Straw, Anchors; Model - 3550-

 R33 - Pisces Quad revision kit with 33cm

  stylet; Model 3550-ORK - Octad

MC581 Invisx Locks Invisx polymer cranial fixation system Single pack $95.00

MC582 Invisx Locks Invisx polymer cranial fixation system 2 pack $175.00

MC689 Neurostimulation System - Lead Revision  Octad Lead Revision Kits Model 3550-26  30 & 45cm; 60 & 75cm $540.00

 & 3550-27

Barrier, Absorbable, Adhesion Prevention

 Global Scientific Pty Ltd

GS199 DuraGen Dural Graft Matrix Collagen 2.5 x 2.5cm $360.00

Prostheses List by Category, Groups and Sponsor Page 138 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GS200 DuraGen Dural Graft Matrix Collagen 2.5 x 7.5cm $545.00

GS201 DuraGen Dural Graft Matrix Collagen 5 x 5cm $605.00

GS202 DuraGen Dural Graft Matrix Collagen 7.5 x 7.5cm $1,120.00

GS203 DuraGen Dural Graft Matrix Collagen 10 x 12.5cm $1,890.00

 Medtronic Australasia Pty Ltd

MC618 Medishield Medishield is a co-polmer gel composed  3cc Syringe $1,300.00 Temporary approval - funded

 of carboxymethylcellulose and  when clinical indications are

Bone Matrix Implants, Artificial

 Medtronic Australasia Pty Ltd

MC626 Macropore FRP (fast resorbing polymer) Polylactide and Polyglycolide polymer 1.8mm x 3-8mm $82.00

MC627 Macropore FRP (fast resorbing polymer) Polylactide and Polyglycolide polymer 100mm x 100mm x 0.75mm $1,940.00

MC628 Macropore FRP (fast resorbing polymer) Polylactide and Polyglycolide polymer 60mm x 80mm x 0.75mm $1,230.00

MC629 Macropore FRP (fast resorbing polymer) Polylactide and Polyglycolide polymer 50mm x 50mm 0.75mm $985.00

MC630 Macropore FRP (fast resorbing polymer) Polylactide and Polyglycolide polymer 25mm x 25mm x 0.75mm $500.00

MC631 Macropore FRP (fast resorbing polymer)  Polylactide and Polyglycolide polymer 2.1mm x 3-8mm $100.00

 screw

Cables/Leads, Other

 Advanced Neuromodulation Systems Australia Pty Ltd

AV001 ANS Spinal Cord Stimulation System  Lead Extensions - in addition to 3341,  60cm length $1,510.00 When used in pain therapy - to

 3342, 3343, 3382 and 3383, additional  be funded when the patient has

 model 3346 - Dual Quad Extension and  undergone a multi-disciplinary

 3386 - single octrode extension assessment and trial of

Prostheses List by Category, Groups and Sponsor Page 139 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AV002 ANS Spinal Cord Stimulation System  Octrode Lead. 8 Electrode (thoracic or  30cm, 60cm $4,293.00 When used in pain therapy - to

 cervical placement). be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV003 ANS Spinal Cord Stimulation System  Quattrode Lead. 4 Electrode. 30cm, 60cm $3,400.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV007 ANS Spinal Cord Stimulation System  Trial Lead. Temporary Screening Lead 30cm, 60cm $485.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV011 ANS Spinal Cord Stimulation System  Lamitrode Plate Electrode Lead One size only $7,040.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV012 ANS Spinal Cord Stimulation System  Lamitrode Dual 8 Plate Electrode Lead One size only $7,640.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV021 A127 Lead Extension A127 Lead Extension 15cm, 40cm, 60cm, 90cm $1,510.00

Catheter, Infusion

 Johnson & Johnson Medical Pty Ltd

JJ488 Prowler Infusion Microcatheters, Prowler Proprietary braid / coil reinforced  Size:  150cm - 170cm.  Distal  $700.00

  Select LPES, Prowler Select Plus,  technology.  Proximal braided shaft.   length:  5cm - 50cm

 Prowler 14, Prowler Select pre-shaped -  Prowler Select LPES infusion catheter. 

 Coil delivery system Prowler Select Plus infusion catheter. 

 Prowler 14 infusion catheter

 Medtronic Australasia Pty Ltd

MC716 Intrathecal Catheter Model 8731 Radiopaque silicone rubber,  Length 104.1cm $820.00 $950.00

 titanium

Prostheses List by Category, Groups and Sponsor Page 140 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheters, Cerebrospinal

 Johnson & Johnson Medical Pty Ltd

JJ160 Hakim Ventricular Catheter with Bactiseal Silicone antibiotic impregnated catheter Ventricular catheter length 14 cm $675.00

  Silicone

Catheters, Hydrocephalic

 CWL Medical Enterprises Pty Ltd

CW007 Cardiac/Peritoneal Catheters SiliconDistal Catheter, ID 1.3mm, OD  90cm, barium impregnated  $185.00

 silicone catheter, closed or open

  ended, with or without slits

CW008 Ventricular Catheters Silicon Ventricular Catheter 15cm - 25cm, optional flanges  $185.00

 or right angle or endoscopic tip.

  ID 1.3mm, OD 2.5mm

 Global Scientific Pty Ltd

GS134 Shunt Lumbar 80cm $1,046.00

GS150 Atrial Catheter  Components - catheter: Atrial Atrial  Length: 46cm, F7.  OD: 2.1mm; $165.00

 Catheters  Hydrocephalux Valve   ID:1.1mm

GS151 Peritoneal Catheter Peritoneal Catheters Length: 91cm, F7.  OD: 2.1mm; $180.00

  ID:1.1mm

 Medtronic Australasia Pty Ltd

MC533 Shunt: Components catheter Ventricular Catheter, CSF Catheter 1.3 - 35cm $149.00

MC583 CSF - Ventricular Catheters PSM Range Non metallic latex free. Barium  ID 1.3mm OD 2.5mm Length  $212.00

 impregnated, include stainless steel stylet. 15cm, 23cm; ID 1.2mm OD

   Model Nos 41101, 41115, 41207,  2.1mm Length 15cm, 23cm

 41103, 41308, Proximal ventricular

Prostheses List by Category, Groups and Sponsor Page 141 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC584 CSF - Distal Catheters Non metallic and latex free, Models  Distal cardiac/peritoneal  $185.00

 43418,43103,43111,43209,43522,43551, catheters ID 1.3mm OD 2.5mm

 27211  Length 90cm, 96cm, 110cm,

 120cm, ID 1.2mm, OD 2.1mm,

  Length 90cm, 75cm, 58cm

MC638 Peritoneal Catheter PSM range with  Translucent silicone elastomer with  60-90cm $255.00

 Barium impregnated stripe.  Catheter

 surface bonded with Hydrogel.

MC639 Ventricular Catheter PSM range with  Translucent silicone elastomer with  15-23cm $249.00

 Barium impregnated stripe. Catheter

 surface bonded with Hydrogel.

Catheters, Intracranial, Ventricular

 B Braun Australia Pty Ltd

BB078 Shunt Accessories Catheter-Ventricular 60cm to 120cm $289.00

 Global Scientific Pty Ltd

GS001 Heyer-Schulte In Line Valve System Anti Siphon Device One size only $390.00 $640.00

GS015 Heyer-Schulte Pudenz Ventricular Catheter - small, standard, right-angled $185.00

GS133 Shunt Components - catheter: Atrial 55cm - 60cm, Low - High  $450.00

 pressure range

GS135 Shunt Peritoneal 90 - 120cm $350.00

GS136 Shunt Ventricular 14.5cm - 23cm $475.00

GS139 Heyer Schulte Portnoy Flanged  Composition - silicone with tantalum  Length 18cm, outer diameter  $475.00

 Ventricular Catheter markings

 Johnson & Johnson Medical Pty Ltd

JJ227 Codman Medos Straight Ventricular  14cm, packaged sterile, silicone rubber 14cm $149.00

Prostheses List by Category, Groups and Sponsor Page 142 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheters, Peritoneal

 Johnson & Johnson Medical Pty Ltd

JJ163 Hakim Ventricular and Peritoneal Catheter Silicone ventricular/peritoneal catheter Peritoneal Catheter length 80  $469.00

  Set with Bactiseal Silicone cm, Ventricular Catheter length

JJ229 Codman Medos Peritoneal Catheter 85cm, packaged sterile, silicone rubber 85cm $185.00

Clamps, Skull

 B Braun Australia Pty Ltd

BB072 Craniofix Titanium Clamps Titanium 11mm $86.00

BB073 Craniofix Titanium Clamps Titanium 16mm $86.00 $127.00

BB168 Craniofix Titanium skull fixation clamp 20mm $86.00 $140.00

Clips

 Stryker Australia Pty Ltd (2)

SK370 Universal Neuro NeuroClip 1.5mm $193.00

Clips, Aneurysm

 B Braun Australia Pty Ltd

BB108 Aneurysm Clip Yasargil 4.5mm x 150g to 25.0mm x 200g $215.00 $230.00

BB109 Aneurysm Clip Yasargil Phynox Mini 2.8mm x 110g to 7.0mm x 130g $205.00

BB110 Aneurysm Clip Yasargil Titanium 4.9mm x 150g to 20.0mm x 200g $258.00

Prostheses List by Category, Groups and Sponsor Page 143 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB111 Aneurysm Clip Yasargil Titanium Mini 2.8mm x 110g to 7.0mm x 110g $270.00

BB112 Aneurysm Clip Yasargil Reinforcing, Titanium/Phynox One size only $422.00

BB175 Yasargil Aneurysm Clip System Phynox temporary clips are manufactured 3mm - 20mm length, phynox  $230.00

  from phynox. temporary clips.

BB176 Yasargil Aneurysm Clip System Titanium termporary clips are  3mm- 25mm length, titanium  $280.00

 manufactured from titanium temporary clips.

BB218 Kopitnik Microneurosurgical AVM Clips Composition: Phynox (Cobalt-base-alloy) 2mm, 3mm, 4mm, 5mm -  $240.00

 straight. 2mm, 3mm, 4mm,

 Johnson & Johnson Medical Pty Ltd

JJ130 Aneurysm Clips Stainless steel alloy AVM Micro Clip Blade length 2-9.5 mm $270.00

JJ131 Aneurysm Clips Stainless steel Graft Clip (with teflon  Blade 2-5mm diameter, 3-7mm  $598.00

 length

JJ134 Aneurysm Clips Stainless steel Reinforcing (booster) Clip Blade length 2-9.5 mm $460.00

JJ136 Aneurysm Clips Stainless steel large clip, curved Blade 6mm diameter, 7.5mm  $420.00

JJ137 Aneurysm Clips Stainless steel large clip, right-angled Blade 6mm diameter, 5mm length $408.00

JJ138 Aneurysm Clips Stainless steel large clip, right-angled Blade 6mm diameter, 7.5-15mm $378.00

  length

JJ139 Aneurysm Clips Stainless steel large clip, 30 degree angle Blade length 12mm $424.00

JJ140 Aneurysm Clips Stainless steel large clip, bayonet Blade length 5-12mm $445.00

JJ141 Aneurysm Clips Stainless steel large clip, fenestrated Blade 6mm diameter, 24mm  $408.00

JJ142 Aneurysm Clips Stainless steel large clip, fenestrated tandem Blade 6mm diameter, 6 mm  $378.00

JJ143 Aneurysm Clips Stainless steel standard clip, straight to  4.5-10mm length $258.00

 right angled

JJ144 Aneurysm Clips Stainless steel standard clip, side angle 0.6mm diameter, 10mm length $260.00

JJ146 Aneurysm Clips Stainless steel standard clip, slightly curved 0.6mm diameter, 15mm length $278.00

JJ147 Aneurysm Clips Stainless steel standard clip, right angle 0.6mm diameter, 5.5 mm length $269.00

JJ148 Aneurysm Clips Stainless steel standard clip, straight to  0.5-0.6mm diameter, 5-15mm  $295.00

 right angle length

Prostheses List by Category, Groups and Sponsor Page 144 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ149 Aneurysm Clips Stainless steel standard clip, straight to  5-25mm length $370.00

JJ150 Aneurysm Clips Stainless steel standard clip, slightly curved 16mm length $370.00

JJ151 Aneurysm Clips Stainless steel standard clip, bayonet 9mm length $345.00

JJ152 Aneurysm Clips Stainless steel standard clip, bayonet 15mm length $350.00

JJ153 Aneurysm Clips Stainless steel standard clip, curved 10-14mm length $365.00

JJ154 Aneurysm Clips Stainless steel standard clip, slightly curved 8-20mm length $408.00

JJ155 Aneurysm Clips Stainless steel standard clip, bayonet to  6-25mm length $406.00

 right angle

JJ217 Aneurysm Clips Stainless steel large clip Blade 4-6mm diameter, 5-25mm $378.00

  length

 National Surgical Corporation Pty Ltd

NI143 Medicon Aneurysm Clips Aneurysym clips titanium, standard  Large $310.00

 titanium, stainless steel

 Taylor Bryant Pty Ltd

TB116 Aneurism Clip Sugita Clips, Standard Slightly Curved, One Size Each $460.00

TB117 Aneurism Clip Sugita Clip, Temporary Straight/S,   One Size Each $405.00

 Sugita Clip, Temporary Straight/L

TB118 Aneurism Clip Sugita Clips: Standard Straight-Short  One Size Each $342.00

 #1/Long #2

TB119 Aneurism Clip Sugita Titanium Anneurysm Clips:  One Size Each $269.00

 Standard Straight/s, Straight-L, Bayonet,

 Angled, Straight-Small, STD Temp-STD

 Small, STD Temp-Straight/Large, STD

 Temp-Bayonet, STD Temp-CVD, Mini

 Straight-Small, Mini Straight/Large, Mini

 Curve, Mini Angled, Mini Curve

Prostheses List by Category, Groups and Sponsor Page 145 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB147 Aneurism Clip Sugita Titanium Clips: Standard Slight  One Size Each $318.00

 Angle, Side CVD, CVD, Angled, Bayonet-

 Small/Large, Straight-Medium, Slight

 CVD, Straight Large, L Angle-

 Small/Medium/Large, 45D CVD

 Small/Medium/Large, STD Temp Slight

 CVD, Temp Mini Straight/Large, Temp

 Mini Angle, Standard 1/4 Curved-

 Small/Large, STD Slight Angle, Standard

 Slight Curve, Curve, 1/4 Curve, Mini

 Curve, Side Curve, Angle, Bayonet,

TB148 Aneurism Clip Sugita Titanium Clips: Standard Side CVD One Size Each $420.00

  Bayonet, Small CVD, Side Angled, Slight

  CVD, J Angle-Small/Medium/Large,

 Slight CVD Small, Temp Mini Straight

 Slim, Standard L Curved- Small/Large,

 Mini Straight Slim, Curve Slim,

TB149 Aneurism Clip Sugita Titanium Clips: Booster One Size Each $435.00

TB150 Aneurism Clip Sugita Clips: Mini Straight Slim, CVD  One Size Each $460.00

TB151 Aneurism Clip Sugita Clips: Fenest, Lrg L Shaped W/CVD One Size Each $500.00

TB152 Aneurism Clip Sugita Clips, Mini CVD Slim One Size Each $618.00

TB153 Aneurism Clip Sugita Clips, Long One Size Each $620.00

TB154 Aneurism Clip Sugita Clip,  Large Straight/Short One Size Each $220.00

TB155 Aneurism Clip Sugita Clip, Temporary Bayonet, Bent One Size Each $230.00

TB156 Aneurism Clip Sugita Clip, STD Sideward CVD One Size Each $236.00

TB157 Aneurism Clip Sugita Clip, Large Sideward Bent, Bent,  One Size Each $296.00

 Bayonnet-Short/Large, Straight-

TB158 Aneurism Clip Sugita Clip, Large L Shaped- One Size Each $319.00

 Short/Medium/Large, Large J Shaped-

 Short/Medium/Large, Fenest Large

 Straight-S/M/L, Large Bent-S/M/L,

 Fenest Large L Shaped-S/M/L

Prostheses List by Category, Groups and Sponsor Page 146 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB159 Aneurism Clip Sugita Clip, Temporary Mini Straight,  5-7mm length x 1.2mm width,  $328.00

 Bent, Mini Straight/Short, Bent,  closing force 125gms

 SDEWARD CVD, CVD

TB160 Aneurism Clip Sugita Clip, Mini CVD 4mm length x 1.2mm width,  $331.00

 closing force 120 & 124gms

TB161 Aneurism Clip Sugita Clip, Mini CVD 5mm length x 1.2mm width,  $366.00

 closing force 132gms

TB162 Aneurism Clip Sugita Clip, Large Slightly Crv- One Size Each $390.00

TB163 Aneurism Clip Sugita Clip, Large 45 D Angle/s, Slightlyn One Size Each $380.00

  Crv/s, Temporary Slighly Crv, Mini

 Straight Slim, Large 1/4 CVD, Mini

TB164 Aneurism Clip Sugita Clip, Large Straight, Bayonet, Mini One Size Each $400.00

  Bayonet

TB165 Aneurism Clip Sugita Clip, Large L Shaped W/CRV-S/L, One Size Each $410.00

  1/4 CVD-S/L

TB166 Aneurism Clip Sugita Clip, Large 45D Angle-M/L One Size Each $400.00

TB167 Aneurism Clip Sugita Clip, Fenest Large L Shaped-L,  One Size Each $460.00

 Bayonet

TB168 Aneurism Clip Sugita Clip, Fenest Large L Shaped W/CVD One Size Each $224.00

TB169 Aneurism Clip Sugita Clips, Standard Bayonnet, Bent,  One Size Each $236.00

 Sideward Bent, Sideward Curve, Slight

TB170 Aneurism Clip Sugita Clips, Standard Sideward Curve,  One Size Each $370.00

 Curved

TB171 Aneurism Clip Sugita Clips, Standard Slight CVD, CVD 11mm length x 1.2 width,  $342.00

 closing force 125-160gms;

 9mm length x 1.2 width, closing

  force 120-155gms

TB294 Mizuho - Titanium Fenestrated Aneuysm  Straight (S/M/L), Bent (S/ M/L),  L- Closing Force 95 to 160 gms $568.00

 Clips Shaped (S/M/L), Bayonet,  L Shaped

 curved to left (S/M/L),  L-Shaped curved

Prostheses List by Category, Groups and Sponsor Page 147 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Victorian Health Care Association Pty Ltd

VH001 Spetzler Titanium Aneurysm Clips Permanent Standard & Temporary Clips.  5mm-13mm $602.91

 Commercially Pure Titanium.

VH002 Spetzler Titanium Aneurysm Clips Fenestrated Clips. Commercially Pure  5mm-13mm $645.66

 Titanium.

Covers, Burr Hole

 Johnson & Johnson Medical Pty Ltd

JJ165 Burr Hole Button Stainless steel ventriculostomy reservoir One size only $375.00

JJ166 Burr Hole Button Silicone or stainless steel ventriculostomy 14mm diameter $450.00

  reservoir

JJ167 Burr Hole Button Silicone ventriculostomy reservoir, flat  One size only $260.00

JJ168 Burr Hole Button Silicone ventriculostomy reservoir,  One size only $172.00

JJ169 Burr Hole Button Silicone ventriculostomy reservoir, large One size only $355.00

JJ170 Burr Hole Button Silicone or stainless steel ventriculostomy One size only $335.00

  reservoir, low profile

JJ171 Burr Hole Button Silicone or stainless steel ventriculostomy 24mm diameter $400.00

  reservoir

JJ284 BIOPLATE Burr hole cover 1.9mm, titanium, flexible contoured burr  18mm $176.00

 hole cover, packaged non-sterile

JJ285 BIOPLATE Burr hole cover 1.5mm, titanium, flexible contoured burr  12mm $176.00

 hole cover, packaged non-sterile

JJ286 BIOPLATE Burr hole cover 1.9mm, titanium, rigid contoured burr  18mm $170.00

 hole cover, packaged non-sterile

JJ287 BIOPLATE Burr hole cover 1.5mm, titanium, rigid contoured burr  12mm $176.00

 hole cover, packaged non-sterile

JJ288 BIOPLATE Burr hole cover 1.5mm, titanium, rigid contoured burr  18mm $182.00

 hole cover, packaged non-sterile

Prostheses List by Category, Groups and Sponsor Page 148 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ289 BIOPLATE Burr hole cover Titanium, burr hole cover, 6 hole,  12mm flat $185.00

 packaged non-sterile

JJ290 Burr hole button Sterile, 10 per package, silicone rubber Button length 35mm, cover  $99.40

 diameter 29mm, stem thickness

 4.1mm

JJ291 Burr hole cover Burr hole cover, sterile, 10 per package,  Seat diameter 10mm, seat depth  $99.40

 silicone rubber 6mm

JJ292 BIOPLATE Burr hole cover 1.5mm, titanium, flexible contoured burr  18mm $182.00

 hole cover, packaged non-sterile

JJ299 BIOPLATE Burr Hole Cover 1.9mm, titanium, flexible contoured burr  12mm $172.00

 hole cover, packaged non-sterile

JJ489 Bioplate ZIP 11mm titanium alloy implant 11mm $82.00

JJ490 Bioplate ZIP 15mm titanium alloy implant 15mm $110.00

JJ491 Bioplate ZIP 18mm titanium alloy implant 18mm $140.00

Dressing Kits

 Taylor Bryant Pty Ltd

TB296 Duraseal Dural Sealant DuraSeal is a Synthetic, absorbable,  5ml of hydrogel sealant $835.00 Temporary approval, pending

 Polyethylene Glycon, hydrogel sealant  review of product group

 used as an adjunct to sutured dural repair

 to achieve watertight closure.

Electrode/Lead, Stimulator, Implantable, Neurological

 Advanced Neuromodulation Systems Australia Pty Ltd

AV027 Lamitrode S Series Leads Lamitrode S Series, 8 Channel, Model #  Length = 30cm $7,040.00

AV028 Lamitrode S Series Leads Lamitrode S Series, 8 Channel, Model #  Length = 60cm $7,040.00

AV029 Lamitrode S Series Leads Lamitrode S Series, 4 Channel, Model #  Length = 30cm $7,040.00

Prostheses List by Category, Groups and Sponsor Page 149 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AV030 Lamitrode S Series Leads Lamitrode S Series, 4 Channel, Model #  Length = 60cm $7,040.00

AV031 Lamitrode C Series Leads Lamitrode C Series, 8 Channel, Model #  Length = 60cm $7,040.00

AV032 Lamitrode C Series Leads Lamitrode C Series, 16 Channel, Model #  Length = 60cm $7,640.00

 3289

Electrodes, Neuromuscular Stimulator

 Medtronic Australasia Pty Ltd

MC690 Neurostimulation System - Octad Leads Octad Standard Lead Kit without  45, 60 & 75cm $4,230.00

 Percutaneous Extension Model 3777,

MC710 Neurostimulation System - Octad Leads Octad Standard Lead Kit with  45, 60 & 75cm $4,230.00

 Percutaneous extension model 3877

MC711 Neurostimulation System - Octad Leads Octad Compact Lead Kit without  45, 60 & 75cm $4,230.00

 Percutaneous Extension Model 3778

MC712 Neurostimulation System - Octad Leads Octad Compact Lead Kit with  45, 60 & 75cm $4,230.00

 Percutaneous Extension Model 3878

Embolization Prostheses, Intravascular

 N Stenning  & Co Pty  Ltd

NG035 MicroPlex Coil System Kit includes delivery pusher, introducer  Coil Size 10, 18 - Loop  $1,505.00 $1,745.80

 sheath, MCS complex coil Diameter 2-14mm,

 16,18,20mm, Length 1-4cm, 6-

 13cm, 15-21cm, 23-24cm, 26-

 28cm, 30-34cm, 38-39cm, 43-

NG038 MicroPlex Coil System; Hydrocoil  MCS Helical Coils Soft; MCS  $1,505.00 $1,745.80

 Helical Coil Regular

NG039 MicroPlex Coil System; Hydrocoil  HES Helical Coils Hydrocoils 2mm Diameter x 3cm Length to $1,854.00 $2,088.00

  3mm Diameter x 7cm Length

Prostheses List by Category, Groups and Sponsor Page 150 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NG040 MicroPlex Coil System; Hydrocoil  HES Helical Coils Hydrocoils 4mm Diameter x 5cm Length to $2,266.00 $2,552.00

  5mm Diameter x 10cm Length

NG041 MicroPlex Coil System, Hydrocoil  HES Helical Coils Hydrocoils 5mm Diameter x 15cm Length  $2,600.00

 to 20mm Diameter x 20cm

Fittings/Adapters

 Advanced Neuromodulation Systems Australia Pty Ltd

AV013 ANS Spinal Cord Stimulation System  Boots, Connectors, Anchors, Strain Relief One size only $730.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

Fixation Device, Internal, Fracture

 Biomet Australia Pty Ltd

BI870 Neurological Packs Plate, Neuro and screws,  Ti 1.5mm or 2mm diameter $720.00

 Johnson & Johnson Medical Pty Ltd

JJ492 BIOPLATE Sterile Packs 813573, 2-Hole straight plate and screws  1 kit $397.00

 - 1.5mm

JJ493 BIOPLATE Sterile Packs 813574, 2-Hole compression plate and  1 kit $387.70

 screws - 1.5mm

JJ494 BIOPLATE Sterile Plates 813575, 2-Hole straight plate and screws  1 kit $400.00

 - 1.5mm

JJ495 BIOPLATE Sterile Packs 813576, Self drilling screws - 1.5mm 1 kit $87.00

JJ496 BIOPLATE Sterile Packs 813577, Self Drilling Screws - 1.5mm 1 kit $256.20

JJ497 BIOPLATE Sterile Packs 813578, X-plate and screws - 1.5mm 1 kit $508.00

JJ498 BIOPLATE Sterile Packs 813579, 4-Hole plate and screws -  1 kit $362.60

Prostheses List by Category, Groups and Sponsor Page 151 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ499 BIOPLATE Sterile Packs 813580, 6-Hole Burr Hole cover and  1 kit $438.00

 screws - 1.5mm

JJ500 BIOPLATE Sterile Packs 813581, 2-Hole straight plate and screws  1 kit $335.80

 - 1.9mm

JJ501 BIOPLATE Sterile Packs 813582, 2-Hole compression plate and  1 kit $397.00

 screws - 1.9mm

JJ502 BIOPLATE Sterile Packs 813583, 2-Hole compression plate and  1 kit $136.00

 screws - 1.9mm

JJ503 BIOPLATE Sterile Packs 813584, Self drilling screws - 1.9mm 1 kit $87.00

JJ504 BIOPLATE Sterile Packs 813585, Self Drilling Screws - 1.9mm 1 kit $256.20

JJ505 BIOPLATE Sterile Packs 813586, X-plate and Screws - 1.9mm 1 kit $508.00

JJ506 BIOPLATE Sterile Packs 813587, Boxcar plate and screws -  1 kit $362.00

JJ507 BIOPLATE Sterile Packs 813588, 6-Hole Burr Hole Cover and  1 kit $438.00

 Screws - 1.9mm

Fixation Device, Internal, Plate

 Australian Surgical Innovations Pty Ltd

AI004 ASI Plates and Screws Plate Straight, Left, Right, X, T and Y $206.00

  shaped

AI005 ASI Plates and Screws Mesh $1,545.00

AI006 ASI Plates and Screws Custom Mesh $6,700.00

 Johnson & Johnson Medical Pty Ltd

JJ534 BIOPLATE Low Profile Low Profile Titanium Screw 1.5mm diam, 3-5mm length $45.00

 Medical & Optical  Instruments Australia Pty Ltd

MO244 Martin Micro Plate Osteosynthesis  1.5mm Titanium Sterile Drill Free Flap  2 - Hole Plate x 3, 1.5 x 4mm  $460.00 Temporary approval, pending

 Pack Kit Screws x 6 review of product group

MO248 Martin Micro Plate Osteosynthesis  Titanuim Cranial Fixation kit contains on  0.6mm Profile Plate and 5mm  $495.00

 Burr Hole Cover and 5 Screws length screws

Prostheses List by Category, Groups and Sponsor Page 152 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Synthes Australia Pty Ltd

SY313 AO/ASIF  Plate Titanium Mesh for reconstruction of  100mm x 100mm square 0.4- $1,684.05

 cranial defects, Low Profile Neuro Mesh 0.6mm thick, Contourable

SY314 AO/ASIF  Plate Titanium Mesh for reconstruction of  200 x 200mm square, 0.6mm  $3,605.00

 cranial defects, Low Profile Neuro Mesh thick, Contourable

SY317 AO/ASIF Plate Titanium Plate - straight 1.6mm Profile, 2-4 holes $113.00

SY318 AO/ASIF Plate Titanium Plate - X, Y Frame, Strut,  1.6mm Profile, 4-6 holes $170.00

SY319 AO/ASIF Plate Titanium Plate - Long Adaption and Burr  1.6mm Profile, 6-24 holes $206.00

 Hole covers

Fixation Device, Internal, Screw

 Australian Surgical Innovations Pty Ltd

AI007 ASI Plates and Screws Screw Width 1.0 - 3.0mm. Length 3.0  $82.00

 - 25mm

Group 1- Fixation: Bone Screw

 Group 1a  - Bone Screw, Monoaxial

 B Braun Australia Pty Ltd

BB011 Spine System Evolution Screw Dia 5 - 8mm, length 30 - 55mm $450.00

BB061 Socon Spinal System Socon Transpedicular Screw Length 35mm-65mm, Dia 5mm- $223.00

 7mm

BB158 Aesculap Cervical System Titanium with locking mechanism Dia 4 - 4.5mm, length 10 - 28mm $395.00

BB161 Bone Screw HMA Monoaxial, Titanium Dia 12mm, length 26 - 38mm $1,150.00

BB162 Bone Screw MACS Locking, Titanium Dia 12mm, length 4mm $377.00

BB163 Bone Screw MACS Graft, Titanium Dia 5mm, length 35mm $110.00

BB226 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 4.5mm & 5mm  - all  $1,200.00

 lengths 25 - 60mm

Prostheses List by Category, Groups and Sponsor Page 153 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB227 S4 Spinal System Monoaxial Screw - titanium various sizes Diameter 6.0mm, 7.0mm &  $1,200.00

 8.0mm - all lengths 25 - 60mm

 De Puy Australia

DP306 Moss Miami (Stainless Steel) Monoaxial Screws 5 - 8mm x 25 - 60mm $850.00 $883.00

DP407 Moss Miami (Titanium) Monoaxial Screw 5 - 8mm x 25 - 60mm $1,104.00

DP449 Kaneda SR (Smooth Rod) Anterior  (TI) Closed Screw 1/4" - 6.25mm x 25 - 60mm $981.00

DP473 Isola System (Stainless Steel) Iliac Screw 6.25 & 7.0mm $557.00

DP489 Isola Paediatric System (Stainless Steel) Cable Wire Screw 4.75 - 5.50mm x 25 - 30mm $678.00

DP492 Isola System (Titanium) Iliac Screws 6.25mm & 7.0mm $553.00

DP504 Anterior Isola System (SS) Open / Closed Screw 1/4" x 5.5-7mm x 20-55mm $834.00

DP567 Peak Polyaxial Anterior Cervical Plate  Graft Screw or Safety Locking Screw 4mm x 9 -15mm $944.00

DP569 Peak Polyaxial  Anterior Cervical Plate  Primary Locking Screw 4mm  x 10 -16mm $910.00 $933.00

 System

DP576 Kaneda Anterior Scoliosis System  S/S Open Screw - Standard or Blunt 3/16" - 6.25mm x 25 - 50mm $822.00

DP577 Kaneda Anterior Scoliosis System  S/S Closed Screw  - Standard or Blunt 3/16" - 6.25mm x 25 - 50mm $852.00

DP830 Profile Anterior Thoracolumbar Plate  Cancellous Screw 6mm x 20 - 60mm $620.00 $641.00

DP831 Profile Anterior Thoracolumbar Plate  Cancellous Bolt 7mm x 25 - 60mm $692.00 $725.00

DP833 Profile Anterior Thoracolumbar Plate  Graft Screw 15 - 30mm   $190.00 $204.00

DP847 Moss Miami 4mm Anterior System (SS) Screws - Monoaxial 6mm x 25 - 55mm $1,035.00 $1,081.00

DY039 TiMX Low Back System Pedicle Screws (Standard or +5 No Cut) 5.5 - 7.75mm x 30 - 50mm $595.00

DY078 Kaneda SR Anterior Kaneda SR Anterior Open Screw 1/4"-6.25mm x 25-60mm, 3/16" $910.00

DY121 VSP System (Stainless Steel) Pedicle Screw (Standard or +5 No Cut) 4.75-7.75mm x 25-50mm $530.00

DY170 Monarch Spinal System Bolts - Pedicle & Reduction 4.75 - 8.5 mm x 30 - 55mm $585.00

DY300 Slim-loc Anterior Cervical Plate System Screws - Self Tapping 4.5 x 12-26mm $215.00 $225.00

DY301 Slim-loc Anterior Cervical Plate System Screws - Large Diameter 4.8 x 12-16mm $215.00 $225.00

DY302 Slim-loc Anterior Cervical Plate System Screws - Self Drilling 4.5 x 12-18mm $215.00 $225.00

Prostheses List by Category, Groups and Sponsor Page 154 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY309 Frontier Anterior Scoliosis System  Bone Screws 5.5 x 25-40mm, 6.5 x 25- $1,004.00 $1,400.00

 60mm, 7.5 x 35-60mm

DY321 Codman Anterior Cervical Plate System Rescue screw 12 & 15mm $178.00

DY333 Summit Cervical Rod System Occipital Bone Screw 4.5 - 5.25 Dia x 6 -16mm length $198.00

DY338 Summit Cervical Rod System Cancellous Bone Screw 3.5-4.5mm x 12-48mm $190.00

DY346 RECO Spinal System Pedicale Screw 4-7mm $841.00

DY401 Monarch Monoaxial Pedicle Screw 4.75mm - 8.5mm x 25 to 80mm $1,004.00 $1,782.00

  length

DY441 Expedium Spine System Monoaxial Screw 4.35, 5, 6, 7 or 8mm diameter x $1,004.00 $1,782.00

  25-55mm length

DY452 Swift Spine System Titanium Anterior Cervical Plate System - 10 - 18mm $850.00

  3.8mm Self-Drilling/Tapping Screw

DY453 Swift Spine System Titanium Anterior Cervical Plate System - 18mm $850.00

  4.2mm Self-Drilling/Tapping Screw

DY454 Swift Spine System Titanium Anterior Cervical Plate System - 10 - 28mm $850.00

  3.8mm Bicortical Screw

DY455 Swift Spine System Titanium Anterior Cervical Plate System - 10mm $850.00

  Graft Screw

 Global Manufacturing Technology Pty Limited

GM025 Maxima/Optima Anterior Cervical Plate  Cancellous Bone Screws 3.5 x 10mm to 20mm; 4.0 x  $190.00

 System 10mm to 20mm

GM034 Optimal Spinal System Pedicle Screw Monoaxial Type 4 x 25 to 8 x 55mm $900.00

GM060 Maxima/Optima Anterior Cervical Plate  Pedicle Screw - Mono Axial Type 4.5 mm -8.5mm Length 25mm- $900.00

 System 60mm

GM074 BacFix (Thoracolumbar System) Smooth profile flexible angle screw -  5 - 8mm x 30 - 60mm $720.00

 Titanium alloy

GM077 AcuFix Cancellous bone screw - Anterior cervical 4mm x 10 - 18mm $190.00

  plate system - Titanium

GM078 AcuFix Self tapping wide root screw - Anterior  4mm x 10 - 18mm $190.00

 cervical plate system - Titanium

Prostheses List by Category, Groups and Sponsor Page 155 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GM079 AcuFix Rescue screw - Anterior cervical plate  4.5mm x 10 - 18mm $190.00

 system - Titanium

 Global Orthopaedic Technology

GO089 Incompass Thoracolumbar Fixation System, Fixed  4.5 - 8.5mm $900.00

 Angle Screw Open

GO090 Incompass Thoracolumbar Fixation System, Fixed  4.5 - 8.5mm $900.00

 Angle Screw Closed

GO105 OctaFix Occipital Cervical Plating System Closed Screw 4mm $1,004.00

GO107 OctaFix Occipital Cervical Plating System Primary Bone Screw 3.5mm $880.00

GO108 OctaFix Occipital Cervical Plating System Bone Screw 3.5 - 4.0mm $880.00

 Howmedica

HW385 Xia Spine System Monoaxial Screw Dia 4.5 - 8.5mm Length 25 -  $1,225.00

HW393 Xia Spine System Bone Screw One size only $577.00

 LSS Surgical

LS003 Solas Spinal System Set Screw One Size $300.00

LS005 Solas Spinal System Monoaxial Pedicle 4 x 25mm to 8 x 55mm $900.00

LS008 Solas Spinal System Axial/Lateral Connectors Small to Large $743.00

 Medtronic Australasia Pty Ltd

MC294 Vertex Spinal System Occipital Buttons Bolt 6 - 30 mm Length $250.00 $575.00

MC296 Vertex Spinal System Occipital Screws  3.0 - 5.0 mm diameter, 4 - 30  $190.00 $447.00

 mm length

MC310 TiMesh TiMesh LP Screw $131.00

MC343 Venture Self Drilling Screws single or multi level plate construct,  4.0mm x 8mm - 21mm ; 4.5mm $190.00

 titanium alloy  x 8mm -21mm variable Angled

MC344 Venture Self Drilling Screws single or multi level plate construct,  4.0mm x 8mm - 21mm, 4.5mm  $190.00

 titanium alloy x 8mm - 21mm Fixed Angled

MC347 Venture Self tapping Screws Single or multi level plate construct,  4.0mm x 8mm - 21mm; 4.5mm  $190.00

 titanium alloy. x 8mm - 21mm Variable Angled

Prostheses List by Category, Groups and Sponsor Page 156 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC348 Venture Self tapping Screws Single or multi level plate construct,  4.0mm x 8mm - 21mm; 4.5mm  $190.00

 titanium alloy. x 8mm - 21mm Fixed Angled

MC384 Colorado 2 Pedicle Screw Diameter 5.5 - 7.5 Lengths 30 -  $1,037.00

 70mm

MC401 TSRH Spinal Implant System 3D - Bolt Small, medium, large $745.00

MC402 CD Horizon Pedicle Screws Diameter 5.5 - 7.5  Lengths 25 - $1,037.00

  80mm

MC423 Atlantis Fixed Angle Cancellous Screw 10-20mm $190.00

MC424 Atlantis Variable Angle Cancellous Screw 10-20mm $195.00

MC427 Dynalok Long Post Bolt 30 - 55mm $595.00

MC428 Dynalok Short Post Bolt 30 - 55mm $595.00

MC447 UCSS Cortical Screws  30 - 50mm $657.00

MC448 UCSS Cortical Lag Screws 36 - 50mm $637.00

MC458 TSRH 3D  Screw 30-55mm $759.00

MC459 TSRH 3D  Extended Post Screw 30-50mm $775.00

MC462 Zephir Cancellous Screw 13-17mm $195.00

MC474 Z Plate II Bolt & Nut 30mm - 55mm $675.00

MC476 Z Plate II Screw 20 - 60mm $713.00

MC482 Axis Cervical Plating System Screw: Cancellous 6 - 24mm $104.00

MC483 Axis Cervical Plating System Screw: Cortical 26 - 54mm $144.00

MC489 Orion Anterior Cervical System Cancellous Screw 10 - 17mm $190.00

MC494 Tenor Pedicle Screw (incl Self Breaking Nuts) 30 - 55mm $623.00

MC495 Tenor Spondylolisthesis Screw - Ti 30 - 55mm $820.00

MC503 CD Horizon Fixed Angle Screw (Titanium) 25 - 90mm $1,037.00

MC511 Premier Anterior Cervical Plate System Screws 10 20mm $190.00

MC598 Equation Spinal System Screw Length 25-55mm $1,037.00

Prostheses List by Category, Groups and Sponsor Page 157 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC611 Z Plate System Vantage Plates and Screws; Thoracic  5.5 x 15-50mm $647.00

MC613 Z Plate System Vantage Plates and Screws; ATL Screw 6.5 x 30-55mm $624.00

MC636 CD Horizon Eclipse Dual Head Screws 20-60mm $1,037.00

MC656 Pyramid Pyramid Bone Screws 6.5mm Diameter, 20 -60mm  $420.00

 length in 5mm increments

MC658 Engage Bolt 5.5 to 8.5mm diameter $1,260.00

MC659 Silo Screw 4.5 - 8.5mm diameter $1,037.00 $1,480.00

MC664 Xantus Xantus Bone Screws 6.5mm Diameter, 20 - 60mm  $420.00

 length in 5mm increments

MC666 CD Horizon Legacy lliac Screw 6.5mm to 8.5mm Diameter $1,320.00

 Orthotech Pty Ltd

OH037 Synergy Spinal System Open/Closed Screws 5.5 to 8.0mm dia $1,004.00

OH047 Synergy Spinal System Variable Locking Screws 6.5 - 7mm $850.00

OH048 Synergy Spinal System Variable Locking Screw Seat 6.35mm $375.00

OH049 Synergy Spinal System Variable Locking Screw Nut 13.8mm $330.00

OH050 Synergy Spinal System Variable Locking Screw Reduction Seat 6.35mm $566.00

OH051 Synergy Spinal System Iliac Screw 6.0 - 10.0mm $1,010.00

OH053 Interpore Bone Plate System TPS Screw 14 - 22mm $600.00

OH064 Anterior Cervical Plate System Titanium Cancellous Bone Screw 4 - 20mm $210.00

OH174 Omega 21 Spine Fixation System Screw, Self Tapping, 4.75mm, 5.5mm,  25mm - 65mm $1,000.00

 6.35mm, 7.5mm, 8.5mm diameter

OH207 Altius Occipito-Cervico-Thoracic (OCT)  Screws 8mm to 32mm $472.00

 System

OH210 Array Spinal System Titanium Alloy Modular Spinal System -  5.5 - 7.5mm x 30 - 55mm $1,110.00

 fixed screw

OH211 Array Spinal System Titanium Alloy Modular Spinal System -  5.5 - 7.5mm x 30 - 55mm $1,260.00

 multiaxial screw

OH245 Ctek/Vue Lock Titanium Cancellous Bone Screw 4 - 20mm $210.00

Prostheses List by Category, Groups and Sponsor Page 158 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Scient'x Australia

SX001 Isobar TTL Monoaxial Screw D: 4.5 - 8mm, L: 25 - 50mm $1,037.00

SX009 Antelys Screw D: 5mm, L: 32.5 to 50mm $250.00

SX012 Stella Screw D: 4-4.5mm, L: 12-20mm $190.00

 Stryker Australia Pty Ltd

ST002 Diapason Millenium - Long Arm Sacral  Titanium Alloy 40-60mm length $1,171.00

ST042 Diapason Millenium - Thoracic Screw,  Titanium Alloy 5,5.5, 6.7 & 7.7mm diameter.  $910.00

 5mm, 5.5mm, 6.7mm & 7.7mm 30-60mm length

ST048 Diapason Millenium - Sacral Screw, 8mm Titanium Alloy 8mm length $1,004.00

  or 9mm

ST057 Diapason Millenium - Long Arm Lumbar  Titanium Alloy 6.7mm diameter; 30-60mm  $1,045.00

 Screw

ST685 Dimso/Stryker Implants Diapason Screw - short arm + ball ring titanium,  5, 5.5, 6.7, 7.7, 8, 9mm by 30- $742.00

 thoracic, lumbar, sacral 60mm with 5mm increment

ST687 Dimso/Stryker Implants Diapason Screw -long arm 5.5, 6.7, 7.7mm by 30-60mm  $879.00

 by 5mm increment

ST896 Stabilis Bone Graft Delivery Unit - BGDU Titanium BGDU diam 11mm $1,025.00 $1,060.00

ST914 Reflex Anterior Cervical Plate - Screw Titanium, locking Dia 4mm lengths 10 - 14mm $250.00 $255.00

ST915 Reflex Anterior Cervical Plate - Screw Titanium, locking Dia 4mm Length 16 - 22mm $250.00 $255.00

ST916 Reflex Anterior Cervical Plate - Screw Titanium, locking Dia 4.5mm  Length 12 - 22mm $250.00 $255.00

 Stryker Australia Pty Ltd (2)

SK223 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V Cortical Plate screw Size 3.5mm $190.00 $215.00

  (Length 6mm-24mm in 2mm

 increments); Cortical Plate

 screw Size 4.0mm (Length

 6mm-24mm in 2mm

 increments); Cortical Plate

 screw Size 4.0mm (Length

SK249 Maps Spinal Fixation System Titanium - Long Post Screw Diameter - 6.50mm, 7.50mm  $1,025.00 $1,090.00

 (Length 40-50mm)

Prostheses List by Category, Groups and Sponsor Page 159 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK251 Maps Spinal Fixation System Titanium - Standard Screw Diam 4.75mm Length 25- $1,025.00 $1,090.00

 50mm, Diam 5.75mm Length

 25-55mm, Diam 6.75 Length

 25-60mm, Diam 7.75mm

 Length 25-60mm, Diam 8.75

SK309 Spiral Radius 90D Locking Screw - Titanium Diameter 6.75mm Length 30- $577.00

SK312 Spiral Radius 90D Standard Screw - Titanium Diameter 4.75mm Length 25- $1,025.00

 50mm, Diameter 5.75mm

 Length 25-55mm, Diameter

 6.75mm Length 25-60mm,

 Diameter 7.75mm Length 25-

 60mm, Diameter 8.75mm

 Stryker Australia Pty Ltd (3)

SR039 Techtonix System Screw, titanium 5-6mm x 25mm-60mm $580.00

 Surgical House

SU071 OGP posterior lumbar rigid screw  OGP pedicle screw 6.5 x 35mm , 6.5 x 40mm, 6.5  $270.00

 fixation system x 45mm

SU091 Bone screw; Olerud Bone Screw Hook/screw & rod spinal system  3.5 & 4mm diam, leng 16- $600.00

 component; Olerud Bone Screw -  65mm; Cannulated: Diameter

 Titanium, cannulated and non-cannulated 3.5, 4.0mm Length 45 - 60mm,

 Non-cannulated: Diameter 3.5,

 4.0 Length 16 -65mm

SU092 Occiput screw Hook/screw & rod spinal system  4mm diam, length14-18 mm $600.00

SU153 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2-part)  Screws/Revision Screws - dia  $270.00

 fixation screws 4.4mm, length 11 - 18mm

SU173 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2-part)  Screws/Revision Screws - dia  $744.00

 fixation screws 4.4mm, length 11 - 18mm -

 Pack of 3

SU200 Olerud Pedicle Screw Titanium Diameter 4, 5, 6, 7mm Length  $577.00

 45 - 90mm

 Synthes Australia Pty Ltd

SY140 Spinal Plate/Plate System AO/ASIF Spinal Anterior thoracolumbar screws -  locking Locking screw 7.5mm, length  $490.00

  Implants 25 - 55mm

Prostheses List by Category, Groups and Sponsor Page 160 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY141 Spinal Plate/Plate System AO/ASIF Spinal Cannulated/self tapping screw (odontoid) 3.5mm dia, 36-50mm length $495.00

  Implants

SY148 Universal Spine System (USS) Pedicle Hook Screw Length 20- 40mm $175.00

SY149 Universal Spine System (USS) Schanz Screws  5-7mm dia  $137.00

SY175 Universal Spine System (USS) Pedicle Screw - USSII 25 - 140mm $1,350.00

SY179 Click'X Spinal Fixation System Pedicle Screw (without head) Length 30-65mm $515.00

SY181 Cervical Spine Locking Plate (CSLP)  Expansion Head Screw Dia 3.5 - 4.5mm,  Length 12 -  $295.00

 25mm

SY187 Cervifix Posterior Cervical  System Screw Dia 3.2 - 4.5mm, Length 6 -  $135.00

SY192 Universal Spine System (USS) Pedicle screw Length 70 - 140mm $1,517.00

SY251 VENTROFIX - MIS Screw 25-65mm $514.00

SY291 Anterior Tension Band Locking Screw 22mm to 36mm $275.00

SY297 SynFix Spinal system Locking Screw 10mm to 40mm, 4.0mm  $300.00

SY299 Vectra Anterior Spinal System Locking Screw 10mm to 26mm $300.00

SY302 TeleFix Spinal System Posterior Screw 20mm to 70mm in length $575.00

SY303 TeleFix Spinal System Anterior Screw 20mm to 70mm in length $575.00

SY334 Arch Fixation System Screws, titanium 2.0mm - 2.4mm screws, 4 to  $160.00

SY339 Vectra T Anterior Spinal System Self tapping, self drilling Titanium 4.0/4.5mm. 12mm to 20mm $300.00

 Taylor Bryant Pty Ltd

TB036 Advanced Spine - Titanium System Clamp Bolt Titanium One size only $252.00

TB096 Advanced Spine - Titanium System 200 Ser Ti Screws/Titanium 5/0 x (30, 35, 40, 45mm); 7/5 x $359.00

  (35, 40, 45, 50, 55mm); 6/5 x

 (35, 40, 45, 50, 55mm); 5/8 x

 (40, 45, 50, 55mm)

TB194 Blackstone Medical Inc Anterior Cervical  Bone Screw, Primary/Rescue Screw 12, 14, 16mm $335.00

 Plate System

TB247 Blackstone - Spinal Fixation System -  Composition - Titanium 5.5mm x 40mm, 5.5mm x  $950.00

 Mono Axial Screws 45mm, 6.5mm x 40mm and

Prostheses List by Category, Groups and Sponsor Page 161 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB325 Lumbar Screw ECF in PEEK optima 32, 36, 40, 44, 48, 52, 56, 60,  $978.00

 65mm

 TiMax Surgical Pty Ltd

TI066 CPS Bioabsorbable Fixation System Anterior Cervical Plate System:  10-20mm $190.00

 PLGA/TMC Copolymer Screws

 Zimmer

ZI333 Dynesys Pedicle Screw Composition : Titanium alloy 35 to 50mm lengths $1,037.00 $1,246.00

ZI487 Trinica Screw Titanium Screws, fixed and variable angle. 4.2mm x 12/14/16/18mm;  $195.00

 4.6mm x 12/14/16/18mm

ZI517 Trinica Anterior Lumbar/Sacral Screw Screw, Titanium, Fixed or Variable Axis 22 to 34mm lengths $538.00

 Group 1b - Bone Screw, Polyaxial

 B Braun Australia Pty Ltd

BB013 Spine System Evolution Head for Polyaxial Screw For 5.2 and 6mm rods $228.00

BB159 Bone Screw MACS Polyaxial & Stabilisation, Titanium Dia 6.5 - 7mm, length 30 - 50mm $541.82

BB160 Bone Screw HMA Polyaxial, Titanium Dia 12mm, length 26 - 38mm $1,800.00

BB174 MACS TL Bone Screws Polyaxial screw - XL 30mm and 40mm $1,800.00

BB224 S4 Spinal System Polyaxial Screw - titanium various sizes Diameter 4.5mm & 5mm - all  $1,550.00

 lengths 25 - 60mm

BB225 S4 Spinal System Polyaxial Screw - Titanium various sizes Diameter 6.0mm, 7.0mm &  $1,550.00

 8.0mm - all lengths 25 - 60mm

 De Puy Australia

DP307 Moss Miami (Stainless Steel) Polyaxial Screws 5 - 7mm x 25 - 60mm $1,330.00 $1,397.00

DP408 Moss Miami (Titanium) Polyaxial Screw 5 - 8mm x 25 - 60mm $1,330.00 $1,769.00

DP848 Moss Miami 4mm Anterior System (SS) Screws - Polyaxial 6mm x 25 - 55mm $1,330.00 $1,619.00

DY171 Monarch Spinal System Pedicle Screws - Polyaxial 4.75 - 8.5 mm x 30 - 55mm $1,330.00 $1,734.00

DY339 Summit Cervical Rod System Mini Polyaxial Screw Standard or High 3.5mm x 12-50mm $1,330.00 $1,923.00

Prostheses List by Category, Groups and Sponsor Page 162 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY431 Expedium Spine System Si Polyaxial Screw 5,6 or 7mm diameter x 25- $1,330.00 $1,629.00

 55mm length

DY440 Expedium Spine System Di Polyaxial Screw 5, 6, or 7mm diameter x 25- $1,330.00 $1,766.00

 55mm length

DY442 Summit SI System Polyaxial Screw - Mini Favoured Angle 3.5 or 4mm diameter x 12- $1,330.00 $1,830.00

 48mm length

 Global Manufacturing Technology Pty Limited

GM035 Optimal Spinal System Pedicle Screw-Poly Type 5 x 30 to 8 x 55mm $1,250.00

GM068 BacFix (Thoracolumbar System) Multi axial bone screw  - Nitinol 5 - 8mm x 30 - 60mm $1,250.00

 Global Orthopaedic Technology

GO080 Nex-Link Spinal Fixation System, Polyaxial Screws 3.5mmx10mm -  $1,250.00

GO088 Incompass Thoracolumbar Fixation System,  5.5 - 7.5 $1,250.00

 Polyaxial Screw Open

GO102 Pathfinder Minimally invasive pedicle fixation system Cannulated Polyaxial Screws 6.5 $1,530.00

  - 7.5mm

 Howmedica

HW384 Xia Spine System Polyaxial Screw Dia 4.5 - 8.5mm Length 25 -  $1,605.00

 LSS Surgical

LS006 Solas Spinal System Polyaxial Pedicle 4 x 30mm to 8 x 55mm $1,250.00

 Medtronic Australasia Pty Ltd

MC439 CD Horizon Cannulated Pedicle Screw 20mm - 80mm $1,330.00 $1,650.00

MC501 CD Horizon Multi-Axial screw (Stainless Steel) 25 - 80mm $1,329.00

MC502 CD Horizon Multi-axial screw (Titanium) 25 - 80mm $1,330.00

MC545 Vertex Spinal System Screws Dia 3.5 - 4.0mm; length 6 - 24mm $1,330.00 $1,590.00

MC579 CD Horizon Spondylolisthesis Screw Diameter: 4.5 - 7.5, Length:  $1,500.00 $1,600.00

 25mm - 50mm

MC586 CD Horizon Sextant Percutaneous  Cannulated titanium percutaneous multi  Dia 3.5 to 9.5mm, Length 15 to  $1,530.00

 Cannulated Multi Axial Screw axial screw 65mm

MC675 CD Horizon Legacy Screw Diameter 4.0 - 9.5mm $1,330.00 $1,480.00

Prostheses List by Category, Groups and Sponsor Page 163 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH176 Omega 21 Spine Fixation System Simple Coupling, Slotted; Titanium One size only $715.00

OH177 Omega 21 Spine Fixation System Multidirectional Coupling, Slotted; Titanium One size only $800.00

OH178 Omega 21 Spine Fixation System Screw, Spondylolisthesis, 4.75mm,  25mm - 65mm $1,480.00

 5.5mm, 6.35mm, 7.5mm diameter

OH181 Spinelink Spinal Fixation System Polydirectional Screws, Titanium (5.5,6.5,7.5, 8.5mm) x (35- $1,050.00

OH190 Omega 21 Spine Fixation System Screw, Expandable, 5.5mm, 6.35mm,  25mm - 65mm $1,480.00

 7mm, 8mm

 Scient'x Australia

SX002 Isobar TTL Polyaxial Screw D: 4.5 - 8mm, L: 30 - 55mm $1,600.00

 Stryker Australia Pty Ltd (2)

SK225 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V Cortical Polyaxial screw Size  $1,330.00 $1,605.00

 3.5mm Length 10mm-24mm (in

  2mm increments); Cortical

 Polyaxial screw Size 4.0mm

 Length 10mm-26mm (in 2mm

 increments); Cortical Polyaxial

 screw Size 4.0mm Length

 26mm-46mm (in 4mm

SK313 Spiral Radius 90D Multi Angle Screw - Titanium Diameter 4.75mm Length 25- $1,330.00 $1,500.00

 50mm, Diameter 5.75mm

 Length 25-55mm, Diameter

 6.75mm Length 25-60mm,

 Diameter 7.75mm Length 25-

 Stryker Australia Pty Ltd (3)

SR042 Xia Precision System Screw, Cannulated, Multi Axial, Titanium 5.5mm - 7.5mm x 35mm - 55mm $1,530.00 $1,700.00

 Synthes Australia Pty Ltd

SY007 Click'X Spinal Fixation System Pedicle Screw: Preassembled Length 25-80mm $1,330.00

SY178 Click'X Spinal Fixation System Head One size only $785.00

SY289 USS llio-Sacral Fixation system Polyaxial screw 20mm to 140mm $1,390.50

Prostheses List by Category, Groups and Sponsor Page 164 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY305 Pangea Spinal System pedicle Screw Diameter, 4.0mm to 10mm.  $1,400.00

 Length, 20mm to 120mm

SY309 Axon Spinal System Variable axis screw 3.0mm - 4.5mm diameter, 4mm $1,330.00

  to 60mm length

SY336 Click'x Spinal System Cannulated Screws 4.0mm to 9.0mm $1,350.00

SY337 Universal Spinal System (USS) Polyaxial Pedicle Screw, titanium 4.0mm to 9.00mm $1,700.00

 Taylor Bryant Pty Ltd

TB240 Spinal Fixation System Multi screw - Titanium 5.5 x 35mm up to 55mm in  $1,200.00

 5mm increments; 6.5 x 35mm

 up to 60mm in 5mm

 increments; 7.5 x 35mm up to

 60mm in 5mm increments

TB275 Blackstone - Posterior Cervical System Occipital Screw 6, 8, 10, 12, 14mm $211.00

TB280 Blackstone - Posterior Cervical System Mini-Multi-Axial Screw 3.5-4mmx10-30mm (2mm  $1,190.00

 increments)

TB310 ICON Modular Spinal Fixation System Screw 4.5mm - 8.5mm x 25-80mm $1,023.00

TB311 ICON Modular Spinal Fixation System Multi-axial body assembly 5.5mm $255.00

 Zimmer

ZI475 Silhouette Spinal System Implants Polyaxial Screw Assembly with Tabs 5.5 x 25mm to 8.5 x 60mm $937.00

 Group 1c - Bone Screw

 De Puy Australia

DP580 Kaneda Anterior Scoliosis System  S/S Radiused Caps for Open Screws 3/16"  $420.00

DY303 Monarch Spinal System Typhoon Cap and Domed Nuts One size only $659.00

 Medtronic Australasia Pty Ltd

MC653 Xantus Xantus cover Plate and Set Screw 40mm - 100mm Length in 4mm $1,150.00

  increments

MC657 Pyramid Pyramid Cover Plate and Set Screw 17mm - 35mm length in 2 mm  $1,135.00

 increments

Prostheses List by Category, Groups and Sponsor Page 165 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH035 Synergy Spinal System Sliders 4.75 - 6.35mm dia $356.00

OH185 Spinelink Spinal Fixation System End Cap, Titanium One size only $360.00

 Synthes Australia Pty Ltd

SY151 Universal Spine System (USS) Sleeve 3.5 - 6mm $225.00

Group 10 - Fixation: C-Ring

 Synthes Australia Pty Ltd

SY360 Universal Spine System (USS) Half Ring SS, Standard, Self-Holding $360.00

 Group 10 - C-Ring

 Medtronic Australasia Pty Ltd

MC436 CD-Horizon C-ring One size only $156.00

 Orthotech Pty Ltd

OH044 Synergy Spinal System C-Ring 4.75 - 6.35mm $260.00

 Taylor Bryant Pty Ltd

TB105 Low Pro Upper Clamp Upper Clamp 1mm $360.00

TB106 Low Pro Upper Clamp Upper Clamp 14 Degree Left/Right, 7 Degree  $452.00

 Left/Right, 2mm, 4mm, 6mm

 Increment, 30 Degree Left/Right

Group 11 - Fixation: Other

 Medtronic Australasia Pty Ltd

MC723 Vertex Spinal System Occipital Buttons Nut 12mm Diameter $508.00

Prostheses List by Category, Groups and Sponsor Page 166 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI334 Dynesys Cord Composition: Sulene 100 or 200 mm long $2,669.00

 Group 11 - Other

 Medtronic Australasia Pty Ltd

MC492 Apofix Support Rod One size only $223.00

MC493 Apofix Clamp Single Rod Upper/lower $398.00

Group 12 - Spacer: Interbody/Fusion Cage

 Group 12a - Interbody / Fusion Cage, Integral Fixation

 Medtronic Australasia Pty Ltd

MC381 Affinity Cervical Cage - D7 - L12 to D9 - L14 $1,949.00

MC589 Affinity Anterior cervical cage System The Affinity Cage is constructed of  6 x 12mm; 6 x 14mm; 7 x  $1,949.00

 titanium alloy - kit includes trials, reamers 12mm; 7 x 14mm; 8 x 12mm; 8

  and inserters.  x 14mm; 9 x 12mm; 9 x

 14mm; 10 x 12mm; 10 x

 14mm; 11 x 12mm; 11 x

 Scient'x Australia

SX010 PCB Plate-Cage Titanium cervical plate-cage L: 14-16mm, W: 12-15mm,  $3,000.00

 Cage Height: 4.5-8mm, Plate

 Height: 23-29mm

 Synthes Australia Pty Ltd

SY298 SynFix Spinal System Interbody fusion cage prefilled or unfilled 5mm to 19mm $7,250.00

 Group 12b - Interbody / Fusion Cage, No Integral Fixation

 B Braun Australia Pty Ltd

BB070 Prospace Block Titanium 9mm-11mm $1,318.00

Prostheses List by Category, Groups and Sponsor Page 167 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB211 KLA Anterior Lumbar Cage System Anterior Lumbar Cage - PEEK 9mm x 5 degrees, 11mm x 5  $4,250.00

 degrees, 13mm x 5 degrees,

 11mm x 9 degrees, 13mm x 9

 degrees, 15mm x 9 degrees,

 13mm X 13 degrees, 15mm X

BB212 CBK Anterior Cervical Cage System Anterior Cervical Cage - PEEK 4.5mm, 5.5mm, 6.2mm, 7mm,  $2,500.00

 8mm, 9mm

BB213 CO Posterior Lumbar Cage System Posterior Lumbar Cage - PEEK L23.5 x 9mm x h8mm, L23.5 x  $2,500.00

 9mm x h9mm, L23.5 x 10mm x

  h10mm, L23.5 x 10.7mm x

 h11mm, L23.5 x 11.7mm x

 h12mm, L23.5 x 12.7mm x

 h13mm, L23.5 x 13.7mm x

 h14mm, L23.5 x 14.7mm x

 h15mm, L23.5 x 9mm x h9mm

BB214 CC Posterior Lumbar Cage System Posterior Lumbar Cage - PEEK L23.5 x 10-12.5mm x h8mm,  $2,500.00

 L23.5 x 10-12.5mm x h9mm,

 L23.5 x 10-12.5mm x h10mm,

 L23.5mm x 11-13.5mm x

 h11mm, L23.5 x 11-13.5mm x

 h12mm, L23.5mm x 11-

 13.5mm x h13mm, L23.5 x 11-

 13.5mm x 14mm, L23.5mm x

BB215 Adonys Posterior Lumbar Cage System Posterior Lumbar Cage - PEEK -  8mm x 4 degrees, 12mm x 4  $2,500.00 The benefit amount/minimum

 degrees, 8mm x 10 degrees,  benefit amount is for an

 12mm x 10 degrees individual product which comes

 as a pack of two

BB216 Adonys Posterior Lumbar Cage System Posterior Lumbar Cage - Short 8mm x 4 degrees, 10mm x 4  $2,500.00 The benefit amount/minimum

 degrees, 12mm x 4 degrees,  benefit amount is for an

 8mm x 10 degrees, 10mm x 10  individual product which comes

 degrees, 12mm x 10 degrees as a pack of two

BB217 Samarys Anterior Cervical Cage System Anterior Cervical Cage - PEEK L15 x w17 x h5mm, L15 x w17 $2,500.00

  x h6mm, L15 x w17 x h7mm,

 L15 x w17 x h8mm, L13 x w17

  x h5mm, L13 x w17 x h6mm,

 L15 x w20 x h5mm, L15 x w20

Prostheses List by Category, Groups and Sponsor Page 168 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB252 T. Lif Intervertebral Cage System T.Lif PEEK Intervertebral Cage All sizes $5,000.00

BB278 Aesculap Interbody Cage Interbody cage All sizes $2,500.00

 Cardinal Health Australia 200 Pty Ltd

CI001 Ava-Tex Radiopaque Bone Cement Kit 13.8g Barium-Polymer Powder & 6mL  12mL $299.00

 Liquid Monomer, Ported Mixing Vial,

 Funnel, 20mL 2-Piece Syringe, Ampoule

 Disposal Container, Monomer

 Dispersement Cannula, Spatula, Four

 Self-Adhesive Charge Labels, Part No. 

 De Puy Australia

DP511 Brantigan I/F Cage ALIF C/F Cage Small - Large 9-15mm $4,250.00

DP514 Brantigan I/F Cage Cervical Brantigan Cage Standard/Large 4-10mm $3,240.00

DP515 I/F Ramp PLIF C/F Ramp 7-11 x 11-15 x 21 - 25 mm $1,435.00

DP851 Surgical Titanium Mesh System Standard & Trapezoidal 10-16mm x 8-17mm Hgt $2,140.00

DY198 Carbon Fibre Cages ALIF 1 C/F Cage 5 - 10 deg Sm to Lg 10 - 18  $3,080.00 $3,128.00

DY406 Leopard 5 Lodotic Carbon Fibre Body  Carbon Fibre cage 7 - 18mm $3,915.00

 Fusion Device

DY407 Leopard Parallel Carbon Fibre Body  Carbon Fibre Cage 7 - 18mm $3,915.00 $4,200.00

 Fusion Device

DY422 Saber Cage PLIF Cage Parallel/Wedge $2,900.00

 Global Manufacturing Technology Pty Limited

GM027 NeoIC (Neo Interbody Fusion Cage) Interbody Fusion Cage Various $3,145.00

GM072 BacFix (Thoracolumbar System) Non-threaded wedge with serrated teeth - 5.5 - 6mm $200.00

  Titanium alloy

 Global Orthopaedic Technology

GO076 Traxis (non sterile) Titanium Interbody Implant 9-13mm $3,000.00

GO077 Traxis Peek-Optima (sterile) Vue Radiolucent Implant 12mm $3,520.00

GO109 Cadence (non sterile) Titanium Interbody Implant 9-15mm $3,340.00

GO110 Cadence Peek - Optima (sterile) Vue Radiolucent Implant 9-13mm $3,340.00

Prostheses List by Category, Groups and Sponsor Page 169 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GO111 Fortitude (non sterile) Titanium Interbody Implant 12mm $6,800.00

GO112 Fortitude Peek-Optima (sterile) Vue Radiolucent Implant 12mm $6,300.00

 Johnson & Johnson Medical Pty Ltd

JJ569 Cougar II ALIF Cage Anterior Lumbar Interbody FusionCage,  Small, Medium, Large, 10 -  $4,360.00

 Carbon Fibre Reinforced Polymer  20mm, 5 or 10 Deg

 LSS Surgical

LS001 SAS Spinal Advanced System Peek-Optima Lumbar Cage 9mm t 15mm $3,340.00

 Medtronic Australasia Pty Ltd

MC297 Verte-Stack Boomerang Width 25 - 36 mm, Height 6 -  $6,563.00

 18 mm

MC380 Interfix C Carbon Cage Diameter range from 12 -  $3,335.00

 20mm, Length range from 20 -

MC413 Cornerstone Cage Sterile and Non-sterile 4, 5, 6, 7, 8, 9, 10mm $2,357.00

MC416 Novus System ALIF II 10-16mm $4,375.00

MC438 Novus System Plif Cage: Cage 12 - 50mm $3,115.00

MC453 Telamon Titanium Cage 8 - 16mm $2,610.00

MC454 Telamon Contour, Carbon Cage 8 - 16mm $3,335.00

MC455 Telamon Contour, Titanium Cage 8 - 16mm $2,610.00

MC456 Interfix  Titanium Cage 12 x 20mm - 24 x 50mm $2,410.00

MC457 LordoTec Cage (LT-Cage) Titanium,  PEEK 18-28mm $2,610.00

MC461 Union Carbon Cage 10 - 16mm $3,476.00

MC508 Novus Systems Cervical Cages 10-16mm $2,030.00

MC577 R90 Spacer Spinal Implant (Peek) Height: 7mm - 16mm, Lordosis:  $3,690.00

 6 degrees - 18 degrees, Length:

 18 -27mm

MC578 Union CC System Cage 6mm - 12mm,  0 - 8 degrees $3,690.00

MC602 Union Verte-Stack Flat Small 12-20mm $2,675.00

Prostheses List by Category, Groups and Sponsor Page 170 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC633 Verte-Stack Capstone Cage. Vertebral Body Spacer Length: 22-36mm $3,763.00

MC673 Verte-Stack Perimeter Cage Small, Medium, Large, Extra  $6,563.00

 Orthotech Pty Ltd

OH123 GEO Structure Vertebral Cage - Alif 3 dimensional titanium intervertebral cage One size only $3,900.00

OH128 Anterior Lumbar Cage Titanium or PEEK Height 2 - 20mm $3,900.00

OH129 Posterior Lumbar Cage Titanium or PEEK Height 7 - 20mm $3,690.00

OH131 Fidji Cervical Cage 12 x 15, 12 x 17, 14 x 17, 14 x  $2,200.00

OH193 EBI Ionic Spine Spacer Titanium alloy 9 - 19mm $3,100.00

 Scient'x Australia

SX007 Antelys Cage H: 9-15mm $2,750.00

SX013 CC-CO Cages PEEK Polymer L: 23.5mm, W: 10-13.5mm, H:  $2,750.00

 8-14mm

SX014 CBK Cage PEEK L: 15mm, W: 13mm, H: 4.5- $2,120.00

 Stryker Australia Pty Ltd

ST711 PEEK Interbody Cages Peek lumbar cages poly ether ether  Size 7-18mm $2,375.00

 ketone 0, 4 & 8 degree

ST712 PEEK Interbody Cages Solis cages poly ether ether ketone 12/5-12/7 and 14/5-14/7 $2,243.00

ST893 Stabilis Frame Titanium Frontal Frame 11 - 13mm  8  $3,690.00

 degrees

ST894 Stabilis Frame Titanium 15mm - 8 degrees $3,690.00

ST895 Stabilis Frame Titanium 17mm - 8 degrees $3,690.00

ST897 Stabilis Bone Graft Delivery Unit - BGDU Titanium BGDU diam 13mm $1,025.00 $1,060.00

ST898 Stabilis Bone Graft Delivery Unit - BGDU Titanium BGDU diam 15mm $1,025.00 $1,060.00

ST899 Stabilis Bone Graft Delivery Unit - BGDU Titanium BGDU diam 17mm $1,025.00 $1,060.00

ST900 Stabilis Oblique Frame Titanium 11mm - 4 degrees $3,690.00

ST901 Stabilis Oblique Frame Titanium 13mm - 4 degrees $3,690.00

ST902 Stabilis Oblique Frame Titanium 15mm - 4 degrees $3,690.00

Prostheses List by Category, Groups and Sponsor Page 171 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST903 Stabilis Oblique Frame Titanium 11mm - 8 degrees $3,690.00

ST904 Stabilis Oblique Frame Titanium 13mm - 8 degrees $3,690.00

ST905 Stabilis Oblique Frame Titanium 15mm - 8 degrees $3,690.00

ST906 Stabilis Frontal Frame Titanium Frontal Frame 11 - 13mm - 4  $3,690.00

 degrees

ST907 Stabilis Frontal Frame Titanium 15mm - 4 degrees $3,690.00

ST908 Stabilis Frontal Frame Titanium 17mm - 4 degrees $3,690.00

ST909 Stabilis Oblique Frame Titanium 11mm - 0 degrees $3,690.00

ST910 Stabilis Oblique Frame Titanium 13mm - 0 degrees $3,690.00

ST911 Stabilis Oblique Frame Titanium 15mm - 0 degrees $3,690.00

 Stryker Australia Pty Ltd (3)

SR050 AVS TL Peek Spacer System Transforaminal Lumbar Interbody Fusion 7-18mm x 25--30mm. 0-4 degree $3,690.00 $4,750.00

  cage, PEEK

 Surgical House

SU112 Hartshill Cancellous bone screws for  6.5mm diam  - 25-30mm length, $136.00

 Horseshoes/STALIF each  5.5mm diam - 25-30mm length

SU171 Cancellous Screws For use with Stalif Implants 5.5mm x 25mm (for use with  $380.00

 37mm Stalif), 6.5mm x 30mm

 (for use with 41/45mm Stalif),

 6.5mm x 25mm (for use with

 41/45mm Stalif). Pack of 4

SU172 Stalif Interbody Spinal Fusion Implant:   37mm x 11, 13, 15mm; 41mm  $5,036.00

 Retroperitoneal/Transperitoneal x 11, 13, 15mm; 45mm x 11,

 13, 15mm; 37mm x 17mm,

 41mm x 17mm, 45mm x 17mm

 Synthes Australia Pty Ltd

SY088 Plif Cage: Cage Contact fusion cage - bone compression  Width 8 - 11mm / height 9 -  $2,704.00

 screw for PLIF cage

SY137 Syncage Interbody fusion cage 12 -19mm Height $3,690.00

SY273 Cervios IBF Cage Interbody Fusion Cage Height 5-10mm (1mm  $2,781.00

Prostheses List by Category, Groups and Sponsor Page 172 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY274 Plivios IBF Cage Interbody Fusion Cage Height  7-17mm $2,942.00

SY275 Trafios IBF Cage Interbody Fusion Cage Height  7-17mm $3,690.00

SY300 Travios Interbody fusion cage, prefilled or unfilled 5mm to 19mm $4,258.00

SY340 PlivioPore Ti PLIF cage Height 7 - 17mm / width 7 -  $3,500.00

SY356 ECD - Expandable Corpectomy Device Vertebral body replacement system,  Angle 4.5Deg/7Deg, Height  $5,440.00

 PEEK/Titanium 17mm - 47mm

SY357 ECD - Expandable Corpectomy Device Locking clip, PEEK/Titanium Universal $300.00

 Taylor Bryant Pty Ltd

TB181 Rabea Peek Vertebral Body Fusion Implant Composition - peek, spinal implant 4, 5, 6, 7 x 12 x 14mm, 8 x 12  $1,545.00

 x 16mm

TB182 Tetris Lumbar Fusion Implant System Titanium or peek, spinal implant 8-12mm x 11mm $1,949.00

TB252 Signus - Semial Composition - PEEK Height (ant) 7.80, 10.40, 13.20;  $3,100.00

 Diameter 38, 43, 48; Height

 (post) 5.4, 8.0, 8.1, 10.8; Angle

 5.00, 10.40

TB269 Blackstone - Spacer Titanium 3/5mm $74.00

TB298 MC+ Implants Intersomatic cages (Open and 'Closed),  12mm x 14mm - 15mm x  $2,625.00

 Anchoring clip

TB299 Roi Implants Intersomatic Lumbar cages 20mm x 7mm - 24mm x 15mm $2,625.00

TB303 Nubic Cervical Fusion Implant in interbody  4x13x14mm, 5x13x14mm,  $2,625.00

 fusion of the Cervical Spine 6x13x14mm, 7x13x14mm,

 8x13x14mm

TB316 Magerl/Kimba Cage Endless Carbon Fibre (ECF) in PEEK- 7, 8, 9, 11, 13, 15mm $3,115.00

 Zimmer

ZI330 Trabecular Metal Spinal Devices Composition - Trabecular Metal Various heights, sizes and  $6,200.00

ZI482 Spine-Tech BAK Cervical Implant Cervical Cage 6 x 12mm, 8 x 12mm, 10 x  $1,564.00

 12mm, 12 x 12mm

Prostheses List by Category, Groups and Sponsor Page 173 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI483 Spine-Tech BAK "L" Cage Lumbar Cage 9 x 20mm, 9 x 24mm, 11 x  $1,719.00

 20mm, 13 x 20mm, 13 x

 24mm, 15 x 20mm, 15 x

 24mm, 17 x 24mm, 17 x 28mm

 Paired

 Medtronic Australasia Pty Ltd

MC725 Telamon Cage 8 - 16mm $3,335.00

 Single

 Medtronic Australasia Pty Ltd

MC452 Telamon Cage 8 - 16mm $3,304.00

Group 13 - Spacer: Non-fusion/Stabilisation

 Group 13a - Non-Fusion / Stabilisation, Interspinous

 Global Manufacturing Technology Pty Limited

GM041 X Stop Interspinous Process Distraction  Spacer assembly and Wing assembly,  Size - 6mm to16mm $4,990.00 Temporary Approval, pending

 System review of product group

 Medtronic Australasia Pty Ltd

MC298 DIAM Sterile 6 - 16 mm $4,313.00

 Orthotech Pty Ltd

OH130 Non-Fusion Spine Stabilising Device Titanium or PEEK Height 8 - 16mm $5,000.00

 Group 13b - Non-Fusion / Stabilisation, Interpedicular

 Zimmer

ZI332 Dynesys Spacer Composition : Polycarbonate 45mm long $620.00

Prostheses List by Category, Groups and Sponsor Page 174 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 14 - Replacement: Disc

 De Puy Australia

DP252 Acroflex Lumbar Artificial Disc Lumbar Disc Replacement Device One size only $951.00

DY359 Sliding Core - 7.5 -11.5mm, 8.5mm, 10.5mm $730.00 $1,100.00

 Medtronic Australasia Pty Ltd

MC585 Maverick Artificial Disc Cobalt Chrome 8mm - 14mm $9,764.00 $12,600.00

 Synthes Australia Pty Ltd

SY329 Spine Solutions Prodisc Artificial mechanical disc, inferior plate  0 Degree, 3 Degree, 8  $4,000.00

 component Degree,Medium, Large

 Group 14 - Disc

 De Puy Australia

DY356 SB Charite Disc Prosthesis End Plates Parallel & Oblique 1 - 5 $4,200.00

 Synthes Australia Pty Ltd

SY327 Spine Solutions Prodisc Artificial mechanical disc, superior plate  3 Degree, 6 Degree, 11 Degree,  $4,000.00

 component Medium, Large

SY328 Spine Solutions Prodisc Artificial mechanical disc, polyethylene  10,12,14mm, Medium, Large $1,500.00

Group 15 - Replacement: Nucleus

 Group 15 - Nucleus

 Medtronic Australasia Pty Ltd

MC617 Nucleus Replacement Spinal Disc Thickness 5-25mm, Diameter  $7,800.00

 10-50mm

Prostheses List by Category, Groups and Sponsor Page 175 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 16 - Replacement: Vertebral Body

 Group 16a - Vertebral Body, Telescoping Cage - Integral Fixation

 De Puy Australia

DY062 Brazenor Device Custom Cervical Buttress One size only $2,155.00

DY420 X-Tenz Telescopic VBR Cage 16mm $6,475.00 $6,689.00

DY421 X-Tenz Telescopic VBR Cage 22mm $6,475.00 $6,689.00

DY429 X-Tenz Telescopic VBR Cage 26mm $6,515.00 $6,714.00

DY430 X-Tenz Telescopic VBR Cage 28mm $6,515.00 $6,714.00

 Global Orthopaedic Technology

GO100 InFix Interbody Fusion System Strut Small - Large $1,060.00

 Orthotech Pty Ltd

OH054 Interpore Bone Plate System TPS Locked Nut 3mm $500.00

 Stryker Australia Pty Ltd (2)

SK425 VBOSS/VLIFT Titanium Available from 10 to 25mm in  $3,605.00 $4,600.00

 Diameter and from 8 to 120mm

 in Length

 Synthes Australia Pty Ltd

SY341 Expandable Cage Titanium Synex II, Titanium Height 14mm-93mm $4,200.00

SY343 Expandable Cage Titanium Synex, Titanium, with endplates Height 14mm - 93mm, Angle 0 - $5,250.00

  40 degree

 Zimmer

ZI536 Trabecular Metal Spinal Devices Composition Trabecular Metal Various heights, diameters and  $6,200.00 $6,405.00

 Group 16b - Vertebral Body, Telescoping Cage - No Integral Fixation

 B Braun Australia Pty Ltd

BB279 TeCorp Vertebral Body Replacement  TeCorp Cervical All sizes $5,000.00

Prostheses List by Category, Groups and Sponsor Page 176 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB280 TeCorp Vertebral Body Replacement  TeCorp Thoracic All sizes $6,000.00

BB281 TeCorp Vertebral Body Replacement  TeCorp Lumbar All sizes $6,000.00

 Global Orthopaedic Technology

GO122 InFix Interbody Fusion System Strut Small - Large $1,060.00

 Medtronic Australasia Pty Ltd

MC507 LIFT/VERTE-SPAN Vertebral Body Cages Short - Extra Long $4,200.00

 Taylor Bryant Pty Ltd

TB293 Wafer Cartridge Assemby, Composition: Peek 8 x 20/25/30mm $2,700.00

 Zimmer

ZI537 Trabecular Metal Spinal Device Composition Trabecular Metal Various heights, sizes and  $6,200.00 $6,405.00

 Group 16c - Vertebral Body, Telescoping Cage - End Plate

 Global Orthopaedic Technology

GO099 InFix Interbody Fusion System Endplate Small - Large $1,110.00

GO101 InFix Interbody Fusion System Endcap 8-10mm $530.00

 Medtronic Australasia Pty Ltd

MC540 LIFT/ VERTE-SPAN End plates (caps) Angulation: -8 - 7 degrees; left  $2,297.00

 and right

 Stryker Australia Pty Ltd (2)

SK339 VBOSS/VLIFT Titanium End caps: Sizes 10 to 25mm  $1,110.00

 (angulation 0 to 8 degrees)

 Synthes Australia Pty Ltd

SY342 Expandable Cage Titanium Synex II, Titanium endplate Angle 0 - 40 degree. Endplate  $700.00

 Size 19x20, 22x25, 26x30

 Group 16d - Vertebral Body, Stackable Cage

 De Puy Australia

DP513 Brantigan I/F Cage Stackable Cage  Small-Large $4,176.00 $4,390.00

Prostheses List by Category, Groups and Sponsor Page 177 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY107 Carbon Fibre Cages Stackable Cage Titanium Interface Screw One size only $815.00 $857.00

DY109 Carbon Fibre Cages Stackable Cage Titanium Protective  5-15mm $79.00

DY110 Carbon Fibre Cages Stackable Cage Titanium Interface Screws M4 / M5 $105.00

DY322 Carbon Fibre Interbody Fusion Device Stackable C/F Cage System Wedges 11 Degree Small-Large $3,305.00 $3,407.00

 Medtronic Australasia Pty Ltd

MC603 Union Verte-Stack Lordotic Small 12-20mm $2,665.00

MC604 Union Verte-Stack Flat Large 12-20mm $2,665.00

MC605 Union Verte-Stack Lordotic Large 12-20mm $2,665.00

MC606 Union Verte-Stack Centre Piece Small 5-40mm $4,614.00

MC607 Union Verte-Stack Centre Piece Large 5-40mm $4,614.00

MC632 Verte-Stack XS Centre Piece. Stackable Corpectomy  Height 5-50mm $4,841.00

 Device.

 Group 16e - Vertebral Body, Mesh

 Medtronic Australasia Pty Ltd

MC378 Pyramesh Titanium Surgical Mesh 51 - 500mm $4,930.00

MC379 Pyramesh Titanium Surgical Mesh 5 - 50mm $2,755.00

MC449 Pyramesh Angled 25 - 150mm $3,605.00

MC450 Pyramesh Curved 130mm $3,605.00

MC451 Pyramesh Ovoid 8 - 70mm $3,605.00

 Stryker Australia Pty Ltd (2)

SK338 VBOSS/VLIFT Titanium Available from 10 to 25mm in  $3,605.00 $4,600.00

 Diameter and from 8 to 120mm

 in Length

 Synthes Australia Pty Ltd

SY293 Synmesh Mesh, Oblong 6mm - 88mm $3,605.00

SY294 Synmesh Mesh, Round 6mm - 88mm $3,605.00

Prostheses List by Category, Groups and Sponsor Page 178 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB284 Blackstone - Surgical Mesh 4 lobe, 6 lobe 4 lobe: 12 x 15mm, 8mm - 17 x  $820.00

 22, 15mm, 6 lobe: (diameter x

 height) 10 - 16 x 10 - 16mm

 (2mm increments), 7 - 70mm

TB302 Blackstone - Surgical Mesh 6 lobe 17 x 22mm, 70mm - 26 x  $2,472.00

 33mm, 90mm

 Group 16f - Vertebral Body, Mesh - End Plate

 Medtronic Australasia Pty Ltd

MC539 Pyramesh End ring/cap 10 - 25mm $1,325.00

MC686 Pyramesh Cleat Titanium Mesh 10mm - 25mm $1,325.00

 Stryker Australia Pty Ltd (2)

SK424 VBOSS/VLIFT Titanium End caps: Sizes 10 to 25mm  $1,110.00

 (angulation 0 to 8 degrees)

 Synthes Australia Pty Ltd

SY295 Synmesh End rings round/oblong $1,133.00 $1,200.00

 Taylor Bryant Pty Ltd

TB282 Blackstone - End Ring Surgical Mesh [Surgical mesh X Angle] 10- $195.00

 16mm (2mm increments) X 0-

Group 17 - Bone Graft: Bone Substitute

 Group 17a - Bone Substitute, Resorbable

 Medtronic Australasia Pty Ltd

MC594 Mastergraft Calcium Phosphate Ceramic Granules 5cc Vial $883.00

MC595 Mastergraft Calcium Phosphate Ceramic Granules 10cc Vial $1,340.00

MC596 Mastergraft Calcium Phosphate Ceramic Granules 15cc Vial $1,850.00

MC597 Mastergraft Calcium Phosphate Ceramic Granules 30cc Vial $2,825.00

MC660 Mastergraft Matrix 5cc $883.00

Prostheses List by Category, Groups and Sponsor Page 179 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC662 Mastergraft Matrix 20cc $2,086.00

MC663 Mastergraft Matrix 10cc $1,340.00

MC671 BCP Biphasic Calcium Phosphate Reabsorbable 20cc $1,700.00

  Graft Supplement

 Group 17b - Bone Substitute, Non-Resorbable - Structural

 Orthotech Pty Ltd

OH166 Mendec Spine Bone Cement Cement $1,900.00

OH171 Mendec Spine Bone Cement Cement Kit $2,000.00

Group 2 - Fixation: Bone Screw Coupling

 B Braun Australia Pty Ltd

BB005 Spine System Evolution Sacral Screw Length 24 - 52mm $120.00

BB012 Spine System Evolution Locking Screw For 5.2 and 6mm rods, length  $67.00

 30 - 55mm

BB014 Spine System Evolution Nut For screws  for 5.2 and 6mm  $225.00

BB165 MACS TL Implant Set - Nut Titanium Dia 15mm $250.00

 De Puy Australia

DP304 Moss Miami (Stainless Steel) Inner Screw and Outer Nut 3 - 5mm $230.00

DP405 Moss Miami (Titanium) Outer Nut or Inner Screw One Size Only $250.00

DP422 Moss Miami 4mm Anterior System (SS) 12 Sided Outie One size only $243.00

DP460 Isola System (Titanium) Right Hand Nut 5/16" $63.00

DP463 Isola System (Titanium) Set Screw 6.35mm $85.00

DP475 Isola System (Stainless Steel) Right Hand Nut 5/16" $49.00

DP501 Isola System (Stainless Steel) Set Screw One size only $55.00

Prostheses List by Category, Groups and Sponsor Page 180 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP832 Profile Anterior Thoracolumbar Plate  Locking Inner Screw One size only $250.00

DP834 Profile Anterior Thoracolumbar Plate  Locking Outer Nut One size only $250.00

DP849 Moss Miami 4mm Anterior System (SS) Washer or Staple or 12 sided outie One size only $255.00 $337.00

DY054 TiMX Low Back System Hexlobe Set Screw or Spherical Nut One size only $78.00

DY059 TiMX Low Back System Modular Cross Connector  Hex Lobe Set  One size only $73.00

 Screw

DY103 Isola System (Stainless Steel) Modular Cross Connector Set Screw One Size Only $54.00

DY106 Isola System (Titanium) Modular Cross Connector Set Screw One size only $64.00

DY108 Isola System Titanium, Locking Screw 60-120mm $670.00 $697.00

DY311 Frontier Anterior Scoliosis System  Twist on Internal Cap One size only $684.00 $719.00

DY340 Summit Cervical Rod System Mini Polyaxial Outer Nut One size only $250.00

DY341 Summit Cervical Rod System Pin Nut with Flange or No Flange One size only $250.00

DY345 Summit Cervical Rod System Transverse Connector Screw One size only $130.00

DY350 RECO Spinal System Set Screw One size only $79.00

DY432 Expedium Spine System Si Screw Set one size $665.00 $692.00

DY439 Expedium Spine System Di Set Screw one size $665.00 $694.00

DY444 Summit SI System Inner Set Screw one size $250.00

 Global Manufacturing Technology Pty Limited

GM032 Optimal Spinal System Set Screw 9 x 1.5 to 10 x 1.5mm $155.00 $280.00

GM062 Maxima/Optima Anterior Cervical Plate  Set Screw One Size $155.00 $280.00

 System

GM069 BacFix (Thoracolumbar System) Serrated tooth locking clip - Titanium alloy Nominal, deep $190.00

 Medtronic Australasia Pty Ltd

MC490 Orion Anterior Cervical System Locking screw One size only $126.36

MC504 CD Horizon Breakoff Set Screw 25 - 55mm $155.00

MC546 Vertex Spinal System Set screw One size only $155.00

Prostheses List by Category, Groups and Sponsor Page 181 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC609 CD Horizon Spinal System Percutaneous Set Screw 25 - 60mm $250.00

MC667 SiLo Set Screw One Size only $155.00

MC674 CD Horizon Legacy set Screw one size only $155.00 $250.00

 Scient'x Australia

SX004 Isobar TTL Nut Blocker, Hemispherical $550.00

 Synthes Australia Pty Ltd

SY363 Universal Spine System (USS) Sleeve 3.5 - 6mm $225.00

 Taylor Bryant Pty Ltd

TB283 Blackstone - Standard Ring Screw Titanium One size only $62.00

 Group 2 - Bone Screw Coupling

 B Braun Australia Pty Ltd

BB230 S4 Spinal System Set Screw - titanium one size $225.00

 De Puy Australia

DY293 Crossover System (Titanium) Crossover Nut or Ball Screw One size only $250.00

 Global Orthopaedic Technology

GO078 Nex-Link Spinal Fixation System, Open Screw  4.00mm $900.00

GO079 Nex-Link Spinal Fixation System, Closed Screw Set 4.0mm $300.00

  Screw

GO084 Incompass Thoracolumbar Fixation System, Open  5.5mm $300.00

 Implant Closure Top

GO085 Incompass Thoracolumbar Fixation System, Closed  5.5mm $300.00

 Implant Set Screw

GO103 Pathfinder Minimally invasive pedicle fixation system Open Implant Closure Top 5.5mm $300.00

 Medtronic Australasia Pty Ltd

MC307 Vertex Spinal System Occipital Buttons Nut 12mm Diameter $508.00

Prostheses List by Category, Groups and Sponsor Page 182 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC394 CD Horizon Nut/Plug, DDT Nuts, double threaded  Each in one size $165.00

 screw nots, plug for closed implants,

 threaded screw plug

MC399 TSRH Spinal Implant System 3D - Nut, Eyebolt locknot, locknut 1/2  Each in one size $165.00

 inch, locking screws, double hex, flush

 break, universal breakoff

MC425 Dynalok Breakoff Nut One size only $123.00

MC435 Colorado Spinal System Break off Nut One size only $165.00

MC475 Z Plate II Non Breakoff Nut One size only $159.00

MC538 Tenor Nuts/plug One size only $195.00

MC601 Equation Spinal System Set Screw One Size Only $155.00

MC615 Z Plate System Vantage Plates and Screws; Lock Nut One Size Only $195.00

MC654 Engage Breakoff Set Screw one size only $155.00

 Orthotech Pty Ltd

OH036 Synergy Spinal System Hex Nut / Cap Nut 3mm $360.00

OH043 Synergy Spinal System Point/Double Hex Set Screw 4.75 - 6.35mm $360.00

OH182 Spinelink Spinal Fixation System Lock Nut, Titanium Standard or Extended $360.00

OH188 OMEGA 21 Spine Fixation System Locking Nut, Titanium One size only $360.00

OH196 Array Spinal System Titanium Alloy Modular Spinal System -  one size $260.00

 set screws

OH204 Altius Occipito-Cervico-Thoracic (OCT)  Locking and CAP Nuts one size only $400.00

 System

 Stryker Australia Pty Ltd (2)

SK112 Xia Spine System Buttress thread locking nut 4.5mm - 6mm $155.00

SK252 Spiral Radius 90D Titanium Locking Cap One Size Only $56.00

 Synthes Australia Pty Ltd

SY006 Click'X Spinal Fixation System Cap One size only $448.00

SY010 VentroFix Set screw One size only $155.00

Prostheses List by Category, Groups and Sponsor Page 183 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY135 Cervical Spine Locking Plate (CSLP)  Locking Screw One size only $54.00

SY152 Universal Spine System (USS) Set Screw Standard $220.00

SY174 Universal Spine System (USS) Nut Standard, SS $173.00

SY186 Cervifix Posterior Cervical System Nut One size only $50.00

SY254 Ventrofix - MIS Locking screw Anterior, posterior $490.00

SY286 USS llio-Sacral Fixation system Locking Screw one size only $490.00

SY304 TeleFix Spinal System Posterior Locking Screw One size only $246.00

SY307 Pangea Spinal System Locking Cap One size only $401.00

SY308 Axon Spinal System Locking Set screw One size only $170.00

 Taylor Bryant Pty Ltd

TB031 Advanced Spine - Titanium System Hex Bolt  Titanium 20mm, 25mm, 30mm $210.00

TB243 Spinal Fixation System Set screw spinal system One size only $107.00

TB281 Blackstone Set Screw Titanium One size only $157.00

TB313 ICON Modular Spinal Fixation System Set Screw one size only $230.00

 Zimmer

ZI479 Silhouette Spinal System Implants Nut, Locking, Polyaxial 1 size $170.00

Group 3 - Fixation: Cable

 Group 3a - Cable, Single Ended

 De Puy Australia

DP480 Isola System (Stainless Steel) Wire with Button or Beaded Wire One size only $64.00

 Medtronic Australasia Pty Ltd

MC417 Orfil Stainless Steel - Wire Spool 1-350mm $361.00

MC441 Atlas Cable System (SS) Single w/crimp and bar One size only $347.00

MC444 Atlas Cable System (Ti) Single (loop end) w/crimp One size only $412.00

Prostheses List by Category, Groups and Sponsor Page 184 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Surgical House

SU110 Hartshill Wire (packet 10)  stainless steel 1.2mm diam  & 0.9mm diam $412.00 $580.00

 Synthes Australia Pty Ltd

SY276 Spine Cable System Single Lead One size only $412.00

 Taylor Bryant Pty Ltd

TB274 Blackstone - Posterior Cervical System Single Loop Cable w/Two Crimps -  One size only $412.00

 Group 3b - Cable, Double Ended

 Medtronic Australasia Pty Ltd

MC442 Atlas Cable System (SS) Double w/2 crimps One size only $381.00

MC445 Atlas Cable System (Ti) Double w/2 crimps One size only $464.00

MC506 Orfil Double Pearl-Tipped Wires 1 - 350mm $97.00

 Surgical House

SU095 Songer cable system  Double loop titanium spinal cable plus  One size only $464.00

 Synthes Australia Pty Ltd

SY277 Spine Cable System Double Lead One size only $535.00

 Taylor Bryant Pty Ltd

TB273 Blackstone - Posterior Cervical System Double  Loop Cable w/Four Crimps -  One size only $464.00

 Titanium

 Group 3c - Cable, Lock / Swage

 Medtronic Australasia Pty Ltd

MC443 Atlas Cable System (SS) Crimp One size only $133.00

MC446 Atlas Cable System (Ti) Crimp One size only $159.00

 Surgical House

SU001 Songer Cable System - 2 Crimps Titanium One size only $189.00

Prostheses List by Category, Groups and Sponsor Page 185 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB272 Blackstone - Posterior Cervical System Crimp Two Pack - Titanium One size only $182.00

Group 4 - Fixation: Connector

 Group 4a - Connector, In-line

 B Braun Australia Pty Ltd

BB064 Socon Spinal System Socon Clamps One size only $1,010.00

BB164 MACS TL Implant Set - Clamp Titanium 1.2cm - 0.9cm $750.00

 De Puy Australia

DP305 Moss Miami (Stainless Steel) Axial Connector 5mm/5mm and 5mm/7mm $855.00 $894.00

DP413 Moss Miami (Titanium) Axial Connector 5mm/5mm $880.00 $924.00

DP462 Isola System (Stainless Steel) Wedding Band 1/4 " & 3/16" $1,150.00 $1,206.00

DP466 Isola System (Titanium) Wedding Band 1/4" & 3/16" $1,400.00 $1,448.00

DP495 Isola Paediatric System (Stainless Steel) Growth/Tandem Connector 3/16" $1,555.00 $1,599.00

DY184 Monarch Spinal System Dual Rod Connectors End to End or Side  6.35 to 6.35mm or 6.35 to  $1,555.00 $1,614.00

 by Side 5.5mm or 6.35 to 4.75mm

DY317 Isola System (Stainless Steel) Band Clamp Connector or Tandem  1/4" & 3/16" $1,268.00

 Howmedica

HW386 Xia Spine System Rod Clamp - Parallel, Axial One size only $996.00

 Medtronic Australasia Pty Ltd

MC407 CD Horizon Domino 3.2mm, 3.5mm, 4.5mm,  $722.00

 5,5mm, 6.35mm

MC409 CD Horizon Connector, Lateral open, lateral closed,  Connector, Lateral open, lateral  $722.00

 closed reduction, DTT Transverse,  closed, closed reduction - 1size,

 Domino, Connecting cylinder, Closed   DTT Transverse - 70 -

 Domino, Connecting Cylinder, Hopf  100mm, Domino - 5.5 -

 screw, ilio sacral, lateral, Stephanie, axial

MC635 CD Horizon Legacy In-Line Connector Length 40-110mm $1,600.00

Prostheses List by Category, Groups and Sponsor Page 186 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH175 Omega 21 Spine Fixation System Connection Rod, Titanium 105-155mm $520.00

OH179 Omega 21 Spine Fixation System Connection Rod, Titanium 165-255mm $800.00

OH180 Omega 21 Spine Fixation System Connection Rod, Titanium 35-95mm $520.00

OH183 Spinelink Spinal Fixation System Link, Standard or Reverse, Ti 21mm - 78mm $1,056.00

OH189 OMEGA 21 Spine Fixation System Transverse Rod Connector , Titanium One size only $722.00

OH197 Array Spinal System Titanium Alloy Modular Spinal System -  Large, Medium, Small, Xsmall,  $950.00

 cross connector 24mm, 22mm, 20mm, 18mm,

 16mm

OH205 Altius Occipito-Cervico-Thoracic (OCT)  Domino Adjustable CC Left & Right One size only $420.00

 System

 Scient'x Australia

SX005 Isobar TTL Clamp Snap-on, Short, Long and  $800.00

 Monobloc

 Stryker Australia Pty Ltd (2)

SK224 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V 3.5mm Rod (Length 80mm);  $722.00

 3.5mm Rod (Length 120mm);

 3.5mm Rod (Length 240mm)

 Taylor Bryant Pty Ltd

TB100 Advanced Spine - Titanium System Lower Saddle 1mm $358.00

TB101 Advanced Spine - Titanium System Lower Saddle 14 Degree Left/Right, 7 Degree  $465.00

 Left/Right, 2mm, 4mm, 6mm

 Increment, 30 Degree Left/Right

 Group 4b - Connector, Offset

 B Braun Australia Pty Ltd

BB004 Spine System Evolution Lateral Connector Small, medium, large $745.00

BB007 Spine System Evolution Clamp for Cross Plate For 5.2 and 6mm rods $480.00

Prostheses List by Category, Groups and Sponsor Page 187 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP060 VSP System (Stainless Steel) Sacral Connector - Left & Right Offset One size only $521.00

DP311 Moss Miami (Stainless Steel) Transverse Connector Rod or Screw or  One size $598.00

DP420 Moss Miami (Titanium) Transverse Connector Hook or Screw or  One Size $1,050.00

DP454 Isola System (Titanium) Slotted Connectors Standard or Extended  1/4" & 3/16" $930.00 $948.00

 or Offset or Angled or Open or Twister

DP459 Isola System (Titanium) Jaw Clamp 1/4" & 3/16" $377.00

DP469 Isola System (Stainless Steel) Slotted Connectors  - Standard or  1/4" & 3/16" $743.00

 Extended or Offset or Angled or Open or

DP474 Isola System (Stainless Steel) Jaw Clamp 1/4" & 3/16" $345.00

DP842 Moss Miami (Stainless Steel) Sacral Extender 5mm x 5 - 20mm length $600.00

DP843 Moss Miami (Titanium) Sacral Extender 5mm x 5 - 20mm length $710.00

DY041 TiMX Low Back System Sacral Connector (Left & Right Offset or One size only $743.00

DY050 TiMX Low Back System Slotted Connector (Left & Right Offset  1/4"           $743.00

 or Straight or Extended or Twister)

DY094 Isola Paediatric System Stainless Steel, Slotted Connector  3/16" $743.00

DY179 Monarch Spinal System Slotted Connectors  One size only $743.00

 (Straight/Extended/Offset/Twister/Mini

 Offset)

DY186 Monarch Spinal System Band Clamp Connector 6.35 & 5.5mm $743.00

DY337 Summit Cervical Rod System Open Cable Connector One size only $1,519.00 $1,597.00

DY342 Summit Cervical Rod System Connectors Left or Right or Neutral One size only $743.00

DY347 RECO Spinal System Block 4-7mm $1,200.00

DY443 Summit SI System Connectors Various $743.00

 Global Manufacturing Technology Pty Limited

GM029 Optimal Spinal System Axial/Lateral Connectors Various $750.00 $1,055.00

GM065 Maxima/Optima Anterior Cervical Plate  Axial/Lateral Connections 7.5mm-30mm $743.00

 System

Prostheses List by Category, Groups and Sponsor Page 188 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Global Orthopaedic Technology

GO106 OctaFix Occipital Cervical Plating System Screw Offset Connector $743.00

 Howmedica

HW391 Xia Spine System Connector - Axial, Dual, Offset 4.5mm - 6mm $996.00

 Medtronic Australasia Pty Ltd

MC376 Colorado Spinal System Colorado 2 Connector For 5mm rod and 5.5mm rod $743.00

MC377 Colorado Spinal System Colorado 2 Clamp $403.00

MC410 CD Horizon Bolt, Left, Right One size only $1,132.00

MC411 CD Horizon Block, Right, Left 5 - 7 mm $1,200.00

MC429 Dynalok Offset, Straight, Extended Connector 5.5 - 6.35mm $293.00

MC434 Colorado Spinal System Connector for Sacral & Ilio-Sacral Plate One size only $743.00

MC460 TSRH 3D  Connector, 5.5mm 6-12mm $743.00

MC498 Tenor Monoclamps - Titanium One size only $403.00

MC499 Tenor Dual Clamps - Titanium  One size only $403.00

MC500 Tenor Offset Clamps - Titanium  One size only $403.00

MC542 Vertex Spinal System Connector Length 10 - 13mm; diameter 3.2 $1,385.00

  - 6.35mm

MC608 TSRH 3D Connector Small, Medium, Large $1,020.00

MC665 Engage Connector Small, Medium, Large $722.00

MC668 CD Horizon Legacy lliac Lateral Connector 20mm and 30mm Length $743.00

MC676 SiLo Lateral Connector 10-40mm $735.00

 Orthotech Pty Ltd

OH186 OMEGA 21 Spine Fixation System Multidirection Coupling, Titanium One size only $780.00

 Stryker Australia Pty Ltd

ST708 Dimso/Stryker Connector  Offset sacral connector titanium One size only $1,215.00 $1,251.00

ST709 Dimso/Stryker Connector  Offset connector  titanium One size only $642.00

Prostheses List by Category, Groups and Sponsor Page 189 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK250 Maps Spinal Fixation System Titanium - Offset Connector, Two Step  Offset Connector - Small,  $743.00

 Locking Connector, Variable Offset  Medium, Large

 Connector

 Surgical House

SU072 OGP posterior lumbar rigid screw  OGP clamp 10,12,14,16,18mm $1,386.00

 fixation system

SU082 Double loop Hook/screw & rod spinal system  Left & right, 3.5 & 5.0mm $630.00

SU090 Screw link   Hook/screw & rod spinal system  0 degrees, 15 degrees, 30  $252.00

SU198 Olerud ME-Connector Titanium. For polyaxial connection of  for use with 3mm and 4mm  $743.00

 Olerud cervical pedicle screws to rod,  Olerud screws

 claws etc for fixation of the cervical

SU199 Olerud PF Blocks Titanium, Threaded or Non-threaded, 0,  To suit 7mm Olerud PF Rods $1,200.00

 10, 13mm offset

 Synthes Australia Pty Ltd

SY012 CerviFix Posterior Cervical System Clamp Left, Right, Medial, Lateral,  $500.00

 Pedicle, Lamina

SY144 Universal Spine System (USS) Fracture Clamps Cranial, Standard, Low Profile $1,278.00

SY145 Universal Spine System (USS) Half Ring SS, Standard, Self-Holding $360.00

SY185 Cervifix Posterior Cervical System Starlock Clamp Upgoing, Neutral, Offset, Offset $600.00

  Neutral, Left, Right

SY250 Universal Spine System Low Profile Transconnector 18-83mm length $1,100.00 $2,565.00

SY287 USS llio-Sacral Fixation system Transconnecting bar One size only $1,100.00

SY288 USS llio-Sacral Fixation system Sacral clamp One size only $1,420.00

SY310 Axon Spinal System transverse bar one size only $571.00

 Taylor Bryant Pty Ltd

TB115 Low Pro Upper Clamp Cross Link Assembly 200 Ser Titanium 7/0cm, 8/0cm, 9/0cm $403.00

TB239 Spinal Fixation System Multi Axial Cross Connector Assembly -  30mm - 75mm in 5mm  $730.00

 Titanium/Lateral Offset

Prostheses List by Category, Groups and Sponsor Page 190 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB278 Blackstone - Posterior Cervical System Cross-Connector 20, 25, 30, 35, 40, 45, 50mm $850.00

TB312 ICON Modular Spinal Fixation System Offset body assembly 8, 11, 14mm $250.00

 Zimmer

ZI477 Silhouette Spinal System Implants Nut, Connector, Transverse 1 size $152.00

 Group 4c - Connector, Transverse (Rod-to-Rod)

 B Braun Australia Pty Ltd

BB009 Spine System Evolution Rod Connector For 5.2 and 6mm rods $481.00

BB065 Socon Spinal System Socon Crossbar Length 50mm-80mm $302.00

BB066 Socon Spinal System Cross Bar Clamp One size only $641.00

BB228 S4 Spinal System S4 Cross Connector - titanium Rigid 22mm - 41mm $1,250.00

BB229 S4 Spinal System S4 Cross Connector - titanium Variable 43mm - 75mm $1,500.00

 De Puy Australia

DP301 Moss Miami (Stainless Steel) Transverse Connector - Complete One size only $1,004.00 $1,055.00

DP412 Moss Miami (Titanium) Transverse Connector - Complete One size only $993.00

DP451 Kaneda SR (Smooth Rod)  Anterior  (TI) Transverse Coupler 1/4" x 13 - 16mm $1,115.00 $1,160.00

DP453 Isola Paediatric System (Stainless Steel) Threadless TRC - Closed or Open Body  3/16" $1,004.00 $1,090.00

 without Rod

DP470 Isola System (Stainless Steel) Transverse Rod Connector or Dual Rod  1/4" & 3/16" $1,115.00 $1,277.00

 Connector

DP490 Isola Paediatric System (Stainless Steel) Wedding Band 3/16" $741.00

DP496 Isola Paediatric System (Stainless Steel) Threadless TRC - Closed / Open Body  3/16" $751.00

 with Rod

DP499 Isola System (Titanium) Transverse Connector or Dual Rod  1/4" & 3/16" $1,115.00 $1,186.00

DY100 Isola System (Stainless Steel) Threadless TRC - Closed or Open Body  1/4" & 3/16" $1,004.00 $1,029.00

 with Rod

DY102 Isola System (Stainless Steel) Threadless TRC - Closed / Open Body -  1/4" & 3/16" $1,004.00 $1,098.00

 No Rod

Prostheses List by Category, Groups and Sponsor Page 191 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY185 Monarch Spinal System Plate J-Hooks 3.5 - 11 mm $575.00

DY289 Crossover System (Titanium) Crossconnector Small 18-30mm $2,456.00 $2,574.00

DY290 Crossover System (Titanium) Crossconnector Medium 32-45mm $2,456.00

DY292 Crossover System (Titanium) Crossconnector Large 45-107mm $2,456.00

DY306 Isola System (Titanium) Threadless TRC - open body with or  1/4" & 3/16" $1,520.00 $1,592.00

 without rod

DY336 Summit Cervical Rod System Cross Connector One size only $1,520.00 $1,597.00

DY344 Summit Cervical Rod System Transverse Connector Hook One size only $556.00 $560.00

DY351 RECO Spinal System Tranverse Connector 4 or 6mm $900.00

 Global Manufacturing Technology Pty Limited

GM031 Optimal Spinal System Traverse Link Assembly 40 to 80mm $900.00

GM063 Maxima/Optima Anterior Cervical Plate  Traverse Link assembly 44mm - 75mm $900.00

 System

 Global Orthopaedic Technology

GO081 Nex-Link Spinal Fixation System, Transverse  4.00mm Rod x 25mm - 45 length $750.00

 Connectors

GO086 Incompass Thoracolumbar Fixation System, Offset  9.5 - 30mm $800.00

 Connector Open

GO087 Incompass Thoracolumbar Fixation System, Offset  7.5 - 30mm $800.00

 Connector Closed

 Howmedica

HW390 Xia Spine System Cross Link Length 40, 60, 80mm $1,050.00

 LSS Surgical

LS002 Solas Spinal System Traverse Link Assembly 30mm - 120mm $900.00

 Medtronic Australasia Pty Ltd

MC398 TSRH Spinal Implant System 3D - Plate, Offset, connector, multi-span, Sacral 20 - 50mm, rest 0.375 -  $740.00

  sacral 3.75 inches

MC400 TSRH Spinal Implant System 3D - Crosslink, Plate, multip-span plate,  Sacral 20 - 50mm, rest 0.375 -  $900.00

 offset plate, sacral plate 3.75 inches

Prostheses List by Category, Groups and Sponsor Page 192 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC403 Colorado Spinal System Colorado 2 Plate Range length 20 - 60mm $900.00

MC408 CD Horizon Crosslink, Plate, Multi-span late, Offset  60 - 200mm $900.00

 plate, Transverse links

MC414 CD Horizon Plate, Chopin Intrapedicular 32mm -  $900.00

 52mm, Chopin plate 32 - 36mm

MC426 Dynalok Crosslink Plate 3cm - 16 cm $806.00

MC496 Tenor Transverse Links - Titanium 40-100mm $743.00

MC590 Vertex Reconstruction System Crosslink  Composition -  titanium alloy. The system One size only $990.00

  allows for the adaptation of components

 from other Sofamor Danek systems to

 provide for constructs tailor made for

MC600 Equation Spinal System Plate Length 40-200mm $504.00

MC634 CD Horizon X10 Crosslink Multi-Span Plate: 25-81mm $2,990.00

MC708 CD Horizon X10 Crosslink Fixed Plate: 16-31mm $1,300.00

 Orthotech Pty Ltd

OH040 Synergy Spinal System Adjustable Transverse Connector With  3 - 6cm $980.00

 Rod/Clamp

OH041 Synergy Spinal System Fixed Transverse Connectors 10.5 - 31.5mm $980.00

OH042 Synergy Spinal System Lateral Connectors (Closed Rod) 4.75 - 6.35mm $824.00

OH192 Spinelink Spinal Fixation System Link, Telescoping, Transverse, Ti 40-59mm, 59-90mm $900.00

OH206 Altius Occipito-Cervico-Thoracic (OCT)  Connector 15, 30,  45 L&R $600.00

 System

OH246 Omega 21 Spine Fixation System Connection Rod, Titanium 105 - 155mm $520.00

OH247 Omega 21 Spine Fixation System Connection Rod, Titanium 165 -255mm $800.00

OH248 Omega 21 Spine Fixation System Connection Rod, Titanium 35 - 95mm $520.00

OH249 OMEGA 21 Spine Fixation System Transverse Rod Connector , Titanium One size only $722.00

 Scient'x Australia

SX016 Easys Straddler - titanium alloy one size $900.00

Prostheses List by Category, Groups and Sponsor Page 193 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd

ST689 Dimso/Stryker Implants Diapason Transverse - Domino titanium One size only $570.00

ST690 Dimso/Stryker Implants Diapason Transverse rod union titanium 10-50mm $320.00

ST691 Dimso/Stryker Implants Diapason Transverse ball links (set of 2) titanium One size only $950.00

ST693 Dimso/Stryker Implants Diapason Transverse - transverse connector  One size only $445.00

 titanium, TLC connector

ST694 Dimso/Stryker Implants Diapason Transverse - transverse bar titanium 50-90mm $392.00

 Stryker Australia Pty Ltd (2)

SK080 Xia Spine System Multi Axial Connector Monobloc, Small, Standard  $630.00

 24mm - 50mm

SK227 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V Transverse Connector; Offset  $900.00 $996.00

 Connector; Rod to Rod

SK241 Xia Spinal System Titanium or Stainless Steel Cross  15-20mm $720.00

SK253 Spiral Radius 90D Titanium Variable Cross Connector -  $900.00

 Long, Medium Short; Fixed

 Cross Connector - 10-30mm

 Surgical House

SU077 Cross bar clamp Hook/screw & rod spinal system  For 7mm rod, for 6mm rod $1,500.00

SU078 Cross bar Hook/screw & rod spinal system  30,45 & 60mm $900.00

 Synthes Australia Pty Ltd

SY008 VentroFix Clamp Single, Double, Fracture, Left,  $1,500.00

 Right

SY011 VentroFix Parallel connector 6.0/6.0mm $1,000.00

SY015 CerviFix Posterior Cervical System Parallel connector 3.5/3.5, 3.5/5.0, 3.5/6.0 $1,000.00

SY146 Universal Spine System (USS) Cross Link Rod 40-80mm length  $109.00

SY147 Universal Spine System (USS) Connectors Parallel, In-line, Transverse, SS, $1,000.00

  15 - 25mm

SY326 Spinal Plate/Plate System AO/ASIF Spinal Internal fixator - cross link clamp One size only $1,174.00

  Implants

Prostheses List by Category, Groups and Sponsor Page 194 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY359 Universal Spine System (USS) Fracture Clamps Cranial, Standard, Low Profile $1,278.00

SY362 Universal Spine System (USS) Pedicle Hook Screw Length 20 - 40mm $175.00

 Zimmer

ZI480 Silhouette Spinal System Adjustable Transverse Connector Sleeve  12 - 90mm lengths $325.00

 with Set Screw

ZI535 Optima Spinal Fixation System - Optima Spinal Fixation System - Rod  Various $1,000.00

 Connectors

Group 5 - Fixation: Hook

 Group 5a - Hook, Open

 B Braun Australia Pty Ltd

BB001 Spine System Evolution Hook Pin Length 25 - 60mm $122.00

BB002 Spine System Evolution Hook, Left and right For 5.2 and 6mm rods,  $543.00

 Thoracic, pedicle, laminar

BB003 Spine System Evolution Counter/angled/universal hook Universal - short, long; Counter  $281.00

 - small, medium; Angled - left,

 De Puy Australia

DP299 Moss Miami (Stainless Steel) Hooks - Pedicle One size only $820.00

DP300 Moss Miami (Stainless Steel) Hooks - Laminar as Wide or Narrow or  One size only $820.00

 Angled or Reduced Distance Supra-

 laminar or Offset or Extended Body

DP329 Moss Miami (Stainless Steel) Hooks - Translation (Pedicle/Reduced  One size only $1,004.00 $1,347.00

 Distance/Narrow/Wide Blade)

DP410 Moss Miami (Titanium) Hooks - Pedicle 3-5 mm $820.00

DP411 Moss Miami (Titanium) Hooks - Laminar as Wide or Narrow or  One size only $820.00

 Angled or Reduced Distance Supra-

 laminar or Offset or Extended Body

DP418 Moss Miami (Titanium) Hooks - Translation One size only $1,115.00 $1,342.00

DP465 Isola System (Titanium) Open Hook and / or Cap 1/4" & 3/16" x 5-11mm $605.00

Prostheses List by Category, Groups and Sponsor Page 195 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP472 Isola System (Stainless Steel) Open Hook Cap or Open 1/4" & 3/16" x 5-11mm $820.00

DP487 Isola Paediatric System (Stainless Steel) Side Tightening Hook - Opened/Closed 3/16" x 3.5mm - 11mm $716.00

DP845 Moss Miami 4mm Anterior System (SS) Hooks 4mm $820.00

DY304 Monarch Spinal System Hooks - Open (Pedicle/Narrow  5-11mm $725.00

 Tapered/Wide Blade)

DY437 Expedium Spine System Hooks (Pedicle, Reduced, Angled,  one size $1,400.00 $1,419.00

 Narrow, Wide)

DY438 Expedium Spine System Hooks (Left/Right Angled, Left/Right  One size $1,400.00 $1,419.00

 Offset, Extended Body)

 Global Manufacturing Technology Pty Limited

GM020 Optimal Spinal System Hooks-open & closed-pedical & laminar Various $745.00

GM064 Maxima/Optima Anterior Cervical Plate  Hooks Open & Closed - Pedicle &  6.5mm-11mm $745.00

 System

GM075 BacFix (Thoracolumbar System) SpeedLink fixed distance rod - Titanium  5.5 - 6mm x 15 - 35mm $1,450.00

GM076 BacFix (Thoracolumbar System) SpeedLink adjustable length rod -  5.5 - 6mm x 39.5 - 75mm $1,670.00

 Titanium alloy

 Global Orthopaedic Technology

GO091 Incompass Thoracolumbar Fixation System, Hooks 5.5mm $720.00

 Howmedica

HW387 Xia Spine System Lamina Hook - Angled, Reduced,  Large Medium, Small $820.00 $1,375.00

 Extended, Standard Blade, Narrow Blade,

HW388 Xia Spine System Pedicle Hook Large, Small $820.00 $1,375.00

 LSS Surgical

LS007 Solas Spinal System Hooks Open & Closed - Pedicle and  4mm - 11mm $800.00

Prostheses List by Category, Groups and Sponsor Page 196 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC375 Colorado Spinal System Colorado 2 Hook, Pedicular hook - small  $820.00

 and large, Laminar hook - small, medium

 and large, Staple for pedicular hooks,

 Open laminar thoracic hook, Supra

 laminar median hook,

 Narrow laminar - 1 size, Open laminar - 1

MC397 TSRH Spinal Implant System 3D - Hook, Offset, left, right, laminar,  Large - small $745.00

 pedicle, Stainless steel, Titanium

MC406 CD Horizon Hook - various Small, Medium or Large $820.00

MC591 Vertex Reconstructive System Laminar  Composition -  titanium alloy 4.5mm / 5.5mm $820.00

MC677 SiLo Hook Right, left, front $820.00

 Orthotech Pty Ltd

OH038 Synergy Spinal System Open/Closed Offset Hooks 4mm $745.00

OH039 Synergy Spinal System Open/Closed Hooks Pedicle/Laminar 4.75 - 6.35mm dia $745.00

OH045 Synergy Spinal System Infant Hooks 4.75mm $772.00

OH191 Omega 21 Spine Fixation System Hook titanium - Pedicle/Lt & Rt  6, 8, 10mm $845.00

 Angle/Wide/Narrow/Reduced

OH198 Array Spinal System Titanium Alloy Modular Spinal System -  one size $845.00

 laminar hook and pedicle hook

OH208 Altius Occipito-Cervico-Thoracic (OCT)  Hook and OC Screws Hook:  12mm to 14mm (L&R),  $925.00

 System OC Screws: 6mm to 20mm

 Scient'x Australia

SX006 Isobar TTL Hooks Small, Large, offset $820.00

 Stryker Australia Pty Ltd

ST696 Dimso/Stryker Implants Diapason Hook - non offset titanium, narrow, wide, One size only $820.00 $1,100.00

  straight, oblique, lumbar

ST697 Dimso/Stryker Implants Diapason Hook - offset titanium,  thoracic - left,  Small, Large $820.00 $1,100.00

Prostheses List by Category, Groups and Sponsor Page 197 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK222 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V Hook, Standard Short; Hook,  $820.00 $1,375.00

 Standard Tall; Hook, Offset,

 Right; Hook Offset, Left

SK254 Spiral Radius 90D Titanium - Hook: Oblique, Lamina,  Oblique - Left & Right; Lamina  $820.00 $900.00

 Thoracic, Pedicle, Offset - Large, Extended Medium,

 Medium, Wide Medium,

 Extended Small, Small, Wide

 Small; Pedicle - Large & Small;

 Offset - Left & Right 5-10mm

 Surgical House

SU093 Lamina hook short Hook/screw & rod spinal system  Short & long $504.00

 component, left & right

SU094 Lamina compression hook Hook/screw & rod spinal system  c1-claw $504.00

 Synthes Australia Pty Ltd

SY306 Pangea Spinal System Pedicle and Lamina Hooks Extra small to Extra Large $1,288.00

SY325 Universal Spine System Hook Small, Medium, Large, Lamina,  $970.26

 Thoracic, Pedicle

 Taylor Bryant Pty Ltd

TB270 Blackstone - Posterior Hook Titanium Large/Angled/Offset/Left/Right/ $463.00

 Narrow/Wide/ThoracicLaminar/

 Lumbar Laminar

 Group 5b - Hook, Closed

 De Puy Australia

DP464 Isola System (Titanium) Closed Hooks 1/4" x 3/16" x 5-11mm $820.00 $901.00

DP471 Isola System (Stainless Steel) Closed Hooks 1/4" & 3/16" x 5-11mm $745.00

DY178 Monarch Spinal System Hooks - Closed (Narrow Tapered / wide  5 - 11 mm $820.00 $991.00

 Blade)

DY507 Isola Paediatric System (Stainless Steel) Side Tightening Hook - Opended/Closed 3/16" x 3.5mm - 11mm $716.00

Prostheses List by Category, Groups and Sponsor Page 198 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Global Manufacturing Technology Pty Limited

GM073 BacFix (Thoracolumbar System) Hook - Titanium alloy 6.5 - 11mm $745.00

GM095 Optimal Spinal System Hooks - open & closed - pedical & laminar Various $775.00

 Global Orthopaedic Technology

GO121 Incompass Thoracolumbar Fixation System, Hooks 5.5mm $720.00

 Medtronic Australasia Pty Ltd

MC724 Colorado Spinal System Colorado 2 Hook, Pedicular hook - small  $820.00

 and large, Laminar hook - small, medium

 and large, Staple for pedicular hooks,

 Closed laminar thoracic hook, Supra

 laminar median hook,

 Narrow laminar - 1 size, Closed laminar -

 1 size

 Orthotech Pty Ltd

OH242 Synergy Spinal System Open/Closed Offset Hooks 4mm $745.00

OH243 Synergy Spinal System Open/Closed Hooks Pedicle/Laminar 4.75 - 6.35mm Dia $745.00

OH244 Synergy Spinal System Infant Hooks 4.75mm $772.00

OH250 Omega 21 Spine Fixation System Hook titanium - Pedicle/Lt & Rt  6, 8, 10mm $845.00

 Angle/Wide/Narrow/Reduced

OH251 Array Spinal System Titanium Alloy Modular Spinal System -  one size $745.00

 laminar hook and pedicle hook

OH252 Altius Occipito-Cervico-Thoracic (OCT)  Hook and OC Screws Hook: 12mm - 14mm (L&R),  $925.00

 System OC Screws: 6mm - 20mm

 Synthes Australia Pty Ltd

SY013 CerviFix Posterior Cervical System Hook Small, Large, Left, Right $600.00

SY039 Spinal Plate/Plate System AO/ASIF Spinal Spondylolysis hook screw (complete)  Screw 45 - 60mm $586.00

  Implants small & large

 Taylor Bryant Pty Ltd

TB034 Advanced Spine - Titanium System Varigrip Lower Hook Titanium (Zone 1,  Zone 1/2/3 $2,616.00

TB035 Advanced Spine - Titanium System Varigrip Upper Hook Titanium (Zone 1, 2, Zone 1/2/3 $1,469.00

Prostheses List by Category, Groups and Sponsor Page 199 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB172 SL Upper Hook Composition - Titanium Zone 5 $4,623.00

TB173 SL Lower Hook Composition - Titanium Zone 5 $3,328.00

 Zimmer

ZI527 Optima Spinal Fixation System - Hooks Titanium Alloy Various $1,130.50

Group 6 - Fixation

 Group 6a - Plate, Integral Fixation

 De Puy Australia

DY069 Codman Anterior Cervical Plate System Anterior Cervical Plate 50 - 70mm $1,271.00 $1,315.00

Group 6 - Fixation: Plate

 Group 6a - Plate, Integral Fixation

 B Braun Australia Pty Ltd

BB006 Spine System Evolution Sacral Plate Left/right for 5.2 and 6mm rods $1,271.00

BB135 Aesculap Cervical System Titanium, rigid Medium 34 - 64mm length $841.00

BB140 Aesculap Cervical System Titanium, rigid Large 67 - 103mm length $1,186.00

BB153 Aesculap Cervical System Titanium, rigid Small 20 - 32mm Length $725.00

BB166 MACS TL Implant Set - Bone Graft Clamp Titanium 1.6 x 1cm $349.00

BB167 MACS Stabilisation Plates Titanium, rigid Length 45 - 100mm $1,059.00

BB248 PACH Plate Titanium 28 & 32mm $975.00

 De Puy Australia

DP251 DOC Ventral Stabilisation System Doc Plate 1-3 Level $1,005.00

DP564 Peak Polyaxial Anterior Cervical Plate  Anterior Cervical Plate 1 - 4 Segment $2,685.00 $2,822.00

DY066 Codman Anterior Cervical Plate System Anterior Cervical Plate 24 - 48mm $765.00

DY070 Codman Anterior Cervical Plate System Anterior Cervical Plate 74 - 110mm $1,431.00 $1,504.00

DY297 Slim-loc Anterior Cervical Plate System Plates - one level 22-37mm $1,271.00

Prostheses List by Category, Groups and Sponsor Page 200 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY298 Slim-loc Anterior Cervical Plate System Plates - two level 39-53mm $1,271.00 $1,692.00

DY299 Slim-loc Anterior Cervical Plate System Plates - three level 54-78mm $1,431.00 $1,946.00

DY447 Swift Spine System Titanium Anterior Cervical Plate System - Level 1 size 15 - 29mm $2,700.00 $2,823.00

  Various size plates

DY448 Swift Spine System Titanium Anterior Cervical Plate System - Level 2 size 30 - 42mm $2,700.00 $2,823.00

  various size plates

DY449 Swift Spine System Titanium Anterior Cervical Plate System - Level 3 size 45 - 63mm $2,700.00 $2,823.00

  various size plates

DY450 Swift Spine System Titanium Anterior Cervical Plate System - Level 4 size 60 - 100mm $2,700.00 $2,822.00

  various size Plates

DY451 Swift Spine System Titanium Anterior Cervical Plate System - 46 - 102mm $2,700.00 $2,823.00

  Corpectomy Plate

DY458 Uniplate ACP System Titanium Anterior Cervical 1 Level Plate 13-22mm $2,700.00 $2,823.00

DY480 Uniplate ACP System Titanium Anterior Cervical 2 Level Plate 28-40mm $2,700.00 $2,822.00

 Global Manufacturing Technology Pty Limited

GM026 Maxima/Optima Anterior Cervical Plate  Anterior Cervical Plates 24mm to 108mm $1,550.00 $1,900.00

 System

GM039 Prima OCT Spinal System Occiput Plate One size only $2,500.00

GM080 AcuFix 1 segment SlimLine plate - Anterior  20 - 34mm $1,220.00

 cervical plate system - Titanium

GM081 AcuFix 2 segment SlimLine plate - Anterior  34 - 54mm $1,271.00

 cervical plate system - Titanium

GM082 AcuFix 3 segment SlimLine plate - Anterior  47 - 71mm $1,431.00

 cervical plate system - Titanium

GM083 AcuFix 4 segment SlimLine plate - Anterior  68 - 92mm $1,431.00

 cervical plate system - Titanium

GM084 AcuFix 2 segment Corpectomy plate - Anterior  34 - 54mm $1,360.00

 cervical plate system - Titanium

GM085 AcuFix 3 segment Corpectomy plate - Anterior  53 - 77mm $1,431.00

 cervical plate system - Titanium

Prostheses List by Category, Groups and Sponsor Page 201 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GM086 AcuFix 4 segment Corpectomy plate - Anterior  68 - 101mm $1,550.00

 cervical plate system - Titanium

 Global Orthopaedic Technology

GO093 AcuFix 1 segment ThinLine plate 20 - 36mm $1,271.00

GO094 AcuFix 2 segment ThinLine plate 34 - 54mm $1,271.00

GO095 AcuFix 1 segment Ant-Cer dynamic plate 24 - 32mm $1,271.00

GO096 AcuFix 2 segment Ant-Cer dynamic plate 34 - 54mm $1,271.00

GO097 AcuFix 3 segment Ant-Cer dynamic plate 50 - 71mm $1,431.00

GO098 AcuFix 4 segment Ant-Cer dynamic plate 68 - 96mm $1,431.00

GO104 OctaFix Occipital Cervical Plating System Occipital Plate $2,770.00

 Medtronic Australasia Pty Ltd

MC345 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy  20mm - 47mm $1,271.00

 and Nitinol

MC346 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy  20mm - 50mm $1,550.00

 and Nitinol

MC418 Atlantis Anterior Cervical Plate Plate 19.0mm -  47.5mm $1,271.00

MC419 Atlantis Anterior Cervical Plate Plate 50.0 - 60.0mm $1,271.00

MC420 Atlantis Anterior Cervical Plate Plate 62.5 -   77.5mm $1,431.00

MC421 Atlantis Anterior Cervical Plate Plate 80.0 -   95.0mm $1,550.00

MC422 Atlantis Anterior Cervical Plate Plate 100.0 - 110.0mm $1,550.00

MC463 Zephir Anterior Cervical Plate 20-70mm $1,220.00

MC510 Premier Anterior Cervical Plate System Plates 23 - 90mm $1,431.00 $1,814.00

MC610 Z Plate System Vantage plates and Screws; Thoracic Plate 3.5 - 8cm $3,700.00

MC612 Z Plate System Vantage Plates and Screws; ATL Plate 4 - 10cm $4,800.00

MC616 Atlantis System Element Express Kit Includes Plate, 4  Plate 23 - 45mm $2,968.00

 Screws, Screwdriver Shaft, Screwdriver

 Handle

Prostheses List by Category, Groups and Sponsor Page 202 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC637 CD Horizon Spire Plate One size $1,398.00

MC704 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy  111mm - 150mm $1,550.00

 and Nitinol

MC705 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy  91mm - 110mm $1,550.00

 and Nitinol

MC706 Venture Anterior Cervical Plate Single or multi level plate, titanium alloy  51mm - 90mm $1,400.00

 and Nitinol

 Orthotech Pty Ltd

OH052 Interpore Bone Plate System TPS Bone Plate 20 - 56cm $3,100.00

OH063 Anterior Cervical Plate System Titanium Locking Plate 20 - 140mm $2,040.00

OH209 Altius Occipito-Cervico-Thoracic (OCT)  TI Occipital Plate 35-45mm, 40-50mm, 45-55mm $2,600.00

 System

OH240 Vuelock (Anterior Cervical Plate) Vuelock (Anterior Cervical Plate) Level 1-4, 12mm - 92mm $1,040.00

OH241 Vuelock (Anterior Cervical Plate) Vuelock Bone Screws 12mm - 16mm $210.00

 Scient'x Australia

SX008 Antelys Plate H: 19-23mm $1,271.00

SX011 Stella Anterior cervical plate - titanium L: 21-121mm $1,550.00

 Stryker Australia Pty Ltd

ST917 Reflex Anterior Cervical Plate System Titanium, locking 1 Level size, 12 - 22mm $1,221.00 $1,350.00

ST918 Reflex Anterior Cervical Plate System Titanium, locking 2 Level size, 24 - 46mm $1,271.00 $1,350.00

ST919 Reflex Anterior Cervical Plate System Titanium, locking 3 Level size, 39 - 69mm $1,431.00 $1,500.00

ST920 Reflex Anterior Cervical Plate System Titanium, locking 4 Level size, 60 - 84mm $1,431.00 $1,500.00

 Surgical House

SU152 Intext Cervical Plate/Intext Screws Intext cervical plate, including (2-part)  Plates - width 13mm, height  $1,190.00

 fixation screws 4mm - 9mm  width 17mm,

 height 4mm - 9mm

 Synthes Australia Pty Ltd

SY134 Cervical Spine Locking Plate (CSLP)  Plate - Special Manuf. 22 - 92mm Length $788.00

Prostheses List by Category, Groups and Sponsor Page 203 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY139 Spinal Plate/Plate System AO/ASIF Spinal Anterior thoracolumbar plate - locking Length 57 - 103mm $3,168.00

  Implants

SY182 Cervical Spine Locking Plate (CSLP)  VA Plate Length 23 - 109mm $2,524.00

SY255 Ventrofix - MIS Double rod implant Monosegmental, bisegmental $4,900.00

SY290 Anterior Tension Band Plate 30mm to 110mm $2,833.00

SY301 TeleFix Spinal System Rod/Plate construct 40mm to 140mm in length $3,168.00

SY338 Vectra T Anterior Spinal System Titanium 14 to 110mm $1,700.00

 Taylor Bryant Pty Ltd

TB192 Blackstone Medical Inc Anterior Cervical  Titanium alloy plate 4.4mm Diameter x 14mm length $2,050.00

 Plate System

TB193 Blackstone Top Locking Plate Holds bone screws and anterior cervical  One size only $1,271.00

 plate in place

 TiMax Surgical Pty Ltd

TI068 CPS Bioabsorbable Fixation System Anterior Cervical Plate System:  19-60mm $1,271.00 $2,700.00

 PLCA/TMC Copolymer

TI069 CPS Bioabsorbable Fixation System Anterior Cervical Plate System:  62.5-110mm $1,550.00 $2,900.00

 PLCA/TMC Copolymer

 Zimmer

ZI489 Trinica Select Anterior Cervical Plate Titanium plate for anterior cervical spine.  Plates for 1 or 2 levels are from  $1,271.00 $1,667.00

 Used to assist spinal fusion.  Attached to  22 to 52mm long in 2mm

 the bone using screws. increments; Plates for 3 levels

 are from 51-72mm long in 3mm

ZI518 Trinica Anterior Lumbar Plate Lumbar Plate, Titanium 37-51mm lengths $3,840.00

ZI519 Trinica Anterior Lumbar Plate Sacral Plate, Titanium 33-51mm lengths $3,840.00

 Group 6b - Plate, No Integral Fixation

 B Braun Australia Pty Ltd

BB008 Spine System Evolution Cross Plate For 5.2 and 6mm rods, length  $349.00

 50 - 100mm

Prostheses List by Category, Groups and Sponsor Page 204 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP450 Kaneda SR (Smooth Rod)  Anterior  (TI) Plates Small/Large -  Caudal or Rostral $1,250.00

DP828 Profile Anterior Thoracolumbar Plate  Plates - Thoracolumbar 50 - 120mm $3,250.00

DP829 Profile Anterior Thoracolumbar Plate  Plates - High Thoracic 40 - 110mm  $3,510.00

DY042 TiMX Low Back System VSP Bone Plate One/One &  $1,700.00

 1/2/Shortened/Double

DY044 TiMX Low Back System VSP Bone Plate Two/Two & 1/2/Three Slot $1,859.00

DY174 Monarch Spinal System Bone Plate ½ to 1½ or 2 - 3 or 3½ $1,833.00

DY332 Summit Cervical Rod System Occipital Plates "Y" or "T" 31-45mm $1,717.00

 Medtronic Australasia Pty Ltd

MC293 Vertex Spinal System Occipital Plate 24 - 40 mm length $2,844.00

MC299 TiMesh TiMesh LP Open Door (OD) Plate $570.00

MC308 TiMesh TiMesh LP Open Door Graft (GP) Plate $320.00

MC309 TiMesh TiMesh LP French Door (FD) Plate $315.00

MC432 Colorado Spinal System Sacral Plate  Left/right $1,487.00

MC433 Colorado Spinal System Ilio-Sacral Plate Left/right $725.00

MC464 Z Plate II Plate 4cm $3,510.00

MC465 Z Plate II Plate 5cm $3,510.00

MC466 Z Plate II Plate 6cm $3,510.00

MC467 Z Plate II Plate 7cm $3,510.00

MC468 Z Plate II Plate 8cm $3,510.00

MC469 Z Plate II Plate 9cm $3,510.00

MC470 Z Plate II Plate 10cm $3,510.00

MC471 Z Plate II Plate 11cm $3,510.00

MC472 Z Plate II Plate 12cm $3,510.00

MC473 Z Plate II Plate 13cm $3,510.00

Prostheses List by Category, Groups and Sponsor Page 205 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC478 Axis Cervical Plating System Plate 11mm $818.00

MC479 Axis Cervical Plating System Plate 13mm $930.00

MC480 Axis Cervical Plating System Plate 15mm $1,044.00

MC481 Axis Cervical Plating System Plate Longer than 15mm $1,166.00

MC484 Orion Anterior Cervical System Convergent or Divergent Plates 21.5 - 47.5mm $1,334.00

MC485 Orion Anterior Cervical System Convergent or Divergent Plates 50 - 60mm $1,450.00

MC486 Orion Anterior Cervical System Convergent or Divergent Plates 62.5 - 77.5mm $1,566.00

MC487 Orion Anterior Cervical System Convergent or Divergent Plates 80 - 95mm $1,653.00

MC488 Orion Anterior Cervical System Convergent or Divergent Plates 100 - 110mm $1,740.00

MC655 Xantus Xantus Plate 40mm -100mm length in 4mm  $2,675.00

 increments

MC661 Pyramid Pyramid Plate 17mm - 35mm $2,675.00

 Stryker Australia Pty Ltd (2)

SK226 Oasys-Occipito Cervico Thoracic System Ti-6A1-4V Occiput Plate; One level Plate;  $1,545.00 $1,585.00

 Two level Plate; Multi level Plate

 Synthes Australia Pty Ltd

SY136 Posterior Cervical Plate System Plate 2 - 20 holes $1,067.00

SY183 Posterior Cervical Plate System Plate 22-33 holes $1,840.00

SY296 Vectra Anterior Spinal System Cervical Plate 10mm to 110mm $1,700.00

SY335 Arch Fixation System Pre contoured mini titanium plates 4 to 16mm $1,000.00

SY364 Cervical Spine Locking Plate (CSLP)  Eepansion Head Screw Dia 3.5 - 4.5mm, Length 12 -  $298.00

SY365 Cervical Spine Locking Plate (CSLP)  VA Plate Length 23 - 109mm $2,524.00

 Taylor Bryant Pty Ltd

TB276 Blackstone - Posterior Cervical System Occipital Anchor 31, 37, 45, 50mm $918.00

Prostheses List by Category, Groups and Sponsor Page 206 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 7 - Fixation: Rod

 Group 7a - Rod, Standard

 B Braun Australia Pty Ltd

BB010 Spine System Evolution Rod Dia 5.2 and 6mm , length 40 -  $283.00

 500mm

BB062 Socon Spinal System Socon Connecting Rods Length 40mm-200mm, Dia  $359.00

BB063 Socon Spinal System Socon Angled Rod Length 45mm-80mm,Dia 6mm $171.00

BB219 S4 Spinal System S4 Straight Rod - Titanium 35mm - 60mm $600.00

BB220 S4 Spinal System S4 Straight Rod - Titanium 70mm - 180mm $600.00

BB221 S4 Spinal System S4 Straight Rod - Titanium 200mm - 500mm $750.00

BB222 S4 Spinal System S4 Pre-bent Rod - Titanium 35mm - 55mm $700.00

BB223 S4 Spinal System S4 Pre-bent Rod - Titanium 60mm - 100mm $725.00

 De Puy Australia

DP315 Moss Miami (Stainless Steel) Pre-Cut Rod 5mm x 30 - 90mm $640.00

DP394 Moss Miami (Titanium) Pre-Cut Rod 5.5mm x 30 - 90mm $610.00

DP400 Moss Miami (Titanium) Rod - Standard 5.5mm x 12 - 48cm $720.00

DP452 Kaneda SR (Smooth Rod)  Anterior  (TI) Pre Cut Rod 1/4" x 45 - 150mm $315.00

DP461 Isola System (Titanium) Spinal Rod 1/4" & 3/16" x 18" & 24" $370.00

DP476 Isola System (Stainless Steel) Eye Rod 1/4" & 3/16" x 18" - 24" $1,040.00

DP477 Isola System (Stainless Steel) Spinal Rod Standard 1/4" & 3/16" x 18" & 24" $320.00

DP488 Isola Paediatric System (Stainless Steel) Pre-Bent Rod 3/16 " $565.00

DP846 Moss Miami 4mm Anterior System (SS) Rods 4.0mm x 30 - 48cm $805.00

DY182 Monarch Spinal System Rods 6.35 & 5.5mm x 450mm $350.00

DY310 Frontier Anterior Scoliosis System  Spinal Rod 4.75 x 200-450mm $920.00

DY313 Monarch Spinal System Rods - Pre Cut/Lordosed 6.35 & 5.5mm x 45 - 95mm $329.00

Prostheses List by Category, Groups and Sponsor Page 207 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY316 Isola System (Stainless Steel) Eye Rod Connector Open or Closed 1/4" & 3/16" $1,132.00

DY318 Isola System (Stainless Steel) Pre-Cut Rod 3/16" x 35 - 90mm $340.00

DY334 Summit Cervical Rod System Transition Rod 3.0/4.0/3.0mm $600.00

DY335 Summit Cervical Rod System Dual Diameter Rod 3x150mm/4.75 - 5.5mm x  $600.00

DY343 Summit Cervical Rod System Rod 3mm x 70-200mm $329.00

DY348 RECO Spinal System Rod 4 or 6mm dia x 70-130mm $220.00

DY349 RECO Spinal System Rod 4 or 6mm dia x 480mm Length $402.00

DY435 Expedium Spine System Rod 5.5mm diameter x 12-48cm $690.00

DY436 Expedium Spine System Rod - Prelordosed 5.5mm diameter x 35-95mm  $345.00

 Global Manufacturing Technology Pty Limited

GM033 Optimal Spinal System Rod 6 x 40 to 6 x 600mm $450.00

GM061 Maxima/Optima Anterior Cervical Plate  Rod 30mm - 100mm $450.00

 System

GM070 BacFix (Thoracolumbar System) Spinal rod, rigid/flex - Titanium alloy 5.5 - 6mm x 50 - 125mm $380.00

GM071 BacFix (Thoracolumbar System) Spinal rod, rigid/flex - Titanium alloy 5.5 - 6mm x 300 - 600mm $560.00

 Howmedica

HW389 Xia Spine System Rod - Titanium alloy 70 - 480mm $695.00

 LSS Surgical

LS004 Solas Spinal System Rod 40 - 400mm $430.00

 Medtronic Australasia Pty Ltd

MC382 Colorado Spinal System Colorado 2 Rod 5.0mm and 5.5mm, length range $444.00

  50 - 600mm

MC396 TSRH Spinal Implant System 3D - Rod Diam 4.75 - 6.35mm, Length  $419.00

 25mm - 80cm

MC404 CD Horizon Rod, Stainless Steel, Titanium 40mm to 600mm $419.00

MC440 CD Horizon Eclipse:  4.5mm Rod 40 - 600mm $414.00

MC497 Tenor Rod (5.5mm) - Titanium  40-180mm $388.00

Prostheses List by Category, Groups and Sponsor Page 208 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC544 Vertex Spinal System Rod 80 - 240mm $491.00

MC587 CD Horizon Spinal System Percutaneous Rod 5.5 x 25mm to 5.5 x 350mm $927.00

MC599 Equation Spinal System Rod Length 50-300mm $419.00

 Orthotech Pty Ltd

OH033 Synergy Spinal System Rods 5cm - 14cm $430.00

OH034 Synergy Spinal System Rods 30 - 60cm $673.00

OH187 OMEGA 21 Spine Fixation System Rods, Titanium 40mm, 60mm, 80mm $874.00

OH194 Array Spinal System Titanium Alloy Modular Spinal System -  5.5mm x 510mm $700.00

 Alloy rod

OH195 Array Spinal System Titanium Alloy Modular Spinal System -  5.5mm x 30 - 100mm $600.00

 Pre-Bent Rod

 Scient'x Australia

SX003 Isobar TTL Rod L: 45-450mm $419.00

SX015 Easys Connector Bar - titanium L: 40-100mm $660.00

 Stryker Australia Pty Ltd

ST695 Dimso/Stryker Implants Diapason Rods titanium 40-210mm $419.00 $695.00

 Stryker Australia Pty Ltd (2)

SK093 Xia Spine System Rod 4.5 - 6mm x 40mm -130mm $419.00 $750.00

SK311 Spiral Radius 90D Non Hex Rods; Spinal Rod with Hex;  Diameter 5.5mm Length 40- $350.00

 Spinal Rod with Sacral Eye - Titanium 120mm; Diameter 5.5mm

 Length 50-600mm; Diameter

 5.5mm Length 200-400mm

 Surgical House

SU002 Rod 3.5mm CVD Titanium alloy; component of the Olerud  120mm $419.00

 Cervical System

SU003 Rod 3.5mm CVD Titanium alloy; component of the Olerud  40mm $419.00

 Cervical System

SU004 Rod 3.5mm CVD Titanium alloy; component of the Olerud  80mm $419.00

 Cervical System

Prostheses List by Category, Groups and Sponsor Page 209 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SU083 Rod straight 40mm Hook/screw & rod Spinal system  3.5mm diam $419.00

SU084 Rod straight 80mm Hook/screw & rod spinal system  3.5mm diam $419.00

SU085 Rod straight 120mm Hook/screw & rod spinal system  3.5mm diam $419.00

SU086 U-Rod 40mm Hook/screw & rod spinal system  3.5mm diam $1,308.00

SU087 U-Rod 80mm Hook/screw & rod spinal system  3.5mm diam $1,547.00

SU088 U-Rod 120mm Hook/screw & rod spinal system  3.5mm diam $1,784.00

SU089 Occiput rod 120mm Hook/screw & rod spinal system  3.5mm diam $2,888.00

 Synthes Australia Pty Ltd

SY014 CerviFix Posterior Cervical System Rod: Occiput, Straight, Tapered 120 - 250mm length $1,440.00

SY143 Universal Spine System (USS) Rods Length 40 - 500mm $900.00

SY361 Universal Spine System (USS) Cross Link Rod 40 - 80mm Length $109.00

SY366 Axon Spinal System transverse bar one size only $571.00

 Taylor Bryant Pty Ltd

TB032 Advanced Spine - Titanium System Support Rod  5mm x12.0", 18.0", 22.0" $417.00

TB033 Advanced Spine - Titanium System Aluminium Master Rod  12", 22" $42.00

TB110 Support Rod 8inch Rod-Titanium 8 inch - Titanium $192.00

TB241 Spinal Fixation System Rod - Titanium 40mm to 100mm in 10mm  $260.00

 increments

TB242 Spinal Fixation System Rod - Titanium 110 to 450mm (110, 120, 140,  $310.00

 160, 180, 200, 450mm)

TB277 Blackstone - Posterior Cervical System Occipital Rod One size only $310.00

TB279 Blackstone - Posterior Cervical System Rods - Titanium 3.0mmx70, 120, 200mm $302.00

 Zimmer

ZI478 Silhouette Spinal System I Adjustable Transverse Connector Rod 1 size $160.00

ZI481 Silhouette Spinal System Implants Rod 5.5 dia x 10cm, 20cm and 47cm $400.00

  length

Prostheses List by Category, Groups and Sponsor Page 210 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 7b - Rod, Telescoping

 Orthotech Pty Ltd

OH058 Synergy Spinal System Growth Rod 30 - 60cm $1,345.00

 Group 7c - Rod, Threaded

 Medtronic Australasia Pty Ltd

MC295 Vertex Spinal System Pre - curved rod 150 - 300 mm length $697.00

 Surgical House

SU074 Olerud spinal system: Threaded rod  Hook/screw & rod spinal system  35mm - 180mm x 7mm $492.00

 Group 7d - Rod, Dual Unit

 De Puy Australia

DP485 Isola System (Stainless Steel) Dual Diameter Rod 3/16" to 1/4" x 18 - 24" $402.00 $420.00

DP494 Isola System (Stainless Steel) Spinal Rod Hex Ends - Easy/Premium 1/4" x 18" $635.00

DP505 Anterior Isola System (SS) Rod with Hex End 1/4" x 18" $325.00

DY105 Isola System (Titanium) Eye Rod 1/4" x 18" $1,049.00

 Medtronic Australasia Pty Ltd

MC505 Orfil L-Shaped Rods 5-510mm $392.00

MC537 Danek Unit Rod System Scoliosis Rods Widths 3/16", 5.5mm or  $1,427.00

 6.35mm; lengths 25 x 45cm

MC707 Danek Unit Rod System Scoliosis S-Rods Widths 5.5 - 6.35mm; left and  $1,427.00

 Surgical House

SU096 Hartshill: Ransford Occipito-cervical - titanium loop 100 degree 9mm-20mm $3,364.00

SU097 Hartshill: Ransford Extra long cross linked - titanium loop 100 degree 45cm x 15mm $5,826.00

SU098 Hartshill Rectangle Stainless steel posterior lumbar fusion  5mm diam 3-5cm length $804.00

SU099 Hartshill Rectangle Stainless steel posterior lumbar fusion  5mm diam  6-8cm length $1,027.00

Prostheses List by Category, Groups and Sponsor Page 211 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SU100 Hartshill Rectangle Stainless steel posterior lumbar fusion  5mm diam  9-11cm length $1,239.00

SU101 Hartshill Rectangle Stainless steel posterior lumbar fusion  5mm diam  12-14cm length $1,471.00

SU102 Hartshill Rectangle Stainless steel posterior  6mm diam 15-19cm length $1,972.00

 thoracic/thoracolumbar fusion system

SU103 Hartshill Rectangle Stainless steel posterior  6mm diam 20-24cm length $2,316.00

 thoracic/thoracolumbar fusion system

SU104 Hartshill Rectangle Stainless steel posterior  6mm diam 25-30cm length $2,700.00

 thoracic/thoracolumbar fusion system

SU105 Hartshill Rectangle Stainless steel posterior  6mm diam  31-36cm length $2,980.00

 thoracic/thoracolumbar fusion system

SU106 Hartshill Rectangle Stainless steel posterior  6mm diam 37-44cm length $3,473.00

 thoracic/thoracolumbar fusion system

Group 8 - Fixation: Plate-Rod

 Group 8 - Plate-Rod

 Medtronic Australasia Pty Ltd

MC509 CD Occipital-Cervical  Loop CD Occipital-Cervical  Loop One size only $3,206.00

MC543 Vertex Spinal System Plate/rod 80 - 240mm $2,960.00

 Stryker Australia Pty Ltd (3)

SR038 Techtonix Plate, titanium 22mm-58mm $1,770.00

 Synthes Australia Pty Ltd

SY184 Posterior Cervical Plate System Plate - rod Special Manufacture - One size  $3,579.00

Group 9 - Fixation: Washer/Staple

 De Puy Australia

DP416 Moss Miami (Titanium) Washers - Slotted / Angled One Size Only $408.00

DP502 Anterior Isola System (SS) Single Hole Washer and Staples 16-22mm $325.00

Prostheses List by Category, Groups and Sponsor Page 212 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP581 Kaneda Anterior Scoliosis System  S/S Staple Single or Double Hole Small - Large $762.00

DY057 TiMX Low Back System Washers - Standard / Tapered 3mm & 4.5mm $75.00

DY176 Monarch Spinal System Washers and Set Screws One size only $79.00 $83.00

DY327 Frontier Anterior Scoliosis System Staple/Washer One size only $762.00

 Global Manufacturing Technology Pty Limited

GM067 BacFix (Thoracolumbar System) Anterior washer - Titanium alloy Small, standard $244.00

 Stryker Australia Pty Ltd (2)

SK242 Xia Spinal System Titanium or Stainless Steel Single Hole Staple; Dual Hole  $408.00 $420.00

 Staples (Caudal/Rostral) - Small,

  Medium, Large

 Synthes Australia Pty Ltd

SY150 Universal Spine System (USS) Washers Pointed, Flat, 4.2 - 7mm $431.00

 Group 9 - Washer / Staple

 De Puy Australia

DY456 Expedium Spine System Washers Various $408.00

 Howmedica

HW392 Xia Spine System Sacral Block One size only $1,119.00

 Medtronic Australasia Pty Ltd

MC395 TSRH Spinal Implant System 3D -Staple, Two hole - left, right Two pronged 16 - 36mm $408.00

MC405 TSRH Spinal Implant System 3D - Washer One size only $408.00

MC412 Cornerstone SRC Cage Staple, Carbon composite $408.00

MC430 Dynalok Washer / Stabiliser One size only $224.00

MC431 Colorado Spinal System Staple One size only $408.00

MC437 CD-Horizon Staples One size only $408.00

MC477 Z Plate II Slot Washer One size only $224.00

MC491 TSRH Titanium Spinal Implant System: Washer One size only $44.00

Prostheses List by Category, Groups and Sponsor Page 213 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC592 CD Horizon System SMA Staple Length 4-10mm $1,374.00

MC593 CD Horizon System SMA Staple Length 12-18mm $1,772.00

MC614 Z Plate System Vantage Plates and Screws; Staple  One Size Only $1,112.00

 (rostral/caudal)

MC672 Engage Washer 6.35mm $224.00

 Orthotech Pty Ltd

OH046 Synergy Spinal System Washers Single/Double 16mm - 21mm $1,040.00

OH184 Spinelink Spinal Fixation System Space Washer, Titanium One size only $374.00

 Taylor Bryant Pty Ltd

TB030 Advanced Spine - Titanium System C-Spacer (various lengths) Titanium 5/0mm x 5/0mm to 7/5mm x  $107.00

TB112 Varilift System  Sleeve nut One size only $93.00

TB267 Blackstone - Fixed System Washer Titanium One Size Only $83.00

TB268 Blackstone - Washer Titanium 2/4/6mm $73.00

TB271 Blackstone - Staple Titanium 2/4/6mm $140.00

Guides, Other

 Global Scientific Pty Ltd

GS194 Electa right angle guide Silicone One Size Only $200.00

Incision and Drainage Kits

 Global Scientific Pty Ltd

GS207 Ventricular Catheter Silicone, with and without right angle  3-15cm, finned, straight and  $310.00

 connectors right angle

Prostheses List by Category, Groups and Sponsor Page 214 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Infusion Pumps

 Medtronic Australasia Pty Ltd

MC313 Synchro Med II Pump Model No's 8637-20 & 8637-40,  20 ml & 40 ml $16,250.00

 Composition - Titanium

Infusion Pumps, Implantable

 Medtronic Australasia Pty Ltd

MC061 Medtronic IsoMed Drug Infusion Pump. Models 8472-20-03, 8472-20-05, 8472- 20ml, 35ml $9,300.00

 20-10, 8472-20-15. Models 8472-35-05,

 8472-35-10, 8472-035-15.  Titanium

MC063 Medtronic IsoMed Drug Infusion Pump Models 8472-60-10, 8472-60-20,  8472- 60 ml $9,750.00

 60-05, 8472-60-25,  8472-60-30, l 8472-

 60-35, 8472-60-15, l 8472-60-40 titanium

Intrathecal Catheter Proximal Revision Kit

 Medtronic Australasia Pty Ltd

MC717 Intrathecal Catheter Proximal Revision Kit Model 8596  Length 66.0cm $500.00

 Radiopaque silicone rubber

MC718 Intrathecal Catheter Distal Revision Kit Model 8598  Length 38.1cm $500.00

 Radiopaque silicone rubber

Prostheses List by Category, Groups and Sponsor Page 215 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Leads

 Medtronic Australasia Pty Ltd

MC077 Medtronic quadripolar itrel II- 7424DBS  DBS Unilateral: Extension kit for Deep  10-66 cm $1,745.00

 Active implantable stimulators & ancillary Brain Stimulation Model 7495-51,PTFE,

  equipment sterile polyurethane,platinum,iridium, nickel alloy

MC305 Low Profile Impedance Extension Kit for  Silicone Rubber 25, 40, 51, 66, 95cm $2,100.00

 DBS Model 7482

MC350 Pisces Z Quad Lead Model 3890 Material - Polyurethane (lead body),  Lead length: 28-56cm; Electrode $3,650.00

 platinum-iridium (electrodes)  length: 3mm; Electrode spacing:

  6mm

MC361 2X4 Hinged Surgical Lead model 3999 Materials: silicone rubber, platinum- 30, 45 & 60cm $4,305.00

 iridium, polyurethane

MC369 Pisces Z Quad Compact Lead Model  Material - Polyurethane (lead body),  Lead length: 25-56cm; Electrode $3,650.00

 platinum-iridium (electrodes)  length: 3mm; Electrode spacing:

  4mm

Leads, Dorsal Column, Implantable

 Medtronic Australasia Pty Ltd

MC102 Medtronic Single Octad Lead Kit Model 3898. Materials -Silicone Rubber,  33cm $4,230.00 When used in pain therapy - to

 Platinum/Iridium be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

Prostheses List by Category, Groups and Sponsor Page 216 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC104 Medtronic Pisces Quad Leads Medtronic Pisces Quad Lead Model  28 - 56cm $3,400.00 When used in pain therapy - to

 3487A, 3487A-56; Pisces Quad Compact  be funded when the patient has

 Lead Model 3887; Pisces Quad Plus Lead undergone a multi-disciplinary

  Model 3888; Resume II Lead Model  assessment and trial of

 3587A, Resume TL Lead Model 3986A;

 On Point In Line Model 3987A. Materials

 - silicone rubber, platinum/iridium. Model

 3887 - quadripolar percutaneous lead with

  4 closely spaced electrodes at the distal

 end design for delivering stimulation.

MC135 Medtronic Australasia, Specify Lead  DCI - Leads: Specify Lead Model 3998.  18cm x 1 $4,150.00 When used in pain therapy - to

 Model 3998, Active Implantable  (dual lead) Materials - Silicone Rubber,  be funded when the patient has

 Stimulators & Ancillary Equipment Platinum/Iridium undergone a multi-disciplinary

 assessment and trial of

Mesh

 Johnson & Johnson Medical Pty Ltd

JJ265 ETHISORB Dura Patch Synthetic Dura substitute, Vicryl fleece,  4 x 6cm $133.00

 PDS foil, replaces natural dura post

 craniotomy, 3 units

JJ266 ETHISORB Dura Patch Synthetic Dura substitute, Vicryl fleece,  6 x 14cm $212.00

 PDS foil, replaces natural dura post

 craniotomy, 1 unit

JJ267 ETHISORB Dura Patch Synthetic Dura substitute, Vicryl fleece,  2 x 3cm $62.44

 PDS foil, replaces natural dura post

 craniotomy, 1 unit

JJ268 ETHISORB Dura Patch Synthetic Dura substitute, Vicryl fleece,  2 x 3cm $50.54

 PDS foil, replaces natural dura post

 craniotomy, 6 units

JJ269 ETHISORB Dura Patch Synthetic Dura substitute, Vicryl fleece,  4 x 6cm $145.00

 PDS foil, replaces natural dura post

 craniotomy, 1 unit

Prostheses List by Category, Groups and Sponsor Page 217 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Mesh, Metallic

 Johnson & Johnson Medical Pty Ltd

JJ255 BIOPLATE Biomesh Titanium, lattice, 48 hole, packaged non- 32 x 44mm $670.00

 sterile

JJ256 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.4mm thickness, 60 x 60mm $782.00

 sterile

JJ257 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.4mm thickness, 85 x 90mm $915.00

 sterile

JJ258 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 65 x 65mm, 90 x 92mm $915.00

 sterile

JJ259 BIOPLATE Biomesh Titanium cranial biomesh, packaged non- 0.4mm and 0.6mm thickness $1,620.00

 sterile

JJ260 BIOPLATE Biomesh Titanium cranial biomesh 3ME, packaged  20 x 20cm $3,455.00

 non-sterile

JJ441 Titanium Mesh 15cm x 15cm $420.00

Mesh, Polyglycolic Acid

 Biomet Australia Pty Ltd

BI883 RapidFLAP LS Cranial Flap Fixation.  Includes pre- One size only $185.00

 attached applier. PGA/PLA

Orthopedic Internal Fixation Systems, Other

 Biomet Australia Pty Ltd

BI716 W Lorenz Osteosynthesis System Pre-Contoured Neuro Mesh; Titanium (80,85) x 53mm x (0.3,0.6)mm $1,315.00

BI717 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 1.5mm system, large $203.00

Prostheses List by Category, Groups and Sponsor Page 218 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI718 W Lorenz Osteosynthesis System Neuro Gap Plate, Titanium 1.5mm system, small $140.00

BI719 W Lorenz Osteosynthesis System Neuro Sub-Temporal Plate, Titanium 1.5mm system, large $410.00

BI720 W.Lorenz Osteosynthesis System Neuro Gap Plate; titanium 1.5 mm system, Medium $170.00

BI721 W Lorenz Osteosynthesis System Plate, Burr Hole, 1.5mm System,  22mm, 25mm $225.00

BI722 W.Lorenz Osteosythesis System Pre-contoured Neuro Mesh, titanium 152 x 108 x (0.3, 0.6)mm $2,370.00

BI728 W.Lorenz Osteosynthesis System Neuro Square Plate, titanium 1.5mm system, 4 hole $125.00

BI729 W.Lorenz Osteosynthesis System Neuro Rectangle Plate, titanium 1.5mm system, 4 hole $140.00

BI773 W Lorenz Osteosynthesis System Neuro sub-temporal plate, 1.5 system,  Small $283.00

 titanium

BI785 W Lorenz Osteosynthesis Mesh 1.5mm system, pre-contoured,  40 x 40 x 0.6mm profile $588.00

Orthopedic Internal Fixation Systems, Spinal

 Zimmer

ZI476 Silhouette Spinal System Implants Fixed Screw with Tab Extensions 5.5 x 25mm to 8.5 x 60mm $710.00

Plates, Bone

 Australian Surgical Design & Manufacture Pty Ltd

AE053 ASDM Bone Plates Custom Skull Mesh Plate, Titanium One size only $8,500.00

AE054 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Small, Single square plate 2x2  $178.00

 holes, T-shape, 90 deg, 5 holes

AE055 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Medium, Double square plate,  $225.00

 3x2 holes; Double Y-shape, 6 or

  7 holes; Y-shape, 6 hole;

 Double T-shape, 9 hole;T-

 shape, 90 deg, 7 holes;L-shape,

 right or left, 5 hole;Straight

Prostheses List by Category, Groups and Sponsor Page 219 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AE056 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Large, Triple square plate, 4x2  $367.00

 holes;Curved plate, 8

 hole;Straight plate, 24 hole;L-

 shape plate, right or left, 8 holes

AE057 ASDM Bone Plates Titanium 1.7mm MF Bone Plate,  Small, Straight plate, 6-8mm, 4  $153.00

 hole;L-Shape, right or left,

 6mm, 4 hole;Curved plate,

AE058 ASDM Bone Plates Tiranium 1.7mm MF Bone Plate,  Medium, L-Shape, right or left,  $225.00

 8mm, 4 hole;Y-Shape, 8mm, 5

 hole;T-Shape, 10mm, 5 hole;L-

 shape, right or left, 10-12mm,

 4-5 holes;Straight Plate, 8

 hole;Double Y-Shape, 6-7

 holes;Curved plate, 6-8

 holes;Single square plate, 2x2

AE059 ASDM Bone Plates Titanium 1.7mm MF Bone Plate,  Large, Triple square plate, 4x2  $459.00

 holes;Straight plate, 16 hole

AE060 ASDM Bone Plates Titanium 2.0mm MF Bone Plate,  Small, Straight plate, 9-13mm, 4 $102.00

  holes;Staright plate, 4 holes;L-

 shape, right or left, 4 holes

AE061 ASDM Bone Plates Titanium 2.0mm MF Bone Plate,  Medium, Y-Shape, 8  $158.00 $204.00

 hole;Double Y-Shape, 6 hole;L-

 Shape, right or left, 5 holes;L-

 Shape, right or left, 9-13mm, 4

 holes;Straight Plate, 6

AE062 ASDM Bone Plates Titanium 2.0mm MF Bone Plate,  Large, Double square plate, 3x2  $204.00

 holes;Curved plate, 10

 hole;Straight plate, 16 hole;L-

 shape plate, right or left, 9 holes

AE063 ASDM Bone Plates Titanium 2.2mm MF Bone Plate,  Small, Straight plate, 8-14mm, 4 $153.00

  holes;Curved plate, 11mm, 4

AE064 ASDM Bone Plates Titanium 2.2mm MF Bone Plate,  Medium, Straight plate, 8- $204.00

 14mm, 6 holes

Prostheses List by Category, Groups and Sponsor Page 220 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AE065 ASDM Bone Plates Titanium 2.2mm MF Bone Plate,  Large, Straight plate, 11mm, 8  $255.00

 holes;Straight plate, 14

 holes;Angled plate, 6 holes

 Johnson & Johnson Medical Pty Ltd

JJ270 BIOPLATE Bone plate Titanium straight plate, 2 hole, 5 per  12mm in length $43.00

 pack, packaged non-sterile

JJ271 BIOPLATE Bone plate Titanium Y plate, 5 hole, packaged non- 19mm $157.00

JJ272 BIOPLATE Bone plate Titanium T-plate, 5 hole, packaged non- 16mm $165.00

JJ273 BIOPLATE Bone plate Titanium boxcar plate, 6 hole, packaged  9 x 18mm $231.00

 non-sterile

JJ274 BIOPLATE Bone plate Titanium boxcar plate, 8 hole, packaged  11 x 25mm $287.00

 non-sterile

JJ275 BIOPLATE Bone plate Titanium cranial straight plate, 2 hole,  1.9mm $47.00

 packaged non-sterile

JJ276 BIOPLATE Bone plate Titanium curved plate, 8 hole, packaged  30mm $151.00

 non-sterile

JJ277 BIOPLATE Bone plate Titanium straight plate, 2 hole, packaged  11mm in length $46.00

 non-sterile

JJ278 BIOPLATE Bone plate Titanium cranial straight plate, 16 hole,  1.5mm and 1.9mm $280.00

 packaged non-sterile

JJ279 BIOPLATE Bone plate Titanium cranial compression plate, 2  1.5mm and 1.9mm $45.00

 hole, 3 per pack, packaged non-sterile

JJ280 BIOPLATE Bone plate Titanium large boxcar plate, 4 hole,  14 x 14mm $157.00

 packaged non-sterile

JJ281 BIOPLATE Bone plate Titanium BIO100, 2 hole plate, 5 per  1.5mm $26.00

 pack, packaged non-sterile

JJ282 BIOPLATE Bone plate Titanium straight plate, 2 hole, 3 per  14mm in length $41.00

 pack, packaged non-sterile

JJ283 BIOPLATE Bone plate Titanium straight plate, 2 hole, packaged  14mm in length $47.00

 non-sterile

JJ535 BIOPLATE Low Profile Low Profile 2-hole Straight Plate 11mm $43.00

Prostheses List by Category, Groups and Sponsor Page 221 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ536 BIOPLATE Low Profile Low Profile 2-hole Straight Plate 14mm $45.00

JJ537 BIOPLATE Low Profile Low Profile 4-hole Straight Plate 19mm $107.00

JJ538 BIOPLATE Low Profile Low Profile 5-hole Y Plate 18mm $156.00

JJ539 BIOPLATE Low Profile Low Profile 6-hole X Plate 17mm $255.00

JJ540 BIOPLATE Low Profile Low Profile 5-hole T Plate 15mm $170.00

JJ541 BIOPLATE Low Profile Low Profile 4-hole Boxcar Plate 10 x 10mm $195.00

JJ542 BIOPLATE Low Profile Low Profile 6-hole Narrow Boxcar Plate 8 x 17mm $231.00

JJ543 BIOPLATE Low Profile Low Profile 8-hole Boxcar Plate 10 x 24mm $281.00

JJ544 BIOPLATE Low Profile Low Profile Flex Contoured Burr Hole  18mm $182.00

JJ545 BIOPLATE Low Profile Low Profile Flex Contoured Burr Hole  12mm $178.00

JJ546 BIOPLATE Low Profile Low Profile Burr Hole Cover 18mm $195.00

JJ547 BIOPLATE Low Profile Low Profile Burr Hole Cover 12mm $169.00

Plates, Cranioplasty

 Biomet Australia Pty Ltd

BI714 RapidFlap Cranial Clamp Clamp, Burr Hole or Craniotomy Line,  12, 16, 20mm $108.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 222 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Plugs

 Medtronic Australasia Pty Ltd

MC086 Accessory Kits - Stimulator; EZ Anchor;  3550-09 - Synergy accessory kit OR  One size only $168.00 When used in pain therapy - to

 Tunnelling Rod; Percutaneous Lead  3550-01 - Boots & anchors OR 3550-02  be funded when the patient has

 Introducer; SCS & PNS Model 3550-24;  - Wrenches & screws OR 3550-03,  undergone a multi-disciplinary

 DBS Model 3550-25; 3550-0SCO - Screening cable OR 3550- assessment and trial of

 04 - Epidural needle OR 3550-05 -

 Percutaneous extension OR 3550-06 -

 Tunnelling tools; 3550-16 - Silicone

 rubber anchors; 3555 - Tunneling Rod;

 3550-12 - Coil guide wire & Introducer

 sheaths; Silcone rubber;

Prostheses, Meningeal

 B Braun Australia Pty Ltd

BB015 Neuro-Patch Polyesterurethane 12 x 14cm $655.00

BB113 Neuropatch Dura Substitute Polyurethane 6 x 14cm $352.00

BB114 Neuropatch Dura Substitute Polyurethane 6 x 8cm $291.00

BB115 Neuropatch Dura Substitute Polyurethane 4 x 10cm $257.00

BB116 Neuropatch Dura Substitute Polyurethane 4 x 5cm $240.00

BB117 Neuropatch Dura Substitute Polyurethane 2 x 10cm $254.00

BB118 Neuropatch Dura Substitute Polyurethane 1.5 x 3cm $72.00

Prosthesis, Internal, Embolisation, Intravascular

 ev3 Australia Pty Ltd

EE009 NXT Detachable Coils NXT Coils, Tetris Diameter 3 -18mm/ Length 4-29 $2,600.00

Prostheses List by Category, Groups and Sponsor Page 223 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EE010 NXT Detachable Coils NXT Coils, Multi Diameter Diameter 4-8mm/ length 10-30cm $2,266.00

EE011 NXT Detachable Coils NXT Coils, Helix and Soft Diameter 2-6mm/ Length 1- $1,850.00

EE012 NXT Detachable Coils NXT Coils, Helix Fibered Diameter 2-4mm/ Length 2- $1,850.00

EE013 NXT Detachable Coils NXT Coils, TensionSafe (SuperSoft) Diameter 2-5mm/ Length 1- $1,850.00

EE014 NXT Detachable Coils NXT Coils, Fibered Cyclone Diameter 2/3, 2/4, 2/5, 2/6mm  $1,850.00

 Length 2.2, 4.2, 6.0, 8.5cm.

Prosthesis, Internal, Stent, Vascular

 Boston Scientific Pty Ltd

BS098 Neuroform Microdelivery Stent System Self-expanding nitinol stent, 3F delivery  diameter 3.0 - 4.5 mm $7,500.00

 catheter, peelable sheath, 2F stabilising  Length 15 mm - 30 mm

 catheter, rotating haemostasis valve (x2)

Reservoirs, Cerebrospinal Fluid

 B Braun Australia Pty Ltd

BB081 Shunt Accessories Reservoir Small, large $450.00

 CWL Medical Enterprises Pty Ltd

CW011 Reservoirs Shunt component 9mm to 25mm, with or without  $512.00

 convertible outlet port, burr hole

  or flat bottom style

 Global Scientific Pty Ltd

GS008 Heyer-Schulte Braden Flushing Reservoir - One size only $347.00

GS011 LPV Shunt System Standard, mini, Pressure range low - high $1,405.00

GS012 Heyer-Schulte Ommaya CSF Reservoir Standard, side-inlet, convertible, mini 1.5 - 2.5cm and mini $717.00

GS016 Heyer-Schulte Foltz Flushing Reservoir - One size only $605.00

Prostheses List by Category, Groups and Sponsor Page 224 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC534 Pressure valve (anti-siphon device or   Neonatal Reservior, CSF Lumbo  2 - 90cm $720.00

 flushing valve or flush pump)

MC535 Pressure valve (anti-siphon device or   Reservoir, CSF Vent Reservoir, Snap  6 - 90mm $1,790.00

 flushing valve or flush pump) Assembly Reservoir

Resinous Compounds, Cranial

 Johnson & Johnson Medical Pty Ltd

JJ303 Cranioplastic Kit (Type 1) Cranioplastic kit containing 2 complete  30grams $240.00

 sets.  Consists of 2 bags of sterile

 powder, 2 vials sterile liquid, 2 sterile

Screws, Bone

 Johnson & Johnson Medical Pty Ltd

JJ244 BIOPLATE Bone screw Titanium alloy self-drilling screws, 5 per  Dia 1.9mm, length 5mm $43.00

 pack, packaged non-sterile

JJ245 BIOPLATE Bone screw Titanium alloy self-drilling screws, 5 per  Dia 1.9mm, length 4mm $43.00

 pack, packaged non-sterile

JJ246 BIOPLATE Bone screw Titanium alloy self-drilling screw, 1 per  Dia 1.9mm, length 3 - 5mm $52.00

 pack, packaged non-sterile

JJ247 BIOPLATE Bone screw Titanium alloy self-drilling screw,  Dia 1.9mm, length 3mm $43.00

 packaged non-sterile

JJ248 BIOPLATE Bone screw Titanium alloy self-drilling screw, 5 per  Dia 1.5mm, length 3 - 5mm $45.00

 pack, packaged non-sterile

JJ249 BIOPLATE Bone screw Titanium alloy self-drilling screw, 1 per  Dia 1.5mm, length 3 - 5mm $52.00

 pack, packaged non-sterile

JJ250 BIOPLATE Bone screw Titanium alloy long screw, 1 per pack,  Dia 1.9mm, length 3, 4, 5, 6, 8,  $44.00

 packaged non-sterile 10mm

Prostheses List by Category, Groups and Sponsor Page 225 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ251 BIOPLATE Bone screw Titanium alloy long screws, 5 per pack,  Dia 1.9mm, length 3, 4, 5, 6, 8,  $36.00

 packaged non-sterile 10mm

JJ252 BIOPLATE Bone screw Titanium alloy long screw, 1 per pack,  Dia 1.5mm, length 3, 4, 5, 6, 8,  $44.00

 packaged non-sterile 10mm

JJ253 BIOPLATE Bone screw Titanium alloy emergency screws, 5 per  Dia 1.8, length 6mm; Dia  $66.00

 pack, packaged non-sterile 2.3mm, length 5mm

JJ254 BIOPLATE Bone screw Titanium alloy emergency screw, 1 per  Dia 1.8, length 6mm; Dia  $74.00

 pack, packaged non-sterile 2.3mm, length 5mm

Shunt Adapters

 B Braun Australia Pty Ltd

BB079 Shunt Accessories Deflector - Burrhole Small, large $180.00

BB080 Shunt Accessories Connector Straight, Y, T, X form $241.00

 Johnson & Johnson Medical Pty Ltd

JJ228 Codman Medos Connector Codman Medos stainless steel shunt  One size only $37.78

 connector straight

Shunts, Hydrocephalic

 CWL Medical Enterprises Pty Ltd

CW002 Neonatal Shunt System Shunt Assembly, includes separate  Medium, low or low-low  $1,335.00

 ventricular catheter, integral distal catheter

CW004 Equi Flow Valves Valve only Small (35mm length) or Regular $1,285.00

  (40mm length); low,

 low/medium and medium

CW005 Equi Flow Shunt Assemblies CSF Shunt, includes silicone ventricular  Small (35mm length) or Regular $1,690.00

 and peritoneal catheters, silicone encased   (40mm length); low,

 overdrainage control valve low/medium and medium

 pressure; various kit

Prostheses List by Category, Groups and Sponsor Page 226 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CW006 Lumboperitoneal Shunt Assemblies CSF LP Shunt includes: silicone catheter,  Straight or "T" tube $325.00

 stainless steel trocar, suture tabs

CW009 Burr Hole Valve Shunt Assemblies Shunt Assembly: silicone encased valve,  16mm or 12mm base; low,  $650.00

 silicone ventricular and peritoneal catheters medium or high pressure,

 various kit configurations

 Global Scientific Pty Ltd

GS002 Spetzler Lumbar-Peritoneal Shunt System Shunt, CSF Reservoir, In-line valve Catheter length 80 - 105cm,  $1,080.00

 Reservoir small & large, Valve

 pressure range low - high

GS006 Novus Hydrocephalic Shunt Kit Pressure range low, medium Standard, mini $2,155.00

GS007 Heyer-Schulte Spetzler Lumbar-Peritoneal - Small, large $425.00

  Low Pressure Flushing Reservoir

GS014 Edwards Barbaro Syringo Peritoneal Shunt 80 x 3.5cm 5FRT-Tube, 90cm peritoneal  One size only $1,445.00

 reflux control catheter

 Step down connector, Foltz CSF

GS142 Novus Hydrocephalic Shunt - Heyer  Novus valve made from  Standard size - low & medium  $1,624.00

 silicone/polysulfone, each valve is packed pressure; Mini size - low &

  with a valve and a right angled catheter  medium pressure

GS144 Spetzler In Line Valve - Heyer Schulte Composition silicone, valve with integral  Low, Medium, High Pressure $1,110.00

 connectors

GS145 Cordis Omnishunt System, Hakim Valve  Hakim Valve System Drainage Cath 110 cm, F7.  $1,030.00

 Series Vent. Cath 15cm, F8.

GS195 Cordis Omnishunt System Silicone and Synthetic ruby Very low to very high pressures $775.00

 Johnson & Johnson Medical Pty Ltd

JJ161 Codman-Medos Non-programmable  Silicone fixed pressure lumber/peritoneal  Peritoneal Catheter length 25- $375.00

 Valve System catheter, James design

JJ162 Codman-Medos Non-programmable  Silicone fixed pressure lumber/peritoneal  Peritoneal Catheter length 65 cm $870.00

 Valve System catheter, Holter design

JJ164 Siphonguard CSF Control Device PET shell anti-siphon device for shunt One size only $390.00

JJ218 HOLTER Intracranial Pressure Shunt HOLTER Ventricular Catheter, packaged  3 - 7cm and 15cm $149.00

 sterile, silicone rubber

Prostheses List by Category, Groups and Sponsor Page 227 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ225 HOLTER Intracranial Pressure Shunt HOLTER distal peritoneal catheter,  90cm in length $155.00

 packaged sterile, silicone

JJ226 HOLTER Intracranial Pressure Shunt HOLTER distal peritoneal catheter  90cm in length $247.00

 Salmon, packaged sterile, silicone

JJ261 ACCU-FLO Intracranial Pressure shunt ACCU-FLO catheter, packaged sterile,  91cm in length $197.00

 silicone rubber

JJ262 ACCU-FLO Intracranial Pressure shunt ACCU-FLO three way connector,  One size only $143.00

 packaged sterile, metal or plastic

JJ263 ACCU-FLO Intracranial Pressure shunt ACCU-FLO barium ventricular catheter,  One size only $154.00

 packaged sterile, silicone rubber

JJ264 ACCU-FLO Intracranial Pressure shunt ACCU-FLO right angle connector,  One size only $69.84

 packaged sterile, metal or plastic

 Medtronic Australasia Pty Ltd

MC531 Hydrocephalus Shunt Ventricular/Peritoneal. CSF Flow Control  12mm-90cm $893.00

 Valves, BioGlide Contoured,

 Ventriculostomy Kit-E, Neonatal Delta

 Snap Shunt

MC640 Strata Shunt, Unitised Adjustable CSF valve with five symmetric 8-13.5cm x 9-120cm $2,560.00

  performance level steps.  Includes strata

 valve, pre-attached ventricular catheter,

 and a pre-attached peritoneal catheter.

 Right Angle Clip. Disposable Quick

 Release Ventricular Catheter Introducer.

 Disposable Subcutaneous Catheter

 Passer. Tuohy-Borst Adapter.

MC649 Delta Shunt Unitised Delta valve is a fixed pressure CSF valve, Delta Unitised Shunt small  $1,725.00

  available in four performance levels.  (Distal 65cm-90cm, ventricular

 Delta Unitised shunt includes a delta  11cm) - 0.5, 1.0, 1.5 and 2.0.

 valve, pre-attached ventricular catheter,  Delta Unitised Shunt regular

 and a pre-attached peritoneal catheter.  (Distal 90cm, ventricular

 Right Angle Clip. Disposable Quick  catheter 13cm) - 0.5, 1.0, 1.5

 Release Ventricular Catheter Introducer.

Prostheses List by Category, Groups and Sponsor Page 228 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC650 Delta Shunt Assembly Delta valve is a fixed CSF pressure valve, 90-120cm (0.5 - 2.0) $1,560.00

  available in four performance levels.

 Includes an Integral (distal) Peritoneal

 Catheter, Disposable Peritoneal Catheter

 Passer, Female Luer Adapter and Prefill

MC652 Strata Shunt Assembly Adjustable CSF valve with five symmetric 90-120cm $2,406.00

  performance level steps. The assembly

 includes an Integrated (distal) Peritoneal

 Catheter. Disposable Peritoneal Catheter

 Passer. Female Luer Adapter and Prefill

 tubing.

Stimulator, Electrical, Analgesic, Spinal

 Advanced Neuromodulation Systems Australia Pty Ltd

AV022 Genesis RC Rechargeable IPG Genesis RC (IPG) Neurostimulation System 70mm $19,150.00

AV023 Genesis RC Rechargeable IPG Genesis RC Dual 4 (IPG)  76mm $19,150.00

 Neurostimulation System

AV024 Genesis RC Rechargeable IPG External Charging System $1,000.00

AV025 Eon Neurostimulation System Eon Neurostimulation Implantable Pulse  Height = 59mm $19,150.00

 Generator #3716

AV026 Eon Neurostimulation System Eon Programmer #3851 $2,831.00

 Medtronic Australasia Pty Ltd

MC312 Octapolar Extension Model 7471 Silicone rubber Lengths: 20, 40, 51, 66 cm $2,000.00

MC315 Low Profile Impedance Extension Kit for  Silicone rubber 10, 25, 40, 51, 66cm $2,138.05

 SCS Model 7489

MC688 Neurostimulation System - Extensions 1 x 8 Synergy Extension Kit Model 7472;  20, 40 & 60cm $1,948.00

 1 x 8 Extension Kit Model 37081

MC691 Restore Rechargeable Neurostimulation  Implantable Neurostimulator Model 37711 Dimensions: 65 x 49 x 15mm $21,000.00

 System

Prostheses List by Category, Groups and Sponsor Page 229 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC692 Restore Rechargeable Neurostimulation  External Patient Recharger System Model one size only $3,000.00

 System  37752

MC693 Restore Rechargeable Neurostimulation  External Patient Programmer Model  One size only $1,346.43

 System

MC694 Restore Rechargeable Neurostimulation  External Patient Programmer Antenna  One size only $171.92

 System Model 37092

Stimulators

 Advanced Neuromodulation Systems Australia Pty Ltd

AV008 ANS Spinal Cord Stimulation System  Transmitter Kit 16 Channel One size only $9,450.00 When used in pain therapy - to

 (SCS) RENEW be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV009 ANS Spinal Cord Stimulation System  Transmitter Kit 8 Channel One size only $6,783.00 When used in pain therapy - to

 (SCS) RENEW be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV017 ANS Spinal Cord Stimulation System  Implantable Pulse Generator - Genesis G4 One Size Only $9,450.00

 (SCS) GENESIS  Model 3604

AV018 ANS Spinal Cord Stimulation System  Implantable Pulse Generator - Genesis XP One Size Only $18,650.00

 (SCS) GENESIS  Model 3609

AV019 ANS Spinal Cord Stimulation System  Implantable Pulse Generator - Genesis XP One Size Only $18,650.00

 (SCS) GENESIS  Dual Model 3644

 Medtronic Australasia Pty Ltd

MC247 Patient Activators Hand held device Models 7434 & 7435 to One size only $1,400.00 When used in pain therapy - to

  be used with Itrel III and Synergy  be funded when the patient has

 Implantable Pulse Generators undergone a multi-disciplinary

 assessment and trial of

MC249 Access Therapy Controller Handheld device used with the Kinetra  One size only $1,400.00 To be funded for the initial

 and Soletra Implantable Pulse Generators implant only.

Prostheses List by Category, Groups and Sponsor Page 230 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stimulators, Electrical, Brain

 Medtronic Australasia Pty Ltd

MC244 Medtronic Australasia DBS Lead Model  Deep brain stimulation lead with four  28 - 40cm $4,150.00

 3389,  Medtronic quadripolar Itrel II-  platinum iridium electrodes Models 3387

 7424DBS, Active Implantable Stimulator  and 3389.  Electrode spacing is 1.5mm

 & Ancillary Equipment apart for Model 3387 and 0.5mm apart

 for Model 3389.  PTFE, polyurethane,

 platinum/iridium, nickel alloy, tungsten

Stimulators, Electroanalgesic, Dorsal Column

 Medtronic Australasia Pty Ltd

MC110 Itrel 3 System - Lead extension Medtronic Lead Extension Kit Models  10 - 66cm $1,510.00 When used in pain therapy - to

 7495,7496,7498 - Materials Silicone  be funded when the patient has

 rubber, Platinum/Iridium undergone a multi-disciplinary

 assessment and trial of

Stimulators, Electroanalgesic, Intracerebral/Subcortical

 Medtronic Australasia Pty Ltd

MC001 Kinetra Dual Channel Implantable Pulse  Titanium, polyurethane One size only $15,060.00

 Generator Model 7428

MC107 Mattrix Dual Channel System - Antenna  Model 3440 DCS Antenna kit. Medical  One size only $173.00 When used in pain therapy - to

 antenna. External component of  be funded when the patient has

 implantable Mattrix system. Polyurethane. undergone a multi-disciplinary

 assessment and trial of

MC141 Epidural Stimulator - Leads Verify Screening lead Model 3862, 3862- 45 - 60cm $485.00 When used in pain therapy - to

 45. Silicone, Platinum/Iridium be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

Prostheses List by Category, Groups and Sponsor Page 231 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stimulators, Electroanalgesic, Spinal Cord

 Advanced Neuromodulation Systems Australia Pty Ltd

AV004 ANS Spinal Cord Stimulation System  Dual Receiver 16 Channel (2 x 8 channel) One size only $12,450.00 When used in pain therapy - to

 (SCS) RENEW be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV006 ANS Spinal Cord Stimulation System  Single Receiver. 8 Channel (1 x 8)  One size only $9,450.00 When used in pain therapy - to

 (SCS) RENEW be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

AV014 ANS Spinal Cord Stimulation System  Implantable Pulse Generator - Genesis  One size only $17,450.00

 (SCS) GENESIS Model 3608

AV015 ANS Spinal Cord Stimulation System  Patient Programmer Model 3850 One size only $2,831.00 When used in pain therapy - to

 (SCS) GENESIS be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of stimulation

AV016 ANS Spinal Cord Stimulation System  Communication Magnet Model 1210 One type only $150.00 When used in pain therapy - to

 (SCS) GENESIS be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of stimulation

AV020 ANS Spinal Cord Stimulation System  QuikLink Patient Programmer Model  One Size Only $1,250.00

 (SCS) GENESIS

 Medtronic Australasia Pty Ltd

MC115 Itrel 3 Implantable Pulse Generator Model 7425, Titanium One size only $9,350.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

MC137 Medtronic A/Asia, Synergy Dual Channel  DCI - Pulse Generator: Synergy Dual  One size only $17,250.00 When used in pain therapy - to

 Implantable Pulse Generator Model 7427,  Channel Implantable Pulse Generator  be funded when the patient has

 Active Implantable Stimulators. Model 7427. Materials - Titanium  undergone a multi-disciplinary

 assessment and trial of

Prostheses List by Category, Groups and Sponsor Page 232 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC687 Neurostimulation System - Accessory  Lead Accessory Plug and Closed Boot Kit $165.30

  Model 3550-29

Stimulators, Neuromuscular, Functional

 Medtronic Australasia Pty Ltd

MC079 Control Magnets Model 7452 Magnet One size only $120.00 When used in pain therapy - to

 be funded when the patient has

 undergone a multi-disciplinary

 assessment and trial of

Stimulators, Neuromuscular, Therapeutic

 Medtronic Australasia Pty Ltd

MC228 Soletra Model 7426 Neurostimulator Sterility - Ethylene Oxide.   One size only $9,050.00

 Neurostimualtor comprised of electronic

 circuitry and a battery, which are

 hermatically sealed in a titanium case

Stimulators, Vagus Nerve, Antiseizure

 Taylor Bryant Pty Ltd

TB300 VNS Therapy Pulse/Pulse Duo Model 102/102R Generator one size only $12,670.00

TB301 VNS Therapy Lead Model 302 one size only $3,400.00

Tissue Reconstructive Materials, Solid

 W L Gore & Associates

GT056 Preclude  Dura Substitute ePTFE 0.3mm Thickness 2 x 10cm $492.00

Prostheses List by Category, Groups and Sponsor Page 233 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT057 Preclude Dura Substitute ePTFE 0.3mm Thickness 5 x 6 cm $707.00

GT058 Preclude  Dura Substitute ePTFE 0.3mm thickness 6 x 10cm $1,335.00

GT059 Preclude Dura Substitute ePTFE 0.3mm thickness 10 x 12cm $2,372.00

Tubes, Connecting

 Global Scientific Pty Ltd

GS010 Heyer-Schulte Connectors for  Pudenz straight, Pudenz right angled,  Each in one size $143.00

 Neurosurgical Use Pudenz three-way (Y)

 Threaded straight, Threaded right angled,

 Double threaded straight

GS193 Connectors Silicone and Stainless Steel Straight, right angle, Y, T $396.00

Valves, Hydrocephalic

 B Braun Australia Pty Ltd

BB074 Pressure Valve Anti Siphon Device   Shunt  Assist Kit 15/11 to 35/25.7 pressure units $1,190.00

BB075 Hydrocephalus Shunt  Monostep Valve 5/3.6 to 16/11.0 pressure units $1,281.00

BB076 Hydrocephalus Shunt  Paedi-Gav. Valve 4/14 to 9/29 pressure units $1,776.00

BB077 Hydrocephalus Shunt  Dual Switch Valve 10/7.4 to 50/36.8 pressure units $2,406.00

 CWL Medical Enterprises Pty Ltd

CW001 Contour-Flex Valves Silicone encased CSF Valve Small (24mm length) or Regular $1,066.00

  (28mm length), low medium or

  high pressure

CW003 Contour Flex Valve Shunt Assemblies Shunt Assembly: silicone encased valve,  Small (24mm length) or Regular $1,335.00

 silicone ventricular and peritoneal catheters  (28mm length); low,

 low/medium and medium

 pressure; various catheter and

Prostheses List by Category, Groups and Sponsor Page 234 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

CW010 Siphon Limiting Device Silicone Shunt Accessory for control of  15mm length, 4.5mm height,  $577.00

 CSF overdrainage 10mm width

 Global Scientific Pty Ltd

GS003 Heyer-Schulte Pudenz Flushing Valve With Anti Siphon Device, Pressure range  12, 16mm $1,425.00

 low - high

GS004 Heyer-Schulte Pudenz Flushing Valve  Pressure range low - high 12, 16mm $780.00

 with Integral Conn

GS005 Heyer-Schulte Mishler Dual Chamber  Burr-hole and flat bottom designs Standard, mini $1,525.00

 Flushing Valve System Pressure range low - high

GS017 Heyer-Schulte In Line Valve System Ultra VS Cylindrical Shunt/Valve system - $893.00

  Neonate style, Pressure range low - high

GS018 Heyer-Schulte In Line Valve System Ultra VS Shunt Valve, Pressure low -  small, standard $893.00

GS137 Shunt Pressure valve (anti-siphon device or   Low - High pressure range $1,885.00

 flushing  valve or flush pump)

GS138 Shunt Reservoir Standard, Large $390.00

GS140 Heyer Schulte Ultra VS Valve Kit  Comprises of silicone, kit includes valve,  Peritoneal catheter 90cm,  $1,624.00

 Neonatal Style peritoneal cather, ventricular catheter and  ventricular catheter 18cm

 rickham style reservoir

GS141 Ultra VS Shunt Kit Standard - Heyer  Composition silicone, kits contain  3.8-5.8mm diameter valve,  $1,624.00

 standard valve, ventricular catheter,  18cm ventricular catheter, low,

 peritoneal catheter, rickham reservoir medium high pressure, 120cm

 peritoneal catheter

GS143 LPV Shunt System Kit - Heyer Schulte Composition silicone, kit includes LPV  Standard - low, medium, high  $1,435.00

 valve, peritoneal catheter, ventricular  pressure; Mini - low, medium,

 catheter, right angle catheter guide high pressure

GS146 Cordis Standard Valve System  Atlas Valve System Drainage Cath 110 cm, F7.  $1,190.00

 Hydrocephalus Valves Vent. Cath 15cm, F8.

GS147 Precision Flow-OSV II Valve System Lumbar peritoneal OSV11- Lumber Catheter 80cm, F5   $1,725.00

 Lumboperitoneal System Hydrocephalus  Peritoneal Catheter 110cm, F7

GS148 Precision Flow-OSV II Valve System  Ventricular/Atrial OSV11-Ventricular  Drainage Cath 110 cm, F7.  $1,725.00

 /Atrial Hydrocephalus Shunt Ventricular Catheters 7,9,13 &

 15 cm

Prostheses List by Category, Groups and Sponsor Page 235 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GS149 Precision Flow-OSV II Valve System Ventricular/Peritoneal OSV11-   Drainage Cath 110 cm, F7.  $1,725.00

 Ventricular/Peritoneal Hyrocephalus  Ventricular Catheters 7,9,13 &

 15 cm

GS196 Gravity Compensating Accessory Silicone/Stainless steel low, medium & high pressures $880.00

 Johnson & Johnson Medical Pty Ltd

JJ156 Hakim Precision Valve System Precision valve standard. Silicone casing  Peritoneal Catheter length 80  $1,110.00

 & catheter; stainless steel ruby ball in  cm, Ventricular catheter length

 cone mechanism with fixed pressure

JJ157 Hakim Precision Valve System Precision valve and pre-chamber. Silicone Peritoneal Catheter length 80  $1,320.00

  casing & catheter; stainless steel ruby  cm, Ventricular catheter length

 ball in cone mechanism with fixed

JJ158 Hakim Programmable Valve System Standard system. Silicone casing without  One size only $2,800.00

 catheter; stainless steel ruby ball in cone

 mechanism with variable pressure

JJ159 Hakim Programmable Valve System Standard system. Silicone casing with  Peritoneal Catheter length 80  $3,140.00

 catheter; stainless steel ruby ball in cone  cm, Ventricular catheter length

 mechanism with variable pressure

JJ219 Hakim Programmable Valve System Fixed pressure hydrocephalus shunt,  One size only $3,250.00

 packaged sterile, stainless steel and ruby

 valve mechanism, silicone rubber

 ventricular and peritoneal catheters.  In

 line or right angled with reservoir.  Valve

 can be reprogrammed non-invasively 18

 pressure settings available in 10mm H20

 increments.  SiphonGuard anti-siphon

 device integrated into valve mechanism.

JJ220 Hakim Precision Valve System Fixed pressure hydrocephalus shunt,  One size only $1,500.00

 packaged sterile, stainless steel and ruby

 valve mechanism, silicone rubber

 ventricular and peritoneal catheters.  In

 line or right angled with reservoir. 

 Opening pressure  H20; Very high

 130mm, high 100mm, medium 70mm,

 low 40mm, very low 10mm. With

Prostheses List by Category, Groups and Sponsor Page 236 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ221 Hakim Precision Valve System Fixed pressure hydrocephalus shunt,  One size only $1,390.00

 packaged sterile, stainless steel and ruby

 valve mechanism, silicone rubber

 ventricular and peritoneal catheters.  In

 line or right angled with reservoir. 

 Opening pressure  H20; Very high

 130mm, high 100mm, medium 70mm,

JJ436 Codman Hakim Programmable Valves 18 different pressure settings, various  One Size Only $2,700.00

JJ437 Codman Hakim Programmable Valves  18 different pressure settings and  One Size Only $3,250.00

 with Siphonguard SIPHONGUARD technology

JJ438 Codman Hakim Precision Valves with  features 5 operating pressures and  Pressure settings 10, 40, 70,  $1,500.00

 Siphonguard, Right Angle Reservoir SIPHONGUARD technlogy 100 and 130mmH2O

JJ439 Codman Hakim Precision Valve with  features 5 operating pressures and  Pressure settings 10, 40, 70,  $1,500.00

 Siphonguard, Inline Reservoir SIPHONGUARD technology 100 and 130mmH2O

JJ440 Codman Hakim Precision Valve, Right  features 5 operating pressures 10, 40, 70, 100, and  $1,390.00

 Angle Reservoir

 Medical Specialties  Australia Pty Ltd

MS003 Sterile Hydrocephalic Shunts Plastic/magnetic. Programmable valve.  3, 8 settings $2,700.00

 Programmer kit and shunts kit.

 Medtronic Australasia Pty Ltd

MC529 Hydrocephalus Shunt Lumbar peritoneal 84cm $450.00

MC530 Hydrocephalus Shunt Ventricular/Atrial, CSF Flow Control  38cm-90cm $450.00

 Shunts, Cont Small Valve

MC532 Hydrocephalus Shunt With Hydrostatic Valve, Delta  12mm-90cm $1,110.00

 Valves/Shunts/BioGlide, Vent Catheters

MC536 Valves, Hydrocephalic Strata Adjustable Delta Valve 12 -16mm $715.00

MC641 Strata Valve Unitised with Bioglide PSM  CSF Flow Valve. Polypropylene and  One size only $2,700.00

 range acetal plastic base. Silicone elastomer

MC642 Strata Valve Assembly with Bioglide PSM CSF Flow Valves. Polypropylene and  One size $2,038.00 $2,730.00

  range acetal plastic base. Silicone elastomer

MC643 Strata Valve with Bioglide PSM range CSF Flow Valve. Polypropylene and  13-16mm x 35-47mm $2,350.00

 acetal plastic base. Silicone elastomer

Prostheses List by Category, Groups and Sponsor Page 237 of 784


NEUROSURGICAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC644 Strata Valve NSC (non siphon control)  CSF Flow Valve. Polypropylene and  13-16mm x 23-32mm (0.5-2.0) $2,020.00

 PSM range acetal plastic base. Silicone elastomer

MC645 Strata Valve Unitised NSC (non siphon  Adjustable CSF valve with five symmetric 8-120cm $2,406.00

 control) PSM range  performance level steps. Includes a

 strata valve, pre-attached ventricular

 catheter, and a pre-attached peritoneal

 catheter. Right Angle Clip. Disposable

 Quick Release Ventricular Catheter

 Introducer. Disposable Subcutaneous

 Catheter Passer. Tuohy-Borst Adapter.

 Polypropylene and acetal plastic base.

 Silicone elastomer dome.

MC646 Strata Valve Assembly NSC (non siphon  Adjustable CSF valve with five  One size $2,245.00

 control) PSM range symmetrical performance level steps.

 Includes a strata valve, an integral distal

 peritoneal catheter and catheter passer,

 and a female leur adaptor and prefill

 tubing. Polypropylene and acetal plastic

MC647 Delta Valve with Bioglide PSM range CSF Flow Valve. Polypropylene and  36-40mm x 9-20mm (0.5-2.0) $1,500.00

 acetal plastic base. Silicone elastomer

 dome. Surface of valve bonded with

 hydrogel (Bioglide surface modification).

MC648 Delta Valve Unitised with Bioglide PSM  CSF Flow Valves. Polypropylene and  8-13.5cm x 90-120cm (0.5-2.0) $1,990.00

 range acetal plastic base. Silicone elastomer

 dome. Unitised system includes the valve,

  integral ventricular and peritoneal

 catheter (all components connected).

 Surface of valve bonded with hydrogel

 (Bioglide surface modification).

MC651 Delta Valve Assembly with Bioglide PSM  CSF Flow Valves. Polypropylene and  90-120cm (0.5, 1.0, 1.5, 2.0) $1,775.00

 range acetal plastic base. Silicone elastomer

 dome. Assembly system includes the

 valve, integral peritoneal catheter, female

 luer adapter and prefill tubing. Surface of

 the valve bonded with hydrogel (Bioglide

Prostheses List by Category, Groups and Sponsor Page 238 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Aqueous/Vitreous Humor Replacement Media

 Advanced Medical Optics Australia Pty Ltd

AO007 Viscoelastic Fluid: AMO Vitrax (sodium  Surgically Implanted Intraocular  0.65mL $90.00

 hyaluronate) 30mg/mL, 0.65mL

AO008 Healon, Intraocular Viscoelastic Fluid Sodium Hyaluronate 10mg/ml Healon 0.4ml, 0.55ml & 0.85ml $80.00

AO009 Healon 5, Intraocular Viscoelastic Fluid HEALON5- Sodium hyaluronate 23mg/ml 0.6ml $85.00

 Alcon Laboratories (Aust.) Pty Ltd

AL005 DUOVISC VISCOELASTIC SYSTEM PROVISC contains sodium hyaluronate,  Small & large packs $110.00

 VISCOAT contains chondroitin sulfate

 and sodium hyaluronate

AL006 PROVISC VISCOELASTIC SOLUTION PROVISC contains sodium hyaluronate 0.55mL & 0.85mL packs $80.00

AL007 VISCOAT Viscoelastic Fluid Chondroitin sulfate and sodium  0.5mL packs $80.00

 Bausch & Lomb Surgical

BL008 Ocucoat Intraocular Fluid 20mg/mL hydroxypropylmethyl cellulose  1mL sterile $95.00

 for intraocular use

BL015 Amvisc Plus injection 15mg/mL Sodium Hyaluronate for  0.5mL and 0.8mL $95.00

 intraocular use

 IQ Medical

IQ002 Ocuvis and Ocumax 2%  20mg/mL hydroxypropylmethyl cellulose  2mL sterile $90.00

 Hydroxypropylmethylcellulose for intraocular use. Pre-loaded in a sterile

 syringe with one cannula for injection, in

 a sterile Tyvek pouch

 Spectrum Ophthalmics

SO025 Ophthalin 1% w/v sodium hyaluronate Aqueous/vitreous humour replacement  1 x 1.0mL $80.00 $120.00

 medium kits

Prostheses List by Category, Groups and Sponsor Page 239 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Aqueous/Vitreous Humor Replacement Medium Kits

 Advanced Medical Optics Australia Pty Ltd

AO010 Healon GV Intraocular Viscoelastic Fluid Sodium Hyaluronate 14mg/mL 0.5mm and 0.85ml $80.00 $95.00

 Alcon Laboratories (Aust.) Pty Ltd

AL015 Cellugel viscoelastic fluid Hypromellose 2% $95.00

Clips, Ligating

 Device Technologies Australia Pty Ltd

DE201 Labtician Tantalum Clips Tantalum 2, 2.5mm $38.00

Corneas, Artificial

 Hydron Pty Limited t/a Cooper Vision Surgical

HY001 AlphaCor A & P Composition poly 2 (hydroxyethyl  AlphaCor A - Diameter 7mm,  $9,220.00

 methacrylate) thickness 0.6mm, radius of

 curvature 8.0/8.0mm; AlphaCor

 P - Diameter 7.0, thickness

 0.6mm, radius of curvature

Prostheses List by Category, Groups and Sponsor Page 240 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Elastomers, Silicone Rubber

 Austmed Pty Limited

AP002 Mira: Scleral Implants Silicone Sponge- Retinal Implant Used in  Sponge- Mira 502 Cylinder  $120.00

 Scleral Buckling (Silicone Elastomer  2mm, Mira 5025 Cylinder

 2.5mm, Mira 503 Cylinder

 3mm, Mira 504 Cylinder 4mm,

 Mira 505 Cylinder 5mm, Mira

 505G Grooved cylinder 5mm,

 Mira 505T Packer tunnel

 cylinder 5mm, Mira 510 Half

 cylinder 5mm, Mira 515

 Brucker two-thirds cylinder

 5mm, Mira 501 Masciulli oval

 2.5mm by 4mm, Mira 506

 Vaiser oval 3mm by 5mm, Mira

 506G Vaiser grooved oval 3mm

 by 5mm, Mira 507 oval 5.5mm

 by 7.5mm, Mira 507G Grooved

 oval 5.5mm by 7.5mm, Mira

 507T Packer tunnel oval 5.5mm

  by 7.5mm, Mira 511 Half oval

 7.5mm, Mira 517 Brucker two-

 thirds oval 7.5mm, Mira 509

 Fuller flat oval 3.5mm by

 7.5mm, Mira 509G Fuller

 grooved flat oval 3.5mm by

 7.5mm, Mira 518 Frederick

 grooved flat oval 2.5mm by

 12mm, Mira 508 Frederick flat

 oval 4mm by 12mm, Mira 508G

  Frederick grooved flat oval

 4mm by 12mm, Mira 513

 Snyder 3+ meridional 7mm by

 4mm, Mira 514 Snyder 4+

 meridional 8mm by 5mm, Mira

Prostheses List by Category, Groups and Sponsor Page 241 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AP003 Mira: Scleral Implants Solid Silicone- Tires-Mira 286 Wendel  $45.00

 Tire/Meridional/Wedge/Pad. Retinal  Symmetrical Oval Tire 6mm,

 Implant used in Scleral Buckling  Mira Symmetrical Oval Tire

 7mm, Mira 287WG Murray

 wide (3.5mm) grooved

 symmetrical tire, 10mm wide,

 Mira 288 ross symmetrical

 grooved tire, low profile 10mm

 wide by 2.5mm, Mira 289

 Symmetrical oval tire 10mm,

 Mira 277Symmetrical tire 7mm,

 Mira 279 Symmetrical tire 9mm,

  Mira 78G Grooved symmetrical

  tire 10mm, Mira 281

 Symmetrical tire 12.5mm, Mira

 275 Munsen Asymmetrical tire

 6mm, Mira 276 Asymmetrical

 tire 7mm, Mira 278 Brockhurst

 asymmetrical tire 8.5mm, Mira

 280LG Large grooved

 asymmetrical tire 10mm, Mira

 77G Grooved hemisphere

 26mm. Meridional- Mira 106

 Meridional Implant 6mm by

 10.5mm, Mira 112 Curved

 Meridional implant 12mm by

 12mm, Mira 103 Meridional

 implant 4mm by 15mm. Wedge-

  Mira 135 Pruett maxi wedge

 14mm, Mira Pruett midi wedge

 12mm, Mira 190 Spencer sub-

 implant 5mm by 10mm. Pad-

 Mira 80 Pad 4mm by 8mm,

AP004 Mira: Scleral Implants Solid Silicone-Sleeve. Retinal Implant  Sleeves-Mira 70 Sleeve 1mm  $25.00

 used in Scleral Buckling  I.D., Mira 71 Sleeve 1mm I.D.,

 (Dimethylmethylvinyl Siloxane Copolymer) Mira 72 McNutt Sleeve 1.57mm

  I.D., Mira 270 Sleeve 0.76mm

Prostheses List by Category, Groups and Sponsor Page 242 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AP006 Mira: Scleral Implants Solid Silicone-Band/Strip/Boat/Clip.  Bands-Mira 40 Circling Band  $35.00

 Retinal Implant used in Scleral Buckling  2mm, Mira 240 Circling Band

 (Dimethylmethylvinyl Siloxane Copolymer) 2.5mm. Strips-Mira 41 Strip

 3.5mm, Mira 42 Strip 4mm,

 Mira 20 Strip 4mm, Mira 219

 Strip 4.5mm, Mira 31 Strip

 4.5mm, Mira 32 Strip 5mm,

 Mira 225 Oval Strip 5mm, Mira

 220 Strip 6mm. Boats-Mira 60

 Boat 2mm, Mira 260 Boat

 2.5mm. Clips-Mira 50 Double

 Tantalum Clip 2mm, Mira 250

 Double Tantalum Clip 2.5mm,

 Mira 51 Singla Tantalum Clip

 3.5mm, Mira 52 Joondeph

 Single Tantalum Clip 4mm

Eyelid Weights, Implantable

 BR & CT Enterprises Pty Ltd

BC005 LIDCHAIN Platinum Eyelid Implant Platinum Weights - 0.8, 1.0, 1.2, 1.4, 1.6, $1,650.00

  1.8 grams

 Device Technologies Australia Pty Ltd

DE182 Lid Load Gold Eyelid Weights; Gold 1.8, 2.0, 2.2, 2.4, 2.6, 2.8 grams $800.00

DE183 Lid Load Gold Eyelid Weights; Gold 0.6, 0.8, 1.0, 1.2, 1.4, 1.6 grams $425.00

Fluids, Mechanical Therapeutic Use

 Alcon Laboratories (Aust.) Pty Ltd

AL013 Perfluoron Kits Perfluoro-n-octane for use as a retinal  5mL $240.00

 surgery additive

AL014 Perfluoron Kits Perfluoro-n-octane for use as a retinal  7mL $335.00

 surgery additive

Prostheses List by Category, Groups and Sponsor Page 243 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AL018 SILIKON 1000 Vitreoretinal Surgical  Purified polydimethylsiloxane (silicone oil) 10 mL $195.00

  for use as a post-operative retinal

 tamponade during vitreoretinal surgery.

 Bausch & Lomb Surgical

BL001 Adato Sil-ol Silicone Oil (various  Adato Sil-Ol Silicone Oil 1000 10mL $195.00

BL002 Adato Sil-ol Silicone Oil (various  Adato Sil-Ol Silicone Oil 5000 10mL $195.00

BL003 Adeto Deca (various) Adato Deca Perfluorodecacarbon 5mL $240.00

BL004 Adato Octa Adato Octa Perfluorooctacarbon 5mL $240.00

BL016 Oxane LMWC Fractioned Silicone Oil Purified fractioned silicone oil 10mL $195.00

BL017 Perfluo-octane (Oktaline) Okta-Line Perfluorocarbon Liquid  for use as a  5mL $240.00

 retinal surgery additive

BL018 DK Line 100% purified perfluorodecalin Perfluorodecalin 7ml $335.00

BL024 Oxane HD Silicone oil - RMN3 mixture 10ml $290.00

 Device Technologies Australia Pty Ltd

DE204 Arcaline (Perfluorodecaline) Liquid perfluorocarbon aid for retinal  3ml, 5ml, 7ml $202.00

 surgery, operative device for retinal

 surgery, in particular retinal detachment

 (RD), RD with giant tear etc.

DE205 Arcotane (Perfloro-N-Octane) Liquid perfluoro-N-Octane aid for retinal  5ml, 7ml $202.00

 surgery, pre-operative device for retinal

 surgery, in particular retinal detachment

 (RD), RD with giant tear, RD with

 proliferative vitreal retinopathy (PVR) etc.

DE227 LSO Silicone Oil Silicone oil for tamponade use in  Vial - 10 ml $189.00

 vitreoretinal surgery

DE228 LSO Silicone Oil Silicone oil for tamponade use in  Syringe - 10 ml $195.00

 vitreoretinal surgery

DE229 LSO Silicone Oil Silicone oil for tamponade use in  Combo Pack with Syringe - 10  $195.00 $275.00

 vitreoretinal surgery

Prostheses List by Category, Groups and Sponsor Page 244 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Spectrum Ophthalmics

SO022 FCI Purified Silicone Oil (Solvent Free) Viscosity: 1000 cst/5000 cst: solvent free  10ml $195.00 $240.00

 purified silicone oil

SO023 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin,  5ml $240.00 $280.00

 FCI - OCTA: Purified perfluoro-N-octane

SO024 FCI - DECA, FCI - OCTA FCI - DECA: Purified perfluorodecalin,  7ml $335.00

 FCI - OCTA: Purified perfluoro-N-

Glaucoma Filtration Implants

 Advanced Medical Optics Australia Pty Ltd

AO012 Baerveldt Glaucoma Implant BG 101-350, Non-valved artificial drainage device,  Surface area 250, 350, 425mm2 $600.00

  Baerveldt Glaucoma Implant BG 103- composition silicone - smooth, tumble-

 425, Baerveldt Glaucoma Implant BG  polished finish

 Spectrum Ophthalmics

SO001 T.Flux: Non-Absorbable Galucoma Drain - One size only $945.00

Intracorneal Rings

 Cytosol Ophthalmics Australia Pty Ltd

CY001 OII PMMA Capsular Tension Ring Capsular Tension Ring - PMMA 12mm and 13mm $135.00

 Design for Vision Pty Ltd

DV003 DORC Retinal Implants Bands and strips Bands 2 - 2.5mm, strips 2 -  $26.20

DV009 Morcher Capsular Tension Ring PMMA Implant 14, 14A, 14C $144.40

DV010 Morcher Coloboma Diaphram  PMMA Implant 96G, 96L $247.00

DV013 DORC Retinal Implants Tantalum clips 2 - 2.5mm $38.00 $45.00

DV014 DORC Retinal Implants Sleeves 0.76 x 1.65mm and 1 x 2.1mm $18.00

Prostheses List by Category, Groups and Sponsor Page 245 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DV015 DORC Retinal Implants Tires 1 - 1.9mm thick, 7 - 11mm  $42.00 $47.00

 wide: 4 styles

DV016 DORC Retinal Implants Sponges 3 - 5mm round, 3 - 5.5mm oval $85.00

 Device Technologies Australia Pty Ltd

DE207 Hanita EndoCapsular Ring (ECR) Maintains the stability and a perfect  One Size Only $196.00

 circular contour of the capsular bag

 equator in cases of intraoperative,

 traumatic or congenital zonular dialysis.

 Emagin Pty Ltd

EG004 Intracorneal Rings PMMA Thickness 0.210mm - 150  $1,110.00 $1,188.00

 degrees Arc Length; Thickness

 0.250mm - 150 degrees Arc

 Length; Thickness 0.275mm -

 150 degrees Arc Length;

 Thickness 0.300mm - 150

 degrees Arc Length; Thickness

 0.325mm - 150 degrees Arc

 Length; Thickness 0.350mm -

 150 degrees Arc Length;

 Thickness 0.400mm - 150

 degrees Arc Length; Thickness

 0.450mm - 150 degrees Arc

 Spectrum Ophthalmics

SO002 Tensiobag: Capsular Tension Ring PMMA Diameter 10 - 14mm $200.00

SO026 Flexiring Capsular Tension Ring Flexizone Hard and Soft Acrylic Diameter 10 - 14 mm $295.00

Intraocular Lens

 Group 1 - Anterior Chamber: aphakic, rigid lenses

 Advanced Medical Optics Australia Pty Ltd

AO019 Verisyse AC IOL Aphakic Model 5mm Optic Diameter x 8.5  $156.00 $416.00

 overall length

 Alcon Laboratories (Aust.) Pty Ltd

AL003 MTAU1-MTAU-7 PMMA + 4 to 28 D $156.00

Prostheses List by Category, Groups and Sponsor Page 246 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Bausch & Lomb Surgical

BL005 Storz (Coburn) Intraocular Lens  121UV;  PMMA Anterior Chamber Intraocular lens 13.75mm length. 6.0mm optic  $156.00

 L122UV PMMAA Anterior Chamber Lens  1 piece size, diopter range 3-30d.

 L122UV: 6.0mm optic,

 13.75mm length, power range;

 Emagin Pty Ltd

EG009 Artisan Anterior Chamber Intraocular Lens Aphakia Model 5.00mm Optic Diameter x 8.5 in $156.00 $263.00

 Composition: PMMA  overall length

 Surface Modification Suffix

 Advanced Medical Optics Australia Pty Ltd

AO001 Intraocular Lens: Model  AC 51B Duralens  PMMA, Anterior Chamber IOL 6.00 mm Optic Diameter x  $156.00

 13.0mm in overall length

AO011 Anterior Chamber IOL; Pharmacia  Anterior chamber heparin coated PMMA  808C: +8.0 to +30.0 diopter  $198.00 $208.00

 Heparin Surface Modified AC IOL Model  lenses 352C. Models 812C, 722C, 757C,  increments  and 352C: - +8.0 to

 808C & 352C. +30.0 diopter increments

 Group 2a - Anterior Chamber: phakic, rigid lenses.

 Advanced Medical Optics Australia Pty Ltd

AO016 Verisyse AC IOL Phakic Intraocular Lens: Model Myopia.   5mm Optic Diameter x 8.5  $680.00 $728.00

 Composition: PMMA overall length; 6mm Optic

 Diameter x 8.5 overall length

AO017 Verisyse AC IOL Phakic Intraocular Lens: Model  5mm Optic Diameter x 8.5  $680.00 $728.00

 Hyperopia.  Composition: PMMA overall length

 Emagin Pty Ltd

EG006 Artisan Anterior Chamber Intraocular Lens Phakic Intraocular Lens: Model Myopia 5.00mm Optic Diameter x 7.5 in $680.00

 Composition: PMMA  overall length; 5.00mm Optic

 Diameter x 8.5 in overall length;

 6.00mm Optic Diameter x 8.5 in

  overall length

EG007 Artisan Anterior Chamber Intraocular Lens Phakic Intraocular Lens: Model Hyperopia 5.00mm Optic Diameter x 8.5 in $680.00

   overall length

Prostheses List by Category, Groups and Sponsor Page 247 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Toric Suffix

 Advanced Medical Optics Australia Pty Ltd

AO018 Verisyse AC IOL Phakic Intraocular Lens: Model Toric 5mm Optic Diameter x 7.5  $888.00 $1,456.00

 overall length

 Emagin Pty Ltd

EG008 Artisan Anterior Chamber Intraocular Lens Phakic Intraocular Lens: Model Toric 5.00mm Optic Diameter x 7.5 in $888.00 $1,338.00

 Composition: PMMA  overall length

 Group 2b - Anterior Chamber: phakic foldable lenses

 Emagin Pty Ltd

EG010 Artiflex Anterior Chamber Intraocular Lens Optic: Hydrophobic Polysiloxane. Haptic:  6mm optic diameter x 8.5 in  $723.00 $880.00

 PMMA overall length

 Group 3 - Posterior Chamber: aphakic, rigid lenses

 Advanced Medical Optics Australia Pty Ltd

AO003 Intraocular Lens: Allergan AMO Duralens Duralens, PMMA, Posterior Chamber  5.5mm-6.5 mm Optic Diameter  $156.00 $198.00

  Posterior Chamber IOL Model  x 12.0mm-13.5mm in overall

 PS42ANB, PS53ANB, PS60ANB,  length.   

Prostheses List by Category, Groups and Sponsor Page 248 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Alcon Laboratories (Aust.) Pty Ltd

AL002 Intraocular Lens: MODIFIED C PMMA  Other:PMMA Range of Powers:-10 to +34 D $156.00

 PC IOL MODEL MZ60BD, MODIFIED

 PMMA PC IOL Model MZ20BD,

 CANTILEVER PMMA PC IOL MODEL

 CVC1U, Modified PMMA PC IOL Model

 MZ30BD, PMMA PC, IOL Model

 MC60BD, PMMA PC, IOL Model

 MC50BD, PMMA PC, IOL Model

 CZ70BD, MODIFIED C PMMA PC IOL

 MODEL 251.60 (MC50BM), MODIFIED

  C PMMA PC IOL MODEL 251.61

 (MC51BM), MODIFIED C PMMA PC

 IOL MODEL 551.61 (MC60CM), Alcon

 JF30BD Cantilever PMMA PC IOL,

 Alcon Cantilever Model LX90BD PMMA

 PC IOL, Alcon Cantilever Model LX10BD

  PMMA PC IOL, Alcon Cantilever Model

 LC80BD PMMA PC IOL, PMAA PC

 Bausch & Lomb Surgical

BL006 Posterior chamber IOLS model P359 UV, PMMA Posterior Chamber lens 1 piece; 12.25mm to 13.75mm length.  $156.00

  P399 UV, 68 UV, 95 BUV, or lolab PC  5.5mm to 7mm optic size,

 One Piece, model 6741B, 8591B, 8191B;  diopter range -4.5 - 45d to 10 -

 Model EZE-Fit 65 34d; EZE-Fit 65: 6.5mm optic,

 13.35mm length, Power range:

 10.0 to 30.0 Diopter

 Surface Modification Suffix

 Advanced Medical Optics Australia Pty Ltd

AO022 Posterior Chamber IOL; Pharmacia  CeeOn Posterior chamber, heparin coated 812C:+8.0 to +40.0 diopter  $198.00 $208.00

 Heparin Surface Modified AC IOL Model   , PMMA lenses, One piece, biconvex.  increments, 722C: +8.0 to +30.0

 812C, 722C, 757C, 808C CeeOn  diopter increments, 757C: -10.0

  to +7.0 diopter increments

Prostheses List by Category, Groups and Sponsor Page 249 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 4a - Posterior Chamber: aphakic, foldable, no edge modification, haptic plate lenses

 Bausch & Lomb Surgical

BL010 Chiroflex Model C11UB Intraocular Lens Foldable Plate Haptic   10.50m length, 6.0mm optic  $281.00

 Silicone Posterior Chamber Foldable Plate size, diopter range 10-30d

  Haptic Lens 1 piece

 ConceptVision Australia Pty Ltd

CS001 Staar foldable silicone intraocular lens:  Plate haptics 6.0mm; Polymide haptics  10.8mm - 13.5mm length; $281.00 $296.00

 Model AA4203VF; Model AA4204VF;  5.5 or 6.3mm optic;

 AA4204VL;

 Aberration Technology Suffix

 IQ Medical

IQ001 UltraChoice 1.0 Rollable Thinlens Model  Acrylic, single piece, rollable, refractive  Dioptric powers from 10.0 to  $374.00 $676.00

 PHC001 multifocal with monofocal function  30.0 D

 meniscus optic, accommodating

 intraocular lens with 50 micron edge

 PP

 ConceptVision Australia Pty Ltd

CS006 Staar foldable silicone IOLs: Model KS-1  5.5mm optic 12.5mm overall length $302.00 $317.00

 (AS-110NV) preloaded Intraocular lens

 Toric Suffix

 ConceptVision Australia Pty Ltd

CS002 Staar Toric foldable silicone intraocular  Plate haptics 6.0mm optic 10.8mm - 11.2mm length $411.00

 lens: Model AA4203TF; Model

 Group 4b - Posterior Chamber: aphakic, foldable, no edge modification lenses

 Advanced Medical Optics Australia Pty Ltd

AO005 Intraocular Lens: Allergan Model SI- PhacoFlex II SI-30NB Silicone or  6.0 mm Optic Diameter x  $281.00

 30NB Silicone PC IOL; or AMO model  PhacoFlex II SI-40NB Silicone; Foldable  13.0mm in overall length.        

 SI-40NB Silicone PC IOL

Prostheses List by Category, Groups and Sponsor Page 250 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AO015 CEEON R Intraoccular Lens Foldable intraocular lenses - ultraviolet  5-10 dioptre in 1.0 dioptre  $229.00

 light absorbing posterior chamber  increments; 1.3-30 dioptre in

 0.5 dioptre increments

 Bausch & Lomb Surgical

BL007 Hydroview Intraocular lens Model H60M Foldable Hydrogel Lens  Hydrogel  12.50mm length, 6.0mm optic  $281.00

 Posterior Chamber Foldable lens 1 piece size, diopter range 15-30d

BL009 Soflex UV Absorbing  Silicone Posterior  Foldable Intraocular Lens  Silicone  13.00mm length, 6.0mm optic  $281.00

 Chamber  IOL Model LI61U Posterior Chamber Foldable Lens 3 piece size, diopter range 5-30d

 ConceptVision Australia Pty Ltd

CS003 Staar foldable silicone intraocular lens:  Polyimide haptics 6.3mm optic - low  14.0mm length $229.00

 Model AQ 5010V

 Device Technologies Australia Pty Ltd

DE263 MicroCryl Acrylic Introcular lenses Foldable Monobloc Micrincision Posterior 6.D-40.0D $310.00

  Chamber Lens

 MC611M1

 Group 4c - Posterior Chamber: aphakic, foldable, posterior edge modification lenses

 Alcon Laboratories (Aust.) Pty Ltd

AL004 Intraocular Lens: Alcon Acrysof Model  Foldable Acrylic Multi-piece Lens Range of Powers: -5 to +30 D $312.00

 MA60BM PC IOL, Alcon Acrysof Model

 MA30BA PC IOL, Alcon Acrysof model

 MA50BM PC IOL, ACRYSOF IOL

 MODEL MA60MA

AL012 Alcon Acrysof Model MA30AC PC IOL,  Foldable acrylic multi-piece lens,  +10 to +30 D $312.00

 Alcon Acrysof Model MA60AC PC IOL asymmetric optic/consistent edge

 Device Technologies Australia Pty Ltd

DE264 MicroCryl Acrylic Introcular lenses Foldable Monobloc Posterior Chamber  6.0D-40.0D $350.00

 Lens

Prostheses List by Category, Groups and Sponsor Page 251 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 T

 Device Technologies Australia Pty Ltd

DE253 MicroSil Toric IOL Silicone Lens (MS6116TU) Standard  Lens Dia =6.00mm Haptics Dia  $500.00 $716.00

 Range -3.00 to 31.00 Dioptres in 0.5  =11.6mm

 steps with cylinder from 2.00 to 12.00

DE254 MicroSil Toric IOL Silicone Lens (MS6116TU) Semi-Custom Lens Diameter = 6.00mm  $500.00 $958.00

  Range -3.00 to 31.00 Dioptres with 1.0  Haptics Dia = 11.6mm

 steps, Cylinder from 3.0 - 14.0 Dioptres

DE255 MicroSil Toric IOL Silicone Lens (MS6116TU) Custom made Lens Dia = 6.00mm Haptics Dia $500.00 $1,537.00

  range: -28 to +31 Sphere and up to 30D   = 11.6mm

 cylinder

 Group 4d - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification

 Advanced Medical Optics Australia Pty Ltd

AO002 Sensar  AR40 Monofocal Acrylic IOL,   Soft Acrylic, Foldable, UV Absorbing,  6 mm Optic Diameter x 13mm  $322.00 $374.00

 Sensar OptiEdge AR40e Foldable Acrylic  Posterior in overall length.     

AO006 Clariflex, Model CLRFLXB Posterior  Foldable Silicone IOL with OptiEdge  One size only $322.00 $374.00

 Chamber Intraocular Lens

AO013 Ceeon Model 911A Edge Foldable UV  Silicon, foldable, UV absorbable  5 - 10D in 1.0 diopter  $312.00

 Absorbing Posterior Chamber IOL intraocular lens with equibiconvex design  increments, 10.5 - 30D in 0.5

 and square optic edge diopter increments

 Alcon Laboratories (Aust.) Pty Ltd

AL011 Intraocular Lens: Alcon Acrysof Model  Foldable Acrylic Single-piece Lens,  Range of Powers: +6 to +40 D $322.00

 SA30AL, Alcon Acrysof Model SA60AT, asymmetric optic/consistent edge

  SA30AT Intraocular Lens; Alcon

 Acrysof PC IOL Model SA65AT

AL024 AcrySof SN60WS Foldable Acrylic Single-piece Lens with  +6 to +36 D $406.00

 Blue light protection and aspheric

 correction, in cartridge.

AL025 AcrySof MN60MA Foldable Acrylic multi-piece Lens with  +6 to +30D $354.00

 Blue light Protection

Prostheses List by Category, Groups and Sponsor Page 252 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AL026 AcrySof MN60AC Foldable Acrylic multi-piece Lens with  +6 to +30 D $354.00

 Blue light Protection

 Bausch & Lomb Surgical

BL019 Akreos Fit acrylic foldable posterior  Composition: Hydrophilic acrylic  10.0 to 15.0 Diopter in 1.0  $322.00

 chamber intraocular lens polymer.  Packaged in lens folding device Diopter increments; 15.0 to 25.0

  in a sterile vial.  Modified C-Loop design  Diopter in 0.5 Diopter

 increments; 25.0 to 30.0 Diopter

  in 1.0 Diopter increments

BL020 Akreos Adapt acrylic foldable posterior  Composition: Hydrophilic acrylic  10.0 to 15.0 Diopter in 1.0  $322.00

 chamber intraocular lens polymer.  Packaged in lens folding device Diopter increments

  in a sterile vial.  Four haptic design 15.0 to 25.0 Diopter in 0.5

 Diopter increments

 25.0 to 30.0 Diopter in 1.0

 Diopter increments

BL021 SoflexSE, Intraocular lenses, Posterior  Composition: silicone, Lenses - foldable,  Range of powers: 5.0 to 30.0  $322.00

 Chamber posterior chamber intraocular lenses Diopter - Optic diameter

 6.0mm; 13.0mm length

 ConceptVision Australia Pty Ltd

CS007 Staar foldable silicone IOLs: Models  Plate haptics 6.0mm; Polymide haptics  10.8mm 0 13.5mm length $281.00 $296.00

 AQ2010V, AQ2017V and AO2003V 5.5 or 6.3mm optic;

 Kevin Grundy (IBD) Pty Ltd

KG001 Rayner C-Flex Hydrophilic HEMA-MMA copolymer,  5.75mm dia optic, 12.00mm dia  $322.00

 foldable with injector overall

KG002 Superflex Hydrophilic HEMA-MMA copolymer,  6.25mm dia optic, 12.5mm dia  $322.00

 foldable with injector overall

 Spectrum Ophthalmics

SO028 IOLTECH Intraocular Lens: Model  IOLTECH Hydrophilic acrylic, foldable,  6.5mm optic diameter x 10.35  $322.00 $468.00

 PC, single piece, Tri-haptic, square edge  overall diameter

 design, UV blocker

SO031 IOLTECH Intraocular Lens, Model  IOLTECH hydrophilic acrylic, foldable,  5.5mm to 6.0mm optic x  $322.00 $354.00

 Stabibag, Model XL Stabi CP, single piece, square edge design, UV  10.5mm to 10.75mm overall

 blocker, Tri-haptic

Prostheses List by Category, Groups and Sponsor Page 253 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SO033 IOLTECH MICS IOL IOLTECH Hydrophilic acrylic, Anti vault  5.5mm - 6.0mm optic X 12mm  $395.00

 haptics, PC, single piece, square edge  overall diameter

 design, UV blocker, contains single use

 Aberration Technology Suffix

 Advanced Medical Optics Australia Pty Ltd

AO014 Tecnis TM Intraocular Lens Foldable Intraocular Lenses - Ultraviolet  5-10 dioptre in 1.0 dioptre  $364.00 $416.00

 light absorbing posterior chamber  increments; 10.5 - 30 dioptre in

 intraocular lenses, Silicone/Acrylic 0.5 increments

 AT

 Bausch & Lomb Surgical

BL022 SofPort Advanced Optic (AO) Posterior chamber, foldable silicone IOL  0 D to 30.0 D $364.00

 with anterior optic-haptic square edge,

 posteriof optic-haptic square edge, 360-

 degree optic square edge and asperic

 optic for aberration control

BL023 Akreos Advanced Optic Posterior chamber, foldable acrylic IOL,  0 D to 30.0 D $364.00

 with anterior optic-haptic square edge,

 posterior optic-haptic square edge, 360

 degree optic square edge and aspheric

 optic for aberration control

 IQ Medical

IQ004 Softec Acrylic, single piece, foldable intraocular  Available in dioptric powers  $350.00 $420.00

 lens with anterior and posterior optic- from -5.0 to +36.0, 1D steps: -

 haptic square edge, 360 degree optic  5.0 to +10.0 and +31.0 to

 square edge design, precision power  +36.0; 0.5D steps: +10.5 to

 calculation and aberration technology +18.0 and +25.0 to +29.5;

 AT, PP

 ConceptVision Australia Pty Ltd

CS008 Preloaded Aspheric Intraocular Lens Silicone intraocular lens 6.0mm $345.00

Prostheses List by Category, Groups and Sponsor Page 254 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Blue Light Filter Suffix

 Alcon Laboratories (Aust.) Pty Ltd

AL016 Alcon Acrysof Natural Model SN60AT Foldable Acrylic Single-piece Lens,  +6 to +40D $364.00

 asymmetric optic/consistent edge, with

 blue light protection

 Blue Light Filter, Aberration Tech Suffix

 Alcon Laboratories (Aust.) Pty Ltd

AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with  +16.0 D to +26.0 D $385.00

 Blue Light Protection and Aspheric

 Blue Light Filter, Pre-Packaged Suffix

 Alcon Laboratories (Aust.) Pty Ltd

AL019 AcrySof Model SN60AS Foldable Acrylic Single-piece lens, in  +6 to +40 D $385.00

 cartridge, with blue light protection

 PP

 ConceptVision Australia Pty Ltd

CS005 Staar foldable silicone intraocular lens:  Silicone, foldable, polyamide haptics 6mm Optic, 12.5mm overall  $302.00 $317.00

 KS-3 Model AS310NV

 Spectrum Ophthalmics

SO032 IOLTECH Intraocular Lens, Model  IOLTECH hydrophilic acrylic, foldable,  5.5mm to 6.0mm optic x  $343.00 $374.00

 Stabibag RTU, Model XL Stabi RTU CP, single piece, square edge design, UV  10.5mm to 10.75mm overall

 blocker, Tri-haptic, Ready to use single

 T,BLF

 Alcon Laboratories (Aust.) Pty Ltd

AL023 Alcon AcrySof Toric PC IOL Models Posterior chamber, UV absorbing,  SN60T3 (1.50 D cylinder),  $562.00 $718.00

 foldable, acrylic, toric, single piece lens  SN60T4 (2.25 D cylinder),

 with blue light protection SN60T5 (3.00 D cylinder),

 SN60T6 (3.75 D cylinder),

 SN60T7 (4.50 D cylinder),

 SN60T8 (5.25 D cylinder),

 SN60T9 (6.00 D cylinder)

Prostheses List by Category, Groups and Sponsor Page 255 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Toric Suffix

 Kevin Grundy (IBD) Pty Ltd

KG003 Rayner Standard Toric C-Flex Hydrophilic HEMA-MMA copolymer,  5.00mm dia optic, 12.00mm dia  $530.00 $936.00

 foldable with injector overall, cyls 2.0D to 6.0D in 2D

  increments

KG004 Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable with  5.75mm dia optic, 12.00mm dia  $530.00 $1,872.00

 injector overall, cyls 1.5D to 11.0D in

 0.5D increments

 Group 5a - Posterior Chamber: aphakic, foldable, multifocal/bifocal lenses

 Advanced Medical Optics Australia Pty Ltd

AO004 Intraocular Lens: Allergan AMO Array  Array Multifocal SA40N, Silicone,  6.0 mm Optic Diameter x  $333.00 $374.00

 Multifocal UV Absorbing Silicone  Foldable IOL 13.0mm overall length.            

 Posterior Chamber IOL Model SA-40N

AO020 ReZoom Acrylic Multifocal Intraocular  Acrylic, foldable, posterior chamber,  6.0mm Optic Diameter x  $333.00 $437.00

 intraocular lens 13.0mm overall length

 Group 5b - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification,

 Advanced Medical Optics Australia Pty Ltd

AO023 Tecnis Multifocal Intraocular Lens Tecnis Multifocal foldable Posterior  +5.0 Diopter to 34.0 Diopter in  $750.00 $950.00

 Chamber Diffractive Intraocular Lens  0.5 diopter increments

 Model ZM900.  Posterior Chamber lens

 with UV light-absorbing, foldable,

 silicone, 3 piece with a diffractive

 posterior optic and a Modified Prolate

 Alcon Laboratories (Aust.) Pty Ltd

AL017 Alcon AcrySof ReSTOR PC Diffractive  Posterior Chamber, UV absorbing,  +10.0 to +30.0 D $780.00 $988.00

 IOL Model SA60D3 foldable, acrylic, single piece lens with

 apodised diffractive optic

Prostheses List by Category, Groups and Sponsor Page 256 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Spectrum Ophthalmics

SO029 IOLTECH Intraocular Lens: Model MF4 Multifocal IOLTECH hydrophilic acrylic,  6.00mm optic diameter x  $676.00

 foldable, PC single piece, Tri-haptic,  10.5mm overall diameter

 square edge design, UV blocker

 BLF

 Alcon Laboratories (Aust.) Pty Ltd

AL022 Alcon AcrySof ReSTOR PC Diffractive  Posterior Chamber, UV absorbing,  +10.0 to +30.0 D $822.00 $1,082.00

 IOL Natural Model SN60D3 foldable, acrylic, single piece lens with

 apodised diffractive optic and blue light

AL027 ReSTOR multipiece apodised diffractive  Foldable acrylic mutli-piece lens with  +6 to +30 Diopters $790.00 $1,040.00

 blue light filtering PC IOL Model  apodised diffractive optic and blue light

 protection

 Group 5c - Posterior Chamber: aphakic, foldable, multifocal, accommodative lenses.

 ConceptVision Australia Pty Ltd

CS004 Eyeonics Inc Crystalens Silicon Multipiece Folding  Optic Diameter:  4.5mm; Overall $676.00

 Accommodating Intraocular Lens  Length:  11.5mm

 Device Technologies Australia Pty Ltd

DE260 ICU Akkomodative® IOL ICU Akkomodative IOL- Acrylic lens  Lens Dia =5.5mm Haptics Dia  $650.00 $950.00

 Range 15-35 Dioptres in 0.5 steps =9.8mm

 P

 IQ Medical

IQ003 Tetraflex Acrylic single piece, foldable  Available in dioptric powers  $490.00 $1,200.00

 accommodating intraocular lens with  from +5.0 to +36.0, 1D steps:

 sqare edge design, custom control  +31.0 to +36.0; 0.5D steps:

 precision and closed loop haptic design +5.0 to +18.0 and +25.0 to

 +30.0; 0.2D steps; +18.0 to

Prostheses List by Category, Groups and Sponsor Page 257 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 6b - Posterior Chamber: Pseudo-phakic, piggy back, multifocal

 Spectrum Ophthalmics

SO030 IOLTECH Intraocular Lens: Model ACOR Pseudo Phakic IOL, IOLTECH  5.75mm - 6.0mm optic diameter $520.00 $707.00

 hydrophilic acrylic, foldable, PC, single   x 12.5mm - 13.5mm overall

 piece, square edges, UV blocker

Ophthalmic Accessories

 Advanced Medical Optics Australia Pty Ltd

AO021 Stabileyes Capsular Tension Ring Polymethylmethacrylate (PMMA) Implant 12mm ring, and 13mm ring $250.00

 Alcon Laboratories (Aust.) Pty Ltd

AL001 Capsular Tension Rings - 10.0 - 12.0 compressed,  12.3 -  $255.00

 14.5 uncompressed

 Emagin Pty Ltd

EG001 Capsular Tension Rings Clear PMMA Implant 10/08, 12/10, 13/11mm $132.00 $143.00

EG002 Iris Prosthetic System Single Element PMMA Implant 1/4, 1/3mm $414.00 $455.40

EG003 Iris Prosthetic System Double Element PMMA Implant 2/3, 2/4mm $414.00 $455.40

EG005 Capsular Tension Rings Coloured PMMA Implant 10/08, 12/10, 13/11mm $144.00 $159.00

Prostheses, Evisceration

 Device Technologies Australia Pty Ltd

DE188 Acrylic Implant Acrylic 12, 14, 16, 18, 20mm. $35.00 $52.00

DE202 John Weiss Glass Mule Globes Glass No: 12, 14, 16, 18, 20mm $53.00

DE203 Katena Plastic Eye Sphere's Non Sterile Acrylic No: 10, 12, 14, 16, 18, 20, 22mm $35.00

Prostheses List by Category, Groups and Sponsor Page 258 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Eyelid

 Design for Vision Pty Ltd

DV005 Gold Eyelid Load  Small Range - standard 0.6g, 0.8g, 1.0g, 1.2g, 1.4g,  $390.00

DV007 Gold Eyelid Load  Large Range 1.8g, 2.0g, 2.2g, 2.4g, 2.6g,  $780.00 $824.00

DV012 Gold Eyelid Load Small range - thin profile 0.6g, 0.8g, 1.0g, 1.2g, 1.4g, 1.6g $390.00 $412.00

 Spectrum Ophthalmics

SO017 FCI Ptose-up Expanded PTFE 15cm long x 2 or 3mm wide x  $315.00

 0.35mm thick

SO018 FCI Eyelid Spacer (Upper & Lower Lids) Expanded PTFE Upper Lid: 20 x 4-16 x 0.35mm; $530.00

  Lower Lid: 20 x 4-16 x 1mm

Prostheses, Orbital Rim

 Spectrum Ophthalmics

SO006 FCI Orbital Implants Orbital Implant, Bioceramic (Aluminium  Bioceramic diameter, 12, 14, 16, $1,000.00

 Oxide)/Hydroxyapatite (Synthetic)  18, 20, 21, 22mm; Synthetic

 Diameter, 10, 12, 14, 16, 18,

 20, 22mm

SO007 FCI Orbital Implants Mesh wrapped orbital implant: mesh  Bioceramic diameter: 16, 18, 20, $1,500.00

 wrapped bioceramic (aluminium oxide),   22mm; Synthetic

 mesh wrapped hydroxyapatite  Hydroxyapatite diameter: 16, 18,

 (synthetic), mesh wrap (polyglycolic

SO019 FCI Obrbital Implants Peg & Sleeve Standard Large $750.00

Prostheses List by Category, Groups and Sponsor Page 259 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Retinal, Detachment, Repair, Prostheses

 Bausch & Lomb Surgical

BL011 Storz E5381 Silicone Strip Silicone Sleeve 1.65mm to 2.2mm diameter,  $32.00

 length 6.1mm to 30mm

BL012 Storz E5395 3 Cylindrical Sponge Implant Retinal Fixation Device 2.3mm x 2.5mm x 80mm, to  $196.00

 7.5mm x 7.5mm x 100mm

BL013 Storz E5381 Silicone Strip Silicone Tire Outside diameter 30.2m to  $32.00

 33.6mm, inner diameter 26mm,

 overall length 10.4mm to

BL014 Storz E5381 Silicone Strip Circling Band Overall length 10.4mm to  $30.00

Scleral Buckling Devices

 Device Technologies Australia Pty Ltd

DE176 Silicon Retinal Implant Mould One size only $167.00

DE178 Silicon Retinal Implant Sponge 2.5 x 4.0 x 80mm, 3.0 x 5.0 x  $75.00

 100mm, 3.25 x 7.0 x 80mm,

 5.5 x 7.5 x 80mm, 1.5 x 80mm,

  2.0 x 80mm, 2.5 x 80mm, 3.0

 x 80mm, 4.0 x 80mm, 5.0 x

 80mm, 7.0 x 80mm

DE179 Silicon Retinal Implant Tire  7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm $38.00

DE180 Silicon Retinal Implant Sleeve 1mm, .76mm, 1.5mm $14.00

DE181 Silicon Retinal Implant Band 0.75 x 2.0 x 125mm, 0.60 x 2.5 $30.00

  x 125mm, 0.75 x 2.5 x 125mm

Prostheses List by Category, Groups and Sponsor Page 260 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Spectrum Ophthalmics

SO009 FCI Scleral Buckling Devices Band/strip: solid silicone Band - 2.0 x 0.75mm Type 40,  $35.00

 3.5 x 0.75mm Type 41, 4.0 x

 1.25mm Type 42, 2.5 x 0.6mm

 Type 240, Morin 3.5 x 0.6mm

 Strip - 5.7mm Type 20, 7.2mm

 Type 31, 9.2mm Type 32, 6mm

  Type 219, 7.5mm Type 220,

 8mm Type 225

SO010 FCI Scleral Buckling Devices Fixation Sleeve: Solid silicone O.D: 1.65 to 2.41mm, Length  $30.00

 30mm

SO011 FCI Scleral Buckling Devices Tire: Solid Silicone Symmetrical: (2.5 mm Groove,  $40.00

 7 to 9mm wide), Biconvex:

 (2.5mm Groove, 7 to 10mm

 wide), Asymetrical: (2.5mm

 Groove, 7 to 10mm wide)

SO012 FCI Scleral Buckling Devices Sponge/Cord: Silicone Cord: 1.0 to 5.0mm O.D. x  $120.00

 150mm length; Half Cord:

 3.0mm to width x1.5mm to

 2.5mm height x150mm; Circular

  Sponge: 3 to 5mm; Oval

 Sponge: 2 to 5.5mm x 4 to

 12mm; Half Sponge: 2 to

 3.1mm x 4 to 7.5mm; Grooved

 Sponge: 3 to 5mm x 5 to 

 12mm; Gain Sponge: 6 x

 2.5mm; Sahal Sponge: 4 to

SO013 FCI Scleral Buckling Devices Strip: Solid Silicone Strip: 1.4 x 4.4 x 100mm, Morin $150.00

  Strip: 7mm wide x 100mm

 long, Caputo Zip Strip: 7 to

 9mm wide x 120mm long,

 Korobelnik Oval Strip: 2 x 5mm

SO014 FCI Scleral Buckling Devices Band: Solid Silicone Devin Band: 1 x 4 x 120mm,  $105.00

 Ducournau Band: height 2 to 2.5

  x 5.5 to 7.5mm x length

 120mm, Ducournau Band II: 2.1

  x 5.5 x 120mm

Prostheses List by Category, Groups and Sponsor Page 261 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SO015 FCI Scleral Buckling Devices Band: Expanded PTFE Ducournau Band: 2.5 x 5.5 to  $455.00

 7.0mm x 120mm, Band: 0.5mm

 to 2.1 x 2.5mm to 15 x 120mm

SO016 FCI Scleral Buckling Devices Sponge/Strip: Expanded PFTE Circular Sponge: 3 to 5 x  $375.00

 90mm, Oval Sponge: 2 to 4mm

 x 3 to 5 x 90mm, Half Sponge:

 2.5 x 7.5 x 120mm; Strip: 9 x

Sleeves

 Device Technologies Australia Pty Ltd

DE187 P-K Flat Headed Peg and Sleeve Set Titanium One size only $66.00

Spheres, Eye

 Device Technologies Australia Pty Ltd

DE184 Hydroxyapatite Ocular Implant (orbital  Coral 16 - 22mm $1,200.00 $1,300.00

 sphere) 

Tubes, Lacrimal

 Austramedex (VIC) Pty Ltd

AR022 Medpor Coated Tear Drain Jones Tube with polyethylene coating.  11 sizes, 3.5mm x 14mm to  $320.00

 Models 81114 - 81120, 81122, 81124,  3.5mm x 28mm

 81126 and 81128

 Design for Vision Pty Ltd

DV021 Eyetec DCR Tubes Stainless steel, silicone tubing, Crawford  32cm $130.00

 lacrimal intubation set

DV022 Eyetec DCR Tubes Stainless steel, silicone tubing, Bodkin  30cm $37.33

 lacrimal intubation set

Prostheses List by Category, Groups and Sponsor Page 262 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DV023 Eyetec DCR Tubes Stainless steel, silicone tubing,  30cm $98.00

 Canaliculus lacrimal intubation set

 Spectrum Ophthalmics

SO020 FCI Lacrimal Intubation Set Silicone Tubing/Silicone Plug/Metal  Bika: 0.64mm O.D. Tube/80 x  $180.00

 Probes/Polypropylene Thread 0.8mm probes, Bika 1.18:

 1.18mm O.D. Tube/40 x 1.2mm

  probes, Bika for DCR: 0.94mm

 O.D. Tube/50 x 0.8mm probes,

 Infant Bika 0.64mm O.D.

 Tube/55 x 0.7mm probes,

 Infant Bika II: 0.64mm O.D.

 Tube/60 x 0.8mm probes,

 Besancon-Nancy Probe:

 0.64mm O.D. Tube/80 x 0.8mm

  probes, Crawford Probe:

 0.64mm O.D. Tube/0.7mm

 thick probes, FCI 2 Probe:

 0.64mm O.D. Tube/80 x 0.8mm

  probes, Ptosis Probe: Tube/80

 x 0.8mm probes, Mini Monoka:

 0.64 x 40mm Tube/2mm Plug,

 Perforated Mini Monoka: 0.64 x

 40mm Tube/2mm, Perforated

 Plug, Medium Collarette

 Monoka, Wide Collarette

 Monoka: 0.64mm O.D. Tube/80

  x 0.8mm probes/4mm Plug,

 Wide Collarette Monoka for

 Infants: 0.64mm O.D. Tube/60

 x 0.8mm probes/4mm Plug,

 Ritleng Lacrimal Intubation Set:

 0.64mm O.D. Tube/

 Polypropylene thread, Self-

 Threading Monoka Ritleng

 Type: 0.64mm O.D.

 Tube/Polypropylene thread/4mm

Prostheses List by Category, Groups and Sponsor Page 263 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SO021 FCI Lacrimal Intubation Set PVP Coated Silicone Tubing/PVP Coated  PVP Bika: 0.64mm O.D.  $230.00

 Silicone Plug/Metal Probes/Polypropylene Tube/80 x 0.8mm probes, PVP

  Thread Differential Bika: 0.64 &

 1.18mm O.D. Tube/40 x 1.2mm

  probes, PVP Bika for DCR:

 0.94mm O.D. Tube/50 x 0.8mm

  probes, PVP Infant Bika

 0.64mm O.D. Tube/55 x 0.7mm

  probes, PVP Infant Bika II:

 0.64mm O.D. Tube/60 x 0.8mm

  probes, PVP Besancon-Nancy

 Probe: 0.64mm O.D. Tube/80 x

 0.8mm probes, PVP Ritleng

 Lacrimal Intubation Set:

 0.64mm O.D.

 Tube/Polypropylene thread, PVP

  Mini Monoka: 0.64 x 40mm

 Tube/2mm Plug, Wide Collarette

  PVP Monoka: 0.64mm O.D.

 Tube/80 x 0.8mm probes/4mm

 Plug, Self-Threading PVP

 Monoka Ritleng Type: 0.64mm

 O.D., Tube/ Polypropylene

 thread/4mm Plug, PVP

 Metaireau Tube Oval Collar:

 40mm Tube/4mm Plug, PVP

 Metaireau Tube Round Collar:

 40mm Tube/4mm Plug,

Tubing, Other

 Device Technologies Australia Pty Ltd

DE177 Lester Jones Tear Duct Tubes Glass 3 x 9 to 16mm, 3.5 x 9 to  $56.00

 18mm, 4.0 x 9 to 24mm, 5.0 x

DE199 The Gladston/Putterman Tubes by  Glass 3.0mm x 10 to 16mm; 3.5mm x $154.00

 Gunther Weiss  9 to 18mm; 4.0mm x 12 to

Prostheses List by Category, Groups and Sponsor Page 264 of 784


OPHTHALMIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DE200 Bayliss Tubes by Gunther Weiss Glass 3.0mm x 10 to 16mm; 3.5mm x $180.00

  9 to 18mm; 4.0mm x 12 to

Valves, Eye

 Design for Vision Pty Ltd

DV017 Molteno Implant Single plate One size only $315.00 $345.00

DV018 Molteno Implant Single plate - dual chamber One size only $340.00 $380.00

DV019 Molteno Implant Double plate One size only $425.00

DV020 Molteno Implant Double plate - dual chamber One size only $510.00

Prostheses List by Category, Groups and Sponsor Page 265 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Anchor, Fixation

 Biomet Australia Pty Ltd

BI320 Arthrotek Harpoon System Suture Anchor, Metal,  Stainless Steel 2.0mm & 3.0mm $450.00

 ConMed Linvatec Australia Pty Ltd

LV003 Ultrafix RC, Anchor Soft Tissue Re-attachment - Titanium 2.9mm predeployed diameter $300.00

LV005 Ultrafix MiniMite StitchPak Suture  Soft Tissue Re-attachment - Stainless  2.3mm predeployed diameter $338.00

LV006 Ultrafix RC StitchPak Suture Anchor Soft Tissue Re-attachment - Titanium 2.9mm predeployed diameter $325.00

LV024 Ultrafix MicroMite Small Joint Anchor Suture Anchoring Device - Titanium 1.5mm predeployed diameter $290.00 $385.00

LV027 Pre-Loaded Ultrafix RC Anchor Surgical Grade Stainless Steel, preloaded  Dia 2.9mm, length 6.5mm $375.00 $445.00

 with 2 #2 sutures

LV091 ThRevo Suture Anchor Titanium screw-in suture anchor 5.0mm OD x 14.2mm L $399.00

LV092 Duet Suture Anchor System with Hi-Fi  Self-Reinforced 96L/4D PLA Copolymer 6.0mm O.D. x 16.5mm L $460.00 $525.00

 Device Technologies Australia Pty Ltd

DE063 Parachute Corkscrew Suture Anchor PLA  & Titanium 3.5mm - 5mm $455.00

DE064 Corkscrew Suture Anchor  Titanium alloy 3.5 - 6.5mm x  5.0mm $255.00

DE066 FASTak Titanium Suture Anchor Titanium alloy One size only $240.00

DE162 FASTak Suture Anchor (Small Bone) Titanium suture anchor, preloaded with  Dia 2.4mm x length 7.5mm $425.00

 polyester suture

DE196 Corkscrew Suture Anchor Titanium alloy with Fibrewire suture 3.5mm - 6.5mm $360.00

DE198 Fastak Suture Anchor (Small Bone) With Fibrewire Suture Dia. 2.4mm x Length 7.5mm $430.00

DE225 Fastak Anchor Titanium with fibrewire suture 2.8mm x 11.7mm $355.00

 Endotherapeutics Pty Ltd

ET044 Resofix Anchor Resofix anchor is a 2-shell expansion bolt Resofix - S Anchor - 10mm;  $1,000.00

  made of amorphous poly DL-Lactide  Resofix - P Anchor - 10mm

 resorbablel polyester

Prostheses List by Category, Groups and Sponsor Page 266 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Howmedica

HW373 Howmedica Mainstay Soft Tissue Anchor With suture - Titanium 4.5 anchor with #2 and #5  $190.00

 suture, 2.7 anchor with #0 suture

HW374 Howmedica Mainstay Soft Tissue Anchor Without suture - Titanium 4.5, 3.5 and 2.7 anchor $152.00

HW375 Howmedica Mainstay Soft Tissue Anchor Zip anchor - Titanium Sip 4.5 anchor with #5 suture  $257.00

 and #2 suture 2 strands, zip 3.5

 anchor with #2 suture and #0

 suture 2 strands, zip 2.7 anchor

 with #0 suture

 Johnson & Johnson Medical Pty Ltd

JJ076 Mitek Ethibond Knotless Suture Anchor Titanium anchor 2.7 x 10.8 mm $385.00

JJ077 Mitek Polypropylene Meniscus Fastner Polypropylene anchor 6 & 8mm x 4mm  $248.00

JJ097 Mitek Fastin RC Anchor  Titanium Anchor, with various sutures 5 x 13.5mm $281.00

JJ124 Intrafix Tibial Sheath High density polyethylene sheath 7 to 10mm x (15 to 30mm) $272.00

 Smith & Nephew Surgical Pty Ltd

SN651 OBL Anchor System Preloaded Soft Tissue Anchor System  Anchor sizes - Titanium: 2.8,  $255.00

 Material: Titanium Alloy or Polyacetal  3.5, 4.0 5.0, 6.5mm Anchor size

 Polymer. Comes with Insertion device   - Polymer: 5.0mm

 and 2 Braided Polyester Sutures

SN652 OBL Anchor System  Soft Tissue Anchor System Non- 4.0 and 6.5mm $218.00

 preloaded Material:  Titanium Alloy

SN703 Absorbable Suture Anchor Preloaded PLLA Suture Anchor 2.9mm & 5.0mm $460.00

SN714 TwinFix Quick-T 2.8 - 6.5mm $460.00

 Stryker Australia Pty Ltd (2)

SK048 Stryker Cuff Anchor Titanium anchor kit for soft tissue  Length 5-8mm $357.00

 reattachment

SK176 Stryker Cuff Anchor Bio Zip PLLA anchor for soft tissue  Dia 3 - 8mm $397.80

 ligament/tendon fixation

SK177 Stryker Cuff Anchor Glenoid Titanium anchor kit for soft  Dia 2 - 3mm $193.80

 tissue reattachment

Prostheses List by Category, Groups and Sponsor Page 267 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI161 Zimmer Internal Fixation Systems: Cable  Cable-Ready Stainless Steel 1.3 mm $330.00

 System

ZI163 Zimmer Internal Fixation Systems: Cable  Cable-Ready Plate Cable Stainless Steel 610 mm long $367.00

 System

ZI164 Zimmer Internal Fixation Systems: Cable  Cable-Ready GTR Distal end Cable -  635 mm long $450.00

 System Cobalt Chrome

ZI167 Zimmer Internal Fixation Systems: Cable  Cable-Ready 6 Hole Plate - Stainless Steel 187mm long $660.00

 System

ZI168 Zimmer Internal Fixation Systems: Cable  Cable-Ready 8 Hole Plate - Stainless Steel 246mm long $710.00

 System

ZI169 Zimmer Internal Fixation Systems: Cable  Cable-Ready 10 Hole Plate - Stainless  305mm long $790.00

 System

ZI170 Zimmer Internal Fixation Systems: Cable  Cable-Ready Pin - Stainless Steel 35, 40, 45, 65mm long $645.00

 System

ZI173 Zimmer Internal Fixation Systems: Cable  Cable-Ready GTR Cable - Proximal  635mm long $505.00

 System

ZI174 Zimmer Internal Fixation Systems: Cable  Cable-Ready Stainless Steel Cable 1.8mm $407.00

 System

ZI234 Cable System  Cable Ready, Cable Button 2,5mm - 5,0mm $183.00

Anchors, Synthetic Ligament

 ConMed Linvatec Australia Pty Ltd

LV001 Linvatec Super Revo Soft Tissue Anchor Contains screw, driver and sutures $357.00 $450.00

LV002 Li Medical Ultrasorb Bioabsorable Suture  Contains anchor, non-absorbable suture,  $410.00 $434.50

 Anchor surgical needles

LV007 Bio Twist Bioabsorbable Rotator Cuff  Soft Tissue Re-attachment - PLLA 6mm diameter $275.00

 Johnson & Johnson Medical Pty Ltd

JJ075 Mitek Ligament Anchor  Titanium anchor 6mm x (15 to 25mm) $440.00

Prostheses List by Category, Groups and Sponsor Page 268 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ082 Mitek Mini Anchor Threader Tab Titanium Suture Anchor 1.8 x 5.4mm $287.00

JJ083 Mitek GII Anchor Threader Tab Titanium Suture Anchor 2.4 x 8.8mm $287.00

JJ084 Mitek Rotator Cuff Anchor Threader Tab Titanium Suture Anchor 2.8 x 11mm $287.00

JJ085 Mitek Super Anchor Threader Tab to bone Titanium Suture Anchor 2.8 x 11.4mm $287.00

JJ086 Mitek Tacit Anchor Threader Tab Titanium Suture Anchor 2.0 x 3.6mm $251.00

JJ087 Mitek Tacit Quick Anchor  Titanium Suture Anchor 2.0 x 3.6mm $255.00

JJ089 Mitek GII QuickAnchor Plus  Titanium Anchor, with various sutures 2.4 x 8.8mm $346.22

JJ091 Mitek Mini QuickAnchor Plus  Titanium Suture Anchor 1.8 x 5.4mm $345.00

JJ093 Mitek Rotator Cuff Quick Anchor Plus  Titanium  Anchor, with various sutures 2.8 x 11mm $345.00

JJ095 Mitek Super Quick Anchor Plus  Titanium  Anchor, with various sutures 2.8 x 11.4mm $345.00

JJ096 Mitek Fastin Anchor  Titanium Suture Anchor 3 x 8.4mm, 4 x 9.7mm, 5.2 x  $281.00

 11.5mm

JJ100 Micro Quick Anchor  Titanium Suture Anchor 1.3 x 3.7mm $289.00

Barrier, Absorbable, Adhesion Prevention

 Johnson & Johnson Medical Pty Ltd

JJ464 Divide Absorbable Adhesion Barrier Oxidised regenerated cellulose 3.8 x 5.1cmm $205.00

Bolts, Bone

 Synthes Australia Pty Ltd

SY131 AO/ASIF Intermedullary Nails Locking bolts - steel 3.9 - 4.9mm , length 18 -  $86.52

SY132 AO/ASIF Intermedullary Nails Locking bolts 3.0mm-6.0mm Dia 10-150mm  $121.06

 Length

Prostheses List by Category, Groups and Sponsor Page 269 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Bone Matrix Implants, Artificial

 Advanced Surgical Technologies

AD104 Osteoset BVF Kit Kit contains calcium sulfate, diluent,  25cc only $1,970.00

 mould, spatula and mixing bowl

AD151 Osteoset Calcium Sulphate 4.8mm pellets 10cc $1,080.00

AD152 Osteoset T Pellets Calcium sulphate with tobramycin 20cc $1,800.00

AD208 OSTEOSET - BVT KIT (STANDARD  Mini Bead Kit 5cc Standard/Fast Cure $840.00

 CURE, FAST CURE)

AD209 Osteoset Pellets - Bone Graft Substitute Calcium Sulphate 4.8mm Pellets 20cc $1,470.00

AD221 Osteoset Bone Void Filler Calcium Sulphate 3mm & 4.8mm Pellets 5cc $735.00

AD222 Osteoset Bone Void Filler Calcium Sulphate 3mm Syringe 1.25cc $566.00

AD223 Osteoset Bone Void Filler Calcium Sulphate 4.8mm Syringe 5cc $735.00

AD227 Osteoset MIIG X3 Injectable Calcium Sulphate Bone Void  5cc $1,795.00

 Filler, Includes Syringe

AD228 Osteoset MIIG X3 Injectable Calcium Sulphate Bone Void  15cc $2,730.00

 Filler, Includes Syringe

AD304 Osteoset T Pellets Calcium sulphate with tobramycin 10cc $1,490.00

 Biomet Australia Pty Ltd

BI023 Endobon Pins  Cylinder, Hydroxyapatite 13-16mm $800.00

BI024 Bone Cement Endobon Bone Substitute  Cylinder, Hydroxyapatite 9-12mm $700.00

 Material

BI025 Bone Cement Endobon Bone Substitute  Granules, Hydroxyapatite Type I or Type II $400.00

 Material

BI026 Bone Cement Endobon Bone Substitute  Block, Hydroxyapatite 5x5x10, 12.5x12.5x10, 20x20x10 $576.00

 Material

BI691 Calcigen-S Bone substitute, Calcium Sodium  5-25mls $2,875.00

Prostheses List by Category, Groups and Sponsor Page 270 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI936 GPS Bone Biologics TCP Granules/GPS, TCP 10ml $1,936.00

BI937 GPS Bone Biologics TCP Granules/GPS, TCP 20ml $2,150.00

BI938 GPS Bone Biologics TCP Granules/GPS, TCP 50ml $3,980.00

 De Puy Australia

DY353 Conduit TCP Bone matrix implant 10cc $1,980.00

DY354 Conduit TCP Bone matrix implant 15cc $2,390.00

DY355 Conduit TCP Bone matrix implant 30cc $3,340.00

DY361 Conduit TCP Conduit Blocks Size 1.  15x15x20mm to  $1,882.00

 25x25x20mm

DY362 Conduit TCP Conduit Cylinder H8-14 x D16-20mm $1,957.00

DY363 Conduit TCP Conduit Wedge H6-18 x D15 x L15 $2,195.00

DY364 Conduit TCP Conduit 20cc $2,150.00

DY427 Conduit TCP Bone matrix implant 5cc $1,570.00

 Device Technologies Australia Pty Ltd

DE194 Salu Cartilage Osteochondral implant 5mm - 25mm $931.43

 Global Manufacturing Technology Pty Limited

GM036 Callos Bone Void Filler Calcium Phosphate 10cc $2,050.00

GM037 Callos Bone Void filler Calcium Phosphate 5cc $1,400.00

 Global Orthopaedic Technology

GO051 ApaPore ApaPore 60. Sterile, hydroxyapatite-based 10ml, 2-5 & 5-10mm $1,200.00

  bone matrix

GO052 ApaPore ApaPore 60. Sterile, hydroxyapatite-based 20ml, 2-5 & 5-10ml $2,300.00

  bone matrix

GO054 ApaPore ApaPore 60. Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5  $4,500.00

  bone matrix & 5-10mm

GO055 ApaPore ApaPore 60. Sterile, hydroxyapatite-based 4cc block $1,000.00

  bone matrix

Prostheses List by Category, Groups and Sponsor Page 271 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GO057 ApaPore ApaPore 70. Sterile, hydroxyapatite-based 10ml, 2-5mm $1,430.00

  bone matrix

GO058 ApaPore ApaPore 70. Sterile, hydroxyapatite-based 20ml. 2-5 & 5-10mm $1,779.00

  bone matrix

GO059 ApaPore ApaPore 70. Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5  $4,500.00

  bone matrix & 5-10mm

GO060 ApaPore ApaPore 70. Sterile, hydroxyapatite-based 4cc block $1,200.00

  bone matrix

GO061 ApaPore ApaPore 70. Sterile, hydroxyapatite-based 10cc block $1,300.00

  bone matrix

GO062 ApaPore ApaPore 80. Sterile, hydroxyapatite-based 10ml. 2-5mm $1,000.00

  bone matrix

GO063 ApaPore ApaPore 80. Sterile, hydroxyapatite-based 20ml. 2-5mm $1,550.00 $1,600.00

  bone matrix

GO064 ApaPore ApaPore 80. Sterile, hydroxyapatite-based 4cc block $1,200.00

  bone matrix

GO065 ApaPore ApaPore 80. Sterile, hydroxyapatite-based 10cc block $2,300.00

  bone matrix

GO066 ApaPore Actifuse. Sterile, hydroxyapatite-based   1-2ml to 10cc $1,080.00 $1,200.00

 bone matrix

GO067 ApaPore Actifuse. Sterile, hydroxyapatite-based  20cc $1,470.00 $2,400.00

 bone matrix

GO068 ApaPore ApaPore 80. Sterile, hydroxyapatite-based High Volume Grafting Kit. 2-5  $4,500.00

  bone matrix & 5-10mm

 Orthotech Pty Ltd

OH237 EUROBONE - Synthetic Bone Substitute EUROBONE 5cc $1,500.00

OH238 EUROBONE - Synthetic Bone Substitute EUROBONE 10cc $1,800.00

OH239 EUROBONE - Synthetic Bone Substitute EUROBONE 20cc $2,400.00

 Stryker Australia Pty Ltd

ST020 Bonesave Calcium phosphate based granules 40gms, granule size 2-4mm $1,750.00

Prostheses List by Category, Groups and Sponsor Page 272 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST021 Bonesave Calcium phosphate based granules 40gms, granule size 4-6mm $1,750.00

 Stryker Australia Pty Ltd (3)

SR047 Stryker TCP Putty Porous tri-calcium phosphate granules  5cc $1,540.00

 and carboxymethylcellulose, sodium

 (CMC) putty additive

SR048 Stryker TCP Putty Porous tri-calcium phosphategranules and 10cc $1,940.00

  carboxymethylcellulose, sodium (CMC)

 putty additive

SR049 Stryker TCP Putty Porous tri-calcium phosphate granules  15cc $2,200.00

 and carboxymethylcellulose, sodiu,

 (CMC) putty additive

 Synthes Australia Pty Ltd

SY001 Chronos TCP Granules Porous Tricalcium Phosphate Granules 20g $1,545.00

SY002 Chronos TCP Granules Porous Tricalcium Phosphate Granules 10g $1,080.00

SY003 Chronos TCP Granules Porous Tricalcium Phosphate Granules 5g $576.80

SY004 Chronos TCP Granules Porous Tricalcium Phosphate Granules 1g $173.81

SY005 Chronos TCP Granules Porous Tricalcium Phosphate Granules 0.5g $120.67

SY176 ChronOS TCP Wedge Small, Medium, Large $1,762.03

SY177 ChronOS TCP Blocks Small, Medium, Large $1,643.24

SY189 ChronOS Cylinder Osteoconductive Bone Substitute 8.5, 9.5, 10.5, 12.5 & 14cm $980.20

SY333 Chronos Porous B Tricalcium Phosphate  Porous B-TCP Granules 2.5cc $400.00

 Granules

SY358 Cervios Cylinder Osteoconductive Bone Substitute F1, 2, 3, 4, 5 & C1, 2, 3, 4, 5 $550.00

 Taylor Bryant Pty Ltd

TB349 Kainos Granules 1 x 2cm3 $265.00

TB350 Kainos Granules 1 x 3cm3 $385.00

TB351 Kainos Granules 1x5cm3 $590.00

TB352 Kainos Granules 1x6cm3 $650.00

Prostheses List by Category, Groups and Sponsor Page 273 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB353 Kainos Granules 1x10cm3 $920.00

TB354 Kainos Granules 1x16cm3 $1,190.00

TB355 Kainos Granules 1x20cm3 $1,390.00

TB356 Kainos Granules 1x30cm3 $1,700.00

TB357 Kainos Blocks 4-8x13x14 $760.00

 Technology For Life Pty Ltd

TE016 Ceraform Cementek Bone Substitute Composite hyclroxy apitite 20-40 gram (per 20g) $1,744.00 $1,810.00

 Trans-Pacific Healthcare Pty Ltd

TR001 Berkeley Bone Void Filler Bi-Ostetic/Cem-Ostetic Granules/Blocks 2.5ml $430.00

TR002 Berkeley Bone Void Filler Bi-Ostetic/Cem-Ostetic Granules/Blocks 5ml $590.00

TR003 Berkeley Bone Void Filler Bi-Ostetic/Cem-Ostetic Granules/Blocks 10ml $1,000.00

TR004 Berkeley Bone Void Filler Bone Putty/Injectable Bone Putty 2.5-3ml $860.00

TR005 Berkeley Bone Void Filler Bone Putty/Injectable Bone Putty 5ml $1,230.00

TR006 Berkeley Bone Void Filler Bone Putty/Injectable Bone Putty 10ml $2,050.00

Bone Matrix Implants, Biological

 Stryker Australia Pty Ltd

ST865 OP-1 Implant - Osteogenic Protein 1,  Osteoinductive and osteoconductive bone 1 vial $6,400.00

  graft substitute

Caps, Bone

 De Puy Australia

DY098 Moss Miami  (Titanium) Pin Nut One size only $826.00

Prostheses List by Category, Groups and Sponsor Page 274 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Cement

 Zimmer

ZI328 Coonrad/Morrey Elbow Cement  PMMA/Plastic Extra Small, Small, Regular $318.00

Cement Dispensers, Orthopedic

 Howmedica

HW003 Exeter Cement Security System Exeter Bone Pug -  PMMA 6, 8, 10, 12, 14, 16, 18, 20mm $180.00

HW006 Exeter Cement Security System X-Change Bone Plug - PMMA 10, 12, 14, 16, 18, 20mm $268.00

 Stryker Australia Pty Ltd (2)

SK181 Simplex Enhancement System Simplex Express PrePack 2 dose Simplex Antibiotic with  $184.00

 Mixevac

Cement, Orthopedic

 Biomet Australia Pty Ltd

BI242 Palamed Bone Cement, PMMA 40gm $147.00

BI243 Palamed G Bone Cement Bone Cement, Gentamicin, PMMA 40gm $215.00

BI844 Palamed G Bone Cement Bone Cement, Methyl methacrylate,  40 gm (2 x 20 gm) $215.00

 Gentamicin

BI845 Palamed G Bone Cement Bone Cement, Methyl methacrylate,  80 gm (2 x 40 gm) $275.00

 Gentamicin

BI846 Generation 4 Bone Cement Bone Cement, Methacrylate- Styrene  40gm pack $400.00

 copolymer

BI847 Generation 4 Bone Cement Bone Cement, Methacrylate- Styrene  80gm pack $500.00

 copolymer

Prostheses List by Category, Groups and Sponsor Page 275 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI879 Palamed Bone Cement Bone Cement, Methyl methacrylate,  20gm (1 x 20 gm) $180.00

 Gentamicin

 De Puy Australia

DP107 CMW Bone Cement CMW Bone Cement Various  without  20, 40 grams $174.00

 Antibiotic

DP108 CMW Antibiotic Bone Cement  CMW Bone Cement Various with  20, 40 grams $184.00

DY084 A-BSM Bone Cement 2.5g $1,914.00

DY085 A-BSM Bone Cement 5.0g $2,670.00

DY086 A-BSM Bone Cement 10.0g $3,833.00

DY097 Vetebrplastic Cement One size only $213.00

 Global Manufacturing Technology Pty Limited

GM009 C-ment1, C-ment 3, Genta C-ment ,  Acrylic Bone Cement 40 grams $215.00 $240.00

 Genta C-ment 3

GM018 C-ment 1, C-ment 3, Genta C-ment,  Acrylic Bone Cement with Gentamicin 40 grams $215.00 $240.00

 Genta C-ment 3

 Heraeus Kulzer Australia Pty Ltd

HK001 Palacos Bone Cement with Gentamicin Single Mix PMMA with Gentamicin 40 grams $215.00 $238.00

 Howmedica

HW320 Antibiotic Simplex Bone Cement with  Polymethyl Methacrylate, Styrene  40 grams $215.00

 Tobramycin Copolymer, Barium Sulfate

HW321 Antibiotic Simplex Bone Cement Erythromycin and Colistin -  Polymethyl  40 grams $184.00

 Methacrylate, Styrene Copolymer, Barium

  Sulfate

HW322 Surgical Simplex P Radiopaque Bone  Polymethyl Methacrylate, Styrene  40 grams $137.00

 Copolymer, Barium Sulfate

 LMT Surgical Pty Ltd

LM046 Fix Ex Fix Ex bone cement is a calcium  5cc - 10cc $1,200.00

 phosphate bone cement

Prostheses List by Category, Groups and Sponsor Page 276 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mathys Orthopaedics Pty Ltd

MA431 Cemfix Acrylic bone cement for orthopaedic  CEMFIX 1 Standard viscosity;  $240.00

 CEMFIX 2 Low viscosity

 Orthotech Pty Ltd

OH126 Cemex bone cement 1 mix  1 mix 40g powder and 13.3g  $260.00

 Methylmethacrylate/Polymethylmethacryl

OH127 Cemex-genta bone cement 1 mix Methylmethacrylate/  1 mix 40g powder and 13.3g  $350.00

 Polymethylmethacrylate with gentamiacin

 Smith & Nephew Surgical Pty Ltd

SN664 Versabond Bone Cement Methy Methacrylate Methyl Acrylate  60g $240.00

 Copolymer, Methylmethacrylate

 Homopolymer, Supplied as pack of

 powder (copolymer) and 28.2ml liquid

 (monomer) in an ampule

SN667 Versabond Bone Cement Methyl Methacrylate Methyl Acrylate  40g $137.00

 Copolymer, Methylmethacrylate

 Homopolymer, Supplied as Powder

 (copolymer) and liquid (monomer) in an

 ampule

 Stryker Australia Pty Ltd (2)

SK184 VITOSS - Synthetic cancellous bone void Beta-tricalcium phosphate 1.2cc dowel $588.00

  filler

SK185 VITOSS - Synthetic cancellous bone void Beta-tricalcium phosphate 15cc morsels $1,620.00

  filler

SK186 VITOSS - Synthetic cancellous bone void Beta-tricalcium phosphate 20cc dowel $1,620.00

  filler

SK187 VITOSS - Synthetic cancellous bone void Beta-tricalcium phosphate 30cc morsels and 30cc dowels $2,670.00

  filler

SK188 VITOSS - Synthetic cancellous bone void Beta-tricalcium phosphate 10cc morsels and 10cc dowels $1,250.00

  filler

SK189 CORTOSS - Synthetic cortical bone void  - 10cc CORTOSS kit $1,535.00

Prostheses List by Category, Groups and Sponsor Page 277 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK191 VITOSS - Synthetic Cancellous bone  Beta-tricalcium phosphate 5cc morsels $588.00

 void filler

 Synthes Australia Pty Ltd

SY281 Norian SRS Reactant Pack Cement Reactant Pack 5cc $1,744.82

SY282 Norian SRS Reactant Pack Cement Reactant Pack 10cc $2,492.60

 William A Cook Aust Pty Ltd

WC145 Osteo-Firm Osteo Bone cement - Osteo Firm One size only $170.00

 Zimmer

ZI226 Zimmer Bone Plug Allen Medullary Plug 8 - 23mm $120.00

ZI232 Palacos "R" bone cement Single mix PMMA 40g $215.00

Cerclage, Orthopedic Fixation

 Smith & Nephew Surgical Pty Ltd

SN460 Wire Cerclage 0.6mmx175mm - 0.8mmx200mm $14.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

Clips, Ligating

 Smith & Nephew Surgical Pty Ltd

SN479 Compression Hip Screw System Hip Screw Clip (ambi only) One size only $81.00

Device Kits With Drugs

 De Puy Australia

DP445 VacuMix Pre Loaded CMW Cement Vaccum Mixing System Pre Loaded with  50, 80 grams $500.00

 Antibiotic Bone Cement

Prostheses List by Category, Groups and Sponsor Page 278 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Drivers

 ConMed Linvatec Australia Pty Ltd

LV028 Pre-loaded BioStinger Bio-Absorbable  Violet, PLLA 10, 13, 16mm $309.00 $350.00

 Meniscal Repair Implant

Electromanometers

 De Puy Australia

DP447 Biosel 2 BIOSEL II Dose 5G (Calcium Phosphates) 5g $695.00

Fixation Device

 Advanced Surgical Technologies

AD257 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS  Large wire 2.0-3.0 - Sizes  $500.00

 Staple - Biocompatible Nitonol 20x20x20, 22x25x22,

 30x30x30, 12x15x12

AD258 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS  Small wire 1.2-1.5 - Sizes  $390.00

 Staple - Biocompatible Nitonol 5x7x5, 7x9x7, 8x11x8,

 10x11x10, 10x13x10,

 12x15x12, 15x15x15,

AD259 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS  Asymmetric - 11x15x13,  $405.00

 Staple - Asymmetric Staples -  11x17x15, 11x17x19 &

 Biocompatible Nitonol Construction 18x18x15

AD260 OSSStaple Osteosynthesis Staple Dynamic Compression Implants OSS  Plate Staple - 15x6, 15x8, 15x10 $540.00

 Plate Staple - Biocompatible Nitonol

AD323 Charlotte Foot & Ankle System Compression Staple, Stainless Steel 13, 15, 20, 25mm interaxis, leg  $698.00

 lengths 11, 13, 15, 17, 20 &

 25mm, 10 Sizes in Total

Prostheses List by Category, Groups and Sponsor Page 279 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD324 Charlotte Foot & Ankle System Quick Staple, Stainless Steel One Size Only $235.00

 Austofix

AX023 Austofix Femoral & Tibial Nailing System 4.0/4.8 Screws; Locking; dual thd; high  Dia 4.0 - 4.8mm; Lengths 20- $120.00

 nitrogen s-s

AX024 Austofix Femoral & Tibial Nailing System F2 Femoral Nail 4.8/6.2; s-s Dia 9 - 12mm; Lengths 320 -  $1,475.00

 460mm

AX025 Austofix Femoral & Tibial Nailing System 6.2/6.5mm Hip Screw; high nitrogen s-s Dia 6.2 & 6.5mm; Lengths 70 -  $189.00

 120mm

AX026 Austofix Femoral & Tibial Nailing System F2 Hip Nail 4.8/6.5; high nitrogen s-s Dia 11mm, Length 170mm -  $760.00

 240mm

AX027 Austofix Femoral & Tibial Nailing System Washer for screws; s-s Dia 11mm & 13mm $110.00

AX028 Austofix Femoral & Tibial Nailing System K-Wire; s-s; trocar tip 1.6mm $27.00

AX029 Austofix Femoral & Tibial Nailing System End Cap; I.M. Nails; s-s 8 - 13mm $123.00

 Biomet Australia Pty Ltd

BI920 EZLoc Femoral fixation Device Ligament Anchor, Ti, PE 7-8; 9-10mm x Short, std or  $445.00

BI921 EBI Paediatric Locking Nail System Femoral Locking Nail - titanium; 28 -42cm x 5.5 - 6.5mm $1,000.00

BI922 EBI Paediatric Locking Nail System Screw Pilot Double Thread - titanium; 20 - 68mm x 4.0mm $140.00

BI923 EBI Paediatric Locking Nail System Nail end cap, titanium 5.5mm - 6.5mm $150.00

 ConMed Linvatec Australia Pty Ltd

LV078 UltraFix Knotless Minimite Suture Anchor Titanium Diameter 2.3mm $439.60 $520.00

LV089 Duet Suture Anchor Self-Reinforced 96L/4D PLA Copolymer 6.0mm O.D. x 16.5mm L $450.00

 Corin Australia Pty Ltd

CR070 Alpha Lock Titanium Counter Sunk  Titanium Counter Sunk Screw Length (mm) 15, 20, 25, 30, 35, $140.00

  40, 45, 50, 55, 60, 65 & 70

CR071 Alpha Lock Plug Screw; Alpha Lock  Titanium One Size Only $120.00

 Locking Screw

 De Puy Australia

DY380 Versa Nail TTC Fusion Nail Sterile 10mm x 15cm up to 12mm x  $1,245.00

Prostheses List by Category, Groups and Sponsor Page 280 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY381 Versa Nail TTC Fusion Nail Unsterile 10mm x 15cm up to 12mm x  $1,110.00

DY382 Versa Nail TTC Nail Cap Unsterile Impinging and  One Size $45.00 $99.00

 Non Impinging

DY383 Versa Nail TTC Nail Cap Sterile Impinging and Non  One Size $45.00 $150.00

 Impinging

DY386 Hoffman Wrist Kit Hoffman Sterile Wrist Kit One size only $1,565.00

 Global Orthopaedic Technology

GO082 Nex-Link Spinal Fixation System, Cervical Hooks 5 & 7mm $720.00

 LMT Surgical Pty Ltd

LM041 Trimed Bearing Plate, Fixation Pegs The fixation pegs are made of medical  Pegs - 2.3 x 10-34mm Threaded $140.00

 grade 316 stainless steel  or unthreaded pegs

 Orthotech Pty Ltd

OH164 Behac Humeral Nail Stainless Steel Elastic Nail Large loop and Small Loop $450.00

OH165 Telegraph Nail Stainless Steel Antegrade Nail 15cm length, 7-9mm Diameter $2,500.00

OH173 Telegraph Screws Self Stabilizing Screws 24mm - 45mm $200.00

OH203 Altius Occipito-Cervico-Thoracic (OCT)  Rod 8 to 24cm x 3.5mm Occipital  $759.00

 System and  Curved Rod

 Smith & Nephew Surgical Pty Ltd

SN772 Trigen Hindfoot Fusion Nail, Titanium Alloy 10 Diameter, 16-25cm Length $1,195.00

SN773 Trigen Hindfoot Fusion Nail, Titanium Alloy 11.5mm Diameter, 16-25cm  $1,195.00

SN776 IMHS CP Self-Captured Nail Cap, Stainless Steel standard $79.00

SN838 Trigen InterTAN Nail Nail, Titanium diameter 10-13mm $1,350.00

 length 18-46cm

 Angle 125°-135°

SN839 Trigen InterTAN Nail Lag/Compression Screw, Titanium 30-120 $410.00

SN841 Trigen META Metaphyseal Nail, Titanium 8.5-13mm $1,250.00

 15x50cm

 Stryker Australia Pty Ltd (2)

SK228 Omega Plus Compression Hip Screw  Cephalic Implants Hansson Twin Hook 50-140mm $195.00

Prostheses List by Category, Groups and Sponsor Page 281 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK229 Omega Plus Compression Hip Screw  Cephalic Implants Hansson Twin Hook  $63.00

 Compression Screw 25mm

SK230 Omega Plus Compression Hip Screw  Cephalic Implants Hansson Pin 70-140mm $335.00

SK243 Gamma LN Lag Screw - Titanium 10.5mmx70mm -  $465.00

SK244 Gamma LN Long - Titanium 120, 124, 130 Deg; Diameter  $1,350.00

 10-12mm; Length 280-420mm

SK245 Gamma LN Locking Screw - Titanium 5x25mm - 5x95mm $155.00

SK246 Gamma LN Standard - Titanium 120, 125, 130 Deg; Diameter  $995.00

 10-12mm; Length 170-200mm

SK247 Gamma LN Set Screw - Titanium 8x17.5mm $95.00

SK248 Gamma LN Proximal/Extension Plug - Titanium 0mm, +5mm, +10mm $95.00

SK304 Gamma LN Anti-rotation screw for Lag Screw -  +1, +3, +5mm $187.20

SK307 Spiral Radius 90D Rod to Rod Connector - Titanium One size only $936.00

SK310 Spiral Radius 90D Screw Offset, Clip Offset - Titanium Long & Short $936.00

SK366 Universal Distal Radius System Universal SMARTLook Locking Plates Standard, Narrow and Wide in  $1,450.00

 Long and short options

SK369 Universal Distal Radius System Leibinger Self-Tapping, Cross-Pin,  2.0mmx16mm to  $125.00

 Titanium Locking Screws/Pegs 2.0mmx26mm; 2.3mmx10mm

 to 2.3mmx38mm in 2mm

 increments; 2.7mmx10mm to

SK371 Matrix SMARTLock Polyaxial Locking  Leibinger Locking Screws 2.7mmx10mm to 2.7mmx28mm $125.00

 System for the Distal Radius  in 2mm increments

 Surgical House

SU201 Panta Arthrodesis Nail Ankle Nail, Titanium Diameter 11-13 mm  $1,000.00

 Length - 150-180 mm

SU202 Panta Arthrodesis Nail Locking Screw, Titanium Diameter 5 mm $79.00

 Length - 20 - 110 mm

SU203 Panta Arthrodesis Nail End Cap, Titanium One Size $45.00

SU204 Uni-Clip Compression Staple (Sterile) Stainless Steel, Notched and Non- Width 11-20mm, Length 13- $750.00

Prostheses List by Category, Groups and Sponsor Page 282 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SU205 Solustaple Standard Staple (Sterile) Stainless Steel 26°, 90°, 8-10mm $235.00

 Synthes Australia Pty Ltd

SY285 AO/ASIF Intramedullary Nails Helical blade 50mm-150mm length $515.00

SY292 Facet Interference Screw Cannulated Screw 7.5mm $500.00

 Taylor Bryant Pty Ltd

TB248 Avanta - SCS Distal Radius Plate System Left and Right, Tined Small, Large $1,140.00

TB250 Diamond Plate Carpal Fusion Plate Large, Small $2,092.00

TB322 I.T.S. Volar Angle Locking Plate (VAL) Locking Plate - titanium Left, Right, 25mm, 32mm,  $2,135.00

 4,6,8,10 and 12 hole

TB323 I.T.S. Volar Angle Locking Plate (VAL) Cancellous Stabilization Screw D=3.5mm, Length = 14mm- $157.00

 30mm (with incremental of 2)

TB324 I.T.S. Volar Angle Locking Plate (VAL) Cortical Screw D=3.5mm, Length=14mm- $53.00

 24mm (with incremental of 2)

TB358 Screws Diamond Carpal Screws 12, 14, 16mm $100.00

 Zimmer

ZI471 NCB-Femur Plate System Complete Complete with all locking screws, gap  Plate size 167 to 324 mm long $2,000.00

 insert, spacers. Special Titanium alloy.

ZI486 Zimmer Periarticular Locking Screws Stainless Steel Periarticular Locking  2.4mm, 2.7mm, 3.5mm,  $170.00

 screws to accompany Periarticular  4.5mm, 5.5mm, and 8mm to

 60mm in 2mm increments and

 60mm to 100mm in 5mm

ZI522 SIRUS Nail Sirus Tibial Nail 8, 9, 10mm diam x 240 to  $1,050.00

 420mm in 14mm increments

ZI523 SIRUS Nail Sirus Femoral Nail 9, 10, 11, 12, 13mm diam x 300 $1,050.00

  to 480mm in 20mm increments

ZI524 SIRUS Nail Sirus Locking Screws 3.9, 4.9mm x 24 to 100mm $138.00

ZI525 SIRUS Nail Sirus Cervical Screws 6.5mm diam x 60 to 140mm in  $219.00

 5mm increments

ZI526 SIRUS Nail Sirus End Cap 5-25mm length in 5mm  $200.00

Prostheses List by Category, Groups and Sponsor Page 283 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Fixation Device, Internal, Pin

 Australian Surgical Design & Manufacture Pty Ltd

AE069 Threaded wires & pins Threaded wires & pins 1.0-5.0mm diameters $89.00

 various threaded lengths

AE070 ASDM Steinmann Pin Steinmann Pin 2.8-5.0mm diameter $33.00

Fixation Device, Internal, Plate

 Advanced Surgical Technologies

AD314 Charlotte MTP Fusion System MTP plate, stainless steel Left & right, small & standard $600.00

AD315 Charlotte MTP Fusion System MTP plate, stainless steel Left & right, extended $730.00

AD317 Charlotte MTP Fusion System MTP plate, stainless steel, SLIM LINE Left & right $730.00

 Darco Australia Pty Limited

DC001 UPS Plate Osteotomy Plate - Titanium 12 - 30mm $450.00

DC003 Calcaneus Plate Titanium fixation plate R/L: S, M, L $1,275.00

DC012 BOW Plate Osteotomy plate, titanium 0 - 7mm $450.00

DC017 Orthner PIA Plate Fusion Plate - Titanium Flat, 2 - 8mm step $450.00

 Johnson & Johnson Medical Pty Ltd

JJ511 Skyline Cervical Plate System Skyline anterior cervical plate.  Various  Size 12-105mm $2,685.00

 size plates. Titanium

JJ525 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Plate.  Various  Level 1 Size 12 - 26mm $2,585.00

 size plates.  Titanium

JJ526 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Plate.  Various  Level 2 Size 28 - 42mm $2,635.00

 size plates.  Titanium

JJ527 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Plate.  Various  Level 3 Size 42 - 60mm $2,685.00

 size plates.  Titanium

Prostheses List by Category, Groups and Sponsor Page 284 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ528 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Screw.  Titanium Self Drilling 3.8mm 10 - 18mm $850.00

JJ529 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Screw.  Titanium Self-Tapping 3.8mm 10-18mm $850.00

JJ530 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Screw.  Titanium Self Tapping 4.3mm 10 - 18mm $850.00

JJ531 EAGLE Anterior Cervical Plate Eagle Anterior Cervical Screw.  Titanium Bi-cortical 10 - 18mm $850.00

 LMT Surgical Pty Ltd

LM033 Trimed Wrist Fixation System, Volar Peg  Stainless Steel Volar Peg Plate 3-hole, Right &  $1,300.00

 Plate Left, 4 and 5 Peg; Volar Peg

 Plate 5-hole, Right & Left, 4 and

LM037 Trimed Bearing Plate The Bearing Plate is a stainless Steel plate  3 - 9 holes $1,450.00

 that has stainless Steel pegs and Screws

 for Fixation

LM038 KMI Distal Volar Radius Plate (DVR) The DVR plates are made of titanium  DVR Plate, 4 or 5 Hole $1,340.00

 with the option of 4 hole and 5 hole

 plates, 2.1mm pegs, 2.4 or 2.8mm 

 Screws and 3.5mm proximal screws

LM039 KMI Distal Volar Radius Plate (DVR) The DVR plates are made of titanium  DVR Pegs, 2.1mm x 10-34mm $147.00

 with the option of 4 hole and 5 hole

 plates, 2.1mm pegs, 2.4 or 2.8mm 

 Screws and 3.5mm proximal screws

LM050 Biotech Easy Lock Osteosystem Titanium and PEEK 2-10 holes  straight $600.00

LM051 Biotech Easy Lock Osteosystem Titanium and PEEK 10-20 holes straight and T- $700.00

LM054 Argomedical Malleolar Plate Titanium 6 - 10 Hole Plates $460.00

LM060 BioTech Xpode 4 PEEK plate Mini and standard $1,100.00

LM062 ArgoMedical Pedofix Titanium fixed angle plate for foot surgery 2.7mm $650.00

LM064 TriMed Ulnar Osteotomy System Stainless Steel Ulnar Osteotomy Plate 5 - 9 holes $900.00

 Medical & Optical  Instruments Australia Pty Ltd

MO243 Polarus Proximal Humeral Plate Titanium Humeral Plate Left, Right, Large, Small, Two  $1,470.00

MO247 Martin Fixation Device Internal - Plate Steile Titanium Y and Double Y Plate 1.5mm system $295.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 285 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO257 Acu-Loc Distal Radius Plate System Distal radius plate, titanium Standard, long, wide, narrow,  $1,675.00

 left, right

MO272 Acumed Tap-Loc Variable angle locking plate system medial; left and right, lateral  $1,550.00

 Olecranon Left and right 6-20

 Pacific Medical

PM111 Gotfried PC.C.P. Internal Hip Compression Plate One size only $750.00

 Smith & Nephew Surgical Pty Ltd

SN831 Peri-Loc UE Locking plates SS: Distal Radius,  2.5-4.5mm, 3-14 holes $1,500.00

 Olecrannon, Humerus, Clavicle

 Surgical House

SU177 Surfix Reinforced Bendable  Composition - 316L Stainless Steel.  To  2 holes, 4 holes/77mm, 4  $810.00

 Osteosynthesis Plates be used only with Surfix Screws/lock  holes/112mm

SU178 Surfix Bendable Osteosynthesis Plates Composition - 316L Stainless Steel.  To  2-4 hole plates $740.00

 be used only with surfix screws/lock

SU179 Surfix Bendable Osteosynthesis Plates Composition - 316L Stainless Steel.  To  5 - 7 hole plates $975.00

 be used only with Surfix screws/lock

SU180 Surfix Distal Humeral Plates Composition - 316L Stainless Steel.  To  Left and right $890.00

 be used only with Surfix screws/lock

SU181 Surfix Femoral Osteosynthesis Plates Composition - 316L Stainless Steel.  To  8/9/10 hole, left and right $1,400.00

 be used only with Surfix screws/lock

SU182 Surfix Distal Femoral Varus Osteotomy  Composition - 316L Stainless Steel. To be One size only $1,150.00

  used only with surfix screws/lock screws

SU183 Surfix Femoral Varus and De-rotation  Composition - 316L Stainless Steel.  To  Surfix Femoral Varus and De- $962.00

 Osteotomy Plates be used only with Surfix screws/lock  rotation Osteotomy Plates - 3

 holes, Surfix Femoral Varus and

  De-rotation Osteotomy Plates -

 4 holes, Surfix Reinforced

 Femoral Varus and De-rotation

 Osteotomy Plates - left and right

SU184 Surfix Proximal Humeral Plate Composition - 316L Stainless Steel. To be '6 - 8 holes' $948.00

  used only with Surfix screws/lock screws

Prostheses List by Category, Groups and Sponsor Page 286 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SU185 Surfix HTO Plates Composition - 316L Stainless Steel. To be Opening wedge HTO plates, left $900.00

  used only with Surfix screws/lock   and right. Closing wedge HTO

 plates, left and right. Reinforced

  closing wedge HTO plates, left

 and right

SU193 Basal Osteotomy Plate Titanium 5 Deg, Left and Right, 10Deg,  $460.00

 Left and Right

SU194 Calcanea, Calcaneal Fracture Plate Titanium Small, Medium, Large $1,275.00

SU207 B-BOP Plantar Basal Osteotomy Plate  Titanium Moderate Correction(5°) Left,  $460.00

 (Sterile) Right. Severe Correction (10°)

 Left, Right

 Surgical Specialties Pty Ltd

SQ001 Rearfoot Plate - RPS Titanium 6-14 holes $750.00

SQ002 Arthrodesis Flat Plate - AFP Titanium 12-16mm $510.00

SQ003 Distal Radius Reconstruction System Radius Plate 2mm $1,650.00

SQ004 Distal Radius  Reconstruction System Ulna/Clavicle Plate 2mm $1,200.00

SQ005 Radius Plating System Standard 1.3mm $1,350.00

SQ006 Radius Plating System Anatomic 1.3mm $1,350.00

SQ007 Osteosynthesis Plates Straight Plate, 4 hole w/wo bar 1.2-2.7mm $140.00

SQ008 Osteosynthesis Plates Straight Plate, 5-13 hole w/wo bar 1.2-2.7mm $240.00

SQ009 Osteosynthesis Plates Plate-T, Y, L, Condylar 2x2 1.2-2.7mm $240.00

SQ010 Osteosynthesis Plates Straight Plate, 16 hole 1.2-2.7mm $320.00

SQ011 Osteosynthesis Plates Plate, 2x2+2, 3x2 1.2-2.7mm $380.00

SQ012 Osteosynthesis Plates Plate, 4x2 1.2-2.7mm $500.00

SQ013 Displacement Plate - DPS Titanium 6-10mm $600.00

 Synthes Australia Pty Ltd

SY351 AO/ASIF Plates Calcaneal Locking Plate 3.5mm, 30-100mm length $1,050.00

Prostheses List by Category, Groups and Sponsor Page 287 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB317 I.T.S Humeral Angle locking Plate (Hal) Humeral head plate 4 hole $1,385.00

Fixation Device, Internal, Screw

 Advanced Surgical Technologies

AD310 Charlotte Foot & Ankle System High demand compression screw,  6.5mm dia, 40-110mm lengths  $400.00

 cannulated, stainless steel in 5mm increments

AD311 Charlotte Foot & Ankle System Multi use compression screw,  3.0 & 4.3mm dia. 10-60mm in  $400.00

 cannulated, stainless steel 2mm increments

AD312 Charlotte Foot & Ankle System Snap-off screws, titanium alloy 2.0 dia 11, 12, 14mm. 2.7 dia  $315.00

 13, 15, 17mm

AD316 Charlotte MTP Fusion System MTP plate screw, stainless steel 2.7 & 3.2 dia. 8-24mm length in $95.00

  2mm increments

 Australian Surgical Design & Manufacture Pty Ltd

AE068 ASDM Clavicle Compression System Clavicle Compression Pin 3.2 & 4.0 mm x 50mm -  $243.00 $690.00

 Titanium Screw, Double Threaded

 ConMed Linvatec Australia Pty Ltd

LV090 Super Revo Sholder Anchor with  5.0mm dia. Titanium, 14.2mm Long  5.0mm dia. Titanium, 14.2mm  $395.00

 Herculine Suture Long Anchor

LV093 Impact Suture Anchor System with Hi-Fi  Self-Reinforced 96L/4D PLA Copolymer 3.5mm O.D. x 10.5mm L $460.00 $575.00

 Suture

 Darco Australia Pty Limited

DC004 Titanium Screw Plate locking threaded head 16 - 40mm, diameter 3.5mm $90.00

DC005 Titanium Screw Standard head, non threaded 16 - 40mm, diameter 3.5mm $90.00

DC006 Titanium Screw Cannulated, self drilling, self tapping 34 - 38mm, diameter 3.5mm $90.00

DC008 Titanium Screw Locking, self tapping 8 - 26mm, diameter 2.7mm $90.00

DC009 Titanium Screw Standard 8 - 26mm, diameter 2.7mm $90.00

DC010 Twist-off Titanium screw 11 - 15mm, diameter 2.5mm $286.00

Prostheses List by Category, Groups and Sponsor Page 288 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DC011 Twist-off Titanium screw 11 - 15mm, diameter 2.0mm $286.00

DC013 Scarf Compression screw 10 - 32mm $286.00

 De Puy Australia

DY478 Uniplate ACP System Rescue Screw 12-18mm $700.00

DY479 Uniplate ACP System Primary Screw 12-18mm $700.00

 Device Technologies Australia Pty Ltd

DE214 Cortical Screw Titanium 10-24mm x 2.3mm $110.00

 Johnson & Johnson Medical Pty Ltd

JJ512 Skyline Cervical Plate System Skyline anterior cervical screw, titanium Self drilling 3.8mm, 10-18mm $850.00

JJ513 Skyline Cervical Plate System Skyline anterior cervical screw. Titanium Self tapping 3.8mm, 10-18mm $850.00

JJ514 Skyline Cervical Plate System Skyline anterior cervical screw.  Titanium Self Tapping 4.3mm, 10-18mm $850.00

JJ515 Skyline Cervical Plate System Skyline anterior cervical screw.  Titanium Bi-cortical 10-18mm $850.00

JJ522 VIPER Spine System Viper Polyaxial Screw, Titanium 5, 6 or 7mm diameter x 25- $1,550.00

 55mm length

JJ523 VIPER Spine System Viper Pre-lordosed Rod, Titanium 35 - 70mm $340.00

JJ524 VIPER Spine System Viper Single Innie Set Screw One size $658.00

 LMT Surgical Pty Ltd

LM029 Kompressor Titanium compression screw 10-34mm $425.00

LM040 KMI Distal Volar Radius Plate (DVR) The DVR plates are made of titanium  DVR Screws, 2.4 - 3.5mm x 10 $120.00

 with the option of 4 hole and 5 hole   - 34mm

 plates, 2.1mm pegs, 2.4 or 2.8mm 

 Screws and 3.5mm proximal screws

LM048 Ascension Radial Head Locking Plate and  Titanium pre-formed anatomical radial  10mm - 40mm $160.00

 screws head Screws

LM049 Biotech omnitech The compression screws are for fixation  2-4mm diameter, 10-36mm  $425.00

 of fractures and are avaliable in titanium

 and stainless steel

LM052 Ascension Compression Screw Titanium Compression Screw 2-5mm diameter ; 12 - 40mm  $425.00

Prostheses List by Category, Groups and Sponsor Page 289 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LM059 Instratek Cannulated Bone Screws Titanium cannulated bone screws 2.3mm - 5.0mm diameter; 5 -  $440.00

 45mm length

LM061 BioTech Xpode 4 Screws titanium Mini and standard $180.00

LM063 ArgoMedical Pedofix Titanium screws 2.7mm x 8 - 28mm Length $50.00

 Medical & Optical  Instruments Australia Pty Ltd

MO249 ACU- LOC Distal Radius Plate System Threaded, non-threaded, locking, non- 2.3mm / 3.5mm diameter, 14- $145.00

 locking screw, peg, Titanium 32mm length

MO252 Martin Fixation Device Internal - Screw 2.0mm diam. Pkt 2 4-11mm $77.30 The benefit amount/minimum

 benefit amount is for an

 individual product which comes

 as a pack of two

MO253 Martin Fixation Device Internal - Screw 2.0mm diam. Pkt 2 12-20mm $125.00 The benefit amount/minimum

 benefit amount is for an

 individual product which comes

 as a pack of two

MO254 Martin Fixation Device Internal - Screw 2.3mm diam. Pkt 2 5-11mm $76.30 The benefit amount/minimum

 benefit amount is for an

 individual product which comes

 as a pack of two

MO255 Martin Fixation Device Internal - Screw 1.5-1.8mm diam. Pkt 2 3.5-9mm $142.00 The benefit amount/minimum

 benefit amount is for an

 individual product which comes

 as a pack of two

MO256 Martin Fixation Device Internal - Screw 1.5-1.8mm diam. Pkt 2 10-15mm $165.00 The benefit amount/minimum

 benefit amount is for an

 individual product which comes

 as a pack of two

MO273 Acumed Tap-Loc Tap screws, Tap-Loc Screws diameter 2.7mm - 3.5mm,  $120.00 $160.00

 length 36mm-60mm

MO274 Acutrak 2 Headless Compression screw 8mm-30mm length $425.00 $550.00

 micro, mini, standard

Prostheses List by Category, Groups and Sponsor Page 290 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthopaedic Solutions Pty Ltd

OE003 Interference Screws, Cannulated,  Interference Screws, cannulated, titanium Diameter 2-9mm, Length 10- $265.00

 titanium alloy, TioFin coated  alloy, TioFin coated, custom

 Orthotech Pty Ltd

OH167 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  Auto Compressive long L10 -  $425.00

OH168 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  FSA 2 part 9-21/14-26 $425.00

OH169 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  Weil self tapping L9 - L15 $425.00

OH170 Forefoot Snap off Screws Titanium Alloy Screws with Snap-off  Arthrodesis large diameter L28 - $425.00

  L40

 Pacific Medical

PM112 Neck, Shaft & Locking Screws Telescopic, Self-Tapping, Primary,  Neck L90 - 140mm; Primary  $190.00

 Locking L20 - 75mm

PM113 Neck, Shaft & Locking Screws Telescopic, Self-Tapping, Primary,  Shaft L31-43mm: $54.00

PM114 Neck, Shaft & Locking Screws Telescopic, Self-Tapping, Primary,  Revision Locking L20-75mm $312.00

 Smith & Nephew Surgical Pty Ltd

SN758 IMHS CP IMHS lag screw 55mm to 150mm $205.00

SN761 IMHS CP Subtrochanteric lag screw 12.7mm x 70mm to 12.7mm x  $205.00

 140mm

SN762 IMHS CP Captured locking screw 4.5mm x 22mm to 4.5mm x  $95.00

SN774 IMHS CP Captured Compression Screw, Stainless  19mm $93.00

SN775 IMHS CP Set Screw, Stainless Steel Standard $65.00

SN827 Peri-Loc UE 3.5mm Volar Distal Radius Locking Plate 60mm - 132mm $1,314.00

SN828 Peri-Loc UE 2.7mm Volar Distal Radius Locking Plate 61mm - 85mm $1,314.00

SN829 Peri-Loc UE 2.7mm Locking Recon Plate 6-14 Holes 48mm - 113mm $1,314.00

SN830 Peri-Loc UE 2.7mm Locking Self Tapping Cortex Screw 10mm - 60mm $120.00

SN832 Peri-Loc UE Self Tapping Cortex Locking Screw 2.5-2.7mm, 10-60mm length $130.00

SN833 Peri-Loc UE Self Tapping Cortex Non Locking Screw 2.5mm, 10-30mm length $50.00

Prostheses List by Category, Groups and Sponsor Page 291 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN840 Trigen InterTAN Nail Lag Screw, Titanium 70-120mm $93.00

 Surgical House

SU186 Surfix Lock Screws For use with Surfix bone screws and  One size only $114.00

SU187 Surfix Screws/Lock Screws Screws - Cancellous, Cancellous  Cancellous/Cancellous  $180.00

 cannulated, cortical, cortical cannulated  cannulated - Diameter 6.5mm,

 Length 20mm - 100mm + Lock

 Screw, Cortical - Diameter

 5.0mm, Length 25mm - 45mm

 + Lock Screw, Cortical -

 Diameter 4.5mm, Length 14mm

  - 65mm + Lock Screw,

 Cortical - Diameter 3.5mm,

 Length 16mm - 30mm + Lock

SU195 Calcanea Locking Screw Cortical Screw, Titanium Diameter 3.5mm, Length 20mm $235.00

  to 45mm

SU196 Calcanea Variable Angle Screw Cortical Screw, Titanium Diameter 3.5mm, Length 20mm $159.00

  to 45mm

SU206 Spin Screw: Snap Off Screw (Sterile) Titanium Diameter 2-3mm, Length 11- $286.00

SU208 Bold Compression Screw (Sterile) Cannulated Titanium 10-34mm $286.00

 Surgical Specialties Pty Ltd

SQ014 Osteosynthesis Screws Screw, Self Tapping or Lag 1.2, 1.7, 2.3mm $75.00

SQ015 Osteosynthesis Screws Screw, Emergency 1.4, 1.9, 2.4mm $75.00

SQ016 Osteosynthesis Screws Screw, Locking or Standard 2.7mm $100.00

SQ017 CBS Screw Titanium Compression Screw,  1-1.5mm $410.00

SQ018 CBS Screw Titanium Compression Screw, Non  1.5mm $330.00 $410.00

 Cannulated

SQ019 Cannulated Screw Titanium 3.5mm $155.00

 Taylor Bryant Pty Ltd

TB318 I.T.S Humeral Angle locking Plate (Hal) Cortical Screw D=4.5mm, L=24-36mm Special  $70.00

 lengths 40-80mm

TB319 I.T.S Humeral Angle locking Plate (Hal) Concellous stabilisation screw D=4.2mm, L=38-60mm special  $80.00

 lengths 10-36mm

Prostheses List by Category, Groups and Sponsor Page 292 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TB320 I.T.S Claviclar Angle Locking Plate  Claviculaplate - Titanium $1,310.00

TB321 I.T.S Claviclar Angle Locking Plate  Stabilisation Screw - TiAL6V4 EL1.  3.5mm, 14mm to 24mm $147.00

 Surface Treatment - Doltise

TB327 MiniFix Finger Mini Fixator System One size $3,328.00

TB329 PIP Finger Prosthesis 'DGT" Proximal part Stainless Steel textured in  1,2 or3 $1,248.00 Tempory approval, pending

 Cobalt Chrome review of product group

TB331 RadioFix Radio Fixator System One size $2,080.00 Tempory approval, pending

 review of product group

TB343 Minos Screws Titanium 2-3mm diameter x 9-21mm  $390.00

TB345 Weil Screws Titanium 7-17mm $390.00

 TiMax Surgical Pty Ltd

TI094 Atlantech graft fixation screw - titanium Titanium ACL Screw 7 x 20mm, 7 x 25mm, 7 x  $161.00

 30mm,  8 x 20mm, 8 x 25mm,

 8 x 30mm, 9 x 20mm, 9 x

Fixation device, internal, spine, construct

 Zimmer

ZI488 Silhouette Transverse Connector Insert Titanium one size only $158.00

Fixation Device, Internal, Staple

 Orthocare Pty Limited

OC013 Orthomed Osteotomy & Ligament Staples Ligament Staple.  Cast Chromium-cobalt  8mm $80.00

 staples, non-absorbable. Non-sterile

OC014 Orthomed Osteotomy & Ligament Staples Ligament Staple.  Cast Chromium-cobalt  11mm $80.00

 staples, non-absorbable. Non-sterile

OC015 Orthomed Osteotomy & Ligament Staples Ligament Staple.  Cast Chromium-cobalt  16mm $80.00

 staples, non-absorbable. Non-sterile

Prostheses List by Category, Groups and Sponsor Page 293 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Fixation Device, Internal, Wire

 De Puy Australia

DP363 Control Cable Control Cable sleeve  One size only $240.00

DP364 Control Cable with Sleeve Control Cable with sleeve  One size only $350.00

 LMT Surgical Pty Ltd

LM065 TriMed Olecranon Sled Stainless Steel Wire Form Length 40-90mm $298.00 $600.00

LM066 TriMed Olecranon Sled Washer one size $200.00

Fixation Plate, Fracture-healing, non-biodegradable

 Johnson & Johnson Medical Pty Ltd

JJ518 AEGIS ALP AEGIS ALP Curved Anterior Plate,  4 - 13mm $2,685.00

JJ519 AEGIS ALP AEGIS ALP Bone Screws, Titanium 4mm x 24-36mm $850.00

Gel, Resorbable, Antiadhesion

 Advanced Surgical Technologies

AD066 Adcon Anti-Adhesion Barrier Gel Adcon Gel 3 gram $730.00 Temporary Approval - Funded

 when clinical indications for use

 are present.

AD067 Adcon Gel for Tendons Adcon Gel 1 gram only $560.00 Temporary Approval - Funded

 when clinical indications for use

 are present.

Prostheses List by Category, Groups and Sponsor Page 294 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Graft Kit, Spinal Fusion

 Medtronic Australasia Pty Ltd

MC682 Infuse Bone Graft Recombinant human Bone Morphogenetic Small 4.2mg $3,200.00 Temporary approval pending

  Protein rhBMP-2 review of listing criteria

MC683 Infuse Bone Graft Recombinant human Bone Morphogenetic Medium 8.4mg $6,000.00 Temporary approval pending

  Protein rhBMP-2 review of listing criteria

MC684 Infuse Bone Graft Recombinant human Bone Morphogenetic Large 12mg $6,400.00 Temporary approval pending

  Protein rhBMP-2 review of listing criteria

Grafts, Bone

 Orthotech Pty Ltd

OH003 Pro-Osteon Implants 500 Granules 10mm x 10mm x 10mm (1cc)  $430.00

OH004 Pro-Osteon Implants 500 Granules 10mm x 10mm x 40mm (4cc)  $1,325.00

OH005 Pro-Osteon Implants 500 Granules 10 x 20 x 50mm (10cc) Block $2,540.00

OH008 Pro-Osteon Implants 500 Granules 10cc $1,110.00

OH010 Pro-Osteon Implants 500 Granules 20cc $1,600.00

OH014 Pro-Osteon Implants 200 Block 20 x 15 x 10mm Block $825.00

OH016 Pro-Osteon Implants 200 Block 0.8cc x 5 Syringes Grannules $200.00

OH055 Pro Osteon Implants 200 Granules, Porous Hydroxyapatite Bone  5cc Syringe $280.00

 Void Filler

 Stryker Australia Pty Ltd (2)

SK219 Stryker Plating System Periarticular Plates Femoral Plate 4.5/6.5mm $1,004.00

SK220 Stryker Plating System Periarticular Plates Tibial Plate 4.5/6.5mm $1,004.00

SK221 Stryker Plating System Periarticular Plates Tibial Plate 3.5/4.0mm $1,004.00

Prostheses List by Category, Groups and Sponsor Page 295 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Surgical House

SU176 MBCP Wedge Composition - 60% hydroxyapatite / 40% MBCP Wedge - 6 degrees to 14  $1,430.00

  Ca3(PO4)2 To be used in combination  degrees

 with Surfix Opening Wedge HTO Plates

 and screws/lock screws

 Zimmer

ZI265 Continuum hip system Hedrocel AVN Rod 3mm - 12mm block $3,208.00

ZI270 Hedrocel block Hedrocel tantulum 2 x 4 x 4mm $3,833.00

ZI272 Hedrocel cylinder Hedrocel tantulum 10mm long $2,787.00

ZI273 Hedrocel half tube Hedrocel tantulum 10mm long $2,787.00

ZI274 Hedrocel Bone Grafts Trabecular Metal (Porous Tantalum) 3.2 - 5.7mm diameter; 36 -  $235.00

 48mm long

Grafts, Bone, Synthetic

 Biomet Australia Pty Ltd

BI946 Calcibon Granules or paste, TCP 10cc $1,080.00

BI947 Calcibon Granules or paste, TCP 20ml $1,545.00

BI948 Calcibon Granules or paste, TCP 50ml $3,000.00

 De Puy Australia

DP509 Brantigan I/F Cage AETI  (Endoscopic) C/F  Cage Wedge 7-13mm x 9-15mm x  $3,096.00

 21-25 mm

DP510 Brantigan I/F Cage PLIF C/F Cage  Straight / Wedge $2,675.00

 Device Technologies Australia Pty Ltd

DE082 Hatric Bone Substitute Ceramic 7mm - 15mm $1,560.00

Prostheses List by Category, Groups and Sponsor Page 296 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DE130 MBCP Micro & Macroporous Biphasic Calcium  0.5-1mm (1cc) $255.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE131 MBCP Micro & Macroporous Biphasic Calcium  0.5-1mm (2cc) $255.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE132 MBCP Micro & Macroporous Biphasic Calcium  1-2mm (2cc) $255.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE133 MBCP Micro & Macroporous Biphasic Calcium  1-2mm (10cc) $510.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE134 MBCP Micro & Macroporous Biphasic Calcium  2-3mm (2cc) $255.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE135 MBCP Micro & Macroporous Biphasic Calcium  2-3mm (10cc) $510.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

DE136 MBCP Micro & Macroporous Biphasic Calcium  2-3mm (16cc) $720.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, granules

Prostheses List by Category, Groups and Sponsor Page 297 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DE137 MBCP Micro & Macroporous Biphasic Calcium  5 x 5 x 10-20mm $350.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

DE138 MBCP Micro & Macroporous Biphasic Calcium  5-12mm $615.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, wedges,

DE139 MBCP Micro & Macroporous Biphasic Calcium  5 x 12 to 15 x 13 $615.00

 Phosphate, composition - ceramic

 consituting calcium phosphate

 hydroxyapatic 60% and tricalcium

 phosphate beta (TCP) 40%, wedges,

 Medical & Optical  Instruments Australia Pty Ltd

MO259 ALLOGRAN N Hydroxyapatite Bone Graft 3.5mm granules 10cc $580.00

MO260 ALLOGRAN N Hydroxyapatite Bone Graft 3.5mm granules 20cc $780.00

MO261 ALLOGRAN N Hydroxyapatite Bone Graft 3.5mm granules 70cc $1,400.00

MO262 STIMULAN Calcium Sulphate Pellets 3mm pellets 5cc $450.00

MO263 STIMULAN Calcium Sulphate Pellets 3mm pellets 10cc $600.00

MO264 STIMULAN Calcium Sulphate Pellets 4.8mm pellets 10cc $600.00

MO265 STIMULAN Calcium Sulphate Pellets 4.8mm pellets 20cc $950.00

MO266 STIMULAN Calcium Sulphate Pellets 3mm pellets 1.5cc Dispenser $450.00

MO267 STIMULAN Calcium Sulphate Pellets 4.8mm pellets 5cc Dispenser $730.00

MO268 STIMULAN Calcium Sulphate Injectable Paste incl.  5cc $1,200.00

 powder mixing solution

MO269 STIMULAN Calcium Sulphate Injectable Paste incl.  10cc $1,800.00

 powder mixing solution

MO275 Allogran R Beta Tri-Calcium Phosphate Resorbable  2mm Granules 5 cc $540.00

 Bone Graft

Prostheses List by Category, Groups and Sponsor Page 298 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO276 Allogran R Beta Tri-Calcium Phosphate Resorbable  2mm Granules $750.00

 Bone Graft 10 cc

MO277 Allogran R Beta Tri-Calcium Phosphate Resorbable  2mm Granules $1,200.00

 Bone Graft 20 cc

 Orthotech Pty Ltd

OH019 Bone Plast Bone Void Filler Powder 20cc $1,903.00

 Smith & Nephew Surgical Pty Ltd

SN672 JAX Advanced Bone Void Filler Two components, granules composed of  10cc $801.00

 calcium sulphate, stearic acid &

 magnesium sulphate & an aqueous gel of

 carboxymethylcellulose, sterile water &

 glycerol

SN674 JAX Advanced Bone Void Filler Two components, granules composed of  4cc $622.00

 calcium sulphate, stearic acid &

 magnesium sulphate & an aqueous gel of

 carboxymethylcellulose, sterile water &

 glycerol

 Synthes Australia Pty Ltd

SY331 Norian CRS/SRS Fast Set Putty 5cc $1,694.00

SY332 Norian CRS/SRS Fast Set Putty 10cc $2,420.00

Guides, Gigli Saw

 Smith & Nephew Surgical Pty Ltd

SN451 Wire Kirschner, Trocar & Bayonet Point 1.3mmx140mm $11.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

SN452 Wire Kirschner, Sterile 0.6-2.0mm Diameter, 70 &  $11.00 To be funded where any or all K-

 150mm Length wires used in a procedure are

 used as an implant.

Prostheses List by Category, Groups and Sponsor Page 299 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN453 Wire Kirschner, Diamond Point (2 point&  228.6mm Length 0.85-1.5mm $11.00 To be funded where any or all K-

 Single), Non Sterile wires used in a procedure are

 used as an implant.

SN454 Wire Kirschner, Diamond Point (2 point&  304.8mm Length 0.85-1.5mm $11.00 To be funded where any or all K-

 Single), Non Sterile wires used in a procedure are

 used as an implant.

SN455 Wire Kirschner, Diamond Point (2 point), Non  127mm Length 0.85-1.5mm $11.00 To be funded where any or all K-

 Sterile wires used in a procedure are

 used as an implant.

SN456 Wire Kirschner, Diamond Point (2 point), Non  177.8mm Length 0.85-1.5mm $11.00 To be funded where any or all K-

 Sterile wires used in a procedure are

 used as an implant.

SN457 Wire Kirschner, Trocar Points (2 Point &  101.6mm Length 0.76-1.5mm  $11.00 To be funded where any or all K-

 single), Sterile Diameter wires used in a procedure are

 used as an implant.

SN458 Wire Kirschner, Threaded Diamond Point (2  228.6mm Length 0.85-1.5mm $11.00 To be funded where any or all K-

 point& Single), Non Sterile wires used in a procedure are

 used as an implant.

Hip - Acetabular Components

 Portland Orthopaedics (Aust) Pty Ltd

PD020 Equator Plus Cup Bone Screw 6.5mm x 15mm - 50mm $225.00

 Group 18a - Cups, cemented, hooded and unhooded, unmodified polyethylene

 Advanced Surgical Technologies

AD125 WMT Acetabular Cups All Poly UHMWPE 42 - 68mm in 2mm increments $504.00

 B Braun Australia Pty Ltd

BB236 Polyethylene Acetabular Cup Chirulen 22.2mm-32mm articulations;  $780.00

 40mm-64mm diameters

Prostheses List by Category, Groups and Sponsor Page 300 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Corin Australia Pty Ltd

CR042 Cenator Hip System Acetabular Cup, Ultra High Molecular  Dia 40 - 62mm, 22, 26, 28  $572.00

 weight Polyethylene

 De Puy Australia

DP115 Duraloc Enduron Liner Polythene Liner in Neutral or 10 or 20  22.225 or 26 or 28 or  32mm  $884.00

 Degree or +4 size 48-74

DP172 PLAD Wroblewski Cup  Angle bore Left and  22mm $695.00

 Right UHMWP

DP173 PLAD PLAD for cups S/S and Polyethylene 22.225mm, 26mm and 28mm $695.00

DP182 Charnley Hip System  Polythene, OGEE or LPW or FLANGED 22.225 or 28 or 32, 40 to 53mm $858.00

DP563 Wroblewski Cup Golf Ball Left and right UHMWP 22mm size 40-53mm $884.00

 ESKA Australia

EK019 ESKA Modular All Poly Cup Snap $572.00

 Global Manufacturing Technology Pty Limited

GM022 Edinburgh Total Hip System (Acetabular  Acetabular Cup UHMWPE 44mm to 56mm $884.00

 Component)

 Link Orthopaedic  Australia

LO018 LINK Lubinus SP Hip Prosthesis Cup: Muller 44 - 58mm, 40mm $553.00

 Orthotech Pty Ltd

OH105 Lima Total Hip Replacement System Mueller UHMWPE Cup (Cemented) 44 - 62mm $884.00 $1,924.00

OH154 Coriolis Polyethylene Cup Dia Int. 22-28 -32/ Dia Ext. 40- $884.00 $1,924.00

 Plus Orthopedics Australia Pty Ltd

PL044 PLUS Hip Joint Prosthesis System PLUS PE cemented cup 42 -64mm dia $489.00

 Smith & Nephew Surgical Pty Ltd

SN288 Reflection Acetabular Cup 22 - 36mm, 42 - 76mm $572.00

 Stryker Australia Pty Ltd

ST552 Osteonics hip prostheses All poly cup polyethylene OD: 46-61mm.  ID: 22, 26, 28,  $832.00

 32mm

Prostheses List by Category, Groups and Sponsor Page 301 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI027 Acetabular Cup Zimmer Cemented Acet. (ZCA) -  47 - 61 $695.00

 Polyethylene

ZI368 Apollo Hip System Apollo Hooded Cement Acetabular Cup -  28/46mm to 28/62mm $813.00

ZI383 MS30 Hip - Cups Cemented Low Profile with Metasul - PE with  38 to 58mm  $2,354.00

 special metal alloy

 Group 18b - Cups, cemented, hooded and unhooded, modified polyethylene

 Biomet Australia Pty Ltd

BI030 Scientific Hip Prostheses System Acetabular Component UHMWPE,  22, 26,28mm x (46-60mm)  $936.00

BI064 Bioclad Hip System Acetabular Cup,  UHMWPE 22,28,32mm, size 39-69mm $936.00

BI067 Stanmore Total Hip System Acetabular Cup, UHMWPE  25-32mm x size 40-53mm $843.00

 Howmedica

HW029 Contemporary Hip System Range Duration Poly Cup -  Enhanced  ID: 26, 28, 32.  OD 46, 48, 50,  $936.00

 52, 54, 56, 58, 60

HW030 Contemporary Hip System Range Exeter Contemporary Flanged Poly Cup -  ID: 26, 28, 32.  OD 46, 48, 50,  $936.00

  Enhanced Polyethylene 52, 54, 56, 58, 60

HW035 Exeter Hip System Exeter Duration Cup - Enhanced  OD:40-60mm, ID: 22, 26, 28,  $936.00

 Polyethylene -  Low and High Profile

HW036 Exeter Hip System Exeter Duration X-Tra Cover Cup -  OD:40-60mm, ID: 22, 26, 28,  $936.00

 Enhanced Polyethylene

 Mathys Orthopaedics Pty Ltd

MA027 CCB Cemented Cup Full profile / low profile special cup 28/32 ID - 42/64 OD $574.00

 Orthotech Pty Ltd

OH104 Lima Total Hip Replacement System Mueller Ceramic and UHMWPE Cup  44 - 62mm $1,768.00

 (Cemented)

 Smith & Nephew Surgical Pty Ltd

SN282 Opera Acetabular Cup Flanged UHMWPE 22 - 28mm; 40 - 53mm $555.00

SN695 Opera Acetabular Cup Flanged - XLPE 22-36mm, 42-76mm $790.00

Prostheses List by Category, Groups and Sponsor Page 302 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN696 Reflection Acetabular Cup - XLPE 22-36mm,40-61mm $790.00

 Stryker Australia Pty Ltd

ST013 Hip - Trident All Polyethelene Cup Enhanced Polyethylene 40-64mm(Outer Diameter) $936.00

 Zimmer

ZI314 ZCA All Poly Acetabular Cup - XLPE Highly crosslinked ultra high molecular  22, 26, 28 & 32 mm heads; 47- $1,768.00

 weight polyethylene 61mm diameter; flanged and

 non-flanged

ZI384 MS30 Hip - Cups Cemented Low Profile - PE 22/36 to 32/64 $494.00

 Group 18c - Cups, cemented, constrained, modified and unmodified polyethylene

 Biomet Australia Pty Ltd

BI091 Kasselt Acetabular Cup System Acetabular Cup, UHMWPE 46-70mm $832.00

 ESKA Australia

EK020 ESKA Modular All Poly Cup Snap Lock $572.00

EK021 ESKA Modular All Poly Cup Assymetric 10 degree $572.00

 Howmedica

HW043 Brunswick Cup Polyethylene 44, 48, 50, 52, 54, 56mm OD $832.00

 Link Orthopaedic  Australia

LO019 LINK Lubinus SP Hip Prosthesis Eccentric 44 - 58mm $718.00

 Group 18d - (to be added)

 Plus Orthopedics Australia Pty Ltd

PL146 POLAR CUP ACETABULAR CUP  DUAL MOBILITY VPS SHELL  43-63MM $1,800.00

 CEMENTED

 Group 19a - Shell, uncemented, Grit blast, not HA

 Advanced Surgical Technologies

AD113 Transcend Articulation System Transcend cup - titanium 42 - 74mm in 2mm increments $2,076.00

Prostheses List by Category, Groups and Sponsor Page 303 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD126 WMT Interseal Acetabular Shells and  Titanium acetabular shell 42 - 68mm in 2mm increments $2,076.00

 Mathys Orthopaedics Pty Ltd

MA439 ExpanSys Cup Cementless acetabular component for hip  acetabular shell/cup 44-72mm  $3,640.00

 arthroplasty titanium expandable cup with

  either p/e or m/m inlay

MA440 ExpanSys Cup Cementless acetabular component for hip  UHMW-PE inlay 44-72mm  $936.00

 arthroplasty titanium expandable cup with

  either p/e or m/m inlay

MA442 seleXys Shell Modular Keramed titanium acetabular  44-72mm (2mm increments) $2,808.00

 component to include

 MACROFIT/TRISTABIL/UNICUP

 Plus Orthopedics Australia Pty Ltd

PL020 PLUS Hip Joint Prostheses System Bicon-PLUS Cup 1 to 9 $2,569.00

PL051 Bicon - PLUS Cementless Cup 01, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 $2,569.00

PL059 PLUS Hip Joint Prostheses System Acetabular Shell 3-11 $2,704.00

 Group 19b - Shell, uncemented, Grit blast, HA

 B Braun Australia Pty Ltd

BB243 Plasmacup Isotan 44mm-68mm $2,080.00

 ESKA Australia

EK010 Metal Shell Type 2000/2000 Plus Metal Shell Screwless or screw fixation $2,496.00

 Howmedica

HW014 ABG 11Cup with Hydroxyapatite ABG11 Acetabular Cup - HA  Sizes 42mm to 74mm OD in  $2,600.00

 2mm increments

HW015 ABG 11Cup with Hydroxyapatite ABG II Ceramic Cup - HA coated/Titanium Sizes 44mm to 66mm OD in  $2,600.00

 2mm increments

 Link Orthopaedic  Australia

LO032 CFP Cup ( TOP CUP) - 40 - 68mm $1,872.00

Prostheses List by Category, Groups and Sponsor Page 304 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH094 Lima Total Hip Replacement System Uncemented Cup with HA/Porous Coat 44 - 66mm $2,600.00

OH140 Atlas Acetabular Cup System Titanium & HA Atlas Cup 40-74mm $2,600.00

OH143 Atlas Acetabular Cup System Titanium & HA Atlas Screw Dia 6.5mm 15- $312.00

 Plus Orthopedics Australia Pty Ltd

PL144 POLAR CUP ACETABULAR CUP  DUAL MOBILITY  VPS SHELL GRIT  43-67MM $2,500.00 $2,600.00

 BLASTED HA

PL145 POLAR CUP ACETABULAR CUP  DUAL MOBILITY VPS SHELL GRIT  43-67MM $3,500.00 $4,900.00

 BLASTED HA WITH PEGS AND

 FLANGES

 Stryker Australia Pty Ltd (2)

SK092 ABG Cup with Hydroxyapatite ABGII Acetabular HA Shell with 32mm  52,54mm OD $5,096.00

 ID ceramic insert

 Group 19c - Shell, uncemented, Beaded, not HA

 Advanced Surgical Technologies

AD103 Lineage Acetabular System Titanium Shells 40 - 80mm in 2mm  $2,435.00

 increments

AD226 Lineage Acetabular System Titanium Deep Profile Multi Hole  46 - 74mm in 2mm increments $2,435.00

 Acetabular Shell

 De Puy Australia

DP360 Sector Cups Sector  (Titanium) Size 48 to 66 $2,435.00

DP361 Solution Deep Profile Cup Deep Profile Titanium Size 56 - 80 mm $2,435.00

DP551 Bantam Shells Bantam Titanium Size 38 - 46 $3,640.00

DP558 Duraloc 100  Series Cup 100 series Titanium Size 48 - 66 $2,096.00

DP975 SROM Total Hip System (Titanium) Obolong Ace both left and right   28mm & 32mm size 51+E15N - $8,840.00

  66+E15N

DY010 SROM Total Hip System (Titanium) ZTT1 & 2 or arthropor 1& 2 or Super  39 - 72 mm $2,435.00

 Cup or Gripper

Prostheses List by Category, Groups and Sponsor Page 305 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Howmedica

HW068 Vitalock Acetabular System Solid-Back Cup -  Vitallium/Porous  42 to 76mm OD in 2mm  $2,435.00

HW069 Vitalock Acetabular System Cluster Cup -  Vitallium/Porous Coated 42 to 76mm OD in 2mm  $2,435.00

 Smith & Nephew Surgical Pty Ltd

SN285 Reflection Acetabular Cup, Porous Titanium Alloy 42 - 80mm $2,435.00

SN287 Reflection Acetabular Cup Titanium Alloy 42 - 76mm $2,318.00

SN290 Reflection Acetabular Shell Ceramic, Porous  46-66mm OD $2,141.00

 Titanium Alloy

 Group 19d - Shell, uncemented, Beaded, HA

 Advanced Surgical Technologies

AD119 Transcend/Lineage Articulation System Titanium HA coated cup 42 - 74mm in 2mm increments $3,276.00

AD287 Orion Acetabular Cup Uncemented, Beaded Acetabular Cup, HA 46-64mm in 2mm increments  $3,276.00

  coated total of 11 sizes

 Australian Surgical Design & Manufacture Pty Ltd

AE038 Heco Hip System  Titanium Cup Implant 42mm - 76mm $3,120.00

 De Puy Australia

DP557 Duraloc Cup Sector or 100 series Polished inner or  Inner 48 to 66 $2,652.00

 polisherd Titanium or  HA

DY031 Option Cup system  Option Ha  46-66 mm $2,860.00

DY278 Pinnacle Acetabular Cup System Pinnacle 100 or 300 or Sector or 1200,  38-80mm $3,276.00

 STD or HA Acetabular Cup

 Finsbury Orthopaedics Australia Pty Ltd

FI002 ADEPT MoP Acetabular Component Porocast Acetabular Shell, CoChr, HA  44-66 outer diameter going up in $3,640.00

 coated size 44-66mm + poly liner  2mm increments

FI003 ADEPT MoP Acetabular Component Porocast Acetabular Shell, CoChr, HA  44-66 Outer diameter going up  $4,160.00

 coated size 44-66mm + poly liner, Extra  in 4mm increments

FI004 ADEPT CoC Acetabular component Porocast Acetabular Shell, CoChr, HA  44-66 Outer diameter going up  $5,200.00

 in 2mm increments

Prostheses List by Category, Groups and Sponsor Page 306 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

FI005 ADEPT CoC Acetabular component Porocast Acetabular Shell, CoChr, HA  44-66 Outer diameter going up  $5,720.00

 coated, ceramic liner, Extra Fixation in 4mm increments

 Global Orthopaedic Technology

GO040 Consensus Hip System Acetabular Shell Porous/HA Ti 42mm to 68mm $3,276.00

 Howmedica

HW070 Vitalock Acetabular System PA Solid-Back and Cluster Cup -   42 to 76mm OD in 2mm  $2,652.00

 Vitallium/Periapatite coated

 Smith & Nephew Surgical Pty Ltd

SN260 Axis  HA Cup Titanium Alloy Axis Shell 44 - 60mm  Axis II  $2,652.00

 Shell  44 - 64mm

SN286 Reflection Acetabular Cup HA Coated Titanium  42 - 80mm $2,652.00

SN688 Reflection HA Coated acetabular ceramic cup Sizes 45 - 66 $2,652.00

 Group 19e - Shell, uncemented, Mesh, not HA

 Zimmer

ZI034 Acetabular Cup Trilogy Shell - Titanium 38 - 80 $2,435.00

ZI042 Acetabular Cup Trilogy AB Multi-Hole Shell - Titanium 48 - 70 $2,435.00

ZI386 Fitmore Cup Uncemented Cup - Fitmore - Ti alloy 42 to 68mm $2,435.00

 Group 19f - Shell, uncemented, Mesh, HA

 Zimmer

ZI035 Acetabular Cup Trilogy HATCP Shell - Titanium 38 - 80 $2,730.00

ZI041 Acetabular Cup Trilogy AB HA/TCP Cluster Hole Shell -  38 - 80 $2,730.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 307 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 19g - Shell, uncemented, Plasma, not HA

 Biomet Australia Pty Ltd

BI028 Asian Hip System Acetabular Cup, UHMWPE, Chrome  28mm x (44-60mm) $2,080.00

 Cobalt Cemented

BI038 Rx90 Hip System Acetabular Cup and liner, Titanium Alloy,  40-70mm $2,080.00

 UHMWPE, Cementless / Cemented

BI065 Vision Acetabular System Acetabular Cup System, Cemented,  9-19mm $2,080.00

 Cementless, Titanium, Chrome Cobalt,

 UHMWPE

BI111 Mallory Head Hip System Acetabular Shell, Titanium 40-80mm $2,080.00

BI699 McLauglin Plus 5 Acetabular Shell Acetabular Titanium Shell 46 - 80mm $2,080.00

 Plus Orthopedics Australia Pty Ltd

PL022 PLUS Hip Joint Prostheses System EP Fit Multi/Hole Cup 40 - 68mm Dia $2,912.00

PL079 Plus Hip Joint Prostheses System Acetabular Shell 42-68 $2,444.00

PL106 PLUS Hip Joint Prosthesis System MPF Cup - Acetabular shell 46/39 to 64/48 $2,444.00

PL117 PLUS Hip Joint Prosthesis System MPF Cup - Revision shell 46/39 to 72/52 $2,444.00

PL140 POLAR CUP ACETABULAR CUP  DUAL MOBILITY SHELL TITANIUM  43-67MM $2,350.00 $2,600.00

PL141 POLAR CUP ACETABULAR CUP  DUAL MOBILITY SHELL TITANIUM  43-67MM $3,350.00 $5,000.00

 VPS WITH PEGS AND FLANGES

 Portland Orthopaedics (Aust) Pty Ltd

PD016 Equator Plus Cup 3-Hole, plasma sprayed shell 44-70 $2,350.00

PD017 Equator Plus Cup 5-hole plasma sprayed shell 44-70 $2,350.00

 Stryker Australia Pty Ltd (2)

SK128 Trident Acetabular Component System Trident Hemispherical Acetabular Shells.  Shell sizes 42mm - 74mm OD $2,444.00

 Made of Titanium (Ti-6A1-4V) with an

 Arc Deposit Surface

Prostheses List by Category, Groups and Sponsor Page 308 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 19h - Shell, uncemented, Plasma, HA

 Biomet Australia Pty Ltd

BI101 Bi Hapro Hip System Ringloc Cup, HAP Coating uncemented 46mm to 70mm $2,704.00

BI110 Mallory Head Hip System Acetabular Shell, HAP Coated, Titanium 40-80mm $2,704.00

BI112 Mallory Head Hip System Acetabular Shell, Solid, HAP Coated,  40-80mm $2,704.00

 Titanium

BI770 Exceed Acetabular System Shell, Ti Shell sizes 40-70mm $2,704.00

BI917 Rim Cup Acetabular Shell Porous/HA Ti 44 to 64mm $2,704.00

 Corin Australia Pty Ltd

CR019 DC Fit Cup Metal Backed CoCr cup, Cor plasma spray with HAP  42mm-70mm $1,976.00

 coating, with/without screws

CR074 Alpha Lock Plus Titanium Hip Cup Titanium hip cup with special pre-closed  42 - 70mm Diameter $2,288.00

 fixation holes for self-tapping counter

 sunk screws, UHMWPE inlay.

CR085 Alpha Cera Fit Hip Cup Cup is made of High Grade Titanium  42, 44, 46, 48, 50, 52, 54, 56,  $2,288.00

 Alloy with Bonit coating 58, 60, 62, 64, 66, 68, 70, &

 Global Manufacturing Technology Pty Limited

GM017 Cer-Met Series II (Acetabular Component) Acetabular Shell Porous/HA Ti 46mm to 66mm $2,704.00

GM047 Contile Fin II Acetabular Shell Porous HA Ti 44 to 72mm $2,704.00

 Plus Orthopedics Australia Pty Ltd

PL142 POLAR CUP ACETABULAR CUP  DUAL MOBILITY SHELL TITANIUM  43-67MM $2,600.00 $2,800.00

 VPS HA

PL143 POLAR CUP ACETABULAR CUP  DUAL MOBILITY SHELL TITANIUM  43-67MM $3,600.00 $5,800.00

 VPS HA WITH PEGS AND FLANGES

 Stryker Australia Pty Ltd

ST548 Trident acetabular component system  Trident shell,  titanium - HA coated 40-74mm OD in 2mm  $2,704.00

ST554 Osteonics secur-fit - HA PSL acetabular  Secur-fit PSL shell  titanium - HA coated OD: 40-72mm in 2mm  $2,704.00

Prostheses List by Category, Groups and Sponsor Page 309 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST555 Osteonics secur-fit - HA PSL acetabular  Secur-fit ABC shell  titanium - HA coated  OD: 40-72mm in 2mm  $2,704.00

  for use with ceramic liners

ST558 Osteonics secur-fir HA PSL acetabular  Secur fit  XTRA shell, titanium - HA  48-80mm OD in 2mm  $2,704.00

 coated  peripheral screw holes

ST933 Trident Multi-Hole Acetabular Shell Composition - Titanium (Ti-6AL-4V)  Shell sizes: 42 - 74mm OD $2,704.00

 with Arc Deposit Surface and Pruefix HA

 Stryker Australia Pty Ltd (2)

SK198 Trident Acetabular Component System HA coated hemispherical acetabular cup  40mm OD through to 74mm  $2,704.00

 (HA= Hydroxyapatite) OD (OD= Outer Diametre)

 Taylor Bryant Pty Ltd

TB068 Groupe Lepine Total Hip Replacement MBA/Pavi  Acetabular Cup 46 - 64mm in 2 mm increments  $1,560.00

 & 0 or 10 Degrees

 Group 19i - Shell, uncemented, Titanium, not HA

 Zimmer

ZI353 Allofit Cup Allopro/Allofit Finned Cup - Titanium  46 - 68mm $2,397.00

ZI385 CLS, CLW Prosthesis - Cups Uncemented Cup for CLS & CLW - Ti  46 to 62mm $2,298.00

ZI396 Variall Screw Cup System Titanium Shell - Ti alloy 46 to 62mm $2,320.00

 Group 19j - Shell, uncemented, Titanium, HA

 Plus Orthopedics Australia Pty Ltd

PL021 PLUS Hip Joint Prostheses System EP Fit PLUS Ti/HA Cup 40 - 68mm Dia $2,796.00

 Group 19k - Shell, uncemented, Other, not HA

 Biomet Australia Pty Ltd

BI928 Tripolar Acetabular Cup Series Ringloc Series, UHMWPE, Chrome Cobalt 24-28mm $3,346.00

 De Puy Australia

DP188 Thackray Hip System Acetabular Cup Self centering cup 28mm size 39-65 $1,456.00

Prostheses List by Category, Groups and Sponsor Page 310 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK041 Metal Shell Porous Screw Fixation BS TiNiob Porous Metal Shell 46-68mm $3,217.00

EK047 Metal Shell Cementless BS TiNiob Coated/HA Metal Shell 46-68mm $2,600.00

 Zimmer

ZI325 Trabecular Metal Modular Acetabular  Porous Tantalum Modular Shell 38-80mm diameter; Cluster,  $3,346.00

 Multiholed, No Holes

 Group 19l - Shell, uncemented, Other, HA

 ESKA Australia

EK038 Metal Shell Cementless BS TiNiob Coated / HA Metal Shell 46-68mm $2,600.00

EK040 Metal Shell Cementless /HA Screw  TiNiob Coating HA/Metal Shell 46-68mm $3,200.00

 Fixation BS

 Group 20a - Liner, unmodified polyethylene

 Advanced Surgical Technologies

AD127 WMT  Acetabular Liners Duramer UHMWPE Liner Grp 0, Grp 1, Grp 2, Grp 3,  $832.00

 Grp 4, Grp 5, and Grp 6

AD263 Procotyl-E cup polyethylene liner Group 1 - 3 sizes 22 - 32 $884.00

 Australian Surgical Design & Manufacture Pty Ltd

AE037 Heco Hip System  Polyethylene Insert 42mm - 76mm $832.00

 B Braun Australia Pty Ltd

BB237 Plasmacup PE insert Chirulen 44mm-68mm diameters,  $884.00

 22.2mm-32mm articulations

 Biomet Australia Pty Ltd

BI916 Rim Cup Acetabular Cup Inserts UHMWPE 28mm 21 to 26mm $884.00

 Corin Australia Pty Ltd

CR022 DC Fit Cup Metal Backed Acetabular Liner 0 & 10 deg offset Sz 1- Sz 6 $676.00

Prostheses List by Category, Groups and Sponsor Page 311 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP112 Duraloc Enduron Liner Enduron Liner 28 or 32mm +4  size  48-66 $884.00

DP222 Thackray Hip System Poly Liner Custom Made to order $1,248.00

DP552 Bantam Liners Bantam  Enduron Polyethylene  10 Degree 22.225 & 26 &  $884.00

 28mm  size 38-46

DP968 SROM Total Hip System UHMWPE or Polythene Liner 22 or 26 or 28 or 32mm size  $1,248.00

 M28 - XL 46mm

DY032 Option Cup system  Liner LPW  or STD 38-80 mm $884.00

DY280 Pinnacle Acetabular Cup System Pinnacle GVF +4 or Neutral or 10 Degree 38-80mm x 22.225 or 26 or 28  $936.00

  or Lipped Liners or 32 or 36mm

DY475 Duraloc Enduron Liner Polythene Liner in Neutral or 10 or 20  22.225 or 26 or 28 or  32mm  $884.00

 Degree or +4 size 48-74

 Endotec Australia Pty Ltd

EA004 Buechel-Pappas Integrated Total Hip  Acetabular Bearing 45mm to 65mm $780.00

 Replacement System

 ESKA Australia

EK077 PE Insert Large Femoral Heads BS 38mm UHMWPE Liner 38mm - 44mm - 48mm $1,100.00

  - 44mm - 48mm

EK082 PE Insert 32mm BS UHMWPE Liner 32mm $850.00

 Finsbury Orthopaedics Australia Pty Ltd

FI022 Adept MoP Acetabular Component Liner, unmodified polyethylene $884.00

 Global Manufacturing Technology Pty Limited

GM016 Cer-Met II (Acetabular Component) Acetabular cup Inserts UHMWPE 46mm to 66mm $936.00

GM048 Contile Fin II Acetabular Cup Inserts UHMWPE 44 to 72mm $1,160.00

 Link Orthopaedic  Australia

LO033 CFP Insert( TOP INSERT) - 40 - 68mm $427.00

 Orthotech Pty Ltd

OH096 Lima Total Hip Replacement System Protruded UHMWPE Liner A, B, C, D, E $936.00

OH141 Atlas Acetabular Cup System Titanium & HA Atlas Poly Insert Std. Dia 28mm $936.00

Prostheses List by Category, Groups and Sponsor Page 312 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OH142 Atlas Acetabular Cup System Titanium & HA Atlas Alumina Insert Dia 28mm $936.00

 Plus Orthopedics Australia Pty Ltd

PL016 PLUS Hip Joint Prostheses System Bicon-PLUS PE - Liner 1 to 9 $832.00

PL017 PLUS Hip Joint Prostheses System Bicon-PLUS PE - Hooded Liner 1 to 9 $832.00

PL023 PLUS Hip Joint Prostheses System EP Fit PE Liner 40 - 68mm Dia $853.00

PL064 PLUS Hip Joint Prostheses System PE Insert <32mm $886.00

PL114 PLUS Hip Joint Prosthesis System MPF Cup - PE Inserts 46-64 $886.00

PL147 POLAR CUP ACETABULAR CUP  DUAL MOBILITY CONSTRAINED  22.2-28MM BY 43-67MM $2,200.00

 LINER FOR POLAR CUP

 Portland Orthopaedics (Aust) Pty Ltd

PD018 Equator Plus Cup UHMWPE encased in CoCr surround 28/46, 28/50, 28/52, 28/56,  $850.00

 28/60, 32/52, 32/56, 32/60,

 Smith & Nephew Surgical Pty Ltd

SN283 Optifix Acetabular: Liner, 20 degree 43 - 76mm $751.00

SN289 Reflection Acetabular Liner 22 - 36mm, 42 - 76mm $832.00

SN293 Reflection Lateralised Liner, UHMWPE 22 - 36mm,  42 - 76mm $884.00

 Stryker Australia Pty Ltd

ST559 Omnifit cup insert Series II - 0 degree cup insert polyethylene 22, 26, 28 & 32mm dia $884.00

ST560 Omnifit cup insert Series I - 0 degree cup insert, polyethylene 22, 26, 28 & 32mm dia $884.00

ST561 Omnifit cup insert Series II - 10 degree cup insert  22, 26, 28 & 32mm dia $884.00

ST562 Omnifit cup insert  Series I - 10 degree cup insert  22, 26, 28 & 32mm dia $884.00

ST563 Omnifit cup insert Series II -20 degree cup insert,   22, 26, 28 & 32mm dia $884.00

ST564 Omnifit cup insert Series I -20 degree cup insert polyethylene 22, 26, 28 & 32mm dia $884.00

 Taylor Bryant Pty Ltd

TB066 Groupe Lepine Total Hip Replacement Liner Hooded/Flat 44 - 64mm in 2mm increments $340.00

 Zimmer

ZI033 Acetabular Cup Trilogy Oblique Liner - Polyethylene 38 - 62 $884.00

Prostheses List by Category, Groups and Sponsor Page 313 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI037 Acetabular Cup Trilogy Liner - Titanium 38 - 80 in 22, 28, 32 $406.00

ZI367 Armour Cup Armor Cup P/E Insert 22 to 32mm, FF to 66QU $604.00

ZI388 Inserts for Cups PE (CLS, CLW, Fitmore, Allofit) 22, 28, 32mm Size 46 to 62 $604.00

ZI491 Trabecular Metal Acetabular Revision  Highly cross-linked (Longevity) PE Liners 28mm x 48mm-80mm - 0deg & $1,127.00

 System Liner  (various)  10deg; 32mm x 54-80mm -

 0deg & 10 deg; 36mm x 58mm-

 80mm - 0deg & 10deg; 40mm x

  62-80mm - 0deg & 10 deg

 Group 20b - Liner, modified polyethylene

 Advanced Surgical Technologies

AD309 Lineage A-Class Crosslinked Polyethylene Standard and lateralized, 0deg and 15deg  28, 32, 36ID $1,115.00

  Liner lipped

 Biomet Australia Pty Ltd

BI106 Mallory Head Hip System Acetabular Liner, UHMWPE 28 & 32mm, Sizes 21 to 28mm $1,144.00

BI107 Mallory Head Hip System Acetabular Liner, UHMWPE  22 & 26mm, Sizes 21 to 28mm $1,144.00

 Corin Australia Pty Ltd

CR073 Alpha Lock, (UHMWPE) Inlays UHMWPE 22-32mm $822.00

CR075 PE Inserts for Alpha Cera Fit Cups  (UHMWPE) Ultra High Molecular Weight  22-28mm Diameter for cup  $842.00

 (UHMWPE) Polyethylene sizes: 42-74mm

 De Puy Australia

DY036 Duraloc Marathon Acetabular Liner Marathon  Polyetholene Neutral or 10  28 or 32 mm size 48 - 66 $1,144.00

DY210 Pinnacle Acetabular Cup System Pinnacle Marathon Liner  + 4 or Neutral  38 - 80 mm x 22.225 or 26 or  $1,144.00

 or 10 Degree or Lipped 28 or 32 or 36mm

 ESKA Australia

EK001 Metal Shell Type 2000/2000 Plus PE Insert Type 2000 with Metal Cap TiAIV $468.00

EK002 Metal Shell Type 2000/2000 Plus PE Insert Type 2000 with Cap $468.00

EK003 Metal Shell Type 2000/2000 Plus PE Insert Type 2000 with Metal Cap  $468.00

 Assymetric 10 Degrees

Prostheses List by Category, Groups and Sponsor Page 314 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EK004 Metal Shell Type 2000/2000 Plus ESKA-CERAM Insert Type 2000 with  $1,144.00

 Metal Cap TiAIV

EK005 Metal Shell Type 2000/2000 Plus ESKA-CERAM Insert Type 2000 with  $1,144.00

 Metal Cap 10 Deg

EK006 Metal Shell Type 2000/2000 Plus ESKA-CERAM Insert Type 2000 $1,144.00

EK007 Metal Shell Type 2000/2000 Plus ESKA-CERAM Insert Tupe 2000  $1,144.00

 Assymetric 10 degrees

 Global Orthopaedic Technology

GO038 Consensus Hip System Acetabular Cup Inserts UHMWPE 22mm  42mm to 68mm $1,160.00

 to 32mm

 Howmedica

HW021 ABG Hip System ABG11 Polyethylene Insert - Enhanced  22mm,28mm,32mm ID $1,160.00

 Polyethylene. Standard or 10deg hooded

 inserts

HW060 PCA Hip System  PCA Cup inserts -  Enhanced  26mm,28mm,32mm ID $1,160.00

HW072 Vitalock Acetabular System System 12 liner -  Enhanced Polyethylene 22mm,26mm,28mm, 32mm ID $1,160.00

  -  For use with Vitalock Cups

HW073 Vitalock Acetabular System 30mm custom insert -  Enhanced  30mm ID $1,160.00

 Polyethylene -  For use with Vitalock Cups

 Mathys Orthopaedics Pty Ltd

MA419 seleXys PE Inlay Modular, Keramed CHIRULEN UHMW- 44mm-72mm $728.00

 PE insert to fit MACROFIT/TRISTABIL/

 

 Plus Orthopedics Australia Pty Ltd

PL026 PLUS Hip Joint Prostheses System EP Fit Rex Pol Liner 42 - 68mm Dia $1,160.00 $1,560.00

PL054 Plus Hip Joint Prosthesis System HXLPE Insert =<32mm $1,160.00 $1,560.00

PL055 Plus Hip Joint Prosthesis System HXLPE Insert >32mm $1,160.00 $1,768.00

PL062 PLUS Hip Joint Prostheses System HXLPE <32mm $1,160.00 $1,560.00

PL063 PLUS Hip Joint Prostheses System HXLPE >32mm $1,160.00 $1,768.00

PL080 Plus Hip Joint Prostheses System HXLPE Liner >32mm $1,160.00 $1,768.00

Prostheses List by Category, Groups and Sponsor Page 315 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL112 PLUS Hip Joint Prosthesis System MPF Cup - HXLPE Inserts <32mm $1,160.00 $1,560.00

PL113 PLUS Hip Joint Prosthesis System MPF Cup - HXLPE Inserts >32mm $1,160.00 $1,768.00

PL148 POLAR CUP ACETABULAR CUP  DUAL MOBILITY CONSTRAINED  22.2-28MM BY 43-67MM $2,500.00

 LINER FOR POLAR CUP - MODIFIED

 POLYETHYLENE

 Smith & Nephew Surgical Pty Ltd

SN291 Reflection Acetabular Liner XLPE 22 - 36mm, 42 - 76mm $1,062.00

SN663 35deg Reflection Liner UHMWPE 50 - 60mm $2,600.00

SN707 Optifix Acetabular Liners, XLPE 43-76mm $884.00

 Stryker Australia Pty Ltd

ST546 Trident acetabular component system Leteralised cup insert, enhanced  26, 28 & 32mm $1,160.00

ST549 Trident acetabular component system Trident polyethlene liner, enhanced  22, 26, 28, 32mm dia $1,160.00

 polyethlene

ST799 ABG Hip System PEEK Composite inserts to be used with  To fit ABG 11 cup sizes OD 50, $1,160.00

 the ABG acetabular shell.  All inserts have  52, 54, 56, 58mm

  a 28mm internal diameter.

ST930 System 12 +4mm Acetabular Insert Composition - Duration stabilized  28 and 32mm ID with a 10  $1,160.00

 polyethylene degree hood to fit all sizes of

 System 12 shells

ST931 System 12 Crossfire Insert Composition - Crossfire polyethylene Fits 46 - 72mm System 12  $1,160.00

 shells in 28 and 32mm ID with

 0 and 10 degree insert orientation

 Stryker Australia Pty Ltd (2)

SK013 Trident Acetabular Component System Elevated Rim Inserts - Crossfire  Fits 50-70mm with 28,32 and  $1,160.00

 36mm ID Options

SK318 SXL Trident Acetabular Inserts Sequentially cross linked polyethylene Inner diameters: 22mm, 26mm,  $1,560.00

 28mm 32mm, 36mm, 38 -

 64mm.  For outer diameter

 shells 40mm - 80mm.

Prostheses List by Category, Groups and Sponsor Page 316 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB174 GL - U Hooded Liner Acetabular component for total hip  46, 48, 50, 52, 54, 56, 58, 60,  $589.00 Also grouped in Hip Group 20e

 62, 64mm

 Zimmer

ZI045 Acetabular Cup Longevity XLPE Polyethylene Liner 7mm 46 - 70 $1,160.00

  Offset

ZI046 Acetabular Cup Longevity XLPE Polyethylene Liner 20  38 - 80 $1,160.00

 Degree

ZI047 Acetabular Cup Longevity XLPE Polyethylene Liner 10  38 - 80 $1,160.00

 Degree

ZI048 Acetabular Cup Longevity XLPE Polyethylene Liner 0  38 - 80 $1,160.00

 Degree

ZI315 Trilogy Acetabular System - Longevity  Highly crosslinked ultrahigh molecular  22 + 28 + 32 Head Diameters;  $1,160.00

 Eccentric weight polyethylene 38 - 80mm Outer Diameters

ZI317 Trilogy Acetabular System - Longevity  Highly crosslinked ultrahigh molecular  22 + 28 + 32 Head Diameters;  $1,160.00

 Oblique weight polyethylene 38 - 80mm Outer Diameters

ZI357 Alpha Durasul Insert Durasul Acetabular Cup Inserts  - Special 22mm x 42 to 28mm x 68 $1,160.00

  UHMWPE

ZI360 Converge Durasul Insert - Special UHMWPE 22/39 to 38/81mm  $1,160.00

ZI393 Variall Screw Cup System Durasul Insert - special UHMWPE II28 to NN28mm $1,160.00

 Group 20c - Liner, ceramic

 Advanced Surgical Technologies

AD116 Transcend/ Lineage Articulation System Ceramic Liner 28mm & 32mm Group 1,2,3 & 4 $1,926.00

AD261 Procotyl-E cup ceramic inserts acetabular cup Group 1 - 3, Size 28 and 32 $2,496.00

 B Braun Australia Pty Ltd

BB235 Plasmacup Ceramic Insert Biolox 44mm-68mm $2,340.00

 Biomet Australia Pty Ltd

BI073 Modular Ceramic System Acetabular Ceramic/ Polyethylene Liner,  28mm, 32mm, -6 to +12mm $2,496.00

 UHMWPE

Prostheses List by Category, Groups and Sponsor Page 317 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI913 Rim Cup Acetabular Cup Inserts Ceramic 28mm 23 to 26mm $2,496.00

 Corin Australia Pty Ltd

CR063 Ceramic Insert for Alpha Cera Fit Cup Biolox Forte 28-36mm $2,496.00

 De Puy Australia

DY034 Option Cup system Liner  Option Ceramic  46-66 mm $2,496.00

DY211 Pinnacle Acetabular Cup System Pinnacle Metal  or Ceramic Insert Neutral 48 - 80 mm  22.225 or 28 or 32 $2,600.00

  or 36 mm

 ESKA Australia

EK065 Insert Eska Ceram BS Ceramic on ceramic bearing insert 48-66mm $2,500.00

 Finsbury Orthopaedics Australia Pty Ltd

FI023 Adept CoC Acetabular component Liner $2,080.00

 Global Manufacturing Technology Pty Limited

GM024 Cer-Met Series II (Acetabular Component) Acetabular cup Inserts Ceramic 46mm to 66mm $2,600.00

GM049 Contile Fin II Acetabular Cup Inserts Biolox Ceramic 44 to 72mm $2,600.00

 Global Orthopaedic Technology

GO039 Consensus Hip System Acetabular Cup Inserts Ceramic 28mm to 42mm to 68mm $2,600.00

  32mm

 Mathys Orthopaedics Pty Ltd

MA421 seleXys Ceramic Inlay Modular, Keramed BIONIT ceramic  44-72mm $2,496.00 $3,328.00

 insert to fit

 MACROFIT/TRISTABEL/UNICAP

 Orthotech Pty Ltd

OH095 Lima Total Hip Replacement System Ceramic Liner A, B, C, D, E $2,496.00

OH220 Atlas Acetabular Cup System Titanium & HA Atlas Alumina Insert Dia  $2,496.00

 Plus Orthopedics Australia Pty Ltd

PL018 PLUS Hip Joint Prostheses System Bicon-PLUS / Ceramic Liner 3 to 9 $2,600.00

PL024 PLUS Hip Joint Prostheses System EP Fit Ceramic Liner 48 - 68mm Dia $2,600.00

PL058 Plus Hip Joint Prosthesis System Ceramic Dysplasia Insert 3-9 $2,600.00

Prostheses List by Category, Groups and Sponsor Page 318 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL060 PLUS Hip Joint Prostheses System Ceramic Insert <32mm $2,600.00

PL061 PLUS Hip Joint Prostheses System Ceramic Insert >32mm $2,600.00

PL081 Plus Hip Joint Prostheses System Ceramic Insert >32mm $2,600.00

PL100 PLUS Hip Joint Prosthesis System MPF Cup - Cermaic Insert >32mm $2,600.00

PL108 PLUS Hip Joint Prosthesis System MPF Cup - Ceramic Insert <32mm $2,600.00

 Portland Orthopaedics (Aust) Pty Ltd

PD019 Equator Plus Cup Ceramic surrounded in CoCr taper ring 28/37/46, 28/39/50, 28/41/52,  $2,500.00

 28/44/56, 28/48/60, 32/39/50,

 32/41/52, 32/44/56, 32/48/60,

 36/44/56, 36/48/60

 Smith & Nephew Surgical Pty Ltd

SN257 Axis  Ceramic Insert AlO3 28, 32mm ID; 44 - 60mm OD $2,007.00

SN297 Reflection  Acetabular Liner Ceramic, AlO3 28 - 36mm, 46 - 66mm OD $2,236.00

 Stryker Australia Pty Ltd

ST565 Alumina acetabular inserts Ceramic insert, alumina 28, 32 & 36mm dia $2,558.00

 Stryker Australia Pty Ltd (2)

SK010 ABGII Cup with Hydroxyapatite Alumina Ceramic Insert 5x sizes in 28mm ID, 3x sizes in $2,558.00

  32mm ID

 Taylor Bryant Pty Ltd

TB177 GL - Alumina U Liner Acetabular component for total hip  46-64mm (increment by 2mm) $2,236.00

 system, polyethylene

 Zimmer

ZI044 Acetabular Cup Trilogy AB Ceramic Liner - Titanium 48 - 70 $2,496.00

ZI354 Alpha Cerasul Insert Cerasul Acetabular Cups Inserts -  52 to 70mm  $2,496.00

 Ceramic / PE

ZI394 Variall Screw Cup System Cerasul Insert - Ceramic II28 to NN28mm $2,496.00

Prostheses List by Category, Groups and Sponsor Page 319 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 20d - Liner, metal

 Advanced Surgical Technologies

AD289 Transcend/Lineage Articulation System Metal CoCr Liner Grp 1, Grp 2, Grp 3, Grp 4  28, $1,926.00

  32 & 36mm

 Corin Australia Pty Ltd

CR062 Metal Insert for Alpha Cera Fit Cup Endocast SL 28mm Inner Diameter for 48- $1,560.00

 74mm Cups

 ESKA Australia

EK037 Metal Insert Silver BS Metal on metal resurfacing bearing insert 46-68mm $2,100.00

EK042 Metal Insert Silver BS Metal on metal bearing insert 46-66mm $2,100.00

 Mathys Orthopaedics Pty Ltd

MA441 ExpanSys Cup Cementless acetabular component for hip  Metal on metal inlay 44-72mm  $2,288.00

 arthroplasty titanium expandable cup with range

  either p/e or m/m inlay

MA464 seleXys Metal on Metal Inlay Modular, Keramed, Metal on Metal,  12 sizes in 28mm internal  $2,200.00

 28mm insert to fit  diameter to accept 28mm MOM

 Macrofit/Tristabel/Unicup Acetabular Cup  femoral head (Size 44-72 in

 2mm increments)

 Orthotech Pty Ltd

OH229 Lima Metal Liner Metal Liner 28mm, 32mm and 36mm $2,000.00

 Plus Orthopedics Australia Pty Ltd

PL019 PLUS Hip Joint Prostheses System Bicon-PLUS Met Liner 1 to 9 $1,926.00

PL025 PLUS Hip Joint Prostheses System EP Fit PLUS Met Liner 48 - 68mm Dia $1,926.00

PL065 PLUS Hip Joint Prostheses System Metal Insert <32mm $1,926.00

PL074 Plus Hip Joint Prosthesis System Metal Dysplasia Insert 1-9 $1,926.00

PL090 PLUS Hip Joint Prostheses System Metal Insert >32mm $2,288.00

PL110 PLUS Hip Joint Prosthesis System MPF Cup - Metal Insert <32mm $1,926.00

PL111 PLUS Hip Joint Prosthesis System MPF Cup - Metal Insert >32mm $2,288.00

Prostheses List by Category, Groups and Sponsor Page 320 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 20e - Liner, constrained

 Biomet Australia Pty Ltd

BI092 Mallory Head Hip System Acetabular Liner,  Constrained, Ringloc,  28-38mm $3,016.00

 UHMWPE

BI878 Freedom Constrained Liner Constrained Acetabular Liner -  23 to 62 $3,016.00

 Corin Australia Pty Ltd

CR088 Alphalock Constrained Liner UHMWPE 48 to 70mm outer diameter in  $1,030.00

 2mm increments

 De Puy Australia

DP014 Duraloc Constrained Liner Constrained liner with titanium alloy ring 28mm or 32mm,  48 - 74mm $1,836.00

DP969 SROM Total Hip System UHMWPE Constrained  0Deg, 10 Deg, 28mm, 32mm, $2,435.00

 Plus Orthopedics Australia Pty Ltd

PL042 PLUS Hip Joint Prosthesis System constrained liner 1 - 9, 28mm, 32mm $2,444.00

PL043 PLUS Hip Joint Prosthesis System Bofor revision Liner standard &  48 -70mm dia $1,872.00

 antidislocation PE

PL056 Plus Hip Joint Prosthesis System Constrained Liner 1-9 $1,352.00

 Smith & Nephew Surgical Pty Ltd

SN689 Reflection Constrained Acetabular Liner - UHMWPE 22 - 32mm, 42 - 76mm $2,144.00

SN701 Reflection Constrained acetabular liner - adaptor ring 42 - 76mm $2,144.00

 Stryker Australia Pty Ltd

ST539 Constrained acetabular insert  Polyethylene & cobalt chrome   22, 26, 28, 32mm dia $3,016.00

ST932 Trident Constrained Acetabular Insert Two pre assembled components: Outer  Match with 6x Trident shell  $3,016.00

 insert component and a captured UHR  sizes E, F, G, H, I, J.  Insert

 (Universal Head) component.   sizes E and F require a 22mm

 Composition - Cobalt chrome alloy and  head size.  Insert sizes G, H, I, J

 UHMWPE (ultra high molecular weight   require a 28mm head size.

 polyethylene) with a Titanium 6A1-4V

Prostheses List by Category, Groups and Sponsor Page 321 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI030 Acetabular Cup Trilogy Constrained Liner - Polyethylene 50 - 80 $1,459.00

ZI318 Trilogy Acetabular System - Longevity  Highly crosslinked ultrahigh molecular  22 + 28 + 32 Head Diameters;  $2,100.00

 Constrained weight polyethylene 38 - 80mm Outer Diameters

 Group 21 - Bonded shell/liner

 Mathys Orthopaedics Pty Ltd

MA031 RM Cementless Cup Monomesh/Ceros 80/Titanium 46mm - 68mm $2,368.00

 Zimmer

ZI339 Press Fit - Uncemented Metasal Cup Protek, Metal alloy/PE 48 - 64mm $4,680.00

ZI387 Press Fit - Uncemented Cup Uncemented Press fit Cup - PE / Ti alloy 22/40 to 32/64mm $2,320.00

 Group 22b - Uncemented metal on metal, not resurfacing

 Biomet Australia Pty Ltd

BI055 Biomet Alternate Bearing Surface Metal on Metal Acetabular Shell, Titanium 46 - 70mm $2,207.00

BI057 Biomet Alternate Bearing Surface Metal Acetabular Insert, Chrome Cobalt Standard $1,465.00

BI783 M2a Modular Head Component & Special Metal on Metal Acetabular, Chrome  48-70 mm $5,588.00

  Acetabular Cup Cobalt, Ti

 De Puy Australia

DY021 Ultima Total Hip System Ultima Metal on metal, Titanium  Size Std 28mm 0D and Avg  $2,354.00

 28mm 10D

DY022 Ultima Total Hip System Ultima Metal on metal shell with 3 hole    Size 48-68 $2,354.00

 Titanium

 Mathys Orthopaedics Pty Ltd

MA023 RM cup with MOM Chrome, cobalt lining Dia 46mm - 64mm $3,588.00

MA461 ExpanSys Cup Cementless acetabular component for hip  acetabular shell/cup 44-72mm  $3,640.00

 arthroplasty titanium expandable cup with

  either p/e or m/m inlay

Prostheses List by Category, Groups and Sponsor Page 322 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Plus Orthopedics Australia Pty Ltd

PL134 POLARSTEM FEMORAL STEM SYSTEM CEMENTED POLISHED TAPERED  0-8 $2,200.00

 STEM STANDARD AND LATERAL

 10/12 TAPER AND 12/14 TAPER

 Zimmer

ZI389 Inserts for Cups - Metasul Uncemented Cup Inserts for CLS, CLW,  28mm $2,354.00

 Fitmore, Allofit, PE / CoCr - special

 Metasul alloy

ZI395 Variall Screw Cup System Metasul Insert - special metal alloy II28 to NN28mm $2,354.00

 Group 24a - Resurfacing, metal, not HA

 Advanced Surgical Technologies

AD313 Conserve Total SUPERFIX Shell Porous coated, super finished, revision  50mm - 72mm OD $6,300.00

 resurfacing cup with fins and screws

 Biomet Australia Pty Ltd

BI841 Resurfacing Hip System Acetabular Shell CoCr, Ti 44 - 66mm $5,793.00

 Zimmer

ZI467 Durom Resurfacing System - Special Acetabular  A - V $6,098.00

 Cup, Metasul/Ti alloy

 Group 24b - Resurfacing, metal, HA

 Advanced Surgical Technologies

AD213 CONSERVE PLUS Total Hip Resurfacing Titanium Acetabular Shell - Super  ID 36 - 54mm, OD 46 - 64mm $5,096.00

  System

AD229 Conserve Plus Total Hip Resurfacing  Titanium Thin Acetabular Shell - Super  36 - 54mm ID in 2mm  $5,084.00

 Polished

AD321 Quadra-Fix Acetabular Shell Dysplasia Cup, Porous Coated, HA O.D. 44mm - 66mm $7,000.00

 Biomet Australia Pty Ltd

BI842 Resurfacing Hip System Acetabular Shell CoCr, Ti, HA Coated 44 - 66mm $6,240.00

Prostheses List by Category, Groups and Sponsor Page 323 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Corin Australia Pty Ltd

CR048 Cormet 2000 Resurfacing Hip Acetabular cup for resurfacing head  Dia 40 -56mm $4,923.00

 Cobalt chrome TiAlloy and HAP bicoat

CR087 Cormet Dysplasia Cup High Carbon Cobalt Chrome 48, 52, 56, 60, 64mm $5,084.00

 De Puy Australia

DY328 ASR Hip System Acetabular Cup 38.5-64.5mm $5,084.00

 Finsbury Orthopaedics Australia Pty Ltd

FI013 Adept MoM Acetabular Component Porocast Acetabular Shell , Co Chr, HA  44-66mm Outer diameter going  $5,200.00

 coated size 44-66mm up in 2mm increments

FI014 Adept MoM Acetabular Component -  Porocast Acetabular Shell , Co Chr, HA  46-66mm Outer diameter going  $6,760.00

 Extra Fixation Cup coated up in 4mm increments

 Global Orthopaedic Technology

GO044 Consensus Hip System Acetabular cup porous coated CoCr 44-66mm $5,084.00

GO048 ICON Hip System Acetabular Cup Porous Coated CoCr 44-66mm cups $5,084.00

 Smith & Nephew Surgical Pty Ltd

SN742 Birmingham Hip Resurfacing Prostheses - Porous Coated 44 - 66 mm cups $5,084.00

  Acetabular Cup

 Stryker Australia Pty Ltd (3)

SR044 Stryker Orthopaedic Traditional  Resurfacing Cup 44mm - 68mm $6,000.00

 Resurfacing HipSystem

 Flange Suffix

 Global Orthopaedic Technology

GO045 Consensus Hip System Dysplasia cup porous coated + screws 46-66mm $7,280.00

GO050 ICON Hip System Dysplasia Cup Porous Coated with  46-66mm $7,280.00

 Screws CoCr

 Smith & Nephew Surgical Pty Ltd

SN744 Birmingham Hip Resurfacing Dysplasia  Acetabular Cup Porous Coated with  Dysplasia Cups:  46 - 66 mm  $7,280.00

 screw fixation

Prostheses List by Category, Groups and Sponsor Page 324 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 24c - Resurfacing, ceramic

 ESKA Australia

EK056 Insert Eska Ceram BS Ceramic on ceramic resurfacing bearing  38-58mm $2,600.00

 Group 24d - Resurfacing, other

 Endotec Australia Pty Ltd

EA003 Buechel-Pappas Integrated Total Hip  Acetabular Cup-Ceramic coated titanium 45mm to 69mm $2,600.00

 Replacement System

Hip - Acetabular Reconstruction Devices

 Group 25 - Acetabular Reconstruction Shells

 Advanced Surgical Technologies

AD262 Procotyl-E cup acetabular cup titanium alloy 52mm - 76mm, in 2mm  $5,096.00

 B Braun Australia Pty Ltd

BB247 Reconstruction Shell Isotan 52-64mm, left and right $2,912.00

 Biomet Australia Pty Ltd

BI142 Mars Acetabular System Acetabular Shell, Titanium  Sizes 48 to 60mm $2,912.00

BI700 Par 5 Protrusio Acetabular System Obturator Hook - Titanium Metal One size only $1,426.00

BI701 Par 5 Protrusio Acetabular System Blade - Titanium Metal One size only $1,426.00

BI703 Par 5 Protrusio Acetabular System Acetabular Flange - Titanium Metal Short (L,R,N), Medium  $1,426.00

 (L,R,N), Long (L,R,N)

BI704 Par 5 Protrusio Acetabular System Acetabular Shells - Titanium Metal 56 - 72mm $6,380.00

BI836 Par 5 Protrusio Acetabular System Acetabular Shell CrCo, Ti, Ha Coated 56 - 72mm $6,760.00

BI914 Batcup Revision Acetabular Cup including  21 to 24mm $4,680.00

 locking ring and lugs

 De Puy Australia

DP945 Octopus Cup System Cup  Size 50, 55mm $1,426.00

Prostheses List by Category, Groups and Sponsor Page 325 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY169 Ultima Acetabular Ring Ultima Acetabular Ring 40 - 62mm $1,301.00

 ESKA Australia

EK027 Cranial Shell type 2000 Acetabular Shell for revision. Screw  52mm - 72mm Left and Right $4,056.00

 fixation - short flap, flap, anatomical flap

EK070 Metal Shell Dysplasia Porous Screw  TiNiob Coating HA/Metal Shell with  46-66mm $4,900.00

 Fixation BS

 Howmedica

HW064 Petrusion Shell Kerboull -  Vitallium 44, 48, 52, 56, 60mm OD $1,153.00

 Link Orthopaedic  Australia

LO013 Link McMinn Acetabular Reconstruction  Cementless Cup HAC Coated 45 - 55 mm $3,744.00

 Cup System

LO014 Link McMinn Acetabular Reconstruction  Polyethylene Insert 45 - 55 mm $756.00

 Cup System

 Orthotech Pty Ltd

OH109 Lima Total Hip Replacement System SPH Revision Cup 50 - 66mm $5,096.00

OH112 Lima Total Hip Replacement System Titanium Revision Bilobo Cup 50 - 58mm $5,720.00

 Plus Orthopedics Australia Pty Ltd

PL039 PLUS Hip Joint Prostheses System Bofor Rev Shell 48-70mm dia $4,170.00

 Smith & Nephew Surgical Pty Ltd

SN265 Contour Acetabular Roof Reinforcement Shell 44 - 74mm OD $1,426.00

 Stryker Australia Pty Ltd

ST547 Restoration acetabular gap ring  Titanium  48-72mm OD in 2mm  $3,432.00

ST557 Restoration gap II acetabular shell GAP CUP II  titanium anatomic (left &  48-72mm OD in 2mm  $3,952.00

Prostheses List by Category, Groups and Sponsor Page 326 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB175 B2C Espace Acetabular Cup Acetabular component for revision hip  Espace Shell 0 degrees peak -  $6,240.00

 diam 50mm, 54mm, 58mm,

 62mm with plastic insert,

 Espace Shell 20 degrees peak -

 diam 50mm, 54mm, 58mm,

 62mm with plastic insert, 

 Espace Shell 8mm extension -

 diam 50mm, 54mm, 58mm,

 62mm with plastic insert,

 Espace Shell 14mm extension -

 diam 50mm, 54mm, 58mm,

 62mm with plastic insert,

 Espace Shell 20mm extension -

 diam 50mm, 54mm, 58mm,

 Zimmer

ZI249 Trabecular Metal Primary Acetabular cups - elliptical Primary 22 and 28mm diameter $3,120.00

ZI271 Hedrocel button Hedrocel tantulum Small and medium x 10mm  $1,352.00

ZI276 Hedrocel strut Hedrocel tantulum 10mm long $4,264.00

ZI371 Lor Acetabular Cup  Oblong Revision Shell, cementless - Ti  52/58 to 72/84 $3,952.00

ZI372 Lor Acetabular Cup  P/E Insert 28, 32 $1,226.00

 Group 26 - Acetabular Reconstruction Cages

 Advanced Surgical Technologies

AD264 Procotyl-E T Plate titanium alloy One size only for left and right $1,040.00

AD265 Procotyl-E screws titanium alloy Diameter 5.5mm, Length 15 -  $395.00

 60mm

AD266 Procotyl-E double plate titanium alloy 4, 5 and 6 holes left and right  $1,040.00

AD267 Procotyl-E hooks titanium alloy 18mm, 23mm, 28mm $811.00

AD268 Procotyl-E L Plates titanium alloy One size only for left and right $1,040.00

Prostheses List by Category, Groups and Sponsor Page 327 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Biomet Australia Pty Ltd

BI872 MAX-Ti Modular Protrusio Cage Modular Protrusion Cage, Ti Protrusio Cage 52, 56, 60, 64,  $6,961.00

 68, 72mm Left & Right

BI874 MAX-Ti Modular Protrusio Cage Modular Protrusion Cage, Ti Iliac Flange Augment 6mm Flat  $889.00

 & Wedge

 De Puy Australia

DP944 Octopus Cup System Screw  6.5mm Diameter length 15-65mm $127.00

DP946 Octopus Cup System Hooded Liner  22.2, 28 and 32mm Size 55, 50 $673.00

DP947 Octopus Cup System Reorientation Liner 22.2, 28 and 32mm Size 50- $675.00

DP948 Octopus Cup System Ring Right and Left  Size 50-55mm $889.00

DP949 Octopus Cup System Ring Long left and right  Size 50-55mm $889.00

DY064 Protrusio Cage Left and right Cobalt Chrome/Titanium Size 52OD X 49ID,  56OD X  $889.00

 53ID,  60OD X 57ID

 Howmedica

HW044 Exeter Hip System X-Change Revision Mesh - Stainless Steel Acetabular, Femoral and Flat  $889.00

HW045 Exeter Hip System X-Change Revision Mesh -Rim -   Small $863.00

 Stainless Steel

HW046 Exeter Hip System X-Change Revision Mesh - Rim -   Large $855.00

 Stainless Steel

 Orthotech Pty Ltd

OH108 Lima Total Hip Replacement System Acetabular Revision Plate 50, 54, 58, 62, 64mm $2,288.00

OH144 Coriolis CrCo - Fixation screws, Support Ring Fixation Screws - Dia  $2,288.00

 6.5mm/Length 15-50mm

 Plus Orthopedics Australia Pty Ltd

PL126 Reko Reconstruction Cage Reconstruction Cage 44-52 Lt & Rt $2,200.00 $2,700.00

PL151 Polar Cup Acetabular Cup System Acetabular Reconstruction Cage Waiting $2,000.00

 Zimmer

ZI001 Zimmer Acetabular Cup Roof ring 46 - 60mm $1,040.00

Prostheses List by Category, Groups and Sponsor Page 328 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI002 Zimmer Acetabular Cup Acetabular Cage - Left, right 52, 58, 64mm OD $1,040.00

ZI390 Acetabular Reinforcement Roof Ring - Ti alloy 44 to 58mm $1,040.00

ZI391 Acetabular Reinforcement Roof Ring with Hook - Ti alloy 36/23 to 64/23mm $1,040.00

ZI392 Acetabular Reinforcement Protrusio Cage - Ti alloy 44 to 50mm (left and right) $1,040.00

 Group 27 - Acetabular Reconstruction Saddles

 Global Manufacturing Technology Pty Limited

GM051 Contile Fin II Revision Ring Ti 52 to 72mm $1,924.00

Hip - Femoral Components - Primary & Revisions

 Group 10 - Thrust Plates

 Zimmer

ZI349 Thrust Plate Prosthesis Allopro Thrust Plate - Ti alloy 38 to 44mm $1,773.00

ZI350 Thrust Plate Prosthesis Allopro Lateral Plate - Ti alloy Std & Long (15 & 25 deg) $1,450.00

ZI351 Thrust Plate Prosthesis Allopro Threaded bolt - CoCr alloy 70 to 89mm $1,177.00

ZI352 Thrust Plate Prosthesis Allopro Cortical Screw - SS 36, 60mm $225.00

 Group 11 - Unipolar / Monoblock

 B Braun Australia Pty Ltd

BB047 Downs Austin-Moore Hip Stem 39-54mm $478.00

BB048 Downs Thompson Stem Stem 38-55mm $395.00

 Biomet Australia Pty Ltd

BI060 Austin Moore Self Locking Hip Prosthesis Straight Standard Femoral Prostheses,  38-55mm $874.00

  System Titanium

BI062 FR Thompson Hip Prosthesis System Modular Curved Femoral Stem, Titanium. 38mm - 55mm  $874.00

BI077 Austin Moore Self Locking Hip Prosthesis Femoral Component, Long Stem,  38 to 56mm $832.00

  System

Prostheses List by Category, Groups and Sponsor Page 329 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP167 Thompson Implantable Hip Thompson stems Ortron Size 41-54 $615.00

DP168 Austin Moore Hip Prosthesis Narrow or Standard Ortron Size 38-54mm $615.00

DP170 Austin Moore Hip Prosthesis Ortron Custom sizes $615.00

 Hipokrat Australia Pty Ltd

HP011 Austin Moore Hip Prostheses Standard and Narrow Stem Standard- Head Diam. 38mm- $460.00

 58mm, Stem Length 127mm-

 154mm; Narrow - Head Diam.

 38mm-58mm, Stem Length

 140mm-152mm

 Howmedica

HW025 Austin Moore Endoprosthesis Long Stem - Vitallium Head size 38 to 63 $1,348.00

HW026 Austin Moore Endoprosthesis Standard Stem - Vitallium 105-165mm length, Head size:  $659.00

 38 to 57

 Zimmer

ZI008 Zimmer Hip Systems Femoral Stem Austin Moore - Stainless Steel Sizes 38 - 60 $728.00

 Group 1a - Cemented, unpolished, no pre-coat, straight, short and standard length, all

 ESKA Australia

EK080 Adapter GHE Long Stem Cemented Femoral Component CoCr 160mm $2,000.00

 Mathys Orthopaedics Pty Ltd

MA016 CCA Cemented Stem Straight / standard / lateral sterile  7.50mm -17.5mm $1,938.00

 Orthotech Pty Ltd

OH226 Exactech Femoral Stem Novation C - Series Femoral Stem 1-8 $2,000.00 $2,100.00

 Smith & Nephew Surgical Pty Ltd

SN010 Basis Femoral Component Hip stem, Cobalt Chromium Length 115 - 135mm $1,094.00

SN277 Endoprosthesis CoCr 38 - 54mm $488.00

Prostheses List by Category, Groups and Sponsor Page 330 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd

ST576 Omnifit hip system OMNIFIT cemented femoral component  Stem sizes 4-11 $2,080.00

 - normalised cobalt chrome

ST577 Omnifit hip system  OMNIFIT 'C' stem - cemented  cobalt  Stem sizes 4-11 $2,080.00

 chrome, collared and collarless, 132

 degree offset

ST586 Osteonics omnifit head/neck hip stem  Head/neck hip stem cobalt chrome Stem sizes  5, 7 & 9 $2,080.00

ST802 Accolade C Femoral Hip System Forged CoCr cemented hip system Stem sizes 2 - 7 $2,080.00

 Zimmer

ZI015 Zimmer Hip Systems Femoral Stem VerSys Cemented - Cobalt Chrome 11 - 17 $2,080.00

ZI337 Natural Hip System Femoral Stem, CoCr 140 - 160mm $2,080.00

 Group 1b - Cemented, unpolished, no pre-coat, tapered, short and standard length, all

 B Braun Australia Pty Ltd

BB275 Excia Hip System Cemented stem cobalt chromium 9mm-18mm $2,100.00

 Biomet Australia Pty Ltd

BI036 Rx90 Hip System Primary Femoral Stem, Chrome Cobalt,  9-17mm $2,080.00

 Cemented

BI039 Integral Hip System Femoral  Centraliser, Cemented , Cobalt  9-17mm $1,707.00

 Chrome

BI042 Answer Hip System Femoral Stem, Chrome Cobalt, Cemented 9-17mm $1,707.00

BI047 Hip Fracture System Femoral Stem, Chrome Cobalt,  8-16mm $2,080.00

 Cemented/Cementless

BI050 Bi-Metric Hip System Interlok Stem, Titanium,  7-17mm $1,707.00

 Cemented/Cementless

BI063 Bimetric Hip System Stem, Modular, Titanium, Chrome Cobalt 7-17mm $1,707.00

BI069 Biomet Taperloc Hip System Femoral Stem, Standard or Laterised.  7.5mm to 20mm diameter $1,687.00

 Titanium, Cemented

BI132 Mallory Head Hip System Femoral Stem, Cobalt Chrome,  7-19mm $2,080.00

Prostheses List by Category, Groups and Sponsor Page 331 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP176 Charnley Hip System CDH Ortron CDH $2,184.00

DP178 Charnley Hip System Ortron Round Back SNS 35, STS 35 $1,976.00

DP180 Charnley Hip System  RB 40, RB 40 NRW, RB 45 Ortron Stem RB 40, RB 40 NRW, RB 45 $1,976.00

DP181 Charnley Hip System  Ortron Stem EH 40 or Fl 35 or 40 or Fl 45 or $1,976.00

  EH 45

DP199 Elite Modular Hip System Elite Plus Stem  Ortron CDH $2,184.00

DP203 Elite Modular Hip System Elite Plus Stem High Offset Ortron Size 2 - 5 $2,184.00

DP208 Elite Modular Hip System Elite Plus Stem Primary Ortron Roundback Size 40 or 1-4 $2,184.00

DP209 Elite Modular Hip System Elite Plus Stem Primary Ortron Flanged Size 2 - 5 $2,184.00

 ESKA Australia

EK031 Adapter Hip System cemented Femoral Stem CoCr Matte finished  Femoral stem 1-7 $1,872.00

EK034 Adapter Hip System Cemented Dual Cone $780.00

EK035 Adapter Hip System Cemented Lateral Offset Cone $1,248.00

 Mathys Orthopaedics Pty Ltd

MA017 FULFIX Cemented Stem Standard modular / lateral modular sterile 3.0mm - 12.5mm $1,938.00

MA423 Unistem 2 Cemented stem for hip arthroplasty Sizes 6-16; Length 125-165mm $686.00

 Portland Orthopaedics (Aust) Pty Ltd

PD023 M-COR Modular Hip System M-CS Cemented Femoral Stem, CoCr Size 1 - Size 8 $2,000.00

 Smith & Nephew Surgical Pty Ltd

SN301 Spectron/Synergy Femoral Stem Non Porous Offset 1- 20 $1,707.00

SN363 Matrix: Modular Hip System Practica Non Porous Stem CoCr Collarless  Stem 8,10,12.  $1,383.00

 Collared Stem  8,10,12,14.

 Collarless/Collared Femur

SN692 Spectrum EF Tantalum marked high offset and  Size 40 - 74mm $2,228.00

 standard stems

Prostheses List by Category, Groups and Sponsor Page 332 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (3)

SR017 Omnifit hip system OMNIFIT cemented femoral component  Stem sizes 4-11 $2,080.00

 - normalised cobalt chrome

SR018 Omnifit hip system OMNIFIT 'C' stem - cemented  cobalt  Stem sizes 4-11 $2,080.00

 chrome, collared and collarless, 132

 degree offset

 Group 2a - Cemented, polished, no pre-coat, straight, short or standard length, all

 Global Orthopaedic Technology

GO036 Consensus Hip System Femoral stem cemented polished CoCr  6 to 14 $2,080.00

 tapered modular

 Taylor Bryant Pty Ltd

TB009 Lyderic II Monotige Femoral Stem HA - Titanium alloy - Cemented -  Sizes 6 - 11 $1,205.00

 Stainless steel

TB067 Groupe Lepine Total Hip Replacement Lyderic II Modular Stem, Cemented Size 6, 7, 9, 9, 10, 11 $1,205.00

 Zimmer

ZI023 Zimmer Hip Systems Femoral Stem Heritage - Cobalt Chrome 11 - 17 $2,080.00

ZI373 MS-30 Hip prosthesis Cemented Stem:MS-30 (Protek) - metal  6 to 16 $1,705.00

 Group 2b - Cemented, polished, no pre-coat, tapered, short or standard length, all

 Advanced Surgical Technologies

AD130 WMT Perfecta Hip System Cemented CoCr 10.5, 12, 13.5, 15, 16.5, 18mm  $2,317.00

 width, 140 - 170 long

AD318 Profemur XTR Femoral Stem Femoral Stem, CoCr, Cemented, Polished 0, 1, 2, 3, 4 $2,300.00

 B Braun Australia Pty Ltd

BB240 BiContact cemented Femoral stem 8-18 $1,976.00

 Biomet Australia Pty Ltd

BI066 Stanmore Total Hip System Modular Femoral Stem - Standard and  Size 1-5  $1,976.00

 Straight, Chrome Cobalt

Prostheses List by Category, Groups and Sponsor Page 333 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI696 Olympia Stem Anatomic design CO CR femoral stem L & R 6 sizes (1 to 6) $2,317.00

BI925 Mallory Head Hip System Femoral Stem, Cobalt Chrome, Polished 7-19mm $2,317.00

BI935 Generation 4 - Polished Hip System Femoral Stem, Cobalt Chrome, Cemented 9-17mm $2,000.00

 Corin Australia Pty Ltd

CR024 Taper Fit Hip System Double taper stainless steel total hip  sizes 1-4 $1,976.00

CR025 Cenator Stem Femoral stem CoCr Stems ex-narrow, narrow, std  $1,976.00

 & large

CR076 Oxford Universal Hip System Proximal femoral stem CoCr Extra small to Large $2,433.00

CR077 Oxford Universal Hip System Proximal femoral stem Cocr -HAP coated Extra small to Large $4,368.00

CR078 Oxford Universal Hip Stem Distal Femoral Stem Cocr Polished 10mm-20mm diameter,120- $2,317.00

 250mm length

 De Puy Australia

DP546 C- Stem  Standard or High Offset or CDH Ortron  Size 1-8 or  size 2-5 or CDH $2,236.00

 Finsbury Orthopaedics Australia Pty Ltd

FI019 Freeman Hip Stem Cobalt Chrome, smooth, cemented 165 lengths, diameter 10-12-14- $2,433.00

 16-18-20, offsets short 36mm

 and medium 40mm

 Global Manufacturing Technology Pty Limited

GM038 Edinburgh Total Hip System (Hip Stem) Femoral stem cemented CoCr CDH to Size 4 Narrow: Size 1 to $2,317.00

  Size 4 Standard

 Global Orthopaedic Technology

GO073 Consensus Hip System Femoral stem cemented polished CoCr  6 to 14 $2,080.00

 straight modular

 Howmedica

HW041 Exeter Hip System Stem: Standard -  Orthinox Stem Sizes 0-6, Offsets 35 - 5,  $2,392.00

 37 - 5, 44, 50mm

 Mathys Orthopaedics Pty Ltd

MA463 twinSys cemented stainless steel, polished surface, 8 sizes in standard and lateral  $2,228.00

  triple tapered femoral stem version (Size 9, 10, 11, 12, 13,

 14, 15, 16)

Prostheses List by Category, Groups and Sponsor Page 334 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH100 Lima Total Hip Replacement System Friendly Stem Cemented Hip 0, 1, 2, 3 $2,317.00

OH199 Lima Accent Hip System Total Hip Replacement 1 -6 $2,317.00

 Plus Orthopedics Australia Pty Ltd

PL014 PLUS Hip Joint Prostheses System CPS-PLUS Stem 1 to 5 $1,791.00

 Smith & Nephew Surgical Pty Ltd

SN268 CPCS Femoral Stem Polished Non Porous, Std  1 - 5 $1,546.00

 and High Offset

SN362 Matrix: Modular Hip System Femoral Stem Polished CoCr 6L-14L $1,159.00

 Stryker Australia Pty Ltd (2)

SK196 Exeter Hip System - ETS (endoprosthesis Orthinox Stainless Steel Endoprosthesis 40mm Offset body with  $1,872.00

  trauma stem) monoblock head sizes 38mm,

 40mm, 41mm, 42mm, 43mm,

 44mm, 45mm, 46mm, 47mm,

 48mm, 49mm, 50mm, 52mm,

SK320 Exeter Cement in Cement Revision Stem Stainless Steel, V40 trunnion, 125mm  44mm Offset, 125mm Length $4,334.00

 Length, 44mm Offset

 Zimmer

ZI009 Zimmer Hip Systems Femoral Stem CPT Zimaloy - Co Cr Sizes 1 - 5 $2,315.00

ZI010 Zimmer Hip Systems Femoral Stem CPT Zimtron - Stainless Steel Sizes 1 - 5 $1,525.00

ZI494 Zimmer Uni-Compartmental High Flex  Femoral Component - Cobalt Chrome Sizes A to G $2,162.00 $2,600.00

 Group 3a - Cemented, unpolished, pre-coat, straight, short or standard length, all

 Howmedica

HW031 Definition PM Femoral Component Femoral Stem -  Vitallium Stem sizes 1 - 7 $2,080.00

Prostheses List by Category, Groups and Sponsor Page 335 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 3b - Cemented, unpolished, pre-coat, tapered, short or standard length, all

 Advanced Surgical Technologies

AD294 WMT Perfecta Hip System Cemented CoCr 10.5, 12, 13.5, 15, 16.5, 18mm  $2,317.00

 width, 140 - 170 long

 De Puy Australia

DY167 G2 Hip System G2 Stem Cemented 1 - 11L $2,080.00

 Howmedica

HW399 Definition PM Femoral Component Femoral Stem -  Vitallium Stem sizes 1 - 7 $2,080.00

 Orthotech Pty Ltd

OH101 Lima Total Hip Replacement System H-MOOS Cemented Hip 1 - 5 $2,080.00

 Group 4a - Cemented, polished and unpolished, long length, conventional.

 Biomet Australia Pty Ltd

BI029 Scientific Hip Prostheses System Femoral Component, Chrome Cobalt,  6 sizes, 0-6 $4,160.00

 Cemented

BI037 Rx90 Hip System Revision Femoral Stem 200mm, Chrome  13-19mm $4,160.00

 Cobalt, Cemented

 Corin Australia Pty Ltd

CR083 Oxford Hip System Distal Stem Revision 300mm 60mm Split, Diameter  $2,317.00

 12-20mm

 De Puy Australia

DP013 Wroblewski Resection Stem Stainless steel 200mm, 250mm $3,695.00

DP175 Charnley Hip System Orton stems or Tumor or Revision or  10" or 12" or 15" stem or  $4,108.00

 Longstem 40 or EH40 or FL 40

 or Resection, LG. NK 1& 2, or

 1 & 2 EH, Longstem LG. NK 1

DP205 Elite Modular Hip System Stem Ortron Custom size $3,848.00

DP212 Elite Modular Hip System Elite Plus Stem Revision Ortron 4-8 length 190 - 250mm or STD $4,108.00

  or  Long Neck

Prostheses List by Category, Groups and Sponsor Page 336 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP223 Thackray Hip System Acetabular Mesh Ortron 90 One size only $144.00

DP550 C- Stem  Revision Stem Ortron Size 4-8 x 200-240 mm length $3,695.00

 ESKA Australia

EK081 Adapter GHE Long Stem Cemented Femoral Component CoCr 180mm - 200mm - 240mm $4,000.00

 Finsbury Orthopaedics Australia Pty Ltd

FI020 Freeman Hip Stem Revision Diameter 14-16/Short and  $4,160.00

 Medium offset +50mm

 Howmedica

HW040 Exeter Hip System Long Stem -  Orthinox Stem Lengths 205  $4,160.00

 Link Orthopaedic  Australia

LO015 LINK Lubinus SP Hip Prosthesis Stem Left & right 01-5 $2,250.00

 Plus Orthopedics Australia Pty Ltd

PL015 PLUS Hip Joint Prostheses System CPS-PLUS Rev Stem 1 to 5 $3,695.00

 Smith & Nephew Surgical Pty Ltd

SN274 Echelon Revision hip stem - Non Porous: Standard 12-16  175-225mm $3,695.00

  Collar

 Stryker Australia Pty Ltd

ST584 Osteonics omnifit cemented long stem Long stem - coated, cobalt chrome Stem sizes  5-11, stem length  $4,160.00

 200, 250 AND 300mm

 Zimmer

ZI301 CPT Hip System CPT hip stem - extra long Sizes 1 - 4 $3,695.00

 Group 4b - Cemented, calcar replacement, long length.

 Biomet Australia Pty Ltd

BI051 Bi-Metric Hip System Head Neck Revision Femoral Stem,  9-15mm  $3,664.00

 Chrome Cobalt, Cemented

 Smith & Nephew Surgical Pty Ltd

SN273 Echelon/Spectron Revision Hip Stem - Non-porous 135mm - 235mm $3,664.00

Prostheses List by Category, Groups and Sponsor Page 337 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI024 Zimmer Hip Systems Femoral Stem VerSys Cemented Revision Stem-Modular One size only $572.00

  Calcar Block

ZI025 Zimmer Hip Systems Femoral Stem VerSys CRC Cemented Revision Stem-  13 - 19 $3,664.00

 Standard - Cobalt Chrome

 Group 5a - Uncemented, Grit Blast, not HA, standard and short, no modularity.

 B Braun Australia Pty Ltd

BB272 HuckStep Hip System Titanium, plasma coated femoral stem,  Short and Standard length $5,500.00

 short and standard length

 Biomet Australia Pty Ltd

BI932 PPF Hip System Hip femoral stem std & Lat ti-6A1-4V 00 thru 12 $3,385.00

 De Puy Australia

DP119 Solution Implantable Hip System  Revision Standard & MMA 8 straight or  6" size 10.5 - 22.5 $3,588.00

 bowed Porous coated

 Finsbury Orthopaedics Australia Pty Ltd

FI021 Adept Hip System Femoral Hip Stem, cementless, titanium 12 standard sizes and 7  $3,588.00

 lateralised sizes

 Link Orthopaedic  Australia

LO107 Beta-Cone Cementless Hip Prosthesis Cementless, HX coated, Titanium Stem 9 Stem sizes 1-9 plus additional  $3,120.00

 9 stems with XL neck length.

 Total 18 sizes

 Mathys Orthopaedics Pty Ltd

MA019 CBC Cementless Stem Titanium femoral stem 5-20mm $3,588.00

MA427 CBH Stem Cementless stem for hip arthroplasty 00-12 $3,588.00

 Orthotech Pty Ltd

OH227 Lima C2 Femoral Stem Ti Femoral Stem 1-8 $3,900.00

 Plus Orthopedics Australia Pty Ltd

PL008 PLUS Hip Joint Prosthesis System PLS cementless grit blasted titanium stem 01-16 $3,588.00 $4,466.00

  standard and offset

Prostheses List by Category, Groups and Sponsor Page 338 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL124 Proxy Plus Cementless Hip Grit Blasted Ti Alloy 5-20 various offsets $3,450.00 $3,950.00

PL138 PLUS HIP JOINT PROSTHESES SYSTEM SL PLUS GRIT BLASTED TITANIUM  01-12 $3,450.00 $4,040.00

 MIA STEM STANDARD AND

 Smith & Nephew Surgical Pty Ltd

SN262 Bio-fit  Femoral Stem Collared Collared size 1-6 $3,005.00

SN360 ITH Femoral Stem Non Porous Titanium Alloy STCOL L120mm- 200mm  Stnd $895.00

  L120mm-200mm

SN842 Platform Hip Stem Titanium grit blasted stem 0-12 $3,450.00

 Zimmer

ZI338 Natural Hip System Femoral Stem Porous, Titanium 140 - 160mm $3,588.00

ZI376 Cone Hip prosthesis Uncemented Stems - Cone - Ti alloy 13 to 24mm $3,520.00

ZI377 Wagner Revision Hip Prosthesis Uncemented Stem Wagner Revision - Ti  190/14 to 385/25 $5,720.00 Also grouped in Hip Group 7a

ZI397 Variall Screw Cup System Variall Stem - Ti alloy sizes 0 to 11, $3,354.00

ZI462 Alloclassic Hip Stem High Offset, Ti alloy, Short Cone, Slender 1 - 14 $4,202.00

  Neck

ZI463 Alloclassic Hip Stem Zweymuller, Ti alloy, Short Cone,  01, 0, 1, 10-13 $4,202.00

 Slender Neck

ZI468 CLS Cementless Hip Varus Stem, Ti alloy 5 - 20 $4,202.00

 Group 5b - Uncemented, Grit Blast, HA, Standard and short, no modularity.

 Advanced Surgical Technologies

AD128 WMT Perfecta Hip System Porous titanium 10.5, 12, 12.7, 13.5, 14.2, 15,  $4,056.00

 16.5, 18mm width, 140 - 175

 B Braun Australia Pty Ltd

BB239 BiContact Cementless Femoral stem 8-21 $3,120.00

 Biomet Australia Pty Ltd

BI046 Biogroove Femoral Component Femoral Stem, Titanium, Cementless 7-14mm $4,212.00

Prostheses List by Category, Groups and Sponsor Page 339 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP943 Corail Hip System Titanium Stem collar or collarless or  Size K9 to K20 or in lengths  $4,420.00

 Coxa Vara or High offset 130-190mm

DY161 Unirom Total Hip System Femoral Stem Stem Taper 11/13 11-17 mm or 16B sml to 22F   $5,338.00

 Finsbury Orthopaedics Australia Pty Ltd

FI018 Freeman Hip Stem Cobalt Chrome, ridged HA coated,  165 lengths, diameter 10-12-14- $4,576.00

 16-18-20, offsets short 36mm

 and medium 40mm

 Link Orthopaedic  Australia

LO111 Beta-Cone Cementless Hip Prosthesis Cementless, Hx coated, Titanium Stem 9 Stem sizes 1-9 plus additional  $3,120.00

 9 stems with XL neck length. 

 Total 18 Sizes

 Mathys Orthopaedics Pty Ltd

MA462 twinSys uncemented Ti6A1V, corundum blasted,  8 sizes in standard and lateral  $4,400.00

 HA coating, plasma sprayed, triple  version (Size 9, 10, 11, 12, 13,

 tapered femoral stem 14, 15, 16)

 Plus Orthopedics Australia Pty Ltd

PL115 PLUS Hip Joint Prostheses System SBG Femoral Stem HA 1 $4,605.00

PL132 POLARSTEM FEMORAL STEM SYSTEM CEMENTLESS GRIT BLASTED WITH  0-8 $4,100.00

 HA STEM STANDARD AND LATERAL

 10/12 TAPER AND 12/14 TAPER

 Smith & Nephew Surgical Pty Ltd

SN259 Axis  Femoral HA Stem Titanium Alloy 120 - 200mm $3,976.00

SN306 Synergy Femoral stem: HA coated Titanium Alloy,  9-20 $4,212.00

 Std and High Offset

 Stryker Australia Pty Ltd

ST573 Omnifit hip stem OMNIFIT - HA  titanium - HA coated Stem sizes 4-14 $4,212.00

 Zimmer

ZI520 Alloclassic Zweymuller Hip Stem HA  Ti Alloy, Short Cone, Slender Neck, HA  1 - 12 $4,400.00

 Coated

Prostheses List by Category, Groups and Sponsor Page 340 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 5c - Uncemented, beaded, not HA, short and standard lengths, no modularity.

 De Puy Australia

DY474 Solution Implantable Hip System Revision Standard & MMA 8 straight or  6" size 10.5 - 22.5 $3,588.00

 bowed Porous coated

 Smith & Nephew Surgical Pty Ltd

SN270 Echelon Femoral Stem Porous Co Cr, Std and  9 - 19 $3,368.00

 High Offset

SN305 Synergy/Anthem Femoral stem Porous Titanium Alloy, Std 9-20 $4,435.00

  and High Offset

SN366 Matrix: Modular Hip System Stem: Opti-fix plus Titanium Alloy 8S - 16L $3,368.00

 Zimmer

ZI022 Zimmer Hip Systems Femoral Stem VerSys Beaded Fullcoat - Cobalt Chrome, 11 - 20 $4,435.00

  Short & Standard

 Group 5d - Uncemented, beaded, HA, short and standard lengths, no modularity.

 De Puy Australia

DP561 IPS HIP Titanium Femoral Hip System Titanium IPS Stem  Left and Right Size 1 to 7 $5,338.00

DY134 Summit Hip System Summit Femoral Stem DUOFIX Coated,  Size 1-10 $5,338.00

 Standard or High Offset

DY423 Proxima Hip System Standard Offset Left/Right Size 1 to 8 $5,338.00

DY424 Proxima Hip System High Offset Left/Right Size 1 to 8 $5,338.00

DY483 Unirom Total Hip System Femoral Stem Stem Taper 11/13 11-17 mm or 16B sml to 22F   $5,338.00

 Howmedica

HW051 Meridian ST Stem ST Stem -  Vitallium/Porous coated Stem size 0 to 9 $5,200.00

HW053 Meridian PA Hip PA Stem -  Vitallium/Periapatite coated Stem size 0 to 9 $5,200.00

HW054 Citation Hip AT Stem -  Vitallium/Porous coated Stem sizes 0 - 8 Left & Right $5,200.00

Prostheses List by Category, Groups and Sponsor Page 341 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN003 Hydroxylapatite coated Primary Femoral  Image Hip Stem, Titanium, left and right Sizes 9 - 18 $4,465.00

 Stems

SN303 Synergy Femoral Stem HA Coated Porous  9 - 18 $5,338.00

 Titanium Alloy, Std and High offset

SN678 Echelon with HA Cobalt Chromium with Hyrdoxyapetite  11-20 $5,338.00

 Coating

SN751 Synergy Shortened Synergy Stem 1-18 $4,689.00

SN825 Mid Head Resection Stem HA Porous Stem 1-19 $5,133.00

SN843 Anthology Hip System HA Coated Porous Tapered titanium stem 0-20 $5,133.00

 Group 5e - Uncemented, mesh, not HA, short and standard lengths, no modularity.

 Zimmer

ZI006 Mayo Hip Titanium Small, medium, large and extra  $4,778.00

 large.

ZI016 Zimmer Hip Systems Femoral Stem VerSys Fiber metal - Titanium 9 - 18 $4,778.00

 Group 5f - Uncemented, mesh, HA, short and standard lengths, no modularity.

 Zimmer

ZI014 Zimmer Hip Systems Femoral Stem Epoch - Titanium 14 - 18 mm $5,096.00

ZI017 Zimmer Hip Systems Femoral Stem VerSys Fiber metal HA/TCP - Titanium 9 - 18 $5,096.00

 Group 5g - Uncemented, plasma, not HA, short and standard lengths, no modularity.

 Biomet Australia Pty Ltd

BI027 Asian Hip System Femoral Stem, Chrome Cobalt, Cemented 7-13mm $4,680.00

BI034 Osteocap RS Hip System Femoral Stem, Titanium, Cementless 9-17mm $4,680.00

Prostheses List by Category, Groups and Sponsor Page 342 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI040 Integral Hip System Titanium Alloy, Cementless, Porus Stem,  Length from 125mm to 175mm, $4,680.00

 3 variations: Standard, Laterised or    9-19mm

 reduced profile

BI041 Integral Hip System Titanium Alloy, Cementless, Porus Stem,  Length from 180mm to 225mm, $4,680.00

 3 variations: Standard, Laterised or   9-20mm

 reduced profile

BI048 Balance Hip System Femoral Stem and Head, Cementless, 7 - 18mm $4,680.00

BI049 Bi-Metric Hip System Porous Stem, Titanium, Cementless 7-17mm $4,680.00

BI074 Biomet Taperloc Hip System Primary Femoral Stem, Titanium,  7.5mm - 22.5mm $4,680.00

BI139 Mallory Head Hip System Femoral Stem, Primary,  Titanium 7-19mm x 135 -180mm  $4,680.00

 Plus Orthopedics Australia Pty Ltd

PL137 POLARSTEM FEMORAL STEM SYSTEM CEMENTLESS WITH TITANIUM  0-8 $4,500.00

 COATING STANDARD AND LATERAL

  10/12 TAPER AND 12/14 TAPER

 Stryker Australia Pty Ltd (3)

SR027 Accolade HFx CoCr Fracture Stem Stem sizes 1-8, 127 degree neck $4,000.00

 Zimmer

ZI296 VerSys Hip System Femoral Stems Anatomic II stem Sizes 9 - 19 $4,680.00

ZI302 VerSys Hip System Femoral Stems Minimally invasive hip stem Sizes 9 - 19 $4,680.00

ZI327 M/L Taper Femoral Stem Cobalt/Chrome, beaded tapered stem 9mm - 18mm in 1mm  $4,680.00

 increments, 10 sizes in all

 Group 5h - Uncemented, plasma, HA, short and standard lengths, no modularity.

 B Braun Australia Pty Ltd

BB274 Excia Hip System Cementless pourous titanium, calcium  8mm-18mm $4,500.00

 phosphate bioactive coating

 Biomet Australia Pty Ltd

BI075 Biomet Taperloc Hip System Femoral Stem, HA, Titanium,  7.5mm - 22.5mm $5,044.00

BI100 Bi Hapro Hip System Femoral Stem, Uncemented, Cobalt  Size 1 to 8  $5,044.00

Prostheses List by Category, Groups and Sponsor Page 343 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI141 Mallory Head Hip System Femoral Stem, Primary, HAP Coated,   7-19mm  $5,044.00

 Titanium

BI779 CDH Hip System Femoral Stem, porous coated, Ti 8-12 mm Diameter $5,044.00

 Corin Australia Pty Ltd

CR068 Alpha Cera Fit Hip (Stem) Prostheses 12- Titanium Alloy with Titanium Plasma &  8mm - 22mm Diameters;  $3,744.00

 14 Taper Bonit Coating in the Proximal Area 128mm - 176mm Lengths;

 Standard and Proximally Modified

CR086 Tri-Fit Hip Titanium stem proximally coated with  5-20mm $3,744.00

 titanium plasma spray and

CR089 Alpha Fit Stem Collared and Collarless Stem with 3  9.5mm, 11mm, 12.5mm,  $4,139.00

 offsets at 43mm, 47mm,& 49mm,  14mm, 15.5mm, 17mm

 Howmedica

HW024 ABG11 Hip Stem Prosthesis(Various) ABG ll Femoral Stem - HA coated/Titanium Stem sizes 1 - 8 Left,  1 - 8  $4,576.00

HW055 Citation Hip TMZF - HA Stem -  Titanium/HA coated  Stem sizes 0 - 8 Left & Right $5,044.00

 Orthotech Pty Ltd

OH228 FH Thira Femoral Stem Ti & HA Femoral Stem 1-10 $3,900.00

OH232 Exactech Femoral Stem Novation Hip System 9-18 $4,850.00 $5,000.00

 Plus Orthopedics Australia Pty Ltd

PL009 PLUS Hip Joint Prostheses System SL PLUS Ti/Ha Stem 1 to 12 $4,860.00

PL125 Proxy Plus Cementless Hip Ti Alloy / HA / Vacuum Ti Plasma Spray 5-20 various offsets $4,850.00

PL133 POLARSTEM FEMORAL STEM SYSTEM CEMENTLESS  WITH TITANIUM  0-8 $4,800.00

 COATING HA STEM STANDARD AND

  LATERAL 10/12 TAPER AND 12/14

 TAPER

PL139 PLUS HIP JOINT PROSTHESES SYSTEM SL PLUS  TITANIUM TVPS/HA MIA  01-12 $4,800.00

 STEM STANDARD AND LATERAL

 Stryker Australia Pty Ltd

ST574 secur-fit HA Max hip stem SECUR-FIT femoral stem, titanium HA  Stem sizes 4-14 in 127 and 132  $5,044.00

 coated degree neck angles

Prostheses List by Category, Groups and Sponsor Page 344 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST575 Osteonics hip prostheses ACCOLADE STEM  titanium - HA coated Stems sizes 0, 1, 2, 2.5,3, 3.5,  $5,044.00

   127 & 132 degree offset 4, 4.5, 5, 5.5, 6, 7, 8

 Surgical House

SU197 Furlong Active Femoral Stem Straight, primary femoral stem. Vacuum  9, 10, 11, 12,14, 16mm $4,664.00

 plasma sprayed H-AC coating over

 titanium base metal.

 Zimmer

ZI492 Trabecular Metal Femoral Stem Trabecular metal (fully porous tantalum)  Sizes 9 to 18 with standard and  $5,044.00

 coated tapered femoral stem extended offsets

ZI493 M/L Taper HA/TCP Coated Stem Plasma sprayed titanium femoral stem Sizes 5 to 22 with standard and  $5,044.00

 extended offsets

ZI495 Zimmer Anatomic II with HA/TCP Anatomic titanium stem with HA coating Sizes 1 - 12, left and right $5,044.00

 Group 5l - Uncemented, other, HA, short and standard lengths, no modularity.

 Mathys Orthopaedics Pty Ltd

MA424 GSS-CO Cementless stem for hip arthroplasty Sizes 1-7; Length 145-200mm $1,520.00

 Zimmer

ZI365 Natural Hip System Femoral Stem CSTi / HA / Ti alloy, high  00 to 7 $4,708.00

 offset

 Group 6a - Uncemented, Grit Blast, not HA, standard and short, modularity.

 Advanced Surgical Technologies

AD124 Infinity Modular Hip System Trochanteric module titanium HA and  A, B, C, D, E, F $2,777.00

 porous coated

AD232 Profemur Total Hip System Titanium E Stem - without HA Plasma  1 Standard - 9 Standard $3,120.00

AD238 Profemur Total Hip System Profemur Z, Titanium Tapered Femoral  Standard Length Sizes 1 - 9 $3,120.00

 De Puy Australia

DP277 Stability Hip System Stem HA or Porocoat Coated Sm,  Lge,  XLge size 10A - 18B $5,200.00

Prostheses List by Category, Groups and Sponsor Page 345 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP981 SROM Total Hip System (Titanium) ZT/HA  Small / Large /XX Large  size  $2,860.00

 14B-24F

DP982 SROM Total Hip System (Titanium) ZTT Cone  Small / Large / XX large size  $2,860.00

 14B-24F

 Global Manufacturing Technology Pty Limited

GM042 BioBall - Femoral modular head system Femoral neck, 12/14 standard, 12/14 7.5  small to 5 XL, M to 5 XL, M to  $3,328.00

 offset, 14/16 standard 5 XL

GM107 Apex Global Modular Hip System Neck Ti (Salvage) 8-10 taper, 9-11 taper, 12-14  $3,000.00

 taper, V40 taper, 353 taper

 Link Orthopaedic  Australia

LO020 Waldemar Link MP Reconstruction Hip  Neck Segment Assembly 35-65mm IN 126 & 135  $3,120.00

 Prosthesis

LO021 Waldemar Link MP Reconstruction Hip  Stem 14 - 25mm x 210, 250, 290 &  $3,120.00

 Prosthesis 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 -MP;

 16 x 160, 180 - MP; 18 x 160,

 180 - MP; 20 x 160, 180 - MP;

 22.5 x 160, 180 -MP; 25 x 160,

LO024 Fixation Screw with Locking Bolt - 38 & 58 mm $463.00

LO025 Prostheses, Femoral Head - 35-65mm IN 126 & 135  $2,860.00

LO026 Proximal Spacer Rings - 10mm - 40mm $416.00

 Orthotech Pty Ltd

OH106 Lima Total Hip Replacement System Modular Revision Hip Titanium Stem  14, 16, 18, 20, 22, 24 $5,200.00

 (Uncemented)

OH107 Lima Total Hip Replacement System Revision Titanium Neck with Locking  50 - 110mm $3,120.00

OH201 Lima Modulus Hip System Modular Total Hip Replacement, Titanium Femoral Stem 16mm - 26mm $3,120.00

 Stryker Australia Pty Ltd

ST001 Restoration T3 Revision Hip System -  Titanium Alloy S,M,L $2,460.00

 Proximal Sleeve

Prostheses List by Category, Groups and Sponsor Page 346 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI379 PFM Hip series Uncemented Stems, PFM Revision (Distal 140 to 260 x 14 to 24 $3,657.00 $4,873.00

  Section) - Ti alloy

 Group 6b - Uncemented, Grit Blast, HA, Standard and short, modularity.

 Advanced Surgical Technologies

AD121 Infinity Modular Hip System Distal stem titanium 11 - 22mm in 1mm increments,  $1,680.00

 135 - 175mm long

AD237 Profemur Total Hip System Anca-fit Femoral Stem with 1/3 proximal  9.5, 11, 12, 13, 14, 15, 16,  $3,546.00

 HA Plasma Spray 17.5, left and right

AD291 Infinity Modular Hip System Trochanteric module titanium HA and  A, B, C, D, E, F $2,777.00

 porous coated

AD292 Infinity Modular Hip System Trochanteric module titanium A, B, C, D, E, F $2,777.00

AD319 Profemur Total Hip System Revision Hip Proximal Body Extension  Sm - Lg L26 x D19mm,  $1,615.00

 Piece, Titanium D21mm & D23mm; Sm - Lg

 L52 x D21mm; ExSM L26 x

 De Puy Australia

DP983 SROM Total Hip System (Titanium) ZTT  OS/ Under Size SM-XXLG size  $2,860.00

 14B-24F

DP984 SROM Total Hip System (Titanium) Standard NK30 or 36 or 42 or 21CR or  14  x 9 x 130mm to 24 x 19 x  $4,605.00

 11/13 or 12/14 Taper 175mm

DY493 Stability Hip System Stem HA or Porocoat Coated Sm,  Lge,  XLge size 10A - 18B $5,200.00

DY501 SROM Total Hip System (Titanium) ZT/HA Small / Large /XX Large  size  $2,860.00

 14B-24F

 ESKA Australia

EK014 Adapter Hip System Cementless HA coating, porous femoral stem and  Femoral stem 1-7, Dual cone 0  $4,368.00

 dual cone degrees to 20 degrees, lateral

 Global Manufacturing Technology Pty Limited

GM090 Apex Global Modular Hip System Femoral Stem Porous / HA Coated  Size 0 to size 9mm $4,428.00

 Modular Ti, standard and short lengths

Prostheses List by Category, Groups and Sponsor Page 347 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Link Orthopaedic  Australia

LO034 CFP Hip Stem A, B, left and right; titanium/ HA Extra small to Extra Large $5,384.00

LO133 Waldemar Link MP Reconstruction Hip  Neck Segment Assembly 35-65mm IN 126 & 135  $458.00

 Prosthesis

LO136 Waldemar Link MP Reconstruction Hip  Stem 14 - 25mm x 210, 250, 290 &  $4,160.00

 Prosthesis 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 -MP;

 16 x 160, 180 - MP; 18 x 160,

 180 - MP; 20 x 160, 180 - MP;

 22.5 x 160, 180 -MP; 25 x 160,

LO139 Fixation Screw with Locking Bolt - 38 & 58 mm $463.00

LO142 Prostheses, Femoral Head - 35-65mm IN 126 & 135  $2,860.00

LO143 Proximal Spacer Rings - 10mm - 40mm $416.00

 Orthotech Pty Ltd

OH097 Lima Total Hip Replacement System F2L Multineck Femoral Stem  1 - 6 $4,605.00

 Uncemented HAC & Porous Coating

OH098 Lima Total Hip Replacement System F2L Modular Neck - Titanium Short & Long (Straight &  $1,227.00

 Portland Orthopaedics (Aust) Pty Ltd

PD002 Margron DTC Hip Replacement Cobalt chrome Margron  YY6, YY7, ZZ6, ZZ7, Dia  $4,504.00

 Oncology/Revision Module 17mm-29mm

PD004 Margron DTC Hip Replacement Femoral Stem CoCr HA Product Size Range: Y+0-Y+2,  $2,777.00

 Z+0-Z+2, 1+0-1+2, 2+0-2+2,

 3+0-3+2, 4+0-4+2, 5+0-5+2,

 6+0-6+2, 7+0-7+2 Length:

 92.5-150mm, Diameter:

 Y:8.0mmx17.0mm,

 Z:9.0mmx19.0mm,

 1:10.0mmx21.0mm,

 2:11.5mmx23.0mm,

 3:13.0mmx25.0mm,

 4:13.5mmx27.0mm,

 5:14.0mmx29.0mm,

 6:14.0mmx31.0mm,

 7:14.0mmx33.0mm

Prostheses List by Category, Groups and Sponsor Page 348 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PD009 Margron DTC Hip Replacement Cobalt Chrome, Revision Modular, HA  Y+1, Y+2, Y+3, Y+4, Y+5,  $5,663.00

 Coated, Double Threaded Cone Stem Z+1, Z+2, Z+3, Z+4, Z+5

 Diameter 17mm - 19mm in

 Zimmer

ZI490 Revitan Modular Proximal Body Grit Blasted Titanium Proximal Body for  55, 65, 75, 85, 95 and 105mm  $4,368.00

 Modular Revision Stem heights

 Group 6c - Uncemented, beaded, not HA, short and standard lengths, modularity.

 Advanced Surgical Technologies

AD293 WMT Perfecta Hip System Porous titanium Non HA 10.5, 12, 12.7, 13.5, 14.2, 15,  $4,056.00

 16.5, 18mm width, 140 - 175

 Group 6d - Uncemented, beaded, HA, short and standard lengths, modularity.

 Smith & Nephew Surgical Pty Ltd

SN819 Emperion Revision Hip Proximal Modular Cone Standard 0, 1, 2, 3, 4 $3,818.00

SN820 Emperion Revision Hip Proximal Modular Cone Long 0, 1, 2, 3, 4 $3,818.00

 Group 6g - Uncemented, plasma, not HA, short and standard lengths,   modularity.

 Biomet Australia Pty Ltd

BI081 Impact Modular Total Hip System Femoral Segment, Diaphyseal, Standard.  10-15mm Diameter $2,288.00

 Titanium

BI082 Impact Modular Total Hip System Femoral Segment, Metaphyseal. Titanium Size 1-6 x Small/Medium $4,680.00

BI087 Impact Modular Total Hip System Femoral Segment, Metaphyseal,  Size 3-6, Small/Medium $4,680.00

 Uncemented , Titanium

BI126 Modular Calcar Mallory Head Revision  Femoral Component, Proximal.  Titanium 34, 45, 55 resection levels x size $7,800.00

 Hip System  a,b,c,d,e

 Orthotech Pty Ltd

OH060 Exactech Total Hip System Modular Titanium Revision Hip -  21 - 23mm, S, M, L, XL $2,288.00

 Metaphyseal Segment

Prostheses List by Category, Groups and Sponsor Page 349 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OH119 Exactech Total Hip System Modular Titanium Revision Hip -  25-27mm, S, M, L, XL $2,288.00

 Metaphyseal Segment

OH120 Exactech Total Hip System Modular Titanium Revision Hip -  29-31mm, S, M, L, XL $2,288.00

 Metaphyseal Segment

 Portland Orthopaedics (Aust) Pty Ltd

PD021 M-COR Modular Hip System M-COR Uncemented Femoral Stem,  29-9Z to 47-17A $2,400.00

PD022 M-COR Modular Hip System M-COR Uncemented Femoral Neck,  31Z to 51A $1,500.00

 Group 6h - Uncemented, plasma, HA, short and standard lengths, modularity.

 Advanced Surgical Technologies

AD234 Profemur Total Hip System Titanium uncemented proximal body - HA X-Small, Small, Standard 1,  $3,411.00

  Plasma sprayed Standard 2, Standard 3,

 Standard 4, Large

AD278 Profemur Total Hip System Titanium Tapered Stem - HA Plasma Spray Sizes 9 to 18 in 1 mm increments $4,605.00

AD279 Profemur Total Hip System Titanium Stem with HA Plasma Spray Size 11 with Fixed Neck  $4,605.00

 Standard Offset and High

 Offset, Standard and Plus Flare.

  Size 12 to 17 - Standard flare

 and Plus Flare. Size 18 -

 Biomet Australia Pty Ltd

BI089 Hap Impact Stem (Various) Femoral Segment, Metaphyseal, HAP  Size 3-6, Small/Medium  $4,992.00

 Coated, Uncemented, Titanium

BI128 Modular Calcar Mallory Head Revision  Femoral Component, Proximal, Revision,  34, 45, 55 resection levels x size $4,992.00

 Hip System HAP Coated. Titanium  a,b,c,d,e

BI837 Reach Revision Hip System Modular Reach Proximal Body -  Proximal Body #1 - 6 $4,992.00

 Collared/Collarless, CrCo, Ti, HA Coated

 Global Manufacturing Technology Pty Limited

GM091 Apex Global Modular Hip System Neck Ti 25mm - 35mm to 35mm -  $3,200.00

Prostheses List by Category, Groups and Sponsor Page 350 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Global Orthopaedic Technology

GO011 UniSyn Hip System a) Stem fluted straight, b) Stem porous  a) 10 x 130 to 20 x 170mm, b)  $3,328.00

 plasma sprayed straight, c) Stem porous  14-20 x 140-170mm, c) 14-18 x

 plasma sprayed bowed, d) Stem fluted   140-160mm, d) 10-20 x 130-

GO014 UniSyn Hip System a) Neck standard Ti, b) Body standard  a) 30-36 x 34-46mm, b) 22-30  $2,652.00

 plasma sprayed Ti, c) Body standard Ti  x 22-34mm, c) 22-30 x 22-

 HA coated, d) Body cone Ti plasma  34mm, d) 22-30mm

GO015 UniSyn Hip System Uncemented, Neck Calcar replacement 36 - 55 x 34 - 46mm $3,328.00

GO016 UniSyn Hip System Uncemented Body Ti plasma HA coated,  22 -38mm $3,328.00

 standard lengths, modular

GO017 UniSyn Hip System Uncemented Calcar body, Ti, HA coated 22 - 30mm $3,328.00

GO018 UniSyn Hip System Uncemented Calcar Body, Ti, Plasma, HA 22-30mm $3,328.00

  coated

GO033 UniSyn Hip System Neck non-standard Ti 24-55mm x 38-50mm $3,328.00

GO034 UniSyn Hip System Stem/Body/Monoblock Porous/HA Fluted 0 to 6 $4,160.00

GO037 Consensus Hip System Femoral Stem Porous/HA Coated short  1 to 5 $4,160.00

 and standard lengths modular

 Orthotech Pty Ltd

OH160 ESOP HA Esop Femoral Stem Metaphyseal Ti/HA Left and Right Size 5-20 $2,652.00

 Taylor Bryant Pty Ltd

TB069 Groupe Lepine Total Hip Replacement MBA Stem 1 - 8 $1,774.00

TB183 Lyderic II HA Modular Stem Forged titanium alloy, double layer coating Size 6-11 $2,288.00

 Group 6i - Uncemented, unpolished and polished, not HA, short and standard lengths,

 Advanced Surgical Technologies

AD236 Profemur Total Hip System Titanium Femoral Necks Length 27 - 38.5mm; Neutral to  $1,118.00

 Ante/Retro - Varus Valgus 2

 Orthotech Pty Ltd

OH059 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11 - 21mm x 135-165mm $3,640.00

Prostheses List by Category, Groups and Sponsor Page 351 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OH061 Exactech Total Hip System Modular Titanium Revision Hip - Neck  32 - 49mm, -5 - +30mm $2,288.00

 Segment

OH116 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11-21mm x 200mm $3,640.00

 Portland Orthopaedics (Aust) Pty Ltd

PD005 Margron DTC Hip Replacement Neck  Module CoCr X, Y Offset 31mm Vert Height  $3,034.00

 22mm

PD012 Margron DTC Hip Replacement Neck  Module CoCr AZ, A, B, C, BA, CA, CB, B+4,  $3,034.00

 C+6, CB+6 Offset-35mm-

 52mm Vert Height 25mm-35mm

 Group 6j - Uncemented, unpolished and polished, HA, short and standard lengths,

 Orthotech Pty Ltd

OH161 ESOP HA ESOP Femoral Stem Diaphyseal Ti Size 9-15 $1,482.00

 Group 6k - Uncemented, other, not HA, short and standard lengths, modularity.

 Biomet Australia Pty Ltd

BI015 Reach Revision Hip System Modular Reach Proximal Body -  Proximal Body #1-6 $4,888.00

 Collared/Collarless; Titanium, Chrome

 ESKA Australia

EK023 Type A Cementless Cut Prosthesis HA coating, femoral stem and dual cone Femoral stems - 80mm-110mm, $4,888.00

  Dual Cone - 10degrees-

 Orthotech Pty Ltd

OH121 Exactech Total Hip System Modular Titanium Revision Hip -  21-31mm $2,600.00

 Metaphyseal Segment - Calcar

 Group 7a - Uncemented, Grit Blast, not HA, long length, no modularity.

 B Braun Australia Pty Ltd

BB273 HuckStep Hip System Titanium, plasma coated femoral stem Long length $5,500.00

Prostheses List by Category, Groups and Sponsor Page 352 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Biomet Australia Pty Ltd

BI097 Kent Hip System Femoral Component, Titanium Narrow, Std.  Size 6 - 16 hole  $9,880.00

BI778 PLR Splined Revision Stem Splined Straight Stem, Ti 14-24mm x 270mm $5,720.00

 Mathys Orthopaedics Pty Ltd

MA428 CBK Revision Stem Uncemented revision stem for hip  Dia 14mm-25mm; Lengths 225, $2,113.00

  265, 305mm

 Plus Orthopedics Australia Pty Ltd

PL010 PLUS Hip Joint Prostheses System Revision SLR-PLUS Ti Stem 1 to 12 $5,408.00

 Group 7b - Uncemented, Grit Blast, HA, long length, no modularity.

 De Puy Australia

DY132 Corail Hip System Kar Femoral Stem Size 12 - 20 $5,512.00

 Group 7c - Uncemented, beaded, not HA, long length, no modularity.

 Smith & Nephew Surgical Pty Ltd

SN272 Echelon Revision Hip Stem - Porous, Standard  Sizes 11 - 22 $4,888.00

 Zimmer

ZI497 Zimmer Hip Systems Femoral Stem VerSys Beaded Fullcoat - Cobalt Chrome, 11 - 20 $4,778.00

  Long

 Group 7d - Uncemented, beaded, HA, long length, no modularity.

 De Puy Australia

DP562 IPS HIP Titanium Femoral Hip System Revision IPS Stem Titanium Size 12 - 20 $6,166.00

 Group 7g - Uncemented, plasma, not HA, long length, no modularity.

 Biomet Australia Pty Ltd

BI052 Bi-Metric Hip System Revision 200 Stem, Titanium, Cemented 9-17mm $6,240.00

BI053 Bi-Metric Hip System Revision 250 Stem, Titanium, Cemented 9-17mm $6,448.00

Prostheses List by Category, Groups and Sponsor Page 353 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI054 Bi-Metric Hip System Revision 300mm Femoral  Stem,  9-17mm $6,656.00

 Titanium, Cemented

BI135 Mallory Head Hip System Femoral Stem, Revision, Titanium 250mm, size 7 to 19mm $6,344.00

BI137 Mallory Head Hip System Femoral Stem, Revision, Titanium 300mm, size 7 to 19mm $6,448.00

BI692 Reach Revision Hip System Titanium porous coated bowed stem Sizes 13 - 19 (L&R) by 200mm  $4,576.00

 Length

BI693 Reach Revision Hip System Titanium porous coated bowed stem Sizes 13 - 19 (L&R) by 250mm  $4,680.00

 Length

BI694 Reach Revision Hip System Titanium porous coated straight stem Sizes 13 - 19  by 200mm  $4,576.00

 Group 7h - Uncemented, plasma, HA, long length, no modularity.

 Plus Orthopedics Australia Pty Ltd

PL011 PLUS Hip Joint Prostheses System Revision SLR-PLUS Stem 3 to 11 $5,304.00

 Stryker Australia Pty Ltd

ST541 Secur-Fit Plus max hip system Secur-Fit Plus femoral stem titanium -  Stem sizes 7-14 $5,200.00

 HA coated

ST587 Osteonics hip prostheses Restoration stem - 155mm  titanium - HA 155mm length - stem sizes 7-12 $5,304.00

  coated

ST588 Osteonics hip prostheses Restoration stem - 205mm  titanium - HA 205mm length - stem sizes  8- $6,136.00

  coated

ST591 Osteonics hip prostheses  Restoration HA long stem titanium - HA  255mm length - stem sizes 8 -  $6,448.00

 coated anatomic (left & right) 14, left & right

 Group 8a - Uncemented, Grit Blast, not HA, long length, modularity.

 Advanced Surgical Technologies

AD230 Profemur Total Hip System Titanium uncemented proximal body X-small, Small, Standard 1,  $3,052.00

 Standard 2, Standard 3,

 Standard 4, Large

AD231 Profemur Total Hip System Titanium tapered Splined or Cylindrical  Length 95 - 135mm, Diameter  $5,304.00

 Straight Stem 10 - 22.5mm

Prostheses List by Category, Groups and Sponsor Page 354 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD235 Profemur Total Hip System Titanium tapered Splined or Cylindrical  Length 175 - 215mm, Diameter  $5,928.00

 Bowed Stem 10 - 22.5mm

 De Puy Australia

DP977 SROM Total Hip System (Titanium) XX-Long, 36 x +21CR or +4 or +8 or  16 x 11 x 300  up to 24 x 19 x  $7,592.00

 right, left or neutral in 11/13 or 14/14

DP978 SROM Total Hip System (Titanium) X-Long 36 or +21CR or +4L or +8L in  16 x 11 x 240 up to 24 x 19 x  $6,971.00

 left, right or neutral or 11/13 or 12/14

DP979 SROM Total Hip System (Titanium) Long NK26 or 36 x +21CR or +4L or  14 x 9 x 205 up to 24 x 19 x  $6,381.00

 +8L or  left right or neutral or 11/13 or

DP980 SROM Total Hip System (Titanium) Stem STD 14 x 09 x 130 NK36mm to $4,605.00

  24 x 19 x 175 NK42mm

 Global Manufacturing Technology Pty Limited

GM052 SMR Modular Hip System Proximal Component 40 to 70mm $3,588.00

GM054 SMR Modular Hip System Distal Component 14x160mm to 24x320mm $4,784.00

 Link Orthopaedic  Australia

LO134 Waldemar Link MP Reconstruction Hip  Neck Segment Assembly 35-65mm IN 126 & 135  $458.00

 Prosthesis

LO137 Waldemar Link MP Reconstruction Hip  Stem 14 - 25mm x 210, 250, 290 &  $4,160.00

 Prosthesis 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 -MP;

 16 x 160, 180 - MP; 18 x 160,

 180 - MP; 20 x 160, 180 - MP;

 22.5 x 160, 180 -MP; 25 x 160,

LO140 Fixation Screw with Locking Bolt - 38 & 58 mm $463.00

LO144 Proximal Spacer Rings - 10mm - 40mm $416.00

 Orthotech Pty Ltd

OH217 Lima Total Hip Replacement System Modular Revision Hip Titanium Stem  14, 16, 18, 20, 22, 24 $6,760.00

 (Uncemented)

OH218 Lima Total Hip Replacement System Revision Titanium 50 - 110mm $3,952.00

 Plus Orthopedics Australia Pty Ltd

PL012 PLUS Hip Joint Prostheses System Revision Modular Proximal Stem 1 to 12 $5,304.00

Prostheses List by Category, Groups and Sponsor Page 355 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL013 PLUS Hip Joint Prostheses System Revision Modular Component 1 to 12 $4,472.00

 Portland Orthopaedics (Aust) Pty Ltd

PD011 Margron DTC Hip Replacement Cobalt Chrome, Revision Modular, HA  1+1, 1+2, 1+3, 1+4, 1+5, 2+1,  $5,663.00

 Coated, Double Threaded Cone Stem 2+2, 2+3, 2+4, 2+5, 3+1, 3+2,

 3+3, 3+4, 3+5, 4+1, 4+2, 4+3,

 4+4, 4+5, 5+1, 5+2, 5+3, 5+4,

 5+5, 5+6, 6+1, 6+2, 6+3, 6+4,

 6+5, 6+6 Diameter 21mm-

 Smith & Nephew Surgical Pty Ltd

SN749 Emperion Revision Hip Stem Modular Titanium Short $5,426.00

SN816 Emperion Revision Hip Stem Modular Titanium Long $5,426.00

SN817 Emperion Revision Hip Short Stem Modular Calcar Build-up +10, +20mm $5,426.00

SN818 Emperion Revision Hip Long Stem Modular Titanium Calcar  +10, +20mm $5,426.00

 Stryker Australia Pty Ltd

ST011 Restoration T3 Revision Hip System -  Titanium Alloy S,M,L $4,846.00

 Proximal Body

 Stryker Australia Pty Ltd (2)

SK059 Stryker Modular Revision Hip System Titanium Alloy Bowed Conical Distal  Restoration Modular bowed  $5,928.00

 conical distal stem 195mm,

 Zimmer

ZI049 Modular Revision Hip System - Proximal  ZMR Taper System - Titanium A - F $5,980.00

ZI050 Modular Revision Hip System - Distal  ZMR Porous System - Titanium 12.5 - 22.5mm $3,657.00

ZI378 PFM Hip series Uncemented Stem -PFM Revision  55 to  85  $3,657.00

 (Proximal Section) - Ti/CoCr alloy

 Group 8b - Uncemented, Grit Blast, HA, long length, modularity.

 Advanced Surgical Technologies

AD320 Profemur Total Hip System Revision Hip Proximal Body Extension  Sm - Lg L26 x D19mm,  $1,615.00

 Piece, Titanium D21mm & D23mm; Sm - Lg

 L52 x D21mm; ExSM L26 x

Prostheses List by Category, Groups and Sponsor Page 356 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP001 Reef Hip System Stem Wings, Titanium alloy Sizes 1, 2, 3 $1,799.00

DP005 Reef Hip System Stem Trochanteric Components,  25 or 35mm $5,264.00

 Titanium alloy, Collared and Collarless

DP009 Reef Hip System Stem, Titanium alloy Dia 10 - 20mm, Length 225 -  $5,663.00

 375mm

DY018 SROM Total Hip System (Titanium) Special Stem with either 230 to 325 in  12 x 06 x 155mm NK30, 14 x  $7,592.00

 Left right Neutral or 11/13 or 12/14  09 x 205mm  NK36

 Global Manufacturing Technology Pty Limited

GM094 Apex Global Modular Hip System Femoral Stem, Porous/HA coated,  Size 1 x 10mm to Size 8 x  $4,428.00

 modular, ti, long length

 Link Orthopaedic  Australia

LO135 Waldemar Link MP Reconstruction Hip  Neck Segment Assembly 35-65mm IN 126 & 135  $458.00

 Prosthesis

LO138 Waldemar Link MP Reconstruction Hip  Stem 14 - 25mm x 210, 250, 290 &  $3,484.00

 Prosthesis 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 -MP;

 16 x 160, 180 - MP; 18 x 160,

 180 - MP; 20 x 160, 180 - MP;

 22.5 x 160, 180 -MP; 25 x 160,

LO141 Fixation Screw with Locking Bolt - 38 & 58 mm $463.00

LO145 Proximal Spacer Rings - 10mm - 40mm $416.00

LO146 CFP Hip Stem A, B, left and right; titanium/ HA Extra small to Extra Large $5,384.00

 Portland Orthopaedics (Aust) Pty Ltd

PD013 Margron DTC Hip Replacement Cobalt chrome Margron  AA6, AA7, AZ6, AZ7, BA6,  $4,504.00

 Oncology/Revision Module BA7, BB6, BB7, CA7, CB7,

 CC7, Dia 21mm - 29mm

 Zimmer

ZI496 Revitan Modular Straight Stem Grit blasted titanium long stem for  14mm diameter x 140mm long  $4,316.00

 revision with CoCr junction to 24mm diameter x 260mm

Prostheses List by Category, Groups and Sponsor Page 357 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 8g - Uncemented, plasma, not HA, long length, modularity.

 Biomet Australia Pty Ltd

BI086 Impact Modular Total Hip System Femoral Segment, Metaphyseal, Revision  Size 3-6 Small/Medium $6,032.00

 Cemented , Titanium

BI926 Impact Modular Total Hip System Femoral Segment, Diaphyseal, Standard.  16-21mm Diameter $2,288.00

 Titanium

 Group 8h - Uncemented, plasma, HA, long length, modularity.

 Biomet Australia Pty Ltd

BI138 Mallory Head Hip System Femoral Stem, Revision, HAP Coated,  300mm, size 7 to 19mm $8,840.00

 Titanium

BI918 Helios Hip System Revision Hip Uncemented Stem 10 x 120mm to 20 x 280mm $4,836.00

BI919 Helios Hip System Revision Neck with Screw 40mm to 80mm $3,640.00

 Global Orthopaedic Technology

GO012 UniSyn Hip System a) Stem fluted straight Ti, b) Stem fluted  a) 10-20 x 170-210mm, b) 12- $4,992.00

 bowed Ti; c) Stem porous plasma  24 x 210mm, c) 14-25 x 180-

 sprayed straight, d) Stem porous plasma  210mm, d) 14-25 x 210mm, e)

 sprayed bowed; e) Stem fluted tapered 10-25 x 170-210mm

GO013 UniSyn Hip System a) Stem fluted bowed Ti; b) Stem porous  a) 12-24 x 260mm, b) 14-25 x  $5,543.00

 plasma sprayed straight, c) Stem porous  260mm, c) 14-25 x 260mm, d)

 plasma sprayed bowed; d) Stem fluted  10-25 x 260mm

GO020 UniSyn Hip System a) Stem fluted bowed Ti, b) Stem porous  a) 12-24 x 310mm, b) 14-25 x  $6,240.00

 plasma sprayed bowed, c) Stem fluted  310mm, c) 10-25 x 310mm

GO074 Consensus Hip System Femoral Stem Porous/HA Coated long  6 - 14 $4,992.00

 lengths modular

 Stryker Australia Pty Ltd (2)

SK056 Stryker Modular Revision Hip System Milled Proximal Body Titanium Plasma  Dia 19-25mm with 2 mill  $6,240.00

 Depths; 27-29mm with 3 Mill

Prostheses List by Category, Groups and Sponsor Page 358 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK058 Stryker Modular Revision Hip System Porous Distal Stems Titanium Plasma  Stem Lengths 127 & 167mm  $4,846.00

 straight & bowed. Diameter 11-

 26mm

SK060 Stryker Modular Revision Hip System Broached Proximal Body Titanium Plasma 1-8 $6,240.00

  Spray

SK061 Stryker Modular Hip System Cone Proximal Body Titanium Plasma  Dia 19-31mm, Heights  $6,240.00

 +0,+10,+20,+30

SK062 Stryker Modular Revision Hip System Calcar Proximal Body Titanium Plasma  Diameter 19-29mm, 3 Heights  $6,240.00

 Stryker Australia Pty Ltd (3)

SR045 Stryker Modular Revision Hip System Modular Long Bowed Titanium Plasma  Length 217mm, 267mm and  $6,500.00

 HA Stem 317mm. Diameter 11mm -

 Group 8i - Uncemented, unpolished and polished, not HA, long length, modularity.

 Orthotech Pty Ltd

OH117 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11-21mm x 250mm $6,760.00

OH118 Exactech Total Hip System Modular Titanium Revision Hip - Stem 11-21mm x 300mm $7,592.00

 Stryker Australia Pty Ltd (3)

SR046 Stryker Modular Revision Hip System Modular Long Bowed Titanium Polished  Length 217mm, 267mm and  $6,500.00

 Fluted Stem 317mm. Diamter 11mm-26mm

 Group 8l - Uncemented, other, HA, long length, modularity.

 Stryker Australia Pty Ltd (2)

SK022 Modular Revision System Fluted Distal  Composition - Titanium Alloy Ti A16 V4  Stem Lengths 127 & 167mm  $4,846.00

 with Arc Deposited Plasma Spray Coating straight & bowed. Diameter 11-

 26mm

 Group 9 - Uncemented, Long stem, Special feature - Calcar Replacement

 Biomet Australia Pty Ltd

BI072 Modular Calcar Mallory Head Revision  STS Distal Femoral Component, Titanium 14mm to 20mm $3,120.00

 Hip System

Prostheses List by Category, Groups and Sponsor Page 359 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI118 Mallory Head Hip System Femoral Stem, Calcar, Titanium 220mm, Size 9-19mm $7,280.00

BI119 Mallory Head Hip System Femoral Stem, Calcar, Titanium 260mm, Size 9-19mm $7,488.00

BI120 Mallory Head Hip System Femoral Stem, Calcar, HAP Coated,  220mm, Size 9-19mm $7,696.00

BI121 Mallory Head Hip System Femoral Stem, Calcar, HAP Coated,  "250 - 260mm, Size 9-19mm" $8,840.00

BI127 Modular Calcar Mallory Head Revision  Femoral Component, Distal. Titanium 170-300mm $3,536.00

 Hip System

 De Puy Australia

DP121 Solution Implantable Hip System  Revision straight or bowed & Calcar or  10" size 13.5 - 22.5 $6,576.00

 10" both left and right

DY007 SROM Total Hip System (Titanium) STD or Long or X-Long or XX-Long  26 x 21 x 175 or 230 or 275 or  $8,528.00

 NK26 or 36 x +21CR or +4L or +8L left,  325mm length

 right or neutral in 11/13 or 12/14 Taper

 Global Manufacturing Technology Pty Limited

GM055 SMR Modular Hip System Calcar Component 40 to 70mm $3,588.00

 Global Orthopaedic Technology

GO069 UniSyn Hip System Uncemented Body Plasma, Ti, HA coated, 22 - 30mm $3,120.00

  short lengths, modular

GO070 UniSyn Hip System Uncemented Body Calcar replacement,  22 -30 $3,640.00

 plasma, Ti, modular

GO071 Unisyn Hip System Uncemented Body Ti plasma HA coated,  22 - 30mm $3,536.00

 long lengths, modular

GO072 UniSyn Hip System Uncemented Calcar Body, Ti, Plasma, HA 22-30mm $3,536.00

  coated, extra long lengths, modular

 Orthotech Pty Ltd

OH219 Exactech Total Hip System Modular Titanium Revision Hip -  21-31mm $3,120.00

 Metaphyseal Segment - Calcar

 Smith & Nephew Surgical Pty Ltd

SN271 Echelon Revision hip stem - Bowed, porous:  Left/Right, 15 and 30mm,  Sizes $5,426.00

 Calcar Replacement Collar  11-22

Prostheses List by Category, Groups and Sponsor Page 360 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN275 Echelon Revision hip stem - Straight, porous:  15, 30mm, Sizes 11-22 $5,426.00

 Calcar Replacement Collar

 Stryker Australia Pty Ltd

ST589 Osteonics hip prostheses Restoration cacar replacement stem  205mm length - stem sizes 8-14 $6,900.00

 15mm  titanium - HA coated

Hip - Femoral Heads

 Group 12 - Bipolar/Multipolar

 Advanced Surgical Technologies

AD269 SLR Bipolar  Endoprosthesis SLR Bipolar Taper Femoral Head Cast  22.5mm - 32mm Femoral Head  $832.00

 Cobalt Chrome Alloy and neck ranging from -3.5mm

AD270 SLR Biploar Acetabular Shell Cast Cobalt Chrome Alloy 38mm - 65mm in millimetre  $1,248.00

 increments

AD271 SLR Bipolar Acetabular Liners UHMWPE 22mm - 32mm ID, ranging  $458.00

 from 38mm to 65mm

 B Braun Australia Pty Ltd

BB249 Bipolar Head Hemi Arthroplasty Head 38 - 60mm $1,300.00

 Biomet Australia Pty Ltd

BI096 Tripolar Acetabular Cup Series Ringloc Series, UHMWPE, Chrome Cobalt 24-28mm $3,346.00

BI129 Mallory Head Hip System Acetabular Cup, UHMWPE 40-80mm $1,872.00

 De Puy Australia

DP171 Hastings HIP Head Size 36 - 56 $857.00

DY160 Ultima Monk Bi-Articular Head 42 - 56mm $811.00

 ESKA Australia

EK015 ESKA Bipolar Head Femoral head snap fit into acetabular cup various diameters $1,248.00

 Global Manufacturing Technology Pty Limited

GM021 Classic Marathon (Acetabular  Bi-Polar 40mm to 54mm $1,248.00

Prostheses List by Category, Groups and Sponsor Page 361 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Link Orthopaedic  Australia

LO036 Vario Cup - 44-65mm $1,456.00

 Mathys Orthopaedics Pty Ltd

MA025 Bipolar Head Bipolar prosthesis head   Dia 28mm $1,872.00

 Orthotech Pty Ltd

OH103 Lima Total Hip Replacement System Heads - Bi-Polar and Fixed 22, 28, 32mm $1,872.00

 Plus Orthopedics Australia Pty Ltd

PL038 PLUS Hip Joint Prostheses System Bipolar Head 39mm-60mm $1,579.00

 Smith & Nephew Surgical Pty Ltd

SN266 Convene Bi-polar Liner =< 32mm $316.00

SN267 Tandem/Convene Shell/Liner 22 - 64mm $1,248.00

 Stryker Australia Pty Ltd

ST566 Osteonics hip prostheses Bipolar head,  cobalt chrome with  ID 22, 26, 28, 32mm dia  $1,579.00

 polyethylene insert (factory Assembled)

 Taylor Bryant Pty Ltd

TB064 Groupe Lepine Bipolar Heads 42 - 60mm in 1mm increments $727.00

 Zimmer

ZI286 Zimmer Acetabular Cup Multipolar (Bipolar) Cup-Co Chr  Outer Diameter 38 - 72mm,  $804.00

 W/WHMWPE Inner Diameter 22,28, or 32mm

 Group 13a - Conventional Femoral Head, =32mm, Stainless steel

 Corin Australia Pty Ltd

CR045 Femoral Head Stainless Steel Modular Femoral Head Dia 22, 26, 28 & 32mm, Short,  $723.00

 Std, Long & Extra Long Neck

 Length

 Howmedica

HW038 V40 Orthinox Head Stainless Steel 22 - 28mm dia $811.00

Prostheses List by Category, Groups and Sponsor Page 362 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mathys Orthopaedics Pty Ltd

MA028 Metal Heads Hip Prosthesis Head Cone 12/14 dia 28mm-58mm  $811.00

 Plus Orthopedics Australia Pty Ltd

PL034 Femoral Head Metal Stainless Steel =< 32mm $811.00

PL135 POLARSTEM FEMORAL STEM SYSTEM FEMORAL HEAD STAINLESS STEEL  22-28MM $780.00

 FOR POLAR STEM

 Smith & Nephew Surgical Pty Ltd

SN697 Femoral Head Stainless steel 22-32mm,+0-+16mm $606.00

 Taylor Bryant Pty Ltd

TB065 Groupe Lepine Total Hip Replacement Stainless Steel Head .-5mm/0mm/+5mm/ +10mm $780.00

 Zimmer

ZI052 Femoral Head Zimaloy - Stainless Steel 22mm, 28mm, 32mm $695.00

 Group 13b - Conventional Femoral Head, =32mm, Cobalt Chrome

 Advanced Surgical Technologies

AD114 Transcend/Lineage Articulation System Metal femoral head CoCr 28 and 32mm, 4 lengths $1,248.00

 B Braun Australia Pty Ltd

BB246 Isodur C Head Hip Prosthesis Head 22.2mm - 54mm diameters,  $936.00

 short, standard, long, X-long

 Biomet Australia Pty Ltd

BI094 Mallory Head Hip System Femoral Head, Offset, Chrome Cobalt 28,32mm $936.00

 Corin Australia Pty Ltd

CR029 CoCr Femoral Head CoCr femoral head 11/13 and 12/14 taper 22,26,28,32mm $728.00

 De Puy Australia

DP124 Solution Implantable Hip System  CoCr Femoral Head Various Tapers &  22 or 26 or 28 or 32 mm size $811.00

 Neck Lengths

DP549 C- Stem  C-Stem Heads Ortron Size -3 to +8 $700.00

DP988 SROM Total Hip System (Titanium) Unipolar  38-66mm $897.00

Prostheses List by Category, Groups and Sponsor Page 363 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK059 Metal Head Eccentric CoCr Mo Femoral Head CoCr 28mm - 32mm $1,200.00

EK060 Metal Head CoCr Femoral Head CoCr 28mm - 32mm $900.00

 Finsbury Orthopaedics Australia Pty Ltd

FI016 Finsbury Modular Heads Cobalt Chromium Diameter 22-26-28-32mm $780.00

 Global Manufacturing Technology Pty Limited

GM008 Edinburgh Total Hip System (Hip Stem) Femoral Head CoCr 28mm and 32mm $936.00

GM043 BioBall - Femoral modular head system Femoral Head CoCr - <32mm 28mm to 38mm $1,144.00

GM056 SMR Modular Hip System Femoral Head Co Chr 22 to 32mm $1,144.00

GM092 Apex Global Modular Hip System Femoral Head CrCo 28mm & 32mm $1,100.00

 Global Orthopaedic Technology

GO009 Consensus Hip System Femoral head CoCr 22-32mm $1,144.00

 Howmedica

HW032 Stryker CoCr Femoral Head 22, 26, 28, 30, 32mm $811.00

 Link Orthopaedic  Australia

LO022 Link Prosthesis Head Head:Chrome Cobalt Short, medium-short, medium  $749.00

 & large

 Mathys Orthopaedics Pty Ltd

MA469 Femoral Head CoCrMo ≤32 mm Hip Prosthesis Femoral Head CoCrMo  28 mm & 32mm,  $900.00 $975.00

 ≤32mm

 Orthotech Pty Ltd

OH062 Acumatch M-Series Total Hip System Modular Titanium Revision Hip - Cobalt  -2 to -5mm, +0 to 10mm $1,248.00

 Chrome Head

OH125 Lima Total Hip Replacement System CRCO Femoral Head S, M, L, XL, XXL $1,248.00

OH162 ESOP HA Femoral Head CoCr 22.2 -32mm $1,248.00

 Plus Orthopedics Australia Pty Ltd

PL057 Femoral Head Chrome Cobalt =< 32mm $936.00

Prostheses List by Category, Groups and Sponsor Page 364 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Portland Orthopaedics (Aust) Pty Ltd

PD001 Femoral Head CoCr Alloy 28mm, 32mm 4 lengths $936.00

 Smith & Nephew Surgical Pty Ltd

SN280 Femoral Head Co Cr, 14/16 taper =<32mm, Short -XXXLong  $728.00

SN281 Femoral Head Co Cr, 12/14Taper =<32mm $728.00

 Stryker Australia Pty Ltd

ST568 Stryker femoral Head Metal head with LFIT treatment 22-32mm $988.00

 Zimmer

ZI051 Femoral Head Zimaloy - Co Cr 22mm, 28mm, 32mm $734.00

ZI358 Durasul Ballhead for Inserts Femoral Metal Ball Head  - CoCr alloy 22, 28, 32 $967.00

ZI362 Natural Hip System Eccentric Ball Heads -  CoCr alloy 28/14 (S,M,L) $1,248.00

ZI364 Natural Hip System Femoral Head Chrome Cobalt alloy 22 to 32mm $967.00

ZI380 Femoral Head Head - Metal (Zweymuller Allopro) -  22mm, 28mm, 32mm $967.00

 Group 13c - Conventional Femoral Head, =32mm, Alumina

 Advanced Surgical Technologies

AD122 Transcend/Lineage Articulation System Head ceramic 28mm, 32mm, 3 lengths $1,889.00

 B Braun Australia Pty Ltd

BB250 Ceramic Head Biolox forte 26 - 32mm diameters, short,  $2,080.00

 standard and long

 Biomet Australia Pty Ltd

BI058 Modular Ceramic System Ceramic Head, Aluminium Alloy 28-32mm -6mm to +12mm $2,080.00

 Corin Australia Pty Ltd

CR065 Ball Heads 12 - 14 Taper (Alumina) Alumina Ball Head >32mm $2,080.00

 De Puy Australia

DP249 AML Modular Heads Ceramic Head Various Tapers & Neck  22 or 26 or 28 or 32 or 36mm $2,080.00

 Lengths

Prostheses List by Category, Groups and Sponsor Page 365 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK008 Metal Shell Type 2000/2000 Plus AI2 O3 Ceramic Head Biolox Forte  $1,300.00

 Fracture Head

EK009 Metal Shell Type 2000/2000 Plus AI2 O3 Ceramic Head Biolox Forte $1,300.00

 Finsbury Orthopaedics Australia Pty Ltd

FI017 Finsbury Modular Heads Ceramic Diameter 22-26-28-32mm $1,300.00

 Global Manufacturing Technology Pty Limited

GM019 Edinburgh Total Hip System (Hip Stem) Femoral Head Biolox Ceramic 28mm and 32mm $2,080.00

GM044 BioBall - Femoral modular head system Femoral head Biolox ceramic 28mm to 36mm $2,080.00

GM045 BioBall - Femoral modular head system femoral modular head system $1,144.00

GM057 SMR Modular Hip System Femoral Head Biolox Ceramic 28 to 32mm $2,080.00

GM093 Apex Global Modular Hip System Femoral Head Ceramic 28mm & 32mm $2,000.00

 Howmedica

HW017 Stryker Biolox Forte Alumina Femoral  28, 32mm $2,080.00

 Link Orthopaedic  Australia

LO023 Link Prosthesis Head Biolox Ceramic Short, medium-short & large  $1,456.00

 Mathys Orthopaedics Pty Ltd

MA020 Ceramic Head Ceramic Cone 12/14  - dia 28mm-32mm $1,722.00

 Orthotech Pty Ltd

OH093 Lima Total Hip Replacement System Ceramic/Femoral Head (Biolox Forte) Small, Medium, Large $2,080.00

OH137 Acumatch M-Series Total Hip System -  Modular Titanium Revision Hip - Ceramic -2 to -5mm, +0 to +10mm $2,080.00

  Head

OH163 ESOP HA Femoral Head Alumina Ceramic 28mm Diameter $2,080.00

 Plus Orthopedics Australia Pty Ltd

PL035 PLUS Hip Joint Prostheses System Fem Head Ceramic S,M,L $1,570.00

PL136 POLARSTEM FEMORAL STEM SYSTEM FEMORAL HEAD CERAMIC FOR  28MM $1,600.00

 POLAR STEM

Prostheses List by Category, Groups and Sponsor Page 366 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Portland Orthopaedics (Aust) Pty Ltd

PD006 Margron DTC Hip Replacement Femoral Head (Ceramic) 28mm, 32mm 3 lengths $1,515.00

 Smith & Nephew Surgical Pty Ltd

SN256 Axis  Ceramic Femoral Head AlO3 12/14Taper =< 32mm $1,579.00

SN278 Femoral Head Ceramic AlO3 14/16 taper, =<32mm, Std -  $1,485.00

SN299 Reflection  Head Ceramic, AlO3 =<32mm $1,990.00

 Taylor Bryant Pty Ltd

TB220 10/12/14 Alumina Head BOTA Alumina Head 28mm (-3.5mm, 0mm,  $2,080.00

 +3.5mm); 32mm (-4mm, 0mm,

 Zimmer

ZI055 Femoral Head Trilogy AB Ceramic Head 12/14 Taper  28 - 32mm $2,080.00

 (Alumina)

ZI346 Ceramic Femoral head for hip prosthesis  Femoral Head - Biolox Ceramic 28 to 32mm $1,660.00

ZI355 Cerasul - Ceramic Ceramic Femoral Head 28mm  $2,080.00

ZI381 Ceramic Head - Sulox Head - Ceramic 22 to 32mm $988.00

 Group 13d - Conventional Femoral Head, =32mm, Titanium Alloy

 Corin Australia Pty Ltd

CR064 Ball Heads 12 - 24 Taper (Tin Coated) Tin Coated (Titanium Nitride) 28mm x Small; 28mm x  $1,664.00

 Medium; 28mm x Large; 28mm

 x XLarge; 28mm x XXLarge;

 28mm x XXXLarge

 Group 13e - Conventional Femoral Head, =32mm, Non-alloy

 Smith & Nephew Surgical Pty Ltd

SN687 Femoral Head 12/14, 14/16 Taper, Oxinium 22 - 32mm, -3 - +16mm $2,340.00

Prostheses List by Category, Groups and Sponsor Page 367 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 13f - Conventional Femoral Head, =32mm, Other

 Global Orthopaedic Technology

GO010 Consensus Hip System Femoral head Biolox ceramic 28-32mm $2,080.00

 Stryker Australia Pty Ltd (3)

SR023 Stryker Revision Femoral Head, Biolox  With pre assembled titanium sleeve 28, 32mm $2,080.00

 Forte Alumina

SR026 Stryker CoCr Femoral Head LFIT Treatment 22-32mm $988.00

SR028 Delta Ceramic Heads Modular Femoral Head - Delta Ceramic  <32mm $2,000.00

 material

 Group 13g - Conventional Femoral Head, =32mm, Zirconium

 Biomet Australia Pty Ltd

BI927 Modular Ceramic System Ceramic Head, Zirconium 28-32mm -6mm to +12mm $2,080.00

 Corin Australia Pty Ltd

CR028 Zirconia Femoral Head Zirconia ceramic femoral head 11/13 and  22,26,28,32mm $1,872.00

 12/14 taper

 Plus Orthopedics Australia Pty Ltd

PL105 PLUS Hip Joint Prosthesis System Ceramic Head Revision 22-60 $1,872.00 To be used with Billing Code

PL118 Plus Hip Joint Prosthesis System Titanium Sleeve adaptor for revision  $936.00 To be used with Billing Code

 fractured ceramic

 Group 14a - Conventional Femoral Head, >32mm, Stainless steel

 Howmedica

HW395 V40 Orthinox Head Stainless Steel >32mm $811.00

 Mathys Orthopaedics Pty Ltd

MA456 Metal Heads Hip Prosthesis Head Cone 12/14 dia 28mm-58mm $811.00

MA467 Hemiprosthesis Head, Stainless Steel Hemiprosthesis Head, Stainless Steel,  42 mm - 58mm $780.00 $1,120.00

 Cone 12/14mm

Prostheses List by Category, Groups and Sponsor Page 368 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Plus Orthopedics Australia Pty Ltd

PL037 PLUS Hip Joint Prostheses System Unipolar Head 38-60 $551.00

PL103 PLUS Hip Joint Prosthesis System Ceramic Head Zirconium >32mm $1,685.00

 Smith & Nephew Surgical Pty Ltd

SN813 Femoral Head Stainless steel >32mm,+0-+16mm $606.00

 Zimmer

ZI498 Femoral Head Zimaloy - Stainless Steel 36mm, 40mm $695.00

 Group 14b - Conventional Femoral Head, >32mm, Cobalt Chrome

 Advanced Surgical Technologies

AD288 Transcend/Lineage Articulation System Metal femoral head CoCr 36mm, 4 lengths $1,248.00

AD308 Transcend/Lineage Articulation System Metal femoral head CoCr 32mm $1,248.00

 Biomet Australia Pty Ltd

BI061 Austin Moore Self Locking Hip Prosthesis Modular Femoral Stem and Modular  38-61mm Head, Std or Narrow  $988.00

  System Head, Titanium.

BI134 Mallory Head Hip System Femoral Modular Head, Chrome Cobalt 28 to 38mm -6 to +12mm $988.00

BI875 Endo II Head Modular Head - CoCr 41 mm through 61mm $988.00 Used with BI876

BI876 Endo II Head Modular Head Taper Insert - CoCr -6mm to +6mm $520.00 Taper insert for BI875

BI877 Freedom 36 mm Modular Head Modular Head 36mm,  -6mm to +9mm $988.00

 Corin Australia Pty Ltd

CR084 Modular Endo Head CoCr Modular Endo Head 38 - 60mm, short, standard and  $936.00

 long necks

 De Puy Australia

DY402 ASR Hip System Modular Cathcart Unipolar Head 41 to 60mm $884.00

 Global Manufacturing Technology Pty Limited

GM066 BioBall - Femoral modular head system Femoral Head CoCr >32mm 28mm to 38mm $1,144.00

Prostheses List by Category, Groups and Sponsor Page 369 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Global Orthopaedic Technology

GO043 Consensus Hip System Femoral head - Modular CoCr 38-58mm $988.00

GO046 Consensus Hip System Femoral Head Cemented CoCr 38-58mm $988.00

 Portland Orthopaedics (Aust) Pty Ltd

PD014 Femoral Head CoCr Alloy 36mm, 38mm in 4 lengths $936.00

 Smith & Nephew Surgical Pty Ltd

SN307 Unipolar Taper Sleeve Co Cr 12/14 and 14/16 tapers, +0,- $281.00 Taper insert for SN308

 3,+4,+8,+12mm.

SN308 Unipolar Head Co Cr 12/14 42 - 61mm $728.00 Used with SN307

SN809 Femoral head Co Cr, 14/16 taper >32mm, Short -XXXLong Neck $728.00

SN810 Femoral Head Co Cr, 12/14Taper >32mm $728.00

 Stryker Australia Pty Ltd (3)

SR025 C-Taper CoCr HeadStryker CoCr  36mm $988.00

 Femoral Heads, LFIT treatment

 Zimmer

ZI359 Durasul Ballhead for Inserts Femoral Metal Ball Head  - CoCr alloy 34 - 38mm $988.00

ZI499 Femoral Head Zimaloy - Co Cr 36mm, 40mm $734.00

ZI500 Femoral Head Head - Metal (Zweymuller Allopro) -  36mm, 38mm $967.00

 Group 14c - Conventional Femoral Head, >32mm, Alumina

 Advanced Surgical Technologies

AD290 Transcend/Lineage Articulation System Head ceramic 36mm, 3 lengths $1,889.00

 Corin Australia Pty Ltd

CR097 Alumina Head Biolox Forte >32mm $2,000.00

 De Puy Australia

DY464 AML Modular Heads Ceramic Head Various Tapers & Neck  22 or 26 or 28 or 32 or 36mm $2,080.00

 Lengths

Prostheses List by Category, Groups and Sponsor Page 370 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK036 Femoral Head BS / Ceram Femoral Head Al2O3 38-48mm $2,000.00

 Global Manufacturing Technology Pty Limited

GM108 BioBall - Femoral Modular Head System Femoral Head Biolox Delta 36mm $2,000.00

 Mathys Orthopaedics Pty Ltd

MA468 Femoral Head Ceramic >32 mm Hip Prosthesis Femoral Head Bionit  36mm (S,M,L,XL,XXL) $2,000.00

 Ceramic > 32mm

MA470 Hemiprosthesis Head, Bionit Ceramic Hemiprosthesis Head, Bionit Ceramic,  42-54mm $2,000.00

 Cone 12/14mm, Alumina

 Orthotech Pty Ltd

OH216 Lima Total Hip Replacement System Ceramic/Femoral Head (Biolox Forte) Small, Medium, Large $2,080.00

 Plus Orthopedics Australia Pty Ltd

PL102 PLUS Hip Joint Prosthesis System Ceramic Head AL >32mm $1,789.00

PL104 PLUS Hip Joint Prosthesis System Ceramic Head Delta >32mm $2,059.00

 Portland Orthopaedics (Aust) Pty Ltd

PD015 Margron DTC Hip Replacement Femoral Head (Ceramic) 36mm, 38mm in 3 lengths $1,515.00

 Smith & Nephew Surgical Pty Ltd

SN806 Axis Ceramic Femoral Head AlO3 12/14Taper >32mm $1,579.00

 >32MM

SN807 Femoral Head Ceramic AlO3 14/16 taper, >32mm, Std - Xlong $1,485.00

SN811 Reflection Head Ceramic, AlO3 >32mm $1,990.00

 Stryker Australia Pty Ltd

HW394 Stryker Bilox Forte Alumina Femoral  36mm $2,080.00

 Stryker Australia Pty Ltd (2)

SK404 Alumina Femoral Head 38mm-60mm Alumina Femoral Head 38mm-60mm $2,000.00 $2,436.00

Prostheses List by Category, Groups and Sponsor Page 371 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 14e - Conventional Femoral Head, >32mm, Non-alloy

 Smith & Nephew Surgical Pty Ltd

SN812 Femoral Head 12/14, 14/16 Taper, Oxinium >32mm, -3 - +16mm $2,340.00

 Group 14f - Conventional Femoral Head, >32mm, Other

 Stryker Australia Pty Ltd (2)

SK405 LFIT Femoral Heads Femoral head with low friction ion  36mm-72mm $2,436.00

 Stryker Australia Pty Ltd (3)

SR029 Delta Ceramic Heads Modular Femoral Head - Delta Ceramic  ≥ 32 mm $2,436.00

 material

 Group 15 - All metal on metal articulated heads

 Biomet Australia Pty Ltd

BI045 Scientific Hip Prostheses System Head, Chrome Cobalt 28mm, -6mm to +12mm $1,260.00

BI056 Biomet Alternate Bearing Surface  Metal on Metal head, Chrome Cobalt 28mm -6mm to +12mm $986.00

BI068 Stanmore Total Hip System Modular Head, Chrome Cobalt 28mm, -6mm to +12mm $1,456.00

BI070 Biomet Taperloc Hip System Modular Head, Chrome Cobalt 28mm, -6 to +12mm $1,260.00

BI895 M2A Magnum Prosthesis Taper Insert, Cobalt chrome 42 - 50mm, -6, -3, STD, +3,  $520.00 Taper insert for BI896

 +6, +9; 52 - 60mm, -6, -3,

 STD,

BI896 M2A Magnum Prosthesis Femoral Modular Head, Cobalt Chrome 38, 40, 42, 44, 46, 48, 50,52,  $2,392.00 Used with BI895

 54, 56, 58, 60mm

BI944 M2a 38 Femoral Head Metal on Metal Femoral Head, Cobalt  38mm $2,300.00

 Corin Australia Pty Ltd

CR016 Cormet 2000 - Modular Endo Head CoCr alloy >32mm $2,392.00

CR020 Metalok Femoral Head Carbon Cobalt Chrome Alloy Head 28mm (short/med/long  $1,263.00

Prostheses List by Category, Groups and Sponsor Page 372 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DY215 Pinnacle Cup/Liners CoCr "M" Femoral Heads Various Tapers  28 or 36 mm $2,392.00

 and Neck Lengths

 ESKA Australia

EK061 Large Metal Head Silver CoCr Femoral Head CoCrMo 38mm - 48mm $2,300.00

EK064 Large Metal Head Silver Surf Femoral Head CoCrMo 38mm - 48mm $2,300.00

 Finsbury Orthopaedics Australia Pty Ltd

FI015 Adept MoM Modular Head Metal on Metal modular head, CoChr,  38 - 58mm going up in 2mm  $2,392.00

 12/14 Eurocone increments. 4 different neck

 Global Orthopaedic Technology

GO047 ICON Hip System Femoral Head - Modular CoCr 38-58mm $2,392.00

 Mathys Orthopaedics Pty Ltd

MA029 Metal on Metal Head Head for MOM articulation 28mm $2,392.00

 Plus Orthopedics Australia Pty Ltd

PL036 PLUS Hip Joint Prostheses System Fem Head Plusmet S-XXL $1,507.00

PL076 PLUS Hip Joint Prosthesis System Femoral Metal Head - Standard Metal >32mm $1,529.00

PL116 PLUS Hip Joint Prosthesis System Femoral Head Metal - PLUSMET >32mm $1,976.00

 Smith & Nephew Surgical Pty Ltd

SN741 Birmingham Modular Femoral Head Cobalt Chrome 38 - 58mm $2,392.00

 Stryker Australia Pty Ltd (3)

SR051 Stryker Orthopaedic Traditional  Modular Femoral Head 38mm - 60mm $2,300.00

 Resurfacing Hip System - Modular Head

 Zimmer

ZI382 Femoral Head Head - Metasul - special metal alloy 28 to 40mm alloy $1,768.00

 Group 16a - Resurfacing, Metal, Cemented

 Advanced Surgical Technologies

AD112 Conserve Hip Resurfacing Hemi Cobalt chrome 36 - 58mm in 1mm increments $2,704.00

Prostheses List by Category, Groups and Sponsor Page 373 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD212 CONSERVE Femoral Surface  CoCr SLT Taper Femoral Head Sizes 38mm-54mm in 2mm  $3,016.00

 increments, -3.5 to +3.5 Neck

AD220 CONSERVE PLUS Total Hip Resurfacing CoCr Femoral Head - Super Polished Sizes 36mm - 54mm in 2mm  $3,432.00

  System increments

AD286 BFH Total, A-class Cobalt Chrome super finished femoral  36mm to 56mm in 2mm  $3,432.00 $3,890.00

 head. Size range from 36mm to 56mm in  increments each with - 3.5mm,

 2mm increments with 3 head lengths per  0mm, + 3.5mm head lengths

 Biomet Australia Pty Ltd

BI839 Resurfacing Hip System Femoral Head CoCr, Cemented 38 - 60mm $3,432.00

 Corin Australia Pty Ltd

CR047 Cormet 2000 Resurfacing Hip Resurfacing femoral head Cobalt chrome  Dia 40 -56mm $3,432.00

 cemented

 De Puy Australia

DY329 ASR Hip System Large Modular Head Adaptor / Sleeve 9/10 or 11/13 or 12/14 taper $1,152.00 Taper insert for DY330

DY330 ASR Hip System Large Modular Head Adaptor 38.5-64.5mm $3,432.00 Used with DY329

DY331 ASR Hip System Resurfacing Femoral Head 38.5-64.5mm $3,432.00

 ESKA Australia

EK039 Hip Surf Replacement Cemented Silver  Femoral Head CoCr 38mm - 68mm $2,600.00

EK079 Hip Surf Replacement Cemented Silver  Femoral Head CoCrMo/TiNb 38mm - 58mm $3,300.00 $3,800.00

 Surf BS

 Finsbury Orthopaedics Australia Pty Ltd

FI001 ADEPT MoM Resurfacing Head Resurfacing Head MoM, Cast CoChr 38-58 going up in 2mm  $3,432.00

 Global Orthopaedic Technology

GO049 ICON Hip System Femoral Head Cemented CoCr 38-58mm head $3,162.00

 Smith & Nephew Surgical Pty Ltd

SN743 Birmingham Hip Resurfacing Prostheses - Cemented 38 - 58 mm heads $3,307.00

   Femoral Component

SN826 Birmingham PC Hip Replacement Resurfacing prostheses - femoral  30-70 $3,300.00

Prostheses List by Category, Groups and Sponsor Page 374 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (3)

SR043 Stryker Orthopaedic Traditional  Resurfacing Head 38mm - 60mm $3,300.00

 Resurfacing Hip System

 Zimmer

ZI466 Durom Resurfacing System - Special Femoral  A - V $3,432.00

 Component, Metasul alloy

ZI472 Durom Resurfacing System - Ballhead Forged CoCr alloy A1 to L1 $2,254.00

 Group 16c - Resurfacing, Metal, Uncemented

 Biomet Australia Pty Ltd

BI838 Resurfacing Hip System Femoral Head CoCr, Ti, HA Coated 38 - 60mm $4,056.00

BI840 Resurfacing Hip System Femoral Head CoCr, Ti 38 - 60mm $4,056.00

 Corin Australia Pty Ltd

CR017 Cormet 2000 Resurfacing Hip System Resurfacing femoral head Cobalt chrome  Dia 40 - 56mm $4,056.00

 HAP coated

CR090 Cormet Resurfacing Head Bi Coated CrCo with titanium plasma spray and HA  40mm-56mm $4,056.00

 ingrowth surface

 ESKA Australia

EK049 Hip Surf Replacement Cementless Silver  Femoral Head CoCrMo/TiNb/HA 38mm-58mm $3,200.00

 Surf HA BS

EK062 Hip Surf Replacement Cementless Silver  Femoral Head CoCrMo/TiNb 38mm - 58mm $3,200.00

EK063 Hip Surf Replacement Cementless Silver  Femoral Head CoCrMo / TiNb / Ha 38mm - 58mm $3,200.00

 BS / Ha

EK067 Hip Surf Replacement cementless Silver  Femoral Head CoCrMo/TiNb/HA 38-58mm $3,200.00

 Cornwall BS/HA

EK068 Hip Surf Replacement cementless Silver  Femoral Head CoCrMo/TiNb 38-58mm $3,200.00

 Cornwall BS

EK069 Hip Surf Replacement cementless Silver  Femoral Head CoCrMo/TiNb 38-58mm $3,200.00

 Surf BS

Prostheses List by Category, Groups and Sponsor Page 375 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB308 HemiCAP Contoured Articular  Articular Component  - Chrome Cobalt Articular Component 25mm -  $4,056.00

 Resurfacing Hip System 2.5mm x 2.5mm to 5.0mm x

 5.0mm offset;  Articular

 Component 30mm - 4.5mm x

 4.5mm to 7.0mm x 7.0mm

 offset; Articular Component

 35mm - 6.0mm x 6.0mm to

TB309 HemiCAP Contoured Articular  Fixation Screw - Titanium Fixation component for  $1,560.00 Used with Billing code TB308

 Resurfacing Hip System 25mm,30mm, 35mm Artuclar

 Components Screw 10.5mm

 Dia & 12.5mm Dia & 15.6mm

 Group 16d - Resurfacing, Ceramic, Uncemented

 ESKA Australia

EK066 Hip Surf Replacement cementless BS /  Femoral Head Ceramic Al2O3 38-58mm $4,600.00

 Group 16e - Resurfacing, Other

 Endotec Australia Pty Ltd

EA005 Buechel-Pappas Integrated Total Hip  Femoral Head-Ceramic coated titanium 28mm to 58mm $5,408.00

 Replacement System

 ESKA Australia

EK078 Hip Surf Replacement Cemented BS /  Femoral Head Ceramic AL2O3 38mm - 58mm $5,200.00

 Group 17 - Item Type - Other

 De Puy Australia

DY026 Elite Hemi Head Elite Plus Hemi Head  42 - 60 mm $1,158.00

 Stryker Australia Pty Ltd

ST570 Large Diameter Moduar Heads UNITRAX Vitallium alloy /CoCr 38-64mm OD 2mm increments $1,179.00

Prostheses List by Category, Groups and Sponsor Page 376 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI054 Femoral Head Endo Head 38 - 63mm $925.00

ZI347 Femoral Head Femoral Head - Unipolar - CoCr alloy /  42 to 60  $1,116.00

Hip - Special Needs Group

 Group 28 - Special Purpose Group

 Biomet Australia Pty Ltd

BI889 Orthopaedic Salvage System Proximal Femoral Component, Letson or  7cm Left or Right $6,552.00

 Finn, Anatomic, Ti

 Howmedica

HW402 Exeter Hip System Stem: Standard - Orthinox Sizes 0-6, Offsets 35 - 5, 37 -  $2,392.00

 5, 44, 50mm

HW403 Exeter Hip System Exeter Duration Cup - Enhanced  OD: 40-60mm, ID: 22, 26, 28, 30 $832.00

 Polyethylene - Low and High Profile

 Smith & Nephew Surgical Pty Ltd

SN693 Hip Component Femoral or acetabular Size 0 - 20 $6,396.00

 Group 29 - Special Purpose Tumour Products

 ESKA Australia

EK016 ESKA Tumor Revision System MML Proximal femoral implant various sizes $11,440.00

 Link Orthopaedic  Australia

LO009 LINK Saddle Prosthesis Saddle Prosthesis Saddle Component One size only $4,976.00

LO010 LINK Saddle Prosthesis Saddle Prosthesis Base Component 60 - 160mm $3,909.00

LO011 LINK Saddle Prosthesis Saddle Prosthesis Set Screw for Base Component One size only $205.00

Prostheses List by Category, Groups and Sponsor Page 377 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LO012 LINK Saddle Prosthesis Saddle Prosthesis Stem 14 - 25mm x 210, 250, 290 &  $1,742.00

 330mm; 12 x 160, 180, 210,

 250 - MP; 14 x 160, 180 - MP;

 16 x 160, 180 - MP; 18 x 160,

 180 - MP; 20 x 160, 180 - MP;

 22.5 x 160, 180 MP; 25 x 160,

LO028 LINK Partial Pelvis Replacement Partial Pelvis Replacement (left/right) 48-67mm $3,848.00

LO029 LINK Partial Pelvis Replacement Partial Pelvis Replacement (left/right)  48-67mm $4,056.00

 with additional Caudal Flange

LO030 LINK Partial Pelvis Replacement Hook for Obturator Foramen Width  6-12mm $678.00

LO031 LINK Endo-Model Partial Pelvis  Fixation Screws, for Obturator Foramen,  20mm - 35mm; four (4) sizes $193.00

 including screw lock

 Mathys Orthopaedics Pty Ltd

MA024 CCE Ring CCE roof reinforcement ring - Dia 46 - 58mm $1,005.00

 Orthotech Pty Ltd

OH091 Lima RPS Femoral System Cemented Revision Stem 280, 330, 380mm $7,176.00

OH092 Lima RPS Femoral System Modular Spacer 20 - 144mm $3,640.00

Hip-Accessory

 Advanced Surgical Technologies

AD322 Quadra-Fix Acetabular Shell Quadra-Fix Double threaded, 6.5mm  35mm - 80mm in 5mm  $380.00

 Cancellous Screw

 Plus Orthopedics Australia Pty Ltd

PL149 Polar Cup Acetabular Cup System Impacting Anchorage Pegs for Polar Cup  15mm $260.00

 Shell

PL150 Polar Cup Acetabular Cup System Corital Screws for Polar Cup Shell 4.5mm by 40-60mm $122.00

Prostheses List by Category, Groups and Sponsor Page 378 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Hydroxyapatite

 Medtronic Australasia Pty Ltd

MC415 BCP Biphasic Calcium Phosphate Reabsorbable 1-3cc $832.00

  Graft Supplement

MC669 BCP Biphasic Calcium Phosphate Reabsorbable 5cc $936.00

  Graft Supplement

MC670 BCP Biphasic Calcium Phosphate Reabsorbable 10cc $1,352.00

  Graft Supplement

 Zimmer

ZI192 Bone Graft Substitute Triosite Granules (0.5 - 1.0 mm grain  1 g Tube $260.00

 sizes)- HATCP

ZI193 Bone Graft Substitute Triosite Granules (2 - 3mm grain size) -  5g Tube $670.00

 HATCP

ZI194 Bone Graft Substitute Triosite Block 5 x 5 x 10mm Box of 4 -  10mm $130.00

 HATCP

ZI195 Bone Graft Substitute Triosite Block 5 x 5 x 20mm Box of 4 -  20mm $185.00

 HATCP

ZI196 Bone Graft Substitute Triosite Block 5 x 5 x 10mm Box of 2 -  10mm $182.00

 HATCP

ZI197 Bone Graft Substitute Triosite Block 5 x 5 x 20mm Box of 2 -  20mm $247.00

 HATCP

ZI198 Bone Graft Substitute Triosite Oesteotomy Wedges - HATCP 6 - 12mm $745.00

Immobilizers, Cervical

 De Puy Australia

DY294 Bremer Halo Crown System Aluminium Crown & Vest Standard & 3D $3,035.00

Prostheses List by Category, Groups and Sponsor Page 379 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY295 Bremer Halo Crown System Titanium Skull Pins Standard & Hi-Fix $451.00

Knee - Femoral Component Total Arthroplasty

 Group 1a - Cemented, Alloy, Posterior Cruciate Retaining

 Advanced Surgical Technologies

AD141 Advance Total Knee System Femoral CoCr component PCR cemented 0, 1, 2, 3, 4, 5, 6 $3,432.00

AD169 Advantim Total Knee System Femoral Components CoCr Total  Small, Medium, Large, Xlarge $1,508.00

 Condylar (Non Porous Coated)

 Australian Surgical Design & Manufacture Pty Ltd

AE039 Active Knee System Active Knee - Cemented Femoral  Sizes 1-5 Left & Right $2,288.00

 B Braun Australia Pty Ltd

BB205 Columbus TKS Femoral component F1 - F7, Left and Right $2,912.00

 Biomet Australia Pty Ltd

BI147 AGC Knee System Femoral Component, Anatomic, Chrome  55-80mm $3,432.00

 Cobalt

BI152 AGC Knee System Femoral Component, Universal, Chrome  55-80mm $3,104.00

 Cobalt

BI168 Maxim Complete Knee System Primary Anatomic Femoral, Cemented,  55-80mm $3,432.00

 Chrome Cobalt

BI790 Ascent Total Knee System Femoral, cruciate retaining, anatomic,  X-Small to XX-Large $3,432.00

 cemented, chrome cobalt

BI898 Vanguard Total Knee System Femoral Component, CR, Cemented,  55, 57.5, 60, 62.5, 65, 67.5, 70, $3,432.00

 anatomic, CoCr.  75, 80 Left and Right

 Corin Australia Pty Ltd

CR013 Rotaglide + Total Knee System, Femoral  Pegged, Cemented Ex Sml - Ex Lge $2,808.00

 Component

CR015 Rotaglide + Total Knee System, Femoral  Stemmed, Cemented Ex Sml - Ex Lge $3,016.00

 Component

Prostheses List by Category, Groups and Sponsor Page 380 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP381 AMK Total Knee system Cemented Femoral left and right Size 1-5 $3,640.00

 ESKA Australia

EK029 Type ST Biocondylar Surface  Fixed bearing left and right femoral  s-small, small, medium, large, x- $3,744.00

 components. Cemented large. Height - 8, 10, 12, 14mm

EK032 Type RP Biocondylar Surface  Mobile bearing. Left and Right Femoral  s-small, small, medium, large, x- $3,744.00

 components. Cemented. large

 Howmedica

HW076 Duracon Femoral Component - Cemented Cruciate Retaining Small, Medium, Medium-Large,  $3,432.00

 Large, Extra-Large

HW147 Kinemax Knee Femoral: Condylar Beadless -  Vitallium XS, S, M, L, XL, XXL $2,358.00

 Mathys Orthopaedics Pty Ltd

MA108 Balansys Femoral Component Left & right  A - E $3,273.00

 Orthotech Pty Ltd

OH020 Optetrak Total Knee System Femoral Component Size 1 -  6 $3,432.00

OH155 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Femoral Implant 40-55 $3,432.00

  Stems & Patellar

 Plus Orthopedics Australia Pty Ltd

PL027 PLUS Knee Joint Prostheses System TC-PLUS Solution (Cemented) Fem 2 to 12 $3,328.00

PL068 Plus Knee Joint Prostheses System Femoral Cemented 1-6 $3,640.00

 Smith & Nephew Surgical Pty Ltd

SN321 Genesis II  Non Porous femoral Left/Right Size 1-8 $2,946.00

SN344 Genesis Femoral Component: Cruciate Retaining:  Left/Right Small - Magnum $2,779.00

 Non Porous: CoCr

 Stryker Australia Pty Ltd

ST023 Scorpio Cemented Femur Cruciate Retaining 3, 5, 7, 9, 11, 13 $3,432.00

ST634 Osteonics Knee System Femoral component cemented cobalt  3, 5, 7, 9, 11, 13 $3,432.00

Prostheses List by Category, Groups and Sponsor Page 381 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK324 Triathlon Femoral Component -  Cruciate Retaining Sizes 1 to 8 $3,640.00

SK332 Scorpio NRG Cemented Femur Cruciate Retaining Sizes 3,4,5,6,7,9,11,13 $3,640.00

 Zimmer

ZI420 Natural Knee Primary Femur - Cemented - CoCr alloy Size 00 to 5 $3,212.00

 Group 1b - Cemented, Alloy, Posterior Stabilised

 Advanced Surgical Technologies

AD133 Advance Total Knee System Femoral PS components CoCr 1, 2, 3, 4, 5, 6 $3,448.00

AD295 Advance Total Knee System Femoral CoCr component PCR cemented 0, 1, 2, 3, 4, 5, 6 $3,432.00

 B Braun Australia Pty Ltd

BB196 Emotion TKS Femoral Component-posterior stabilized F1 - F7, Left and Right $3,016.00

BB206 Columbus TKS Femoral component - posterior stabilized F1 - F7, Left and Right $3,016.00

 Biomet Australia Pty Ltd

BI150 AGC Knee System Femoral Component, Anatomic, Post.  55 to 80mm $3,432.00

 Stabilised Chrome Cobalt

BI158 AGC Knee System Femoral Prosthesis, Posterior Stabilised,  55-80mm $3,598.00

 Universal. Chrome Cobalt

BI178 Maxim Complete Knee System Femoral Component, Posterior Stabilised  55-80mm $3,432.00

 Anatomic Chrome Cobalt

BI191 TRAC Knee System Femoral Component, Posterior Stabilised  55-80mm $3,640.00

 CoCr

BI195 Oxford Tricompartmental Knee System Femoral Component, Posterior Stabilised, 60-75mm $3,432.00

  Cemented, CoCr

BI795 Ascent Total Knee System Femoral, anatomic, posterior stabilised,  X-Small to X-Large $3,432.00

 open box, cemented, chrome cobalt

BI897 Vanguard Total Knee System Femoral Component, Posterior Stabilised, 55, 57.5, 60, 62.5, 65, 67.5, 70, $3,432.00

  Cemented, anatomic, CoCr.  75, 80 Left and Right

Prostheses List by Category, Groups and Sponsor Page 382 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI902 ROCC Knee Prosthesis Femoral Component, cemented,  1-8 $3,432.00

 anatomic, CoCr

 De Puy Australia

DP004 LCS Complete System Femoral Cemented Small - xlarge $3,183.00

DP149 PFC Knee System Range PFC Sigma C/S  Size 1-6 $3,016.00

DP380 AMK Total Knee system Posterior or Congruency stabilised  Size 1-5 $5,929.00

 femoral or STD Femoral post Chrome

DY404 RPF Cemented Femur Size 1 to 6 $3,016.00

 Finsbury Orthopaedics Australia Pty Ltd

FI025 DBK Total Knee System Femoral Component, CoChr Alloy,  Sizes 1-6, Left and Right $2,600.00

FI028 MRK Total Knee System Femoral Component, Cemented, CoChr  0-5 Left and Right $2,600.00

 Global Orthopaedic Technology

GO006 RBK Total Knee System Femoral Component, Primary, Mobile  0 - 5 $3,234.00

 Bearing, Co Coatings

GO021 Consensus Knee System Femoral component nonporous CoCr and 1-6 L & R $3,068.00

 Howmedica

HW080 Duracon Total Knee System Monolithic Stabiliser -  Vitallium Small, Medium, Medium-Large,  $3,432.00

 Large, Extra-Large

HW396 Duracon Femoral Component - Cemented Posterior Stabilised Small, Medium, Medium-Large,  $3,432.00

 Large, Extra-Large

 Link Orthopaedic  Australia

LO037 Gemini MkII Knee Joint Prostheses System Femoral component, Standard,  Extra Small - Extra Large $2,496.00

 Orthotech Pty Ltd

OH212 Optetrak Total Knee System Femoral Component Size 1 -  6 $4,264.00

OH221 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Femoral Implant 40-55 $3,432.00

  Stems & Patellar

 Smith & Nephew Surgical Pty Ltd

SN327 Genesis II/Profix PS Non Porous Femoral Component Left/Right, Size 1-8 $3,432.00

SN660 Profix Constrained Femur Cobalt Chromium Left & Right, 2-7 $3,068.00

Prostheses List by Category, Groups and Sponsor Page 383 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (3)

SR003 Scorpio NRG Cemented Femur Posterior Stabilised Sizes 3,4,5,6,7,9,11,13 $3,640.00

SR005 Scorpio Cemented Femur Posterior Stabilised 3, 5, 7, 9, 11, 13 $3,432.00

SR009 Triathlon Femoral Component -  Posterior Stabilised Sizes 1 to 8 $3,640.00

SR019 Osteonics Knee System Femoral component cemented cobalt  3, 5, 7, 9, 11, 13 $3,432.00

 Zimmer

ZI119 NexGen Knee Femoral Components PS Option - Co Cr A - H (L&R) $7,280.00

ZI421 Natural Knee Primary Femur - Cemented P.S. - CoCr  Size 00 to 5 $3,432.00

 Group 1c - Cemented, Alloy, Totally Constrained

 Biomet Australia Pty Ltd

BI180 Maxim Complete Knee System Constrained Anatomic Femoral  60-75mm $5,408.00

 Component, Anatomic. Chrome Cobalt

BI799 Ascent Total Knee System Femoral Anatomic, posterior stabilised or  X-Small to X-Large $5,720.00

 constrained, closed box, cemented,

 chrome cobalt

BI933 Vanguard SSK Knee System Femoral Component, CoCr, Ti 55 to 80mm $5,200.00

 De Puy Australia

DP150 PFC Knee System Range PFC Sigma TC3 Femur  Size 1-5 $3,614.00

 Howmedica

HW149 Kinemax Knee Femoral: Stabilizer Beadless -  Vitallium XS, S, M, L, XL, XXL $2,756.00 Also grouped in Knee Group 11

 Orthotech Pty Ltd

OH024 Optetrak Total Knee System CCK Femoral Component Size 1 - 6 $6,240.00

 Smith & Nephew Surgical Pty Ltd

SN315 Genesis II/Profix Non Porous Constrained Femoral  Left & Right, Size 1-8 $3,068.00

 Tornier Pty Ltd

TO008 HLS Noetos Total Knee Replacement -  Femur Cemented 1 - 6 CoCr $4,000.00

Prostheses List by Category, Groups and Sponsor Page 384 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 1d - Cemented, Alloy, PMMA coating, Posterior Cruciate Retaining

 Zimmer

ZI111 NexGen Knee Femoral Components CR Precoat - Co Cr A - H (L&R) $3,432.00

ZI113 NexGen Knee Femoral Components CRA Precoat - Co Cr A - H (L&R) $7,540.00

 Group 1e - Cemented, Alloy, PMMA coating, Posterior Stabilised

 Orthotech Pty Ltd

OH233 Optetrak RBK Optetrak RBK Femoral Component  1-6 $3,300.00

 Zimmer

ZI063 NexGen Flex Femoral Components Cobalt Chrome Sizes A - G, Left & Right $4,680.00

 GSF C to G Left & Right

ZI117 NexGen Knee Femoral Components PS Precoat - Co Cr A - H (L&R) $3,432.00

 Group 1f - Cemented, Alloy, PMMA coating, Totally Constrained

 Smith & Nephew Surgical Pty Ltd

SN814 Genesis II Femoral Component Constrained Co Cr Left & Right size 1-8 $3,068.00

 Group 1g - Cemented, Non-Alloy, Posterior Cruciate Retaining

 Endotec Australia Pty Ltd

EA007 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented Primary  $3,952.00

 Replacement System (Primary and  Tibial components with mobile  Femoral sizes 1-6(inc) Left &

 Polyethelene inserts, all polyethelene

 patella ceramic coated, titanium backed

 Smith & Nephew Surgical Pty Ltd

SN333 Genesis II/Profix C/R Femoral Component, Oxinium 1-9 $4,992.00

Prostheses List by Category, Groups and Sponsor Page 385 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 1h - Cemented, Non-Alloy, Posterior Stabilised

 De Puy Australia

DY371 LCS Complete System PS Femur CoCr Cemented TiNi Sml to Lge Plus Left and Right $5,189.00

DY374 LCS Complete System Femoral Cemented TiNi Small - Large Plus Left and Right $5,189.00

 Smith & Nephew Surgical Pty Ltd

SN704 Genesis II / Profix Posterior Stabilised Oxinium Femoral  Size 1 - 8 $5,189.00

 Components

SN779 Renasys Knee Non Porous Femur 1-10 $5,189.00

SN803 Genesis II/Profix P/S Femoral Component, Oxinium 1-9 $4,992.00

 Group 1i - Cemented, Non-Alloy, Totally Constrained

 Smith & Nephew Surgical Pty Ltd

SN736 Legion Revision Constrained Oxinium Femoral Component Size 1 - 9 $8,320.00

SN804 Genesis II/Profix Constrained Femoral Component,  1-9 $4,992.00

 Group 1j - Uncemented, Alloy, Posterior Cruciate Retaining

 Advanced Surgical Technologies

AD140 Advance Total Knee System Femoral CoCr PCR component porous 0, 1, 2, 3, 4, 5, 6 $4,150.00

AD168 Advantim Total Knee System Femoral Components CoCr Total  Small, Medium, Large, Xlarge $2,309.00

 Condylar (Porous Coated)

 Biomet Australia Pty Ltd

BI159 AGC Total Knee System Femoral Prostheses, Anatomic, Porous  55-80mm $3,744.00

 Coat, CoCr, Ti

BI167 Maxim Complete Knee System Primary Anatomic Femoral, Uncemented, 55-80mm $3,744.00

  Chrome Cobalt

BI794 Ascent Total Knee System Femoral, cruciate retaining, anatomic,  X-Small to XX-Large $4,160.00

 uncemented, chrome cobalt, titanium

 porous coat

Prostheses List by Category, Groups and Sponsor Page 386 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI886 Vanguard Total Knee System Femoral Component, CR, uncemented,  55, 57.5, 60, 62.5, 65, 67.5, 70, $4,160.00

 anatomic, CoCr, Ti  75, 80 Left and Right

 Corin Australia Pty Ltd

CR012 Rotaglide + Total Knee System, Femoral  Pegged, Porous Coat Ex Sml - Ex Lge $2,903.00

 Component

 De Puy Australia

DP148 PFC Knee System Range PFC Sigma C/R porous  Size 1-6 $2,652.00

DP237 LCS Total Knee System Femoral Tray Chrome cobalt Sm+ to Lge++ $3,414.00

 ESKA Australia

EK030 Type ST Biocondylar Surface  Fixed bearing left and right femoral  s-small, small, medium, large, x- $3,744.00

 components. Uncemented large. Height - 8, 10, 12, 14mm

EK033 Type RP Biocondylar Surface  Mobile bearing. Left and Right Femoral  s-small, small, medium, large, x- $3,744.00

 components. Uncemented. large

 Finsbury Orthopaedics Australia Pty Ltd

FI026 DBK Total Knee System Femoral Component, CoChr Alloy,  Sizes 1-6, Left and Right $3,120.00

 uncemented

 Global Orthopaedic Technology

GO022 Consensus Knee System Femoral component porous CoCr 1-6 L & R $3,203.00

 Howmedica

HW075 Duracon Femoral Component -  Cruciate Retaining Small, Medium, Medium-Large,  $3,744.00

 Large, Extra-Large

HW146 Kinemax Knee Femoral: Condylar Beaded -  Vitallium XS, S, M, L, XL, XXL $3,442.00

 Link Orthopaedic  Australia

LO049 LINK T.A.C.K. Knee Femoral Cementless Extra-small, small, medium &  $2,496.00

 Mathys Orthopaedics Pty Ltd

MA457 Balansys Femoral Component Left & right A - E $3,273.00

 Orthotech Pty Ltd

OH213 Optetrak Total Knee System Femoral Component Size 1 -  6 $3,432.00

Prostheses List by Category, Groups and Sponsor Page 387 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OH222 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Femoral Implant 40-55 $3,744.00

  Stems & Patellar

 Plus Orthopedics Australia Pty Ltd

PL053 Plus Knee Joint Prostheses System Femoral Cementless 1-6 $4,160.00

 Smith & Nephew Surgical Pty Ltd

SN326 Genesis II  Porous femoral Left/Right Size 1-8 $3,744.00

SN345 Genesis Femoral: Cruciate Retaining: Porous:  Left/Right Small - Magnum $2,652.00

SN375 Profix Femoral Porous  Left/Right Size 1-8 $3,120.00

 Stryker Australia Pty Ltd

ST033 Scorpio Femoral Component -  Cruciate Retaining 3,5,7,9,11,13 $3,848.00

 Stryker Australia Pty Ltd (2)

SK387 Triathlon Total Knee System Uncemented, porous beaded femoral  1 to 8 $3,952.00

 component, cruciate retaining, left and

 right, cobalt chrome

 Zimmer

ZI109 NexGen Knee Femoral Components CR Porous - Co Cr A - H (L&R) $3,744.00

ZI418 Natural Knee Primary Femur - Porous - Ti/CoCr alloy Size 00 to 5 $3,744.00

 Group 1k - Uncemented, Alloy, Posterior Stabilised

 Advanced Surgical Technologies

AD186 Ortholoc Modular Total Condylar Femoral components CoCr Posterior  Small, Medium, Large, Xlarge $4,318.00

 Stabilised (Porous Coated)

AD300 Advance Total Knee System Femoral CoCr PCR component porous  1, 2, 3, 4, 5, 6 $4,150.00

 and HA

 Biomet Australia Pty Ltd

BI165 AGC Total Knee System Femoral Prostheses, Posterior Stabilised,  55-80mm $4,264.00

 Uncemented, Chrome Cobalt

BI174 Maxim Complete Knee System Femoral Component, Posterior Stabilised, 55-80mm $4,992.00

  Porous, Chrome Cobalt

Prostheses List by Category, Groups and Sponsor Page 388 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI192 TRAC Knee System Femoral Component, Porous, Posterior  55-80mm $4,992.00

 Stabilised CoCr, Ti

BI796 Ascent Total Knee System Femoral, anatomic, posterior stabilised,  X-Small to X-Large $4,992.00

 open box, uncemented, chrome cobalt,

 titanium porous coat

BI910 Oxford Tricompartmental Knee System Femoral Component, Posterior Stabilised, 60 - 75mm $4,992.00

  Porous, CoCr, Ti

 De Puy Australia

DP003 LCS Complete System Femoral Porocoat Small - large $3,727.00

DP268 SROM Knee System Femoral Component XSml -Lge $4,009.00

DP518 LCS Universal Knee LCS Ultra Femorals Chrome cobalt Sm - Lge+ $3,557.00

 Finsbury Orthopaedics Australia Pty Ltd

FI029 MRK Total Knee System Femoral Component, cementless, CoChr  0-5 Left and Right $3,120.00

 Alloy

 Howmedica

HW397 Duracon Femoral Component -  Posterior Stabilised Small, Medium, Medium-Large,  $3,744.00

 Large, Extra-Large

 Orthotech Pty Ltd

OH214 Optetrak Total Knee System Femoral Component Size 1 - 6 $3,744.00

OH223 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Femoral Implant 40-55 $4,264.00

  Stems & Patellar

OH234 Optetrak RBK Optetrak RBK Femoral Component  1-6 $4,000.00

 Uncemented

 Plus Orthopedics Australia Pty Ltd

PL077 Plus Knee Joint Prostheses System TC Plus Solution, Femur PS 2-12 $4,992.00

 Smith & Nephew Surgical Pty Ltd

SN328 Genesis II/Profix PS Porous Femoral  Component Left/Right, Size 1-8 $4,264.00

SN815 Profix Femoral Porous Left/Right Size 1-8 $3,120.00

Prostheses List by Category, Groups and Sponsor Page 389 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK386 Triathlon Total Knee System Uncemented, porous beaded femoral  Sizes 1 to 8 $3,952.00

 component, posterior stabilized, left and

 right cobalt chrome

 Stryker Australia Pty Ltd (3)

SR007 Scorpio Femoral Component -  Posterior Stabilised 3,5,7,9,11,13 $3,848.00

 Zimmer

ZI115 NexGen Knee Femoral Components PS Porous - Co Cr A - H (L&R) $4,264.00

ZI419 Natural Knee Primary Femur - Porous P.S. - Ti/CoCr  Size 00 to 5 $4,576.00

 Group 1l - Uncemented, Alloy, Totally Constrained

 Smith & Nephew Surgical Pty Ltd

SN383 Profix Porous Femoral with Taper Right/Left Size 1-7 $4,218.00

 Group 1m - Uncemented, Alloy, HA coating, Posterior Cruciate Retaining

 Advanced Surgical Technologies

AD194 Ortholoc Advantim HA Porous Coated  Femoral components CoCr HA coated  Small, Medium, Large, Xlarge $2,912.00

 Knee System femoral components

AD275 Advance HA Coated Femoral Component HA Coated Femoral Component 1 - 6 Left and Right $4,420.00

AD301 Advance Total Knee System Femoral CoCr PCR component porous  1, 2, 3, 4, 5, 6 $4,150.00

 and HA

 Australian Surgical Design & Manufacture Pty Ltd

AE041 Active Knee System Active Knee - Cementless  Femoral  Sizes 1-5 Left & Right $3,380.00

 Component

 B Braun Australia Pty Ltd

BB232 Emotion TKS Femoral Component - Cementless F1 - F8, Left and Right $3,380.00

BB234 Columbus TKS Femoral Component - Cementless F1 - F7, Left and Right $3,536.00

Prostheses List by Category, Groups and Sponsor Page 390 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Corin Australia Pty Ltd

CR011 Rotaglide + Total Knee System, Femoral  Pegged, Hap Coat Ex Sml - Ex Lge $4,141.00

 Component

CR014 Rotaglide + Total Knee System, Femoral  Stemmed, HAP Coat Ex Sml - Ex Lge $4,160.00

 Component

 De Puy Australia

JJ462 LCS Complete DuoFix Femur CoCr femur with PoroCoat and HA  Small, Medium, Standard,  $4,160.00

 coating for cementless fixation Large, Right and Left

 Global Orthopaedic Technology

GO007 RBK Total Knee System - Femoral  Porous coating 1-5 $3,245.00

 Component

GO023 Consensus Knee System Femoral component porous CoCr/Ti 1-6 L & R $4,160.00

 Howmedica

HW077 Duracon Femoral Component -  Cruciate Retaining Small, Medium, Medium-Large,  $4,160.00

 Cementless with PA Large, Extra-Large

 Link Orthopaedic  Australia

LO054 LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): femoral  Extra-small, small, medium &  $3,016.00

 component

 Plus Orthopedics Australia Pty Ltd

PL028 PLUS Knee Joint Prostheses System TC-PLUS Solution (Cementless) Fem 2 to 12 $4,160.00 Also grouped in Knee Groups 3b,

  5e, 10

 Smith & Nephew Surgical Pty Ltd

SN332 Genesis II/Profix Femoral Component HA Coated Co Cr 1-8 $4,160.00

 Stryker Australia Pty Ltd

ST030 Scorpio Femoral Component - cementless Cruciate Retaining 3,5,7,9,11,13 $4,160.00

  with PA

 Stryker Australia Pty Ltd (2)

SK325 Triathlon Femoral Component -  Cruciate Retaining Sizes 1 to 8 $4,264.00

SK334 Scorpio NRG Cementless Femur Cruciate Retaining Sizes 3,4,5,6,7,9,11,13 $4,264.00

Prostheses List by Category, Groups and Sponsor Page 391 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI110 NexGen Knee Femoral Components CR Porous HA/TCP - Co Cr A - H (L&R) $4,420.00

 Group 1n - Uncemented, Alloy, HA coating, Posterior Stabilised

 Advanced Surgical Technologies

AD299 Advance HA Coated Femoral Component HA Coated Femoral Component 1 - 6 Left and Right $4,420.00

AD302 Advance Total Knee System Femoral CoCr PCR component porous  1, 2, 3, 4, 5, 6 $4,150.00

 and HA

AD306 Advance HA Coated Femoral Component HA Femoral Component 1 - 6 Left and Right $4,420.00

 Biomet Australia Pty Ltd

BI887 ROCC Knee Prosthesis Femoral Component, uncemented,  1-8 $4,264.00

 anatomic, HA or Porous HA Coated,

BI911 Oxford Tricompartmental Knee System Femoral Component, Posterior Stabilised, 60 -75mm $4,680.00

  Porous, HA Coated, CoCr, Ti, HAP

 Howmedica

HW398 Duracon Femoral Component -  Posterior Stabilised Small, Medium, Medium-Large,  $4,160.00

 Cementless with PA Large, Extra-Large

 Link Orthopaedic  Australia

LO128 Gemini MkII Knee Joint Prostheses System Femoral Component, Standard, HX  Extra Small - Extra Large $936.00

 Stryker Australia Pty Ltd (3)

SR004 Scorpio NRG Cementless Femur Posterior Stabilised Sizes 3,4,5,6,7,9,11,13 $4,264.00

SR006 Scorpio Femoral Component - cementless Posterior Stabilised 3,5,7,9,11,13 $4,160.00

  with PA

SR011 Triathlon Knee System HA Coated femoral component left and  Sizes 1 to 8 $4,264.00

 right cobalt chrome

SR024 Triathlon Femoral Component Posterior Stabilised Size 1 - 8 $4,264.00

 Zimmer

ZI062 NexGen Flex Femoral Component -  Cobalt Chrome Sizes A-G Left & Right $4,743.00

 Porous HATCP

Prostheses List by Category, Groups and Sponsor Page 392 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 1o - Uncemented, Alloy, HA coating, Totally Constrained

 Tornier Pty Ltd

TO018 HLS Noetos Total Knee Replacement -  Femur Cementless 1 - 6 CoCr $4,680.00

 Group 1p - Uncemented, non-Alloy, Posterior Cruciate Retaining

 Endotec Australia Pty Ltd

EA006 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat Primary  $4,888.00

 Replacement System (Primary and  Tibial components with mobile  Femoral sizes 1-6(inc) Left &

 Polyethylene inserts, all polyethylene

 patella ceramic coated, titanium backed

 Group 1q - Uncemented, non-Alloy, Posterior Stabilised

 De Puy Australia

DY373 LCS Complete System Femoral Porocoat TiNi Small - Large Plus Left and Right $4,056.00

Knee - Femoral Component: Two-compartmental Arthroplasty

 Group 12c: Cemented, non-Alloy

 Smith & Nephew Surgical Pty Ltd

SN835 Competitor Deuce Oxinium Femoral Component 1-8 $5,000.00

Knee - Femoral Component: Uni-Compartmental Knee Replacement

 Group 2a - Cemented, Alloy

 Advanced Surgical Technologies

AD205 Advance-Unicondylar Knee System Femoral component - cobolt chrome Sizes 1, 2, 3, 4 $2,704.00

Prostheses List by Category, Groups and Sponsor Page 393 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Australian Surgical Design & Manufacture Pty Ltd

AE066 Active Uni Compartmental Knee Uni compartmental knee resurfacing   All sizes for Femoral  $2,288.00

 prostheses, consisting of a Femoral

 component manufactured from Chrome

 Cobalt Molybdenum alloy, and a Tibial

 component manufactured from Ultra high

  Molecular Weight Polyethylene

 Biomet Australia Pty Ltd

BI031 Oxford Meniscal Knee System Mark III Femoral Component, Chrome  Small, Medium, Large, Extra  $2,370.00

 Cobalt, Cemented

BI203 Repicci II Unicondylar Knee System Femoral Component, Cemented, Chrome  45-60mm $2,704.00

 Cobalt

 De Puy Australia

DY112 Preservation Miu Knee System MIU Cemented Femoral Size 1-5 $1,976.00

DY471 PFC Knee System Range PFC Sigma C/R porous Size 1-6 $2,652.00

 Global Orthopaedic Technology

GO032 Global re-surfacing uni-compartmental  CoCrMo Size 1-5 Right medial/left lateral; $3,328.00

 knee femoral implant  Size 1-5 Left medial/right lateral

 Link Orthopaedic  Australia

LO059 LINK Endo-Model SLED Prosthesis: Femoral Component Short, medium-short, medium  $2,288.00

 & large 

 Mathys Orthopaedics Pty Ltd

MA451 balanSys UNI Femoral component, cemented CoCrMo A, B,C,D,E $3,120.00

 Plus Orthopedics Australia Pty Ltd

PL050 UC-PLUS Solution Knee System Unicompartmental Femur Cemented Femoral - 4, 6, 8, 10. $2,080.00

 Smith & Nephew Surgical Pty Ltd

SN338 Genesis Uni Femoral Component CoCr X-Small - Magnum Plus $1,976.00

 Stryker Australia Pty Ltd

ST055 EIUS Femoral Component Cobalt Chrome XS, S, M, L, XL $2,080.00

Prostheses List by Category, Groups and Sponsor Page 394 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Tornier Pty Ltd

TO007 HLS Uni Evolution - Uni Knee  Femoral Component - Cemented 1 - 4 CoCr $2,288.00

 Replacement - Femur

 Zimmer

ZI401 Allegretto Unicompartmental Knee Femur - CoCr alloy Size 1 to 3, Size 1+ to 3+ $2,560.00

 Group 2b - Cemented, Alloy, PMMA coating

 B Braun Australia Pty Ltd

BB197 Emotion TKS Femoral Component F1 - F8, Left and Right $2,096.00

 Orthotech Pty Ltd

OH230 Optetrak Uni Knee Uni Femoral Component 1-6 $2,079.00 $2,400.00

 Zimmer

ZI106 Miller Galante  Unicompartmental Femoral Component - Co Cr 42 - 60 mm $2,162.00

 Group 2c - Cemented, non-Alloy

 Corin Australia Pty Ltd

CR059 AMC Uni Condylar, Cemented Femur Cemented Femur, Cobalt Chrome with  1-4 $2,096.00

 Titanium Nitrite Coating

 Smith & Nephew Surgical Pty Ltd

SN710 Genesis Uni Femoral Component, Oxinium X-Small - Magnum $3,120.00

 Group 2d - Uncemented, Alloy

 De Puy Australia

DY113 Preservation Miu Knee System MIU Porous Femoral Size 1-5 $2,278.00

 Zimmer

ZI428 Natural Knee Unicompartmental - Femur  - Ti/CoCr  Size 1 to 7 $2,162.00

Prostheses List by Category, Groups and Sponsor Page 395 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 2e - Uncemented, Alloy, HA coating

 Biomet Australia Pty Ltd

BI859 Oxford Meniscal Knee System Mark III Femur, Porous or HA Coated,  Small - Extra Large $2,704.00

 CoCr, Ti, HA.

 Stryker Australia Pty Ltd

ST655 Unicompartmental Knee (Femoral  Femoral component cobalt chrome with  1, 2, 3, 4 $2,104.00

 Component) HA  coating

 Taylor Bryant Pty Ltd

TB304 HemiCAP Contoured Articular Knee System Articular Component - Cobalt Chrome Articular Component 15mm -  $2,704.00

 0.5mm x 0.5mm to 2.0mm x

 2.0mm offset;  Articular

 Component 20mm - 1.0mm x

 1.0mm to 4.0mm x 4.0mm

TB305 HemiCAP Contoured Articular Knee System Fixation Screw - Titanium Component for 15mm & 20mm  $1,560.00 Used with Billing Code TB304

 Articular Components Screw

 9.5mm Dia x 20mm

 Group 2f - Uncemented, non-Alloy

 Corin Australia Pty Ltd

CR058 AMC Uni  Condylar, Femur Component,  Femoral Component, Cobalt Chrome,  1-4 $2,652.00

 Bonit Coat Titanium Nitrate Ceramic Coated, Bonit

 (Calcium Phosphate) ingrowth surface

Knee - Patellar Components

 Group 9a - Cemented, all polyethylene

 Advanced Surgical Technologies

AD137 Advance Total Knee System All poly patella UHMWPE 25, 28, 32, 35, 38, 41mm $458.00

AD174 Advantim Total Knee System Patellae All Poly UHMWPE 25,28,32mm $551.00

Prostheses List by Category, Groups and Sponsor Page 396 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Australian Surgical Design & Manufacture Pty Ltd

AE050 Other Active Knee Components Patella Sizes 1 - 5 $426.00

 B Braun Australia Pty Ltd

BB202 Emotion TKS Patella - 1 - Peg and 3 - Pegs P1 to P6, 26 - 41 x 7 - 12mm $614.00

BB208 Columbus TKS Patellar Components, 3 pegs P1 - P4 $614.00

 Biomet Australia Pty Ltd

BI176 Maxim Complete Knee System Patella Button, UHMWPE  size 25 to 37mm $614.00

BI194 Oxford Tricompartmental Knee System Patella Button, UHMWPE, Chrome Cobalt Size 25 to 37mm $614.00

BI899 ROCC Knee Prosthesis Patella Component, all PE, cemented, 1  1-8 $614.00

 peg, UHMWPE

 Corin Australia Pty Ltd

CR005 Rotaglide + Total Knee System, Patella  Asymmetric Sml (35/29mm)) - Lg  $520.00

 UHMWPE

CR006 Rotaglide + Total Knee System, Patella  Dome Sml (26mm OD) - Lg (34mm  $520.00

 UHMWPE

 De Puy Australia

DP152 PFC Knee System Range PFC Sigma Patella or Universal insert  Size SM - LG. Or 25-32mm $468.00

DP264 SROM Knee System Noiles UHMWPE & Poly Patella  Size 30-38 $468.00

DP377 AMK Total Knee system Poly Patella  Size 30 - 38mm $468.00

DP524 LCS 3 Pegged Patella All Poly & all Poly 3peg Patella  Std - Lge+ $614.00

 Endotec Australia Pty Ltd

EA012 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP All Poly Patella sizes 1-6(inc) $614.00

 Replacement System (Primary and  Tibial components with mobile

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 ESKA Australia

EK024 Type RP Biocondylar Surface  Patella Component 3 peg cemented or  small, medium, large $468.00

 cementless

Prostheses List by Category, Groups and Sponsor Page 397 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Finsbury Orthopaedics Australia Pty Ltd

FI009 DBK Total Knee System Patella Component S/M/L Form, 23-26-30-34  $468.00

FI012 MRK Total Knee System Patella Component, polyethylene, cemented 20-30mm $468.00

 Global Orthopaedic Technology

GO001 RBK Total Knee System - Patellar  Polyethylene 24mm - 40mm $593.00

GO030 Consensus Knee System Patellar component all UHMWPE 7.5mm sz 0-2; 10mm sz 1-3 $593.00

 Howmedica

HW105 Duracon Total Knee System Patella - all polyethylene    Small, Medium, Large, Xlarge $520.00

HW140 Kinematic Rotating Knee Patella -  Polyethylene Small, Medium, Large $520.00

HW182 PCA Knee Patella: All Poly -  Vitallium Small, Medium, Large, Extra  $520.00

 Link Orthopaedic  Australia

LO042 LINK Endo Model Rotational Knee  Patella Component Small, medium & large $614.00

LO051 LINK T.A.C.K. Knee Patella cemented Small & large $426.00

LO057 LINK Lubinus Total Patella Glide  Patella Component Small, medium & large $614.00

 Replacement

 Mathys Orthopaedics Pty Ltd

MA111 Balansys Patella Component Polyethylene Dia 25mm $614.00

 Orthotech Pty Ltd

OH023 Optetrak Total Knee System Patella 32 - 42mm $614.00 $1,070.00

OH158 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Patellar 34-38mm Dia/ 8-10mm  $614.00 $1,070.00

  Stems & Patellar Thickness

 Plus Orthopedics Australia Pty Ltd

PL032 PLUS Knee Joint Prostheses System TC-PLUS Patella 26mm, 29mm, 32mm $614.00

PL073 Plus Knee Joint Prostheses System Patella 0-4 $614.00

 Smith & Nephew Surgical Pty Ltd

SN323 Genesis II/Profix Cemented All Poly Patella 23-35mm  $614.00

SN350 Genesis Cemented All Poly Patella X-Small - Large $426.00

Prostheses List by Category, Groups and Sponsor Page 398 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN382 Profix Patella, Inset and Onset 23-35mm $571.00

SN781 Renasys knee Patella Biconvex and Resurfacing 23-35mm $614.00

 Stryker Australia Pty Ltd

ST636 Osteonics Knee System Patella polyethylene  3, 5, 7, 9, 11, 13 $520.00

 Stryker Australia Pty Ltd (2)

SK323 Triathlon Knee System Patella Component - all poly Symmetric: 27mm x 8mm,  $520.00

 29mm x 8mm, 31mm x 9mm,

 33mm x 9mm, 36mm x 10mm,

 39mm x 11mm; Assymetric:

 29mm x 9mm, 32mm x 10mm,

 35mm x 10mm, 38mm x

SK411 Scorpio X3 Polyethylene Medialised dome patella, sequentially  5 - 11 mm $590.00 $700.00

 crossed linked polyethylene

SK412 Scorpio X3 Polyethylene Concentric dome patella, sequentially  5 - 11 mm $590.00 $700.00

 crossed linked polyethylene

SK413 Scorpio X3 Polyethylene Universal dome patella, sequentially  3 - 11 mm $590.00 $700.00

 crossed linked polyethylene

SK414 Scorpio X3 Polyethylene Recessed patella, sequentially crossed  26mm, 28mm, 30mm, 32mm X $590.00 $700.00

 linked polyethylene  10mm

SK415 Scorpio X3 Polyethylene Inset patella, sequentially crossed linked  $590.00 $700.00

 polyethylene

SK418 Triathlon X 3 Polyethylene Symmetric patella, sequentially crossed  27mm X 8mm, 29mm X 8mm,  $590.00 $700.00

 linked polyethylene 31mm X 9mm, 33mm X 9mm,

 36mm X 10mm, 39mm X

SK419 Triathlon X 3 Polyethylene Asymmetric patella, sequentially crossed  29 x33 x 9mm, 32 x 36 x  $590.00 $700.00

 linked polyethylene 10mm, 35 x 39 x 10mm, 38 x

 42x 11mm, 40 x 44 x 11mm

 Tornier Pty Ltd

TO009 HLS System Total Knee Prostheses (HLS UHMWPE Patella Component small, medium, large $520.00

 Zimmer

ZI071 Insall-Burstein II Femoral Component Patella Button - UHMWPE 32 - 41mm $614.00

Prostheses List by Category, Groups and Sponsor Page 399 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI093 Miller Galante II Patella Button: Poly -UHMWPE 32 - 41mm $614.00

ZI148 NexGen Knee Patella Button Polyethylene 26 - 41 $450.00

ZI432 Natural Knee Patella -PE Size 0/7mm to 3/10 mm $604.00

 Group 9b - Cemented, polyethylene metal backed, mobile

 Biomet Australia Pty Ltd

BI903 ROCC Knee Prosthesis Patella Component, rotating, cemented, 3  1-8 $1,144.00

 pegged, CoCr, UHMWPE

 De Puy Australia

DP523 LCS 3 Pegged Patella Cemented & Textured or porous coated   Sm - Lge+ $1,352.00

 3 peg Patella

 Group 9c - Cemented, polyethylene metal backed, moulded

 Stryker Australia Pty Ltd

ST609 Osteonics Knee System Scorpio resurfaced patella components  26-32mm in 2mm increments  $520.00

 cobalt chrome 10mm thick

 Zimmer

ZI431 Natural Knee Patella -Metal Back - PE / Ti alloy Size 0 to 3 $520.00

ZI454 Natural Knee Patella Titanium metal backed, Durasul UHMWPE 0-3 $520.00 $1,144.00

 Group 9d - Uncemented, polyethylene metal backed, mobile

 Biomet Australia Pty Ltd

BI901 ROCC Knee Prosthesis Patella Component, rotating, uncemented, 1-8 $1,352.00

  3 pegged, HA or Porous HA, CoCr,

 UHMWPE, Ti, HA

 De Puy Australia

DP520 LCS Universal Knee LCS Ultra Patella Sm - Lge+ $1,196.00

DY502 LCS 3 Pegged Patella Cemented & Textured or porous coated   Sm - Lge+ $1,352.00

 3 peg Patella

Prostheses List by Category, Groups and Sponsor Page 400 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Endotec Australia Pty Ltd

EA011 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat Mobile Patella $1,352.00

 Replacement System (Primary and  Tibial components with mobile   sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 Global Orthopaedic Technology

GO008 RBK Total Knee System - Patella  Polyethylene/metal/hydroxyapatite coating sizes 1 - 5 $1,352.00

 Group 9e - Uncemented, polyethylene metal backed, moulded

 Advanced Surgical Technologies

AD175 Advantim Total Knee System Patellae Metal Backed 25,28,32mm $982.00

 Global Orthopaedic Technology

GO029 Consensus Knee System Patellar component porous Ti/UHMWPE 10mm sz 1-3 $1,144.00

 Howmedica

HW108 Duracon Total Knee System Patella - Periapatite - Insert -   Small, Medium, Large, Xlarge $764.00

 Polyethylene and Vitallium coated with

 Zimmer

ZI147 NexGen Knee Patella Button TM Porous Patella 26 - 41 $1,144.00

Knee - Patello Femoral Replacement Femoral Component

 Group 7 - Patello femoral replacement femoral component

 Biomet Australia Pty Ltd

BI945 Vanguard PFR Femoral Component, Ti XS to Xlarge $2,855.00

 De Puy Australia

DY111 LCS Patellofemoral Joint Prosthesis LCS PFJ Trochlear Components Right  Small - Large $2,969.00

 and Left

 Global Orthopaedic Technology

GO035 RBK Total Knee System - Femoral  Trochlear Component, no coating CoCrMo Size 1 to 5 $3,640.00

 Component

Prostheses List by Category, Groups and Sponsor Page 401 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Link Orthopaedic  Australia

LO058 LINK Lubinus Total Patella Glide  Femoral Component Small, medium, large, extra large $2,026.00

 Replacement

 Orthotech Pty Ltd

OH152 Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear  Trochlear Component - Sml/  $2,969.00

 Component & Patellar Med/ Large

OH153 Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear  Patellar - Sml/ Med/ Large $1,070.00

 Component & Patellar

 Smith & Nephew Surgical Pty Ltd

SN371 MOD III  Femoral Component Small & Large $1,685.00

SN834 Competitor Deuce Patello Femoral Oxinium Sm, Med Lg, XLg $3,000.00

 Stryker Australia Pty Ltd

ST600 Avon Patello-femoral Prostheses Vitallium Extra Small, Small, Medium,  $2,969.00

Knee - Patello Femoral Replacement Patellar Component

 Group 8 - Patello femoral replacement patellar component

 De Puy Australia

DY484 LCS Patellofemoral Joint Prosthesis LCS PFJ Trochlear Components Right  Small - Large $2,969.00

 and Left

 Orthotech Pty Ltd

OH225 Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear  Patellar - Sml/ Med/ Large $1,070.00

 Component & Patellar

 Smith & Nephew Surgical Pty Ltd

SN394 Patella Femoral Resurfacing System Mini-Large $1,311.00

 Stryker Australia Pty Ltd (2)

SK314 Avon Patello Femoral Prosthesis Polyethylene patella button Small, Medium, Large $683.00

Prostheses List by Category, Groups and Sponsor Page 402 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Knee - Revisions

 Group 11 - Revisions

 Advanced Surgical Technologies

AD142 Advance Revision Knee System Femoral Augments titanium 1 - 5, 5mm thick, 10mm thick,  $645.00

 posterior and distal

AD143 Advance Revision Knee System Femoral component CoCr 1, 2, 3, 4, 5 $4,430.00

AD144 Advance Revision Knee System Femoral stem titanium 11 - 22mm in 1mm increments,  $2,236.00

 100 & 140mm lengths

AD145 Advance Revision Knee System PS and CCK Insert UHMWPE 1, 2, 3, 4, 5, 6 in 10 - 30mm in  $1,508.00

 2mm increments

AD146 Advance Revision Knee System Tibial augments/wedges titanium 15 degree, sizes 1, 2/1+, 3/2+,  $884.00

 4/3+, 5/4+, 6/5+, Blocks 5mm,

 10mm, 15mm

AD147 Advance Revision Knee System Tibial component titanium, non porous 0+, 1, 1+, 2, 2+, 3, 3+, 4, 4+,  $3,656.00

 5, 5+, 6

AD148 Advance Revision Knee System Tibial stem titanium, non cemented 10, 12,14, 16, 18 x 65mm, 15 x $1,966.00

  30mm

AD149 Advance Revision Knee System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm  $266.00

 increments long

AD185 Ortholoc 11 Revision Knee Femoral components CoCr Revision  Small, Medium, Large, Xlarge $5,762.00

 (Porous Coated)

AD187 Ortholoc 11 Revision Knee Tibial Revision Smooth/Finned Titanium 6" Length in Small - Xlarge $1,186.00

AD188 Ortholoc 11 Revision Knee Tibial inserts posterior stabilised UHMWPE Small, Medium, Large, X-Large  $1,111.00

 - 10 to 35mm in 2mm increments

AD190 Ortholoc 11 Revision Knee Tibial Components Modular Stem Thick  Small, Small Plus, Medium,  $3,162.00

 Base (Porous Coated) Medium Plus, Large, Large

 Plus, Xlarge

AD191 Ortholoc 11 Revision Knee Tibial Components Modular Stem  Small, Small Plus, Medium,  $2,979.00

 Wedged Base (Porous Coated) Titanium Medium Plus, Large, Large

 Plus, Xlarge

Prostheses List by Category, Groups and Sponsor Page 403 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD195 Ortholoc 11 Revision Knee Femoral stems titanium 5 Degree 6", 7 Degree 6" $1,256.00

AD214 ADVANCE Total Knee System Stemmed condylar femoral medial pivot  1, 2, 3, 4, 5, All in left & right $4,940.00

 component - porous

AD217 ADVANCE Total Knee System Offset tibial Block Augments 1, 2/1, 3/2, 4/3, 5/4, 6/5, All in  $1,248.00

 5mm, 10mm, 15mm

AD219 ADVANCE Total Knee System Stemmed condylar femoral medial pivot  1, 2, 3, 4, 5  All in Left & Right $4,680.00

 component - nonporous

 Biomet Australia Pty Ltd

BI146 AGC Knee System Revision System consisting of : Femoral  60-75mm, 80-120mm,  63-83  $12,007.00

 Component; Femoral Stem, Femoral &  mm, 63-83 mm

 Tibial Augmentation; Tibial Component.,

BI171 Maxim Complete Knee System Tibial Stem, Titanium 40mm 80mm $1,024.00

BI182 Maxim Complete Knee System One Piece Tibial Plate and Stem, CoCr. 59-91mm $2,902.00

BI183 Maxim Complete Knee System Tibial Femoral Wedge or Augmentation  55-80mm $1,248.00

 Block, Titanium

BI184 Maxim Complete Knee System Tibial or Femoral Stem, Modular,  55-80mm $1,830.00

BI201 AGC Total Knee System - Dual Articular  Femoral, Tibial, Bearing, Stems, Chrome  Size 55 to 75mm Fem,  Size 59  $16,110.00

 Knee System Cobalt, UHMWPE to 83mm Bearing, Size 37 to

 126mm stems, Size 63 to 91mm

BI789 Ascent Knee System Femoral augmentation block, posterior or  4, 8, 12mm $1,371.00

 distal, titanium

BI800 Ascent Total Knee System Femoral revision stem w/screw, coronal  5 or 7 degree, 100mm, 150mm  $2,922.00

 slot, titanium lengths, 10-24mm diameters

BI811 Maxim Complete Knee System Offset tibial tray & adapter, fixation  Width 59-91mm offset tibial  $4,212.00

 screws, chrome cobalt, titanium trays neutral; 2.5mm, 5.0mm

 offset tibial tray adapters

BI821 AGC Total Knee System Tibial augments, titanium 6-16mm $1,264.00

 Corin Australia Pty Ltd

CR003 Rotaglide + Total Knee System, Stem  Cobalt chrome 30mm - 70mm $858.00

 Extensions

CR004 Rotaglide + Total Knee System Tibial Augmentation Blocks Small 4mm - Large12mm $536.00

Prostheses List by Category, Groups and Sponsor Page 404 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP143 PFC Knee System Range PFC Flute Tib Rod & Extension  Size 75-150mm $1,560.00

DP151 PFC Knee System Range PFC Sigma CVD or PLI  Poly tibial  Size 1-6 $988.00

DP153 PFC Knee System Range PFC Sigma ROD or FC femoral  Size 5 Deg to 7 Deg $2,137.00

DP154 PFC Knee System Range PFC Sigma FEM AUG  Size 2-5 $1,497.00

DP155 PFC Knee System Range PFC Sigma Femoral stem / Bolt / Collar Neutral to +2 $520.00

DP158 PFC Knee System Range PFC Sigma Femoral Distal or Post  Size 1-6 $1,507.00

 Augments or Combo augments

DP161 PFC Knee System Range PFC Mod PL TB WDG Types Hemi/ Stp  Size 2-5 $1,708.00

 / Full or Augmented tibial wedges

DP254 SROM Knee System Noiles Hinge Femoral Comp XSml-Lge $4,880.00

DP260 SROM Knee System SROM Noiles Tibial Augments 4-10mm size 2-6 $926.00

DP261 SROM Knee System Noiles Modular Tibial Sleeve 37-61mm $2,425.00

DP266 SROM Knee System SROM Noiles Femoral Extension with  11 x 100mm to 129 x 100mm $1,748.00

DP267 SROM Knee System PLUG Modular Sleeve with Screw One size only $126.00

DP269 SROM Knee System SROM Noiles Femoral Augmentation  1-6 4-16mm $1,393.00

DP271 SROM Knee System Noiles Femoral Sleeve Por Coated  Size 31-46mm $2,636.00

DP272 SROM Knee System Noiles Femoral Stem Extn/Screw Size 9 x 100 to 19  x 150 $1,733.00

DP287 AMK Coordinate Revision Knee System Revision Tibial tray or Full wedge Tray  Size 1-5 $3,744.00

 Chrome cobalt

DP290 AMK Coordinate Revision Knee System Cemented stem 10mm Chrome cobalt or  Size 1-6 or 8-27mm Thickness  $2,277.00

 Fluted stem STD - Revision x 95-140mm Length

DP294 AMK Coordinate Revision Knee System Insert 4 and 10mm Thick Tibial inserts Size 1-5 $3,744.00

DP378 AMK Total Knee system Co ordinate Femoral wedge DIS / Post  Size 1-5 $618.00

 Chrome cobalt

DP383 AMK Total Knee system Revision Pin Tibial Chrome cobalt One size only $331.00

DP570 AMK Coordinate Revision Knee System Tibial Ultra or STD Tibial or Varus  Size 1-5 or 2-10mm $1,768.00

 Valgus Constrained Inserts

Prostheses List by Category, Groups and Sponsor Page 405 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP821 LCS Revision Knee system Revision Femoral Chrome cobalt STD - LGE+ $6,132.00

DP822 LCS Revision Knee system Revision tibial Tray Chrome cobalt STD- LGE+ $3,952.00

DP823 LCS Revision Knee system Stem Extension Chrome cobalt 10 x 55mm to 22x110mm $2,292.00

DP824 LCS Revision Knee system LCS DIST or Post or BLK Femoral  SM-LGE+ $666.00

 Augments Chrome cobalt

DP825 LCS Revision Knee system LCS Revision Bearings SML+ to LGE++ 10m-25mm in  $1,726.00

 each size

DP826 LCS Revision Knee system Revision Textured Tibial Tray Chrome  Size 1-7 $3,856.00

DP827 LCS Revision Knee system Revision Textured femoral Chrome cobalt Size SM - LG+ $3,640.00

DY148 LCS Complete Revision System LCS Complete Revision Femoral  Small - Large $5,278.00

 Cemented Right and Left

DY149 LCS Complete Revision System LCS Complete Revision Femoral  Small - Large $5,719.00

 Porocoat Right and Left

DY151 LCS Complete Revision System MBT Revision Trays Cemented or  1 - 7 $3,630.00

DY153 LCS Complete Revision System LCS Complete Revision Femoral Distal   Small 5mm - Large + 15mm $1,664.00

 or Posterior Augments

DY156 LCS Complete Revision System LCS Complete PFC Sigma Revision  20 - 46mm $2,704.00

 Femoral Sleeves Porocoat

DY157 LCS Complete Revision System MBT Revision Tibial Sleeve Porous Coated 37 - 61mm $2,704.00

DY158 LCS Complete Revision System LCS Complete Revision Insert Small 10mm - large + 30mm $1,201.00

DY159 LCS Complete Revision System MBT Step Wedge or revision Tibial  1, 5mm - 7, 15mm $1,430.00

DY368 LCS Complete System Modular Femur Cemented CoCr Sml to Lg + Left and Right $7,425.00

DY460 SROM Knee System Noiles Cap with Screw for Tibial Base One size only $313.00

DY463 SROM Knee System Noiles Replacement Bumper Noiles  XSml - Medium $135.00

 Modular or Replacement Hinge Bearing

DY467 PFC Knee System Range PFC Sigma Knee Offset Tibial Tray  or  Size 1-6 $3,905.00

 Modular Plus tibial Tray

Prostheses List by Category, Groups and Sponsor Page 406 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Endotec Australia Pty Ltd

EA013 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat Revision  $5,408.00

 Replacement System (Primary and  Tibial components with mobile  Femoral sizes 1-6(inc) Left &

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA014 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented Revision  $4,597.00

 Replacement System (Primary and  Tibial components with mobile  Femoral sizes 1-6(inc) Left &

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA015 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat Revision tibial $5,439.00

 Replacement System (Primary and  Tibial Components with mobile   sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA016 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented Revision  $4,690.00

 Replacement System (Primary and  Tibial components with mobile  tibial sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA017 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat revision  $5,928.00

 Replacement System (Primary and  Tibial components with mobile  hinged femoral assembly sizes

 polyethelene inserts all polyethelene patella 1-6(inc) Left & Right

  ceramic coated, titanium backed

EA018 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented revision  $5,439.00

 Replacement System (Primary and  Tibial components with mobile  hinged femoral assembly sizes

 polyethelene inserts all polyethelene patella 1-6(inc) Left & Right

  ceramic coated, titanium backed

EA019 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat hinged tibial  $5,626.00

 Replacement System (Primary and  Tibial components with mobile  sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA020 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented hinged tibial  $5,439.00

 Replacement System (Primary and  Tibial components with mobile  sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

Prostheses List by Category, Groups and Sponsor Page 407 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EA021 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat thick hinged  $5,928.00

 Replacement System (Primary and  Tibial components with mobile  tibial sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA022 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented thick hinged  $5,439.00

 Replacement System (Primary and  Tibial components with mobile  tibial sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

EA023 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Revision stems 9mm - $1,248.00

 Replacement System (Primary and  Tibial components with mobile  20mm (inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 Global Orthopaedic Technology

GO113 RBK Total Knee System Revision Femoral Component, CrCo Sizes 0 to 5 $5,500.00

GO114 RBK Total Knee System Tibial and Femoral Stems, Titanium 10mm to 24mm thick x 80mm  $2,189.00

 to 170mm long

GO115 RBK Total Knee System Revision Tibial Tray, CrCo Size 00 to 5 $3,600.00

GO116 RBK Total Knee System Tibial Inserts, Titanium 4mm and 10mm thick $3,000.00

GO117 RBK Total Knee System Posterior stabilised tibial insert, UHMWPE Size 0 to 5, 10mm to 20mm thick $1,000.00

GO118 RBK Total Knee System Femoral Inserts, Titanium 4mm and 10mm thick $590.00

GO119 RBK Total Knee System Rotating Hinge Bushing Mechansim Complete mechanism $4,540.00

 Howmedica

HW082 Duracon Total Knee System Augmentation Femoral Spacers -   5mm, 10mm $1,576.00

HW084 Duracon Total Knee System Augmentation Locking Screw -  Vitallium 5mm, 10mm $184.00

HW085 Duracon Total Knee System Augmentation Modular Stabiliser Box -   Small, Medium, Medium-Large,  $614.00

 Vitallium Large, Extra-Large

HW097 Duracon Total Knee System Tibial Baseplate Screw -  Vitallium 6.2mm diameter in 15mm,  $194.00

 20mm, 25mm, 30mm, 35mm,

 40mm, 50mm, 55mm, 60mm

HW098 Duracon Total Knee System Augmentation Stem Extension Cementless 40mm, 80mm, 155mm lengths $1,154.00

  -  Vitallium

Prostheses List by Category, Groups and Sponsor Page 408 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW099 Duracon Total Knee System Augmentation Tibial Wedge -  Vitallium 5mm, 10mm $1,045.00

HW102 Duracon Total Knee System Tibial Insert - Revision (crossover) -   Small, Medium, Large, Extra- $1,217.00

 Polyethylene Large in each thickness 9mm,

 11mm, 13mm, 16mm, 19mm,

 22mm, 25mm, 28mm, 31mm

HW153 Kinemax Knee Femoral Augmentation Cobalt Chromium 5mm/10mm $900.00

HW167 Kinemax Knee Tibial: Fixation Peg -  Vitallium 20mm $333.00

HW168 Kinemax Knee Tibial: Wedge Full -  Vitallium 10mm per size $801.00

HW169 Kinemax Knee Tibial: Wedge -  Vitallium 7.5mm per size $504.00

HW170 Kinemax Knee Tibial : Block -  Vitallium 5mm, and 10mm per size $406.00

HW171 Kinemax Knee Femoral/Tibial: Extension Stem -  Vitallium 40mm, 80mm, 155mm for each $790.00

HW401 Kinemax Knee Femoral: Condylar Beaded -  Vitallium XS, S, M, L, XL, XXL $3,442.00

 Orthotech Pty Ltd

OH026 Optetrak Total Knee System CCK Tibial Augmentation Block Size 1 - 6 $764.00 $1,342.00

OH027 Optetrak Total Knee System CCK Tibial & Femoral Stems Size 1 - 6 $3,011.00

OH029 Optetrak Total Knee System CCK Femoral Augmentation Block Size 1-6 $1,628.00

OH056 Optetrak Total Knee System Tibial Stem Screw One size only $764.00 $1,081.00

OH057 Opetrak Total Knee System Femoral Stem Extension Adapter One size only $764.00 $1,351.00

 Plus Orthopedics Australia Pty Ltd

PL083 PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented 95-120 $1,997.00

PL084 PLUS Knee Joint Prostheses System Revision - Tibial Augments 5mm, 10mm $1,446.00

PL085 PLUS Knee Joint Prostheses System Revision - Stems Cemented 80-150 $2,184.00

PL086 PLUS Knee Joint Prostheses System Revision - Stems Cementless 10/80 - 20/150 $2,184.00

PL087 PLUS Knee Joint Prostheses System Revision - Stems cementless valgus 10/80 - 20/150 $2,288.00

PL088 PLUS Knee Joint Prostheses System Revision - Tibial insert substituted 1-5 $1,196.00

 1-5

PL089 PLUS Knee Prostheses System RT PLUS Hinged Knee - Femur 0-10 $7,488.00

Prostheses List by Category, Groups and Sponsor Page 409 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL091 PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem cemented 95-160 $2,184.00

PL092 PLUS Knee Joint Prostheses System Revision - Femur VKS1/TC2-VKS5/TC10 $6,084.00

PL093 PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented 160 $2,340.00

PL094 PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented 200 $2,808.00

PL095 PLUS Knee Prostheses System RT PLUS Hinged Knee - Femoral  5-10mm $1,420.00

PL096 PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibial augments 5-10mm $1,420.00

PL097 PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibial insert with 0-10 $1,966.00

  clamp

PL098 PLUS Knee Prostheses System RT PLUS Hinged Knee - Screws and  0-10 $884.00

PL099 PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibia 0-10 $3,536.00

PL107 PLUS Knee Joint Prostheses System Revision - Femoral Augments 5mm, 10mm $1,144.00

PL109 PLUS Knee Joint Prostheses System Revision - Tibia V1TSI/TC2-VKS5/TC10 $3,536.00

 Smith & Nephew Surgical Pty Ltd

SN314 Genesis II  Conversion module Left/Right size 1-8 $1,167.00

SN316 Genesis II  Femoral/tibial long stems 10-24x100mm, 10-20 x 150mm $1,220.00

  10-16x 200mm

SN330 Genesis II  Wedge Full Tibial, Distal Femoral,  1-8 $738.00

 Stacked Femoral L, Posterior Femoral,

 Angled Hemi, Stepped Hemi, Medial

SN341 Genesis Constrained Conversion Module: CoCr Left/Right Small-Magnum Plus $2,345.00

SN351 Genesis PS Conversion Module Resurfacing: Co Cr Left/Right Small - Magnum $771.00

SN353 Genesis Revision Articular Insert Left/Right Constrained Small -  $2,031.00

 Xlarge, Crutiate retaining Size 1-

 8, Post Stabilising Size 1-8,

 Tricon/Genisis Small-Xlarge

SN358 Genesis Wedge Small-Magnum 4mm-15mm $454.00

SN381 Profix Non Porous Wedge, Distal and L-Wedge 1-7. Small - Large  $646.00

SN384 Profix Porous wedge 1-7 $909.00

Prostheses List by Category, Groups and Sponsor Page 410 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN715 Genesis II Long Stem Tibial Components 18 - 24mm x 200mm $1,976.00

SN717 Genesis II/Profix Offset Couplers 2 - 4mm $2,095.00

SN802 Genesis II Patella Biconvex UHMWPE Revision 23-35mm $614.00

SN805 Profix Constrained Femur Insert, UHMWPE Revision Left & Right, Size 1-6, 10 -  $1,118.00

SN821 Legion Revision Legion Femoral Augment 5-15mm $1,180.00

SN822 Legion Revision Legion Tibial Augment 5-15mm $1,410.00

SN823 Legion Revision Legion stem extension 120-220mm $1,810.00

SN824 Legion Revision Legion revision baseplate 1-8 $2,950.00

 Stryker Australia Pty Ltd

ST018 Scorpio Augmentation Femoral / Tibial Cobalt Chrome 5mm & 10mm for all sizes of  $1,009.00

 femur and tibia. 5 degrees for all

  tibia sizes

ST024 Scorpio Tibial Insert Revision 8-24mm for all tibia sizes $1,841.00

ST026 Scorpio Offset Adaptor Cobalt Chrome 2mm-8mm $1,226.00

ST034 Scorpio Tibial Tray Revision 3,5,7,9,11,13 $2,593.00

ST061 Scorpio Femoral Component Revision 3,5,7,9,11,13 $5,304.00

ST601 Duracon total knee system Tibial insert stabiliser revision  vitallium Extra Small, Small, Medium,  $1,596.00

 Medium Large, Large, Extra

ST602 Duracon total knee system Femoral component stabiliser revision   Extra Small, Small, Medium,  $5,928.00

 vitallium Medium Large, Large, Extra

ST603 Duracon total knee system Augmentation offset adaptor  vitallium 4mm, 6mm, 8mm $1,321.00

ST604 Duracon total knee system Augmentation revision  vitallium 5mm, 10mm $1,050.00

ST606 Duracon total knee system Stem fluted - femoral/tibia  vitallium 10mm-19mm, 21mm, 23mm in  $1,466.00

 80mm and 155mm lengths

ST658 Osteonics Knee System Augmentation - Fem/Tib  cobalt chrome  3, 5, 7, 9, 11, 13 in 4mm, 8mm, $728.00

  10 degree and 20 degree

Prostheses List by Category, Groups and Sponsor Page 411 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK410 Scorpio X3 Polyethylene Tibial insert, totally stabilised, fixed  3 - 11 mm 7F/5T, 5F/7T,  $1,770.00 $2,000.00

 bearing, sequentially crossed linked  11F/9T, 9F/11T

 10mm-24mm

 Stryker Australia Pty Ltd (3)

SR034 Triathlon Revision Knee System Revision, cemented, stemmed baseplate 1 to 8 $3,500.00

SR035 Triathlon Revision Knee System Revision, cemented, tibial stems 9x50mm, 9x100mm, 9x150mm, $1,600.00

  12x50mm, 12x100mm,

 12x150mm, 15x50mm,

 15x100mm, 15x150mm

SR036 Triathlon Revision Knee System Revision, cemented, side specific, half  1 to 8, 5mm and 10mm $1,300.00

 tibial augments

 Zimmer

ZI064 Insall-Burstein II Articulating Surface CCK - UHMWPE 10 - 25mm $946.00

ZI065 Insall-Burstein II Articulating Surface CCK (extra thick) - UHMWPE 30, 35mm $2,123.00

ZI067 Insall-Burstein II Augmentation Distal - TI, Co Cr 5, 10mm $1,258.00

ZI072 Insall-Burstein II Femoral Component Tibial/Femoral Stem - Ti 10 - 24mm $1,056.00

ZI075 Insall-Burstein II Wedge Full - Ti 7 - 20mm $1,654.00

ZI095 Miller Galante II Stem: Long - Ti 12 - 18mm $993.00

ZI096 Miller Galante II Stem: Regular - Ti 12 - 18mm $525.00

ZI104 Miller Galante II Other Tibial Tray:Porous Flat (revision) -  A - K $3,276.00

ZI137 NexGen Knee Articulating Surfaces CCK - UHMWPE 10 - 35mm $1,258.00

ZI140 NexGen Knee Tibial Augments Half Wedge - Ti 1 - 10 $1,518.00

ZI141 NexGen Knee Tibial Augments Full Wedge - Ti 1 - 10 $1,518.00

ZI142 NexGen Knee Tibial Augments One Third Wedge - Ti 1 - 10 $1,518.00

ZI143 NexGen Knee Tibial Augments Half Block - Ti 1 - 10 $1,518.00

ZI144 NexGen Knee Femoral Augments Dist.,Ant or Post - Ti A - H $1,258.00

ZI145 NexGen Knee Femoral Augments Dist + Post 1 - 10 $1,258.00

Prostheses List by Category, Groups and Sponsor Page 412 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI146 NexGen Knee Stem Extensions Titanium Length - 35 - 155mm,  $1,258.00

 Diameters - 10 - 24 mm

ZI266 Continuum knee system Hedrocel augment - patella prosthesis Small, medium, large and x- $3,216.00

ZI305 Nexgen Rotating Hinge Femur Cobalt chrome femoral component for  B-F $15,076.00

 rotating hinge knee, available left to right

ZI307 Nexgen Rotating Hinge Articulating  Ultra high molecular weight polyethylene  12-26mm, sizes B-F $1,565.00

 articulating tibial insert

ZI308 Nexgen Rotating Hinge Tibia Cobalt chrome rotating platform tibial plate 1-6 $3,068.00

ZI309 Nexgen Rotating Hinge Replacement Hinge Rotating hinge replacement bushing for  B-F $4,722.00

ZI404 Natural Knee System Tibial Spacers - special metal alloy 4 to 8mm  Size 00 to 5 $1,066.00 Also grouped in Knee Group 10

ZI416 Natural Knee Revision -Tibial Baseplate - Ti alloy 0 to 5 $3,406.00

ZI417 Natural Knee Revision -Tibial Stem - Ti alloy 60 to 215mm $1,664.00

ZI422 Natural Knee Femoral Spacer Lug - Ti alloy 4 to 12mm $5,330.00

ZI423 Natural Knee Revision - Femur Porous -Ti/CoCr alloy Size 00 to 4 (left & right),  $5,330.00

ZI424 Natural Knee Revision - Femur Stem, Ti alloy 10.5mm/125mm to  $3,058.00

ZI426 Natural Knee Femoral Stem Screw - metal alloy One size only $302.00

ZI427 Natural Knee Revision Posterior Stabilising Bar - CoCr  One size only $302.00

 alloy

ZI504 Natural Knee Revision - Femoral Spacers Non Porous - Size 0 to 4 $2,142.00

  metal alloy

Knee - Special Indications

 Group 10 - Special Indications

 Advanced Surgical Technologies

AD241 Limb Salvage System for the skeletally  Repiphysis non invasive expandable  Custom Made $67,600.00

 immature - Repiphysis custom designed Tibial Extension.

 Comprised of tibial base, axial bushing,

 axial pin - CoCr, Titanium, UHMWPE

Prostheses List by Category, Groups and Sponsor Page 413 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD242 Limb Salvage System for the Skeletally  Repiphysis non invasive expandable  Custom Made $67,600.00

 Immature - Repiphysis custom designed Distal Hinge Femoral

 Extension. Distal hinge femur, stem

 fixation pin, spring housing tube, anti-

 rotation cylinder & pins, end cap,

 retaining tube, spring, antenna, isolant

 ring - CoCr, Titanium, PEEK Polyacetal

AD243 Guardian Limb Salvage System Guardian Femoral Neck & Mid-Section -  40, 50, 60, 70, 90, 110, 140mm $2,959.00

 Standard Taper - Titanium

AD244 Guardian Limb Salvage System Guardian Distal Femur Left & Right $4,841.00

AD245 Guardian Limb Salvage System Guardian Tibial Hinge Assembly  One Size only $4,046.00

 With/Without Rotational Stop Pin - CoCr

AD246 Guardian Limb Salvage System Guardian Distal Femur Quick Snap Axial  1, 2, 3, 4 $2,267.00

 Pin - CoCr, Titanium

AD248 Guardian Limb Salvage System Guardian Tibial Sleeve 1 - 5 $4,982.00

AD249 Guardian Limb Salvage System Guardian Duramer Tibial Sleeve Spacer -  8, 10, 12, 16, 20mm $2,475.00

 UHMWPE

AD250 Guardian Limb Salvage System Guardian Male-Male Mid-Section Taper -  40, 50, 60, 70, 90, 110, 140mm $3,671.00

 Titanium

AD251 Guardian Limb Slavage System Guardian Non Porous Femoral Stem  11, 13, 15, 17mm x 152mm $2,735.00

 Straight/Tapered - Titanium

AD252 Guardian Limb Salvage System Guardian Proximal Tibia - Titanium One Size Only $7,176.00

AD253 Guardian Limb Salvage System Guardian Resurfacing Femur - CoCr,  2, 3, 4, Left & Right $7,540.00

 Titanium

AD254 Guardian Limb Salvage System Guardian femoral Stem Straight With  9, 11, 13 x 120mm $3,630.00

 Plasma Collar - Titanium

AD255 Guardian Limb Salvage System Guardian porous Collared Femoral Stem  11, 13, 15, 17mm x 152mm $3,702.00

 Straight/Tapered - Titanium

AD256 Guardian Limb Salvage System Guardian Femoral Stem Straight - Titanium 9, 11, 13 x 120mm $2,694.00

 Biomet Australia Pty Ltd

BI864 Orthopaedic Salvage System Stem, Cemented or Porous, Ti (9-19)mm diameter x  (90- $3,037.00

 300)mm length

Prostheses List by Category, Groups and Sponsor Page 414 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI865 Orthopaedic Salvage System Femoral Component, Resurfacing or  30 - 70mm $8,211.00

 Segmental, CoCr,Ti

BI866 Orthopaedic Salvage System Femoral or Tibial Augment, Ti Femoral Sleeve - One Size;  $2,137.00

 Femoral Flange - One Size;

 Tibial Block Augment 10-20mm;

   Tibial Augment Sleeve -

BI867 Orthopaedic Salvage System Femoral/Tibial Interlocking  One size only except for  $5,408.00

 devices:Locking Pin, Femoral and Tibial  Locking Screw - Small or

 Bushings, Tibial Bearing, Axle,  Large; Tibial Bearing - 12-22mm

 Reinforced Yoke, Locking Screws. CoCr,

BI868 Orthopaedic Salvage System Diaphyseal Segment or Diaphyseal  Diaphyseal Segment 3-23cm,  $4,410.00

 Coupler, Stacking Adapter and Locking  Diaphyseal coupler 10-30cm

BI869 Orthopaedic Salvage System Tibial Component, Resurfacing or  63-83mm $8,102.00

 Segmental, Modular and non Modular,

BI890 Rotating Hinge Knee (RHK) Augments, Femoral and Tibial, CoCr, Ti Femoral; 10, 20, 30mm LL,  $1,872.00

 LM, RL, RM, Tibial; 10, 15mm

 RM/LL, RL/LM, 20mm

BI891 Rotating Hinge Knee (RHK) Resurfacing Tibial Tray, Modular and  Stemmed 59, 63, 67, 71mm  $7,176.00

 Stemmed widths; Modular 59, 63, 67, 71,

 75, 79, 83mm widths

BI892 Rotating Hinge Knee (RHK) Femoral Component, Resurfacing,  Small, Standard, Large; Left and $7,384.00

 cemented,anatomic, CoCr  Right

BI893 Rotating Hinge Knee (RHK) Interlocking Components: Bearing Insert,  Bearing Insert - 12, 14, 16, 18,  $4,841.00

 Yoke, Tibial and Femoral Bushings, Axle,  20mm thicknesses, Yoke - short

 Axle Locking Pin, UHMWPE, Ti, CoCr  and long, Axle - one size, Axle

 Lock Pin - one size, Tibial and

 Femoral Bushings - one size

 De Puy Australia

DP255 SROM Knee System Noiles Replacement Bumper Noiles  XSml - Medium $135.00

 Modular or Replacement Hinge Bearing

DP262 SROM Knee System Noiles Cap with Screw for Tibial Base One size only $313.00

 ESKA Australia

EK017 ESKA Tumor Revision System MML Total femoral implant various sizes $11,440.00

Prostheses List by Category, Groups and Sponsor Page 415 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EK018 ESKA Tumor Revision System MML Distal femoral implant various sizes $11,440.00

 Howmedica

HW141 HMRS Tibial Baseplate Cobalt Chrome Small, Medium, Large $3,536.00

HW143 HMRS Femoral Component Cobalt Chromium Left, Right $6,552.00

HW144 Kinematic Rotating Knee Tibial Component -  Vitallium Small and Medium 11mm/15mm $2,933.00

  by 110mm/180mm

HW145 Kinematic Rotating Knee Axles, Bumpers, Bushings -  Vitallium One size only $728.00

HW202 Howmedica Modular Resection System Wedge -  Vitallium One size only $211.00

HW231 Howmedica Modular Resection System Tibial Rotating Component -  Vitallium One size only $3,453.00

HW232 Howmedica Modular Resection System Tibial Insert -  Polyethylene  6, 10, 14mm $2,070.00

HW233 Howmedica Modular Resection System Tibial Sleeve -  Vitallium One size only $785.00

HW234 Howmedica Modular Resection System Tibial Stemmed Tray -  Vitallium One size only $8,772.00

HW248 HMRS Tibial Insert Polyethylene Extra Small, Small, Medium,  $2,127.00

 Large, Extra Large

 Link Orthopaedic  Australia

LO041 LINK Endo Model Rotational Knee  Intracondylar total rotation knee join with  Small, medium & large $17,001.00

 Anti Lux device: with patella flange

LO043 LINK Endo Model Rotational Knee  Tibial Spacers Small, Medium, Large $526.00

LO044 LINK Endo-Model Rotational Knee  Total Rotational Knee Joint with Anti Lux  Small, medium & large $17,001.00

 Device, with Patella Flange and

 Replacement of Femoral and/or Tibial

 Bone Structures, Distal femur

LO046 LINK Endo Model Rotational Knee  Total Rotational Knee Joint with Anti Lux  Extra small, small, medium &  $20,785.00

 Device, with Patella Flange and

 Replacement of Femoral and/or Tibial

 Bone Structures, distal femur & proximal

LO047 LINK Endo Model Rotational Knee  Total hinge knee: without patella flange Small, medium & large $10,415.00

LO048 LINK Endo Model Rotational Knee  Total hinge knee: with patella flange Small, medium & large $11,303.00

Prostheses List by Category, Groups and Sponsor Page 416 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN694 Knee Component Femoral, tiabial or insert Size 0 - 10 $6,396.00

 Stryker Australia Pty Ltd (2)

SK156 Howmedica Modular Resection System GMRS Proximal Tibial Component, Cast  Small, Standard $8,034.00

 Chrome Cobalt

SK157 Howmedica Modular Resection System GMRS Distal Femoral Component, Cast  Small Left 65mm, Small Left  $8,008.00

 Chrome Cobalt 75mm, Small Left 85mm, Small

 Left 95mm, Small Right 65mm,

 Small Right 75mm, Small Right

 85mm, Small Right 95mm,

 Standard Left, Standard Right

SK158 Howmedica Modular Resection System GMRS Proximal Femoral Component,  Standard, Trochanteric, Smooth $8,466.00

 Cast Chrome Cobalt

SK159 Howmedica Modular Resection System GMRS (HMRS+) Curved Anchorage  12, 13, 14, 15, 16, 17, 19mm $5,034.00

 Stems, Cobalt Chrome

SK161 Howmedica Modular Resection System GMRS Extension Piece, Titanium/Cobalt  30, 40, 50, 60, 70, 80, 100,  $4,576.00

 Chrome 120, 140, 160, 180, 200,

SK162 Howmedica Modular Resection System GMRS Connection Piece,  Left 80, 90mm; Right 80, 90mm $4,498.00

 Titanium/Cobalt Chrome

SK166 Howmedica Modular Resection System GMRS Press fit stems long bowed  11, 12, 13, 14, 15, 16, 17, 18,  $5,034.00

 19mm

SK168 Howmedica Modular Resection System GMRS Press fit stems straight fluted 8, 9, 10, 11, 12, 13, 14, 15, 16,  $4,498.00

 17, 18, 19mm

SK330 Modular Replacement System MRS femoral stems with female taper 11 x 127mm, 13 x 127mm, 15 x $6,760.00

  127mm, 17 x 127mm

SK331 Modular Rotating Hinge Knee System MRH HDP ASSEMBLY PACK,  One size only $3,172.00

 consisting of 1 x polyethylene tibial

 sleeve, 1 x polyethylene bumper insert

 and 2 x polyethylene femoral bushing

 Zimmer

ZI425 Natural Knee Revision - Femoral Spacers Non Porous - Size 0 to 4 $2,142.00

  metal alloy

Prostheses List by Category, Groups and Sponsor Page 417 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Knee - Tibial Insert: Total Knee Arthroplasty

 Group 5a - Posterior Cruciate Retaining, fixed

 Advanced Surgical Technologies

AD138 Advance Total Knee System Traditional tibial insert 1, 2, 3, 4, 5, 6 in 10 - 30mm in  $915.00

 2mm increments

AD139 Advance Total Knee System Metal pivot UHMWPE tibial 0, 1, 2, 3, 4, 5, 6 in 10 - 25mm  $1,550.00

 thicknesses

AD171 Advantim Total Knee System Tibial Inserts Total Condylar UHMWPE 10-36mm in 2mm increments $697.00

AD280 Advance Double High Tibial Insert Double-High Tibial Insert - UHMWPE All inserts are available in Left  $1,550.00

 and Right: Sizes 1.5, 0, 1, 2, 3,

 4, 5, & 6, in the following

 increments of 10, 12, 14, 17, 20

 Australian Surgical Design & Manufacture Pty Ltd

AE049 Other Active Knee Components Meniscal Insert Sizes 1 - 5 Thickness 6 - 15.5mm $858.00

 Biomet Australia Pty Ltd

BI149 AGC Total Knee System Tibial Bearing, 'Tradition' Cruciate  59-91mm $1,144.00

 Retaining, UHMWPE

BI172 Maxim Complete Knee System Tibial Bearing Primary, UHMWPE 59-91mm $1,144.00

BI798 Ascent Total Knee System Tibial bearing, cruciate retaining,  59, 63/67, 71/75, 79/83,  $1,144.00

 UHMWPE, curved or lipped 87/91mm widths, 10-20mm

BI801 Ascent Total Knee System Tibial bearing, posterior or anterior  59-91mm width x 8-20mm  $1,404.00 Also grouped in Knee Group 5c

 stabilised, UHMWPE thickness

BI888 Vanguard Total Knee System Tibial Bearing, CR, curved or lipped,  59, 63/67, 71/75, 79/83, 87/91  $1,144.00

 UHMWPE widths, 10, 12, 14, 16, 18,

 20mm thicknesses

 De Puy Australia

DP162 PFC Knee System Range PFC Sigma Knee Duofix insert Size 1-6 $915.00

DY481 PFC Knee System Range PFC Sigma CVD or PLI  Poly tibial Size 1-6 $988.00

Prostheses List by Category, Groups and Sponsor Page 418 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK022 Type ST Biocondylar Surface  Polymer articulating components Various sizes and heights $1,144.00

 Global Orthopaedic Technology

GO027 Consensus Knee System Congruent tibial insert UHMWPE 1-2 to 5-6 L & R 10-18mm $810.00

 Howmedica

HW091 Duracon Total Knee System Tibial Insert - AP Lipped -  Polyethylene Small, Medium, Large, Extra- $1,248.00

 Large in each thickness 9mm,

 11mm, 13mm, 16mm, 19mm,

 22mm, 25mm

HW160 Kinemax Knee Tibial Insert: Low Stress, Duration -   8, 10, 12, 15, 18, 21, 25mm per $739.00

 Vitallium

HW162 Kinemax Knee Tibial Insert: All Poly, Duration -  Vitallium 8, 10, 12, 15, 18, 21mm per  $739.00

HW174 Kinemax Knee Tibial Insert: KMS -  Vitallium 8, 10, 12, 15, 18, 21, 25mm per $739.00

 Johnson & Johnson Medical Pty Ltd

JJ509 PFC Sigma Curved X-Linked Insert PFC Sigma Curved X-Linked Inserts Size 2 - 8mm, 10mm, 12.5mm,  $1,100.00

 15mm, 17.5mm, 20mm; Size

 2.5 - 8mm, 10mm, 12.5mm,

 15mm, 17.5mm, 20mm; Size 3

 - 8mm, 10mm, 12.5mm, 15mm,

  17.5mm, 20mm; Size 4 - 8mm,

  10mm, 12.5mm, 15mm,

 17.5mm, 20mm; Size 5 - 8mm,

 10mm, 12.5mm, 15mm,

 17.5mm, 20mm

 Mathys Orthopaedics Pty Ltd

MA110 Balansys Tibial Component Tibial insert  Insert 64/8 - 85/15.5 $818.00

 Plus Orthopedics Australia Pty Ltd

PL049 UC-PLUS Tibial Component All Poly Tibial Component All Poly 40 (8mm, 10mm, 12mm,  $816.00

 14mm), 44 (8mm, 10mm, 12,,

 14mm), 48 (8mm, 10mm,

 12mm, 14mm), 52 (8mm,

 10mm, 12mm, 14mm), 56

PL082 Plus Knee Joint Prostheses System Tibial Insert Standard 1-6 $822.00

Prostheses List by Category, Groups and Sponsor Page 419 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN310 Genesis II Inserts Deep dished 1-8. 9 - 21mm $1,144.00

SN317 Genesis II  Inserts Articulating  1-8  9mm-18mm $831.00

SN348 Genesis Insert: Articular: Cruciate Retaining:  Left & Right XS-Magnum  $684.00

 UHMWPE 8MM-15MM

SN372 Genesis II/Profix Cruciate Retaining Insert Left/Right, Size 1-8 $1,114.00

SN389 Profix Tibial Insert Left/Right Size 1-6 10-20mm $730.00

 Stryker Australia Pty Ltd

ST608 Scorpio Tibial Insert Cruciate Retaining 8-18mm in 2mm increments $1,248.00

ST643 Osteonics Knee System Tibial insert primary polyethylene 3, 5, 7, 9, 11, 13 in 8, 10, 12,  $1,144.00

 15, 18, 21,24mm

 Stryker Australia Pty Ltd (2)

SK091 Duracon Total Knee System Tibial Insert CS-Lipped - Duration  XS,S,M,L,XL Thickness  $1,350.00

 Polyethylene 9,11,13,16,19,22,25mm

SK328 Triathlon Tibial Insert Cruciate Retaining Sizes 1 to 8  $1,430.00

 (9/11/13/16/19/22/25mm

SK333 NRG Knee System Tibial inserts, cruciate retaining and  Sizes 3,4,5,6,7,9,11,13, x  $1,430.00

 posterior stabilised (8/10/12/15/18/21/24mm

SK407 Scorpio X3 Polyethylene Tibial insert, cruciate retaining, fixed  3 - 11 mm $1,100.00 $1,600.00

 bearing, sequentially crossed linked  8mm-24mm

SK409 Scorpio X3 Polyethylene Tibial insert, cruciate retaining, fixed  3 - 11 mm $1,350.00 $1,600.00

 bearing, sequentially crossed linked  8mm-24mm

SK417 Triathlon X 3 Polyethylene Tibial insert, cruciate retaining, fixed  1 to 8 $1,100.00 $1,600.00

 bearing, sequentially crossed linked

 Zimmer

ZI077 Miller Galante I Articulating Surface - UHMWPE 8 - 22mm $932.00

ZI088 Miller Galante II Articulating Surface - UHMWPE 9 - 23mm $932.00

ZI134 NexGen Knee Articulating Surfaces Standard - UHMWPE 9 - 23 mm $801.00

ZI135 NexGen Knee Articulating Surfaces Ant. Constr. - UHMWPE 9 - 23mm $801.00

Prostheses List by Category, Groups and Sponsor Page 420 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI139 NexGen Knee Articulating Surfaces Anatomically Rotated - UHMWPE 9 - 23mm $1,056.00

ZI291 NexGen Prolong Articulating Surface Highly Crosslinked - Ultra High Molecular Purple, Striped Purple, Yellow,  $1,144.00 $1,404.00

  Weight Polyethylene Striped Yellow, Green, Striped

 Green, Blue, Striped Blue in

 9mm, 10mm 12mm 14mm

ZI410 Natural Knee PE Tibial Baseplate Insert - Congruent 00 to 22mm $803.00

ZI411 Natural Knee PE Tibial Baseplate Insert - Ultra  9 to 22mm $1,056.00

ZI450 Natural Knee PE Insert Highly crossed linked Durasul PE One size only $1,144.00 $1,404.00

 Group 5b - Posterior Cruciate Retaining, mobile

 Australian Surgical Design & Manufacture Pty Ltd

AE046 Active Mobile Bearing Meniscal Insert Sizes 1 - 5 Thickness 6 -  $915.00

 B Braun Australia Pty Ltd

BB255 Columbus Tibia Plateau Rotating Platform - Tibial  $1,040.00

 Biomet Australia Pty Ltd

BI197 Oxford Tricompartmental Knee System Tibial Bearing, UHMWPE 60-75mm $1,300.00

 Corin Australia Pty Ltd

CR007 Rotaglide + Total Knee System, Tibial  Mobile 7mm - 17mm $858.00

 Insert UHMWPE

CR008 Rotaglide + Total Knee System, Tibial  Fixed 9.5mm - 17mm $858.00

 Insert UHMWPE

 De Puy Australia

DP008 LCS Complete System APG Insert or APG Guide Arm small - xlarge, sizes 10 - 20mm  $1,212.00

 or Size 1-7

DP026 LCS Complete System RP Tibial Insert Small - large, size 10 - 30mm $1,120.00

DP238 LCS Total Knee System Meniscal or Rotating Platform Bearings  10-17.5mm Std to Lge+ $1,120.00

 Standard and Deep Dish

DP273 SROM Knee System PROM Insert Curved & Stabilised (Noiles) Size 2-5 $936.00

DP521 LCS Universal Knee LCS Ultra inserts Sm - Lge+ $1,212.00

Prostheses List by Category, Groups and Sponsor Page 421 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY369 LCS Complete System Tibial Inserts Small to Large + thickness 10- $1,212.00

 25mm

DY375 LCS Complete System APG Insert or APG Guide Arm TiNi Aml - Xlrge, sizes 10-20mm or  $1,212.00

 Size 1-7

DY376 LCS Complete System RP Tibial Insert for TiNi Small - Large + from thickness  $1,212.00

 10-25mm

 Endotec Australia Pty Ltd

EA010 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR mobile bearing insert  $1,300.00

 Replacement System (Primary and  Tibial components with mobile  sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 ESKA Australia

EK044 Tibial Plateau RP/B Polymer Articulating Component 8-10-12-14mm $1,100.00

EK048 Tibial Plateau RP/A Polymer Articulating Component 8-10-12-14mm $1,100.00

 Finsbury Orthopaedics Australia Pty Ltd

FI006 DBK Total Knee System Tibial Insert, Polyethylene, Mobile  S/M/L Form, 9-17mm thickness $884.00

 Bearing, posterior cruciate retaining

 Global Orthopaedic Technology

GO002 RBK Total Knee System - Tibial insert Polyethylene 1-5, 10-20mm $1,071.00

 Link Orthopaedic  Australia

LO050 LINK T.A.C.K. Knee Rotating Platform Extra-small, small, medium &  $936.00

LO053 LINK T.A.C.K. Knee Bridging Articulating Surface Extra-small, small, medium &  $936.00

LO131 Gemini MkII Knee Joint Prostheses System Extra Small - Extra Large $2,652.00

 Orthotech Pty Ltd

OH022 Optetrak Total Knee System Insert Size 1 -  6 $1,300.00

OH157 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Tibial Insert 40-55/10-20mm $1,300.00

  Stems & Patellar

 Plus Orthopedics Australia Pty Ltd

PL031 PLUS Knee Joint Prostheses System TC-PLUS Tibial Insert Mobile Bearing  2-12 : 9-19mm $1,018.00

 C.R./C.S.

Prostheses List by Category, Groups and Sponsor Page 422 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN320 Genesis II  Mobile Bearing Standard Insert Left & Right, Size 1-8, 9-15mm $912.00

SN378 Profix Mobile Bearing Stabilised Insert Size 1-8 10-16mm $1,026.00

SN379 Profix Mobile Bearing Standard Insert Size 1-8 10-16mm $837.00

SN699 Profix Mobile bearing stabilised insert 1-8, 18-20mm $1,212.00

 Stryker Australia Pty Ltd

ST032 Scorpio Tibial Insert Mobile Bearing 8-24mm for all tibia sizes $1,404.00

ST912 Duracon Total Knee Tibial Insert Duracon ISA Mobile-Bearing PE Tibial  Small, medium, large, X-large -  $1,300.00

 left, right

 Stryker Australia Pty Ltd (3)

SR031 Triathlon Mobile Mearing Knee System Mobile bearing knee, cruciate retaining,  1 to 8, 9mm to 19mm $1,350.00

 tibial insert

 Zimmer

ZI138 NexGen Knee Articulating Surfaces MBK - UHMWPE 9 - 23mm $936.00

ZI408 Natural Knee PE Insert Mobile Bearing  00 to 22mm $1,056.00

ZI434 SAL Knee PE Insert - Mobile Bearing Mobile Bearing - 0/1 to E/16 $936.00

ZI503 Natural Knee Primary Tibial Baseplate - Mobile Bearing  Size 00 to 5 $2,420.00

 Non Porous - CoCr alloy

ZI515 NexGen Prolong CR Mobile Bearing  NexGen Prolong CR Mobile Bearing  Sizes A - G 9mm to 20mm $1,100.00

 Articulating Surface Aticulating Surface

 Group 5c - Posterior Stabilised, fixed

 Advanced Surgical Technologies

AD136 Advance Total Knee System PS Tibial UHMWPE 1, 2, 3, 4, 5, 6 $1,487.00

 Australian Surgical Design & Manufacture Pty Ltd

AE047 Other Active Knee Components Posterior Stabilised Meniscal Insert Sizes 1 - 5 Thickness 6 - 15.5mm $915.00

Prostheses List by Category, Groups and Sponsor Page 423 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Biomet Australia Pty Ltd

BI179 Maxim Complete Knee System Tibial Bearing, Posterior Stabilised  59-91mm $1,404.00

 UHMWPE

BI905 AGC Total Knee System Tibial Bearing 'Tradition' Posterior  59-91mm $1,270.00

 Stabilised, UHMWPE

 Finsbury Orthopaedics Australia Pty Ltd

FI027 MRK Total Knee System Tibial Insert, Polyethylene 1/2/3, 8-18mm thickness $884.00

 Global Orthopaedic Technology

GO028 Consensus Knee System a) PCL substituting tibial insert; b)  a) 1-2 to 5-6 L & R 10-18mm;  $972.00

 Posterior stabilized tibial insert b) 1-2 to 5-6 L & R 10mm-18mm

 Howmedica

HW092 Duracon Total Knee System Tibial Insert - Stabilised -  Polyethylene Small, Medium, Large, Extra- $1,404.00

 Large in each thickness 9mm,

 11mm, 13mm, 16mm, 19mm,

 22mm, 25mm

 Johnson & Johnson Medical Pty Ltd

JJ508 PFC Sigma Stab X-Linked Insert PFC Sigma Stab X-Linked Inserts Size 2 - 8mm, 10mm, 12.5mm,  $1,100.00

 15mm, 17.5mm, 20mm,

 22.5mm, 25mm; Size 2.5 -

 8mm, 10mm, 12.5mm, 15mm,

 17.5mm, 20mm, 22.5mm,

 25mm; Size 3 - 8mm, 10mm,

 12.5mm, 15mm, 17.5mm,

 20mm, 22.5mm, 25mm; Size 4

 - 8mm, 10mm, 12.5mm, 15mm,

  17.5mm, 20mm, 22.5mm,

 25mm; Size 5 - 8mm, 10mm,

 12.5mm, 15mm, 17.5mm,

 20mm, 22.5mm, 25mm

 Plus Orthopedics Australia Pty Ltd

PL075 Plus Knee Joint Prostheses System Tibial Insert Substituted 1-6 $1,237.00

PL078 Plus Knee Joint Prostheses System TC Plus Solution, Tibial Insert PS 2-12 $1,196.00

 Smith & Nephew Surgical Pty Ltd

SN331 Genesis II Inserts Inserts PS 1-8. 9-25mm $1,073.00

Prostheses List by Category, Groups and Sponsor Page 424 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN349 Genesis Insert: PS Articular: UHMWPE Right/Left S-XL 8mm-25mm $816.00

SN392 Profix Tibial PS Insert Left/Right Size 1-6 10 - 35mm $1,163.00

SN727 Genesis II High Flex PS Insert, UHMWPE 1-8, 9-25mm thickness $1,349.00

SN780 Renasys Knee P/S Insert 8-30mm, 1-10 $1,560.00

 Stryker Australia Pty Ltd

ST644 Osteonics Knee System Tibial insert posterior stabilised - PSI  3, 5, 7, 9, 11, 13 in 8, 10, 12,  $1,404.00

 polyethylene 15, 18, 21,24mm

ST645 Osteonics Knee System Tibial insert posterior stabilised - PSII  3, 5, 7, 9, 11, 13 in 8, 10, 12,  $1,404.00

 polyethylene 15, 18, 21,24mm

ST646 Osteonics Knee System Tibial insert posterior stabilised - PSIII  3, 5, 7, 9, 11, 13 in 8, 10, 12,  $1,404.00

 polyethylene 15, 18, 21,24mm

ST925 Scorpio Tibial Bearing Insert Scorpio tibial insert - superflex.   3, 5, 7, 9 , 11, 13 in thickness  $1,404.00

 Composition - N2VAC UHMWPE 8, 10, 12, 15, 18, 21, 24mm

 Stryker Australia Pty Ltd (2)

SK406 Scorpio X3 Polyethylene Tibial insert, posterior stabilised, fixed  3 - 11 mm $1,100.00 $1,600.00

 bearing, sequentially crossed linked  8mm-24mm

 polyethylene

SK408 Scorpio X3 Polyethylene Tibial insert, posterior stabilised, fixed  3 - 11 mm $1,350.00 $1,600.00

 bearing, high flexion, sequentially crossed 8mm-24mm

  linked polyethylene

SK416 Triathlon X 3 Polyethylene Tibial insert, posterior stabilised, fixed  1 to 8 $1,350.00 $1,600.00

 bearing, sequentially crossed linked

 polyethylene

 Stryker Australia Pty Ltd (3)

SR002 Triathlon Tibial Insert Posterior Stabilised Sizes 1 to 8  $1,430.00

 (9/11/13/16/19/22/25mm

SR008 Scorpio Tibial Insert Posterior Stabilised 8-18mm in 2mm increments $1,248.00

SR012 NRG Knee System Tibial inserts, cruciate retaining and  Sizes 3,4,5,6,7,9,11,13, x  $1,430.00

 posterior stabilised (8/10/12/15/18/21/24mm

SR020 Osteonics Knee System Tibial insert primary polyethylene 3, 5, 7, 9, 11, 13 in 8, 10, 12,  $1,144.00

 15, 18, 21,24mm

Prostheses List by Category, Groups and Sponsor Page 425 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI057 NexGen Articulating Surfaces LPS Flex Polyethylene Sizes 9 - 23mm $936.00

ZI066 Insall-Burstein II Articulating Surface PSK - UHMWPE 8 - 25mm $932.00

ZI136 NexGen Knee Articulating Surfaces PS - UHMWPE 9 - 23mm $801.00

ZI409 Natural Knee PE Tibial Baseplate Insert - P.S. 00 to 22mm $1,056.00

ZI521 NexGen LPS Prolong Articulating  NexGen LPS Prolong Aticulating Surface Sizes A - G, 9mm to 20mm $1,100.00

 Group 5d - Posterior Stabilised, mobile

 Biomet Australia Pty Ltd

BI885 ROCC Knee Prosthesis Rotating Platform Bearing, ARCOM  1-6 (tray size), 10-20mm  $1,788.00

 UHMWPE (bearing size)

BI894 ROCC Knee Prosthesis Tibial Baseplate, Cemented, Chrome  1-8 $2,704.00

 Cobalt, UHMWPE

BI907 TRAC Knee System Bearing Posterior Stabilised UHMWPE 59 - 91mm $1,788.00

 De Puy Australia

DP166 PFC Knee System Range PFC Sigma Knee PR Insert Size 1-6 $1,120.00

DP270 SROM Knee System NPS Tibial Plateau  XSml -Lge $1,889.00

DP388 AMK Total Knee system Posterior stabilised or Tibial or  Size 1-5 $1,120.00

 Congruency or Constrained insert

DY372 LCS Complete System PS Tibial Insert - Mobile Sml to Lge Plus 10-25mm $1,120.00

DY405 RPF PS Tibial Inserts Size 1 to 6 from 10 to 17.5mm $1,560.00

DY457 PFC Knee System Range PFC Sigma C/S Size 1-6 $3,016.00

DY459 SROM Knee System PROM Insert Curved & Stabilised (Noiles) Size 2-5 $936.00

DY465 LCS Total Knee System Meniscal or Rotating Platform Bearings  10-17.5mm Std to Lge+ $1,120.00

 Standard and Deep Dish

DY476 LCS Complete System RP Tibial Insert Small - large, size 10 - 30mm $1,120.00

Prostheses List by Category, Groups and Sponsor Page 426 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Finsbury Orthopaedics Australia Pty Ltd

FI024 DBK Total Knee System Tibial Insert, Polyethylene, Mobile  S/M/L Form, 9-17mm thickness $884.00

 Bearing, posterior stabilised

 Orthotech Pty Ltd

OH215 Optetrak Total Knee System Insert Size 1 - 6 $1,300.00

OH224 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Tibial Insert 40-55/10-20mm $1,300.00

  Stems & Patellar

OH235 Optetrak RBK Optetrak RBK Mobile Insert 1-6 $1,350.00 $1,500.00

 Plus Orthopedics Australia Pty Ltd

PL066 PLUS Knee Joint Prostheses System TC-PLUS Tibial Insert Ultra Congruent 2-12 : 9-19mm $1,018.00

PL067 Plus Knee Joint Prostheses System Tibial Insert SB 1-6 $1,248.00

 Stryker Australia Pty Ltd (3)

SR013 Scorpio Tibial Insert Mobile Bearing -24mm for all tibia sizes $1,404.00

SR032 Triathlon Mobile Bearing Knee System Mobile bearing knee, posterior stabilised,  1 to 8, 9mm to 22mm $1,350.00

 tibial insert

 Tornier Pty Ltd

TO020 HLS Noetos Total Knee Replacement -  UHMWPE 1 - 6, 9,11 & 13mm $1,120.00

 Tibial Insert

 Zimmer

ZI058 NexGen Articulating Surface LPS Mobile Articulating surface  Sizes 9 - 23mm $936.00

 Group 5e - Totally Constrained, fixed

 B Braun Australia Pty Ltd

BB207 Columbus TKS Gliding Surface T1 - T5 $811.00

BB209 Columbus TKS Gliding Surface with Screw T1 - T5 $832.00

 Biomet Australia Pty Ltd

BI181 Maxim Complete Knee System Tibial Bearing, Contrained. UHMWPE 59-91mm $1,560.00

Prostheses List by Category, Groups and Sponsor Page 427 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI802 Ascent Total Knee System Tibial bearing, constrained, UHMWPE 59, 63/67, 71/75, 79/83,  $1,560.00

 87/91mm widths, 10-20mm

BI904 Vanguard Total Knee System Tibial Bearing, PS, PS+.  UHMWPE 59, 63/67, 71/75, 79/83, 87/91,  $1,560.00

 widths, 10. 12, 14, 16, 18, 20,

 22, 24mm thicknesses

BI939 Vanguard SSK Knee System Tibial Bearing Insert, PSC, UHMWPE 59-75mm x (10-24mm) $1,500.00

 De Puy Australia

DP145 PFC Knee System Range PFC Sigma PLI or CVD or CS inserts or  Size 1-6 $832.00

 Howmedica

HW161 Kinemax Knee Tibial Insert: Stabilizer -  Vitallium 8, 10, 12, 15, 18, 21, 25mm per $910.00

 Mathys Orthopaedics Pty Ltd

MA459 Balansys Tibial Component Tibial insert Insert 64/8 - 85/15.5 $818.00

 Orthotech Pty Ltd

OH025 Optetrak Total Knee System CCK Tibial Insert with Screw Size 1 - 6 $1,560.00

 Smith & Nephew Surgical Pty Ltd

SN313 Genesis II/Profix Constrained Insert Left/Right, Size 1-8, 10-30mm $1,118.00

SN340 Genesis Constrained Articular Left/Right Small- XLarge 10mm $832.00

  - 25mm

 Group 5f - Totally Constrained, mobile

 B Braun Australia Pty Ltd

BB198 Emotion TKS Articulating surface T1 to T8 Size: 10 to 24mm $842.00

 De Puy Australia

DP257 SROM Knee System NRH Tibial Plateau size  XSml - Med $3,914.00

DY367 PFC Knee System Range PFC Sigma RP TC3 Size 1.5 to 5 thickness of 15.5  $1,768.00

 to 30mm

 Johnson & Johnson Medical Pty Ltd

JJ532 LCS Complete Revision System LCS Complete Revision VVC insert small-large+, 10 - 25mm $1,900.00

Prostheses List by Category, Groups and Sponsor Page 428 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mathys Orthopaedics Pty Ltd

MA311 Balansys Mobile Insert Tibial Polyethylene Component Mobile  64/8mm - 85/15.5mm $818.00

 Bearing

 Stryker Australia Pty Ltd (3)

SR033 Triathlon Mobile Bearing Knee System Mobile bearing knee, cruciate  1 to 8, 9mm to 22mm $1,400.00

 supplementing or constrained, tibial insert

Knee - Tibial Insert: Uni-Compartmental Knee Arthroplasty

 Group 6a - Fixed bearing

 Advanced Surgical Technologies

AD307 Advance-Unicondylar Knee System Poly insert for metal-backed tibial  $866.00

 B Braun Australia Pty Ltd

BB203 Emotion Unicondylar Uni gliding surface F1 and F5, 3mm $520.00

 Biomet Australia Pty Ltd

BI202 Repicci II Unicondylar Knee System Tibial Component, Cemented, UHMWPE 32-42mm $1,248.00

BI205 Repicci II Unicondylar Knee System Tibial Bearing, Modular, UHMWPE Std, Large, Xlarge $640.00

 De Puy Australia

DY115 Preservation Miu Knee System MIU Fixed or Mobile Bearing Inserts  1, 9.5mm - 5, 13.5mm $866.00

 RM/LL and LM/RL

 Mathys Orthopaedics Pty Ltd

MA454 balanSys UNI PE insert - fixed bearing 5,6,7,9 $818.00

 Plus Orthopedics Australia Pty Ltd

PL131 UC-PLUS Solution Knee System Unicomprtmental Tibia Insert Cemented $750.00

 Smith & Nephew Surgical Pty Ltd

SN334 Genesis Uni Articular Insert UHMWPE  x-Small-Magnum 8mm-12mm $732.00

SN837 Competitor Deuce Tibial Insert 10-18mm $833.00

 Stryker Australia Pty Ltd

ST656 Unicompartmental Knee (Tibial Bearing) Tibial insert polyethylene 1, 2, 3, 4 in 8, 10, 12, 15mm $1,456.00

Prostheses List by Category, Groups and Sponsor Page 429 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Tornier Pty Ltd

TO016 HLS Uni Evolution - Uni Knee  Tibial Insert (All Polyethylene) - Cemented 1 - 6 UHMWPE $1,976.00

 Replacement - Tibia

 Zimmer

ZI105 Miller Galante  Unicompartmental Articulating Surface - UHMWPE 8 - 14 mm $670.00

ZI429 Natural Knee Unicompartmental - Tibia PE Insert 1,2 x 9mm to 5,6 x 13mm $780.00

 Group 6b - Mobile bearing

 Biomet Australia Pty Ltd

BI032 Oxford Meniscal Knee System Mark III Tibial Bearing , UHMWPE Small Standard, Large, Xlarge,  $790.00

 sizes 3-9

BI861 Oxford Meniscal Knee System Mark III Tibial Bearing, Anatomic,  (Small - Extra Large) x (3-9) $832.00

 UHMWPE.

 Corin Australia Pty Ltd

CR060 AMC Uni Condylar, Tibial Insert Bearings UHMWPE Bearings Height 4, 5, 6, 7, 8, 9, 10, 11,  $578.00

 12mm; Size 1-4

 De Puy Australia

DP351 LCS UNI Knee system AP GLIDE Tibial Porocoat Chrome  Size 1-6 $790.00

DY472 PFC Knee System Range PFC Sigma PLI or CVD or CS inserts or  Size 1-6 $832.00

 Mathys Orthopaedics Pty Ltd

MA455 balanSys UNI PE insert - mobile 5,6,7,9 $818.00

Knee - Tibial Tray Component: Total Knee Arthroplasty

 Group 3a - Cemented, all polyethylene

 Advanced Surgical Technologies

AD170 Advantim Total Knee System All Poly Tibial UHMWPE Small, Medium, Large, Xlarge $1,030.00

 Australian Surgical Design & Manufacture Pty Ltd

AE048 Other Active Knee Components All Polyethylene Tibial Implant Sizes 1 - 5 Thickness 6 - 15.5mm $1,016.00

Prostheses List by Category, Groups and Sponsor Page 430 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP285 AMK All Poly Tibia All Poly Tibial tray  Size  1/2 to 5 $936.00

 Howmedica

HW095 Duracon Total Knee System Tibial Baseplate All Polyethylene -   Small, Medium, Large, Extra- $1,248.00

 Polyethylene

 Smith & Nephew Surgical Pty Ltd

SN322 Genesis II/Profix All Poly Tibial Base Left/Right, Size 1-8 $1,016.00

 Stryker Australia Pty Ltd

ST647 Osteonics Knee System Tibial component All polyethylene cobalt  3, 5, 7, 9, 11, 13 $1,248.00

 chrome

 Zimmer

ZI127 NexGen Knee Tibial Components Stemmed All Poly - Ti 1 - 10 $1,248.00

 Group 3b - Cemented, Alloy, Modular

 Advanced Surgical Technologies

AD135 Advance Total Knee System Tibial base CoCr cemented 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5,  $1,706.00

AD172 Advantim Total Knee System Tibial Primary Smooth/Finned Titanium  3" Length in Small-Xlarge $598.00

AD173 Advantim Total Knee System Tibial Primary Smooth/Finned Titanium  6" Length in Small-Xlarge $548.00

AD192 Ortholoc Modular Total Condylar Tibial Components Modular Stem Base  Small, Small Plus, Medium,  $1,279.00

 (Non Porous Coated) CoCr Medium Plus, Large, Large

 Plus, Xlarge

AD218 ADVANCE Total Knee System Offset tibial base - nonporous 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+ $4,368.00

  in Left & Right

 Australian Surgical Design & Manufacture Pty Ltd

AE040 Active Knee System Tibial Component Cemented Sizes 1-5  $1,373.00

 Biomet Australia Pty Ltd

BI169 Maxim Complete Knee System Tibial Plate Primary, Cemented, Titanium 59-91mm $2,132.00

BI177 Maxim Complete Knee System One Piece Revision Tibial Plate and Stem  59-91mm $2,600.00

 Boss, Ti

Prostheses List by Category, Groups and Sponsor Page 431 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Corin Australia Pty Ltd

CR010 Rotaglide + Total Knee System, Tibial  Latched, Cemented Ex Sml - Ex Lge $2,756.00

 Component

 De Puy Australia

DP130 PFC Knee System Range PFC CK cemented or Modular Tibial Tray Size 1-6 $2,132.00

DP444 AMK Chrome CobaltTray Cemented CoCr Keeled tray and Porous  Size 1-5 $3,609.00

 Coated trays

DP889 AMK Chrome CobaltTray Cobalt Chrome Tibial TEX  or TX FX  Size 1-5 $4,667.00

DY378 LCS Complete System Cemented Keeled or Cemented Tibial  1-6 $2,132.00

 Tray TiNi

 ESKA Australia

EK025 Type ST Biocondylar Surface  Tibial Tray Component - cemented s-small, small, medium, large, x- $2,340.00

 large

 Finsbury Orthopaedics Australia Pty Ltd

FI010 MRK Total Knee System Tibial Tray Component cemented, CoChr  1-5 $2,132.00

 Alloy

 Global Orthopaedic Technology

GO024 Consensus Knee System a) Stemmed tibial baseplate nonporous  a) 1-6 L & R; b) 1-6 L & R $2,600.00

 CoCr; b) Stemmed tibial baseplate CCM

 nonporous Ti

 Howmedica

HW087 Duracon Total Knee System Tibial Baseplate Cemented -  Vitallium Small, Medium, Large, Extra- $2,132.00

HW093 Duracon Total Knee System Tibial Baseplate Universal - Cemented -   Small, Medium, Large, Extra- $2,345.00

 Vitallium

HW154 Kinemax Knee Tibial Component: Beadless -  Vitallium XS, S, M, L, XL $1,725.00

 Johnson & Johnson Medical Pty Ltd

JJ510 PFC Sigma Modular Tibial Tray  PFC Sigma CoCr Tray with highly  Size 2, 2.5, 3, 5, 6 $2,050.00

 Cemented - CoCr polished surface cemented

 Mathys Orthopaedics Pty Ltd

MA109 Balansys Tibial Base Plate  Metal back 64mm - 85mm $2,132.00

Prostheses List by Category, Groups and Sponsor Page 432 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH021 Optetrak Total Knee System Tibial Component Size 1 -  6 $2,132.00

 Plus Orthopedics Australia Pty Ltd

PL069 Plus Knee Joint Prostheses System Tibia Cemented 1-6 $2,132.00 $2,600.00

 Smith & Nephew Surgical Pty Ltd

SN309 Genesis II Tibial Base Non Porous Titanium 1 - 8 $2,132.00

SN354 Genesis Tibial Base: Non Porous  Left/Right Small- Magnum  $1,700.00

 8mm-15mm

SN390 Profix Tibial Non Porous Right/Left Size 1-7 $2,132.00

 Stryker Australia Pty Ltd

ST066 Scorpio Tibial Tray Cemented 3, 5, 7, 9, 11, 13 $2,132.00

 Stryker Australia Pty Ltd (2)

SK327 Triathlon Knee System Cemented tibial baseplate cobalt chrome Sizes 1 to 8 $2,132.00

 Tornier Pty Ltd

TO019 HLS Noetos Total Knee Replacement -  Tibial Tray, Cemented, fixed & mobile  1 - 6 CoCr $2,080.00

 Tibial Tray bearing components

 Zimmer

ZI435 SAL Knee Tibial Baseplate - CoCr alloy 60/AOA to 92/E $2,288.00

 Group 3c - Cemented, Alloy, Modular, PMMA coating

 B Braun Australia Pty Ltd

BB204 Columbus TKS Tibial component T1 to T5 $2,236.00

 Plus Orthopedics Australia Pty Ltd

PL029 PLUS Knee Joint Prostheses System TC-PLUS Tibial Cementless 2 to 12 $3,229.00

 Zimmer

ZI073 Insall-Burstein II Femoral Component Tibial Tray - Ti 54 - 74mm $2,250.00

ZI102 Miller Galante II Stemmed Tibial Tray:Precoat - Ti A - K $2,250.00

Prostheses List by Category, Groups and Sponsor Page 433 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI122 NexGen Knee Tibial Components Pegged Precoat - Titanium 1  - 10 $2,250.00

ZI125 NexGen Knee Tibial Components Stemmed Precoat - Titanium 1  - 10 $2,250.00

ZI126 NexGen Knee Tibial Components Stemmed Precoat AP Wedge - Ti 1 - 10 $2,250.00

ZI130 NexGen Knee Tibial Components Stemmed Fluted - Ti 1 - 10 $2,250.00

ZI413 Natural Knee Primary Tibial Baseplate -with Stem  Size 00 to 5 $2,211.00

 Cemented - Ti alloy

 Group 3d - Cemented, Alloy, Moulded polyethylene

 Biomet Australia Pty Ltd

BI148 AGC Knee System Tibial Component, High Post Posterior  63-87mm $2,184.00

 Stabilised, Chrome Cobalt, UHMWPE

BI153 AGC Knee System Tibial Component, Moulded, V2,  63-91mm $2,184.00

 UHMWPE, Chrome Cobalt

BI810 Maxim Complete Knee System Tibial bearing & tray, ' Pop Top' Cruciate 51-91mm $3,900.00

  Retaining or Posterior Stabilised, CoCr

 UHMWPE

 Group 3f - Cemented, Alloy, for mobile insert

 Australian Surgical Design & Manufacture Pty Ltd

AE044 Active Mobile Bearing Tibial Tray - Cemented Sizes 1-5 $1,446.00

 B Braun Australia Pty Ltd

BB253 Columbus Tibia Plateau Rotating Platform Cemented $2,860.00

 Biomet Australia Pty Ltd

BI196 Oxford Tricompartmental Knee System Tibial Component, Chrome Cobalt 63-87mm $2,704.00

BI906 TRAC Knee System Tibial Tray CoCr 59 -91mm $2,704.00

 De Puy Australia

DP032 LCS Complete System MBT Cemented Keeled  or Cemented  Sizes 1 - 7 $2,964.00

 Tibial Tray

Prostheses List by Category, Groups and Sponsor Page 434 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP235 LCS Knee system Textured PCR or Rotating Platform or  Std to Lge ++ $2,153.00

 PCR tibial tray Chrome cobalt

DP240 LCS Total Knee system Cemented Cruciate retention Tibial  Std to Lge ++ $2,153.00

 Chrome cobalt

DP519 LCS Universal Knee LCS Ultra Tibial Chrome cobalt Std - Lge+ $2,704.00

DY370 LCS Complete System MBT DuoFix CoCr or Universal Tibial  1-6 $4,108.00

 Trays HA on Porocoat

 Endotec Australia Pty Ltd

EA009 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Cemented Primary  $2,704.00

 Replacement System (Primary and  Tibial components with mobile  Tibial sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 ESKA Australia

EK050 Tibial Component Cemented RP Tibial Tray Cemented CoCr S - Small - Small - Medium -  $2,900.00

 Large - X-Large

 Finsbury Orthopaedics Australia Pty Ltd

FI007 DBK Total Knee System Tibial Tray Component cemented 1-6 $2,600.00

 Global Orthopaedic Technology

GO003 RBK Total Knee System - Tibial Base No coatings 0 - 5 $3,692.00

 Link Orthopaedic  Australia

LO055 T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining,  Small 1, Small 2, Large 1, Large2 $1,872.00

 Without HX Coating

LO129 Gemini MkII Knee Joint Prostheses System Tibial Component, Microporous/ HX TM  Extra Small - Extra Large $3,016.00

 Coating

 Mathys Orthopaedics Pty Ltd

MA312 Balansys Mobile Base Plate Tibial Base Plate Mobile Bearing 64/8mm - 85/15.5mm $2,522.00

 Plus Orthopedics Australia Pty Ltd

PL071 Plus Knee Joint Prostheses System Tibia SB cemented 1-6 $3,120.00

 Smith & Nephew Surgical Pty Ltd

SN369 Mobile Bearing Knee Tibial Base Non Porous Titanium Left & Right, Size 1-8 $2,153.00

Prostheses List by Category, Groups and Sponsor Page 435 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd

ST069 Scorpio Tibial Tray Mobile Bearing Cemented 3, 5, 7, 9, 11, 13 $1,952.00

ST913 Duracon Total Knee System Duracon ISA Mobile-Bearing CoCr Tibial  Small, medium, large, X-large $1,952.00

 Baseplate

 Stryker Australia Pty Ltd (3)

SR030 Triathlon Mobile Bearing Knee System Mobile bearing knee, cemented, baseplate 1 to 8 $2,800.00

 Group 3g - Cemented, Alloy, for mobile insert, PMMA coating

 Orthotech Pty Ltd

OH236 Optetrak RBK Optetrak RBK Mobile Tibia 1-6 $2,500.00

 Plus Orthopedics Australia Pty Ltd

PL030 PLUS Knee Joint System Tibial Tray Cemented Mobile Bearing 2 to 12 $2,236.00

 Zimmer

ZI061 NexGen Tibial Components Stemmed -  Titanium Sizes 1 - 10 $2,775.00

 Fluted Mobile Option

ZI129 NexGen Knee Tibial Component - Mobile CoCr Alloy 1 - 10 $2,775.00

ZI415 Natural Knee Primary Tibial Baseplate - Mobile Bearing  Size 00 to 5 $2,420.00

 Non Porous - CoCr alloy

 Group 3h - Uncemented, Alloy, Modular

 Advanced Surgical Technologies

AD183 Advance Total Knee System Tibial base porous or HA titanium or  1, 1+, 2, 2+, 3, 3+, 4, 4+, 5,  $3,838.00

AD193 Ortholoc Modular Total Condylar Tibial Components Stemless or  Small, Small Plus, Medium,  $1,841.00

 W/Modular Stem Base (Porous Coated)  Medium Plus, Large, Large

 Plus, Xlarge

 Biomet Australia Pty Ltd

BI170 Maxim Complete Knee System Tibial Plate Primary, Uncemented, Titanium 59-91mm $2,298.00

Prostheses List by Category, Groups and Sponsor Page 436 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP259 SROM Knee System Noiles Modular Tibial Base XSml-Xlge $2,792.00

 Finsbury Orthopaedics Australia Pty Ltd

FI011 MRK Total Knee System Tibial Tray Component cementless,  1-5 $3,120.00

 CoChr Alloy

 Global Orthopaedic Technology

GO025 Consensus Knee System Resurfacing tibial baseplate porous Ti 1-6 L & R $3,536.00

 Howmedica

HW086 Duracon Total Knee System Tibial Baseplate Cementless -  Vitallium Small, Medium, Large, Extra- $2,272.00

 Plus Orthopedics Australia Pty Ltd

PL070 Plus Knee Joint Prostheses System Tibia cementless 1-6 $3,328.00

 Smith & Nephew Surgical Pty Ltd

SN311 Genesis II/Profix Porous Tibial Base Plate Left/Right, Size 1-8 $2,298.00

SN356 Genesis Tibial Base: Porous Left/Right Small - Magnum $2,199.00

 Stryker Australia Pty Ltd

ST029 Scorpio Tibial Tray Cementless 3,5,7,9,11,13 $2,272.00

 Stryker Australia Pty Ltd (2)

SK388 Triathlon Total Knee System Uncemented, porous beaded tibial  Sizes 1 to 8 $2,652.00

 baseplate, primary, cobalt chrome

 Zimmer

ZI086 Stemmed Tibial Tray:Porous Ti A - K $2,298.00

ZI103 Miller Galante II Other Tibial Tray:Porous Wedged - Ti A - K $3,611.00

ZI120 NexGen Knee Tibial Components Pegged Porous - Titanium 1  - 10 $2,298.00

ZI123 NexGen Knee Tibial Components Stemmed Porous - Titanium 1  - 10 $2,298.00

ZI412 Natural Knee Primary Tibial Baseplate with Stem  Size 00 to 5 $2,298.00 Also grouped in Knee Group 11

 Porous - Ti alloy

Prostheses List by Category, Groups and Sponsor Page 437 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 3i - Uncemented, Alloy, Modular, HA coating

 Advanced Surgical Technologies

AD189 Ortholoc Advantim HA Porous Coated  Tibial base HA Ti Components Small, Small Plus, Medium,  $2,162.00

 Knee System Medium Plus, Large, Large

 Plus, Xlarge

AD276 Advance HA Coated Tibial Base Titanium HA Coated Tibial Base 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5,  $3,229.00

 Australian Surgical Design & Manufacture Pty Ltd

AE043 Active Knee System Tibial Component Cementless Sizes 1-5  $2,288.00

 B Braun Australia Pty Ltd

BB231 Columbus TKS Tibial Component - Cementless T1 - T5 $2,652.00

 Biomet Australia Pty Ltd

BI186 Maxim Complete Knee System Tibial Tray, HA Coated, Ti 59 - 91mm $3,229.00

 De Puy Australia

DP891 AMK Chrome CobaltTray Duofix Cobalt Chrome tibial Tray HA  Size 1-5 $3,888.00

 ESKA Australia

EK026 Type ST Biocondylar Surface  Tibial Tray Component - uncemented s-small, small, medium, large, x- $2,683.00

 large

 Global Orthopaedic Technology

GO005 RBK Total Knee System - Tibial base Porous and hydroxyapatite coating 1-5 $4,108.00

GO026 Consensus Knee System Stemmed tibial baseplate porous CoCr/Ti 1-6 L & R $3,224.00

 Howmedica

HW088 Duracon Total Knee System Tibial Baseplate Cementless with PA -   Small, Medium, Large, Extra- $2,652.00

 Vitallium with PA coating

HW094 Duracon Total Knee System Tibial Baseplate Universal - Cementless -   Small, Medium, Large, Extra- $2,652.00

 Vitallium

 Plus Orthopedics Australia Pty Ltd

PL101 PLUS Knee Joint Prostheses System TC-PLUS Tibial Cementless 2 to 12 $3,229.00

Prostheses List by Category, Groups and Sponsor Page 438 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN312 Genesis II/Profix HA coated, Porous Tibial Baseplate Left & Right, Size 1-8 $2,288.00

 Stryker Australia Pty Ltd

ST031 Scorpio Tibial Tray PA 3,5,7,9,11,13 $2,652.00

ST648 Osteonics Knee System Tibial component H/A cobalt chrome with 3, 5, 7, 9, 11, 13 $2,652.00

  HA coating

 Stryker Australia Pty Ltd (2)

SK326 Triathlon Knee System HA coated tibial baseplate Sizes 1 to 8 $2,652.00

 Zimmer

ZI121 NexGen Knee Tibial Components Pegged Porous HA/TCP - Titanium 1  - 10 $2,683.00

ZI124 NexGen Knee Tibial Components Stemmed Porous HA/TCP - Titanium 1  - 10 $2,683.00

 Group 3j - Uncemented, Alloy, Moulded polyethylene

 Biomet Australia Pty Ltd

BI863 AGC Knee System Tibial Component, Moulded, V2 Porous  (63-91) x (8-22)mm $2,902.00

 coated UHMWPE, Chrome Cobalt, Ti

 De Puy Australia

DY462 SROM Knee System Noiles Modular Tibial Base XSml-Xlge $2,792.00

 Zimmer

ZI295 NexGen TM Monoblock Tibial  Trabecular Meta (Tantalum) and  Sizes 3 - 8, Height 10mm - 17mm $4,358.00

 Ultrahigh Molecular Weight Polyethylene

 Group 3l - Uncemented, Alloy, for mobile insert

 B Braun Australia Pty Ltd

BB254 Columbus Tibia Plateau Rotating Platform  $3,068.00

 Biomet Australia Pty Ltd

BI771 Oxford Tricompartmental Knee System Tibial component, Porous, CoCr, Ti 63-87mm $3,900.00

BI908 TRAC Knee System Tibial Tray, Porous CoCr 59 - 91mm $4,992.00

Prostheses List by Category, Groups and Sponsor Page 439 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP031 LCS Complete System MBT Porocoat Keeled or Porocoat Tibial  Sizes 1 - 7 $3,900.00

DP163 PFC Knee System Range PFC Sigma Knee Offset Tibial Tray  or  Size 1-6 $3,905.00

 Modular Plus tibial Tray

DY377 LCS Complete System MBT Porocoat Keeled or Porocoat Tibial  1-6 $3,900.00

DY461 SROM Knee System Noiles Modular Tibial Base XSml-Xlge $2,792.00

DY466 LCS Knee system Textured PCR or Rotating Platform or  Std to Lge ++ $2,153.00

 PCR tibial tray Chrome cobalt

DY469 PFC Knee System Range PFC Sigma CVD or PLI  Poly tibial Size 1-6 $988.00

 Endotec Australia Pty Ltd

EA008 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP TKR Ultracoat Primary  $3,900.00

 Replacement System (Primary and  Tibial components with mobile  Tibial sizes 1-6(inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

 ESKA Australia

EK045 Tibial Component Cementless RP Tibial Tray Cementless CoCr MO S-Small-Small-Medium-Large- $2,900.00

 X-Large

 Finsbury Orthopaedics Australia Pty Ltd

FI008 DBK Total Knee System Tibial Tray Component, cementless 1-6 $3,120.00

 Global Orthopaedic Technology

GO004 RBK Total Knee System - Tibial base Porous coating 1-5 $4,007.00

 Mathys Orthopaedics Pty Ltd

MA460 Balansys Mobile Base Plate Tibial Base Plate Mobile Bearing 64/8mm - 85/15.5mm $2,522.00

 Orthotech Pty Ltd

OH156 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Tibial Base Plate 40-55 $3,640.00

  Stems & Patellar

 Plus Orthopedics Australia Pty Ltd

PL048 PLUS SB Total Knee Replacement -  Ti-Plasma Sprayed Tibial Component 2, 4, 6, 8, 10, 12 $3,900.00

 Uncemented Tibial Component

Prostheses List by Category, Groups and Sponsor Page 440 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PL072 Plus Knee Joint Prostheses System Tibia SB Cementless 1-6 $3,900.00

 Smith & Nephew Surgical Pty Ltd

SN370 Mobile Bearing Knee Tibial Base Porous Titanium Left & Right, Size 1-8 $2,263.00

 Stryker Australia Pty Ltd

ST067 Scorpio Tibial Tray Mobile Bearing Cementless 3, 5, 7, 9, 11, 13 $2,752.00

 Zimmer

ZI414 Natural Knee Primary Tibial Baseplate - Mobile Bearing  Size 00 to 5 $2,564.00

 Porous - CoCr alloy

 Group 3m - Uncemented, Alloy, for mobile insert, HA coating

 Australian Surgical Design & Manufacture Pty Ltd

AE045 Active Mobile Bearing Tibial Tray - Cementless Sizes 1-5 $2,402.00

 B Braun Australia Pty Ltd

BB233 Emotion TKS Tibial Component - Cementless T1 - T8 $2,340.00

 Biomet Australia Pty Ltd

BI900 ROCC Knee Prosthesis Tibial Baseplate, uncemented, HA coated  1-8 $3,600.00

 or Porous HA coated, CoCr, Ti, HA,

BI909 Oxford Tricompartmental Knee System Tibial Component, Porous, HA Coated,  63 - 87mm $3,900.00

 CoCr, Ti, HAP

 Corin Australia Pty Ltd

CR009 Rotaglide + Total Knee System, Tibial  Latched, HAP Coat Ex Sml - Ex Lge $4,108.00 Also grouped in Knee Group 3m

 Component

 De Puy Australia

DP035 LCS Complete System MBT DuoFix or Universal Tibial Trays  Tibial sizes 1 - 7 $4,108.00

 HA on Porocoat

DY379 LCS Complete System MBT DuoFix or Universal Tibial Trays  1-6 $4,108.00

 HA on Porocoat TiNi

DY495 LCS Complete System MBT DuoFix CoCr or Universal Tibial  1-6 $4,108.00

 Trays HA on Porocoat

Prostheses List by Category, Groups and Sponsor Page 441 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Link Orthopaedic  Australia

LO052 LINK T.A.C.K. Knee Tibial cementless Extra-small, small, medium &  $2,652.00

LO127 T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining,  Small 1, Small 2, Large 1, Large2 $2,652.00

 with HX Coating

 Smith & Nephew Surgical Pty Ltd

SN368 Mobile Bearing Knee Tibial Base HA Coated Porous Titanium Left & Right Size 1-8 $3,345.00

Knee - Tibial Tray Component: Uni-Compartmental Knee

 Group 4a - Cemented, all polyethylene

 Advanced Surgical Technologies

AD206 Advance-Unicondylar Knee System All poly tibial component Sizes 1, 2, 3, 4 in 7mm, 8mm,  $1,378.00

 9mm, 10mm

 Australian Surgical Design & Manufacture Pty Ltd

AE067 Active Uni Compartmental Knee Uni compartmental knee resurfacing  All sizes for Tibial Component $1,248.00

 prostheses, consisting of a Femoral

 component manufactured from Chrome

 Cobalt Molybdenum alloy, and a Tibial

 component manufactured from Ultra high

  Molecular Weight Polyethylene

 Corin Australia Pty Ltd

CR091 Uniglide All Polyethylene Fixed Tibial  All polyethylene Sizes 3, 5 & 7, thicknesses  $1,248.00

 Component 7mm to 13mm

 De Puy Australia

DY114 Preservation Miu Knee System MIU All Poly Tibials RM/LL and LM/RL 1, 7mm - 5, 11.5mm $1,246.00

 Global Orthopaedic Technology

GO031 Global re-surfacing uni-compartmental  Uni-compartmental knee, tibial tray  0-5 6.5mm - 9.5mm regular $1,352.00

 knee tibial implant component, cemented, moulded,

 Orthotech Pty Ltd

OH231 Optetrak Uni Knee Uni Tibial Component 1-6 $1,325.00 $1,800.00

Prostheses List by Category, Groups and Sponsor Page 442 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN337 Genesis Uni Tibial Base UHMWPE   Left & Right, X Small- Magnum $1,232.00

  Plus,  8mm-15mm

 Stryker Australia Pty Ltd

ST054 EIUS Tibial Component Polyethylene XS, S, M, L, XL $1,248.00

 Zimmer

ZI108 Miller Galante  Unicompartmental All Poly Tibial Tray - UHMWPE 40 - 56 mm $1,378.00

ZI402 Allegretto Unicompartmental Knee Tibia Allpoly - PE 9/38 to 15/48mm $1,378.00

 Group 4b - Cemented, Alloy, modular

 Advanced Surgical Technologies

AD200 Advance-Unicondylar Knee System Metal-backed tibial component 1,2,3,4 in 10,11,12mm $1,591.00

 Biomet Australia Pty Ltd

BI204 Repicci II Unicondylar Knee System Tibia Plate, Modular, Cemented, Titanium Std, Large, Xlarge $1,483.00

 De Puy Australia

DY118 Preservation Miu Knee System MIU Fixed Tibial Tray Porous or Mobile   Size 1-5 $1,491.00

 RM/LL and LM/RL

 Mathys Orthopaedics Pty Ltd

MA452 balanSys UNI Tibial component - fixed bearing 1,2,3,4,5 $1,664.00 $2,340.00

 Plus Orthopedics Australia Pty Ltd

PL130 UC-PLUS Solution Knee System Unicompartmental Tibial Tray Cemented Tibial - 40 - 56 x (8, 10, 12,  $1,500.00

 Smith & Nephew Surgical Pty Ltd

SN336 Genesis Uni Tibial base Titanium Alloy XSmall-Magnum $1,491.00

SN836 Competitor Deuce Tibial Baseplate, titanium 1-8 $1,530.00

 Tornier Pty Ltd

TO017 HLS Uni Evolution - Uni Knee  Tibial Insert (Polyethylene/Metal Back) -  1 - 6 UHMWPE, CoCr $1,591.00

 Replacement - Tibia Cemented

Prostheses List by Category, Groups and Sponsor Page 443 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI107 Miller Galante  Unicompartmental Tibial Tray - Ti 40 - 56 mm $1,591.00

 Group 4d - Cemented, Alloy, moulded polyethylene

 Biomet Australia Pty Ltd

BI871 Vanguard unicondylar Knee System Tibial Component, CoCr UHMWPE (A-E) x (5-8) $2,288.00

 Link Orthopaedic  Australia

LO060 LINK Endo-Model SLED Knee Prosthesis Tibial Plateaus, Metal Backed, Polyethylene 7mm-13mm in 45, 50, 55  $1,915.00

 Zimmer

ZI403 Allegretto Unicompartmental Knee Tibial Baseplate Monoblock - Ti alloy / PE 7.5/38 to 15/48mm $1,976.00

 Group 4f - Cemented, Alloy, for mobile insert

 Biomet Australia Pty Ltd

BI033 Oxford Meniscal Knee System Mark III Tibial Tray, Chrome Cobalt,  (38-53mm) x sizes 26-34 $1,732.00

 Cemented

 Corin Australia Pty Ltd

CR061 AMC Uni Condylar, Cemented Tibial Base AMC Uni Condylar Tibial Component  Sizes 1 - 8 inclusive $1,732.00

  Plate (CoCr) Cemented with Titanium Nitrite

 Ceramic Coating

 De Puy Australia

DY117 Preservation Miu Knee System MIU Fixed or mobile Tibial Tray  Size 1-5 $1,560.00

 Cemented  RM/LL and LM/RL

 Mathys Orthopaedics Pty Ltd

MA453 balanSys UNI Tibial component - mobile 1,2,3,4,5 $1,664.00 $2,340.00

 Zimmer

ZI502 Natural Knee Primary Tibial Baseplate - Mobile Bearing  Size 00 to 5 $2,420.00

 Non Porous - CoCr alloy

Prostheses List by Category, Groups and Sponsor Page 444 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 4g - Cemented, Alloy, for mobile insert, PMMA coating

 B Braun Australia Pty Ltd

BB201 Emotion TKS Tibial component T1 to T8, left and right $2,288.00

 Group 4i - Uncemented, Alloy, modular, HA coating

 Smith & Nephew Surgical Pty Ltd

SN335 Genesis Uni Tibial Base HA coated Left & Right, X Small- Magnum $1,294.00

  Plus

 Stryker Australia Pty Ltd (2)

SK329 Unix unicompartmental knee system HA tibial tray, unicompartmental Sizes 1 to 4 $1,768.00

 Group 4l - Uncemented, Alloy, for mobile insert

 Zimmer

ZI430 Natural Knee Unicompartmental -Tibia Baseplate - Ti  Por 1 to Por 6 $1,649.00

 Group 4m - Uncemented, Alloy, for mobile insert, HA coating

 Biomet Australia Pty Ltd

BI860 Oxford Meniscal Knee System Mark III Tibial Tray, HA or Porous  (38-53) x (26-34)mm $2,524.00

 coated, CoCr, HA, Ti.

 Corin Australia Pty Ltd

CR057 AMC Uni Condylar Tibial Component -  Tibial Base Plate, Cobalt Chrome,  1-8 $2,524.00

 Bonit Coat Titanium Nitrate Ceramic Coated, Bonit

 (Calcium Phosphate) Ingrowth Surface

Prostheses List by Category, Groups and Sponsor Page 445 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Knee - tumour

 Group 10 - Tumor implants

 Biomet Australia Pty Ltd

BI166 Compress Finn Limb Salvage System Distal Femoral Replacement: Anchor  15 plugs, 9 segments, 8 pins, 14 $13,560.00

 Plug, Femoral segment, transverse pins,   sleeves, 26 spindles

 centering sleeves, spindle. Chrome

 Howmedica

HW191 Howmedica Modular Resection System Proximal Femur -  Vitallium 120, 140, 160mm $4,667.00

HW192 Howmedica Modular Resection System Hex Screw -  Vitallium 16-30mm in 2mm increments  $37.00

 and 35-70mm in 5m increments

HW195 Howmedica Modular Resection System Plug Screw -  Vitallium One size only $218.00

HW196 Howmedica Modular Resection System Tibial Joint -  Vitallium One size only $5,553.00

HW197 Howmedica Modular Resection System Proximal Tibia -  Vitallium 120mm, 140mm, 160mm $6,346.00

HW200 Howmedica Modular Resection System Plug Screw Axis -  Vitallium One size only $217.00

HW201 Howmedica Modular Resection System Axis -  Vitallium One size only $572.00

HW204 Howmedica Modular Resection System Extension Piece -  Vitallium 60mm, 80mm, 100mm $3,871.00

HW205 Howmedica Modular Resection System Straight Anchorage Piece -  Vitallium 11, 12, 13, 14, 15mm $4,451.00

HW206 Howmedica Modular Resection System Curved Anchorage Piece -  Vitallium 12, 13, 14, 15, 16, 17, 19mm $4,451.00

HW207 Howmedica Modular Resection System Connecting Piece -  Vitallium One size only $6,768.00

HW208 Howmedica Modular Resection System Hex Socket Bolt -  Vitallium One size only $415.00

HW209 Howmedica Modular Resection System Screw Jack -  Vitallium One size only $275.00

HW227 Howmedica Modular Resection System Rotating Hinge Distal Femur -  Vitallium 120, 140, 160mm $8,433.00

HW228 Howmedica Modular Resection System Rotating Hinge Axle -  Vitallium One size only $820.00

HW229 Howmedica Modular Resection System Rotating Hinge Femoral Bushing -  Vitallium One size only $407.00

HW230 Howmedica Modular Resection System Rotating Hinge Bumper -  Vitallium Insert 0degree, 3degree, 5degree $777.00

HW243 Howmedica Modular Resection System Duration Screw Jack -  Vitallium One size only $311.00

Prostheses List by Category, Groups and Sponsor Page 446 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW244 Howmedica Modular Resection System Oncology Proximal Femur -  Vitallium 26mm, 28mm head with 70mm  $5,804.00

 segment

HW245 Howmedica Modular Resection System Oncology Distal Femur Condyle -  Vitallium Small, Standard $7,095.00

HW246 Howmedica Modular Resection System Oncology Femoral Body -  Titanium Standard Diametre 40-220mm in $3,689.00

  20mm increments and small

 diameter 40-160mm in 20mm

 increments

HW249 Howmedica Modular Resection System Oncology Proximal Tibia -  Vitallium 95mm segment $7,252.00

HW250 Howmedica Modular Resection System Oncology Tibial Stem -  Vitallium 127mm in 9, 11, 13mm  $3,757.00

HW251 Howmedica Modular Resection System Oncology Tibial Insert -  Polyethylene Small and Medium in 11, 13, 16, $1,648.00

  21mm

 Stryker Australia Pty Ltd (2)

SK160 Howmedica Modular Resection System GMRS (HMRS+) Straight Anchorage  11, 12, 13, 14, 15mm $4,841.00

 Stems, Cobalt Chrome

SK167 Howmedica Modular Resection System GMRS Press fit stems short bowed 150mm 11, 12, 13, 14, 15, 16, 17, 18,  $4,429.00

 19mm

Ligators

 Device Technologies Australia Pty Ltd

DE059 Arthrex Meniscal Dart PLA 10mm - 14mm $304.00

DE140 Bio-Fastak Composition - Poly  (L-lactide-co-D, L- 3-11mm $390.00

 lactide) with an insert molded eyelet of

 non-absorbable polyester suture

DE197 Bio - Fastak with Fibrewire suture 3mm x 11mm $440.00

DE218 Mini Bio-Suture Tak PLDLA, with Fibre Wire 2.4mm x 5 -7mm $430.00

Prostheses List by Category, Groups and Sponsor Page 447 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Mesh

 Morton Surgical Pty Ltd

MG020 Surgimesh WN / Surgimesh WN non- Surgimesh WN no-adherent Tintra R 12,5cm $985.00

MG021 Surgimesh WN / Surgimesh WN non- Surgimesh WN non-adherent Tintra M 22x15x10cm $1,300.00

MG022 Surgimesh WN / Surgimesh WN non- Sugimesh WN non-adherent Tintra L 30x30x20cm $1,300.00

MG023 Surgimesh wn/surgimesh wn non- Surgimesh WN Alfi ep Talfi - 8  $108.00

 80g

MG024 Surgimesh wn/surgimesh wn non- Surgimesh WN 1/2 ovale T613 - 85 $106.00

 6x13cm FPD ep 80g

MG025 Surgimesh wn/surgimesh wn non- Surgimesh WN T1015 10x15cm $106.00

MG026 Surgimesh wn/surgimesh wn non- Surgimesh WN T1115-8  $191.00

 11x15cm, 80g

MG027 Surgimesh wn/surgimesh wn non- Surgimesh WN with window T1115-8F $198.00

 , 11x15cm

MG028 Surgimesh wn/surgimesh wn non- Surgimesh WN T1415-8 $191.00

  14x15cm

MG029 Surgimesh wn/surgimesh wn non- SurgimeshWN T3030 $237.00

 30x30cm

Mesh, Metallic

 De Puy Australia

DP426 Surgical Titanium Mesh System Mesh - Long/Oval 26 x 33mm x 50 - 90mm $5,112.00

DP427 Surgical Titanium Mesh System Mesh - Curved or Long/Oval 14mm  x 130mm or 17 - 22 x  $6,072.00

 22 - 28mm x 50 - 150mm Hgt

DP430 Moss Miami (Stainless Steel) Washers - slotted, angled Slotted/Angled or 3-5mm $248.65

Prostheses List by Category, Groups and Sponsor Page 448 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP436 Surgical Titanium Mesh System Mesh - Oval or Flat or Long/Round 17-22 x 22-28mm - 10-15mm  $4,135.00

 Hgt or 90mm x 90mm or 10 -

 16mm x 30 - 100mm Hgt

DP438 Surgical Titanium Mesh System Mesh  - Oblong 12 - 13 x 15 -17mm x 10 - 20mm $6,325.00

DY087 Surgical Titanium Mesh System End Plate or Screws or End Cap (Round / 17-22mm x 22-33mm $243.00

  Oblong / Trapezoidal)

DY088 Surgical Titanium Mesh System Rings (Standard and Angled) 17-26mm x 22-33mm $1,362.00

Nails, Bone

 Austofix

AX001 Austofix Intramedullary Nail Humeral Nail, stainless steel 7mm and 8mm $660.00 $800.00

AX004 Austofix Intramedullary Nail Femoral & Tibial Nails, stainless steel 8mm, 9mm, 10mm $430.00 $650.00

AX005 Austofix Intramedullary Nail Supracondylar Nail, stainless steel 10mm & 13mm  $640.00 $1,000.00

AX006 Austofix Intramedullary Nail Hip Nail, stainless steel 120 & 130 Degree $350.00 $460.00

AX007 Austofix Intramedullary Nail Long Hip Nail, stainless steel 13/10mm $650.00 $800.00

AX008 Austofix Intramedullary Nail Proximal Tibial Nail, stainless steel 10/9mm $650.00

AX009 Austofix Intramedullary Nail Custom Nails, stainless steel 5-13mm $1,350.00

AX010 Austofix Intramedullary Nail Cannulated Femoral Nail, stainless steel 13mm $625.00 $1,000.00

AX013 Proximal Humeral Nail Stainless Steel Diameter 8 mm, Length 170  $1,075.00

AX020 S2 Nail System Cannulated supracondylar nail, stainless  11/13mm x 160-380mm $1,050.00 $1,400.00

 B Braun Australia Pty Ltd

BB107 BRAUN AUST Intramedullary Nails Nail for small bones Dia 3mm-8mm $1,617.00 $3,200.00

 Biomet Australia Pty Ltd

BI248 SST Small Bone Locking Nail Forearm Nail, Titanium 3.5mm x (180-260mm) $1,617.00

BI249 SST Small Bone Locking Nail Screw, Distal Fixator, Titanium One size only $115.00

BI250 SST Small Bone Locking Nail Set Screw w/holder, Titanium One size only $115.00

Prostheses List by Category, Groups and Sponsor Page 449 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI251 SST Small Bone Locking Nail Nail End Cap, titanium low profile, one size only $218.00

BI252 SST Small Bone Locking Nail Fibula Nail, titanium (3.5, 4.5mm) x 150mm $1,333.00

BI281 Femoral Interlocking Nail Nail, Interlocking, Titanium (10-15mm) x (300 - 440mm) $688.00

BI282 Femoral Interlocking Nail Screws, Femoral Nail, Titanium 5mm x (25-70mm) $84.00

BI283 Femoral Interlocking Nail Screws, Femoral Nail, Titanium 6.4mm x (70-120mm) $152.00

BI284 Femoral Interlocking Nail Screws, Femoral Nail, Titanium 6mm x (30-100mm) $97.00

BI285 Femoral Interlocking Nail Femoral Nail End Cap 10-11mm & 12-16mm $55.00

BI286 Uniflex Tibial Nail Tibial Nail, Titanium 8-14mm x 240-420mm $950.00

BI287 Uniflex Tibial Nail Tibial Nail Transverse Screw, Titanium 4.0, 5.0mm x (20-70mm) $184.00

BI288 Uniflex Tibial Nail Tibial Nail, Ti 8 - 9mm x (240-380mm) $591.00

BI289 Uniflex Tibial Nail Tibial Nail, Ti 10 - 11mm x (240-420mm) $673.00

BI290 Uniflex Tibial Nail Screw, Tibial Nail, Ti 4 - 5mm x (20-70mm) $87.00

BI291 Uniflex Tibial Nail Nail, End Cap, Ti 4 - 18mm diameter $105.00

BI292 Humeral Nail Humeral Nail, Titanium  8.0- 9.0mm x (180-280mm) $990.00

BI293 Humeral Nail Screws, Transverse Humeral Nail, Titanium (4.0-4.5mm) x (16-46mm) $184.00

BI294 Humeral Nail Nail, Humeral, Titanium (8.0- 9.0mm) x (180-280mm) $975.00

BI295 Kuntscher Cloverleaf Medullary Nails  Stainless Steel 6-12mm x (140-520mm) $280.00

BI296 Kuntscher Cloverleaf Medullary Nails  Stainless Steel 13-16mm x (280-520mm) $1,400.00

BI297 Kuntscher Cloverleaf Medullary Nails  Stainless Steel 17-20mm x (300-750mm) $2,000.00

BI299 Kuntschner Y Nail Stainless Steel 1.0-3.0mm x (100-310mm) $145.00

BI803 ST Pro Nailing System End cap, stainless steel Dia 8-16mm $80.00

BI804 ST Pro Nailing System Fixation screws, stainless steel Fully threaded - dia 4-6mm, 20- $90.00

 100mm length; Partially

 threaded - dia 6.4mm, length

BI805 ST Pro Femoral Nail Cannulated, stainless steel Dia 10-16mm, length 260-520mm $730.00

BI806 ST Pro Humeral Nail Solid, stainless steel Dia 8-9mm, length 180-280mm $660.00

Prostheses List by Category, Groups and Sponsor Page 450 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI807 ST Pro Tibial Nail Cannulated, solid, stainless steel Dia 8-11mm, length 240- $550.00

BI940 Peritrochanteric Nail System Lag Screw, Telescoping, Ti 65mm - 120mm $896.00

BI941 Peritrochanteric Nail System Lag Screw, Solid, Ti 65mm - 120mm $406.00

BI942 Peritrochanteric Nail System Trochanteric Nail Ti 24cm - 48cm $2,060.00

BI943 Peritrochanteric Nail System End Cap Ti 0 - 15mm $225.00

 De Puy Australia

DP528 Nancy Nail System Pediatric Flexible Nail 2.5 or 3.0 mm x 190 -290mm $431.00

DP529 Nancy Nail System Pediatric Flexible Nail 3.5 mm x  270-350mm $475.00

DP531 Nancy Nail System Pediatric Flexible Nail 4.0 mm x  330-450mm $475.00

DY323 Ace Trochanteric Nail Trochanteric Lag Screw Sterile 60 to 120mm $255.80

DY324 Ace Trochanteric Nail Trochanteric Anti Rotation Screw Sterile 60 to 100mm $96.00

DY325 Ace Trochanteric Nail Trochanteric End Cap Sterile 5 to 25mm $161.00

DY326 Ace Trochanteric Nail Trochanteric Nails Sterile in Standard or  320 x 11 x 130 up to 420 x 13 x $1,735.00

 Left or Right  130 or 125 to 140 Deg from 9

 to 13mm dia

 Device Technologies Australia Pty Ltd

DE061 Fixion Nailing System Stainless Steel 18x 6.7mm - 440 x 12mm $1,990.00

DE095 Fixation IM Nail - Proximal femur Stainless steel Dia 10 x 220mm, length 12 x  $2,750.00

 380mm

DE096 Fixion IM nail - Humeral Stainless steel Dia 6.7 - 8.5mm (reduced),  $1,990.00

 length 180 - 280mm

 Orthotech Pty Ltd

OH138 Lima Humeral Nail Stainless steel Dia 7 - 8mm, length 200 - 300mm $1,990.00

 Smith & Nephew Surgical Pty Ltd

SN494 Ender Nails - 3.5mmx22cm - 4.5mmx48cm $120.00

SN495 Intermedullary Nailing System Foresight Locking Screw 2.7mm Diameter 8-18mm Length $70.00

SN496 Intermedullary Nailing System Foresight Nail 4-5mm Diameter 20-26cm  $660.00

Prostheses List by Category, Groups and Sponsor Page 451 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN497 Intermedullary Nailing System Knee Fussion Nail, Stainless Steel 11x 65-75 & 12 x 65-85cm $4,400.00

SN498 Intermedullary Nailing System Nail Cap One size only $79.00

SN499 Intermedullary Nailing System Revision, Ankle Fusion Nail 11mmx15cm -13x21cm $1,075.00

SN500 Russel Taylor Delta II Femoral Nail 8mmx24cm - 10mmx38mm $1,476.00

SN501 Russel Taylor Delta II Reconstruction Nail Left/Right 8mmx24cm -  $1,500.00

 9mmx38cm

SN502 Russel Taylor Delta Reconstruction & Femoral Plus  Left/Right 10-11 32-48mm. $971.00

 Nails, Stainless Steel

SN503 Russel Taylor Delta Tibial & Tibial Pro Nails, Stainless  8 x 27-42mm  9 x 27-36mm. 10 $549.00

  x 32-48mm  11 x 32-48mm.

SN505 Russel Taylor Femoral/Tibial Interlocking Nails 11mmx28.5cm - 16mmx50cm $438.00

SN507 Russel Taylor Humeral Nails 7-9 x 18-30cm $1,140.00

SN509 Russel Taylor Intermedullary Hip Screw Nail (IMHS)  Standard 10-16mm 21 cm  $650.00

 Stainless Steel length, Long 10-12mm Diameter

  Right& Left 34-42cm Length

SN510 Russel Taylor Intermedullary Supracondylar Nail,  11mmx15cm -13mmx25cm. $999.00

 Stainless Steel

SN515 Russel Taylor Reconstruction Nails, Stainless Steel 12mmx32cm -15mmx50cm. $700.00

SN518 Russell Taylor  Femoral Interlocking Retrograde Nail 11mmx30cm - 13mmx48cm $1,051.00

SN763 IMHS CP Intramedullary Hip Nail, stainless steel 10 - 16mm x 19.5cm left and  $760.00

SN764 IMHS CP Intramedullary Hip Nail, stainless steel 10 - 14mm x 32 - 44cm left and $830.00

  right

 Stryker Australia Pty Ltd

ST035 Stryker Trauma Locking Nail System:  Titanium One size only $165.00

 Compression Screw

ST043 Stryker Trauma Locking Nail System:  Titanium 20-120mm $140.00

 Locking Screw with & without shaft

ST045 Stryker Trauma Locking Nail System:  Titanium Standard, +5, +10, +15 $95.00

 End Cap

Prostheses List by Category, Groups and Sponsor Page 452 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST046 Stryker Trauma Locking Nail System:  Standard, Proximal & Distal; Titanium 8-15mm diameter; 240-420mm  $800.00

 Tibial Nail length

ST047 Stryker Trauma Locking Nail System:  Titanium One size only $96.00

 Condyle Screw (including nut)

ST059 Stryker Trauma Locking Nail System:  Titanium 13-15mm diameter; 240-480mm $800.00

 Femoral Nail  length

 Stryker Australia Pty Ltd (2)

SK006 Stryker Trauma Locking Nail System Titanium - Humeral Nail Dia 7,8,9mm length 140 - 320mm $2,195.00

SK199 Stryker Trauma Locking Nail System Proximal Humeral Nail Nail Left/Right $2,157.85

SK201 Stryker Trauma Locking Nail System Proximal Humeral Nail Proximal Humerous Washer  $51.50

 round/square

SK202 Stryker Trauma Locking Nail System SCN Diameter 11m - 14mm, Length  $990.00

 170mm - 240mm

SK203 Stryker Trauma Locking Nail System SCN Condyle Screws 5mm x  $324.45

 (40mm-120mm)

SK204 Stryker Trauma Locking Nail System SCN Nut for Condyle Screws 5mm $231.75

SK214 Stryker Trauma Locking Nail System Reconstruction Nail Recon Nail Left/Right $1,200.00

SK215 Stryker Trauma Locking Nail System Reconstruction Nail Recon Lag Screw $260.00

SK216 Stryker Trauma Locking Nail System Reconstruction Nail Blocking Screw $95.00

SK337 Stryker Trauma Locking Nail System Arthrodesis Nail - Knee Arthrodesis Nail Left/Right;  $5,182.00

 11.5mm and 13mm

 Synthes Australia Pty Ltd

SY041 AO/ASIF Intermedullary Nails Femoral Nail 7.0mm-19mm dia 200-600mm  $934.73

 length

SY060 AO/ASIF Intermedullary Nails Cannulated and Solid Nail - tibial / femoral 7.0mm-19mm dia 200-600mm  $910.00

 length

SY064 Titanium Elastic Nail 1.5mm dia - 4.0mm dia $220.00

SY123 AO/ASIF Intermedullary Nails Femoral reamed, tibial nail 9 - 19mm , length 200 -  $648.90

Prostheses List by Category, Groups and Sponsor Page 453 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY124 AO/ASIF Intermedullary Nails Proximal sleeve Standard 130 deg antigrade,  $360.50

 spiral blade

SY125 AO/ASIF Intermedullary Nails End cap 0 - 40mm $207.03

SY126 AO/ASIF Intermedullary Nails Spiral blade Length 20 - 150mm $655.08

SY128 AO/ASIF Intermedullary Nails Tibial unreamed - steel 8 - 9 mm , length 255 - 420mm $1,009.40

SY129 AO/ASIF Intermedullary Nails Humeral Nail 6.0 - 12.0 mm length 100 -  $865.20

SY130 AO/ASIF Intermedullary Nails Arthrodesis - special manufacture Custom made $4,429.00

SY133 AO/ASIF Intermedullary Nails Sealing screw 0 - 20mm $41.00

SY262 AO/ASIF Intermedullary Nails Proximal Femoral Nail - PFN 9-15mm dia / 120-150 deg / 200 $2,060.00

  - 500mm Length

SY263 AO/ASIF Intermedullary Nails Hip Pin 12.0mm, 30-200mm Length $391.40

SY264 AO/ASIF Intermedullary Nails Distal Femoral Nail - DFN 9-15mm / 160-420mm Length $1,081.50

SY265 AO/ASIF Intermedullary Nails Locking Screws 15 -150mm $123.60

SY270 Antegrade Femoral Nail (AFN) &  Synthes Antegrade Femoral Nail AFN Diameter 6.5-18mm,  $1,030.00

 Associated Implants Length 30-500mm

Orthopedic External Fixation Systems

 Pacific Medical

PM092 Orthopaedic External Fixation System -  Complete System Sterile One size only $2,055.00

 Radiolucent Wrist Fixator

PM095 Orthopaedic External Fixation System Screw Shaft Dia 3.0 - 6.0mm, Thread  $115.00

 Dia 6.0 - 2.0mm, Total Length

 40 - 260mm, Thread Length 15

PM097 Orthopaedic External Fixation System Osteotite Screw Shaft Dia 3.0 - 6.0mm, Thread  $149.00

 Dia 6.0 - 2.0mm, Total Length

 40 - 260mm, Thread Length 15

PM098 Orthopaedic External Fixation System -  Metadiaphyseal Fixator One size only $2,429.00

 Xcaliber External Fixator

Prostheses List by Category, Groups and Sponsor Page 454 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

PM099 Orthopaedic External Fixation System -  Articulated Ankle Fixator One size only $3,139.00

 Xcaliber External Fixator

PM100 Orthopaedic External Fixation System -  Hybrid Fixator One size only $2,159.00

 Xcaliber External Fixator

 Taylor Bryant Pty Ltd

TB326 Scaminos Screws Titanium 13-31mm Length $390.00

TB332 Carpal Button Titanium x3 Sizes with various screw  $1,695.00

 hole options

TB340 Poing Fix Wrist Fixator System One size $2,808.00

TB341 Wrist Fixator PFII Wrist Fixator System One size $2,912.00

TB342 MicroFix Finger Mini Fixator System one size $1,664.00

Orthopedic External Fixation Systems, Fracture

 Biomet Australia Pty Ltd

BI697 Small Fragment Set Stainless Steel Screws 3.5, 4.0mm length, Sizes 10 -  $55.00

BI698 Small Fragment Set Stainless Steel Plates Plates 25 - 125mm $100.00

BI775 EBI XFIX DynaFix System Distal radius fixator, wristfix, sterile,  One size only $2,460.00

 De Puy Australia

DP391 Ace External Fixator Pin Holder Bolt - Titanium 15mm $47.22

DY218 Ace External Fixator Olive wire - stainless steel 1.5-1.8mm $856.00

DY219 Ace External Fixator Wire bayonet point - titanium 1.5mm $82.00

DY220 Ace External Fixator Olive wire bayonet point - stainless steel,  1.5 or 1.8mm $260.00

 packet of 3

DY221 Ace External Fixator Wire bayonet point - stainless steel 1.8mm $41.00

DY223 Ace External Fixator Ring, aluminium 1/3 ring small 6" diameter $376.00

DY225 Ace External Fixator Ring, composite 1/3 ring large $446.00

Prostheses List by Category, Groups and Sponsor Page 455 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY226 Ace External Fixator Ring, composite 1/3 ring medium $423.00

DY227 Ace External Fixator Ring, composite 1/3 ring small $394.00

DY228 Ace External Fixator Threaded Rod, titanium 1/4" x 10cm $122.75

DY229 Ace External Fixator Threaded Rod, titanium 1/4" x 15cm $164.00

DY230 Ace External Fixator Threaded Rod, titanium 1/4" x 20cm $210.00

DY231 Ace External Fixator Threaded Rod, titanium 1/4" x 25cm $258.00

DY234 Ace External Fixator Titanium half pin thread 15-80mm, 155 x 5mm to 220 x  $117.00

 5mm

DY236 Ace External Fixator Spacer with bolt, titanium 2.5-5mm $22.00

DY237 Ace External Fixator Ring, aluminium 2/3 ring, large 10" diameter $908.00

DY238 Ace External Fixator Ring, composite 2/3 ring, medium $908.00

DY240 Ace External Fixator Ring, aluminium 2/3 ring, small 6" diameter $411.00

DY241 Ace External Fixator Ring, composite 2/3 ring, small $463.00

DY242 Ace External Fixator Stainless steel transfix pin 250/300 x 5mm with 40-70mm  $263.00

 thread

DY243 Ace External Fixator Titanium Transfix Pin 250/300 x 5mm with 40-70mm  $167.00

 thread

DY244 Ace External Fixator GRUB screw ACE/FISCHER, titanium 5mm $2.00

DY245 Ace External Fixator TIP CapS, polyethylene 5mm $6.00

DY246 Ace External Fixator Peg, titanium 5mm $81.00

DY248 Ace External Fixator Adaptor rod, titanium 8mm $180.00

DY249 Ace External Fixator Pin holder adaptor, aluminium 90" $311.00

DY251 Ace External Fixator Anchor assembly, titanium One size only $308.00

DY252 Ace External Fixator Articulation, titanium One size only $904.00

DY253 Ace External Fixator Bolt clevis, titanium One size only $29.00

DY256 Ace External Fixator Locking nut, titanium One size only $36.00

Prostheses List by Category, Groups and Sponsor Page 456 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DY257 Ace External Fixator Nut, stainless steel One size only $81.00

DY258 Ace External Fixator Position pins I/C foot plate, titanium One size only $105.00

DY259 Ace External Fixator Ring adapter bolt, titanium One size only $46.50

DY260 Ace External Fixator Ring connector, titanium One size only $199.00

DY262 Ace External Fixator Spherical nut and washer, titanium One size only $214.00

DY263 Ace External Fixator U rings, aluminium One size only $736.00

DY264 Ace External Fixator Universal joint, titanium One size only $360.00

DY266 Ace External Fixator Wire bolt hinge, titanium One size only $435.00

DY267 Ace External Fixator Wire fixation bolt, cannulated or slotted  One size only $188.00

 (stainless steel)

DY268 Ace External Fixator Connecting rod, aluminium X-Short, short, medium or long $690.00 $1,062.00

DY270 Ace External Fixator External fixator, aluminium One size only $1,030.00

DY271 Ace External Fixator Ring adaptor, titanium One size only $209.00

 Pacific Medical

PM012 Orthofix External Fixation System Ankle  Anodised aluminium and stainless steel One size only $4,607.00

 Fixator

PM013 Orthofix External Fixation System Pennig Anodised aluminium and stainless steel One size only $3,991.00

  Wrist Fixator

PM061 Orthofix External Fixation System Elbow  Anodised aluminium and stainless steel One size only $5,440.00

 Fixator

PM062 Orthofix External Fixation System Hybrid Anodised aluminium and stainless steel One size only $5,220.00

  Fixator

PM063 Orthofix External Fixation System Knee  Anodised aluminium and stainless steel One size only $5,955.00

 Fixator

 Smith & Nephew Surgical Pty Ltd

SN033 Distal Radius System Distal Radius External Fixation System,  One size only $3,600.00

 composition - carbon fibre, modular rod

 and clamp system

Prostheses List by Category, Groups and Sponsor Page 457 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN034 Hex Fix External Fixator System Composition either aluminium, graphile  6.4mm Diameter (65-125mm  $6,945.00

 composile or stainless steel.  System  lengths)

 comprises of hex bar, clamps, spools and

SN035 Colles Gold External Fixator System Dynamic external fixator, anodised  One size only $2,240.00

 aluminium for distal radius fractures

SN433 Half Pin Hex Fix, Stainless Steal 4-6mm x 20-80mm $100.00

SN434 Half Pin Arrow 4-6mm x 20-80mm $205.00

SN435 Half Pins Hex Fix Titanium 4-6mm x 20-80mm $115.00

SN437 Hex Fix Pins Cancellous Crane Pin Threaded 5/8" - 1 1/4" $133.00

SN708 Jet X Bar External Fixation Bar with Cap 100mm to 600mm $4,750.00

SN709 Jet X Central Modular Versitile Ankle Fixation Frame 99mm to 158mm $4,500.00

 Stryker Australia Pty Ltd

ST878 Monticelli-Spinelli External Fixation Anodized metal alloy, three quarter ring Small, Medium, Large $6,585.00

ST884 Apex Pins Stainless Steel Orthopaedic Pins 2 - 6mm $135.00

ST891 Hoffmann II External Fixation System Pin clamp assembly with no post One Size Only $645.00

ST892 Hoffmann II Compact External Fixation  Pin clamp assembly with no post One Size Only $695.00

 System

ST935 Hoffman II External Fixation System Anodised metal alloy, rod to rod coupling 8/8mm $655.00

ST936 Hoffman II External Fixation System Anodised metal alloy, pin to rod coupling 8/4, 5mm $655.00

ST937 Hoffman II External Fixation System Anodised metal alloy, 30 deg angled post,  One size only $99.00

 stainless steel

ST938 Hoffman II External Fixation System Anodised metal alloy, straight post,  One size only $99.00

 stainless steel

ST939 Hoffman II External Fixation System Anodised metal alloy, aluminium  8mm x 65-500mm $52.00

 connecting rod

ST940 Hoffman II External Fixation System Anodised metal alloy, carbon connecting  8mm x 65-500mm $69.00

ST941 Hoffman II External Fixation System Anodised metal alloy, stainless steel  8mm x 65-500mm $52.00

 connecting rod

Prostheses List by Category, Groups and Sponsor Page 458 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST942 Hoffman II External Fixation System Anodised metal alloy, curved aluminium  Small, Medium, Large $90.00

 rod semi-circular

ST943 Hoffman II External Fixation System Anodised metal alloy, adjustable  Long, short $765.00

 connecting rod

ST944 Hoffman II External Fixation System Anodised metal alloy,  One size only $99.00

 dynamization/distraction rod,

 compression/distraction rod,

 dynamization/distraction rod to rod

ST945 Monotube External Fixation System Anodized metal alloy, dynamic tube  15mm $4,780.00

 assembly yellow

ST946 Monotube External Fixation System Anodized metal alloy, dynamic tube  20mm $4,945.00

 assembly blue

ST947 Monotube External Fixation System Anodized metal alloy, dynamic tube  25mm $5,110.00

 assembly red

ST948 Monotube External Fixation System Anodized metal alloy, dynamic tube  15mm $2,485.00

 assembly yellow

ST949 Monotube External Fixation System Anodized metal alloy, dynamic tube  20mm $2,650.00

 assembly blue

ST950 Monotube External Fixation System Anodized metal alloy, dynamic tube  25mm $5,110.00

 assembly red

ST951 Monotube External Fixation System Anodized metal alloy, pin clamp yellow,  15, 20, 25mm $1,215.00

 blue, red

ST952 Monotube External Fixation System Anodized metal alloy, single pin clamp  15, 20, 25mm $1,215.00

 yellow, blue, red

ST953 Monotube External Fixation System Anodized metal alloy, T-Adapter yellow,  15, 20, 25mm $580.00

 blue, red

ST954 Monotube External Fixation System Anodized metal alloy, tube to tube clamp  15, 20, 25mm, 15/20mm,  $645.00

 yellow, blue, red, yellow/blue, blue/red

ST955 Monotube External Fixation System Anodized metal alloy, hybrid clamp blue,  One size only $1,215.00

 hybrid clamp red

ST956 Monotube External Fixation System Monticelli/Spinelli Ring Frame One size only $2,600.00

ST957 Monotube External Fixation System 3/4 ring blue, green and white 147mm, 165mm, 187mm $455.00

Prostheses List by Category, Groups and Sponsor Page 459 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST958 Monotube External Fixation System Monticelli/Spinelli Kirschner Wire Holder One size only $1,215.00

ST959 Monotube External Fixation System With sliding clamp One size only $1,215.00

ST960 Monotube External Fixation System With sliding clamp and spacer One size only $578.00

ST961 Monotube External Fixation System Carbon tube assembly yellow 015 150, 200, 250, 300mm $645.00

ST962 Monotube External Fixation System Carbon tube yellow 015 150, 200, 250, 300mm $220.00

ST963 Monotube External Fixation System Carbon tube blue 015 150, 200, 250, 300mm $330.00

ST964 Monotube External Fixation System Carbon tube red 015 150, 200, 250, 300mm $420.00

ST965 TenXor External Fixation System Anodized metal alloy, open ring 150, 180, 210, 250mm $1,105.00

ST966 TenXor External Fixation System Anodized metal alloy, ring clamp One size only $645.00

ST967 TenXor External Fixation System Anodized metal alloy, wire post, pin post One size only $595.00

ST968 TenXor External Fixation System Anodized metal alloy, ring to monotube  One size only $1,215.00

 triax tube clamp

ST969 TenXor External Fixation System Anodized metal alloy, blue, red 20, 25mm $220.00

ST970 TenXor External Fixation System Anodized metal alloy, Monticelli Spinelli  One size only $330.00

 kirschner wire holder

ST971 TenXor External Fixation System Anodized metal alloy, with sliding clamp One size only $250.00

ST972 TenXor External Fixation System Anodized metal alloy,with sliding clamp  One size only $645.00

 and spacer

 Stryker Australia Pty Ltd (2)

SK007 Hoffmann II External Fixation System Hoffmann II Compact - One size only $2,440.00

 Compression/Distraction Rod

SK008 Hoffmann II External Fixation System Hoffmann II Compression/Distraction  One size only $2,440.00

SK009 Hoffmann II External Fixation System Hoffman II Miami Post One size only $510.00

SK014 Hoffmann II Hoffmann II Mini- Linking Pivot for 2mm One size only $186.00

  & 3mm pins

SK015 Hoffmann II Hoffmann II Mini- Shank Straight Pin  2, 3 mm $225.00

 Holder - for 1.5mm & 2.0mm pins

Prostheses List by Category, Groups and Sponsor Page 460 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK016 Hoffmann II Hoffmann II Mini- Shank 'T' Offset Pin  2mm $305.00

 Holder - for 1.5mm & 2.0mm pins

SK017 Hoffmann II Hoffmann II Mini- 3 Hole Vise One size only $210.00

SK018 Hoffmann II Hoffmann II Mini- Simple Swivel Clamp One size only $680.00

SK019 Hoffmann II Hoffmann II Mini- Insulated Smooth Vise One size only $186.00

SK020 Hoffmann II Hoffmann II Mini- Articulating Coupling 3x3, 2x3 $595.00

SK021 Hoffmann II Hoffmann II Mini- Adjustable Swivel  One size only $1,275.00

SK045 Hoffmann II Hoffmann II Mini- Shank Offset Pin  2, 3mm $247.00

 Holder - for 1.5mm & 2.0mm pins

SK117 Tenxor External Fixation System -  Non-Olive tipped 1.5mm & 2.0mm $125.00 To be funded where any or all K-

 Kirschner Wires wires used in a procedure are

 used as an implant.

SK118 Tenxor External Fixation System -  Olive tipped 1.5mm & 2.0mm $125.00 To be funded where any or all K-

 Kirschner Wires wires used in a procedure are

 used as an implant.

SK206 Hoffmann II External Fixation System Hoffmann II Micro Rod to rod coupling 3/3 $645.00

SK207 Hoffmann II External Fixation System Hoffmann II Micro Rod to rod coupling 5/3 $645.00

SK208 Hoffmann II External Fixation System Hoffmann II Micro Pin to rod coupling $645.00

SK209 Hoffmann II External Fixation System Hoffmann II Micro Multipin clamp $645.00

SK210 Hoffmann II External Fixation System Hoffmann II Micro 90 degree multipin clamp $645.00

SK211 Hoffmann II External Fixation System Hoffmann II Micro Carbon rods 3mm (30-120mm) $68.00

SK212 Hoffmann II External Fixation System Hoffmann II Micro Stainless steel rods 3mm x (30- $52.00

 120mm)

SK213 Hoffmann II External Fixation System Hoffmann II Micro K-wire $127.00

SK364 Hoffman II External Fixation System Hoffman II Sterile Pre-Packs Sterile Tibia Kit $4,895.00 Temporary approval, pending

 review of product group

SK365 Hoffman II External Fixation System Hoffman II Sterile Pre-packs Sterile Ankle Kit $4,700.00 Temporary approval, pending

 review of product group

Prostheses List by Category, Groups and Sponsor Page 461 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK373 Hoffman II External Fixation system Hoffman II MRI Pelvic Clamp $1,135.00 Temporary approval, pending

 review of product group

SK374 Hoffman II External Fixation System Hoffman II MRI Posts 8mm and 5mm $111.00 Temporary Approval, pending

 review of product grouping

SK375 Hoffman II External Fixation System Hoffman II MRI Coupling Pin to Rod, Rod to Rod, Tube to $770.00 Temporary approval, pending

  Rod, Pin Clamp Assembly review of product group

SK376 Stryker Plating System Numelock II Locking Plate System Proximal Tibia, Lateral and  $1,450.00

 Medial, 4 hole to 11 holes, left

 and right

SK378 Hoffman II External Fixation System Hoffman II Sterile Pre-Packs Sterile Pelvic Kit $7,680.00 Temporary approval, pending

 review of product group

SK390 Hoffman II External Fixation System Hoffman II MRI Compression/Dystraction Tube,  $770.00 Temporary approval, pending

 Dynamisation Tube review of product group

SK393 Hoffman II External Fixation System Hoffman II MRI 8mm Connecting rod (100mm -  $155.00 Temporary approval, pending

 500mm), 5mm Connecting rod  review of product group

 (100mm - 500mm), Semi

 Circular Curve Rod

SK396 Hoffman II External Fixation System Hoffman II Compact Sterile Pre-Packs Sterile Wrist Kit $4,855.00 Temporary approval, pending

 review of product group

 Synthes Australia Pty Ltd

SY193 Orthopaedic External Fixator Systems Rod / Bar 2.0mm-15.0mm dia 20.0mm- $144.20

 445mm L

SY194 Orthopaedic External Fixator Systems Curved rod - carbon fibre 11mm $1,353.00

SY195 Orthopaedic External Fixator Systems Protective caps for rods, protection caps One size only $10.30

SY196 Orthopaedic External Fixator Systems Rod/Bar 450mm length - 650mm Length $148.32

SY197 Orthopaedic External Fixator Systems Hybrid Rings 11mm diameter 1/4 ring -  $721.00

 205mm diameter full ring

SY198 Orthopaedic External Fixator Systems Distractors and lengthening apparatus Mini - lengthening apparatus,  $3,178.38

 mini - distractor/lengthening

 apparatus, medium and large

 distractor

SY199 Orthopaedic External Fixator Systems External fixator clamps, double clamp 4-6mm Diameter $509.85

Prostheses List by Category, Groups and Sponsor Page 462 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY200 Orthopaedic External Fixator Systems External fixator clamps, transverse clamp 4-6mm Diameter $1,077.41

SY201 Orthopaedic External Fixator Systems External fixator clamps, clamp or open  1.25-6mm Diameter $566.50

SY202 Orthopaedic External Fixator Systems External fixator clamps, clamp for hybrid 1.8-11mm Diameter $1,114.23

SY203 Orthopaedic External Fixator Systems External fixator clamps, tube to  11mm Diameter $769.36

 tube/universal clamp

SY204 Orthopaedic External Fixator Systems External fixator clamps, open/clip on  4-6mm Diameter $478.95

SY205 Orthopaedic External Fixator Systems External fixator clamps, connecting  3-4mm Diameter $327.54

SY206 Orthopaedic External Fixator Systems External fixator clamps, adjustable clamp 4.0mm $1,390.22

SY207 Orthopaedic External Fixator Systems External fixator clamp components,  14mm diameter $221.45

 threaded rod

SY208 Orthopaedic External Fixator Systems External fixator clamp components, spare 1.25-6.0mm $61.80

SY209 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $129.09

 knurled nut

SY210 Orthopaedic External Fixator Systems External fixator clamp components, spare 1.25-6.0mm $61.80

  screw

SY211 Orthopaedic External Fixator Systems External fixator clamp components, nut  11mm $16.14

 for threaded rod

SY212 Orthopaedic External Fixator Systems External fixator clamp components, nut  1.25-6.0mm $51.50

 spring loaded

SY213 Orthopaedic External Fixator Systems External fixator clamp components, nut  1.25-6.0mm $92.70

 for open adjustable clamp

SY214 Orthopaedic External Fixator Systems External fixator clamp components, nut  1.25-6.0mm $450.00

 for fixation screw

SY215 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $463.50

 holding sleeve with wing screw

SY216 Orthopaedic External Fixator Systems External fixator clamp components,  6mm, 40mm $125.33

 fixation screw

SY217 Orthopaedic External Fixator Systems External fixator clamp components,  6mm, 67mm $129.09

 fixation screw

Prostheses List by Category, Groups and Sponsor Page 463 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY218 Orthopaedic External Fixator Systems External fixator clamp components,  6mm, 85mm $199.02

 fixation screw

SY219 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $188.26

 clamp for halo, oral rod

SY220 Orthopaedic External Fixator Systems External fixator clamp components,  12mm, L 360mm $185.00

 threaded rod

SY221 Orthopaedic External Fixator Systems External fixator clamp components,  12mm, L 260mm $190.55

 threaded rod

SY222 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $1,220.35

 double joint, complete

SY223 Orthopaedic External Fixator Systems External fixator clamp components,  Large $1,133.30

 angled piece

SY224 Orthopaedic External Fixator Systems External fixator clamp components,  3.5-11.0mm $1,167.30

 angled piece

SY225 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $515.00

 transport nut with catch

SY226 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $295.84

 clamp body with two nuts

SY227 Orthopaedic External Fixator Systems External fixator clamp components, vice  1.25-6.0mm $216.30

SY228 Orthopaedic External Fixator Systems External fixator clamp components, vice  1.25-6.0mm $403.42

 plate double

SY229 Orthopaedic External Fixator Systems External fixator clamp components, vice  1.25-6.0mm $360.50

 plate for open

SY230 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $360.50

 intermediate piece

SY231 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $360.50

 locking sleeve for open

SY232 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $334.75

 clamp body of open

SY233 Orthopaedic External Fixator Systems External fixator clamp components, angle 3mm $92.70

SY234 Orthopaedic External Fixator Systems External fixator clamp components,  3mm $2,563.67

Prostheses List by Category, Groups and Sponsor Page 464 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY235 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $827.96

 sliding carriage, complete

SY236 Orthopaedic External Fixator Systems External fixator clamp components, halo  1.25-6.0mm $1,545.00

 with visor

SY237 Orthopaedic External Fixator Systems 3 degree, 6 degree, 11 degree. Medium,  1.25-6.0mm $226.60

SY238 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $51.50

 connecting tube

SY239 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $535.60

 angled piece with nut

SY240 Orthopaedic External Fixator Systems External fixator clamp components, bar  1.25-6.0mm $96.82

 for lower jaw for children

SY241 Orthopaedic External Fixator Systems External fixator clamp components, bar  1.25-6.0mm $699.26

 for upper jaw

SY242 Orthopaedic External Fixator Systems External fixator clamp components, bar  1.25-6.0mm $700.00

 for upper jaw

SY243 Orthopaedic External Fixator Systems External fixator clamp components, malar 1.25-6.0mm $721.00

  plates

SY244 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $180.25

 simple hook

SY245 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $154.50

 knurled nut M23

SY246 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $824.00

 sliding carriage

SY247 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $1,721.24

 double joint

SY248 Orthopaedic External Fixator Systems External fixator clamp components,  1.25-6.0mm $515.00

 holding sleeve with wing screw

 Zimmer

ZI484 Wristore Disposable External Fixation device for  Wristore Pack $998.00 Temporary approval, pending

 the treatment of distal radial fractures. review of product group

Prostheses List by Category, Groups and Sponsor Page 465 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic External Fixation Systems, Other

 Biomet Australia Pty Ltd

BI262 EBI XFIX Dynafix System Bone Screw, Cortical, tapered,  2.4mm to 6.00mm diameter $110.00

 Cancellous, Stainless Steel

BI264 EBI XFIX Dynafix System Distal Radius Fixator, Dimension,  One size only $3,305.00

 Stainless Steel, Aluminium

BI265 EBI XFIX Dynafix System Hybrid Fixation System, Stainless Steel,  Rings - 1/3, 2/3, Rotating,  $6,361.00

 Aluminium 100mm-220mm.  Ring Bolt -

 Xsmall, adult. Ring to fixator

 connector. Rotation adaptor -

 male, female, Xsmall, adult.

 Variable wire (1 size) or Variable

  Screw Carriage (fixed and

 angulating). Wire (1.6-2mm x

BI267 EBI XFIX Dynafix System Fixator Complete - includes T-Clamp,  Standard, Small, Extra Small $5,108.00

 Compression/Distraction, Dynamisation,

 Articulating Ankle Clamp

BI270 EBI XFIX Dynafix System Pelvic Fixator  Screws, Stainless Steel,  One size only $7,456.00

 Aluminium

BI271 EBI XFIX Dynafix System Wire Straight or Olive with Washer,  160 or 200mm x (1.6 or  $150.00

 Chrome Cobalt

BI272 EBI XFIX Dynafix System Distal Radius Fixator, Wristfix, Stainless  One size only $2,065.00

 Steel, Aluminium

BI776 EBI XFIX DynaFix System OptiROM Articulating Fixator Complete Small and Large $8,042.00

BI777 EBI XFIX DynaFix System Mini fixator/lengthener with comp/dist Small, Medium, Long, 100mm,  $2,413.00

 150mm

BI818 EBI XFIX Dynafix System Rail (Aluminium/Titanium) 100-420mm $690.00

BI819 EBI XFIX Dynafix System Multi Axial Correction and Metaphyseal  4-8cm, Xsmall - Adult $5,075.00

 Arc Module complete with T-clamp

BI823 Alveolar Ridge Distraction System -  distraction device, single tooth 10-20mm $1,312.00

Prostheses List by Category, Groups and Sponsor Page 466 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI824 Alveolar Ridge Distraction System -  distraction device, multi tooth 10-20mm $1,360.00

BI825 Alveolar Ridge Distraction System -  Shim plate, titanium 1-3mm $100.00

BI827 EBI XFIX Vision System Rod Clamps/Connector, stainless  Dia 9.5mm $2,300.00

 steel/aluminium

BI828 EBI XFIX Vision System Clamp/Rod, stainless steel/aluminium 4mm/6mm, 3-5 hole, 50- $1,175.00

BI829 EBI XFIX Vision System Screw, Transfixing, Stainless steel 4 - 6mm diameter $410.00

BI830 EBI XFIX Vision System Ring Connector Assembly, stainless  1 or 2 bolt model $1,450.00

 steel/aluminium

BI831 EBI XFIX Vision System Post, Bone Screw, Telescoping, stainless  One size only $850.00

BI832 EBI XFIX Vision System Rods, Bars, stainless  Dia 9.5mm, 150-400mm length $185.00

 steel/aluminium/carbon fibre

BI849 EBI XFIX DynaFix System OptiROM Passive Distractor Module One Size Only $2,600.00

BI850 EBI XFIX DynaFix System Hip Distractor Aluminium, Stainless Steel, One Size Only $5,989.00

  Titanium

BI851 EBI XFIX Dynafix System Clamp (Straight, Transport, Rotational T- Ex Small, Small, Adult, 4-6mm $1,662.00

 clamp, Adaptor, Lenghtener, Shim, Single)

BI852 EBI XFIX Dynafix System Clamp (Rotational Serrated T-clamp,  Ex Small, Small, Adult, 4-6mm $3,348.00

 Swivel, Translational, Uniplaner, CD)

BI853 EBI XFIX Dynafix System CD Clicker Ex Small, Small, Adult, 5-20cm $2,413.00

BI854 EBI XFIX Dynafix System Rail Accessory (Adaptor, CD Support,  Ex Small, Small, Adult, 4-6mm $1,020.00

 Dynamization, Bridge)

BI855 EBI XFIX Dynafix System Wrench Ex Small, Small, Adult, 4-6mm $200.00

BI856 EBI XFIX Dynafix System Rail (Carbon Fiber) 100-420mm $2,950.00

 Howmedica

HW328 Howmedica Dynamic Joint Distractor Complete Straight Body Frame -   One size only $4,070.00

 Stainless Steel

 Smith & Nephew Surgical Pty Ltd

SN031 Original Ilazarov System External circular fixation system, stainless Adult and Paediatric $10,165.00

  steel and composite carbon fibre

Prostheses List by Category, Groups and Sponsor Page 467 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN146 Taylor Spatial Frame Pre-assembled circular external fixator,  One size only $9,925.00

 carbon-fibre rings, telescopic rods

SN436 Half Pins Ilizarov Stainless Steel 4 x 120 -180mm 30mm 35mm - $247.00

  thread   50mm conic

SN439 Ilizarov Jurgan Pin Balls 0.7-5.0mm $82.00

SN440 Ilizarov Wires 300-370 length x 1-1.8mm  $69.00

SN441 Ilizarov Wires with stopper 300-370 length x 1-1.8mm  $155.00

 Stryker Australia Pty Ltd

ST885 Howmedica Dynamic Joint Distractor Y Body Assembly - Stainless Steel One size only $1,240.00

ST886 Howmedica Dynamic Joint Distractor Pin Stop Collar - Stainless Steel One size only $190.00

ST887 Howmedica Dynamic Joint Distractor Pin to Rod Coupling - Stainless Steel One size only $385.00

ST888 Howmedica Dynamic Joint Distractor Complete Y Body Frame - Stainless Steel One size only $4,070.00

ST889 Howmedica Dynamic Joint Distractor Straight Body Assembly - Stainless Steel One size only $1,025.00

 Stryker Australia Pty Ltd (2)

SK183 Leibinger Intraoral Distractor (Multiguide  Manufactured from stainless steel, allows Frame 20mm - 35mm, 2.0mm  $4,375.00

  gradual, independent, and simultaneous  diameter, 50 - 90 mm length

 distraction of the mandible in 3 planes. Auto - Pilot Pins

Orthopedic Internal Fixation Systems

 Austofix

AX022 Austofix Femoral & Tibial Nailing System Tibial Nail 4.0/4.8; s-s Dia 8 - 11mm, Lengths 260 -  $1,009.00

 420mm

Prostheses List by Category, Groups and Sponsor Page 468 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems, Fracture

 Advanced Surgical Technologies

AD101 LOCON-T Radius Plating System Stainless steel cortical bone screw 1.8, 2.7, 3.5mm dia x 6 - 40mm $135.00

  length in 2mm increments

AD102 LOCON-T Radius Plating System Stainless steel volar plate, left and right  1.2 - 1.5mm thick, left and right $1,460.00

 dorsal plates  - small, medium, large

AD207 LOCON-T Radius Plating System Stainless Steel Lateral Plate Extender One size only $680.00

 Biomet Australia Pty Ltd

BI253 BMP Cable System Cable Chrome Cobalt 1.6mm or 2.0mm $348.00

BI254 BMP Cable System Cable Sleeve, Chrome Cobalt, Stainless  One Size only $240.00

BI255 BMP Cable System Trochanteric Grip, Chrome Cobalt 1.6mm or 2.0mm $545.00

BI256 BMP Cable System Cable, Stainless Steel 1.6mm or 2.0mm $320.00

BI258 BMP Cable System Dynamic Compression Plate, 3 hole,  One size only $850.00

 Stainless Steel

BI259 BMP Cable System Dynamic Compression Plate, 5 hole,  One size only $1,200.00

 Stainless Steel

BI260 BMP Cable System Dynamic Compression Plate, 7 hole,  One size only $1,638.00

 stainless steel

BI261 BMP Cable System Dynamic Compression Plate, 9 hole,  One size only $1,800.00

 Stainless Steel

BI768 Mandibular Fracture System Screw, IMF 2./2.4 Mandibular Fracture,  2.0 x (9-13)mm $45.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI769 Mandibular Fracture System Screw, IMF, 2.0/2.4 Mandibular  Dia 2.0 x 5.0, 7.0mm length $40.00 Only to be funded where used in

 Fracture, Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 469 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP330 Tibial Nail System  Tibial Nail or Dynamic Tibial Nail  8-13mm x 25.5-42.5cm $1,405.00

 Titanium Unsterile or Sterile

DP331 Tibial Nail System  End Cap Titanium  One size only $65.00

DP338 Tibial Nail System  Solid Cortical Titanium Screw Unsterile  6.5mm x 20 -120mm $130.00

 or Sterile

DP339 Femoral Nail End Cap Titanium  One size only $45.00

DP342 Femoral Nail System Solid Cortical Screw Titanium Sterile or  4.5 or 5.5mm x 20-80mm $64.00

 Unsterile

DP343 Femoral Nail System Femoral Nail Titanium Sterile or Unsterile 9-15mm x 30- 50cm  $1,740.00

DP366 Supacondylar Nail System Solid End Cap Titanium Unsterile or Sterile One size only $57.22

DP367 Humeral Nail System Humeral Nail Titanium Sterile or Unsterile 7-9mm x 22cm-30cm $1,032.00

DP371 Humeral Nail System End Cap Various Titanium Unsterile or  One size only $65.00

DP571 Art Retrograde Nail Femoral Nail Titanium Unsterile or Sterile 9 -12mm x 30 - 50cm $1,740.00

DP590 Compression Hip Screw 6.5mm Solid Lag Screw Stainless Steel  22mm Thread length 40 to  $146.00

DP592 Small / Large  Fragment Set Cannulated Cancellous Lag Screw Titanium 6.8 or 8mm Dia 25-120mm  $214.00

 Length 22 or 40mm Thread

DP593 Small / Large  Fragment Set Cannulated Cancellous Screw  4mm or 16mm or 32mm  $227.00

 Thread, 26-120mm Length

DP597 Small / Large  Fragment Set Solid Cortical Screw Titanium 3.5 mm 10-48 mm Length $98.00 $140.00

DP598 Small / Large  Fragment Set Cannulated Cortical. Bone Screw 3.5 mm length 50-60 mm $98.00 $175.00

DP605 Small / Large  Fragment Set Cancellous Lag Screw Titanium 4.8 mm Dia 30mm to 60mm $132.00

DP608 Small / Large  Fragment Set Straight Plate Titanium 3-12 Hole $366.00

DP609 Small / Large  Fragment Set 100 Tube Plate Titanium 3.5mm Dia and 3 to 8 holes $177.00

DP610 Small / Large  Fragment Set S/S Femoral Condylar Plate 4-8 Hole    $475.00

DP611 Small / Large  Fragment Set Reconstruction T Plate Titanium 4-8 Hole $475.00

DP612 Small / Large  Fragment Set Active Compression Plate Titanium 3.5mm  5 to 10 Hole $192.50

Prostheses List by Category, Groups and Sponsor Page 470 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP613 Small / Large  Fragment Set Humeral and Radial Plate Titanium  Wide - Narrow - Long - Extra  $329.00

DP615 Small / Large  Fragment Set Universal Reconstruction Ribbon  3.5mm with 8 to 10 holes $534.88

DP617 Small / Large  Fragment Set Universal Reconstruction Ribbon  3.5mm with 14 holes $796.00

DP618 Small / Large  Fragment Set Universal Reconstruction Ribbon  3.5mm with 3 to 7 holes $402.00

DP627 Small / Large  Fragment Set Solid Cancellous Screw Titanium 4mm or 5mm Dia 10-48 mm  $121.50

DP632 Small / Large  Fragment Set Solid Cancellous Screw Titanium 5.0mm Length 50 - 80mm $147.00

DP635 Small / Large  Fragment Set Solid Cancellous Lag Screw  Partial  4mm Dia 10-60mm Length $227.00

 Thread Titanium

DP638 Small / Large  Fragment Set Solid Cancellous Bone Screw Full Thread 4mm Dia 50-110mm Length $180.00

  Titanium

DP640 Small / Large  Fragment Set Cancellous Cannulated  Lag Screw Partial 4mm 10 to 70mm Length $225.00

  Thread

DP643 Small / Large  Fragment Set Cannulated Cancellous Screw Full  4mm or 7mm x 10 -100mm  $186.00

 Threaded - Stainless Steel

DP646 Small / Large  Fragment Set Washer Titanium - Flat/Cup/Countersink One size only $23.00

DP650 Small / Large  Fragment Set S/S Cortical Screw - Stainless Steel 1.5 or 2 or 2.7 or 3.5mm x 22 -  $19.00

 44mm Length

DP654 Small / Large  Fragment Set S/S Cortical Screw Diameter - Stainless Steel 3.5 or 4.5 x 12 - 48mm Length $15.00

DP655 Small / Large  Fragment Set S/S Cortical Self Tapping Screw 3.5 or 4.5 mm x 8-60 mm Length $14.00

DP656 Small / Large  Fragment Set S/S Malleolar Stainless Steel Screw - Stainless 25 - 70mm $22.00

  Steel

DP657 Small / Large  Fragment Set S/S Malleolar Cann Cor Stainless Steel Screw  25 - 70mm $118.00

 - Stainless Steel

DP658 Small / Large  Fragment Set S/S Cortical Stainless Steel Cannulated Screw 3.5 x 8-70 mm $98.00 $113.36

  - Stainless Steel

DP660 Small / Large Fragment Set S/S Cannulated Screw Diameter partially  Dia 4 x 10-60 $30.00

 threaded - Stainless Steel

DP662 Small / Large Fragment Set S/S Cannulated Cancellous Screw 16 or 32  6.5mm x 25-140mm Length $125.00

Prostheses List by Category, Groups and Sponsor Page 471 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP663 Small / Large Fragment Set S/S Cannulated Cancellous Screw Part  4mm or 6.5mm x 10- 140mm  $131.91

 Thread Screw Length

DP664 Small / Large Fragment Set S/S Cannulated Cancellous Screw 16 or 32  7mm x 25-140mm Length $160.00

DP665 Small / Large Fragment Set S/S CHS Compression Screw - Stainless Steel Neutral to +2 $34.50

DP668 Small / Large Fragment Set S/S CHS Lag Screw Stainless Steel Sterile  Length 50-145mm $224.00

 and Unsterile

DP670 Small / Large Fragment Set S/S Tronchanteric Support Plate Small-Large $503.00

DP672 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel   2-8 Hole 95 to 150 Deg $348.00

DP673 Small / Large Fragment Set S/S SCS Plate Sterile 3-9 Hole $631.00

DP675 Small / Large Fragment Set S/S Broad Bone Plate Stainless Steel  3-6 Hole for 1.5mm $149.00

DP678 Small / Large Fragment Set S/S Small or Narrow DCP Plate 2.7mm or 3.5mm with 2 - 12  $98.00

DP683 Small / Large Fragment Set S/S Cerclage Wire Loop Stainless Steel  0.8-1.2mm x 280-600 $17.00

DP689 Small / Large Fragment Set S/S Condylar Plate & Mini Condylar Plate 1.5mm  or 2mm $177.50

DP692 Small / Large Fragment Set S/S Cloverleaf Plate Stainless Steel      3-4 Hole $204.00

DP693 Small / Large Fragment Set S/S T-Plate Stainless Steel            3 up to 8 Hole $1,700.00

DP695 Small / Large Fragment Set S/S Y-Plate Stainless Steel            2 + 2 + 4 or 4 + 4 + 4 Slots $184.00

DP696 Small / Large Fragment Set S/S Plates - Mini T or L, Oblique, Straight 2.0mm or 2.7mm with 2-12  $31.00

DP701 Small / Large Fragment Set S/S Bored K/Wire Stainless Steel  2.0-3.0mm x 80/30-200-15 $98.00

DP702 Small / Large Fragment Set S/S Threaded K/Wire 1.5-2.5mm $11.45

DP705 Small / Large Fragment Set S/S Reconstruction Plate 3.5mm 3-12 Hole $228.00

DP708 Small / Large Fragment Set S/S Reconstruction Plate 3.5mm 14 to 18 Hole $353.00

DP709 Small / Large Fragment Set S/S Reconstruction Plate 3.5mm 20-28 Hole $450.00

DP714 Small / Large Fragment Set S/S Reconstruction Plate 2.7mm 8-26 Hole $233.00

DP719 Small / Large Fragment Set S/S Reconstruction Plate 4.5 - 6.5mm 3-8 Hole $209.00

DP723 Small / Large Fragment Set S/S Reconstruction Plate 4.5 - 6.5mm 9 - 18 Hole $321.00

DP725 Small / Large Fragment Set S/S Cortical Screw Diameter 3.5 or 4.5 x 55 - 110mm $53.00

Prostheses List by Category, Groups and Sponsor Page 472 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP733 Small / Large Fragment Set S/S Angle Blade Plate DCP Stainless Steel 95 Degrees 14-18 Hole $580.00

DP734 Small / Large Fragment Set S/S Angle Blade Plate DCP 95 Degrees 5 - 12 Hole $417.00

DP735 Small / Large Fragment Set S/S Angle Blade Plate Stainless Steel 95 Degrees 45mm x 8mm $317.00

DP737 Small / Large Fragment Set S/S Angle Blade Plate 90 Degrees 35-50mm x 8- $354.00

DP739 Small / Large Fragment Set S/S Angle Blade Plate 90 Degrees 60 to 65 x 10-15mm $372.00

DP741 Small / Large Fragment Set S/S Broad DCP Plate 6 to 10 Hole $161.00

DP744 Small / Large Fragment Set S/S Broad DCP Plate 11 to 14 Hole $235.00

DP746 Small / Large Fragment Set S/S Broad DCP Plate 16 to 17 Hole $320.00

DP749 Small / Large Fragment Set S/S Broad DCP Plate 18 to 26 Hole $347.00

DP753 Small / Large Fragment Set S/S Blade Plate Stainless Steel 95 Degrees 5-6 Hole $342.00

DP754 Small / Large Fragment Set S/S Cannulated Screw Diameter 4mm x 10-60mm Length $125.00

DP758 Small / Large Fragment Set S/S Cerclage  0.8-2.5mm D898 $13.60

DP759 Small / Large Fragment Set S/S Washer Spiked, Standard, Cancellous,  One size only $14.00

 Cortical & Fastening Wire

DP761 Small / Large Fragment Set S/S Cancellous Screw 4mm Dia and 10 - 28 Length $125.00

DP766 Small / Large Fragment Set S/S Cancellous Screw 32 Thread - Stainless  Dia 6.5mm x 130-140mm $54.27

DP772 Small / Large Fragment Set S/S Cancellous Screw 6.5mm x 14-110mm Length $35.00

DP774 Small / Large Fragment Set S/S Cancellous Screw 16 or 32 Thread 6.5mm x 25 - 130mm Length $35.00

DP776 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel   10 Hole 135-150 Deg $648.00

 Sterile or Unsterile

DP777 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel   12 Hole 135-150 Deg  $685.00

 Sterile or Unsterile

DP778 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel   12-14 Hole 135-150 Deg $739.00

 Sterile or Unsterile

DP780 Small / Large Fragment Set S/S CHS Plate Standard & Short Barrel   5-14 Hole 135-150 Deg $545.00

 Sterile or Unsterile

DP784 Small / Large Fragment Set S/S CHS Plate Stainless Steel 16 Hole 135-150 Deg    $800.00

Prostheses List by Category, Groups and Sponsor Page 473 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP786 Small / Large Fragment Set S/S Cortical Screw Self Tapping 3.5 or 4.5 x 30 - 110mm Length $30.00

DP793 Small / Large Fragment Set S/S K/Wire Stainless Steel  0.8 to 3.0 mm x 6-9" or 150- $7.00

DP796 Small / Large Fragment Set S/S Narrow Bone Plate 5-18 Hole $81.88

DP802 Small / Large Fragment Set S/S Small or Narrow DCP Plate 2.7mm or 3.5mm 8-16 Hole $120.00

DP809 Small / Large Fragment Set S/S K-wire standard 1/8 inch $30.00

DP810 Small / Large Fragment Set S/S K-Wire Double Point  each 5/32 inch $11.00 $31.00

DP812 Small / Large Fragment Set S/S SCS Plate Sterile 10-12 Hole 95 Degrees $747.00

DP813 Small / Large Fragment Set S/S SCS Plate Sterile 14-16 Hole 95 Degrees $788.00

DP814 Small / Large Fragment Set S/S Threaded Steinmann Pin 0.5-3mm $30.00

DP820 Small / Large Fragment Set S/S Cortical Screw Diameter 3.5 or 4.5 x 45 -100mm $23.00

DP835 Peak Channelled Plate System Channel Plate 2 - 8 Segment $1,200.00

DP836 Peak Channelled Plate System Channel Plate Locking Washer 9 x 13mm $162.00

DP837 Peak Channelled Plate System Cortical Bone Screw 3.5mm $70.00 $118.00

DP929 Supacondylar Nail System Supracondylar Titanium Nail Sterile or  10 to 12 mm x 15-30cm $1,210.00

 Unsterile

DP931 Small / Large Fragment Set S/S Solid Cortical Screw Titanium 6.5mm x 40 - 100mm $116.00

DY131 Small / Large  Fragment Set Low Profile Cannulated Cancellous  4mm x 10mm - 48mm Length $225.00 $367.42

 Screw, Partially Thread

DY162 Fragment Set Small/Large Low Profile Cannulated Cancellous  4mm x 50 - 75mm $250.00 $441.00

 Screw, Partially Thread

DY164 Small / Large Fragment Set Low Profile Cannulated Cancellous  4mm x 10 - 50mm Length $182.85

 Screw, Fully Thread

DY165 Fragment Set Small/Large Low Profile Cannulated Cancellous  4mm x 55 - 75mm $225.00

 Screw, Fully Thread

 Howmedica

HW274 Alta Modular Trauma System -  Cortical Screw/Screw Nut Assembly -  5mm $280.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 474 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW294 Alta Modular Trauma System -  Washer - Cancellous Screw -  Titanium One size only $103.00

 Components Screws

HW338 Gamma Locking Nail Gamma Complete -  Orthinox 125,130,135 degrees x 180mm  $92.00

 length

HW341 Gamma Locking Nail Long Nail -  Orthinox 125,130,135 degrees x 340- $939.00

 440mm length

HW342 Gamma Locking Nail Distal Screw -  Orthinox 25-95mm length $110.00

HW343 Gamma Locking Nail Lag Screw -  Orthinox 85-120mm length $203.00

HW344 Gamma Locking Nail Set Screw -  Orthinox 8mm dia x 22-27 mm length $86.00

HW345 Gamma Locking Nail Proximal Plug -  Orthinox 17mm $100.00

HW346 Grosse & Kempf Locking Nail Femoral - Rods and Screws -  Stainless  10,11,12,13,14,15, 16mm  $627.00

 width, 260-380mm length

HW347 Grosse & Kempf Locking Nail Tibial - Rods and Screws -  Stainless Steel 7.5,9,10,11,12,13, 14,15mm  $567.00

 width, 240-375mm length

HW348 Grosse & Kempf Locking Nail Unreamed -  Stainless Steel 7.5mm dia,  240 - 390mm  $549.00

HW349 Grosse & Kempf Locking Nail Cross Screw -  Stainless Steel 6.28mm  x 15-95mm $131.00

HW350 Grosse & Kempf Locking Nail Cross Screw -  Stainless Steel 3.7mm x 25-70mm $99.00

HW354 Metaizeau Nail Stainless Steel 2-4mm x 400-500mm $160.00

 LMT Surgical Pty Ltd

LM001 TriMed Wrist Fixation System Washer $115.00

LM002 TriMed Wrist Fixation System Plates, Stainless Steel Radial and Ulna pin plate -  3  $915.00 $950.00

 hole, 5 hole, 7 hole;  L plate -

 left and right

LM004 TriMed Wrist Fixation System Buttress Pin Stainless Steel Wire Form 16 - 42mm Length, 8 - 14mm  $452.00

LM005 TriMed Wrist Fixation System Small Fragment Clamp  Stainless Steel  16 - 32mm Length, 10 - 20mm  $465.00

 Inner and Outer Component Wire Form Bend

LM007 TriMed Wrist Fixation System Cortical Bone Screw, Stainless Steel Diameter 2.3 - 3.2mm, Length  $120.00

 10 - 32mm

Prostheses List by Category, Groups and Sponsor Page 475 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medical & Optical  Instruments Australia Pty Ltd

MO150 Acumed Congruent Plate System Foot & Ankle Plate, Titanium 4 to 9 Hole $470.00

MO151 Acumed Congruent Plate System Distal Radius Plate Titanium 6 to 7 hole $465.00

MO152 Acumed Congruent Plate System Thumb Plate Titanium 5 to 6 hole $448.00

MO153 Acumed Congruent Plate System Screw Titanium 2.1, 2.7, 3.5, 4.0mm diameter,  $94.00

 6mm to 28mm length

MO154 Polarus Proximal Humeral Fixation  Polarus Proximal Humeral Rod  150 - 300mm length $1,925.00

 Standard/Plus Titanium

MO156 Polarus Proximal Humeral Fixation  Polarus Screws Cancellous/Cortical  12.5 to 60mm length $220.00

MO158 Polarus Humeral Rod System Polarus Washer 3.5mm $20.00

MO159 Polarus Humeral Rod System Polarus Ulna Rod Titanium 210 to 270mm length $1,460.00

MO160 Polarus Humeral Rod System Polarus Retrograde Rod Titanium 200 to 300mm length $1,415.00

MO161 Polarus Humeral Rod System Polarus Radius Rod Titanium 190 to 230mm length $1,460.00

MO190 Acumed Congruent Plate System Mid-shaft compression plate - titanium 4 - 12 hole $410.00

MO191 Acumed Congruent Plate System Metatarsal osteotomy plate - titanium Right, left $465.00

MO192 Acumed Congruent Plate System Malleolar plate - titanium Medial, anterior, lateral 5 hole,  $552.00

 lateral 7 hole

MO193 Acumed Congruent Plate System Fibula guide plate - titanium 3 - 7 hole $550.00

MO194 Acumed Congruent Plate System Elbow plate - titanium Epicondyle, Olecranon,  $1,308.00

 Coronoid, Posterior, Radial

 Head, Small, Medium, Long,

 Extra Long, 10-Hole, Standard

MO195 Acumed Congruent Plate System Screw - titanium 2.7, 3.5, 4.0mm dia, 30 - 65  $120.00 $147.00

MO209 Acumed Congruent Plate System Threaded K-Wire - Titanium WT-1606STT: Length 15cm x  $73.00 To be funded where any or all K-

 Diameter 0.62"; WT-0906STT:  wires used in a procedure are

 Length 15cm x Diameter 0.35" used as an implant.

MO211 Accumed Congruent Plate System Clavicle Plate - Titanium Small, Medium, Large, J-Shape, $1,386.00

  Left, Right

Prostheses List by Category, Groups and Sponsor Page 476 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Pacific Medical

PM109 Orthofix External Fixation Systems MiniRail System Short, Standard, Long and  $2,150.00

 Articulated Horizontal and

 Vertical Axis

PM110 Orthofix External Fixation Systems Pennig Minifixator Short, Standard, Long $4,800.00

 Smith & Nephew Surgical Pty Ltd

SN519 TriGen Capture Reconstruction Screws Titanium 6.4mm diameter 65-125mm  $219.00

SN520 TriGen Captured Screws Titanium 4.5 & 5.0mm diameters, 20- $120.00

 110mm lengths

SN521 TriGen  Femoral Antegrade Nail (FAN) 10 x 26cm - 13 x 50cm $750.00

SN522 TriGen  Knee Nail 8.8, 10, 11.5 & 13mm  $1,050.00

 diameters, 26-50cm lengths

SN665 TriGen TAN Titanium 6A1-4V 10, 11.5 & 13mm Diameter, 30  $750.00

 - 50cm Length

SN666 TriGen Nail Cap Titanium 0 - 20mm body length $45.00

SN713 Trigen Stable-Lok Nut One Size Only $346.00

SN739 Trigen Self Tapping Cortical Screw 20mm - 60mm $95.00

SN740 Trigen Humeral Nail 7-11cm x 16-30cm $660.00

 Stryker Australia Pty Ltd

ST062 Auto Pilot 1.7mm Quik Flap System Kit contains three titanium 2 hole plates,  2 hole plate. 4mm length screw $420.00

 and 6 titanium alloy bone screws

ST063 Auto Pilot 1.7mm Quik Burr System Kit contains one 14mm Malleable Burr  14mm plate. 4mm length screw $407.00

 Hole Cover plate and 5 titanium alloy bone

ST064 Square Fit 1.7mm Quik Burr System Kit contains one 14mm Malleable Burr  14mm plate. 4mm length screw $380.00

 Hole Cover plate and 5 titanium alloy bone

ST065 Cross Slot 2.0mm Quik Flap System Kit contains three titanium 2-hole plates  2 hole plate. 4.0mm length  $407.00

 and six titanium low profile bone screws

ST804 Grosse and Kempf Locking Nail - 4.6mm Cross screws 20 - 70mm length $93.00

Prostheses List by Category, Groups and Sponsor Page 477 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK367 Stryker Plating System Numelock II Locking Plate System Distal Femur - 5 holes to 11  $1,500.00

 holes, left and right

SK368 Stryker Plating System SPS Locking Plate System Distal Medial and Lateral tibia, 4  $1,450.00

 hole to 10 hole, left and right

SK377 Stryker Plating System SPS Locking Plate System Distal Femur - 4 holes to 12  $1,500.00

 holes, Left and right

SK379 Stryker Plating System SPS Locking Plate System Proximal Humerus 3 Holes to 5  $1,400.00

 Holes Left and Right

SK380 Stryker Plating System Numelock II Locking Plate System Proximal Humerus 4 Holes to 10 $1,400.00

  Holes Left and Right

SK381 Stryker Plating System Numelock II Locking Plate System Distal Humerus, Lateral and  $1,400.00

 Medial, 1 hole to 5 holes

SK382 Stryker Plating System Numelock II Locking Plate System Locking screws: 4.5mm x  $185.00

 14mm to 4.5mm x 75mm,

 6.5mm x 27mm to 6.5mm x

SK383 Stryker Plating System SPS Locking Plate System Proximal Tibia, Lateral and  $1,450.00

 Medial, 4 hole to 12 holes, left

 and right

SK384 Stryker Plating System Numelock II Locking Plate System Distal tibia, 3 hole to 9 hole, left  $1,450.00

 and right

SK395 Stryker Plating System SPS Locking Plate System Locking Screws:  3.0mm x  $185.00

 8mm to 3.0mm x 30mm,

 3.9mm x 14mm to 3.9mm x

 120mm, 5.1mm x 14mm to

 Synthes Australia Pty Ltd

SY355 AO/ASIF Plates DHS Blade 60mm - 150mm $240.00 $400.00

 Zimmer

ZI149 Periarticular Plates Periarticular 6.5mm Cancellous Screws -  16mm Thread - 35-90mm Long, $159.00

 Stainless Steel  32mm Thread - 45-90mm

 Long, Fully Threaded - 25-

Prostheses List by Category, Groups and Sponsor Page 478 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI150 Periarticular Plates Periarticular 4.0mm Cancellous Screws -  Part thread - 30-60 mm, Full  $105.00

 Stainless Steel thread 30-110 mm

ZI151 Periarticular Plates Periarticular 4.5mm Self Tapping Screws 26 - 90mm $125.00

  - Stainless Steel

ZI152 Periarticular Plates Periarticular 3.5mm Self Tapping Screws 10 - 80mm $136.00

  - Stainless Steel

ZI153 Periarticular Plates Periarticular Tibial Plateau Plates -  2 holes - 14 holes Left & Right $1,219.00

 Stainless Steel

ZI154 Periarticular Plates Periarticular Femoral Condylar Plates -  4 holes - 18 holes Left & Right $1,211.00

 Stainless Steel

ZI157 Zimmer Internal Fixation Systems:  Freelock/Versa-fx tube plate - Stainless  2 holes - 20 holes $695.00

 Compression Hip Screw

ZI158 Zimmer Internal Fixation Systems:  Freelock/Versa-fx lag screw - Stainless  50 mm - 150 mm long $247.00

 Compression Hip Screw

ZI236 Intramedullary Nails  End Caps - Stainless Steel 0 - 15mm $123.00

ZI237 Intramedullary Nails  Humeral Nail - Stainless Steel 6 - 13mm $854.00

ZI238 Intramedullary Nails  Retrograde Nail - Stainless Steel 9 - 14mm $854.00

ZI239 Intramedullary Nails  Tibial Nails - Stainless Steel 6 - 15mm $635.00

ZI240 Intramedullary Nails  Femoral/Recon Nails - Stainless Steel 8 - 16mm $733.00

ZI242 Intramedullary Nails  Nuts - Stainless Steel 6.5 mm $55.00

ZI243 Periarticular Plates Stainless Steel 2 - 20 Hole $974.00

ZI320 ITST Intramedullary Nails Stainless Steel Intertrochanteric Nailing  Diameter 10 - 14mm; Length 18 $665.00

 System  - 50cm

ZI321 Intramedullary Nail Caps Stainless Steel Intertrochanteric Nailing  Diameter 0 - 20mm $110.00

 System

ZI322 ITST Intramedullary Nailing System -  Stainless Steel Intertrochanteric Nailing  Diameter 11mm: Length 70mm  $205.00

 Lag screw System - 120mm

ZI331 Zimmer Periarticular Locking Plates Periarticular Locking Plating System Various lengths and numbers of  $1,400.00

 holes

Prostheses List by Category, Groups and Sponsor Page 479 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems, Other

 Biomet Australia Pty Ltd

BI206 Arthrotek Ligament Fixation System Washerloc Fixator, Screw, and Fixator  Fixator 16mm, Screw 24-60mm $1,085.00

 Titanium

BI233 Arthrotek Ligament Fixation System Suture Button, HMWPE 15mm, 19mm $185.00

BI234 Arthrotek Ligament Fixation System Ligament Washer, Titanium 14mm, 18mm $335.00

BI235 Arthrotek Ligament Fixation System Bone Screw, Ligament, Titanium 30,35,40mm $195.00

BI236 Arthrotek Ligament Fixation System Bone Screw, Titanium 3.5mm (10-40mm) $195.00

BI237 Arthrotek Ligament Fixation System Channel Ligament, Clamp, Titanium 10mm, 13mm 15mm $673.00

BI238 Arthrotek Ligament Fixation System Channel Ligament, Cortical Screws Pk 6 3.5mm (10-40mm) $185.00

BI239 Arthrotek Ligament Fixation System Interference Screw, Titanium 15-30mm $475.00

BI240 Arthrotek Ligament Fixation System Screw, Bicortical, Titanium 30-60mm $25.00

BI246 Arthrotek Ligament Fixation System Bone Mulch Screws, Titanium 10.5mm x (20-35mm) $445.00

BI576 Distraction Technology System Distractor, Flexible Shaft, Facial, Titanium 1 - 3inch $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI580 Distraction Technology System Distractor, Midface, Drive Screw with  20 - 30mm $785.00 Only to be funded where used in

 Sleeve.  Titanium a service for which a Medicare

 Benefit is payable

BI582 Distraction Technology System Plate, Anterior or Posterior, Mid Face Standard or Long $1,840.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI586 Distraction Technology System Mandibular, Straight Plate or Distractor  10-25mm $2,040.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI588 Distraction Technology System Distractor, Paediatric,  Titanium 10 - 30mm $1,955.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 480 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP039 Orthosorb Absorbable Pin Orthosorb K-Wire  - Stainless Steel L300 D2.0mm Thread Each $16.50

DP099 Coventry Screw System S/S Cannulated Screws 7.00 mm dia $175.00 $521.00

DP102 Coventry Screw system  Cannulated Screws 4mm and 4.50 mm $90.00 $270.00

DP105 Coventry Screw system S/S Standard or Heavy or Extra Heavy Duty  2 -4 or 3- 4 Hole Standard or  $442.00

 130 Deg

DP106 Coventry Screw system S/S Cancellous Screw 4mm or 4.5mm 16-90mm Length $275.00

DP854 Songer Cable System - Titanium Flex Bar - Large/Small or Flanged Crimp  35mm/30mm $159.00 $222.45

 2 Hole Bar /Flat Bar (Pk 2)

DP858 Songer Cable System  - Stainless Steel Flanged Crimp/Flat Bar (Pk2) or 2 Hole  One size only $185.00

 Bar (Pk 2)

DP859 Songer Cable System  - Stainless Steel Isola Single Cable & Crimp (Pkt 6) One size only $2,005.00

DP860 Songer Cable System  - Stainless Steel Double Loop Cable with 2 Crimps One size only $660.00

DP862 Songer Cable System  - Titanium Double Loop Cable with 2 Crimps One size only $682.00

DP864 Songer Cable System  - Titanium Isola Single Cable & Crimp (Pkt 6) One size only $3,260.00

 Howmedica

HW183 First Step High Tibial Osteotomy System Proximal Component 5mm Step -  Vitallium 60 to 90mm in 5mm increments $632.00

HW184 First Step High Tibial Osteotomy System Proximal Component 10mm Step -   60 to 90mm in 5mm increments $632.00

HW185 First Step High Tibial Osteotomy System Proximal Component 15mm Step -   60 to 90mm in 5mm increments $632.00

HW186 First Step High Tibial Osteotomy System Distal Component -  Vitallium 30 to 55mm in 5mm increments $1,004.00

HW187 First Step High Tibial Osteotomy System Total Procedure -  Vitallium 60 to 90mm in 5mm increments $1,480.00

   30mm to 55mm in 5mm

HW257 Wichita Fusion Nail System Femoral Component -  Vitallium 18mm $2,690.00

HW258 Wichita Fusion Nail System Tibial Component -  Vitallium 12mm $1,695.00

HW259 Wichita Fusion Nail System Compression Screw -  Vitallium One size only $1,152.00

HW260 Wichita Fusion Nail System Transverse Screw -  Vitallium 30-60mm in 5mm increments $181.00

Prostheses List by Category, Groups and Sponsor Page 481 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 LMT Surgical Pty Ltd

LM008 Spider and Mini-Spider Limited Wrist  Stainless Steel 8 hole spider plate, 6 hole mini- $2,200.00

 Fusion System spider plate

LM009 The Subtaler MBA Implant Titanium 6, 8, 9, 10, 12mm and guide pin $1,300.00

  2mm

 Medical & Optical  Instruments Australia Pty Ltd

MO134 Martin Miniplate Osteosynthesis System Screw Fami Titanium 2mm diameter, 8mm length $164.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO135 Martin Internal Distraction System Titanium Distractor 10 to 20mm $2,700.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO136 Intra Oral Mandibular Distraction System   Vertical 6 to 15mm $2,220.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO137 Intra Oral Mandibular Distraction System   Ramus 15 to 25mm $2,840.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO200 Polarus Proximal Humeral Fixation  End cap, titanium Only size only $45.00 $180.00

MO201 Intra-Oral Vertical Distractor Titanium distraction device utilising  Two-hole threaded fixation  $1,260.00 Only to be funded where used in

 micro-threaded fixation plates, distraction plates - one size only; distraction a service for which a Medicare

  screws and positioning screws.  screws - 8,10,12,14mm;  Benefit is payable

 positioning screws -

 National Surgical Corporation Pty Ltd

NI139 Distraction Device Medicon Ti - Mandibular  15 - 20mm $2,070.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NI140 Distraction Device Medicon Ti - Mandibular Distraction 10 - 25mm $2,000.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Pacific Medical

PM108 Orthofix Limb Reconstruction System Adult and paediatric - Short,  $6,500.00

 Standard and Long

Prostheses List by Category, Groups and Sponsor Page 482 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN443 Reis Cable and Swage 1.6 & 2.0mm $330.00

SN444 Reis Swage 1.6 & 2.0mm $170.00

SN730 Accord Orthopaedic Cable System, Titanium  150-250mm $2,550.00

SN731 Accord Orthopaedic Cable System, Sm Cable  75-255mm $1,400.00

SN732 Accord Orthopaedic Cable System, SS Cable  2.0mm $621.00

SN733 Accord Orthopaedic Cable System, SS Button  One Size Only $355.00

 Plate Adapter

SN734 Accord Orthopaedic Cable System, SS Screw  One Size Only $275.00

 Plate Adapter

SN735 Accord Orthopaedic Cable System, Std Cable  85-265mm $2,000.00

 Stryker Australia Pty Ltd (2)

SK316 Secure Strand Cable System Bone Reapproximation Cable Diameter 1.0mm $260.00

 Stryker Australia Pty Ltd (3)

SR040 Universal Quick Flap System Sterile pack containing 3 x Titanium 2  $540.00

 hole plates, 6 x Viper self drilling 1.5 x

 4mm screws

SR041 Universal Quik Flap System Sterile pack containing, 3 x Titanium 2  $540.00

 hole Plates, 6 x self-tapping screws 1.5 x

 Surgiplas Medical

SP045 Logic Distraction System Distractor, spacers & activation set Straight, Curved 18-52mm $3,150.00

 TiMax Surgical Pty Ltd

TI043 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.   1.5-2.5 mesh plates, 14 x 14  $2,490.00

 Polylactic Acid Trimethylene Carbonate  holes; 1.5mm baby mesh plate

 Copolymer 14 x 14 holes

TI044 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.   1.5-2.5 mesh plate, 7 x 7 holes;  $1,200.00

 Polylactic Acid Trimethylene Carbonate  1.5mm baby mesh plate 7 x 7

 Copolymer

Prostheses List by Category, Groups and Sponsor Page 483 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TI045 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.   1.5mm baby plates:- 20 hole, c- $350.00

 Polylactic Acid Trimethylene Carbonate  plate & x-plate 7 hole, 2 hole

 Copolymer

TI046 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.   1.5mm plates:- 20 holes, c-plate  $310.00

 Polylactic Acid Trimethylene Carbonate  & x-plate 7 hole, L-plate 7 hole

 Copolymer L & R. burrhole

TI047 CPS Bioabsorbable Fixation System CPS Systems and Baby System Plates.   1.5-2.5mm plates:- 2-10 hole  $240.00

 Polylactic Acid Trimethylene Carbonate  plates and extended, c-plate &

 Copolymer x-plate 7 hole, H-plate 8 hole,

 orthognathic hole and L-plate L

TI051 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Plates 6 & 8 hole $433.00

 copolymer

TI052 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Plates 2 & 2.5 systems 4,6,8,  $240.00

 copolymer 10 hole

TI053 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Pin 1.5 & 2 mm dia x 20-50  $185.00

 copolymer mm long

TI056 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 2.8 x 6-23mm, 3.1 x 6- $260.00

 copolymer

TI057 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 3.1 x 6 - 30mm and 2.5 $155.00

 copolymer  x 30mm

TI058 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 2.8 x 40mm, 2.5 x  $349.00

 copolymer 30mm, 4.5 x 90mm

TI059 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 4.5 x 20-55mm, 3.1 x  $310.00

 copolymer

TI060 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 2 x 9-19mm, 2.5 x 10- $40.00

 copolymer 23mm and 2.8 x 10 - 23mm

TI061 CPS Bioabsorbable Fixation System OTPS fixation system: PLGA/TMC  Screws 1.5 - 2.5mm dia x 5- $530.00

 copolymer 8mm long

TI062 CPS Bioabsorbable Fixation System Trinion meniscus screw: PLGA/TMC  10 & 12mm long $179.00

 copolymer

Prostheses List by Category, Groups and Sponsor Page 484 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems, Spinal

 Device Technologies Australia Pty Ltd

DE164 Expandable Spinal Fusion System Composition - titanium, locking ring  Dia 4.85/10 - 9/15mm x Length  $4,524.00

 nickel titanium 22 - 25mm

 Johnson & Johnson Medical Pty Ltd

JJ516 X-Tenz Lordotic Cage X-tenz Lordotic Cage, Titanium 30 - 60mm, 10 degrees $3,200.00

JJ517 X-Tenz Lordotic Cage X-tenz Lordotic Cage, Titanium 30 - 60mm, 0 degrees $3,200.00

 Surgical House

SU073 Olerud PF Blocks Stainless Steel, Threaded or Non- To suit 7mm Olerud PF Rods $1,106.00

 threaded, 0, 10, 13mm offset

SU075 Olerud Pedicle Screw Stainless Steel Diameter 5, 6, 7mm Length 45 - $163.00

  80mm

SU081 Bone screw Hook/screw & rod spinal system  Diam 4,5,6mm 55-70mm $162.00

 Synthes Australia Pty Ltd

SY180 Cervical Spine Locking Plate (CSLP)  Small Stature Plate Length 20-77mm $1,250.00

 Taylor Bryant Pty Ltd

TB315 Delivery Track Composition: Peek 8 x 20/25/30mm $824.00

 Zimmer

ZI510 Optima Spinal System - Transverse Link  Small, Medium, Large $936.00

 Assembly

ZI511 Optima Spinal System - Set Screw One size only $312.00

ZI512 Optima Spinal System - Rod Dia 5-7mm, length 40-400mm $513.00

ZI513 Optima Spinal System - Monoaxial  Dia 4-8mm, length 20-60mm $936.00

 Pedicle Screw System

ZI514 Optima Spinal System - Polyaxial Pedicle  Dia 4-8mm, length 20-60mm $1,300.00

 Screw System

Prostheses List by Category, Groups and Sponsor Page 485 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Pins, Bone

 B Braun Australia Pty Ltd

BB071 Kirshner Wires all Sizes Steel Dia 0.8mm-3.0mm, Length  $11.00 $30.00 To be funded where any or all K-

 70mm-310mm wires used in a procedure are

 used as an implant.

 Biomet Australia Pty Ltd

BI232 Moore Pins Scan Pin, Stainless Steel 16mm x 51-152mm $210.00

BI298 Rush Intramedullary Pins Stainless Steel 2.4-6mm x (30-440mm) $400.00

BI302 Knowles Hex Drive Pins Stainless Steel 4.0, 4.7mm x (57-152mm) $250.00

BI303 Rush Intramedullary Pins Stainless Steel 2.4mm x (30-35mm) $84.00

BI304 Rush Intramedullary Pins Stainless Steel 3.2mm x (100-250mm) $300.00

BI305 Rush Intramedullary Pins Stainless Steel (2.4, 4.8)mm dia x (30-360)mm $135.00

BI306 Rush Intramedullary Pins Stainless Steel (6 - 6.4mm) x (280 - 440mm) $175.00

 De Puy Australia

DP088 Orthosorb Absorbable Pin Orthosorb - Polydiaxanone Fixation Pins  2mm $298.00

DP089 Orthosorb Absorbable Pin Orthosorb Pkt3 - Polydiaxanone 40mm x2mm $372.00

DP090 Orthosorb Absorbable Pin Orthosorb Pkt 3 - Polydiaxanone 1mm x 40mm x 1.3mm $734.00

DP091 Orthosorb Absorbable Pin Orthosorb Pkt 1 - Polydiaxanone 40 x 2.0mm $736.00

DP092 Orthosorb Absorbable Pin Orthosorb K Wire  - Stainless Steel  1 x 40mm x 1.3mm Pk 3 $206.00

 Tapered Pins

DP093 Orthosorb Absorbable Pin Orthosorb -Polydiameterxanone 1.3mm $164.82

DP094 Orthosorb Absorbable Pin Orthosorb Pk 2 - Polydiaxanone 40mm x 2.0mm $291.00

DP095 Orthosorb Absorbable Pin Orthosorb Arthroscopic Fix-Set -  1.3MM $671.00

 Polydiaxanone

DP572 Nancy Nail System  Pediatric Flexible Nail 2.0 mm x 130mm $414.00

Prostheses List by Category, Groups and Sponsor Page 486 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP892 Rockwood Clavical Pin Rockwood Clavicle Pin + Nut S/S 2.5 to 4.5mm $243.00

DP893 Rockwood Clavical Pin Nut Clavical Pin S/S 2.5 to 4.5mm $135.00

DY272 Clavicle Pin (Sterile) Clavicle pin assembly 2.5-4.5mm $358.00

 Device Technologies Australia Pty Ltd

DE070 TransFix Implant Screw System -  Titanium alloy 40mm & 50 mm $445.00 $743.55

DE124 Fixion Hip Pin Stainless Steel Diameter 5mm x length 60- $210.00 $320.00

DE129 Fixion Peg Stainless steel peg with inflatable distal  Diameter 8mm x lengths 80, 90, $960.00

  100, 110, 120mm

 Howmedica

HW362 Osteo Kirschner Wire Kirschner -  Stainless Steel 28-62 x 4/9 $11.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

HW368 Osteo Kirschner Wire K wire -  Stainless Steel 1.5mm $11.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

HW369 Osteo Kirschner Wire K wire -  Stainless Steel 2.0mm $11.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

 Johnson & Johnson Medical Pty Ltd

JJ024 Cross Pin - 6.5mm x 40, 50mm lengths $455.00

JJ420 MiniLok Quick Anchor Plus with  Anchor composition is PLA MiniLok Quick Anchor Plus # 0  $438.00

 Suture OS-2 Needles; MiniLok

 Quick Anchor Plus # 2/0 Suture

  V5 Needles

JJ421 MicroFix Quick Anchor Plus with  Anchor composition is PLA MicroLok Quick Anchor Plus  $438.00

 Ethibond Suture with 3/0 Ethibond Suture and

 V4 Needles; MicroLok Quick

 Anchor Plus 4/0 Ethibond

 Suture and C1 Needles;

 MicroLok Quick Anchor Plus

 with 4/0 Ethibond and P3

Prostheses List by Category, Groups and Sponsor Page 487 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ422 MiniLok Quick Anchor Plus with Panacryl Anchor composition is PLA MiniLok Quick Anchor Plus #  $432.00

 2/0 Suture RB1 Needles

JJ424 Panalok RC Loop Anchor with Ethibond  Anchor composition is PLLA One size only $439.60

 Suture

JJ425 Panalok RC Loop Anchor with Panacryl  Anchor composition is PLLA One size only $439.60

 Suture

JJ426 Bioknotless RC Anchor with Panacryl  Anchor composition is PLLA One size only $439.60

JJ427 Lupine Loop Anchor with Panacryl or  Anchor composition is PLLA One size only $439.60

 Orthocord

JJ428 BioFastin RC Anchor with Ethibond Suture Anchor composition is PLLA One size only $439.60

JJ429 Bioknotless RC Anchor with Ethibond  Anchor composition is PLLA One size only $439.60

JJ430 BioFastin RC Anchor with Panacryl Suture Anchor composition is PLLA One size only $439.60

JJ431 Lupine Loop Anchor with Ethibond Anchor composition is PLLA One size only $439.60

 Link Orthopaedic  Australia

LO100 LINK Arthrodesis Pin Cobalt Chromium 90mm $6,300.00

LO101 LINK Arthrodesis Pin Tilastan 90mm $7,300.00

 Medical & Optical  Instruments Australia Pty Ltd

MO162 Tension Band Pin Stainless Steel 50 to 90mm $156.00

 Smith & Nephew Surgical Pty Ltd

SN438 Hip Pin Cannulated 30-135mm $203.00

SN445 Steinmann Pins Skeletal Traction Pin-Cove Point 150-200mm $73.00

SN446 Steinmann Pins Skeletal Traction Pin-Cove Point 250mm+ $121.00

SN447 Steinmann Pins Non Threaded, Various Tips 9"x5/64 - 9"x3/16 $25.00

SN461 Bone Staple Fixation Staple 1.16x 1.2- 3.8 x1.2-3.4.   $22.00

 Staple 3.32 x 5.8-7.8 x 3.4. 

 Staple with Spikes XSM- Large.

   Staple W/O Spikes XSM-

 Large.  Trac Pin 9"

Prostheses List by Category, Groups and Sponsor Page 488 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN462 Bone Staple Fixation - Scaphoid Staples Scaphoid Staple S,M, M- Long  $125.00

 & Large 

SN463 Bone Staple Fixation - Osteotomy Fixation Staple 5mm- 14mm.   $163.00

 McConnel HTO PF 15mm 0-S

SN464 Bone Staple Fixation - Short Leg Xsmall - large $125.00

SN465 Bone Staple Fixation - Table Small -Medium  13mm - 16mm. $205.00

SN466 Bone Staple Krackow HTO 12,14,16mm $249.00

SN630 Cannulated Hip Pins Knowles 1.8 x 2 - 5.32 x 5 1/2.   $125.00

SN631 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook Pins 2.3mm Diameter 25.4mm-  $110.00

 101.6mm

SN632 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook Pins 3.1mm Diameter 101.6mm-254 $110.00

SN633 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook Pins 4.7mm Diameter 20.3mm- $135.00

SN634 Cannulated Hip Pins Rush Nails, Round Bevil Point Hook Pins 6.3mm Diameter 27.9mm- $135.00

 Stryker Australia Pty Ltd

ST007 Stryker Plating System - K Wires Stainless Steel or Titanium 150mm length in 1.25, 1.6,  $18.00 To be funded where any or all K-

 2.0mm diameter wires used in a procedure are

 used as an implant.

ST890 Steinmann Pins Stainless Steel 7,9" $90.00

 Surgical House

SU010 K-Wire (Kirschner) Stainless steel 70mm, 100mm, 200mm length $40.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

SU011 Tac-Pin (Threaded) Compression pin-titanium 1.7mm diam 15-25mm length $225.00

 Synthes Australia Pty Ltd

SY051 AO/ASIF K-Wires, Pins, Washers Seldrill 4.0/3.0mm & 4.0 - 6mm / 80 -  $110.21

 250mm L

SY090 AO/ASIF K-Wires, Pins, Washers etc -  Steinmann pins/schanz screws 4.5 / 5.0 / 3.5 / 3.0 / 4.0 , length $88.58

  60 - 300 mm, T

SY249 AO/ASIF K Wires, Pins Washers -  Hybrid Pins - Spade point wires/reduction 1.8, 2.0mm Diameters $128.75

 Steel/Ti Sterile & Non Sterile  wires

Prostheses List by Category, Groups and Sponsor Page 489 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Trewavis Surgical Instruments Pty Ltd

TS002 Trewavis Surgical Steinmann Pins Composition:  Stainless Steel, Model Nos: Dia 3.0 - 5.0mm $55.00

  200 - 950-L to 200-970-Q

Pins, Bone, Absorbable

 B Braun Australia Pty Ltd

BB060 BRAUN AUST Intramedullary Nails Isosorb Resorbable Fixation Pin 2mmx60mm-3.5mmx80mm $213.00

 Biomet Australia Pty Ltd

BI275 Lactosorb Suture Anchors Suture Anchor, Lactosorb, PGA/PLA 2.0mm, 3.0mm $405.00

BI276 Readsorbable Meniscal Staple PGA/PLA 11mm, 13mm $594.00

BI277 Re-Unite Orthopaedic Bone Pin Bone Pin, PGA/PLA (1-4)mm dia x (20-70)mm $160.00

BI797 Weil-Carver Hammertoe Implant PGA/PLA One size only $320.00

BI809 Lactosorb Suture Anchor Threaded, PGA/PLA Dia 3.5mm, 5.5mm $444.00

 ConMed Linvatec Australia Pty Ltd

LV008 Preloaded Bio-Anchor Absorbable Suture  Soft Tissue Re-attachment - PLLA 3.5mm diameter $300.00 $360.00

 Anchor

LV088 SmartPin Resorbable Bone Fixation Pin,  Self-Reinforced PLLA 10, 20, 30 & 40mm $220.00

 1.1mm

 De Puy Australia

DP584 PLA Centraliser Poly Lactic Acid+D108 Centraliser 9-20mm $313.00

 Device Technologies Australia Pty Ltd

DE080 Tissue Button PLA 6.5mm - 10mm $180.00

DE126 Chondral Dart Polylactide Compositition Length 18mm $289.00 $409.00

DE127 Bio-Transfix Composition Poly (L-lactide) Diameter 5mm, length 50mm $455.00 $956.80

 Johnson & Johnson Medical Pty Ltd

JJ078 Rigidfix ACL Cross Pin System  Polylactic acid pin 2.7 & 3.3mm x 42mm $465.00

Prostheses List by Category, Groups and Sponsor Page 490 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ098 Panalok RC Quick Anchor Plus  Polylactic acid absorbable anchor 2.9 x 11.0mm $436.75

JJ099 Panalok Absorbable Anchor  Polylactic acid absorbable anchor 4.1 x 6.0mm $435.00

JJ231 Bioknotless Anchor Anchor composition is PLLA Dia 3.9mm, length 9mm $435.00

JJ232 Cufftack rotator cuff anchor Composition of anchor is a) tack -  Anchor diameter 4.5mm, length  $434.50

 abosorbable PLA b) pin - absorbable L  23mm

 PLA c) sleeve - Prolene

JJ233 Panalok RC QuickAnchor Plus DS  Anchor composed of PLA, Suture  Anchor diameter 2.9mm, length  $432.00

 Panacryl Suture composed of PLA and PGA 11mm

JJ234 Panalok RC QuickAnchor Plus DS  Anchor composed of PLA, Suture  Anchor diameter 2.9mm, length  $432.00

 Ethibond Suture composed of polyester 11mm

Plates, Bone

 Aus Systems Pty Ltd

AU001 Aus Systems Titanium Miniplates (Bone  2hole x 2hole Strip Plate Stiff 1.2mm profile, 4, 6, 8mm length $56.00 Only to be funded where used in

 Plates)  between inner holes a service for which a Medicare

 Benefit is payable

 Austofix

AX014 Distal Radius Fracture Repair System DVR-A, distal volar radius locking plate,  Standard, left & right $1,075.25

 titanium

AX015 Distal Radius Fracture Repair System DVR-A, distal volar radius locking plate,  Narrow, wide, short, narrow- $1,239.00

 titanium left & right

AX016 Distal Radius Fracture Repair System DNP, dorsal nail plate, titanium Standard, left & right $1,180.00

AX017 Distal Radius Fracture Repair System Fragment locking plate, titanium Right, left, straight, Y $815.00

 Australian Surgical Design & Manufacture Pty Ltd

AE036 Opening Wedge Tibial Ostectomy Plate Titanium 6mm - 20mm $975.00

 B Braun Australia Pty Ltd

BB067 Caspar Cervical Plate Titanium and Steel 24mm-90mm $512.00

BB068 Caspar Screws Stainless Steel 10mm-28mm $10.00

Prostheses List by Category, Groups and Sponsor Page 491 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB069 Caspar Screws Titanium 10mm-28mm $29.00

 Biomet Australia Pty Ltd

BI145 Vari-Angle Hip System Compression Hip Screw, Lag + Plate,  2-14 hole plate, 4.5mm to  $2,345.00

 Stainless Steel 15mm screws

BI834 EBI XFIX DynaFix System Screw, VS Osteotomy System, Ti 6mm x (30mm-110mm) $131.00

BI843 EBI XFIX DynaFix System Plate, VS Osteotomy  Ti 4 hole, 6 hole $975.00

 Darco Australia Pty Limited

DC002 Lapidus Plate Arthrodesis Plate - Titanium Flat, 1 - 6mm step $510.00

DC018 MPJ Fusion Plate Titanium S, M, L $600.00

 De Puy Australia

DP045 Isola System (Stainless Steel) Double Wire One size only $165.50

DP046 VSP System (Titanium) Pedicle Screw (Standard or +5 No Cut) 4.75-7.75mm x 25-50mm $470.00

DP049 VSP System (Titanium) Washers - Standard / Tapered 3 & 5mm $63.00

DP051 VSP System (Titanium) VSP Bone Plate One - Two Slot $1,395.00

DP052 VSP System (Titanium) VSP Bone Plate Two ½ - Three ½ or Four -  $1,695.00

 Five Slot

DP058 Isola System (Stainless Steel) Modular Cross Connector Hex Nut One size only $47.19

DP072 Isola System (Titanium) Modular Cross Connector  J-Hooks 1/4 & 3/16" $478.00

DP073 Isola System (Titanium) Modular Cross Connector Plates 0 - 70mm $569.00

DP074 Isola System (Titanium) Modular Cross Connector Hex Nut One size only $57.00

DP075 Isola System (Stainless Steel) Modular Cross Connector Plates 0 - 70mm $265.00

DP076 Isola System (Stainless Steel) Modular Cross Connector J-Hooks 1/4 & 3/16" $463.00

DP869 Bridge Plates Bridge P.F.P. Femoral  / Humeral 90 and 140-170mm $1,112.00

DP888 Calcaneal Periarticular Plate Calcaneal Periarticular Plate - Titanium Extra small to Ex Large $530.00

DP904 Periarticular Plating System Plate Calcaneal  - Titanium Small - Large $528.00

DP905 Periarticular Plating System Fibula Composite Plate - Titanium   5 Hole $317.00

Prostheses List by Category, Groups and Sponsor Page 492 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP906 Periarticular Plating System Medial Pilon Plate - Titanium  3 Hole $340.00

DP907 Periarticular Plating System Meta Plate - Titanium Sm - Lge  3 Hole $340.00

DP908 Periarticular Plating System Periarticular Pilon Plate  - Titanium 4 to 10 hole $386.00

DP909 Periarticular Plating System SPIDER Plate.(2p/p) Titanium Sm $204.00

DP910 Periarticular Plating System SPIDER Plate (2p/p) and offset Titanium Lg $204.00

DP911 Periarticular Plating System Meta Plate - Titanium       Sm -Lge  5 Hole    $338.00

DP912 Periarticular Plating System Fibula Composite Plate - Titanium   11 Hole  $397.00

DP913 Periarticular Plating System Fibula Composite Plate - Titanium   7 Hole  $360.00

DP914 Periarticular Plating System Fibula Composite Plate - Titanium   9 Hole  $383.00

DP915 Periarticular Plating System Medial Pilon Plate - Titanium 5 Hole  $346.00

DP916 Periarticular Plating System Medial Pilon Plate - Titanium 7 Hole  $381.00

DP917 Periarticular Plating System Periarticular Spider Washer - Titanium One size only $193.00

DP921 DOC Ventral Stabilisation System Outer Bone Screw 4.0mm x 12-16mm $195.00

DP922 DOC Ventral Stabilisation System Inner Bone Screw 12 - 16mm $225.00

DP923 DOC Ventral Stabilisation System Platform - Straight Non Locking Screw 3.5 - 4mm $225.00

DP924 DOC Ventral Stabilisation System Platform - Angled Screw 20Deg Lockable 3.5 - 4mm $417.00

DP927 DOC Ventral Stabilisation System Assembly - Various single or two or three 30-110mm $1,470.00

  level

DP928 DOC Ventral Stabilisation System Platform/Cross Connector Locking  3.5 - 4mm $180.00

 Screw or Graft Screw

DY096 DOC Ventral Stabilization System Graft Platform or Cross Connector One size only $186.00

DY123 VSP System (Stainless Steel) VSP Bone Plate One-Two Slot $1,600.00

DY124 VSP System (Stainless Steel) VSP Bone Plate Two 1/2-Three 1/2 Slot $1,645.00

DY125 VSP System (Stainless Steel) VSP Bone Plate Four-Five Slot $1,785.00

DY127 VSP System (Stainless Steel) Washers - Standard / Tapered 3 & 5mm $66.00

DY305 VSP System (Titanium) Sacral Connector - Left & Right Offset One size only $644.00

Prostheses List by Category, Groups and Sponsor Page 493 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Device Technologies Australia Pty Ltd

DE055 Osteotomy Plates Osteotomy, Tibial -  Stainless Steel 5mm - 17.5mm $820.00

DE078 Osteotomy Plates Osteotomy, Femoral - Stainless Steel 7.5mm - 17.5 mm $1,193.00

DE094 Osteotomy Plates Anterior/posterior sloped.  Stainless steel 5 - 15mm length $1,098.00

DE215 Arthrex Osteotomy Plates Metatarsal 2mm - 5mm $550.00

DE216 Arthrex Osteotomy Plates Tibial, Composition Titanium 3mm - 17.5mm $1,300.00

DE217 Arthrex Osteotomy Plates Femoral, Titanium 5mm - 17.5mm $1,480.00

 Howmedica

HW376 Profyle - Hand and Small Fragment System Condylar Plates - Titanium 1.7mm, 2.3mm $190.00

 Link Orthopaedic  Australia

LO062 LINK Giebel Blade Plates - 50- 80mm $376.00

LO063 LINK Giebel Blade Plates  - Cortical  - 6-40mm $35.00

LO064 LINK May Bone Plates Distal Tibia Plate 80mm $413.00

LO065 LINK May Bone Plates Distal Tibia Plate 122mm $413.00

LO066 LINK May Bone Plates Distal Tibia Plate 158mm $449.00

LO067 LINK May Bone Plates Distal Tibia Plate 194mm $491.00

LO068 LINK May Bone Plates Distal Tibia Plate 230mm $532.00

LO069 LINK May Bone Plates Distal Fibular Plate 122mm $413.00

LO070 LINK May Bone Plates Distal Fibular Plate 158mm $449.00

LO071 LINK May Bone Plates Distal Fibular Plate 194mm $491.00

LO072 LINK May Bone Plates Distal Fibular Plate 230mm $532.00

LO073 LINK May Bone Plates Lateral Proximal Tibia Plate  80mm $413.00

LO074 LINK May Bone Plates Lateral Proximal Tibia Plate 122mm $413.00

LO075 LINK May Bone Plates Lateral Proximal Tibia Plate 158mm $449.00

LO076 LINK May Bone Plates Lateral Proximal Tibia Plate 194mm $491.00

Prostheses List by Category, Groups and Sponsor Page 494 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LO077 LINK May Bone Plates Lateral Proximal Tibia Plate 230mm $532.00

LO078 LINK May Bone Plates Medical Proximal Tibia Plate 80mm $392.00

LO079 LINK May Bone Plates Medical Proximal Tibia Plate 122mm $392.00

LO080 LINK May Bone Plates Medical Proximal Tibia Plate 158mm $424.00

LO081 LINK May Bone Plates Medical Proximal Tibia Plate 194mm $460.00

LO082 LINK May Bone Plates Medical Proximal Tibia Plate 230mm $506.00

LO083 LINK May Bone Plates Distal Femur Plate 80mm $413.00

LO084 LINK May Bone Plates Distal Femur Plate 122mm $413.00

LO085 LINK May Bone Plates Distal Femur Plate 158mm $449.00

LO086 LINK May Bone Plates Distal Femur Plate 194mm $491.00

LO087 LINK May Bone Plates Distal Femur Plate 230mm $532.00

LO088 LINK May Bone Plates Proximal Femur Plate 122mm $413.00

LO089 LINK May Bone Plates Proximal Femur Plate 158mm $449.00

LO090 LINK May Bone Plates Proximal Femur Plate 194mm $491.00

LO091 LINK May Bone Plates Proximal Femur Plate 230mm $532.00

LO092 LINK May Bone Plates Distal Humerus Plate Y-shape: Angle 40deg 122mm $449.00

LO093 LINK May Bone Plates Distal Humerus Plate Y-shape: Angle 50deg 150mm $449.00

LO094 LINK May Bone Plates Distal Humerus Plate Y-shape: Angle 30deg 90mm $449.00

LO095 LINK May Bone Plates Distal Humerus Plate Y-shape: Angle 30deg 120mm $449.00

LO096 LINK May Bone Plates Distal Humerus Plate Y-shape: Angle 45deg 150mm $449.00

LO097 LINK May Bone Plates Humerus Plate Proximal - Neutral 80mm $413.00

LO098 LINK May Bone Plates Humerus Plate Proximal - Neutral 98mm $413.00

LO099 Schwabe Plates Distal Radius Bone Plates Small & large $352.00

 Medical & Optical  Instruments Australia Pty Ltd

MO138 Martin Bone Plate Compression Plate  Y Plate Titanium 1.0mm $160.00

Prostheses List by Category, Groups and Sponsor Page 495 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO139 Martin Bone Plate Compression Plate T Plate Titanium 1.0mm $223.00

MO140 Martin Bone Plate Compression Plate Y, L Plate Titanium 1.0mm $215.00

MO141 Martin Bone Plate Compression Plate Straight Titanium 1.0mm $215.00

MO142 Martin Bone Plate Compression Plate T,L, Straight Titanium 1.2mm $350.00

MO202 Acumed Bone Plate MCP Fusion Plate - Titanium 4 Hole left and right $572.00

MO208 Acumed Bone Plate Wrist Fusion Plate - Titanium Standard, Mini $2,092.00 $2,200.00

 Medtex

MX002 Judet Plate Implantable stainless plates for fixation  4 prong x 12 through to 24mm  $231.00 $251.00

 and stabilisation of rib fractures in 2mm increments:  6 prong x

 12 through to 24mm in 2mm

 increments

 Smith & Nephew Surgical Pty Ltd

SN001 TC 100 Quarter Tubular plates (2.7mm  Sterile 23 - 63mm $42.00

 cortex screws)

SN006 TC 100 1.5mm Mini Plates Stainless steel, Sterile Straight 3-6 holes, T-Plates 3-4  $155.00

 holes

SN011 TC 100 3.5mm Small Fragment  Sterile, 14 - 26 hole 169 - 265mm $294.00

 (Compression) plates

SN012 TC 100 3.5mm One Third Tubular plates Sterile, 2 - 8 holes 25 - 97mm $42.00

SN013 TC 100 3.5mm Curved Reconstruction  Sterile, 6 - 8 holes 70 - 94mm $183.00

SN026 135 degree Angled Blade Plates - Shaft length 60 - 200mm $200.00

SN044 TC 100 3.5mm Small Fragment  Sterile, 2 - 7 holes 25mm - 85mm $81.00

 (Compression) Plates

SN046 TC 100 2.0mm Condylar plates Sterile, Left and right 7 holes $190.00

SN062 TC 100 4.5mm Narrow Compression  Sterile, 5 - 7 holes 87 - 119mm $95.00

SN063 TC 100 2.7mm Small Fragment  2 - 12 holes 20 - 100mm $120.00

 (Compression) plates

SN065 TC 100 4.5mm T-Buttress plates Sterile, 4 - 6 holes 80 - 112mm $170.00

Prostheses List by Category, Groups and Sponsor Page 496 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN068 TC 100 1.5mm Condylar plates Sterile, Left and right One size only $190.00

SN069 TC 100 3.5mm Reconstruction plates Sterile, Straight 9 - 11 holes 106 - 130mm $231.00

SN071 TC 100 4.5mm Narrow Compression  Sterile, 2 - 4 holes 39 - 71mm $79.00

SN073 TC 100 2.0mm T-plates Sterile, 2 hole shaft One size only $75.00

SN074 TC 100 Bone Plates with provisional  3.5mm Small Compression Plate 7 - 8 hole $47.00

 fixation holes

SN075 TC 100 4.5mm Reconstruction plates Sterile, 10 - 13 holes 157 - 205mm $270.00

SN076 TC 100 3.5mm Curved Reconstruction  Sterile, 14 - 18 holes 166 - 214mm $260.00

SN077 TC 100 3.5mm Curved Reconstruction  Sterile, 10 - 12 holes 118 - 142mm $260.00

SN078 TC 100 4.5mm Broad Compression plates Sterile, 20 - 26 holes 326 - 423mm $320.00

SN080 TC 100 4.5mm T-plate Sterile, 5 - 8 holes 100 - 148mm $204.00

SN081 TC 100 2.0mm H-plates Sterile One size only $108.00

SN083 TC 100 2.0mm T-plates Sterile, 9 hole shaft 3 - 4 holes $155.00

SN087 TC 100 Semi Tubular plates 8 - 12 holes 135 - 199mm $70.00

SN088 TC 100 Semi Tubular plates Sterile, 5 - 7 holes 87 - 119mm $56.00

SN089 TC 100 2.7mm Condylar plates Sterile Right/left $190.00

SN090 TC 100 2.0mm L-plates Sterile, Right/left, Oblique right/left One size each $75.00

SN091 TC 100 Bone Plates with provisional  Lateral Tibial Head Buttress 7 - 9 hole 149 - 181mm $502.00

 fixation holes

SN092 TC 100 Bone Plates with provisional  4.5mm Narrow Compression 11 - 12 hole $147.00

 fixation holes

SN093 TC 100 Bone Plates with provisional  4.5mm Narrow Compression 8 - 10 hole $113.00

 fixation holes

SN094 TC 100 Bone Plates with provisional  4.5mm Narrow Compression 5 - 7 hole $95.00

 fixation holes

SN095 TC 100 Bone Plates with provisional  Semi-Tubular 6 - 7 holes 103 - 119mm $58.00

 fixation holes

Prostheses List by Category, Groups and Sponsor Page 497 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN096 TC 100 Bone Plates with provisional  Semi-Tubular 4 - 5 holes 71 - 87mm $58.00

 fixation holes

SN097 TC 100 Bone Plates with provisional  4.5mm Broad Compression 12 - 14 hole $215.00

 fixation holes

SN098 TC 100 4.5mm Reconstruction plates Sterile, 14 - 16 holes 221 - 253mm $295.00

SN099 TC 100 Bone Plates with provisional  4.5mm Broad Compression 6 - 8 hole $138.00

 fixation holes

SN101 TC 100 Bone Plates with provisional  L-Buttress, Left and right angled One size each $175.00

 fixation holes

SN102 TC 100 Bone Plates with provisional  T-Plate Oblique 50 - 73mm $215.00

 fixation holes

SN103 TC 100 Bone Plates with provisional  T-Plate Right angled 50 - 67mm $310.00

 fixation holes

SN104 TC 100 Bone Plates with provisional  1/3 Tubular with Collar 7 - 10 hole $46.00

 fixation holes

SN105 TC 100 Bone Plates with provisional  1/3 Tubular with Collar 3 - 6 hole $46.00

 fixation holes

SN106 TC 100 Bone Plates with provisional  3.5mm Small Compression Plate 9 - 10 hole $330.00

 fixation holes

SN107 TC 100 4.5mm Condylar Buttress plates Sterile,  right, 11 - 15 hole 221 - 285mm $480.00

SN108 TC 100 Bone Plates with provisional  4.5mm Broad Compression 9 - 10 hole $165.00

 fixation holes

SN109 TC 100 3.5mm Reconstruction plates Sterile, Straight 4 - 8 holes 46 - 94mm $170.00

SN116 TC 100 2.7mm T-plates Sterile One size only $83.00

SN117 TC 100 Semi Tubular plates Sterile, 2 - 4 holes 39 - 71mm $56.00

SN118 TC 100 3.5mm Small Fragment  Sterile, 8 - 12 hole 97 - 145mm $123.00

 (Compression) plates

SN119 TC 100 4.5mm T-plate Sterile, 3 - 4 holes 68 - 84mm $147.00

SN121 TC 100 Bone Plates with provisional  3.5mm Small Compression Plate 5 - 6 hole $777.00

 fixation holes

Prostheses List by Category, Groups and Sponsor Page 498 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN125 TC 100 Bone Plates with provisional  T-Plate 4 - 8 holes 84 - 148mm $216.00

 fixation holes

SN126 TC 100 4.5mm Condylar Buttress plates Sterile, Left and right,  7 - 9 hole 158 - 190mm $451.00

SN129 TC 100 1.5mm Mini Plates Stainless steel, Sterile H-Plates 4 holes $100.00

SN130 TC 100 3.5mm One Third Tubular plates Sterile, 9 - 12 holes 109 - 145mm $58.00

SN131 TC 100 4.5mm Narrow Compression  Sterile, 14 - 24 holes 231 - 390mm $225.00

SN132 TC 100 4.5mm Narrow Compression  Sterile, 11 - 13 holes 183 - 215mm $180.00

SN133 TC 100 4.5mm Narrow Compression  Sterile, 8 - 10 holes 135 - 167mm $102.00

SN134 TC 100 3.5mm Reconstruction plates Sterile, Straight 16 - 22 holes 190 - 263mm $380.00

SN135 TC 100 95 Degree Condylar Plates Small stature Shaft length 92 - 299 mm, blade $360.00

  length 50 - 80mm

SN136 TC 100 Small T-Plates Sterile, right angled and oblique 3 - 4 holes in head, 3 - 6 holes  $102.00

 in shaft

SN137 TC 100 4.5mm Broad Compression plates Sterile, 6 - 8 holes 103 - 135mm $138.00

SN142 TC 100 4.5mm Broad Compression plates Sterile, 9 - 12 holes 151 - 199mm $165.00

SN143 TC 100 4.5mm Reconstruction plates 3 - 9 holes 45 - 141mm $183.00

SN144 TC 100 2.7mm L-plates Sterile, Right/left, Oblique right/left 3 holes $75.00

SN145 TC 100 3.5mm Reconstruction plates Sterile, Straight 12 - 15 holes 142 - 178mm $270.00

SN468 Compression Hip Screw System Ambi Standard Barrel Plates 60mm -80mm, 2-3 slot $305.00

SN469 Compression Hip Screw System Ambi Standard Barrel Plates 100mm -220mm, 4-10 slot $500.00

SN470 Compression Hip Screw System Ambi Standard Barrel Plates 260mm+, 12-14 slot $660.00

SN471 Compression Hip Screw System Ambi Short Barrel Plates 100mm, 4-5 slot $440.00

SN472 Compression Hip Screw System Ambi Short Barrel Plates 120mm, 4-5 slot $427.00

SN473 Compression Hip Screw System Classic Standard Barrel Plates 60-140mm, 2-3 slot $338.00

SN474 Compression Hip Screw System Classic Standard Barrel Plates 180-220mm, 4-10 slot $427.00

SN475 Compression Hip Screw System Classic Standard Barrel Plates 260mm+, 12-14 slot $660.00

Prostheses List by Category, Groups and Sponsor Page 499 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN476 Compression Hip Screw System Classic Short Barrel Plates 100mm, 4-5 slot $465.00

SN477 Compression Hip Screw System Classic Short Barrel Plates 120mm, 4-5 slot $465.00

SN478 Compression Hip Screw System Classic Supracondylar Plate 90-95 6-12SL $740.00

SN490 Intermediate Osteotomy System Plate (hip screw) 90-150Deg $789.00

SN493 Paediatric Osteotomy System Plate (hip screw) With Prox slot 90D - 140D $937.00

SN532 TC 100 Plate 2.0mm Straight Plate 3-20 hole $81.00

SN542 TC 100 Plate Multifragment Plates One size only $113.00

SN543 TC 100 Plate Pelvic Fragment Plates 3-18 hole, 45-190mm $160.00

SN557 TC 100 Plate 4.5mm Broad Compression Plate 14-18 hole $270.00

SN569 TC 100 Plate Calcaneal Plate Sterile 60mm,70mm & 9 hole $420.00

SN570 TC 100 Plate Cloverleaf Plate 3-4 hole $180.00

SN571 TC 100 Plate Cloverleaf Plate 5-6 hole $380.00

SN572 TC 100 Plate Cloverleaf Plate 7-8 hole $397.00

SN573 TC 100 Plate Cloverleaf Plate 9 hole $442.00

SN574 TC 100 Plate Cobra Head Plate 8-11 hole $433.00

SN577 TC 100 Plate Hook Plate 123mm 4 hole $330.00

SN578 TC 100 Plate Large L-Buttress Plate Left & right Angled $160.00

SN581 TC 100 Plate Lateral Tib Head Buttress Plate 3-7 hole Left & Right $450.00

SN582 TC 100 Plate Lateral Tib Head Buttress Plate 9-13 hole Left & Right $518.00

SN592 TC 100 Plate Spoon Plate 5 hole & 6 hole $160.00

SN659 HTO Plates Titanium 6 - 20mm $1,010.00

SN670 Femoral Osteotomy Plate Titanium Wedge 6 - 20mm thick x 20mm wide $655.00

SN671 Femoral Osteotomy Plate Titanium Femoral Plate 6-8 hole, 6 - 18mm wide $370.00

SN685 Opening Wedge Tibial Ostectomy Plate Titanium 6 - 20mm $360.00

Prostheses List by Category, Groups and Sponsor Page 500 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN745 Peri-Loc Plates, Stainless Steel, Locking, Lefts and 4.5mm $1,314.00

  Rights

SN771 Peri-Loc Plates, Stainless Steel, Locking, Lefts and 3.5mm $1,314.00

  Rights

SN782 Peri-Loc Plates, Stainless Steel, Non-Locking,  4.5mm $407.00

 Narrow, Lefts & Rights

SN783 Peri-Loc Plates, Stainless Steel, Non-Locking,  4.5mm. 6-16 hole $320.00

 Broad, Left & Rights

SN784 Peri-Loc Plates, Stainless Steel, Non-Locking,  4.5mm. 18-22 hole $433.00

 Broad, Left & Rights

SN795 Peri-Loc Plates, Stainless Steel, Locking,  3.5mm $334.00

 Compression & Tubular, Lefts and Rights

SN796 Peri-Loc Plates, Stainless Steel, Locking,   3.5mm, 4 - 12 holes $506.00

 Compression, Lefts and Rights

SN797 Peri-Loc Plates, Stainless Steel, Locking,  3.5mm, 14 - 18 holes $685.00

 Compression, Lefts and Rights

SN798 Peri-Loc Plates, Stainless Steel, Locking,  3.5mm, 20 - 22 holes $740.00

 Compression, Lefts and Rights

SN800 Peri-Loc Plates, Stainless Steel, Non-Locking,  3.5mm, 4-10 holes $231.00

 Reconstruction, Lefts and Rights

SN801 Peri-Loc Plates, Stainless Steel, Non-Locking,  3.5mm, 12-14 holes $340.00

 Reconstruction, Lefts and Rights

 Stryker Australia Pty Ltd

ST003 Stryker Plating System Screws - Cortical  Stainless Steel/Titanium Diameter 2.7mm, screw length  $19.00

 2.7 & 3.5 8-20mm

ST008 Stryker Plating System Small & Basic  Narrow or Broad 2-20 holes, 26-260mm plate  $310.00

 Fragment - Compression Plate

ST017 Stryker Plating System Small & Basic  Stainless Steel or Titanium 50-60mm $380.00

 Fragment - Calcaneal Plate

ST025 Stryker Plating System Small Fragment  Stainless Steel 4-9 Holes $497.00

Prostheses List by Category, Groups and Sponsor Page 501 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST036 Stryker Plating System Small & Basic  Oblique T Plate or T Plate, Stainless Steel 42-86mm Length $304.00

 Fragment - T Plate  or Titanium, Oblique

ST037 Stryker Plating System SmallFragment Set One Third Tubular Plate with Collar 2-8 Holes $113.00

ST038 Stryker Plating System -  Reduction Pin 4.5mm Diameter, Stainless Steel One size only $175.00

ST039 Stryker Plating System Small & Basic  Stainless Steel or Titanium, Left or Right 3-20 Holes, 67-339mm Plate  $231.00

 Fragment - L Plate Length

ST040 Stryker Plating System - Washers & Nuts Stainless Steel or Titanium Nuts 5.0 or 4.5mm thickness;  $18.00

 Washers 7 - 13mm diameter

ST041 Stryker Plating System Basic Fragment  Waisted Compression Plate Broad 6-14 holes $316.00

ST051 Stryker Plating System Small Fragment  Cloverleaf Plate 3-5 Holes $340.00

ST671 Leibinger Plates  Leibinger scaphoid platinum, titanium One size - left, right, neutral  $90.00

 orientation

ST715 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 4 hole $152.00

 system, fixation straight plate, titanium

ST716 Leibinger Titanium Implant System Leibinger profyle hand & small fragment  1.2mm system, 16 hole $253.00

 system, fixation straight plate, titanium

ST717 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 5 holes $247.00

 system, fixation plate,T-shape, 90 deg,

 narrow, titanium

ST718 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 5 holes $247.00

 system, fixation plate, T-shape, oblique,

 right/left, titanium

ST719 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 5 holes $234.00

 system, fixation plate, Y-shape, narrow,

 titanium

ST720 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 2x2 holes $267.00

 system, fixation plate, 3D plate, titanium

ST721 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 3x2 holes, 2x2  $395.00

 system, fixation plate,  3D plate, titanium + 2 holes

ST722 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 4x2 holes $520.00

 system, fixation plate,  3D plate, titanium

Prostheses List by Category, Groups and Sponsor Page 502 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST723 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.2mm system, 4x2 holes $440.00

 system, fixation plate, replant plate, titanium

ST724 Leibinger Titanium Implant System Leibinger profyle hand & small fragment  1.2mm diameter  x 4-13mm $78.00

 system, cross-slot screw, self-tapping,

ST725 Leibinger Titanium Implant System Leibinger profyle hand & small fragment  1.4x3mm, 1.4x5mm, 1.4x7mm, $77.00

 system, emergency screw, cross-slot,   1.4x9mm

ST726 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 4 holes $152.00

 system, straight plate, titanium

ST727 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 4 holes $152.00

 system, fixation straight plate with bar,

 titanium

ST728 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 16 holes $330.00

 system, fixation straight plate, titanium

ST729 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 6 holes $225.00

 system, fixation plate, L-shape, 90 deg,

 right/left, titanium

ST730 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 6 holes $225.00

 system, fixation plate, L-shape, oblique,

 right/left, titanium

ST731 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 6 holes $247.00

 system, fixation plate, T-shape, 90 deg,

 narrow, titanium

ST732 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7 mm system, 6 holes $247.00

 system, T-shape, narrow, oblique,

 right/left, titanium

ST733 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 7 holes $267.00

 system, fixation plate, T-shape, 90 deg,

 titanium

ST734 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 7 holes $285.00

 system, Y-shape, narrow, titanium

ST735 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 9 holes $305.00

 system, Z-shape, titanium

Prostheses List by Category, Groups and Sponsor Page 503 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST736 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 4x2 holes $520.00

 system, replant plate, titanium

ST737 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 5 holes $234.00

 system, condylar compression plate with

 bar, right/left, titanium

ST738 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 2x2 holes $267.00

 system, fixation, 3D plate, titanium

ST739 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 2x2 + 2 holes $395.00

 system, fixation, 3D plate, titanium

ST740 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 3x2 holes $395.00

 system, 3D plate, titanium

ST741 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm system, 4x2 holes $520.00

 system, 3D plate, titanium

ST742 Leibinger Titanium Implant System Leibinger profyle hand & small  fragment  1.7mm diameter  x 5-17mm $49.00

 system, cross-slot, self-tapping screws,

 titanium

ST743 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 1.7mm diameter x 18-24mm $54.00

  System, cross-slot, self-tapping screws,

 titanium

ST744 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 1.6mm diameter $56.00

  System, cross-slot, self-tapping screws ,

  Titanium

ST745 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 1.9x5mm $60.00

  System, emergency, cross-slot, self-

 tapping screw, Titanium

ST746 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4 holes $160.00

  System, fixation straight plate and

 compression plate, Titanium

ST747 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4 holes $160.00

  System, straight plate and compression

 plate, with bar, Titanium

ST748 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 5 holes $157.00

  System, straight compression plate,

Prostheses List by Category, Groups and Sponsor Page 504 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST749 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $160.00

  System, straight compression plate,

ST750 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 16 holes $330.00

  System, fixation straight plate, Titanium

ST751 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $247.00

  System, fixation and compression plate,

 L-shape, 90 deg, right/left, Titanium

ST752 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $247.00

  System, fixation and compression plate,

 L-shape, oblique, right/left, Titanium

ST753 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $267.00

  System, fixation and compression plate,

 T-shape, narrow, 90 deg, Titanium

ST754 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $267.00

  System, fixation and compression plate,

 T-shape, narrow, oblique, right/left,

ST755 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 7 holes $280.00

  System, fixation and compression plate,

 T-shape, 90 deg, Titanium

ST756 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 7 holes $305.00

  System, fixation and compression plate,

 Y-shape, narrow, Titanium

ST757 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 13 holes $320.00

  System, fixation plate, Z-shape, Titanium

ST758 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 5 holes $228.00

  System, condylar compression plate,

 right/left, Titanium

ST759 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $228.00

  System, condylar compression plate,

 right/left, Titanium

ST760 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4x2 holes $435.00

  System, replant plate, Titanium

Prostheses List by Category, Groups and Sponsor Page 505 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST761 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 2x2 holes $267.00

  System, fixation plate, 3D plate, Titanium

ST762 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 2x2 +2 holes $395.00

  System, 3D plate, Titanium

ST763 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 3x2 holes $380.00

  System, fixation plate, 3D plate, Titanium

ST764 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4x2 holes $505.00

  System, fixation plate, 3D plate, Titanium

ST765 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm diameter x 6-18mm $50.00

  System, cross-slot, self-tapping screw,

 Titanium

ST766 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm diameter x 19-24mm $49.00

  System, cross-slot, self-tapping screw,

 Titanium

ST767 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.5mm diameter x 6mm $54.00

  System, emergency cross-slot screw,

ST768 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 4 holes $222.00

  System, compression plate with bar,

ST769 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 5 holes $239.00

  System, compression plate with bar,

ST770 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $267.00

  System, compression plate with bar,

ST771 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 7 holes $285.00

  System, compression plate with bar,

ST772 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 8 holes $300.00

  System, compression plate with bar,

ST773 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $275.00

  System, compression plate, 90 deg, L-

 shape, right/lef, Titanium

ST774 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $275.00

  System, compression plate, T-shape, 90

 deg, Titanium

Prostheses List by Category, Groups and Sponsor Page 506 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST775 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3mm system, 6 holes $280.00

  System, compression plate, T-shape,

 oblique, right/left, Titanium

ST776 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.3x5mm, 2.3x6mm, 2.3x8mm, $50.00

  System, screw and emergency screw,   2.3x9mm, 2.3x10mm,

 2.3x12mm, 2.3x13mm,

ST777 Leibinger Titanium Implant System Leibinger Profyle Hand & Small Fragment 2.5mm diameter $50.00

  System, screw, Titanium

ST778 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates,  Palmar Fracture Plate - Medium $195.00

ST779 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates, Titanium Palmar Fracture Plate - Large $253.00

ST780 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates,  Dorsal Fracture Plate Medium  $275.00

 Left and Right

ST781 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates,  Dorsal Fracture Plate Large Left $253.00

  and Right

ST782 Leibinger Titanium Implant System Rogachefsky Distal Radius Screws,  2.7mm diameter - 12mm-38mm $54.00

  in 2 mm increments,

ST783 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  2.3x8mm, 2.3x10mm,  $76.00

 System, screw, Titanium 2.3x12mm, 2.3x14mm

ST784 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  2.7x12mm, 2.7x14mm,  $140.00

 System, screw, Titanium 2.7x16mm, 2.7x18mm,

ST785 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  3.0x14mm, 3.0x16mm,  $140.00

 System, emergency screw, Titanium

ST786 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  4 holes $320.00

 System, straight plate, Titanium

ST787 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  6 holes $480.00

 System, straight plate, Titanium

ST788 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction  4 holes $330.00

 System, curved plate, Titanium

ST789 Leibinger Titanium Implant System Leibinger Plates - Wrist Arthrodesis  8 and 12 holes $90.00

 Plates, partial and total, right/left, Titanium

ST983 Stryker Plating System DuPont Distal Humeral Plate 7,9,11,13 holes $773.00

Prostheses List by Category, Groups and Sponsor Page 507 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd (2)

SK031 Leibinger Titanium Implant system Profyle hand and small fragment plate  1.2mm sys XS, T-shape 8 holes $515.00

SK037 Leibinger Titanium Implant system Profyle hand and small fragment plate  2.3mm system M, fixation 3D  $435.00

 6x2 holes

SK038 Leibinger Titanium Implant system Profyle hand and small fragment plate  2.3mm system L, compr 10  $1,410.00

 hole T bar

SK039 Leibinger Titanium Implant system Profyle hand and small fragment plate  2.3mm system M, compr 8  $165.00

 holes straight bar

SK049 Stryker Plating System Screws Cancellous bone screws, full and partial  Dia 4.0mm, 10-20mm $48.00

SK050 Stryker Plating System Screws Cancellous bone screws, full and partial  Dia 4.0mm, 22-30mm $48.00

SK051 Stryker Plating System Screws Cancellous bone screws, full and partial  Dia 4.0mm, 32-50mm $35.00

SK052 Stryker Plating System Screws Cancellous bone screws, full and partial  Dia 4.0mm, 55-100mm $48.00

SK055 Matta Pelvic System Straight acetabular plate 10-14 Holes $368.00

SK057 Matta Pelvic System Straight acetabular plate 15-20 Holes $160.00

SK064 Matta Pelvic System Straight acetabular plate 4-9 Holes $800.00

SK066 Matta Pelvic System Symphysis Publis Plates Radius 75 4-6 Holes $800.00

SK067 Matta Pelvic System Curved Pelvic Plate Radius 108 4-9 Holes $53.00

SK069 Matta Pelvic System Curved Pelvic Plate Radius 108 10-14 Holes $32.00

SK070 Matta Pelvic System Curved Pelvic Plate Radius 108 15-20 Holes $800.00

SK071 Matta Pelvic System Curved Pelvic Plate Radius 88 4-9 Holes $61.00

SK073 Matta Pelvic System Curved Pelvic Plate Radius 88 10-14 Holes $800.00

SK074 Matta Pelvic System Curved Pelvic Plate Radius 88 15-20 Holes $800.00

SK075 Stryker Plating System Basic Fragment  4.5mm Reconstruction Plate 3-9 Holes $780.00

SK077 Stryker Plating System Basic Fragment  4.5mm Reconstruction Plate 10-16 Holes $780.00

SK081 Stryker Plating System Small Fragment  Waisted compression plate 2-10 Holes $220.00

SK082 Stryker Plating System Small Fragment  Waisted compression plate 11-20 Holes $220.00

Prostheses List by Category, Groups and Sponsor Page 508 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK083 Stryker Plating System Small Fragment  Standard compression plate 2-9 Holes $166.00

SK084 Stryker Plating System Small Fragment  Standard compression plate 10-20 Holes $220.00

SK086 Stryker Plating System Screws Cortical bone screws 4.5mm diameter 22-38mm $25.00

SK088 Stryker Plating System Basic Fragment  Waisted Compression Plate Broad 15-26 Holes $325.00

SK094 Stryker Plating System Small Fragment  Calcaneal Plate 70-80mm $605.00

SK095 Stryker Plating System Screws Cortical bone screws 4.5mm diameter 40-64mm $25.00

SK096 Stryker Plating System Screws Cortical bone screws 4.5mm diameter 65-95mm $25.00

SK097 Stryker Plating System Screws Cortical bone screws 4.5mm diameter 100-150mm $25.00

SK098 Stryker Plating System Small Fragment  Stainless steel, reconstruction plate 10-22 Holes $551.00

SK099 Stryker Plating System Small Fragment  One Third Tubular Plate with Collar 9-14 Holes $175.00

SK100 Stryker Plating System Small Fragment  T Plates, standard 40-57mm Length $155.00

SK101 Stryker Plating System Small Fragment  T Plates, standard 66-100mm Length $155.00

SK102 Stryker Plating System Small Fragment  Cloverleaf Plate 6-10 Holes $330.00

SK103 Stryker Plating System Screws Cortical bone screws Dia 2.7mm, screw length 22- $25.00

SK104 Stryker Plating System Screws Cortical bone screws Dia 2.7mm, screw length 40- $25.00

SK105 Stryker Plating System Screws Cortical bone screws Dia 3.5mm, screw length 10- $15.00

SK106 Stryker Plating System Screws Cortical bone screws Dia 3.5mm, screw length 22- $19.00

SK107 Stryker Plating System Screws Cortical bone screws Dia 3.5mm, screw length 40- $25.00

SK108 Stryker Plating System Screws Cortical bone screws Dia 3.5mm, screw length 65- $25.00

SK109 Stryker Plating System Screws Cortical bone screws Dia 3.5mm, screw length 100- $25.00

 120mm

SK110 Stryker Plating System Basic Fragment  Waisted compression plate narrow 2-9 Holes $152.00

SK111 Stryker Plating System Basic Fragment  Waisted compression plate narrow 10-22 Holes $152.00

Prostheses List by Category, Groups and Sponsor Page 509 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK335 Matrix SmartLock Polyaxial Locking  Titanium locking plates for reconstruction Matrix SmartLock Palmar  $1,450.00

 System - Plates  of intra-articular and extra-articular  Radius Locking Plate, Medium,

 fractures of the distal radius and  Short; Matrix SmartLock

 reconstruction of the distal radius Palmar Radius Locking Plate,

 Medium, Long; Matrix

 SmartLock Palmar Radius

 Locking Plate, Large, Short;

 Matrix SmartLock Palmar

 Radius Locking Plate, Large,

 Long; Matrix SmartLock Dorsal

  Radius Locking Plate, Left,

 Medium; Matrix SmartLock

 Dorsal Radius Locking Plate,

 Left, Large; Matrix SmartLock

 Dorsal Radius Locking Plate,

 Right, Medium; Matrix

 SmartLock Dorsal Radius

SK336 Matrix SmartLock Polyaxial Locking  Titanium Cross Pin Screws for  Matrix SmartLock Locking  $125.00

 System - Screws reconstruction of intra-articular and  Screws, diameter 2.7mm,

 extra-articular fractures of the distal  lengths 10-28mm; Matrix

 radius and reconstruction of the distal  SmartLock Bone Screws,

 diameter 2.7mm, lengths 8-

 38mm; Matrix SmartLock

 Cancellous Bone Screws,

SK372 Matrix - SMARTLock Polyaxial Locking  Radius Locking Plates Dorsal: Medium and Large, left  $1,450.00

 System for Distal Radius and Right; Palmer: Medium and

 Large, Long and Short

SK391 Leibinger Universal Distal radius System Universal Distal Radius SMARTLock  Radial Column - Long and  $1,350.00

 Column Locking Plates Short; Ulna Column - Long and

 Short, Left and Right

 Surgical House

SU169 Hallu-Fix Plates Composition - titanium, Hallu-C Plate: left Hallu-C Plate left and right  $654.00

  and right, Hallu-S Plate: left and right 40,45,50mm; Hallu-S Plate right

  50,55mm, left 60mm

 Synthes Australia Pty Ltd

SY016 AO/ASIF Plates  3.5mm cloverleaf 3-6 hole, length 104mm $674.40

SY017 AO/ASIF Plates 3.5mm calcaneal Length 60 - 70mm $752.47

Prostheses List by Category, Groups and Sponsor Page 510 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY018 AO/ASIF Plates Straight & Curved 3.5mm, reconstruction 5-22 hole $740.00

SY019 AO/ASIF Plates Steel, left & right, 4.5mm T & L plate,  3-12 hole $388.83

SY020 AO/ASIF Plates Steel, spoon plate,4.5mm  5-12 hole $415.00

SY021 AO/ASIF Plates Steel, left & right,4.5mm conylar buttress 7-15 hole $572.00

SY022 AO/ASIF Plates 3.5mm calcaneal 50-100 Length $524.27

SY023 AO/ASIF Plates Steel, left & right, lateral, proximal, tibial,  3-13 hole $830.87

 buttress, 4.5mm lateral tibial

SY024 AO/ASIF Plates  4.5mm cobra head 8-11 hole $572.00

SY025 AO/ASIF Plates  1.5mm, straight / T & H shaped / L- 3-20 hole / 9-100mm length $227.00

SY026 AO/ASIF Plates Steel, 3.5mm cloverleaf 3-9 hole / 88 - 184mm length $361.00

SY027 AO/ASIF Plates 2.0mm reconstruction 20 hole, length 100mm $274.00

SY028 AO/ASIF Plates Condylar Plate - Left & Right 2.0-2.7mm $227.00

SY029 AO/ASIF Plates  2.7mm straight, 1/4 tubular & DCP Plate 2-50 hole / 23 - 300mm length $369.00

SY030 AO/ASIF Plates Steel, DHS plates 130-150 deg/ 2-16 hole / 43- $875.00

 27mm length / barrel 25 - 38mm

SY031 AO/ASIF Plate Steel, 3.5mm narrow,  DCP/LCDCP 2-10 hole / length 25mm - 155mm $159.00

SY032 AO/ASIF Plates 3.5mm broad DCP/LCDCP 7-22 hole $240.00

SY033 AO/ASIF Plates   4.5mm semi tubular 2 - 28 hole $165.00

SY034 AO/ASIF Plates  4.5mm narrow, DCP/LCDCP 2-28 hole $378.00

SY035 AO/ASIF Plates  4.5mm broad,  DCP/LCDCP 2-28 hole $484.00

SY036 AO/ASIF Plates Tubular plate, 3.5mm 1/3 tubular 2-28 hole $157.93

SY037 AO/ASIF Plates Wrist fusion plate - standard bend, short  2-28 hole $1,456.00

 bend, straight

SY038 AO/ASIF Plates DHS trochanteric stabilizing plate sterile 3-16 hole $679.80

SY040 AO/ASIF Plates Osteotomy plate - adult  4 Hole /blade 40 - 110mm / 90- $854.12

 130 deg

SY042 AO/ASIF Plates - Steel 3.5mm - 1/3 tubular plate 2-12 hole / 25 - 145mm length $75.00

Prostheses List by Category, Groups and Sponsor Page 511 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY043 AO/ASIF Plates - Steel 3.5mm T plate 3-5 hole shaft / 3-4 hole head  $158.67

 (incl. oblique) length 38mm -

SY044 AO/ASIF Plates 2.7mm straight, 1/4 tubular & DCP 2-12 hole / length 23-63mm $330.00

SY045 AO/ASIF Plates 2.7mm, shaped plate 2-18 hole $113.00

SY046 AO/ASIF Plates 2.7 condylar Left & Right $376.00

SY052 AO/ASIF Plates Distal radius plate - volar plates - left &  2.4mm $963.05

SY053 AO/ASIF Plates DHS/DCS plate 125-160deg 2-28 hole $484.10

SY057 AO/ASIF K-Wires, Pins, Washers etc Wire mount One size only $109.00

SY058 AO/ASIF Plates 1.2mm and 1.3mm straight, external, T,   3-4 hole $420.00

 Y button plate,  2.4mm Unilock angled,

 straight, T, Y condylar, DCP

SY059 AO/ASIF Plates Unilock, angled, straight, T, Y, condylar,  2.4mm 16-20 hole $1,545.00

 DCP, LCDCP, left & right, plate

SY061 AO/ASIF Screws LISS screws - locking head & screw  5.0 x 81mm - 5.0 x 85mm $118.45

 hole insert

SY062 AO/ASIF Screws LISS fixator - Lat. proximal tibia / distal  5-13 holes $1,042.77

 femur / right & left

SY093 AO/ASIF Plates Specially manufactured plate all sizes Custom made $3,605.00

SY094 AO/ASIF Plates Shaped 2.0mm & 2.7mm $348.14

SY095 AO/ASIF Plates - Steel 4.5mm semi tubular 2-12 hole $79.00

SY096 AO/ASIF Plates - Steel 4.5mm narrow DCP/LCDCP 2-24 hole length 34-286mm $216.30

SY097 AO/ASIF Plates - Steel 4.5mm broad DCP/LCDCP 6-26 hole/ length 106 - 359mm $644.00

SY098 AO/ASIF Plates - Steel 4.5mm reconstruction 3 - 16 hole $415.00

SY099 AO/ASIF Plates 4.5mm lengthening broad 2-28 hole $294.00

SY100 AO/ASIF Plates 4.5mm Hook Plate 3-12 hole $530.00

SY101 AO/ASIF Plates Osteotomy Plate - Adult / LC angle blade  4 hole, 5-6 hole/30-40mm blade  $453.00

 / cannulated angle blade length/ 90 - 100 deg, 10- 20 mm

  displacement

Prostheses List by Category, Groups and Sponsor Page 512 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY102 AO/ASIF Plates Osteotomy plate - adolescent 90 deg, blade 40 - 60mm, displ  $278.00

 10 - 15mm

SY103 AO/ASIF Plates Osteotomy plate - infant Child, toddler & infant, 115 deg  $301.80

 bifurcated, blade 25 - 45mm, 80

  - 100 deg, 4 - 8mm offset,

 displ 7 - 12mm, height 49-

SY104 AO/ASIF Plates Osteotomy plate - high tibial 95 deg condylarprox tibia , 50- $1,042.77

 60 mm, displ 15-20mm

SY105 AO/ASIF Plates - Steel Condylar & small condylar, angled plate 5 - 24 hole, blade length 50 -  $974.00

 90mm, 95 degree

SY106 AO/ASIF Plates - Steel Angled plate 4 - 12 hole,  length 50 - 110mm  $1,081.50

 130 degree

SY107 AO/ASIF Plates - Steel DCS plate  95 deg, 10 hole - 22 hole, length $1,214.99

  100 - 370mm, barrel 25mm.

SY111 AO/ASIF Plates Specially manufactured plate 1.0mm - 6.5mm $3,914.00

SY112 AO/ASIF Plates Plate 1.5mm, 2 - 28 hole $401.70

SY113 AO/ASIF Plates 2.0mm condylar Left & right $420.00

SY114 AO/ASIF Plates 3.5mm narrow, DCP/LCDCP 2-22 hole $231.00

SY115 AO/ASIF Plates 3.5mm, T- PLATE - right & oblique  2-8 hole $294.00

SY116 AO/ASIF Plates 4.5mm recon plate 2-28 hole $840.00

SY117 AO/ASIF Plates 4.5mm,T-plate  - left & right 3 hole - 9 hole $572.00

SY118 AO/ASIF Plates 4.5mm, head buttress plate lateral tibial  5 - 13 hole $1,246.30

 left & right

SY119 AO/ASIF Plates 4.5mm condylar buttress plate left &  7 - 15 hole $1,246.30

SY120 AO/ASIF Plates 4.5mm, spoon plate  5 - 6 hole $300.00

SY121 AO/ASIF Plates 4.5mm condylar, angled plate 4-22 hole $1,200.00

SY122 AO/ASIF Plates 4.5mm, angled plate 4-22 hole $1,200.00

SY153 AO/ASIF Plates - Steel Osteotomy plate - shoulder Dislocation 80-90 deg.  blade  $920.00

 length 35 - 40mm

Prostheses List by Category, Groups and Sponsor Page 513 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY161 LCP Plate 1/3 Tubular Plate Dia 3.5mm, length 2-16 hole $175.00

SY162 LCP Plate Distal Tibial Plate, sterile/non sterile Dia 3.5 - 5.0mm, length 4-16  $1,800.00

SY163 LCP Plate Proximal Tibial Head Plate, Sterile/Non  Dia 3.5 - 5.0mm, length 4-18  $1,854.00

 Sterile

SY164 LCP Plate Distal Femoral Buttress Plate, Sterile/Non  Dia 5.0mm, length 4-22 hole $1,854.00

 Sterile

SY165 LCP Plate Tomofix Plate, Sterile/Non Sterile Dia 5.0mm, length 2-8 hole $1,211.62

SY166 LCP Plate Locking Proximal Humeral Plate,  Dia 3.5mm, length 4-10 hole $1,376.00

 Sterile/Non Sterile

SY167 LCP Plates Cloverleaf Plate, Dia 3.5mm, length 3-6 hole $300.00

SY168 LCP Plates Oblique left & right and right angled  Dia 3.5mm, length 3 - 6 hole $198.79

 plates, Sterile/Non Sterile

SY169 LCP Plate L & T Plates, L & T Buttress Plates,  Dia 3.5 - 5.0mm, length 2-10  $257.99

 Sterile/Non Sterile

SY170 LCP Plate Reconstruction Plate, Sterile/Non Sterile Dia 3.5 - 5.0mm, length 3-22  $598.00

SY171 LCP Spacer and LCP Washer Dia 2.7 - 5.0mm $62.83

SY172 LCP Plate Straight Plate, Sterile/Non Sterile Dia 3.5 - 5.0mm, length 2-20  $229.00

SY188 AO/ASIF Plates Calcaneal, Locking 3.5mm, 30 - 100mm $1,209.22

SY190 AO/ASIF Plates Proximal Tibial Plate 3.3mm-5.0mm dia 2.0-28mm $1,450.00

SY191 AO/ASIF Plates Medial Distal Tibial Plate 3.5 and 4.5mm, 6 - 12 hole $1,450.00

SY253 AO/ASIF Plates Foot plates - steel - multiple hole 2 - 4mm $669.50

SY259 Locking Distal Radius Plate System Small & Mini Fragment Plates - Volar Plate LCP - Volar Plate 2.4mm Left & $2,350.00

  Right, 2.4 Volar Plates Straight

SY279 Small & Mini Fragment Plates Locking Distal Radius Plate System LCP Dorsal T, L, Straight Plates $1,184.50

  2.4mm Long/Short

SY280 Small & Mini Fragment Plates Locking Distal Radius Plate System LCP-ORP Dorsal 2.4mm Plate  $1,715.00

 Left & Right

SY283 LCP Plate LCP  Olecranon Plate, left and right, non  2-20 hole plates $1,308.10

 sterile/sterile

Prostheses List by Category, Groups and Sponsor Page 514 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY284 LCP Plate LCP Distal humerus plate, dorso-lateral,  2-20 hole plates $1,308.10

 left and right, non sterile/sterile; LCP

 Distal humerus plate, dorso-lateral with

 support, left and right, non sterile/sterile;

 LCP Distal humerus plate, medial, left and

  right, non sterile/sterile

SY323 AO/ASIF Plates Unilock, angled, straight, T, Y, condylar,  2.4mm 4-12 hole $566.50

 DCP, LCDCP, left & right, plate

SY350 AO/ASIF Plate 3.5mm Reconstruction Plate 2-24 holes $530.00

 Zimmer

ZI209 ZPS Nut Small & Large $40.00

ZI210 ZPS Washer/Spiked washer Small & Large $43.00

ZI211 ZPS 1/3 Tube Plate 3 - 8 Hole $46.00

ZI212 ZPS Small Narrow Plate 3 - 8 Hole $113.00

ZI214 ZPS Mini Plates 3 - 8 Hole $153.00

ZI215 ZPS Small SCP plate 3 - 12 Hole $113.00

ZI216 ZPS SCP Forearm plate 4 - 12 Hole $113.00

ZI217 ZPS Buttress Plate 4 - 6 Hole $355.00

ZI218 ZPS Spoon Plates 5 - 6 Hole $243.00

ZI219 ZPS T Plate 68 - 147mm $248.00

ZI220 ZPS Cloverleaf plates 88 - 104mm $227.00

ZI222 ZPS Epiphysis plate 2 - 6 Hole $113.00

ZI223 ZPS 1/4 Tubular Plate 3  - 8 Hole $264.00

ZI224 ZPS Narrow Plate 2 - 12 Hole $243.00

ZI225 ZPS Broad Plate 5 - 14 Hole $449.00

ZI227 ZPS 3.5mm Straight Recon Plates 6 Hole $801.00

ZI228 ZPS 3.5mm Curved Recon Plates 6 Hole $857.00

Prostheses List by Category, Groups and Sponsor Page 515 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI230 ZPS 4.5mm Straight Recon Plate 6 Hole $880.00

ZI231 ZPS Recon Bridge Plate 4 Hole $950.00

Plugs

 Biomet Australia Pty Ltd

BI780 Optiplug Cement Restrictor Restrictor, PEGT/PBT 10-20mm Diameter $120.00

 De Puy Australia

DY077 Apex Hole eliminator  Hole eliminator screw Titanium One size only $266.00

 Howmedica

HW005 Artisan Bone Plug Artisan Cement Restrictor - Polyethylene Small, Medium, Large $180.00

HW009 HNR System Head Neck Replacement System - Non- Medium, Large, X-Large, XX- $2,600.00

 Porous Stem - Cobalt Chrome Large  Body Size 33, 43, 53mm

 Link Orthopaedic  Australia

LO106 Intramedullary Plug P/E Intramedullary Plug 12 to 20 mm $120.00

 Zimmer

ZI356 Medullary Plug, MS 30 Centring Plug, cement restrictor, hip - PE 1 to 7 $145.00

ZI451 Allofit screw hole plugs Sterile, 7 per set One size only $52.00

Prep Kits

 De Puy Australia

DP446 VacuMix Pre Loaded CMW Cement Vaccum Mixing System Pre Loaded with  50, 80 grams $484.00

 Non - Antibiotic Bone Cement

Prostheses List by Category, Groups and Sponsor Page 516 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Procedure Trays, Surgical

 William A Cook Aust Pty Ltd

WC135 Vertebroplasty Procedure Pack Percutaneous Vertebroplasty set with  11/13 Gauge 10/15CM M1,  $527.00

 Osteo-Site needle and bone cement M1M, M2

Prostheses, Arm

 Smith & Nephew Surgical Pty Ltd

SN138 Neer 3 Total Shoulder System Humeral stems Head size 15 - 16, stem diam 8 - $2,740.00

  12mm

Prostheses, Bone, Freeze-Dried

 Advanced Surgical Technologies

AD068 Surgibone Bovine Granulated Bone 4/12 mesh, 12/20 mesh $475.00

AD070 Surgibone Bovine Onlays & Pins 50mm, 80mm, 100mm,  $536.00

 120mm, 33mm x 11mm x 5.5mm

AD071 Surgibone Bovine Cubes 3 gram $300.00

AD072 Surgibone Bovine Cubes 10 gram $860.00

AD075 Surgibone Bovine Threaded Dowels 12mm, 13mm, 15mm $683.00

AD076 Surgibone Bovine Cavity Blocks & Granulated Bone 20mm x 20mm x 10mm, 20/30  $520.00

 Mesh

AD078 Surgibone Bovine Lumbar Blocks 30x15x14mm, 16mm, 18mm,  $1,016.00

 20mm, 22mm

Prostheses List by Category, Groups and Sponsor Page 517 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD081 Surgibone Bovine Tapered Disks, Cervical Blocks & 40x2x6mm, 8mm,10mm,  $777.00

  Dowels, Lumbar Blocks 50x2x6mm, 8mm, 10mm,

 12mm, 14mm, 30x10x14mm,

 16mm, 18mm, 20mm, 22mm

AD082 Surgibone Bovine Compound Wedge 55x25x10mm, 13mm, 15mm,  $831.00

 60x15x30mm

AD083 Surgibone Bovine Plain Wedge & Tapered Wedge 55mm x 15mm x 25mm, 50mm $635.00

  x 6mm, 8mm

Prostheses, Carpal

 Advanced Surgical Technologies

AD106 Orthosphere Yttria-stabilized zirconia ceramic 9mm - 14mm $2,150.00

AD167 Wright Swanson Titanium Carpal  Titanium 1 - 5 left and right $1,318.00

 Scaphoid, Carpal Lunate, Basal Thumb

Prostheses, Cerclage, Bone

 Global Orthopaedic Technology

GO092 C-Fix Cable Fixation System Titanium Leader Cable Assembly 1-1.3mm $1,200.00

 Howmedica

HW300 Dall Miles Cable Grip System - Stainless  Stainless Steel: Cable -  Stainless Steel 1.6 and 2mm  $250.00

HW301 Dall Miles Cable Grip System - Stainless  Stainless Steel: Sleeve -  Stainless Steel 1.6 and 2mm  $195.00

HW302 Dall Miles Cable Grip System - Stainless  Stainless Steel: Trochanter Grip -   Small, Medium, Large $545.00

 Stainless Steel

HW303 Dall Miles Cable Grip System - Stainless  Stainless Steel: Cable & Sleeve -   1.6 and 2mm  $360.00

 Stainless Steel

HW304 Dall Miles Cable Grip System - Stainless  Stainless Steel: Cable & Sleeve Beaded -   1.6 and 2mm  $330.00

 Stainless Steel

Prostheses List by Category, Groups and Sponsor Page 518 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW305 Dall Miles Cable Grip System - Stainless  Stainless Steel Plate:5 hole -  Stainless  6 inches $640.00

HW306 Dall Miles Cable Grip System - Stainless  Stainless Steel Plate:7 hole -  Stainless  8 inches $804.00

HW307 Dall Miles Cable Grip System - Stainless  Stainless Steel Plate:9 hole -  Stainless  10 inches $819.00

HW308 Dall Miles Cable Grip System - Stainless  Stainless Steel Plate:11 hole -  Stainless  12 inches $866.00

HW309 Dall Miles Cable Grip System - Vitallium Vitallium: Cable -  Vitallium 1.6 and 2mm $355.00

HW310 Dall Miles Cable Grip System - Vitallium Vitallium: Sleeve -  Vitallium 1.6 and 2mm $225.00

HW311 Dall Miles Cable Grip System - Vitallium Vitallium: Trochanter Grip -  Vitallium Small, Medium and Large $545.00

HW312 Dall Miles Cable Grip System - Vitallium Vitallium: Mini Cleat. Vitallium One size only $320.00

HW313 Dall Miles Cable Grip System - Vitallium Vitallium: Grooved Button -  Vitallium One size only $240.00

HW314 Dall Miles Cable Grip System - Vitallium Vitallium: Cable and Grip Combined -   1.6 and 2mm $555.00

 Vitallium

HW315 Dall Miles Cable Grip System - Vitallium Vitallium: Cable and Sleeve -  Vitallium 1.6 and 2mm $570.00

HW316 Dall Miles Cable Grip System - Vitallium Vitallium: Cable and Sleeve Beaded -   1.6 and 2mm $155.00

 Vitallium

 Plus Orthopedics Australia Pty Ltd

PL006 PLUS Endoprothetik Cerclage Systems CCG Band - Pure Titanium Length 27cm $450.00

PL007 PLUS Endoprothetik Cerclage Systems CCG-GF Band - Pure Titanium Length 27cm $625.00

PL033 PLUS Endoprothetik Cerclage System CCG Stabilizer with Band XS - L $1,290.00

 Stryker Australia Pty Ltd (2)

SK398 Trochanteric Grip Dall-Miles Trochanteric Grip Plate 100mm - 200mm $2,550.00

SK399 Trochanteric Grip Dall-Miles Trochanteric Grip Plate 110mm - 210mm $4,000.00

SK400 Trochanteric Grip Dall-Miles Trochanteric Grip with 2  Small, Medium and Large $1,400.00

 Stainless Steel Cables

SK401 Trochanteric Grip Dall-Miles Trochanteric Grip with 2  Small, Medium and Large $1,750.00

 Chrome Cobalt Cables

SK402 Trochanteric Grip Dall-Miles Trochanteric Grip Plate, with 2 100mm - 200mm $3,652.00

  Cables

Prostheses List by Category, Groups and Sponsor Page 519 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK403 Trochanteric Grip Dall-Miles Trochanteric Grip Plate, with 2 110mm - 210mm $5,102.00

  Cables

Prostheses, Femoral Head

 Stryker Australia Pty Ltd

ST569 Unipolar head system Neck extention, vitallium alloy -4 TO +12mm $285.00

ST821 Titanium Adapter Sleeve For use with V40 spiggots/trunnions One size only $165.00

ST927 Titanium Adapter Sleeve Composition - titanium, Morse taper Use with C-taper alumina heads  $160.00

 28, 32 and 36mm dia

Prostheses, Femoral, Upper

 Howmedica

HW048 Trochanteric Mesh Stainless Steel Small/Large $500.00

HW049 Trochanteric Mesh Wire mesh -  Stainless Steel 50 x 50mm $666.00

 Surgical House

SU065 Supravit hydroxapatite granules - 30g $610.00

 Taylor Bryant Pty Ltd

TB184 12/14 Modular U Necks Cobalt chrome Standard straight/Varus  $720.00

 Antecerted Nalgise

Prostheses, Finger/Thumb

 Advanced Surgical Technologies

AD163 WMT Orthopaedic Implants Hand Trapezium silastic 1, 2, 3, 4, 5 $590.00

AD164 WMT Orthopaedic Implants Hand Silastic tendon spacer 24in long, 3, 4, 5, 6mm wide $310.00

Prostheses List by Category, Groups and Sponsor Page 520 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 De Puy Australia

DP002 Roseland Thumb Trap CIM Small, Large $1,035.00

DP015 Roseland Thumb Meta 1/3 HAC & CIM Small, Large, Xlarge $1,792.00

DP017 Roseland Thumb Trap HAC Small, Large $1,028.00

DP573 Neuflex Finger    Neuflex MCP implant - Anasil Silicone Size 0-60 $762.00

DY400 Neuflex Finger Neuflex PIP 1 to 20 $770.00

 LMT Surgical Pty Ltd

LM011 Ascension PIP Pyrocarbon Total Joint Pyrocarbon Proximal Interphalangeal size  $1,400.00

 10, 20, 30, 40 distal, Proximal

 interphalageal size 10, 20, 30, 40

  proximal

LM012 Ascension MCP Pyrocarbon Total Joint Pyrocarbon implant 10D/10P, 20D/20P, 30D/30P,  $1,400.00

 40D/40P, 50D/50P,

 Taylor Bryant Pty Ltd

TB197 SR Hand Implant System SR Hand MCP/PIP/TMC (Basal Thumb)  XS/S/M/L/XL, 1,2,3,4,5 $1,569.00

 Implants - CoCr- Titanium Alloy,

Prostheses, Foot

 De Puy Australia

DY135 Barouk Screws 2.5mm x 10-22mm $287.80

Prostheses, Foot Arch

 Surgical House

SU009 Kalix  Flat foot implant titanium/UHWP 9-14mm diam $1,165.00

 TiMax Surgical Pty Ltd

TI075 Futura Domed Subtalar Implant UHMWPE Extra small, small, medium,  $1,290.00

 large, extra large

Prostheses List by Category, Groups and Sponsor Page 521 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TI076 Futura Conical Subtalar Implant Titanium 7 - 12 $1,390.00

Prostheses, Joint

 Advanced Surgical Technologies

AD159 WMT Orthopaedic Implants Finger/Thumb Silastic finger joint with/without Ti  00, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9 $585.00

 grommets 470 series

 Medimen Australia Pty Ltd T/A Alpha Medical Services

MM001 MOJE Toe and Finger Implants Includes distal and proximal implants $1,500.00

 Smith & Nephew Surgical Pty Ltd

SN032 Compass Universal Hinge Circular external hinged fixator, graphite  One size only $8,530.00

 composite

SN661 Compass PIP Kit assembly includes 0.45 x 5" K Wires,  Single sterile PIP Hinge Kit $955.00

 1 Small Pin Support Block, 1 Hexdriver, 1

  Compass PIP (Packed Sterile)

 Stryker Australia Pty Ltd

ST818 Osteonics Solar Elbow System - humeral  Titanium alloy with polyethylene bushing Standard, large $3,570.00

 assembly

ST819 Osteonics Solar Elbow System - long  Titanium alloy with polyethylene bushing Standard, large $4,618.00

 humeral assembly

ST820 Osteonics Solar Elbow System - ulna  Titanium alloy Small, standard, large $1,410.00

 component

 Taylor Bryant Pty Ltd

TB200 Proximal Interphalangeal Joint Implant Sutter Proximal Interphalangeal Joint  10, 20, 30, 40, 50 $600.00

 Implant - Silicon

TB201 Metacarpophalangeal Implant Sutter Metacarpophalangeal Joint Implant  00, 10, 20, 30, 40, 50 $600.00

 - Silicon

Prostheses List by Category, Groups and Sponsor Page 522 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Joint, Ankle

 De Puy Australia

DP871 Agility Ankle System Agility Ankle Talar Size 1 - 6 $2,679.00

DY082 Agility Ankle System Agility Ankle Tibial Shell Right and Left Size 1-6 $1,724.00

DY083 Agility Ankle System Agility Ankle Tibial Insert and +2 Size 1-6 $660.00

DY408 Agility Ankle System Mobile Bearing 1-6 from 3-11mm $925.00

DY409 Agility Ankle System Wide Ankle Talus 1 to 6 $3,675.00

DY418 Mobile Ankle System Tibial Tray Size 1-6 $2,000.00 $2,500.00

DY419 Mobile Ankle System Talus Size 1-6 $2,300.00 $3,600.00

 Endotec Australia Pty Ltd

EA001 BPU Revision Total ankle Prostheses Thick or Revision Talar - Ceramic coated 1-6 $4,900.00

  titanium

EA002 Buechel-Pappas Total Ankle Prosthesis -  Primary Talar - Ceramic coated titanium 1 to 6 $3,850.00

 Primary Talar

EA036 BPU Revision Total Ankle Prostheses Tibial componenet ceramic coated  1-6 $3,850.00

EA037 Buechel-Pappas Total Ankle Prosthesis -  Polyethylene mobile bearing 3mm - 11mm $925.00

 Primary Talar

 Link Orthopaedic  Australia

LO001 Star (cemented) Talar Component Small , medium & large $1,967.00

LO002 Star (cemented) Tibial Component Small, medium & large $1,587.00

LO003 Star (cemented) Polyethylene Sliding Core 6- 10 mm $555.00

LO004 Hydroxyapatite Coated (Hac) Talar Component Extra extra small, extra small,  $2,425.00

 small, medium & large

LO005 Hydroxyapatite Coated (Hac) Tibial Component Extra small, small, medium,  $1,915.00

 large & extra large

Prostheses List by Category, Groups and Sponsor Page 523 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Orthotech Pty Ltd

OH146 Ramses Total Ankle Replacement CrCo, Polyethylene - Tibial, Talar, Poly  Tibial - Sml/Med/Large $1,915.00

 Insert UHMWPE

OH147 Ramses Total Ankle Replacement CrCo, Polyethylene - Tibial, Talar, Poly  Talar - Sml/Med/Large $2,650.00

 Insert UHMWPE

OH148 Ramses Total Ankle Replacement CrCo, Polyethylene - Tibial, Talar, Poly  Poly Insert UHMWPE - Sml 10- $725.00

 Insert UHMWPE 16/ Med 11-17/ Large 12-18

 Surgical House

SU113 Hintegra Total Ankle Prosthesis Tibial implant Right and left, sizes 1 - 6 $2,000.00

SU114 Hintegra Total Ankle Prosthesis Talar implant Right and left, sizes 1 - 5 $2,300.00

SU115 Hintegra Total Ankle Prosthesis Sliding insert Sizes 1 - 5, thickness 5 - 9mm $622.00

SU116 Hintegra Total Ankle Prosthesis Cortical fixation screw, Composition -  Length 12 - 42mm $100.00

 Stainless Steel

SU188 Hintegra Total Ankle Prosthesis Talar Implant - Flat talar resection Left - Size 1-5, Right - Size 1-5 $3,193.00

SU191 Hintegra Total Ankle Prosthesis Tibial Implant Right & Left, Sizes 1 - 6,  $2,700.00

 Thickness 8mm or 12mm

 Tornier Pty Ltd

TO001 Cheville Salto Ankle Prostheses Components include tibial, mobile  Tibial/Talar Sizes 1small to 3 =  $6,250.00

 bearing, talar, malleolar for use as a total  x-large. Mobile Bearing

 ankle prostheses, Ti CoCr Thickness 4,5,6,7 mm.

Prostheses, Joint, Elbow

 Advanced Surgical Technologies

AD156 Sorbie Questor Elbow System Total joint CoCr and UHMWPE Left and right in sizing 48mm  $2,577.00

 wide, 46mm, 44mm

 Biomet Australia Pty Ltd

BI016 IBP Elbow Cemented, UHMWPE, Titanium, Cobalt  Small Standard, Large, Xlarge  $5,800.00

 Chrome

Prostheses List by Category, Groups and Sponsor Page 524 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI017 Kudo Elbow Humeral Component, Cemented , Cobalt  Small, Large $3,000.00

 Chrome

BI018 Kudo Elbow Ulnar Component, Cemented, Titanium Small, Large  $2,480.00

BI019 Kudo Elbow Humeral Component, Uncemented, Cobalt Small, Large  $3,200.00

  Chrome

BI020 Kudo Elbow Ulnar Component, Uncemented, Titanium Small, Large  $2,800.00

BI695 Liverpool Radial Head Replacement System Porous Coated CO CR Stem 16 x 18mm length, 18 x 14 -  $2,900.00

 28mm Length

BI781 Discovery Elbow System UHMWPE, Ti 3 - 6 mm x 75 - 150 mm $9,700.00

 De Puy Australia

DY137 Acclaim Elbow Humeral Stem, Std/Lge 100-200mm $7,185.00

DY138 Acclaim Elbow Ulnar Stem, Std/Lge-Left/Right 60-85mm $1,300.00

DY139 Acclaim Elbow Humeral Bobbin One size only $2,565.00

DY140 Acclaim Elbow Linked Ulnar Metal Bearing or  One size only $555.00

 Polyethylene Yoke

DY142 Acclaim Elbow Pin Assembly  or Pin or Poly sleeve  or  One size only $332.00

 Unlinked Poly Ulnar

DY146 Acclaim Elbow Linked Ulnar Bearing Screw One size only $230.00

DY288 Acclaim Elbow Unconstrained Ulnar Poly Bearing 15mm $230.00

 Howmedica

HW377 Souter Strathclyde Elbow Humeral - Long stem, left and right Medium, Large $2,665.00

HW378 Souter Strathclyde Elbow Ulnar - Retentive, non retentive 50 - 90mm (Non), 70 - 90mm  $1,670.00

 (Retentive)

HW379 Souter Strathclyde Elbow Revision Humeral  - Custom, Long Stem A, B, C, D $8,942.00

HW380 Souter Strathclyde Elbow Revision Ulnar - Custom, Long stem Small, Medium $4,425.00

 Link Orthopaedic  Australia

LO008 LINK Elbow Prosthesis Small, medium & large $5,247.00

Prostheses List by Category, Groups and Sponsor Page 525 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Tornier Pty Ltd

TO013 Tornier Latitude Total Elbow Prosthesis Ulnar Cap Small, Medium, Large $1,530.00

 Zimmer

ZI003 Coonrad-Morrey Elbow Ulna - Titanium Petite, Left, Right $3,577.00

ZI004 Coonrad-Morrey Elbow Humerus - Titanium 4, 6, 8 inch, Left & Right $4,618.00

ZI005 Coonrad-Morrey Elbow Bushing -  Polyethylene, Titanium 1 & 2 $1,440.00

ZI342 GSB Cemented Elbow GSB Humerus - CoCr alloy/PE 76,86,86L   $4,673.00

ZI343 GSB Cemented Elbow GSB Humeral Medullary Plug - PE One size only $173.00

ZI344 GSB Cemented Elbow GSB Ulna Component - CoCr alloy 12/71,12/61,16/71,16/61 $1,313.00

ZI345 GSB Cemented Elbow GSB Washer - PE 2/12,4/12,6/12,2/16,4/16,6/16  $138.00

ZI464 GSB Elbow Ulna Extension One size only $1,339.00

ZI465 GSB Elbow Special Bushing for Humerous Length 76 - 86mm $1,650.00

Prostheses, Joint, Hip

 Advanced Surgical Technologies

AD118 Transcend/Lineage Articulation System Apical plug titanium One size only $266.00

AD120 Transcend/Lineage Articulation System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm  $270.00

 increments long

AD131 WMT Perfecta Hip System PMMA cement spacer/Bone Plug 9 - 21mm in 1mm increments $270.00

 Corin Australia Pty Ltd

CR041 Hardinge Canal Occluder UHMWPE One size only $165.00

CR044 Taper Fit Hip System Canal Occluder Polymethyl Methacrylate Small & Standard $150.00

CR081 Oxford Hip System Cement Wiper One size only $180.00

 ESKA Australia

EK054 Nail TiNb Nail TiNb 3 x 30, 40, 50mm length $600.00

Prostheses List by Category, Groups and Sponsor Page 526 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EK055 Profi Peg Nail TiNb Peg TiNb 6 x 30, 40, 50mm length $600.00

EK057 Profi Peg Nail CoCr Peg CoCr 10 x 30, 40, 50mm length $600.00

EK058 Nail TiNb Nail TiNb 6 x 30, 40, 50mm length $600.00

 Global Orthopaedic Technology

GO019 UniSyn Hip System Locking nut Ti 30-54mm $200.00

GO041 Consensus Hip System 6.5mm Ti Cancellous Bone Screws 15mm to 50mm $200.00

GO042 Consensus Hip System Protrustion Spacer Ti 42mm to 68mm $1,035.00

 Orthotech Pty Ltd

OH145 Coriolis CrCo - Fixation screws, Support Ring Support Ring - 44-64 $235.00

 Smith & Nephew Surgical Pty Ltd

SN019 Low Profile Classic Compression Hip  130 - 150 deg Hot forged stainless steel 5 - 6 holes $365.00

 Screw System

SN020 Osteotomy Plates Blade, 130 deg Adult osteotomy 50 - 110mm $975.00

SN021 Osteotomy Plates Blade, 95 deg Adult osteotomy 50 - 80mm $395.00

SN022 Osteotomy Plates Blade, Adult osteotomy 4 hole 40 - 80mm $983.00

SN023 Osteotomy Plates Blade, 90 deg adolescent osteotomy 3  40 - 60mm $294.00

SN024 Osteotomy Plates Blade, 130 deg Angled Blade Plate Small  shaft 60 - 152mm $20.00

 Stature 50 - 80mm

SN025 Osteotomy Plates Blade, 95 deg Condylar Blade 40 - 70 Shaft 92 - 156mm $56.00

SN139 Osteotomy Plates Blade, 90 deg Infant Osteotomy 25 - 32mm $87.00

SN140 Low Profile Classic Compression Hip  130 - 150 deg Hot forged stainless steel 3 - 4 holes $350.00

 Screw System

Prostheses, Joint, Hip, Acetabular Component

 Biomet Australia Pty Ltd

BI702 Par 5 Protrusio Acetabular System Screws - Titanium Metal 6.5mm $450.00

Prostheses List by Category, Groups and Sponsor Page 527 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI915 Batcup 6.5mm Ti Cancellous Bone Screws 12mm to 45mm $180.00

 Global Manufacturing Technology Pty Limited

GM050 Contile Fin II 6.5mm Ti Cnacellous Bone Screws 20 to 50mm $225.00

 Plus Orthopedics Australia Pty Ltd

PL127 Reko Reconstruction Cage Spacer for Reconstruction Cage 5mm, 10mm, 15mm $1,035.00

PL128 Reko Reconstruction Cage Fixation Screw for spacer 1 size $250.00

PL129 Reko Reconstruction Cage Cancellous bone screw 6.5 x 20, 6.5 x 55 $320.00

Prostheses, Joint, Hip, Femoral Component

 B Braun Australia Pty Ltd

BB276 Excia Hip System Distal Centraliser 8mm-18mm $140.00

BB277 Excia Hip System Cement plug 8mm-18mm $185.00

 De Puy Australia

DP884 Streamline Centraliser - Size 11-16 $207.00

DY147 C-Stem End Cap One size only $137.00

DY168 G2 Hip System Distal Centraliser 1 - 11 $409.00 $420.00

DY403 Modular Cathcart Unipolar Spacers -3 to +10mm $1,035.00

 Mathys Orthopaedics Pty Ltd

MA018 Intramedullary Plug Cement Restricter Small to Extra Large $209.00 $217.00

MA026 Distal Centraliser For fullfix stem - PMMA Dia 8.0/9.5mm - 15/12mm $150.00

 Orthotech Pty Ltd

OH200 Lima Modulus Hip System Modular total Hip Replacement, Titanium Neck w/screw, small and large $3,000.00

 Smith & Nephew Surgical Pty Ltd

SN753 Accord Cable System Titanium Plate 150mm $1,900.00

SN754 Accord Cable System Titanium Plate 250mm $2,500.00

Prostheses List by Category, Groups and Sponsor Page 528 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN755 AccordCable System Titanium Plate 200mm $2,200.00

 Stryker Australia Pty Ltd

ST801 Accolade C Femoral Hip System Distal modular PMMA spacer Small, medium, large $145.00

 Taylor Bryant Pty Ltd

TB063 Groupe Lepine U Neck Straight/anteverted/retroverted/  $700.00

 valgus/varus

 Zimmer

ZI311 Spacer-G Temporary implantable device for the  Short Stems,  Head size 46mm,  $2,025.00

 treatment of infected total hip  54mm, 60mm

 replacement, Composition - stainless steel

  core surrounded by PMMA impregnated

ZI312 Spacer-G Temporary implantable device for the  Long Stems, Head size 46mm,  $2,530.00

 treatment of infected total hip  54mm, 60mm

 replacement, Composition - stainless steel

  core surrounded by PMMA impregnated

Prostheses, Joint, Hip, Total

 B Braun Australia Pty Ltd

BB238 Acetabular Fixation Screws Isotan 16mm-68mm $129.00 $140.00

BB245 Distal centraliser PMMA 7mm - 18mm $140.00

 Biomet Australia Pty Ltd

BI098 Kent Hip System Transverse Screws, Titanium 4.5mm x (26-55mm) $480.00

BI105 Bi Hapro Hip System Acetabular Screws, Titanium Alloy 6.5mm x(15 to 50mm)  $290.00

BI109 Mallory Head Hip System Screw, Acetabular (6.5 - 5.5)mm dia x (15 -  $160.00

 70)mm length

BI122 Mallory Head Hip System Trochanter Bolt, Titanium Round/Oblong $495.00

BI123 Mallory Head Hip System Trochanter Plate, Titanium   Sizes 40-70 $460.00

Prostheses List by Category, Groups and Sponsor Page 529 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI124 Modular Calcar Mallory Head Revision  Trochanteric Claw, Titanium Medium, Large  $430.00

 Hip System

BI125 Modular Calcar Mallory Head Revision  Trochanteric Connector Sizes 40-70mm $570.00

 Hip System

BI130 Bio-Plug Cement Restrictor Canal Plug, UHMWPE "7-20mm" $200.00

BI131 Mallory Head Hip System Femoral Sleeve, UHMWPE 9-17mm $270.00

BI140 Mallory Head Hip System Acetabular Shell, Ringloc.  Replacement  Size 1 $190.00

 Ring, Titanium alloy

BI144 Bio-Plug Cement Restrictor Compression plug, PMMA Sizes 8-25mm $400.00

 Corin Australia Pty Ltd

CR027 Freeman -Morgan Total Hip System Canal occluder 12,14,16mm diameter $334.00

CR079 Oxford Universal Hip System Distal stem lock nut One size only $170.00

CR080 Oxford Universal Hip System Cement restrictor 22, 26, 28 & 32mm $207.00

 De Puy Australia

DP192 Thackray Hip System Charnley cement restrictor EA  One size only $205.00

 Polymethylmethacrylate

DP224 Thackray Hip System Charnley Spring Wires - Stainless Steel 0.5mm to 3.00mm $349.00

DP250 Anatomic Medullary Locking System Locking Rings Titanium Size 38 - 74 $168.00

DP296 Cementraliser Cementraliser  Size 10 -13 $206.00 $213.00

DP297 Cementraliser Stem Centraliser Distal Centralisers 10-18mm $208.00

DP298 Centralisers Centraliser  Size 11 - 18 $206.00 $213.00

DP976 SROM Total Hip System (Titanium) Locking Pin Acetabular  5.0mm $158.00

DP986 SROM Total Hip System (Titanium) Trochanteric Washer  40 x 31, 60 x 45, 70 x 54 $566.00

DP998 SROM Total Hip System (Titanium) Acetabular Apical Hole Plug        One size only $126.80

DP999 SROM Total Hip System (Titanium) Unipolar Adaptor Sleeve +10 $165.00 $624.00

DY020 SROM Total Hip System (Titanium) Trochanteric Screw 42mm, 52mm, 62mm $583.00

Prostheses List by Category, Groups and Sponsor Page 530 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK052 Cancellous Screw Cancellous Screw TiA1V 15mm - 90mm $225.00

 Global Manufacturing Technology Pty Limited

GM046 Edinburgh Total Hip System PMMA - distal plug and centraliser 12mm to 30mm $242.00

GM053 SMR Modular Hip System Locking Screw 40 to 70mm $200.00

GM058 SMR Modular Hip System 6.5mm Cancellous Bone Screws 15 - 80mm $200.00

GM059 SMR Modular Hip System 4.5mm Cortical Bone Screws 20 to 80mm $64.00 $200.00

 Howmedica

HW011 ABG Hip System Screw - Titanium, used with ABG11  12,15,20,25,30,35,40,45 and  $118.77

 50mm lengths

HW012 ABG Hip System Spikes - Titanium, used with ABG11  7mm, 8mm, 9mm lengths $85.00

HW034 Definition PM Femoral Component Distal Centraliser -  PMMA -  Ring  11-22mm $55.00

 Centraliser

HW047 Exeter Hip System X-Change Bone Screws -  Stainless Steel 3.5mm X 10, 15, 20, 25, 30,  $129.00

HW057 RELIANCE HIP Distal Centraliser -  PMMA 10-18mm $55.00

HW071 Vitalock Acetabular System Cancellous Bone Screw -  Vitallium 12mm to 30mm in 2mm  $150.00

 increments - 35mm to 50mm in

 5mm increments

 Orthotech Pty Ltd

OH102 Lima Total Hip Replacement System UHMWPE Cement Plug 8mm - 16mm $250.00

OH110 Lima Total Hip Replacement System Lateralising Spacer B, C, D, E $1,055.00

OH111 Lima Total Hip Replacement System Titanium  Bone Screw 20 - 60mm $230.00

 Plus Orthopedics Australia Pty Ltd

PL040 PLUS Hip Joint Prostheses System CPS Centralizer 1 to 5 $180.00

PL041 PLUS Hip Joint Prosthesis System Cancellous bone screw titanium 15-60mm long 6.4mm dia $280.00

PL052 PLUS Hip Joint Prostheses System Cover for HI shell 3-5, 6-11 $250.00

Prostheses List by Category, Groups and Sponsor Page 531 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Smith & Nephew Surgical Pty Ltd

SN269 CPCS Polished Cemented Stem Distal  8 - 18 $120.00

SN284 Screws Cancellous 15mm - 50mm $185.00

SN292 Reflection Fixation peg Titanium Alloy One size only $181.00

SN361 ITH Trunnion Sleeve One size only $165.00

SN364 Matrix: Modular Hip System Revision Distal Sleeve, Porous and Non- Straight Sizes 8-16, 10 -   $1,051.00

 Porous 21mm, x +10mm, 60mm ; 

 Bowed  Sizes 8 - 16,  x +85mm,

SN365 Matrix: Modular Hip System Sleeve -Trunnion One size only $165.00

 Stryker Australia Pty Ltd

ST545 Osteonics hip prostheses  Cancellous bone screw, Titanium 6.5mm & 5.5mm dia $137.00

ST551 Osteonics hip prostheses Dome hole plug titanium One size only $165.00

ST581 Osteonics hip prostheses Distal spacer  PMMA 8-15mm $155.00

ST582 Osteonics hip prostheses  Cement restrictor Polyethylene Universal and sizes 1-8 $155.00

ST596 Osteonics hip prostheses Custom made for extended indications   Custom made per patient $1,125.00

 titanium, polyethylene, vitallium

 Stryker Australia Pty Ltd (2)

SK315 Exeter Hip System Exeter Distal Centraliser -PMMA One Size Only $142.80

 Tornier Pty Ltd

TO006 Bone Plug UHMWPE - Cement Plug 24mm $215.00

 Zimmer

ZI013 Zimmer Hip Systems Femoral Stem CPT PMMA Centraliser  PMMA Size 1 $142.00

ZI020 Zimmer Hip Systems Femoral Stem VerSys Proximal Centraliser - PMMA 11 - 17 $100.00

ZI021 Zimmer Hip Systems Femoral Stem VerSys Distal Centraliser - PMMA 10 - 18 $140.00

ZI036 Acetabular Cup Trilogy Bone Screw - Titanium 15 - 60 $230.00

ZI188 Zimmer Bone Cement Systems Poly Medullary Plug - PMMA 8 - 23 mm $120.00

Prostheses List by Category, Groups and Sponsor Page 532 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI329 CPT Impaction Grafting Mesh Titanium Femoral or acetabular mesh 6 sizes acetabular rim (small and $3,367.00

  large), medial wall (small and

 large), flat and femoral meshes

ZI366 Natural Hip System Distal Centraliser - PE 10 to 19 $245.00

ZI374 MS-30 Hip prosthesis  Centralizer for Cemented Stems (Protek)  8 to 18 $145.00

 - metal alloys

ZI473 APR Conversion Ring Titanium 39 to 71 $906.00

ZI474 Durom Hip Resurfacing System -  Forged CoCr allo A1 to L1 $126.00

 Adaptor Sleeves

Prostheses, Joint, Knee

 De Puy Australia

DP384 AMK Total Knee system Primary Locking Pin S/S One size only $290.00

 Smith & Nephew Surgical Pty Ltd

SN339 Genesis Compression Screws 16-22mm $90.00

SN342 Genesis Custom Flex Lock Peg Left & right $150.00

SN343 Genesis Custom Peg 10x65mm - 20x325mm $250.00

SN346 Genesis Flex-Lok Peg Fem & Tibial $90.00

SN347 Genesis I/M Peg: Femoral and Tibial: Titanium 10-16mm Diameter x  40- $250.00

 200mm Length

SN357 Genesis Tibial Compression Screw 16-22mm $149.00

SN376 Profix I/M Peg Femoral or Tibial 10-20mm x 100mm. 10- $1,254.00

 20x150mm 10-20 x 200mm

SN377 Profix Metaphyseal Tibial Stem 14-20mm $644.00

SN393 Profix Tibial Screw 15-50mm $80.00

SN723 Genesis II Revision Tibial Wedge Screw 10-100mm $2,700.00

Prostheses List by Category, Groups and Sponsor Page 533 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Stryker Australia Pty Ltd

ST044 Scorpio Augmentation Locking Screw Cobalt Chrome 5-15mm $138.75

 Zimmer

ZI079 Miller Galante I Bone Screw - Ti 20 - 60mm $135.00

ZI089 Miller Galante II Bone Screw - Ti 20 - 80mm $177.00

ZI132 NexGen Knee High Tibial Osteotomy  Plate - Ti 1 - 10 $632.00

ZI133 NexGen Knee High Tibial Osteotomy  Screw - Ti 4.5 - 10 - 80 mm, 6.5 - 10 - 80  $250.00

ZI313 Spacer-K Temporary implantable device for the  Small, Medium, Large $2,079.00

 treatment of infected total knee

 replacement, Composition - stainless steel

  core surrounded by PMMA impregnated

ZI398 High Tibia Osteotomy High Tibia Osteotomy - Ti alloy L shaped steel alloy plate;   $964.00

 Standard & Long

ZI406 Natural Knee Tibial Spacer Screw - Ti alloy One size only $250.00

ZI407 Natural Knee Tibial Spacer Peg - Ti alloy One size only $250.00

Prostheses, Joint, Knee, Femoral Component

 Stryker Australia Pty Ltd (3)

SR037 Triathlon Primary Knee System PS  Modular femoral distal fixation peg one size $400.00

 Femoral Pegs

 Zimmer

ZI516 Trabecular Metal Femoral Cone  Trabecular Metal Femoral Void Filling  Small, Medium, Large $6,000.00 $8,150.00

 Augment

Prostheses List by Category, Groups and Sponsor Page 534 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Joint, Knee, Total

 Advanced Surgical Technologies

AD176 Advantim Total Knee System Cortical Bone Screws, Femoral, Titanium 4.5mm x 2.0 - 7.5cm in 0.5cm  $220.00

 increments long

 Australian Surgical Design & Manufacture Pty Ltd

AE042 Active Knee System Bone Screw Titanium 20mm - 50mm $135.00

 Biomet Australia Pty Ltd

BI173 Maxim Complete Knee System Tibial Locking Bar, Titanium One size only $120.00

 Global Orthopaedic Technology

GO120 RBK Total Knee System Screw, Ti 5mm to 5.7mm x 5mm to  $280.00

 17.5mm long

 Link Orthopaedic  Australia

LO038 LINK Endo Model Rotational Knee  Intracondylar Total Rotation Knee Joint:  Small, medium & large $12,289.00

 Without Patella Flange

LO039 LINK Endo Model Rotational Knee  Intracondylar Total Rotation Knee Joint:  Small, medium & large $13,241.00

 With Patella Flange

LO040 LINK Endo Model Rotational Knee  Intracondylar total rotation knee join with  Small, medium & large $13,541.00

 Anti Lux device: without patella flange

LO045 LINK Endo Model Rotational Knee  Total Rotational Knee Joint with Anti Lux  Small, medium & large $13,752.00

 Device, with Patella Flange and

 Replacement of Femoral and/or Tibial

 Bone Structures, proximal tibia

LO056 LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): tibial  9- 16.5mm $2,596.00

 Orthotech Pty Ltd

OH159 Academia Knee CoCr, Titanium, Femoral, Tibial, Bearing, Stems 70-140 length/ 10-14mm  $743.00

  Stems & Patellar

 Smith & Nephew Surgical Pty Ltd

SN318 Genesis II  Lug One size only $204.00

Prostheses List by Category, Groups and Sponsor Page 535 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN319 Genesis II  Metaphyseal Stem 1-8 $644.00

SN329 Genesis II  Tibial screws  15-50mm $135.00

SN367 Mobile Bearing Knee Locking Screw Co Cr One size only $203.00

Prostheses, Joint, Shoulder

 Advanced Surgical Technologies

AD184 Olympia-Total Shoulder System Cobolt chrome head standard & +/-3mm 40,44,48,52,56,60mm $1,525.00 $2,500.00

AD201 Olympia - Total Shoulder System Slotted and non slotted stem Length 72 & 125mm, width 6 -  $3,500.00

 16mm

AD202 Olympia - Total Shoulder System Revision stem Length 175 & 225mm, width 10 $4,965.00

  - 16mm

AD203 Olympia - Total Shoulder System All poly finned glenoid 40, 44, 48, 52, 56, 60mm $1,350.00

 Biomet Australia Pty Ltd

BI207 Bi-Angular Shoulder System Humeral Prostheses, Titanium 6.5mm-14mm $3,464.00

BI208 Bi-Angular Shoulder System Bi Polar Shell, Titanium/  Size 40-60mm $1,660.00

 UHMWPE/Chrome Cobalt

BI209 Bi-Angular Shoulder System Bi Polar Head, Chrome Cobalt Std to +4mm $1,300.00

BI210 Bi-Angular Shoulder System Glenoid Metal backed. UHMWPE, Titanium Small Medium Large x 4 or  $2,050.00

BI211 Bi-Angular Shoulder System Glenoid, UHMWPE Small Medium Large x 4 or  $1,900.00

BI212 Bi-Angular Shoulder System Humeral Head, Chrome Cobalt 40-52mm $1,040.00

BI213 Bio-Modular Shoulder System Bi-Polar cup 40-60mm $1,100.00

BI214 Bio-Modular Shoulder System Bi-Polar shell/ Titanium, chrome Cobalt 40-60mm $1,660.00

BI215 Bio-Modular Shoulder System Humeral Head, Chrome Cobalt 40-54mm $1,400.00

BI216 Bio-Modular Shoulder System Humeral Stem, titanium 6-15mm $3,500.00

BI217 Bio-Modular Shoulder System Glenoid Component, Cemented,  Small, Medium, Large x 4 or 7mm $1,731.00

 Titanium/UHMWPE

Prostheses List by Category, Groups and Sponsor Page 536 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI218 Bio-Modular Shoulder System Modular Head, Chrome Cobalt Std, +2, +4mm $1,310.00

BI219 Bio-Modular Shoulder System Glenoid Liner Noncemented, UHMWPE Low Profile $1,020.00

BI220 Bio-Modular Shoulder System Glenoid Screw 5mm x (15-40mm) $145.00

BI221 Bio-Modular Shoulder System Glenoid Shell, Titanium Low Profile $1,660.00

BI222 Bio-Modular Shoulder System Shoulder Offset Head, Chrome Cobalt 40-54mm $2,330.00

BI223 Nottingham Shoulder System Humeral Stem, Chrome Cobalt, Titanium 6-12mm $3,500.00

BI224 Nottingham Shoulder System Humeral Head, Chrome Cobalt Std +2, +4mm  $1,310.00

BI225 Nottingham Shoulder System Glenoid Tray, Chrome Cobalt Size 3, 4, 5.  $1,620.00

BI226 Nottingham Shoulder System Glenoid Bearing, UHMWPE Size 3, 4, 5. $1,100.00

BI227 Kirschner Integrated Shoulder System Neer II Humeral, Chrome Cobalt,  Stem 6.3 to 12.7mm Head 15- $3,345.00

 22mm

BI228 Kirschner Modular Shoulder Humeral Head, Modular, Chrome Cobalt 38-51mm $1,525.00

BI229 Kirschner Modular Shoulder Humeral Stem, Chrome Cobalt 6.3 -15.9mm $3,500.00

BI230 Kirschner Modular Shoulder Glenoid Component, UHMWPE Small, Std $1,850.00

BI231 Humeral Replacement System Proximal Shoulder System: Chrome  Body: std, +10mm Stem  6.5- $12,366.00

 Cobalt, Titanium, UHMWPE  12.5mm Sleeve 6.5-12.5mm

 Humeral Head 40-52mm

BI342 Copeland Shoulder System Glenoid, UHMWPE One size only $1,965.00

BI343 Copeland Shoulder System Humeral, Chrome Cobalt Small, Std, Large (no specific  $2,330.00

BI344 Copeland Shoulder System Glenoid Component, HA Coated, Chrome  Small, Std, Extra Deep (no  $3,300.00

 Cobalt, UHMWPE specific size)

BI345 Copeland Shoulder System Humeral Component, Chrome Cobalt Small, Std, Large (no specific  $3,200.00

BI835 Bio-Modular Shoulder System Extended Articular Surface Humeral  40 - 54mm $1,950.00

 Head, CrCo

BI880 Mosaic Humeral Replacement System Mosaic System - CoCr, Ti Proximal Body - Std to +20 $5,200.00

BI881 Mosaic Humeral Replacement System Mosaic System - CoCr, Ti Segment - 80 to 140 mm $4,500.00

Prostheses List by Category, Groups and Sponsor Page 537 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI882 Mosaic Humeral Replacement System Mosaic System - CoCr, Ti Stem - 6.5 to 14.5 mm x 50 to  $3,000.00

 200 mm

 De Puy Australia

DP020 Global Advantage Shoulder Eccentric Head, Cobalt chrome alloy 44- 56mm x 18, 21mm $1,824.50

DP029 Global Advantage Shoulder Revision Stem Titanium alloy 8mm x 200mm - 14mm x 220mm $4,965.00

DP030 Global Advantage Shoulder Stem Standard, Titanium alloy 6mm - 16mm $3,500.00 $4,300.00

DP077 Global Advantage Shoulder Global Advantage Stem STD or Long  Size 8 to 14 or Length 6-16mm $3,845.00

DP081 Global Shoulder Global Advantage HUM HD  Size 44 - 52 by size  x 15 /18 or $1,525.00

DP086 Global Shoulder  Global FIN/ Peg  Glenoid Size 40-56 $2,215.00

DP898 S-Fit Metal Glenoid S-FIT Glenoid Bearing  Size 40-52 $1,040.00

DP899 S-Fit Metal Glenoid S-FIT M/B Glenoid  Size 40-52 $2,920.00

DP950 Delta Shoulder system Standard Metaglene  INOX/ ST. Steel +  One size only $2,100.00

 Aluminia+HAC

DP951 Delta Shoulder system Revision Metaglene INOX/ ST. Steel +  One size only $2,508.00

 Aluminia+HAC

DP952 Delta Shoulder system Centror Glenoid INOX / ST.Steel /  Size 36-40 /42 $2,290.00

 Nichtrostender St.

DP954 Delta Shoulder system Metaglene Screw Stainless Steel 3.5mm and 4.5mm $213.00

DP956 Delta Shoulder system Cementless Diaphysis INOX/ ST. Steel +  Size 1-4 $3,875.00

 Aluminia+HAC

DP957 Delta Shoulder system Cemented Epiphysis INOX/ ST. Steel +  Size 1-4 in 26-42mm $2,436.00

 Aluminia+HAC

DP958 Delta Shoulder system Humeral Cup Laterilised Polyethylene 36-42mm in  +0 to +6 /STD /  $815.00

 LAT /STD Retentive

DP962 Delta Shoulder system DELTA Humeral Head INOX / ST.Steel /  36 - 42 mm in +0-+4 $1,200.00

 Nichtrostender St.

DP964 Delta Shoulder system Humeral Spacer INOX / ST.Steel /  Dia 36/42 + 9 $1,420.00

 Nichtrostender St.

Prostheses List by Category, Groups and Sponsor Page 538 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP965 Delta Shoulder system Revision Cementless Diaphysis INOX /  Size 1-4 $3,818.00

 ST. Steel + Aluminia+HAC

DP966 Global FX Shoulder Global FX Stem Chrome 6-12mm and STD and revision  $3,969.00

 160-220mm length

DY129 Global Advantage CTA Head 44 x 18 - 56 x 23 $5,495.00

DY273 Global FX Porocoat FX PC Stem Standard / Long 6-12mm $3,500.00 $4,297.98

DY360 Global Advantage Shoulder Anchor Peg Glenoid 40 to 56 mm $2,770.00

 Device Technologies Australia Pty Ltd

DE168 Univers 3D Shoulder Prostheses Stem 6-12mm $5,880.00

DE169 Univers 3D Shoulder Prostheses Glenoid Metal Back Small, Medium, Large $1,419.00

DE170 Univers 3D Shoulder Prostheses Glenoid PE-Inlay Small, Medium, Large $920.00

DE171 Univers 3D Shoulder Prostheses Metal Head 43/15 - 51/22 $1,130.00

DE172 Univers 3D Shoulder Prostheses Cemented glenoid Small, Medium, Large $930.00

DE173 Univers Fracture Prostheses Shaft 8-13mm $6,220.00

DE174 Univers Fracture Prostheses Metal head 43/15 - 51/22 $1,519.00

 ESKA Australia

EK028 ESKA Modular Shoulder System Humeral Stem Universal $2,295.00

EK071 ESKA Modular Shoulder System Stem Extension 20mm - 40mm $400.00

EK072 ESKA Modular Shoulder System Humeral Plate 35mm - 43mm $1,285.00

EK073 ESKA Modular Shoulder System Humeral Component 20mm - 40mm $2,920.00

EK074 ESKA Modular Shoulder System Glenoid Universal Size $950.00

 Global Manufacturing Technology Pty Limited

GM102 Lobe Lok Total Shoulder System CTA Head Small to Large $3,230.00

GM103 Lobe Lok Total Shoulder System Contoured Glenoid Flange Ti Small to Large $2,035.00

GM104 Lobe Lok Total Shoulder System Lobe Lok Head 30mm CrCo Small to Large $2,875.00

GM105 Lobe Lok Total Shoulder System Humeral Socket Ply Insert-UHMWPE Small to Large $1,903.00

Prostheses List by Category, Groups and Sponsor Page 539 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GM106 Lobe Lok Total Shoulder System Humeral Socket Shell-Ti small to large $2,940.00

 Johnson & Johnson Medical Pty Ltd

JJ557 DELTA Xtend Non Locking Metaglene Screw Dia 4.5 4.5mm; 18, 24, 30, 36, 42 $215.00

JJ558 DELTA Xtend Locking Metaglene Screw Dia 4.5 4.5mm; 24, 30, 36, 42, 48 $276.00

JJ559 DELTA Xtend Standard Humeral PE Cup 38 + 42;  3, 6, 9mm $815.00

JJ560 DELTA Xtend Retentive Humeral PE Cup 38 + 42; 6mm $815.00

JJ561 DELTA Xtend Humeral Spacer 9mm $1,420.00

JJ562 DELTA Xtend Metaglene $2,096.00

JJ563 DELTA Xtend Revision Metaglene $2,508.00

 Mathys Orthopaedics Pty Ltd

MA422 Articula Shoulder Prosthesis Articula Humeral Head Bionit Ceramic  44mm, 46mm, 48mm $5,650.00

 (A1203)

MA465 Articula Shoulder Prosthesis Articula Central Part (TiA16V4) 18mm & 15mm $1,550.00

MA466 Articula Shoulder Prosthesis Artucula Humeral Stem (TiA16V4, A1203) 8mm x 125mm, 9.5mm x  $2,575.00

 125mm, 11mm x 125mm, 8mm

  x 175mm, 9.5mm x 175mm &

 11mm x 175mm.

 Medical & Optical  Instruments Australia Pty Ltd

MO147 Acumed Shoulder Joint Prostheses  Titanium 130 to 280mm stem,13 to  $6,800.00

 15mm body, 16 to 23mm head.

 Orthotech Pty Ltd

OH082 Lima RPS Tumor System RPS Humeral Head 46, 52, 58mm $3,680.00

OH083 Lima RPS Tumor System RPS Total Shoulder Replacement Stem 200, 240, 280mm $6,900.00

OH084 Lima RPS Tumor System RPS Additional Spacer 40, 60, 90, 120mm $1,900.00

OH085 Randelli Total Shoulder Randelli Shoulder Uncemented Stem 8 - 16mm $2,800.00

OH086 Randelli Total Shoulder Randelli Neutral Taper 0 - 6mm $950.00

OH087 Randelli Total Shoulder Randelli Humeral Head 42, 46, 50, 54mm $2,330.00

Prostheses List by Category, Groups and Sponsor Page 540 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

OH088 Randelli Total Shoulder Randelli Eccentrical Adapter 0 - 6mm $1,000.00

OH089 Randelli Total Shoulder Randelli Humeral Body with Locking Screw One size only $2,580.00

OH090 Randelli Total Shoulder Randelli Shoulder Cemented Stem 8, 10, 12, 14, 16mm $2,900.00

OH113 Lima Randelli Shoulder System Cemented Glenoid Mini, Small, Standard $1,990.00

OH114 Lima Randelli Shoulder System Uncemented Glenoid Mini, Small, Standard $2,220.00

OH115 Lima Randelli Shoulder System Uncemented Glenoid Liner Mini, Small, Standard $1,960.00

 Smith & Nephew Surgical Pty Ltd

SN395 Cofield Humeral stem component Standard & Long, small- large $2,740.00

SN396 Cofield Screw Long, Short, Standard $193.00

SN397 Cofield  Glenoid All Polyethylene component Small, Standard $1,650.00

SN398 Cofield  Glenoid Component Metal backed Standard Base. Base Insert.   $2,220.00

 Glenoid Comp Sm, Stan, St

SN399 Cofield  Glenoid Insert Small, Standard $400.00

SN400 Modular Cofield + 2 insert Small, Standard, Standard with  $1,620.00

 offset

SN401 Modular Cofield All Poly + 2 insert Small, Standard, Standard with  $1,620.00

 offset

SN403 Modular Cofield Humeral Head 14x36mm - 36x58mm $1,500.00

SN404 Modular Cofield Humeral Stem 6mmx115mm - 16mmx245mm $3,070.00

SN407 Modular Cofield Posterior Lipped All poly Glenoid Small - Large $1,650.00

SN409 Modular Cofield Standard Articular Insert Small, Standard $470.00

SN410 Neer Neer II Humeral 22 x 6.3-9.5mm, 33 x 12.7mm,  $1,235.00

 15 x 6.3-12.7mm

SN411 Neer Neer II Glenoid Standard Glenoid  Resurf  $950.00

 Glenoid XS Metal Back Glenoid

SN668 Standard Stems Humeral Components Modular Shoulder System, Chromium  6 - 16mm Diameter, 125 -  $935.00

 175mm Length

Prostheses List by Category, Groups and Sponsor Page 541 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN669 Standard Humeral Components Modular Shoulder System Humeral Head,  11.25 - 25mm Height, 40 -  $1,080.00

 Chromium Cobalt 49.5mm Diameter

SN676 Genoid Components Anatomic Glenoid Component, Ti-6A1- Extra Small & Standard $2,220.00

 4V, UHMWPE

 Stryker Australia Pty Ltd

ST027 Solar - Dual Offset Humeral Head Cobalt Chrome 40-50mm diameter, 15-21mm  $2,330.00

 thickness

ST672 Osteonics Solar Shoulder Prostheses  Humeral head polyethylene 40-55mm by 12-34mm $1,525.00

ST673 Osteonics Solar Shoulder Prostheses Dual offset humeral head polyethylene 40,45,50mm Diameter by 15,  $1,356.00

 18, 21mm Thickness

ST674 Osteonics Solar Shoulder Prostheses  Humeral stem polyethylene 3,5,7,9,11 $3,845.00

ST675 Osteonics Solar Shoulder Prostheses  Glenoid component polyethylene 5,7,9,11 $2,365.00

ST676 Osteonics Solar Shoulder Prostheses Solar bipolar humeral inner head, cobalt  22mm with 0, +2 and +4mm  $1,835.00

 chromium neck lengths

ST877 Osteonics Solar Shoulder Prostheses Solar bipolar humeral  outer head, cobalt  22mm with 0, +2 and +4mm  $1,835.00

 chromium neck lengths

 Tornier Pty Ltd

TO002 Aequalis Primary Shoulder Prostheses Includes Glenoid component, Humeral  6.5-15mm - 1mm increm wide,  $3,600.00

 Stem & Screw + Humeral Head, Ti CoCr 66-167mm long

TO003 Aequalis Primary Shoulder Prostheses Humeral Head CoCr, includes the Glenoid Diameter:  $1,327.00

  component, Humeral Stem & Screw +  37,39,41,43,46,48,50,52mm

 Humeral Head.

TO004 Aequalis Primary Shoulder Prostheses UHMWPE Keeled Glenoid Component 31mm,35mm,39mm dia (small,  $1,670.00

 medium & large)

TO010 Aequalis Shoulder Prostheses Reverse Ti,CoCr, UHMWPE Reverse Humeral  Stem 6.5-15mm dia, 100- $13,515.00

 Stem, Gleno sphere, metaphysis, base  210mm long. Base plate,

 plate, insert & fixation screws sphere,metaphysis (diameter 36

 & 42mm). Insert (dia 36 &

 42mm x6,9,12mm high. Screws

TO011 Aequalis Shoulder Prostheses Reverse CoCr Reverse Humeral Neck diameter 36 & 42mm wide x  $1,827.00

 9mm high

Prostheses List by Category, Groups and Sponsor Page 542 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Zimmer

ZI289 Bigliani Shoulder System Cobalt Chrome Lengths 130 - 200mm,  $3,026.00

 Thickness 6 - 16mm

ZI300 Bigliani Shoulder System Bigliani-Flatow Shoulder - Heads (Cobalt  40, 46, 52, 52mm diameters $843.00

 chrome)

ZI304 Bigliani Shoulder System Bigliani-Flatow shoulder - Glenoid  40, 46 and 52mm diameters $2,320.00

 (UHMWPE)

ZI319 Bigliani Flatow Total Shoulder System -  Trabecular Metal Backed Glenoid  Diameter 40 - 52mm $4,088.00

 Glenoids (uncemented)

ZI440 Anatomical Glenoid - PE S, M, L $1,459.00

ZI441 Select Shoulder Humeral Head Eccentric - CoCr alloy 44/19 to 56/32  $1,747.00

ZI442 Select Shoulder Glenoid - PE S, M, L, XL  $920.00

ZI443 Select Shoulder Stem - Ti alloy 7mm Short to 14.5mm $3,770.00

ZI444 BiPolar Head Humeral Head used with Select Shoulder  26/42 to 26/60 $1,401.00

 Humeral Stem - CoCr alloy/ PE

ZI445 Intermedics Select Shoulder UniPolar Head  -metal alloy 40 x 16mm to 56 x 32mm $1,148.00

ZI446 Intermedics Select Shoulder Long Stem - Ti alloy 7 to 14.5mm $3,550.00

Prostheses, Joint, Toe

 Advanced Surgical Technologies

AD109 WMT Orthopaedics Implants Hinge Toe  Silastic flexible hinge toe with/without  0, 1, 2, 3, 4, 5, 6, 7 $577.00

 and Hammertoe Implant grommets

AD110 Wright Titanium Great Toe Great toe titanium 0,1, 2, 3, 4 $1,308.00

AD277 LPT Great Toe Implant Titanium LPT Metatarsal Component  Sizes 1, 2 & 3 Regular Great  $1,290.00

 available in Regular and Angled Toe Toe Implants. Sizes 1 & 2

 Angled Great Toe Implants

 Biomet Australia Pty Ltd

BI021 Total Toe System Metatarsal Component UHMWPE, Titanium Small, Medium, Large Extra  $2,000.00

Prostheses List by Category, Groups and Sponsor Page 543 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI022 Toe Joint Replacement Phalangeal Component, Titanium Small, Medium, Large Extra  $1,073.00

 De Puy Australia

DP883 Barouk SCR Sys Staples and Buttons Barouk Screw System Button Prosthesis  8-20mm $307.00

 - SS or Ceramic

 Plus Orthopedics Australia Pty Ltd

PL004 Toefit - Plus Titanium alloy Metatarsal Component XS-L $810.00

PL005 Toefit - Plus Titanium Alloy Phalangeal Component XS-L $790.00

PL045 Toefit - Plus Chromium Cobalt Distal Insert 13 - 17mm $740.00

PL046 Toefit - Plus Polyethylene Polyethylene Distal Insert 11 -  $530.00

 15mm

PL047 Toefit - Plus Chromium Cobalt Proximal Insert 6, 7, 8 $800.00

 Surgical House

SU129 Reflexion 1st MPJ Implant System Reflexion metatarsal stems, 3 part 1st  Small, medium, large $991.00

 MPJ reconstruction system, 2 part

 composition - titanium/cobalt chrome, 1

 part composition - titanium/UHMWPE,

SU130 Reflexion 1st MPJ Implant System Reflexion metatarsal heads, 3 part 1st  Standard, long, extra-long $560.00

 MPJ reconstruction system, 2 part

 composition - titanium/cobalt chrome, 1

 part composition - titanium/UHMWPE,

SU131 Reflexion 1st MPJ Implant System ReflexionPhalangeal Bases, 3 part 1st  Small, medium, large $1,000.00

 MPJ reconstruction system, 2 part

 composition - titanium/cobalt chrome, 1

 part composition - titanium/UHMWPE,

 Taylor Bryant Pty Ltd

TB145 Great Toe M-P Joint Metallic Hemiarthroplasty resurfacing  Small 17mm, medium 20mm,  $1,020.00

 prostheses for the hallux  large 23mm

 metatarsophalangeal joint

TB232 Toe Joint Metallic Hemiarthroplasty resurfacing  8mm, 8.75mm, 9.5mm,  $1,205.00

 prosthesis for the Hallux  10.25mm, 11mm, 11.75mm,

 Metatarsophalangeal Joint 12.5mm, 13.25mm, 14mm

Prostheses List by Category, Groups and Sponsor Page 544 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Joint, Wrist

 Advanced Surgical Technologies

AD211 SWANSON II Wrist Joint Implant Silicone Intermedullary Stemmed Implant  1, 2, 3, 4, 5 $1,070.00

 - Titanium Grommet Optional

 De Puy Australia

DP127 Biax Wrist Biax Wrist STD and Long Small - Large $3,570.00

 Global Orthopaedic Technology

GO083 Nex-Link Spinal Fixation System, Spinal Rod 120 & 240mm $350.00

 LMT Surgical Pty Ltd

LM010 Universal Total Wrist Implant System  Consists of 3 parts, proximal radius  Radial Component - Small - left  $9,500.00

 component made of cobalt/chrome, distal & right, Medium - left & right,

  titanium plate, titanium screws and  Large - left & right; Carpal

 polyethylene joint surface Component - Small, Medium,

 Large; Polyethylene Carpal

 Component - Small - Standard,

 +1, +2,  Medium - Standard,

 +1, +2, Large - Standard, +1,

 +2; Bone Screws - 4.5mm

 Diameter 15 - 35mm lengths

LM056 Ascension DRUJ Ulna Head, Implant  Cobalt chromium stem with PyroCarbon  0, 1, 2, 3, 4 $2,300.00

 or Cobalt Chromium Articular Surface

LM058 Ascension Total Wrist Replacement Stainless, Poly and Chrome Cobalt Total  Radial, Carpal and Poly  $9,500.00

 Wrist Replacement Components: X - Small - Large

 Orthopaedic Solutions Pty Ltd

OE002 BioProfile Pyrocarbon Carpal  Includes: Proximal Scaphoid; Scapho- One Size Only $4,350.00

 Trapezium; Resurfacing Capitate &

 Trapezium Interposition Implants.

 Composition: Pyrolitic Carbon

Prostheses List by Category, Groups and Sponsor Page 545 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Leg

 De Puy Australia

DY187 Limb Preservation System Proximal Femoral Body Component  Neutral in Std, Trochanter body $6,990.00

 Left/Right

DY188 Limb Preservation System Distal Femoral Replacement Component  Extra small $15,300.00

 Left/Right

DY189 Limb Preservation System 2cm LPS Femoral Stem Cemented  11 mm diameter x 150 mm  $7,230.00

 length - 17 mm diameter x 200

DY190 Limb Preservation System 2cm LPS Femoral Stem Porous Coated  12.5 mm diameter x 150 mm  $7,220.00

 (Bowed) length - 18.5 mm diameter x

 200 mm length

DY191 Limb Preservation System Total Femoral Segment Component  55 mm $1,700.00

 (Male/Male)

DY192 Limb Preservation System Segmental Component (Male/Female) 25 to 65mm Length $1,825.00

DY193 Limb Preservation System Standard Cemented Stem (straight) 9 mm diameter x 100 mm length $4,550.00

  - 17 mm diameter x 125 mm

DY194 Limb Preservation System Standard Porous Stem (straight) 10.5 mm diameter x 100 mm  $4,875.00

 length - 18.5 mm diameter x

 125 mm length

DY195 Limb Preservation System Tibial Replacement Component X-Sm - Med $8,645.00

DY196 Limb Preservation System Tibial Hinge Insert X-Sm 12mm height - Med 31  $7,288.00

 mm height

DY217 Limb Preservation System Intercalary Segment Component  55mm $7,288.00

 (Male/Female)

 Howmedica

HW110 Howmedica Modular Resection System Total Knee Reconstruction 120mm, 140mm, 160mm $18,967.00

HW188 Howmedica Modular Resection System Growing Prosthesis -  Vitallium Expandable prostheses -   $26,429.00

 Custom made to child

Prostheses List by Category, Groups and Sponsor Page 546 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW189 Howmedica Modular Resection System Femoral Head -  Vitallium 32mm in short, medium, long  $1,444.00

 and 22mm, 26mm standard

HW190 Howmedica Modular Resection System Femoral Head 26mm -  Vitallium 26mm $656.00

HW193 Howmedica Modular Resection System Distal Femur -  Vitallium 120, 140, 160mm $6,980.00

HW194 Howmedica Modular Resection System Femoral Joint -  Vitallium One size only $3,502.00

HW198 Howmedica Modular Resection System Patella -  Polyethylene Small, Medium, Large $743.00

HW199 Howmedica Modular Resection System Circlip -  Vitallium One size only $74.37

HW203 Howmedica Modular Resection System Bearing -  Vitallium One size only $178.00

HW210 Howmedica Modular Resection System Fixation Plate -  Vitallium One size only $462.00

HW211 Howmedica Modular Resection System Barr Bolt -  Vitallium 51, 57, 64, 70, 76, 83mm $93.24

HW212 Howmedica Modular Resection System Barr Bolt Nut -  Vitallium 51, 57, 64, 70, 76, 83mm $88.00

HW213 Howmedica Modular Resection System Humeral Bearing -  Vitallium One size only $175.38

HW214 Howmedica Modular Resection System Humeral Head Fixed -  Vitallium One size only $3,388.00

HW215 Howmedica Modular Resection System Humeral Head Rotating -  Vitallium One size only $4,526.00

HW216 Howmedica Modular Resection System Distal Humerus Cone -  Vitallium One size only $4,580.00

HW217 Howmedica Modular Resection System Distal Humerus Flange -  Vitallium One size only $4,347.00

HW218 Howmedica Modular Resection System Humerus Connection Piece -  Vitallium One size only $4,122.00

HW219 Howmedica Modular Resection System Humerus Connecting Screw -  Vitallium One size only $653.00

HW220 Howmedica Modular Resection System Humerus Hex Socket Bolt -  Vitallium One size only $565.00

HW221 Howmedica Modular Resection System Humerus Extension Piece -  Vitallium 5, 15, 30, 45, 60, 75, 90, 105,  $5,243.00

 120, 135, 150, 165mm

HW222 Howmedica Modular Resection System Humeral Anchorage Piece -  Vitallium 9, 10, 11, 12mm $4,393.00

HW223 Howmedica Modular Resection System Ulna Joint -  Vitallium One size only $3,783.00

HW224 Howmedica Modular Resection System Humeral Axis -  Vitallium One size only $829.00

HW225 Howmedica Modular Resection System Revision Bushing -  Vitallium One size only $211.00

HW226 Howmedica Modular Resection System Revision Rings -  Vitallium One size only $984.00

Prostheses List by Category, Groups and Sponsor Page 547 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

HW235 Howmedica Modular Resection System Duration Plug Screw Axis -  Vitallium One size only $241.00

HW236 Howmedica Modular Resection System Duration Femoral Bushing -  Vitallium One size only $495.00

HW237 Howmedica Modular Resection System Duration Tibial Insert -  Polyethylene 6, 10, 14mm $2,539.00

HW238 Howmedica Modular Resection System Duration Tibial Sleeve -  Vitallium 10, 12, 13, 14, 15, 16, 17,  $1,128.00

HW239 Howmedica Modular Resection System Duration Bumper -  Vitallium One size only $997.00

HW240 Howmedica Modular Resection System Duration Wedge -  Vitallium One size only $258.00

HW241 Howmedica Modular Resection System Duration Bearing -  Vitallium One size only $199.00

HW242 Howmedica Modular Resection System Duration Fixation Plate -  Vitallium One size only $508.00

HW247 Howmedica Modular Resection System Oncology Femoral Stem -  Vitallium 127mm and 203mm length 11,  $3,847.00

 13, 15, 17mm diameter

HW252 Howmedica Modular Resection System Oncology Duration Tibial Insert -   Small and Medium in 11, 13, 16, $1,790.00

 Polyethylene  21mm

HW253 Howmedica Modular Resection System Oncology Duration Tibial Plug -   One size only $1,847.00

HW254 HMRS Oncology Humeral Head/Cap Cobalt Chromium 40, 44mm, Cap $4,260.00

HW255 Howmedica Modular Resection System Oncology Humeral Body -  Titanium 40 - 140mm in 20mm increments $2,827.00

HW256 HMRS Oncology Humeral Stem Cobalt Chromium 7x75mm, 7x115mm, 9x75mm,  $4,778.00

 9x115mm, 11x115mm,

 25mmx75mm, 25mmx100mm,

 50mmx75mm,

 50mmx100mm,75mmx100mm,

 100mmx50mm

 Stryker Australia Pty Ltd (2)

SK163 Howmedica Modular Resection System GMRS Adaptors for Restoration (inc  Standard, +10mm, +20mm,  $3,625.00

 locking bolt), Titanium/Cobalt Chrome

SK165 Howmedica Modular Resection System GMRS Press fit stems straight 11, 12, 13, 14, 15, 16, 17, 18,  $4,020.00

 19mm

SK172 Howmedica Modular Resection System GMRS Adaptors Male/Female Taper,  Male Taper; Female Taper $1,965.00

 Titanium/Forged Cobalt Chrome

Prostheses List by Category, Groups and Sponsor Page 548 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Ligament

 Corin Australia Pty Ltd

CR032 Lars Ligamanet Augmentation  Woven polyester prosthetic ligaments 60,80,100 & y shaped fibres $4,156.00 $4,534.00

 reconstruction system

 Smith & Nephew Surgical Pty Ltd

SN777 GTS Sleeve Polypropylene non-absorbable woven  one size only $270.00

 Surgical House

SU059 ABC Prosthetic Ligament Cruciate prosthesis carbon  12.5cm-18.5cm; ABC Carbon  $3,600.00

 fibre/polyester, ABC Carbon/Polyester  Polyester & ABC

 Medial/Lateral Collateral Ligament, ABC  Polyester/Polyester - One size

 Polyester/ Polyester Medial/Lateral

SU062 Surgicraft Fixation bollard One size only $475.00

 Zimmer

ZI182 Zimmer Internal Fixation Systems: Soft  Statak/Mini-Statak - Suture, Stainless  2, 5 mm - 5, 0mm $240.00

 Tissue Re-attachment Device

Prostheses, Meningeal

 W L Gore & Associates

GT054 Preclude Spinal Membrane ePTFE 0.7mm Thickness 6 x 6cm $472.00

GT055 Preclude Spinal Membrane ePTFE 0.7mm Thickness 6cm x 12cm $785.00

Prostheses, Radial Head

 Corin Australia Pty Ltd

CR002 Corifix Radial Head Implant Cobalt chrome Small - Large $1,325.00

Prostheses List by Category, Groups and Sponsor Page 549 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Howmedica

HW381 Radial Head Prostheses Radial Head - Small, Medium, Large 8 - 15mm $2,245.00

 Tornier Pty Ltd

TO005 Radial Head Prostheses  Ti CoCr, Elbow prostheses, consists of  Stem 6.5mm & 8mm Mod Head $3,816.00

 Radial Stem + Cup.  size 19mm & 22mm

Prostheses, Radial/Ulna Head

 Advanced Surgical Technologies

AD105 Evolve Modular Radial Head Cobalt chromium alloy, standard and plus Stem 5.5 - 9.5mm Standard & +4 $1,325.00

  stems

AD160 WMT Orthopaedic Implants Radial/Ulna  Radial head implant HP silastic 1, 1.5, 2, 2.5, 3 $730.00

 Head

AD161 WMT Orthopaedic Implants Radial/Ulna  Radial head titanium 1, 1.5, 2, 2.5, 3 $1,720.00

 Head

AD283 E-Centrix Ulnar Head Replacement Ulnar Head 16 x 1.5mm Offset, 16 x  $1,525.00

 3.0mm Offset, 18 x 1.5mm

 Offset, 20 x 1.5Offset, 20 x

AD284 E-Centrix Ulnar Head Replacement Ulnar Stem 5.5 STD, 6.5 STD, 7.5 STD,  $1,410.00

 8.5 STD

AD285 E-Centrix Ulnar Head Replacement Ulnar Stem Extender 20mm $820.00

AD303 Evolve Modular Radial Head Cobalt chromium alloy head Head 20-28mm Std +2 and +4mm $1,334.00

 Medical & Optical  Instruments Australia Pty Ltd

MO145 Martin Ulna Head prosthesis Stem Titanium Small, medium and  $2,258.00

 large,2mm,4mm and 17mm

MO146 Martin Ulna Head prosthesis Ceramic Head, Chromium Cobalt Small, medium and large $2,800.00

 Taylor Bryant Pty Ltd

TB204 Ulnar Head Implants Ulna Head - CoCr Stem: 2,3,4 Head: 2,3,4 $1,334.00 $2,208.00

TB205 Radial Head Implants Radial/RECON RHead - CoCr Stem: 2,3,4  Head: 2,3,4,4N $2,072.00

Prostheses List by Category, Groups and Sponsor Page 550 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Soft Tissue

 De Puy Australia

DY136 Restore Orthobiologic Soft Tissue  Restore Patch One size only $5,935.00

Prostheses, Tendon

 Surgical House

SU055 Gateshead rod (Arthrotomy set) -pack of 3 Cartilage repair-carbon fibre implant 3 x 12.5mm $830.00

SU056 Gateshead rod (Arthrotomy set) -pack of 5 Cartilage repair-carbon fibre implant 3 x 12.5mm $1,045.00

Prostheses, Tibial

 Link Orthopaedic  Australia

LO006 Revision Tibial Component - Extra small, small, medium,  $2,204.00

 large and extra large

Prosthesis

 Orthotech Pty Ltd

OH172 Tenolig Percutaneous Achilles Tendon Repair  Diameter .85 mm - Length 33  $1,586.00

Prosthesis, Internal, Joint, Ankle, Total

 ESKA Australia

EK043 PE Articular Surface Component Ankle  4mm, 6mm, 8mm $595.00

Prostheses List by Category, Groups and Sponsor Page 551 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EK046 Talar Component Ankle Joint Cementless CoCrMo Small, Medium, Large $2,750.00 Temporary Listing pending

 review of product group

EK051 Tibial Component Ankle Joint Cementless Tibial Component Ankle Joint  Small, Medium, X-Medium,  $1,980.00 Temporary Listing pending

 Large, X-Large review of product group

EK053 Tibial Component Ankle Joint Cementless Tibial Component Ankle Joint CoCrMo Small, Medium, X-Medium,  $1,980.00 Temporary Listing pending

 Large, X-Large review of product group

EK075 Talar Component Ankle Joint Cementless  CoCRMo/Ha Small, Medium, Large $2,750.00 Temporary listing pending review

  of product group

 Finsbury Orthopaedics Australia Pty Ltd

FI030 Box Ankle Tibial Component CoChr. Cementless Small, Medium and Large $1,980.00 Temporary Listing pending

 review of product group

FI031 Box Ankle Talar Component CoChr. Cementless Small, Medium and Large $2,750.00 Temporary Listing pending

 review of product group

FI032 Box Ankle Meniscal Insert, UHMWPE Small 5-8mm, Medium 5-8mm  $595.00 Temporary Listing pending

 and Large 5-8mm review of product group

 LMT Surgical Pty Ltd

LM044 KMI Total Ankle Replacement The ankle is a three component system  Small, Small +, Medium,  $6,250.00 $6,500.00

 consisting of a CoCr with titanium plasma Medium +, Large, Large +

  spray (TPS) talus component and tibia

 component and a bearing component

 made of untra high molecular weight

 polyethylene (UHMWPE).

Prosthesis, Internal, Joint, Digit

 De Puy Australia

DY410 Hand and Foot Fracture Systems FRST wist off screw 11 to 14mm $309.00 $380.00

DY411 Hand and Foot Fracture Systems FRSStandard Staple, Straight 8 to 10mm $300.00

DY412 Hand and Foot Fracture Systems FRS Screw 10mm to 34mm L x 2.5mm  $309.00

 Diameter

DY413 Hand and Foot Fracture Systems FRS .S.O.C Pin 9 to 40 mm Thread Length $228.50

Prostheses List by Category, Groups and Sponsor Page 552 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 ESKA Australia

EK012 ESKA Great Toe Metatarsal Components; Phalangeal  various sizes $2,800.00

 Components

EK013 ESKA Finger System Proximal, distal MCP joints, PIP joints various sizes $1,732.00

 Global Manufacturing Technology Pty Limited

GM087 ROTO-glide Great Toe System Metatarsal, CrCo, Porous Titanium, HA Small, Medium, Large $924.00 Temporary Listing pending

 review of product group

GM088 ROTO-glide Great Toe System Meniscus, UHMWPE Small, Medium, Large - 6 to 7mm $531.00 Temporary Listing pending

 review of product group

GM089 ROTO-glide Great Toe System Phalangeal, CrCo, Porous Titanium, HA Small, Medium, Large, X-Large $970.00 Temporary Listing pending

 review of product group

 LMT Surgical Pty Ltd

LM015 Kinetik Great Toe Implant Phalangeal Component made of titanium  0,1,2,3 $2,400.00

 alloy 01-2010, 01-2012, 01-2014, 01-

LM016 Kinetik Great Toe Implant Metatarsal Component  made of chrome  1, 2, 3 Right & Left $2,000.00

 cobalt 01-2002, 01-2004, 01-2006, 01-

 2003, 01-2005, 01-2007

LM018 Ascension Silicone MCP Replacement MCP - Injection - Moulded Medical  Size 10, 20, 30, 40, 50 $800.00

 Grade Silicone Elastomer; SMCP-500-10,

  20, 30, 40, 50

LM028 Ascension Pyrocarbon CMC Finger  Pyrocarbon layer encasing a graphite  10 - 40 $1,935.00

LM031 K2 Hemi Toe Implant System Cobalt Chrome with Titanium plasma  1-4 $1,500.00

LM047 Ascension IBD Pyrocarbon interpositional prosthesis  1-5 $1,500.00

 intended for use in the CMC basal thumb

LM053 Osteotec Silicone PIP Joint Replacement 2 component hinged joint replacement for 5 - 50 $560.00

  the proximal interphalangeal joint

 Mathys Orthopaedics Pty Ltd

MA081 Finger Prosthesis - distal, proximal, standard,  L18 D4.0 - L26 D6.0 $1,600.00 $2,000.00

 Orthotech Pty Ltd

OH202 Daphne Metacarpophalangeal Joint Prosthesis 3, 4, 5, 6 $1,040.00

Prostheses List by Category, Groups and Sponsor Page 553 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Taylor Bryant Pty Ltd

TB257 Avanta - Preflex MCP Finger Joint Implant 00/10/20/30/40/50/60mm $611.00

TB328 MCP Finger Prosthesis "Ariadna" Distal part, Stainless Steel 1,2 or3 $1,040.00 Tempory approval, pending

 review of product group

TB330 MCP Finger Prosthesis "Ariadna" Proximal part, Stainless Steel 1,2,or 3 $1,248.00 Tempory approval, pending

 review of product groups

TB333 Trapezio Metacarpal Prosthesis DLC Stem - Cobalt Chrome 1 or 2 $884.00 Temporary approval, pending

 review of product group

TB334 Carpal Screw Titanium 2.5mm diameter in sizes 12mm  $125.00

 - 20mm length

TB335 Elektra Stem Cobalt Chromium/Hydroxyapatite coated 6-8mm $1,664.00 Temporary approval, pending

 review of product group

TB336 Elektra Neck Cobalt Chromium Extra Short, Short, Medium,  $780.00 Temporary approval,pending

 review of product group

TB337 Memofix Staples Nitinol 10-17mm x 12-20mm Length $718.00

TB339 Trapezio Metacarpal Prosthesis DLC Neck Cobalt Chrome Short, Medium or long $780.00 Tempory approval, pending

 review of product group

TB344 PIP Finger Prosthesis "DGT" Distal part, Stainless Steel texture with  1,2 or3 $1,040.00 Temporary approval, pending

 Cobalt Chrome review of product group

TB346 Elektra Cup Cobalt Chromium and Hydroxyapatite  One size only $884.00 Temporary approval, pending

 review of product group

TB347 Hemi CAP Articular Resurfacing Great  Articular Component 12mm (1-2mm x 1.5-3mm  $1,500.00

 Toe System offset), 15mm (1.5-2.5mm x

 2.5-4.5mm offset)

TB348 Hemi CAP Articular Resurfacing Great  Fixation Component 8mm x 16mm, 9.5mm x 18mm $900.00

 Toe System

Prostheses List by Category, Groups and Sponsor Page 554 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Joint, Elbow, Humeral Component

 Device Technologies Australia Pty Ltd

DE257 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis Head 41/16 - 53/20 $1,600.00

 Tornier Pty Ltd

TO012 Tornier Latitude Total Elbow Prosthesis Humeral Spool, Humeral Stem, Ulnar  Humeral Spool - (Small,  $9,925.00

 Medium, Large) (Anterior,

 Posterior, Centered) (Left,

 Right); Humeral Stem - (Small,

 Medium, Large) (Left, Right);

 Ulnar Stem - (Small, Medium,

Prosthesis, Internal, Joint, Elbow, Radial Component

 De Puy Australia

DY414 Guepar Radial Implants Radial Stem, Radial Head +0 to+4 $1,558.25

DY415 Guepar Radial Implants Radial Stem, Radial Head 14/12mm to 16/16mm $1,558.25

 Tornier Pty Ltd

TO014 Tornier Latitude Total Elbow Prosthesis Radial Head, Radial Stem Radial Head - (Small, Medium,  $1,980.00

 Large); Radial Stem - (Diameter

 - 5mm, 6.5mm)

Prosthesis, Internal, Joint, Knee, Total

 B Braun Australia Pty Ltd

BB210 Columbus TKS Obturator - Extension Stem Small & Large D12 to 14 $1,110.00 $1,200.00

BB241 End cap Modular tibial component 12mm, 14mm $820.00

BB242 Extension stem Modular tibial component 12mm, 14mm, short and long $1,110.00 $1,200.00

Prostheses List by Category, Groups and Sponsor Page 555 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Endotec Australia Pty Ltd

EA024 Buechel-Pappas Ultracoat Total Knee  Ceramic Coated, Titanium Femoral and  BP Rebar Screws 20mm -50mm $220.00

 Replacement System (Primary and  Tibial components with mobile   (inc)

 polyethelene inserts all polyethelene patella

  ceramic coated, titanium backed

Prosthesis, Internal, Joint, Knee, Unicondylar

 B Braun Australia Pty Ltd

BB199 Emotion TKS Articulating surface-posterior stabilized T1 to T8 Sizes: 10 to 24mm $936.00

BB200 Emotion TKS Extension Shaft Short, D: 10 to 20 , Medium, D: $1,110.00 $1,200.00

  10 to 20, Long, D: 10 to 20

Prosthesis, Internal, Joint, Shoulder, Glenoid Component

 ESKA Australia

EK076 Rotator Cuff Head CTA Head Rotator Cuff Head CoCr small, medium, large $2,330.00 $3,000.00

 Johnson & Johnson Medical Pty Ltd

JJ555 DELTA Xtend Eccentric Glenosphere 38 + 42 $2,375.00

JJ556 DELTA Xtend Standard Glenosphere 38 + 42 $2,290.00

 Tornier Pty Ltd

TO015 Aequalis Pegged Glenoid USA Pegged Glenoid Polyethylene (UHMWPE) Small, Medium, Large, Extra  $1,995.00

Prosthesis, Internal, Joint, Shoulder, Humeral Component

 Device Technologies Australia Pty Ltd

DE256 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis  41 - 53mm $3,400.00

DE258 Eclipse Humeral Head Prosthesis Eclipse Humeral Head Prosthesis Cage  Small - X-Large $1,000.00

Prostheses List by Category, Groups and Sponsor Page 556 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Johnson & Johnson Medical Pty Ltd

JJ548 DELTA Xtend Monobloc Humeral Cemented Epiphysis  1 + 2  8, 10, 12, 14mm $6,800.00

 Standard

JJ549 DELTA Xtend Monobloc Humeral Cemented Epiphysis  1 + 2  8, 10, 12, 14mm $7,750.00

 Revision

JJ550 DELTA Xtend Modular Humeral Diaphysis 10, 12, 14, 16mm $4,000.00

JJ551 DELTA Xtend Modular Centered Epiphysis 1 + 2 $2,436.00

JJ552 DELTA Xtend Modular Eccentric Epiphysis Size 1 Right 1 + 2 Left + Right $2,482.00

JJ553 DELTA Xtend High Mobility Humeral PE Cup 38 + 42;  3, 6, 9mm $1,280.00

JJ554 DELTA Xtend Delta Xtend CTA Head Dia 48 x 21mm 48 + 52; 21, 26mm $5,520.00

 LMT Surgical Pty Ltd

LM045 Epoca Resurfacing Head The humeral head surface replacement is  Diameter 40 - 54mm $1,525.00 $3,000.00

 designed to replace the humeral

 articulating surface and is chrome cobalt

 with hydroxyapatite coating underneath

 Taylor Bryant Pty Ltd

TB306 HemiCAP Contoured Articular  Articular Component  - Chrome Cobalt Articular Component 25mm -  $4,035.00

 Resurfacing Shoulder System 2.5mm x 2.5mm to 5.0mm x

 5.0mm offset;  Articular

 Component 30mm - 4.5mm x

 4.5mm to 7.0mm x 7.0mm

 offset; Articular Component

 35mm - 6.0mm x 6.0mm to

 9.5mm x 9.5mm; Articular

 Component 40mm - 8.0mm x

 8.0mm to 12.0mm x 12.0mm

TB307 HemiCAP Contoured Articular  Fixation Screw - Titanium Fixation component for 25mm,  $1,545.00 Used with Billing code TB306

 Resurfacing Shoulder System 30mm, 35mm, 40mm Artuclar

 Components Screw 10.5mm

 Dia & 12.5mm Dia & 13.7mm

Prostheses List by Category, Groups and Sponsor Page 557 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Joint, Shoulder, Total

 Biomet Australia Pty Ltd

BI884 Comprehensive Fracture Stem Fracture Stem Cobalt Chrome, Titanium 4,6,8,10,12,14mm $3,969.00

 De Puy Australia

DY416 Total Shoulder System Global CAP Conserv Head PC, Global  40 x 15 to 56 x 21 $1,525.00 $6,065.00

 CAP Conserv Head HA

DY417 Total Shoulder System Global CAP Conserv Head PC, Global  40 x 15 to 56 x 21 $1,525.00 $6,120.00

 CAP Conserv Head Porous Coated

 Endotec Australia Pty Ltd

EA025 Buechel-Pappas Total Shoulder System Glenoid Fixation Cup - Ceramic coated  44mm-52mm $2,100.00

 titanium

EA026 Buechel-Pappas Total Shoulder System Glenoid Bearing - Polyethelene 2 to 4 $950.00

EA027 Buechel-Pappas Total Shoulder System Humeral Resurfacing Component- 44mm-56mm $4,800.00

 Ceramic coated Titanium

EA028 Buechel-Pappas Total Shoulder System Humeral-Stem w / PC-Ceramic coated  8-14mm $3,550.00 $4,200.00

 titanium

EA029 Buechel-Pappas Total Shoulder System Humeral Head-Ceramic coated titanium 44mm-52mm $2,200.00

EA030 Buechel-Pappas Total Shoulder System Salvage Humeral Stem-ceramic coated  8-14mm $4,200.00

 titanium

EA031 Buechel-Pappas Total Shoulder System All-Poly Glenoid 2-4 $1,950.00

EA032 Buechel-Pappas Total Shoulder System Humeral Head Extension - Ceramic  2.5 -10mm $800.00

 coated titanium

EA033 Buechel-Pappas Total Shoulder System Modular Humeral Stem Ceramic coated  12mm $5,440.00

 titanium

EA034 Buechel-Pappas Total Shoulder System Modular Salvage Stem - Ceramic coated  1-4 $4,000.00

 titanium

EA035 Buechel-Pappas Total Shoulder System Stem Extension -  Ceramic coated  8-20mm $1,300.00

Prostheses List by Category, Groups and Sponsor Page 558 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Global Manufacturing Technology Pty Limited

GM002 Lobe Lok System Bone Screw 4 x 15mm to 4 x 30mm $225.00 Temporary approval, pending

 review of application in August

GM003 Lobe Lok System Glenoid small to large $1,903.00 Temporary approval, pending

 review of application in August

GM004 Lobe Lok System Humeral Coupling single size $1,890.00 Temporary approval, pending

 review of application in August

GM005 Lobe Lok System Humeral Head - Ceramic 40 to 56mm $3,625.00 Temporary approval, pending

 review of application in August

GM006 Lobe Lok System Humeral Head - CoCr 42 to 54mm $2,875.00 Temporary approval, pending

 review of application in August

GM007 Lobe Lok system Humeral stem 135 to 155mm $2,875.00 Temporary approval, pending

 review of application in August

GM028 Lobe Lok System Neck Extension 126 to 135 $2,940.00 Temporary approval, pending

 review of application in August

GM030 Lobe Lok System A/P insert with locking screw Size 1 to 3 $1,960.00 $2,700.00 Temporary approval, pending

 review of application in August

GM096 Maxima/Optima Anterior Cervical Plate  Pedicle Screw - Mono Axial Type 4.5mm - 8.5mm length 25mm -  $900.00

 System 60mm

GM097 Maxima/Optima Anterior Cervical Plate  Hooks ppen & closed - Pedicle & laminar 6.5mm - 11mm $745.00

 System

GM098 BacFix (Thoracolumbar System) SpeedLink fixed distance rod - Titanium  5.5 - 6mm x 15 - 35mm $1,450.00

GM099 BacFix (Thoracolumbar System) SpeedLink adjustable length rod -  5.5 - 6mm x 39.5 - 75mm $1,670.00

 Titanium alloy

GM100 Lobe Lok Total Shoulder System Glenoid - Metal Backed UHMWPE Ti HA Small to Large $3,200.00

GM101 Lobe Lok Total Shoulder System Humeral ReSurf Cap - CrCo Small to Large $5,900.00

 LMT Surgical Pty Ltd

LM020 Epoca Custom Offset Shoulder  Epoca Stem 6 - 14mm, Length: 115 -  $3,000.00

LM021 Epoca Custom Offset Shoulder  Epoca ZF Cementless Stem 6 - 14mm, Length: 115 -  $3,000.00

LM022 Epoca Custom Offset Shoulder  Epoca Head 40 - 54mm, Height: 15 - 20.25mm $1,525.00

Prostheses List by Category, Groups and Sponsor Page 559 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LM023 Epoca Custom Offset Shoulder  Epoca Eccenter One size only $540.00 $600.00

LM024 Epoca Custom Offset Shoulder  Epoca Glenoid 40mm - 54mm $1,600.00

LM025 Epoca Custom Offset Shoulder  Epoca Glenoid Shell Screw 10; 15; 20mm $250.00

LM026 Epoca Custom Offset Shoulder  Epoca Reco Glenoid 42 - 52mm $3,300.00

LM027 Epoca Custom Offset Shoulder  Epoca Glenoid Insert 42 - 54mm $1,200.00

 Mathys Orthopaedics Pty Ltd

MA448 Affinis Total Shoulder Prosthesis Head - CoCr; Stem - Titanium; Glenoid -  Diameter 39, 41, 43, 45, 47, 49, $1,525.00

 UHMWPE  51, 53mm

MA449 Affinis Total Shoulder Prosthesis Stem - CoCr; Stem - Titanium; Glenoid -  Cemented 6, 9, 12, and  $3,890.00

 UHMWPE 15mm;Cementless 6, 7.5, 9,

 10.5, 12, 13.5 and 15mm

MA450 Affinis Total Shoulder Prosthesis Glenoid - CoCr; Stem - Titanium; Glenoid Size 1 to 4 Cemented $2,200.00

  - UHMWPE

 Plus Orthopedics Australia Pty Ltd

PL119 Promos Shoulder Replacement Humeral Stem 01-5 $2,560.00

PL120 Promos Shoulder Replacement Body 30-50mm $2,500.00

PL121 Promos Shoulder Replacement Inclination Set 20-26mm $1,220.00

PL122 Promos Shoulder Replacement Ball head anatomic R19/H14-R26/H21 $2,750.00

PL123 Promos Shoulder Replacement Glenoid 1-23: - 4-29 $1,300.00

 Zimmer

ZI326 Bigliani/Flatow Trabecular Metal Humeral  Porous Tantulum Humeral Stem 6mm-19mm diameter $5,169.00

 Shoulder

ZI528 Zimmer Trabecular Metal Reverse  Trabecular Metal Humeral Stem Titanium  12mm x 130mm; 12mm x  $3,799.00 $5,000.00

 Shoulder System Alloy and Tantalum 170mm; 14mm x 130mm

ZI529 Zimmer Trabecular Metal Reverse  Polyethylene Liner Standard 7 Deg. & Retentive 65  $1,100.00

 Shoulder System Deg; 36mm - Neutral, Plus

 3mm, Plus 6mm; 40mm -

 Neutral, Plus 3mm, Plus 6mm

Prostheses List by Category, Groups and Sponsor Page 560 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI530 Zimmer Trabecular Metal Reverse  Spacer 9mm, 12mm Taper Insert $1,420.00

 Shoulder System

ZI531 Zimmer Trabecular Metal Reverse  Dual Taper Insert One Size Only $1,000.00

 Shoulder System

ZI532 Zimmer Trabecular Metal Reverse  Glenosphere - CoCr - Mo Alloy 36mm, 40mm $1,200.00 $1,500.00

 Shoulder System

ZI533 Zimmer Trabecular Metal Reverse  Trabecular Metal Reverse Base Plate - Ti  One Size Only $2,100.00 $3,500.00

 Shoulder System Alloy & Tantalum

ZI534 Zimmer Trabecular Metal Reverse  Inverse/Reverse Screw 4.5mm 18mm, 24mm, 27mm, 30mm,  $145.00

 Shoulder System 33mm, 36mm, 42mm, 48mm

Prosthesis, Internal, Joint, Wrist, Total

 Taylor Bryant Pty Ltd

TB253 Avanta - Total Wrist Implant System Left and Right Radial Components Small, Medium, Large $3,275.00

TB254 Avanta - Total Wrist Implant System Carpal Screws 15, 18, 22, 26, 30mm $131.00

TB255 Avanta - Total Wrist Implant System Carpal Ball Small, Medium, Large $445.00

TB256 Avanta - Total Wrist Implant System Carpal Component Small, Medium, Large $2,645.00

Prosthesis, Internal, Knee, Tibial Component

 Zimmer

ZI485 Trabecular Metal Cone Trabecular Metal Tibial void filling cone Full and Stepped Cone $4,000.00

Prostheses List by Category, Groups and Sponsor Page 561 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Ligament, Anchor

 De Puy Australia

DY477 BioIntrafix Tibial Soft Tissue Fastener  Absorbable composite (TCP/PLA)  30mm $345.00

 (Sheath) fixation device (sheath) used in

 conjunction with a screw

 Device Technologies Australia Pty Ltd

DE220 Bio-Suturetak PLDLA Bioabsorbable Suture Anchor Diameter 3mm, Length 14.5mm $430.00

DE261 PEEK Pushlock PEEK Suture Anchor 3.5mm x 14mm $600.00

 Johnson & Johnson Medical Pty Ltd

JJ457 Spiralok Absorbable Dual Eyelet Threaded Spiralok is an absorbable threaded Anchor Diameter 5mm x Length 30mm; $488.00

  Suture Anchor with Panacryl (with   made from PLA with Panacryl   Diameter 6.5mm x Length 30mm

 absorbable suture.

JJ458 Spiralok Absorbable Dual Eyelet Threaded Spiralok is an absorbable threaded Anchor Diameter 5mm x Length  $493.00

  Suture Anchor with Ethibond (without   made from PLA with Ethibond non- 30mm;Diameter 6.5mm x

 needles) absorbable polyethylene suture. Length 30mm

JJ460 Spiralok Absorbable Dual Eyelet Threaded Made from PLA with Ethibond non- Diameter 5mm x Length 30mm; $487.11

  Suture Anchor with Ethibond (with  absorbable polyethylene suture  diameter 6.5mm x Length

JJ461 RapidLoc Meniscal Repair System with  PLA (absorbable) backstop and PDS  One size only $256.72

 (absorbable) top hat and Panacryl

 absorbable suture connecting the top hat

JJ471 Spiralok Absorbable Dual Eyelet Threaded Made from PLA with Panacryl absorbable Diameter 5mm x Length 30mm; $488.00

  Suture Anchor with Panacryl (without   suture  Diameter 6.5mm x Length 30mm

 needles)

JJ472 BioKnotless Anchor with Ethibond PLA absorbable material with a non- Single Implant: Length 11mm,  $493.00

 absorbable braided Ethibond polyethylene  Diameter 2.9mm

 suture

JJ473 BioIntrafix Tibial Soft Tissue Fastener  Absorbable composite (TCP/PLA)  6-8mm, 7-9mm, 8-10mm by  $350.00

 (Screw) fixation device (screw) used in  30mm Length

 conjunction with a sheath for the repair

Prostheses List by Category, Groups and Sponsor Page 562 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ483 SPIRALOK Absorbable Dual Eyelet  Absorbable threaded anchor, PLA with  5mm, 6.5mm $480.00

 Threaded Suture Anchor with Orthocord  Orthocord suture

 Suture

JJ484 MILAGRO (TCP/PLGA) Interference  MILAGRO (TCP/PLGA) Interference  7mm x 23mm, 7mm x 30mm,  $375.00

 ACL Screw System 8mm x 23mm, 8mm x 30mm,

 9mm x 23mm, 9mm x 30mm,

 9mm x 35mm, 10mm x 23mm,

 10mm x 30mm, 10mm x

 35mm, 11mm x 30mm, 11mm

 x 35mm, 12mm x 30mm,

 TiMax Surgical Pty Ltd

TI090 AutoCuff System - Suture Cartridge SmartStitch Magnum Wire - Ultra high  $110.00

 tensile strength

TI091 AutoCuff System - Suture Cartridge SmartStitch Suture Cartridge Number 2 braided polyester $85.00

TI092 AutoCuff System Magnum Knotless Implant - w/ inserter  One Size Only $730.00

TI093 Magnum Arthroscopic Knotless Anchor  Arthroscopically implanted stainless steel  1 - 2.8mm x 8.0mm x 5.0mm;   $690.00

 Implant suture anchor for rotator cuff or labrum  2 - 2.8mm x 13mm x 7.2mm

Prosthesis, Internal, Plug, Subtalar

 LMT Surgical Pty Ltd

LM055 KMI Bioresorbable MBA PLLA 6-14mm $1,800.00

Prosthesis, Internal, Radial Head

 Advanced Surgical Technologies

AD272 Evolve Radial Head Plate Evolve Radial Plate System Stainless Steel 32mm x 20 - 26mm in 2mm  $1,360.00

 increments

AD274 Evolve Locking Cancellous Bone Screws The Evolve stainless steel locking screw 2.0mm x 14 - 28mm $100.00

AD281 Micronail intramedullary radial fixation Titanium, Distal radial nail 1, 2, 3, and 4 $1,620.00

Prostheses List by Category, Groups and Sponsor Page 563 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AD282 Micronail intramedullary radial fixation 2.7mm Titanium Screw 10mm - 20mm $220.00

AD305 Micronail Intramedullary Radial Fixation 2.5mm ti buttress screw 16 - 28mm $250.00

 LMT Surgical Pty Ltd

LM035 Katalyst Anatomic Bipolar Radial Head The Katalyst is a radial head prosthesis  Radial Head sizes 16mm -  $1,339.00 $1,400.00

 consisting of cobalt chrome, U.H.M.W.

 Pe and Stainless Steel Components

LM036 Katalyst Anatomic Bipolar Radial Head The Katalyst is a radial head prosthesis  Shaft/Stem Assembly Sizes 20 - $1,400.00

 consisting of cobalt chrome, U.H.M.W.   30mm

 Pe and Stainless Steel Components

LM043 Ascension Radial Head The Ascension Radial Head is modular  Head Size - 20 Short and Long,  $3,090.00 $3,500.00

 with a Pyrocarbon Head and Metal Stem  22 Short and Long, 24 Short

 which is made of Cobalt Chromium Alloy and Long; Stem Size -

  compliant with  ASTM F1537-00, also

 available in all CoCr

LM057 Ascension Radial Head Locking Plate and  Titanium pre-formed anatomical radial  small and large $1,310.00

 Screws head plate

 Medical & Optical  Instruments Australia Pty Ltd

MO270 Acumed Total Radial Head Head 20-28mm $3,300.00

MO271 Acumed Total Radial Head Stem 6-10mm diameter, 0-8mm neck  $2,100.00

 height

 Orthopaedic Solutions Pty Ltd

OE001 BioProfile Modular Pyrocarbon Radial- A Modular Titanium/Pyrocarbon Radial- One Size Only $5,261.00

 Head Prosthesis which includes a stem,

 neck, head and expansion screw.

 Synthes Australia Pty Ltd

SY354 Small & Mini Fragment Plates LCP Radial Head Plates 2.4mm $1,320.00

Prosthesis, Internal, Spine, Cage

 Medtronic Australasia Pty Ltd

MC685 Verte-Stack Crescent PEEK Height 6 - 18mm $4,713.00

Prostheses List by Category, Groups and Sponsor Page 564 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Spine, Vertebral Body

 Device Technologies Australia Pty Ltd

DE226 B-Twin Vertebral Body Reconstruction  Titanium, locking ring Nitinol Diameter - 11.5/13 - 15.5/17,  $4,524.00

 System length 25 - 27mm

Prosthesis, Internal, Tendon

 Surgical House

SU174 SEM Rotator Cuff Tendon and Prosthesis Polyester 1, 2, 3, 4 $3,550.00

  for Tenoplasty

Restrictors, Orthopedic Cement

 Advanced Surgical Technologies

AD178 Bone Plug PMMA Cement 8, 10, 12, 14, 16mm $270.00

 De Puy Australia

DP233 Hardinge Cement Restrictor Hardinge cement Restrictor (ea) One size only $202.00

DP448 BIO Stop G Biostop Restrictor (Gelatin, Glkycerol,  size 8-20 $205.00

 PHBM, Water)

DP575 C-Stem End Cap End Cap Biostop Restrictor (Gelatin,  Size 8- 20  $136.00

 Glycerol, PHBM, water)

 Howmedica

HW001 Hardinge Cement Restrictor PMMA 6,9 and 12 Leaf $125.00

HW002 Seidel Plugs Seidel Cement Restrictor - Polyethylene. 8, 10, 12, 14, 16, 18mm $120.00

 Smith & Nephew Surgical Pty Ltd

SN263 Buck Cement Restrictor  18.5 - 35mm $120.00

Prostheses List by Category, Groups and Sponsor Page 565 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN264 Buck IM Prep Kit One size only $225.00

SN712 Bio Buck Cement Restrictor Bioabsorbable 13mm - 35mm $120.00

Rods

 ConMed Linvatec Australia Pty Ltd

LV050 Bionx Implants - Rods  PGA, PLA or PLLA 1.5mm x 10-70mm $250.00 $325.00

LV051 Bionx Implants - Rods  PGA, PLA or PLLA 2.0mm $275.00 $350.00

LV052 Bionx Implants - Rods  PGA, PLA or PLLA 3.2mm x 30-70mm $300.00 $375.00

LV063 Bionx Implants - rods PLLA (Smart Nail) 1.5mm $225.00 $431.00

LV084 SmartNail 2.4 Self-reinforced 96L / 4D PLA 16, 25, 35 & 45mm $220.00

 Device Technologies Australia Pty Ltd

DE163 Bio-Post & Washers PLLA composition Implant 35mm - 50mm,  $750.00

 Washers 16mm

 Johnson & Johnson Medical Pty Ltd

JJ126 Contack Fastener Polylactic acid tack (3.5 to 7.5mm) x11.5mm $447.14

JJ307 Rapidloc Meniscal Repair PLA Tophat  Composition: PLA Implant and Ethibond  2/0 $253.48

 with Ethibond Suture Suture, non absorbable suture

JJ308 Rapidloc Meniscal Repair PLA Tophat  Composition: PLA Implant and Panacryl  Straight needle, 12 degree  $253.48

 with Panacryl Suture Suture curved needle, 27 degree curved

 Zimmer

ZI336 Polypin Resorbable Bone Pin Polylactide 1.5, 2.0, 2.7mm $246.00

Screws

 Biomet Australia Pty Ltd

BI005 Re-Unite Orthopaedic System Rotator Cuff Butress, Lactosorb; PGA/PLA One size only $430.00

Prostheses List by Category, Groups and Sponsor Page 566 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI012 Re-Unite Orthopaedic System Pop-Rivet - PGA/PLA One size only $292.00

BI241 Gentle Threads Ligament Fixation Screws Screw, Graft Interference, PGA/PLA 7mm, 8mm, 9mm, 10mm $466.00

BI278 Re-Unite Orthopaedic Screws Screw, PGA/PLA (2-5)mm dia x (5-70)mm $320.00

BI279 Re-Unite Orthopaedic System Plates, PGA/PLA 4 - 7 hole $113.00

BI808 Reunite Orthopaedic System Plate, dorsal or volar, PGA/PLA Dorsal - long, small; Volar - one $540.00

  size only

BI822 Reunite Orthopaedic System Sheet, mesh panel PGA/PLA 50-75mm square $1,195.00

BI826 Meniscal Screw Screw PGA/PLA One size only $340.00

 ConMed Linvatec Australia Pty Ltd

LV019 BioScrew Bioabsorbable Interference  ACL Fixation - PLLA Diameter 7.0 - 9.0mm, Length  $251.48 $330.00

 20 - 30mm

LV021 BioStinger - V Bio - Absorbable Meniscal  Meniscal Repair Device - PLLA 10mm - 16mm $270.00

 Repair Device

LV022 EndoPearl Bio-Absorbable Implant - ACL  ACL Fixation - PLLA 7mm - 9mm $164.00 $195.00

 Fixation

LV055 Bionx Implants - Screws PLA Full Thread  3.5mm $340.00 $415.00

LV056 Bionx Implants - Screws PLA Full Thread  4.5mm $360.00 $435.00

LV057 Bionx Implants - Screws PLA Cannulated 4.5mm $380.00 $450.00

LV058 Bionx Implants - Screws PLLA Lag Screw  3.5mm x 10-28mm $335.00 $415.00

LV059 Bionx Implants - Screws PLLA Lag Screw  3.5mm x 30-45mm $340.00 $415.00

LV060 Bionx Implants - Screws PLLA Lag Screw  4.5mm x 25-70mm $370.00 $450.00

LV061 Bionx Implants - Screws PLLA Lag Screw  6.3mm Diameter $494.00 $550.00

LV062 Bionx Implants - screws ACL PDLA Screws & Wedges Dia 5mm, 7mm, 8mm, 9mm $346.00 $515.00

LV065 Bionx Implants - screws PLLA Screws (Contour Labral Nail) 3.5mm $333.00 $415.00

LV066 Bionx Implants - screws Biofix PLA full threaded crosshead screw Dia 2mm, length 6 - 10mm $267.24 $345.00

LV067 Bionx Implants - screws Biofix PLA full threaded crosshead screw Dia 2mm, length 12 - 20mm;  $287.73 $365.00

 Dia 2.7mm, length 6 -24mm

Prostheses List by Category, Groups and Sponsor Page 567 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LV071 Contour Meniscus Arrow 80L/20D, LPLA & PLLA 1.1mm x 10, 13,16mm $230.00 $285.00

LV072 Contour Meniscus Arrow 80L/20D, LPLA, Pre-loaded Cartridge  1.1mm x 10, 13,16mm $230.00 $285.00

 Pack of 1

LV074 Contour Meniscus Arrow 80L/20D, LPLA, Pre-loaded Cartridge  1.1mm x 10, 13,16mm $690.00 $844.00

 Pack of 3

LV075 Bionix Screws Biocuff C PLA Screw 6.0mm OD x 28mm LONG;  $400.00 $480.00

 6.0mm OD x 36mm LONG

 Device Technologies Australia Pty Ltd

DE069 Interference Screws Bio-Cortical - PLA 8 x 17 - 11 x 17mm and 8 x 20  $299.00

 - 10 x 20mm

DE072 Bio-Interference Screw PLA 7mm - 9mm $288.00

DE075 Arthrex Headed Bio-absorbable  PLA 8mm $420.00

DE081 Tissue Tak PLDLA 3mm - 4.5mm $420.00

DE125 Bio-Corkscrew Composition - polylactide, eyelet -  3.5-6.5mm $400.00

DE166 Bio-Tenodesis Screw Composition PLLA Dia 5.5-9mm $570.00 $670.00

DE167 Bio-Interference Screw Composition - PLLA, delta tapered Dia6.5 - 10.5mm to 8 - 12mm x $450.00 $550.00

  28 - 35mm length

DE195 Bio Corkscrew With Fibrewire Suture 3.5mm - 6.5mm $435.00

DE224 Retro Screw Composition PLLA 8-10mm x 20mm $340.00 $550.00

 Johnson & Johnson Medical Pty Ltd

JJ002 Meniscal Screw Bioabsorbable Poly Lactic Acid $251.42

JJ073 Mitek Phantom Screw - Absorbable  Polylactic acid Bioabsorbable Screw 7,8 & 9mm x (20 to 30mm) $230.00

JJ127 Absolute Absorbable Interference Screw  Polylactic acid screw 7 to11mm x (23 to 30mm) $230.00

JJ337 Biocryl - TCP/PLA Interference Screw Composition - Tricalcium Phosphate &  7x23mm; 7x30mm; 8x23mm;  $303.00

 Polylactic Acid 8x30mm, 9x23mm; 9x30mm;

 10x23mm; 10x30mm;

 Smith & Nephew Surgical Pty Ltd

SN004 Bioabsorbable screw BioRCI-HA Screw, Medial, Portal,  7 x 20mm - 12 x 35mm $350.00

 Reverse thread, Tibial specific, Trans-

Prostheses List by Category, Groups and Sponsor Page 568 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN008 Rotorloc Absorbable PLA Suture Anchor  - One size only $305.00

 System

SN421 ACL/PCL Reconstructions Absorbable PLLA Screw 7-12mm diameter, 25-35mm  $228.00

SN430 ACL/PCL Reconstructions EndoFix Bioabsorbable Screw 7 x 20mm - 9mm x30mm $185.00

 Stryker Australia Pty Ltd (2)

SK392 Universal Distal Radius System Self Tapping cross Head Titanium Bone  Sizes range from: 2.3mm x  $125.00

 Screws 10mm to 2.3mm x 38mm in 2

 mm increments (Full Thread);

 2.7mm x 10mm to 2.7mm x

 26mm in 2mm increments (Full

 Synthes Australia Pty Ltd

SY322 AO/ASIF Screw Headless Compression Screw 3.0mm Short Thread 10-40mm; Long  $196.00

 Thread 10-40mm

 Zimmer

ZI447 Bioresorbable Screw Polylactide One size only $260.00

Screws, Bone

 Austofix

AX002 Austofix Intramedullary Screws Nail Locking Screw, stainless steel 3.5mm, 4.0mm & 4.5mm $95.00 $105.00

AX003 Austofix Intramedullary Screws Humeral Head Screw, stainless steel 4.3mm $105.00 $145.00

AX011 Austofix Intramedullary Screws Femoral Locking Screw, stainless steel 5.5mm, 6.2mm, 6.5mm $105.00

AX012 Austofix Intramedullary Screws Proximal Thread Locking Screw,  4.0mm & 4.5mm $145.00

 stainless steel

AX018 Distal Radius Fracture Repair System Locking peg, threaded, partly threaded,  2.5mm x 14-30mm $125.00

 smooth, titanium

AX019 Distal Radius Fracture Repair System Bone screw, cancellous/cortical titanium 2.5mm-3.5mm x 10-28mm $107.25

AX021 S2 Nail System 6.2mm condylar screws 6.5mm x 60-85mm $175.00

Prostheses List by Category, Groups and Sponsor Page 569 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Australian Surgical Design & Manufacture Pty Ltd

AE007 MF-Cortex Screw Titanium 1.0 - 2.7mm dia,  length 2 -  $14.00 $31.00

AE012 ASDM Bone Screw Titanium  2.0 - 6.5mm dia, length 4-150mm $41.00

AE013 Shaft Screw, Pure  Threaded Pin, Manufactured from pure  3.2 x 50 - 100mm, 4.0 x 70 -  $74.00 $290.00

 Titanium 110mm

AE020 Cortex Screws  Stainless Steel 1.5mm length 6-20mm $10.00

AE021 Cortex Screw  Stainless Steel   2.0mm length 6-38mm $12.00

AE022 Cortex Screws Stainless Steel 2.7mm length 6-40mm $9.00

AE023 Cortex Screws Stainless Steel  3.5mm length 10-110mm $25.00

AE024 Small Cannulated Screws Short Thread Stainless Steel  3.5mm length 10-50mm $30.00 $115.00

AE025 Small Cannulated Screws Internally threaded, manufactured from  3.2 x 0 comp, 3.2 x 2 comp,  $135.00

 pure Titanium 4.0 x 0 comp, 4.0 x 2 comp

AE026 Cancellous Bone Screws Fully Threaded Stainless Steel 4.0mm length 10-60mm $14.00

AE027 Cancellous Bone Screws Short Thread Stainless Steel  4.0mm length 10-50mm $14.00

AE028 Large Cannulated Screws  Stainless Steel 16mm Thread 7.0mm dia, length 30-150mm $90.00 $120.00

AE029 Large Cannulated Screws Stainless Steel 32mm thread 7.0mm dia, length 45-150mm $90.00 $130.00

AE030 Large Cannulated Screws  Fully Threaded Stainless steel 7.0mm dia, length 70-100mm $100.00 $140.00

AE031 Cortex Screw Stainless Steel 4.5mm length 14-140mm $28.00

AE032 Malleolar Screws Stainless Steel 4.5mm length 25-70mm $20.00

AE033 Cancellous Bone Screws Threaded Stainless Steel 16mm Thread 6.5mm dia, length 30-120mm  $30.00

AE034 Cancellous Bone Screws  Threaded Stainless Steel 32mm thread 6.5mm dia, length 45-150mm  $30.00

AE035 Cancellous Bone Screws  Fully Threaded Stainless Steel  6.5mm dia, length 20-110mm $35.00 $40.00

AE051 ASDM Bone screw Titanium Dia 7 - 9 mm, length 20 - 40mm $140.00

 B Braun Australia Pty Ltd

BB051 BRAUN AUST Intramedullary Nails Compression Nail 100mmx10.5mm- $1,600.00

BB052 BRAUN AUST Intramedullary Nails Compression Screw 4.5mmx64mm-4.5mmx102mm $150.00

Prostheses List by Category, Groups and Sponsor Page 570 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB056 BRAUN AUST Intramedullary Nails Fixation Screws Dia 4.5mm-6mm,Length 20mm- $55.00 $75.00

 96mm

BB057 BRAUN AUST Intramedullary Nails Closure Screws Length 8mm-10mm $60.00

BB059 BRAUN AUST Intramedullary Nails Huckstep Fine Thread Screw 4.5mmx19mm-4.5mmx57mm $55.00 $80.00

BB271 Aesculap Schanz Screw Stainless steel All sizes $105.00

 Biomet Australia Pty Ltd

BI143 Compression Screw Set Supracondylar Plate, Stainless Steel 6-14 hole $1,200.00

BI309 Compression Hip Screw Plate, Titanium 2-14 hole x 53-257mm $1,336.00

BI311 Compression Hip Screw  Support Screw, Titanium, Stainless Steel 4.5 - 6.5 x (14-70mm) $200.00

BI312 Compression Hip Screw  Lag Screw, Titanium, Stainless Steel 12.7, 15mm x (55-150mm) $30.00

BI313 Cannulated Screws Fixator, Ulson, Complete Stainless Steel 25mm x 135-200mm $1,050.00

BI314 Cannulated Screws Fixator, Ulson, Clamp Assembly One size only $350.00

BI315 Compression Hip Screw  Plate, Stainless Steel 25-38mm x 2-7 hole for use  $370.00

 with plate size 50-150mm

BI316 Compression Hip Screw  Plate, Stainless Steel  25-38mm x 8-14 hole for use  $440.00

 with plate size 50-150mm

BI317 Compression Hip Screw  Lag Screw, Stainless Steel 12.5,14mm x (50-150mm) $200.00

BI318 Compression Hip Screw  Cortical Screws Pk 10, Stainless Steel 2.7-4.5mm x (10-140mm) $23.00

BI319 Compression Hip Screw  Compression Screw 1.5-4.5 x (6-70mm) $46.35

BI321 Cannulated Screws (Various) Ulsan Fixator, Percutaneous Pins (Pair) 135, 200mm $211.00

BI820 EBI XFIX DynaFix System Screw, HA coated, cortical, cancellous Dia 2-6mm $274.00

 ConMed Linvatec Australia Pty Ltd

LV009 Revo Cancellous Screw Soft Tissue Re-attachment - Titanium 4mm diameter $335.00

LV010 Mini-Revo Screw Soft Tissue Re-attachment - Titanium 2.7mm diameter $340.00

LV011 Soft Tissue Anchoring Implant - Spiked  Soft Tissue Re-attachment - Titanium 1.3 x 14mm -  2.5 x 20mm $335.00

 Washer

LV012 Soft Tissue Anchoring Implant - Flat  Soft Tissue Re-attachment - Titanium 14, 17mm $162.00

Prostheses List by Category, Groups and Sponsor Page 571 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

LV013 Soft Tissue Anchoring Implant - Cortical  Soft Tissue Re-attachment - Titanium 30 -  80mm $175.00

 Screw

LV014 Soft Tissue Anchoring Implant -  Soft Tissue Re-attachment - Titanium 25 -  65mm $200.00

 Cancellous Screw

LV016 Propel Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length  $150.00 $220.00

 20 - 30mm

LV017 Guardsman Femoral Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length  $185.00 $260.00

 20 - 30mm

LV018 Cannulated Interference Screws ACL Fixation - Titanium Diameter 7.0 - 9.0mm, Length  $148.00 $220.00

 20 - 40mm

LV077 BioScrew XtraLok Tibial Fixation Device PLLA Diameter 8, 9, 10, 11mm;  $262.00 $335.00

 Length 35 & 40mm

 Corin Australia Pty Ltd

CR031 LARS Interference Screw Titanium Interference screw 5.2 - 10mm diameter,  $340.00 $450.00

 15 - 30mm

CR033 Dysplasia Cup Screw Tapered, constant thread screw Lengths 25 - 70mm $285.00

 De Puy Australia

DP040 Bone Screw Screw Cancellous Titanium Dia 3.5 or 5 or 6.5 or 7mm  $91.00

 length 15 -110mm

DP042 Chandler Plate Tibial Osteotomy Plate -Stainless Steel 50-70mm $1,165.00

DP043 Chandler Plate Self Tap Screw 4.5mm Length -Stainless  60-100mm $175.00

DP868 Barouk Screw System Barouk Screw - Titanium 10-34mm Length $210.00

DP882 Twistoff Screw TwistOff Screw Titanium 11-14mm Long $320.00

DP894 Rockwood Shoulder Screw Rockwood Shoulder Screw  S/S One size only $231.00

DP895 Rockwood Shoulder Screw Rockwood Shoulder washer  S/S One size only $45.73

DP896 AC Percu Screw AC Percu screw S/S Size 32-52mm $236.00

DP897 AC Percu Screw AC Percu Screw Washer S/S One size only $47.00

DP900 Albizza Nail Albizza Nail - Stainless Steel 240-320mm Length $10,692.00

Prostheses List by Category, Groups and Sponsor Page 572 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DP901 Albizza Nail Albizza Nail Cotter Screw 3.5 or 4.5 0r 5.5 mm 25-75 mm $95.00

  length

DY074 Codman Anterior Cervical Plate System Cancellous Bone Screw - Standard/Self  10 - 26mm $310.00

 Tapping/Variable Depth

 Device Technologies Australia Pty Ltd

DE060 Avulsion Screw Titanium  45mm $446.00 $566.00

DE068 Interference Screws ARTHREX Non-sheathed 7 x 28mm - 12 x 28mm $160.00

DE077 Cancellous Bone Screws Low Profile 30mm - 40mm $211.00

DE128 Cortical Screw Self locking screws, cancellous and  Diameter 3.5-6mm, length 10- $230.00

 110mm

 Howmedica

HW295 Asnis Guided Screw System Screw, Stainless Steel 35-130mm $140.00

HW296 Asnis Guided Screw System Screw -  Titanium 4, 5, 6.5,8mm $155.00

HW297 Asnis Guided Screw System Guide Pin, Stainless Steel 1.4,2.0,3.2mm $60.00

HW298 Asnis Guided Screw System Washer, Stainless Steel One size only $39.00

HW299 Asnis Guided Screw System Washer -  Titanium 4, 5, 6.5,8mm $46.00

HW330 Omega Plus Compression Hip Screw  Hip Sideplate - Standard Barrel -   2,3,4,5 hole 130-150 degrees $350.00

 Stainless Steel

HW331 Omega Plus Compression Hip Screw  Hip Sideplate - Short Barrel -  Stainless  6,8,10,12 hole 130-150 degrees $675.00

HW332 Omega Plus Compression Hip Screw  Supracondylar Sideplate -  Stainless Steel 6,8,10,12,14 holes $570.00

HW333 Omega Plus Compression Hip Screw  Lag Screw - Standard -  Stainless Steel 50-130mm length  $195.00

HW334 Omega Plus Compression Hip Screw  Lag Screw - Super -  Stainless Steel 50-130mm length  $260.00

HW335 Omega Plus Compression Hip Screw  Compression Screw -  Stainless Steel 25mm length $50.00

HW336 Omega Plus Compression Hip Screw  Cortical -  Stainless Steel 4.5mm dia $19.00

HW337 Omega Plus Compression Hip Screw  Cancellous -  Stainless Steel 6.5mm dia $50.00

 Johnson & Johnson Medical Pty Ltd

JJ071 Mitek Kurosaka Advantage Fixation  Titanium Screw Cannulated - Advantage 7 & 9mm x (15 to 40mm) $169.00

Prostheses List by Category, Groups and Sponsor Page 573 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ072 Mitek Kurosaka Fixation Screw Titanium Screw Cannulated - Profile 7,8 & 9mm x (20 to 30mm) $169.00

JJ079 Mitek Cancellous Screw Low Profile Titanium screw 4.5mm x (26 to 76mm) $162.00

JJ080 Mitek Cancellous Screw Low Profile Titanium screw 6.5mm x (25 to 55mm) $162.00

JJ125 Intrafix Tibial Tapered Screw Plastic tapered screw 6 to 10mm x (15 to 30mm) $285.66

 Mathys Orthopaedics Pty Ltd

MA032 RM Cup Screws Titanium                     4 x 22mm - 4 x 48mm $150.00

MA420 seleXys Cancellous Bone Screws Modular, Keramed PROTHITAN  Diameter 6.5mm to fit  $280.00

 cancellous screw MACROFIT/TRISTABIL/UNIC

 UP acetabular cup system 15-

 Medical & Optical  Instruments Australia Pty Ltd

MO005 HBS Bone screw Compression - standard, high Length 10 - 30mm $330.00

MO143 Martin Bone Screw Titanium 2.0mm diameter,20 to 24mm  $53.00

MO144 Martin Bone Screw Titanium 2.0mm diameter,26 to 32mm  $55.00

MO148 Acumed Implantable Screw Fixation Screw Titanium 2.7/3.5mm diameter 12 to  $191.00

 24mm length

MO172 Dynamic Martin Screw Plate  Stainless Steel 2 to 8 hole $1,185.00

MO173 Dynamic Martin Screw Plate  Stainless Steel 10 to 12 hole $1,545.00

MO174 Dynamic Martin Screw Plate Stainless Steel 14 hole $1,695.00

MO175 Dynamic Martin Screw Support Screw Stainless Steel 50 to 120mm length $282.00

MO176 Dynamic Martin Screw Lag Screw Stainless Steel One size only $31.00

MO177 Acutrak Fixation Screw Wire Kirschner Stainless Steel 0.70mm to 1.6mm diameter, 4  $20.00 To be funded where any or all K-

 to 9in (10.16 to 22.86mm)  wires used in a procedure are

 used as an implant.

MO178 Acutrak Fusion Screw Titanium 24 to 37mm $330.00

MO179 Acutrak Fixation Screw Acutrak Cannulated Screw Titanium 8mm to 50mm $425.00

MO180 Acutrak Fixation Screw Acutrak Plus, 6/7, 4/5 Cannulated Screw  25mm to 120mm $425.00 $495.00

 Titanium

Prostheses List by Category, Groups and Sponsor Page 574 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Pacific Medical

PM116 ISKD Internal Limb Lengthening System Titanium Alloy Diameter 12.5 - 14.5mm $16,500.00

 Smith & Nephew Surgical Pty Ltd

SN294 Reflection Tapered hole cover (Reflection Interfit) One size only $110.00

SN295 Reflection Threaded hole cover (Reflection) One size only $165.00

SN419 ACL/PCL Reconstruction Aims Screws, Titanium 7-9mm diameter, 20 -25mm  $165.00

SN420 ACL/PCL Reconstruction RCI Screws Titanium 7-11mm diameter, 25-40mm  $178.00

SN422 ACL/PCL Reconstructions Acufex Fixation Post 25 -55mm $241.00

SN423 ACL/PCL Reconstructions Acufex Tibial Fixation Anchor One size only $185.00

SN425 ACL/PCL Reconstructions Cannuflex Silk & Soft Silk Interference  5.5 x 20mm - 9x30mm $185.00

SN432 ACL/PCL Reconstructions Tibial Post Screw Small, Standard $158.00

SN449 Washer For Cannulated screw systems, Stainless  One size only $32.00

SN467 Compressing Screw For Intermedullary and compression Hip  19mm & 28.5mm $32.00

 Screw Systems

SN480 Compression Hip Screw System Intermedullary Hip Screw (IMHS),  One size only $115.00

 Centering Sleeve, Stainless Steel

SN481 Compression Hip Screw System Standard Lag Screw 55-125mm $196.00

SN482 Compression Hip Screw System Standard Lag Screw 130mm+ $196.00

SN483 Compression Hip Screw System Super Lag Screw 55mm-140mm $196.00

SN488 Intermediate Osteotomy System Compressing One size only $114.00

SN489 Intermediate Osteotomy System Lag 35 mm - 85mm, 1 1/2" - 3-3/4" $472.00

SN491 Paediatric Osteotomy System Compressing Screw One size only $87.00

SN492 Paediatric Osteotomy System Lag Screw 22mm- 40mm $421.00

SN504 Russel Taylor Femoral Locking screw F/fem nl 30-90mm. F/r-t nl 25- $80.00

 90mm.

SN506 Russel Taylor Humeral Locking Screw 4.0mm Diameter 12-60mm $95.00

Prostheses List by Category, Groups and Sponsor Page 575 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN508 Russel Taylor Intermedullary Hip Screw (IMHS) Set  One size only $60.00

SN511 Russel Taylor Locking Screw 4.5mm Diameter 20-65mm $95.00

SN512 Russel Taylor Locking Step Screw 5.0/6.4mm 25mm-110mm $95.00

SN513 Russel Taylor Proximal Locking Screw (Recon) 6.4 x 85 to 8 x 110mm. $95.00

SN514 Russel Taylor Proximal Set Screw (Recon) Short & Long $148.00

SN516 Russel Taylor Stable-Lok Nut One size only $172.00

SN517 Russel Taylor Washer One size only $20.00

SN540 TC 100 1.5mm Screw Hex, Cruciate or Self-tapping 6-24mm $13.00

SN593 TC 100 Screw 6.5mm Cancellous Screw Fully Threaded 6.5mm Diameter, 25-60mm  $35.00

SN594 TC 100 Screw 6.5mm Cancellous Screw Fully Threaded 6.5mm Diameter, 65-110mm  $35.00

SN595 TC 100 Screw 6.5mm Cancellous Screw Fully Threaded 6.5mm Diameter, 115mm-150mm $129.00

SN600 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter,32mm thread,  $35.00

 45-100mm Length

SN601 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter, 32mm thread, $35.00

  105-125mm Length

SN602 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter, 32mm thread, $60.00

  130mm+ Length

SN603 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter,16mm thread,  $35.00

 30-70mm Length

SN604 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter, 16mm thread, $35.00

  75-120mm Length

SN605 TC 100 Screw 6.5mm Cancellous Screw Partially  6.5mm Diameter, 16mm thread, $35.00

  125mm+ Length

SN606 TC 100 4mm Cancellous Screw Fully or Partially Threaded 10 - 20mm $14.00

SN607 TC 100 4mm Cancellous Screw Fully or Partially Threaded 22 - 32mm $16.00

SN608 TC 100 4mm Cancellous Screw Fully or Partially Threaded 32 - 50mm $16.00

SN609 TC 100 4mm Cancellous Screw Fully or Partially Threaded  55mm + $21.00

Prostheses List by Category, Groups and Sponsor Page 576 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN612 TC 100 3.5mm Cortex Screw Hex, Cruciate or Self-tapping 85mm + $70.00

SN618 TC 100 Screw 2.7mm Cortex Bone screw, hexagonal or  2.7mm Diameter, 6mm-28mm  $20.00

 crutiate head Length

SN619 TC 100 Screw 2.7mm Cortex Bone screw, hexagonal or  2.7mm Diameter, 30mm+ Length $20.00

 crutiate head

SN621 TC 100 3.5mm Cortex Screw Hex, Cruciate or Self-tapping 10 - 40mm $22.00

SN625 TC 100 Screw Malleolar Bone Screw, Sterile 25x12mm - 70x32mm $30.00

SN629 Bone Screw Full & Partial Thread , Self tapping,  3.5mm Diameter, 1/2-4" length $38.00

 Stainless Steel

SN635 Cannulated Screw Partial Thread, Stainless Steel 6.5mm Diameter, 16&20mm  $201.00

 Thread, 20-135mm

SN636 Cannulated Screw Partial Thread, Stainless Steel 6.5mm Diameter, 32mm thread, $228.00

  45-130mm

SN637 Cannulated Screw Partial and Fully Threaded, Stainless Steel 5.5mm Diameter, 20-120mm $143.00

SN638 Cannulated Screw Partial and Fully Threaded, Stainless Steel 7.0mm Diameter, 30-150mm $150.00

SN639 Cannulated Screw 6.5mm screw Titanium 6.5mm Diameter, 40mm- $163.00

SN640 Cannulated Screw 7.0mm screw Titanium 7.0mm Diameter 30-150mm  $163.00

SN641 Cannulated Screw 5.5mm screw Titanium 5.5mm Diameter 8x20mm-  $150.00

 32x120mm

SN642 Cannulated Screw 4.0mm Screw Titanium 4.0mm Diameter 20-70mm length $140.00

SN643 Cannulated Screw 8mm Cannulated screws 8mm Diameter 65-125mm $207.00

SN644 Cannulated Screw 6.4mm Cannulated screws 6.4mm diameter 65-125mm  $221.00

SN675 HTO Screws Titanium 4.5mm Diameter, 20 - 80mm  $223.00

 Length

SN700 RCI Screw with Perforations Tinanium interference screw Dia 7 - 10mm, length 25 -  $200.00

SN765 Peri-Loc Fixation device, internal, locking and non- 2.7mm $50.00

 locking, stainless steel, cortical and

 cancellous screws

Prostheses List by Category, Groups and Sponsor Page 577 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN766 Peri-Loc Fixation Device, Internal, Non-Locking,  3.5mm $50.00

 Stainless Steel, Cortical & Cancellous

 Screw  Size: 3.5mm

SN767 Peri-Loc Fixation Device, Internal, Locking and  4.0mm, 10mm - 75mm length $50.00

 Non-Locking, Stainless Steel, Cortical &

 Cancellous Screw

SN768 Peri-Loc Fixation Device, Internal, Locking,  4.5mm $150.00

 Stainless Steel, Cortical & Cancellous

SN769 Peri-Loc Fixation device, internal, locking and non- 5.7mm $150.00

 locking, stainless steel, cortical and

 cancellous screw

SN770 Peri-Loc Fixation device, internal, locking and non- 6.5mm $80.00

 locking, stainless steel, cortical and

 cancellous screw

SN790 Peri-Loc Fixation Device, Internal, Locking,  3.5mm, 10mm - 85mm length $130.00

 Stainless Steel, Cortical & Cancellous

SN791 Peri-Loc Fixation Device, Internal, Locking,  3.5mm, 90mm - 110mm length $70.00

 Stainless Steel, Cortical & Cancellous

SN792 Peri-Loc Fixation Device, Internal, Locking and  4.0mm, 80mm - 100mm length $70.00

 Non-Locking, Stainless Steel, Cortical &

 Cancellous Screw

SN793 Peri-Loc Fixation Device, Internal, Non-Locking,  4.5mm, 10mm -110mm length $70.00

 Stainless Steel, Cortical & Cancellous

SN794 Peri-Loc Fixation Device, Internal, Non-Locking,  4.5mm, 115mm -130mm length $80.00

 Stainless Steel, Cortical & Cancellous

 Stryker Australia Pty Ltd

ST004 Stryker Plating System Screws - Cortical  Titanium or Stainless Steel 10-20mm $25.00

 4.5mm

ST005 Stryker Plating System Screws -  6.5mm Stainless Steel or Titanium 20-50mm $35.00

ST006 Stryker Plating System Screws -  Stainless Steel or Titanium, Full or Partial  10-60mm Screw Length $70.00

 Cancellous 4.0mm Thread

ST068 Connector - Multi Axial Titanium 29-99mm $4,950.00

Prostheses List by Category, Groups and Sponsor Page 578 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST830 Stryker Wedge Interference Screw Small threaded titanium screw for  Diameter 7 - 9mm, Length 20 -  $177.60

 ligament/tendon fixation 25mm

ST866 Leibinger 2.7mm Profyle Modular Screw Titanium screws for fixation of hand  2.7 x 8, 10, 12mm $140.00

ST867 Leibinger 2.7mm Profyle Modular Screw Titanium screws for fixation of hand  2.7 x 14, 16, 18mm $74.00

ST868 Leibinger 2.7mm Profyle Modular Screw Titanium screws for fixation of hand  2.7 x 20, 22, 24mm $45.00

ST869 Leibinger 2.7mm Profyle Modular Screw Titanium screws for fixation of hand  2.7 x 26, 28, 30mm $69.00

ST870 Leibinger 2.7mm Profyle Modular Screw Titanium screws for fixation of hand  2.7 x 32, 34, 36, 38mm $70.00

ST871 Leibinger 3.0mm Profyle Modular Screw Titanium screws for fixation of hand  3.0 x 8, 10, 12mm $95.00

ST872 Leibinger 3.0mm Profyle Modular Screw Titanium screws for fixation of hand  3.0 x 14, 16, 18mm $95.00

ST873 Leibinger 3.0mm Profyle Modular Screw Titanium screws for fixation of hand  3.0 x 20, 22, 24mm $95.00

ST874 Leibinger 3.0mm Profyle Modular Screw Titanium screws for fixation of hand  3.0 x 26, 28, 30mm $95.00

ST875 Leibinger 3.0mm Profyle Modular Screw Titanium screws for fixation of hand  3.0 x 32, 34mm $95.00

 Stryker Australia Pty Ltd (2)

SK023 ACL Wedge Interference Screw Threaded titanium screw for  Dia 7 - 12mm, length 20 -  $255.00

 ligament/tendon fixation

SK024 Stryker Cross-screw Threaded titanium screw for  8mm x 40-60mm $455.00

 ligament/tendon fixation

SK026 Leibinger screws Profyle titanium hand and small fragment  Dia 1.2mm, length 14 - 20mm $85.00

 system screws

SK027 Leibinger screws Profyle titanium hand and small fragment  Dia 1.9mm, length 8 - 12mm $70.00

 system screws

SK028 Leibinger screws Profyle titanium hand and small fragment  Dia 2.3mm, length 26 - 38mm $62.00

 system screws

SK029 Leibinger screws Profyle titanium hand and small fragment  Dia 2.5mm, length 8 - 12mm $65.00

 system screws

SK030 Leibinger screws Profyle titanium hand and small fragment  Dia 3.0mm, length 8 - 34mm $99.00

 system screws

SK046 Stryker Wedge Interference Screw Threaded bioabsorbable screw for  Dia 7 - 12mm, length 20 -  $306.00

 ligment/tendon fixation

Prostheses List by Category, Groups and Sponsor Page 579 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK047 Stryker Wedge Interference Screw Threaded biosteon screw for  Dia 7 - 12mm, length 20 -  $342.00 $565.50

 ligment/tendon fixation

SK053 Stryker Plating System Screws -  6.5mm Diameter, full and partial thread Length 55-95mm $305.00

SK054 Stryker Plating System Screws -  6.5mm Diameter, full and partial thread Length 100-150mm $305.00

SK154 Stryker Cross-Screw HA/PLLA screw for ligament/tendon  Dia 6mm: Length 40-60mm $350.00 $572.00

SK155 Wedge Interference screw Threaded PLLA screw with cross pin for Dia 7-12mm, Length 20-40mm;  $163.00

  ligament/tendon fixation pin length standard

SK256 TwinFix Cannulated Compression Screw  Diameter 3.2mm, lengths 14- $440.00

 System

SK397 Matrix - SMART Lock Polyaxial Locking  Titanium Bone Screws 2.7mm x 8mm to 2.7mm x  $125.00

 System for Distal Radius 38mm in 2mm increments,

 3.0mm x 8mm to 3.0mm x

 34mm in 2mm increments

 Surgical House

SU006 Bold Compression Screw Cannulated titanium 3mm diam 10-34mm length $286.00

SU007 ICOS Screw: Ideal Compression Screw Cannulated titanium 4mm diam 26-60mm length,  $412.00

 6.5mm diam 40-90mm length

SU008 Spin Screw: Snap Off Screw Titanium Diameter 2mm, Length 11- $286.00

 14mm; Diameter  2.7mm, 

 Various Lengths; Diameter

 3.0mm, Various Lengths

 Synthes Australia Pty Ltd

SY049 AO/ASIF Screws Mini cannulated screw 3.0mm dia / 8 - 40mm length $178.74

SY050 AO/ASIF Screws Plate pin 1.8mm buttress pin 12 - 30mm $45.00

SY054 AO/ASIF Plates DHS/DCS lag screw 50-145mm L $247.20

SY056 Cortex Screws 2.7mm - 5.00mm diameter,  $92.70

 5mm - 100mm Length

SY065 Cortex Screw Cortex Screws 1.0mm - 2.6mm diameter, 5mm $67.00

  - 100mm Length

SY068 AO/ASIF Screws Cancellous,- ligament, bunionectomy, full 4.0mm dia / 10 - 105mm $91.03

  & short thread

Prostheses List by Category, Groups and Sponsor Page 580 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY069 AO/ASIF Screws Malleolar Screws 46.0 - 80.0mm $108.30

SY071 AO/ASIF Screws Steel 3.5mm cannulated screws   Short thread 10 - 50mm / full  $175.10

 thread  10 - 50mm

SY072 AO/ASIF Screws Steel Cannulated screws 1/3 thread & long thread / 10 -  $165.49

 50mm /4.0mm cannulated

SY073 AO/ASIF Screws Steel 4.5mm cannulated screws Short thread, 1/3 thread, full  $185.40

 thread / 20 - 72mm, 4.5mm

SY074 AO/ASIF Screws Steel 7mm cannulated screws 16, 32mm, & full thread / 30 -  $312.99

 150mm / 7.00 mm cannulated

SY075 AO/ASIF Screws Steel 7.35mm cannulated screws 16, 32mm, & full thread / 20 -  $294.30

 150mm / 7.3mm cannulated

SY076 AO/ASIF Screws Steel Cannulated implant  Custom made $288.40

SY081 AO/ASIF Screws 4.0mm Cancellous Screws 29.0 - 70.0mm $48.93

SY082 AO/ASIF Screws 6.5mm cancellous screws 10-150mm L $144.99

SY085 AO/ASIF Screws 7.3mm cannulated screws 20-150mm L $213.21

SY108 AO/ASIF Plates - Steel DHS/DCS lag screws 12.5mm, length 50 - 145mm $210.54

SY109 AO/ASIF Plates DHS/DCS compression screw 36mm length $46.35

SY110 AO/ASIF Plates DHS/DCS locking device screw One size only $503.54

SY127 AO/ASIF Intermedullary Nails Shaft screw 5.0mm , length 70 - 125mm $156.56

SY173 Locking Head Screws Self drilling, Self Tapping, Sterile/Non  Dia 3.5 - 5.0mm, Length 10 -  $178.19

 100mm

SY266 AO/ASIF Screws Malleolar Screws 20.0 - 45.0mm $94.76

SY267 AO/ASIF Screws 6.5mm Cancellous Screws 20.0 - 65mm $71.83

SY268 AO/ASIF Screws 2.0mm Cortex Screw 21.0 - 40.0mm $53.00

SY278 AO/ASIF Cortex Screws Locking Head Screws Diam 2.4mm - 5.0mm, Length 6 $180.25

  -90mm

SY320 AO/ASIF Screw Locking Head Screw 2.0mm Length: 6-40mm $144.20

Prostheses List by Category, Groups and Sponsor Page 581 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY321 AO/ASIF Screw 2.4mm Cannulated Screw Short thread 15-40mm; Long  $164.80

 Thread 5-35mm

SY353 Cortex Screws Cortex Screws pack of four 2.7mm - 5.0mm diameter,  $370.80

 5.0mm - 100mm Length

 Taylor Bryant Pty Ltd

TB062 Groupe Lepine Acetabular Screws 5.5mm dia in 15mm-60mm  $57.00

 length 5mm increments

 TiMax Surgical Pty Ltd

TI048 CPS Screws Polylactic acid trimethylene carbonate  1.5-3.1mm screw ring 5 pcs $40.00

 copolymer

TI050 CPS Screws Polylactic acid trimethylene carbonate  Hexalon ACL screw 7-10 x 20- $90.00

 copolymer 30mm

 Zimmer

ZI176 Zimmer Internal Fixation Systems:  Magna-FX - Stainless Steel 16 mm Thread - 30-30 mm; 32  $205.00

 Cannulated Screw mm Thread - 40-120 mm; Fully

 Threaded - 30-130 mm Long

ZI177 Zimmer Internal Fixation Systems:  Mini Magna-FX - Stainless Steel 4 & 5mm diameters $216.00

 Cannulated Screw

ZI178 Zimmer Internal Fixation Systems:  Scaphiod - Titanium Scaphoid - 12 - 30mm length $360.00

 Herbert Bone Screw

ZI179 Zimmer Internal Fixation Systems:  Herbert/Whipple - Titanium 12 mm - 30 mm $420.00

 Herbert Bone Screw

ZI180 Zimmer Internal Fixation Systems:  Cannulated 4.5mm - Titanium 30 - 70mm $450.00

 Herbert Bone Screw

ZI181 Zimmer Internal Fixation Systems:  Cannulated 6.5mm - Titanium 25 mm - 100mm $490.00

 Herbert Bone Screw

ZI199 Zimmer ECT Screws 1.5mm Cortical Screws 6 - 18mm $54.00

ZI200 Zimmer ECT Screws 2.0mm Cortical Screws 6 - 24mm $52.00

ZI201 Zimmer ECT Screws 2.7mm Cortical Screws 6 - 50mm $54.00

ZI202 Zimmer ECT Screws 3.5mm Cortical Screws 10 - 130 mm $60.00

Prostheses List by Category, Groups and Sponsor Page 582 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ZI203 Zimmer ECT Screws 4.0mm Cancellous Screws 10 - 60 mm $80.00

ZI204 Zimmer ECT Screws 4.5mm Cortical Screws 14 - 120mm $67.00

ZI205 Zimmer ECT Screws 4.5mm Self tapping Cortical Screws 14 - 70mm $70.00

ZI206 Zimmer ECT Screws 4.5 Malleo Screw 25 - 70mm $65.00

ZI207 Zimmer ECT Screws 6.5mm Cancellous Screws 25 - 110mm $125.00

ZI370 Cancellous Screws Orthopaedic Screws - Ti alloy 20 to 60 $148.00

ZI399 Cancellous Screws Screws- Cancell - Ti alloy 6.5/15 to 6.5/70mm $142.00

ZI400 Cortical Screws Screws- Cortical - Ti alloy 4.5/30 to 60mm $142.00

ZI448 Cannulated Screw Ti alloy One size only $145.00

 Screws, Bone

 Synthes Australia Pty Ltd

SY352 Cortex Screws Cortex Screws pack of four 1.00mm 2.6mm diameter, 5mm  $268.00

 - 100mm length

Screws, Cranioplasty Plate

 Smith & Nephew Surgical Pty Ltd

SN002 TC 100 3.5mm Cortical Screws Hex, Cruciate or Self Tapping 45 - 85mm $38.00

SN007 TC 100 3.5mm Cortical Screws Sterile, Hex or Cruciate 10 - 40mm $15.00

SN014 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 14 - 60mm $19.00

SN018 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 100 - 145mm $60.00

SN061 TC 100 4.5mm Cortical Screws Hex, Cruciate or Self-tapping 62 - 95mm $35.00

SN082 TC 100 2.7mm Cortical Screws Hex, Cruciate or Self-tapping 6 - 55mm $16.00

SN112 TC 100 2.0mm Cortical Screws Self Tapping, Hex or cruciate 6 - 38mm $19.00

SN123 TC 100 3.5mm Cortical screw Sterile - Hex or Cruciate, Self tapping 10 - 40mm $15.00

Prostheses List by Category, Groups and Sponsor Page 583 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Sleeves

 De Puy Australia

DP574 C-Stem Centraliser Centraliser Polymethylmethacrylate  One size only $259.00

DP872 Charnley Centraliser Charnley Centraliser  EA  Size 1 and 2 $212.00

 Polymethylmethacrylate

 Johnson & Johnson Medical Pty Ltd

JJ128 Cuff Link  High density plastic link 8mm $579.00

 Smith & Nephew Surgical Pty Ltd

SN359 Invis Distal Centraliser PMMA 7 - 21mm $171.00

Spinal Cage

 Johnson & Johnson Medical Pty Ltd

JJ520 CONCORDE Spine System CONCORDE Parallel Carbon Fibre Body  7 - 13mm $4,133.00

 Fusion Device

JJ521 CONCORDE Spine System CONCORDE Lordotic Carbon Fibre Body 7 - 13mm $4,139.00

  Fusion Device

Staples, Bone

 ConMed Linvatec Australia Pty Ltd

LV015 Staple Fixation System Soft Tissue Re-attachment - Titanium 9.5 - 16.5mm $160.00

LV025 Staplizer Bone Staple Cartridge 5 Titanium staples per cartridge 7 x 7mm, 7 x 10mm, 10 x  $295.00 $370.00

 7mm, 10 x 10mm, 10 x 15mm,

 13 x 7mm, 13 x 10mm, 13 x

 15mm, 13 x 20mm, 16 x

 10mm, 16 x 15mm, 16 x

Prostheses List by Category, Groups and Sponsor Page 584 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Darco Australia Pty Limited

DC019 Mini Staple Titanium - oblique / rectangular 8 - 12mm $285.00

 De Puy Australia

DP878 Barouk System Staples Varisation Staple  Stainless Steel 26-90Deg x 8-10mm $193.00

DP879 Barouk System Staples Memory Staple - Titanium Alloy 13-20mm Long $710.00

DP880 Barouk System Staples TIFLEX Staple  / Pin -  Titanium 1.6 - 2.5 Dia 7-24mm width  $217.00

 13/15-36/50mm Length

 Device Technologies Australia Pty Ltd

DE062 Ligament Staples Cobalt Chromium Molybdenium Alloy 6mm - 16mm $135.00

 ESKA Australia

EK011 Fixation Device Internal Staple Metal Staple 7 different sizes $300.00

 Howmedica

HW317 Rutherford Staple Ellison Arched Staple, Vitallium 9,12,15mm x 23mm $177.00

HW318 Rutherford Staple Ellison Flat Staple, Vitallium 8,11,14 x 23mm $135.00

HW319 Rutherford Staple Ellison Soft Tissue Retainer,  Vitallium 8,11,14mm  $125.00

 Orthocare Pty Limited

OC009 Orthomed Osteotomy & Ligament Staples Osteotomy Staple.  Cast Chromium- 5mm $110.00

 cobalt non-absorbable. Stainless Steel

 non-absorbable. Non-sterile 57-73

OC010 Orthomed Osteotomy & Ligament Staples Osteotomy Staple.  Cast Chromium- 10mm $110.00

 cobalt non-absorbable. Stainless Steel

 non-absorbable. Non-sterile 57-74

OC011 Orthomed Osteotomy & Ligament Staples Osteotomy Staple.  Cast Chromium- 15mm $110.00

 cobalt non-absorbable. Stainless Steel

 non-absorbable.  Non-sterile 57-75

OC012 Orthomed Osteotomy & Ligament Staples Ligament Staple.  Cast Chromium-cobalt  6mm $80.00

 staples, non-absorbable. Non-sterile

 Surgical House

SU012 Solustaple Standard Staple Stainless steel 90 deg & 26 degree 8 & 10mm length $235.00

Prostheses List by Category, Groups and Sponsor Page 585 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SU013 Uni-Clip Compression Staple Stainless steel Width 11mm - 20mm, Length  $750.00

 13mm - 20mm; Notched -

 Width 11mm - 20mm, Length

 13mm - 20mm;

 Taylor Bryant Pty Ltd

TB338 Trapezio Metacarpal Prosthesis DLC Cup, Polyethylene One size only $416.00 Tempory Approval, pending

 review of product group

Staples, Tissue

 Smith & Nephew Surgical Pty Ltd

SN414 Shoulder Reconstruction Suretac Absorbable Staple 6-8 x 16mm $273.00

Stimulators, Bone Growth

 Biomet Australia Pty Ltd

BI245 EBI Bone Healing System DC Generator, Titanium, Platium, Silver,  1, 2 or 4 lead models $5,020.00

 Silicone

Suture Buttons

 Device Technologies Australia Pty Ltd

DE252 Tightrope Syndesmosis Repair Kit Titanium or stainless steel, with non  One size only $589.00

 absorbable Fiberwire suture material

 Smith & Nephew Surgical Pty Ltd

SN426 ACL/PCL Reconstructions EndoButton 4 x 12mm $248.00

SN427 ACL/PCL Reconstructions Fixation Button 12-17mm $35.00

SN428 ACL/PCL Reconstructions EndoButton CL 20-50mm $369.00

Prostheses List by Category, Groups and Sponsor Page 586 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Suture Units, Other

 Smith & Nephew Surgical Pty Ltd

SN141 T-Bar Suture Retention System Fastfix One size only $335.00 $425.00

SN413 Shoulder Reconstruction 3.7mm TAG & Wedge Suture Wedge 3.7mm $135.00

SN415 Shoulder Reconstruction TAG Bioabsorbable Anchor Wedge 3.7mm $129.00

SN417 T-Bar Suture Retention System T-Fix RCG  1.8mm $235.00

SN418 T-Bar Suture Retention System T-Fix Single & Double T-Fix Suture Bar, Straight  $188.00

 Needle, Double Suture

SN442 Mini TAG Suture Anchor 2.0mm 2.0mm $149.00

Sutures, Polyester

 Smith & Nephew Surgical Pty Ltd

SN416 Shoulder Reconstruction  Fastentor Suture Anchor One size only $290.00

SN429 ACL/PCL Reconstructions EndoButton Tape One size only $159.00

Sutures, Stainless Steel Monofilament

 De Puy Australia

DP232 Suture Wire Wire Suture Stainless Steel 0.5 to 5mm $101.00

Prostheses List by Category, Groups and Sponsor Page 587 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Tissue Reconstructive Materials

 Halas Dental Pty Ltd

HD001 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 0.25gm $99.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

HD002 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 0.5gm $170.00 $176.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

HD003 Bio-Oss Bone Natural Bone Mineral Derived from bovine bone 2.0gm $528.94 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

 Zimmer

ZI459 Collagen Meniscus Implant Porous collagen-glycosaminoglcan matrix 7.5mm, 9mm $5,000.00

Washers, Bone Screw

 Darco Australia Pty Limited

DC007 Titanium Screw Ring washer - $45.00

 Device Technologies Australia Pty Ltd

DE071 Arthrex Spiked Washer Titanium alloy 14 - 15mm $162.00 $369.00

 Johnson & Johnson Medical Pty Ltd

JJ081 Mitek Soft Tissue Washer Titanium washer 14mm, 17mm & 20mm $240.00

 Smith & Nephew Surgical Pty Ltd

SN424 ACL/PCL Reconstructions Acufex Spiked Washer One size only $162.00

SN450 Washer For Cannulated screw systems, Titanium One size only $49.00

SN626 TC 100 Washers Stainless Steel 7-13mm $14.00

Prostheses List by Category, Groups and Sponsor Page 588 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SN627 TC 100 Washers Titanium Non Sterile 4.5mm -13mm $23.00

SN628 TC 100 Washers Titanium Sterile 4.5mm -13mm $47.00

 Synthes Australia Pty Ltd

SY092 AO/ASIF K-Wires, Pins, Washers etc. Washers/nuts 1.0mm - 16mm dia $103.00

SY261 LCP Spacer/Washer LCP Wiremount Spacer Diameter 2mm - 6mm $62.83

 Zimmer

ZI279 Washer system Hedrocel tantulum 12mm x 15mm $742.00

Wires, Bone

 Medical & Optical  Instruments Australia Pty Ltd

MO164 Osteo Clage Cable System CoCr Cable 2mm diameter 850mm length $336.00

MO165 Osteo Clage Cable System CoCr Cable Sleeve 2mm diameter 850mm length $240.00

MO166 Osteo Clage Cable System Stainless Steel Cable 850mm $336.00

MO167 Osteo Clage Cable System Stainless Steel Cable Sleeve 2mm $240.00

MO196 Osteo Clage Cable System Cerclage wire and sleeve 500mm $435.00

 Smith & Nephew Surgical Pty Ltd

SN459 Wire Suture 18Ga - 28Ga $80.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

 Synthes Australia Pty Ltd

SY087 AO/ASIF K-Wires, Pins, Washers etc -  K-wire single ended 0.06 - 3.0mm / length 70 -  $27.81 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

SY089 AO/ASIF K-Wires, Pins, Washers etc -  K-wires threaded 0.25 & 15mm / dia .08 - 3.0mm $72.10 To be funded where any or all K-

  & length 70-300mm wires used in a procedure are

 used as an implant.

SY091 AO/ASIF k-Wires, Pins, Washers etc Pinless pins/clips Asymetric small and large $767.35

Prostheses List by Category, Groups and Sponsor Page 589 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY256 A/O/ASIF K-wires, Pins, Washers etc -  Cerclage Wire - coils with and without eye 0.4-2.0mm/80-600mm Length $42.23 To be funded where any or all K-

 Steel - Sterile & Non Sterile wires used in a procedure are

 used as an implant.

SY257 A/O/ASIF K-wires, Pins, Washers etc -  Cerclage Wire - coils with and without eye 0.4-2.5mm $56.42 To be funded where any or all K-

 Steel - Sterile & Non Sterile wires used in a procedure are

 used as an implant.

Wires, Bone, Implantable

 Australian Surgical Design & Manufacture Pty Ltd

AE052 ASDM K-wire Stainless steel - sterile Dia 0.7 - 2.5mm, length 100 -  $11.00 To be funded where any or all K-

 230mm wires used in a procedure are

 used as an implant.

 Biomet Australia Pty Ltd

BI857 Kirschner Wires Stainless Steel wire (1-3.2mm) diameter x (100 to  $17.00 To be funded where any or all K-

 310mm) length wires used in a procedure are

 used as an implant.

 Darco Australia Pty Limited

DC014 K Wire K wire - stainless steel Diameter 0.9 - 2.0mm $10.83

DC015 K Wire K wire - stainless steel threaded Diameter 1.2 - 2.0mm $10.83

DC016 K Wire K wire - titanium threaded Diameter 1.6 - 2.0mm $11.67

 LMT Surgical Pty Ltd

LM014 Trimed Marked K-Wire Stainless Steel Diameter 0.9 - 1.1mm $40.00 To be funded where any or all K-

 wires used in a procedure are

 used as an implant.

Prostheses List by Category, Groups and Sponsor Page 590 of 784


ORTHOPAEDIC

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtex

MX003 Kirschner Extension Wire Implantable extension wires for  100mm length x 0.4mm thru to  $8.00 To be funded where any or all K-

 osteosynthesis and fixative purposes 2.2mm diameter in 1mm  wires used in a procedure are

 increments. 150mm length x  used as an implant.

 0.6mm thru to 2.2mm diameter

 in 1mm increments. 230mm

 length x 0.8mm thru to 3mm

 diameter in 1mm increments.

 305mm length x 0.8mm thru to

 3mm diameter in 1mm

 increments.

 Surgical House

SU048 The Bone Tie Stainless steel wire & tie One size only $229.00

 Trewavis Surgical Instruments Pty Ltd

TS001 Trewavis Surgical Kirschner Wires Composition: Stainless Steel, Model No:  Dia 0.7-2.8mm, Length 100- $11.00 To be funded where any or all K-

 200-000-A to 200-930-K wires used in a procedure are

 used as an implant.

 Zimmer

ZI290 Cable Ready Cable Grip System Titanium - comes with two cables (Co  23 x 53mm, 1.8 x 635mm $1,736.00

 Cr), Integral Crimps

ZI293 Zimmer Wires Stainless Steel Length 23cm, Thickness 2mm,  $11.00 To be funded where any or all K-

 0-4mm, 8mm wires used in a procedure are

 used as an implant.

ZI294 Zimmer Wires Stainless Steel Length 7, 6cm - 23cm,  $11.00 To be funded where any or all K-

 Thickness 0mm, 7mm - 2mm,  wires used in a procedure are

 used as an implant.

ZI297 Cable Ready Cable Grip System Titanium 5 hole GTR with 4 cables $4,050.00

ZI298 Cable Ready Cable Grip System Titanium 2 hole GTR with 4 cables $2,600.00

ZI299 Cable Ready Cable Grip System Titanium 4 hole GTR with 4 cables $3,750.00

ZI310 Stayfuse Titanium inter-digital fusion device Screw 2.8-3.8mm or 3.8 x  $309.00

 6mm, 4.3 x 6mm, 5.0 x 5mm,

 5.0 x 6mm; Hex 2.5-3.0mm

ZI323 Zimmer Wires Stainless Steel Rushpins Diameter 2.4 - 6.4mm; Length  $206.00

 2.5 - 52.7cm

Prostheses List by Category, Groups and Sponsor Page 591 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Anastomosis Couplers, Vascular

 LMT Surgical Pty Ltd

LM030 Synovis Coupler High Density polyethylene (ring);  Diameter 1-3mm $610.00 Only to be funded where used in

 Stainless Steel (pins) a service for which a Medicare

 Benefit is payable

Bone Matrix Implants, Artificial

 Biomet Australia Pty Ltd

BI487 Mimix Calcium Phosphate Bone Void Filler Calcium Phosphate 5 grams $1,004.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI488 Mimix Calcium Phosphate Bone Void Filler Calcium Phosphate 10 grams $1,900.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI489 Mimix Calcium Phosphate Bone Void Filler Calcium Phosphate 20 grams $2,300.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Implant Innovations Australia Pty Ltd

NW003 Biogran Resorbable Synthetic Bone Graft 3i Biogran 750mg Glass Syringe $110.00 Only to be funded where used in

  2 pack; 3I Biogran 750mg  a service for which a Medicare

 Glass Syringe 7 pack; 3I  Benefit is payable

 Biogran 500mg Mixing Cup 7

 pack; 3I 750mg Mixing Cup 7

 pack; 3I Biogran 1500mg

 Medtronic Australasia Pty Ltd

MC547 Macropore Z Plates 10 hole $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 592 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC548 Macropore Cranial Recon 29 - 64mm $520.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC549 Macropore Cranial Recon 65 - 165mm $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC550 Macropore Rectangle Plates 4 hole $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC551 Macropore Protective Disc 25mm $150.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC552 Macropore Rectangle Plates 8 hole $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC553 Macropore Oblong Plates 6 - 8 hole $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC554 Macropore CraniDisk 23 - 28mm $182.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC555 Macropore Oblique Plates 6 - 8 hole $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC556 Macropore Protective Sheets 50 x 50 x 0.5mm - 50 x 50 x  $800.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC557 Macropore Protective Sheets 25 x 25 x 0.5mm - 25 x 25 x  $380.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC558 Macropore Orbital Floor Liner 30mm $610.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 593 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC559 Macropore L Plates 8 hole, Left & Right $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC560 Macropore Protective Sheets 60 x 80 x 0.5mm - 60 x 80 x  $890.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC561 Macropore Protective Sheets 100 x 100 x 0.5mm - 100 x 100 $1,430.00 Only to be funded where used in

  x 1.0mm a service for which a Medicare

 Benefit is payable

MC562 Macropore Y Plates 7 hole $160.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC563 Macropore Straight Plates 4 hole $110.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC564 Macropore Straight Plates 8 hole $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC565 Macropore Straight Plates 20 hole $220.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC566 Macropore C Plates 8 hole $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC567 Macropore Clover Leaf Plates 4 hole $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC568 Macropore Bur Hole Cover 25mm $155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC569 Macropore Screws 2.0mm x 4mm - 3.0mm x  $48.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 594 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC570 Macropore Tacks 1.5 x 4mm - 2.0 x 6mm $47.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC580 Macropore Locks 2 - 20mm $700.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd (2)

SK232 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix  2.5gm pack $650.00 Only to be funded where used in

 Replacement. Sodium Phosphate Solution a service for which a Medicare

  and Mixing Bowl included Benefit is payable

SK233 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix  5gm pack $1,250.00 Only to be funded where used in

 Replacement. Sodium Phosphate Solution a service for which a Medicare

  and Mixing Bowl included Benefit is payable

SK234 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix  10gm pack $1,920.00 Only to be funded where used in

 Replacement. Sodium Phosphate Solution a service for which a Medicare

  and Mixing Bowl included Benefit is payable

SK235 BoneSource Classic Bone Cement Calcium Phosphate Bone Matrix  25gm pack $3,960.00 Only to be funded where used in

 Replacement. Sodium Phosphate Solution a service for which a Medicare

  and Mixing Bowl included Benefit is payable

Covers, Burr Hole

 Johnson & Johnson Medical Pty Ltd

JJ209 Bioplate Burr Hole Cover  Titanium cranial fixation system - burr  1.5mm diam, 12mm length $165.00 Only to be funded where used in

 hole, 6 hole a service for which a Medicare

 Benefit is payable

JJ210 Bioplate Burr Hole Cover  Titanium cranial fixation system - burr  1.5mm diam, 18mm length $192.00 Only to be funded where used in

 hole, 6 hole a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 595 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Distractor

 Medical & Optical  Instruments Australia Pty Ltd

MO233 Internal Distraction Device Titanium 1.5mm $3,370.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO234 Martin Rigid External Distraction System  RED II Titanium Cranial Fixation Screws 45-55mm $165.00 Temporary approval, pending

 II (REDII) review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO235 Internal Distraction Device Kit Titanium 1.5mm $7,600.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO236 Martin Rigid External Distraction System  RED II Aluminium Cranium Frame and  One Size Only $8,147.00 Temporary approval, pending

 II (RED II) Carbon Fibre Rods review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO239 Intra-Oral Distraction System Titanium Distraction Device 1.0mm - 2.7mm $7,800.00 Temporary approval, pending

 review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO240 Martin Rigid External Distraction Device  RED II Titanium Maxillary Fixation 1.5mm - 1.8mm $1,696.00 Temporary approval, pending

 II (REDII) review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO241 Martin Rigid External Distraction System  RED II Titanium Threaded Fixation  2.0mm - 15-21mm $180.00 Temporary approval, pending

 II (REDII) review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO242 Martin Rigid External Distraction Device  RED II Titanium Fixation Plate 1.5mm $145.00 Temporary approval, pending

 II (REDII) review of product group. Only to

  be funded where used in a

 service for which a Medicare

Prostheses List by Category, Groups and Sponsor Page 596 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Expanders, Skin

 Device Technologies Australia Pty Ltd

DE034 Biospan Tissue Expander Silicone Elastomer. Saline filled. 200 - 850 cm3 $1,244.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

DE123 Skin & Tissue Expander Remote Port - Silicone Shell 10cc to 2000cc $670.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

 Medical Device Alliance Pty Ltd

MP040 Silimed Tissue Expanders Round Model # 800, 801, 802, 809 50-900ml $600.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP041 Silimed Tissue Expanders Oval Model # 720, 729 250-800ml $820.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP042 Silimed Tissue Expanders Anatomical Model # 20760, 20769 200-800ml $1,000.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP043 Silimed Tissue Expanders Double Chamber Model # 730, 20739 140/180-400/450ml $1,244.00 $1,800.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP044 Silimed Tissue Expanders Anatomical Double Chamber Model #  430-740ml $1,600.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP045 Silimed Tissue Expanders Crescent Model # 820, 821, 829 12-700ml $600.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP046 Silimed Tissue Expanders Rectangular Model # 810, 811, 819 30-1000ml $600.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 597 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MP047 Silimed Tissue Expanders Longditudinally Curved Model # 830, 831 220-520ml $850.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP048 Silimed Tissue Expanders Ball Shaped Orbital Model # 741, 747 3-60ml $480.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP049 Silimed Tissue Expanders Auricular Model # 841, 847 16-55ml $480.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP050 Silimed Tissue Expanders Calf Model # 880, 882 145-185ml $500.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP051 Silimed Tissue Expanders Finger Syndactylism Model # 851, 857 1-5ml $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Mentor Medical Systems

MN001 Mentor Radovan Tissue Expander - Volume 25cc - 1000cc $670.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

MN002 Expanders, skin - Volume 350cc - 800cc $1,000.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

 Surgiplas Medical

SP010 Nago Tissue Expander Remote port - silicone shell 10 to 2000cc $890.00 Only to be funded where used in

 a service for which a Medicare

 benefit is payable.

 Technology For Life Pty Ltd

TE001 PMT (Enhanced Surface) Breast Expander Custom 2 Stage and 3 Stage, silicone 10 x 13cm to 16.5 x 16 cm.  $2,180.00 $5,650.00 Only to be funded where used in

 Plus custom made a service for which a medicare

 benefit is payable.

TE004 # PMT Tissue Expander - Extremity +  Single stage, silicon Shaped 3 x 4cm to 8 x 18 cm $2,180.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 598 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TE005 # PMT Tissue Expander - Extremity +  Two stage, silicon Shaped 3 x 4cm to 11 x 22 cm $2,630.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

TE006 # PMT Tissue Expander - Extremity +  Three stage, silicon Shaped 3 x 4cm to 11 x 22 cm $2,180.00 $3,640.00 Only to be funded where used in

 a service for which a medicare

 benefit is payable.

TE007 # PMT Breast Expander Single stage, silicon 10 x 13cm to 14 x 18 cm. 13 x  $2,180.00 $2,940.00 Only to be funded where used in

 11cm to 15 x 13cm a service for which a medicare

 benefit is payable.

TE008 # PMT Breast Expander Two stage, silicon 10 x 13cm to 15 x 16 cm. Plus  $2,180.00 $3,266.00 Only to be funded where used in

 custom made a service for which a medicare

 benefit is payable.

TE009 # PMT Breast Expander Three stage, silicon plus 10 x 13cm to 16.5 x 16 cm.  $2,180.00 $4,879.00 Only to be funded where used in

 Plus custom made a service for which a medicare

 benefit is payable.

Facial Implant, PTFE

 Atrium Australia-Pacific Rim Pty Ltd

AC024 Atrium Advanta PTFE Facial Implant Composition is PTFE  Round Strands - Diameter  $970.00 Only to be funded where used in

 (Polytetrafluoroethylene). The implants  1.8mm - 3.0mm Length 15cm  a service for which a Medicare

 are available in round and oval 15cm  with or without preattached  Benefit is payable.

 strands and with or without a stainless  trocar; Oval Strands - Diameter

 steel trocar introducer. 2.0mm - 3.5mm by 3.2mm -

 6.5mm Length 15cm with or

Fixation Device

 Biomet Australia Pty Ltd

BI924 Lactosorb Resorbable Craniomaxillofacial  Orbital Floor Plate, 1.5mm System,  Left or right $615.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 599 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Karma Medical

KM001 Endotine Forehead Fixation Device Bioabsorbable sutureless fixation device.   3.0mm & 3.5mm $350.00 Only to be funded when used in

 Polymer made up of 82/18L -  a service for which a Medicare

 Benefit is payable.

 Stryker Australia Pty Ltd (2)

SK420 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate,  1.7mm $220.00

SK421 Orthodontic Skeletal Anchor Plate Orthodontic Skeletal Anchor Plate  1.7mm $355.00

Fixation Device, Internal, Plate

 Medical & Optical  Instruments Australia Pty Ltd

MO214 Martin Fixation Device Internal - plate Sterile Titanium Straight Plate 2.0mm system 4 - 6 hole $152.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO215 Martin Fixation Device Internal - Plate Sterile Titanium Straight Plate 2.0mm system 8 - hole $231.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO216 Martin Fixation Device Internal - Plate Sterile Titanium Shaped Plate 2.0mm system 4 - 12 hole $235.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO219 Martin Fixation Device Internal - plate Sterile Titanium Plate 1.0mm system 4-8 hole $203.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO220 Martin Fixation Device Internal - Plate Sterile Titanium straight Plate 1.0mm system 12-16 hole $294.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO221 Martin Fixation Device Internal - plate Sterile Titanium shaped Plate 1.0mm system 5 to 10 hole $295.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO222 Martin Fixation Device Internal - Plate Sterile Titanium straight Plate 1.0mm system 24 to 32 hole $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 600 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO223 Martin Fixation Device Internal - Plate Sterile Titanium shaped Plate 1.0mm system 10 to 16 hole $355.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO224 Martin Fixation Device Internal - Plate Sterile titanium Lindorf chin plate 1.5mm to 2.0mm diameter system $350.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO225 Martin Fixation Device Internal - Plate Sterile Titanium Lindorf Plate 1.5mm system left and right plate $350.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO226 Martin Fixation Device Internal - Plate Sterile Titanium shaped Plate 1.5mm system $304.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO227 Martin Fixation Device Internal - Plate Sterile Titanium plate 1.5mm system 4 to 8 hole $205.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO228 Martin Fixation Device Internal - Plate Sterile Titanium Plate 1.5mm system 2 hole $131.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO237 Martin Fixation Device Internal - Plate Sterile Titanium Straight Plate 1.5 - 2.0mm System 16 - Hole $294.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO238 Martin Fixation Device Internal - Plate Sterile Titanium Straight Plate 1.5mm System 8 - Hole $205.00 Temporary approval, pending

 review of product group. Only to

  be funded where used in a

 service for which a Medicare

MO250 Martin Microplate Osteosynthesis system 1.5mm Titanium Plate 2-6 Hole $226.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Synthes Australia Pty Ltd

SY311 Fixator System Anterior Foot Plates Left and Right,  2.0mm, 6-14mm; Short,  $2,575.00 Only to be funded where used in

 Posterior Foot Plates, Distractor body,  Medium, Tall - 7-12mm offset;  a service for which a Medicare

 10-25mm advancement; 3.5mm  Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 601 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY312 AO/ASIF Facio-maxillary Plates Titanium Locking Mandible Plates,  2.0mm, small (1.0mm thickness $740.00 Only to be funded where used in

 straight and angled and crescent  to Medium (1.3mm thickness)  a service for which a Medicare

 2-20 holes length Benefit is payable

SY315 AO/ASIF Facio-maxillary Plates Titanium Locking Mandible Plates,  2.0mm Large (1.5mm  $1,030.00 Only to be funded where used in

 straight and angled and crescent thickness) Straight and angled ,  a service for which a Medicare

 Benefit is payable

SY316 AO/ASIF Facio-maxillary Plates Titanium Locking Mandible Plates,  2.0mm, Large (1.5mm  $360.50 Only to be funded where used in

 straight and angled and crescent thickness) crescent shaped a service for which a Medicare

 Benefit is payable

Fixation Device, Internal, Screw

 Cochlear Limited

CO034 Face to Face Fixture MK II - Titanium Composition 10mm $635.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

CO035 Face to Face Cover Screw with Internal Hexagon One Size Only $142.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

CO036 Face to Face Abutment Complete - Titanium 3, 4, 5.5, 7mm $412.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

CO037 Face to Face Console Abutment Unigrip - Titanium 30, 60, 90, 110 Degrees $895.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

CO038 Face to Face Healing Abutment Unigrip - Titanium 7mm $285.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

CO039 Flangeless Fixtures Titanium Fixtures part numbers 3.0mm, 4.0mm $635.00

 90611, 90613

Prostheses List by Category, Groups and Sponsor Page 602 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medical & Optical  Instruments Australia Pty Ltd

MO212 Martin Fixation Device Internal - Screw Sterile Titanium Screw 2.00mm diameter; 4 to 11mm  $294.00 Only to be funded where used in

 length a service for which a Medicare

 Benefit is payable

MO213 Martin Fixation Device Internal Screw Sterile Titanium Screw 2.0mm diameter; 12 - 20mm  $357.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO217 Martin Fixation Device Internal - Screw Sterile Titanium Screw 2.3mm diameter 5 to 11mm  $325.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO218 Martin Fixation Device Internal - Screw Sterile Titanium Screw 1.0mm to 1.2mm diameter 2 to  $466.00 Only to be funded where used in

 7mm length a service for which a Medicare

 Benefit is payable

MO229 Martin Fixation Device Internal - Screw Sterile Titanium Screw 1.5mm to 1.8mm diameter;  $470.00 Only to be funded where used in

 3.5mm to 9mm length a service for which a Medicare

 Benefit is payable

MO230 Martin Fixation Device Internal - Screw Sterile Titanium Screw 1.5mm to 1.8mm diameter; 10  $545.00 Only to be funded where used in

 to 15mm length a service for which a Medicare

 Benefit is payable

MO232 Martin Fixation Device Internal - Plate Sterile Titanium Y & Double Y Plate 2.0mm System $226.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd (2)

SK422 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary  1.7mm $110.00

 Fixation Screw, Self-Drilling

SK423 Orthodontic Skeletal Anchor Screw Anchor Screw for Mandibular Maxillary  2.0mm $110.00

 Fixation Screw, Self-Drilling

 TiMax Surgical Pty Ltd

TI086 Ultimax Bone Screws Titanium-Sterile 1.0-2.3 x 2-22mm, each $40.00

TI087 Ultimax Bone Screws Titanium-Sterile 1.0-2.3 x 2-22mm, 4 pack $34.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 603 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TI088 Ultimax Bone Screws Titanium-Sterile 1.0-2.3 x 2-22mm, 5 pack $34.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Grafts, Bone, Synthetic

 Austramedex (VIC) Pty Ltd

AR001 Nova Bone Bonegraft particulate 6cc/8g $500.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Pacific Medical

PM001 Perioglas:  Bioglass granules 0.5cc $85.00 $107.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Jaw Fracture Fixation Devices

 Synthes Australia Pty Ltd

SY154 AO/ASIF Facio-maxillary Plates Micro - Shaped, L, Y, T, X & H Plates,  1.0mm, 4 - 34 hole $187.46 Only to be funded where used in

 Double, Burr Hole Cover, Orbital Floor a service for which a Medicare

 Benefit is payable

SY155 AO/ASIF Facio-maxillary Plates Mini - Shaped, Straight, L, Y, T, X   1.5mm, 2-20 hole $300.00 Only to be funded where used in

 Plates, Shaft, Burr Hole Cover, Right &  a service for which a Medicare

 Left, adaption, orbital floor Benefit is payable

SY157 AO/ASIF Facio-maxillary Plates Mini plate, shaped, locked &non-locked 2.0mm, 2-30 hole $247.20 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

SY158 AO/ASIF Facio-maxillary Plates Mandible Plate, Locking 2.4mm 2-50 hole $1,545.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 604 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SY159 AO/ASIF Facio-maxillary Plates 1.3mm Plates 2-24 hole $662.29 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

SY160 AO/ASIF Facio-maxillary Plates Mesh Plate 1.0 - 1.5mm $1,047.51 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

SY324 AO/ASIF Facio-maxillary Plates Mandible Plate, Non-locking 2.4mm 2-50 hole $721.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Mesh

 Aus Systems Pty Ltd

AU057 Titanium Surgical Mesh Titanium Surgical Mesh Mesh to suit 2mm screw $460.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AU058 Titanium Surgical Mesh Titanium Surgical Mesh Mesh to suit 1.5mm screw $390.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Medical & Optical  Instruments Australia Pty Ltd

MO251 RESORB X OSTEOSYNTHESIS  Orbital Floor Mesh 0.6mm Profile $1,580.00 Only to be funded where used in

 SYSTEM MESH PLATE a service for which a Medicare

 Benefit is payable

Mesh, Metallic

 Stryker Australia Pty Ltd (2)

SK305 Leibinger Dynamic Mesh Titanium Mesh Dynamic Mesh 90x90x0.6mm  $1,155.00 Only to be funded where used in

 for screws 1-1.4mm a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 605 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Mesh, Polyglycolic Acid

 Stryker Australia Pty Ltd

ST526 Stryker Leibinger Resorbable Fixation  Resorbable Mesh Tripolymer 55x55mm $1,020.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Mesh, Polymeric

 TiMax Surgical Pty Ltd

TI064 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane &  a) 30 x 40mm membrane kit; b)  $345.00 Only to be funded where used in

 6 tack kit and applicator a service for which a Medicare

 Benefit is payable

TI065 Inion GTR Biodegradable System PLGA/TMC Copolymer: membrane &  6 tack kit $315.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Orthopedic External Fixation Systems, Other

 Biomet Australia Pty Ltd

BI812 Blue Device Multivector Distraction System Blue device frame, aluminium & carbon  One size only $8,147.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

BI813 Blue Device Multivector Distraction System Blue device, pre-stretched wire, titanium 12 inches, 18-24 gauge $3.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 606 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI814 Blue Device Multivector Distraction System Attachment plates, titanium 4-6 Hole $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

BI815 Blue Device Multivector Distraction System Distraction assembly, aluminium and  One size only $2,070.00 Only to be funded where used in

 carbon fiber a service for which a Medicare

 Benefit is payable.

BI816 Blue Device Multivector Distraction System Cranial screw, titanium 45mm $150.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

BI817 Blue Device Multivector Distraction System Threaded fixation screw, titanium 2.0mm system, 15-25mm $150.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

BI934 Lactosorb Distraction System Plate, drive screw and distractor,  Small, Medium, Large $3,500.00

 PGA/PLLA, Ti

 Medical & Optical  Instruments Australia Pty Ltd

MO246 Martin Rigid External Distraction System  REDII Aluminium and Carbon Fibre  One size only $1,560.00 Temporary approval, pending

 II (REDII) Cross-Bar Assembly review of product group. Only to

  be funded where used in a

 service for which a Medicare

 Synthes Australia Pty Ltd

SY349 Multi Vector Distractor Set Titanium Multi Vector Distractor MVD Arms:15mm-85mm. Pin  $4,250.00

 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-

Prostheses List by Category, Groups and Sponsor Page 607 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems

 Surgiplas Medical

SP039 Bioresorbable Fixation System Screws 1.6 x (4-8)mm, 4pack; 2.0 x (4- $420.00 Only to be funded where used in

 8)mm, 4 pack a service for which a Medicare

 Benefit is payable

SP041 Product Name Plates Comminution Plate, 20 x 30mm  $644.00 Only to be funded where used in

 Bioresorbable Fixation System Mesh, Neuro Fixation Set a service for which a Medicare

 Benefit is payable

SP042 Bioresorbable Fixation System Plates "L" Plate Left & Right, "T"  $340.00 Only to be funded where used in

 Plate, Double "Y" Plate Short &  a service for which a Medicare

 Long, Orbital Plate, 4 & 8 Hole  Benefit is payable

 straight Plate, Square Plate

SP043 OsteoMed Plating & Fixation System Plates 50 x 50mm Bioresorbable Mesh; $1,250.00 Only to be funded where used in

  111 x 191mm, 125 x 180mm,  a service for which a Medicare

 & Medium Mesh Plate; 40 x  Benefit is payable

 40mm, 90 x 90mm Osteoform

SP044 OsteoMed Plating & Fixation System Plates 100 x 100mm Bioresorbable  $2,975.00 Only to be funded where used in

 Mesh; 150 x 300mm, & Large  a service for which a Medicare

 Mesh Plate; 90 x 90mm, 95 x  Benefit is payable

 165mm, & Large Pre-formed

 Synthes Australia Pty Ltd

SY344 Titanium Sternal Fixation System Locking Plate - straight, H or star Straight: 12 - 30 holes. H: small  $1,500.00

 & large star: 6- 12 holes

SY345 Titanium Sternal Fixation System Titanium Emergency Release Pin One Size only $125.00

SY346 Titanium Sternal Fixation System Titanium Locking Screw 3.0mm, 8 - 18mm length $90.00

SY347 Titanium Sternal Fixation System Locking Plate - straight 20 or 30 holes $1,800.00

Prostheses List by Category, Groups and Sponsor Page 608 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems, Fracture

 Biomet Australia Pty Ltd

BI492 Small Fragment Titanium System Plate, Rectangle, 1.2mm, 1.7mm, 2.3mm  2 x 2 hole x (0.6mm or 1) mm  $204.00 Only to be funded where used in

 System, Titanium height a service for which a Medicare

 Benefit is payable

BI493 Small Fragment Titanium System Plate, Rectangular, Parallelogram,  4 x 2 hole x (0.6mm, 1mm)  $392.00 Only to be funded where used in

 Trapezoid; 1.2mm or 1.7mm or 2.3mm  a service for which a Medicare

 Benefit is payable

BI495 Small Fragment Titanium System Plate, Y or L or T; 1.2mm System,  (5-9) hole x 0.6mm height $193.00 Only to be funded where used in

 1.7mm System; Titanium a service for which a Medicare

 Benefit is payable

BI496 Small Fragment Titanium System Plate, Straight, Std or Compression;  (0.6mm or 1mm height) x (4-6  $104.00 Only to be funded where used in

 1.7mm or 2mm or 2.3mm System;  a service for which a Medicare

 Benefit is payable

BI497 Small Fragment Titanium System Plate, Straight, 1.2mm or 1.7mm System, 16 hole x 0.6mm height $250.00 Only to be funded where used in

  Titanium a service for which a Medicare

 Benefit is payable

BI499 Small Fragment Titanium System Washer, Lag Screw 1.2,1.7, 2.3mm  0.6mm or 1mm height $14.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI512 Small Fragment Titanium System Bone Screw, Titanium 1.4mm x (4 - 10) mm $40.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI515 Small Fragment Titanium System Bone Screw, Titanium 1.2mm x (7 - 19) mm $55.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI520 Small Fragment Titanium System Bone Screw, Titanium 1.7mm x (5 - 10) mm $40.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 609 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI523 Small Fragment Titanium System Bone Screw, Titanium 1.7mm x (11 - 27) mm $40.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI525 Small Fragment Titanium System Bone Screw, Emergency Titanium (1.9mm or 2.5mm) x (5-6mm) $34.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI528 Small Fragment Titanium System Bone Screw, Titanium 2.3mm x (6 - 23) mm $37.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI530 Small Fragment Titanium System Bone Screw, Titanium 2.3mm x (25 - 33) mm $43.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI532 Small Fragment Titanium System Plate, Straight, Compression; Titanium (4-6 hole) x 1.25mm height $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI538 Small Fragment Titanium System Plate, Condylar, Left or Right, 1.7mm or  (5 or 7 hole) x (0.6mm or 1)  $209.00 Only to be funded where used in

 2.3mm System mm height a service for which a Medicare

 Benefit is payable

BI541 Small Fragment Titanium System Y Plate, 2.3mm System, Titanium (7 or 9 hole) x (1.0 or 1.25) mm $242.00 Only to be funded where used in

  height a service for which a Medicare

 Benefit is payable

BI544 Small Fragment Titanium System Plate, T or L,  2.3mm System, Titanium (6 - 9 hole) x (1.0 or 1.25) mm  $209.00 Only to be funded where used in

 height a service for which a Medicare

 Benefit is payable

BI546 Small Fragment Titanium System Plate, T or L, Compression, 2.3mm  6 hole x (1.00 or 1.25) mm  $190.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI551 Small Fragment Titanium System Z Plate, 2.3mm System, Titanium 13 hole, 1mm height $278.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI723 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular  2.7 x (6-20)mm $53.00 Only to be funded where used in

 Fracture, Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 610 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI726 Mandibular Fracture System Screw, High Torque (HT), Emergency,  Dia 2.3mm x 4.0, 5.0, 7.0, 9.0,  $45.00 Only to be funded where used in

 2.0/2.4 Mandibular Fracture System,  11.0, 13.0, 15.0mm  Lengths a service for which a Medicare

 Benefit is payable

BI731 Mandibular Fracture System Washer, for High Torque (HT) Lag  2.0 (dia), 2.4 (dia) $109.00 Only to be funded where used in

 Screw, 2.0/2.4 Mandibular Fracture  a service for which a Medicare

 Benefit is payable

BI744 Mandibular Fracture System Screw, High Torque 2.0/2.4 Mandibular  2.0 x (9-17)mm $45.00 Only to be funded where used in

 Fracture, Titanium a service for which a Medicare

 Benefit is payable

BI747 Mandibular Fracture System Screw, High Torque (HT), Lag,  2.0/2.4  Dia 2.0 x 19, 21.0, 23, 25, 27,  $53.00 Only to be funded where used in

 Mandibular Fracture System, Titanium 29mm  Lengths a service for which a Medicare

 Benefit is payable

BI748 Mandibular Fracture System Screw, High Torque (HT), 2.0/2.4  Dia 2.4 x 6.0mm, 8.0, 10.0,  $47.00 Only to be funded where used in

 Mandibular Fracture System, Titanium 12.0, 14.0, 16.0, 18.0mm  a service for which a Medicare

 Benefit is payable

BI749 Mandibular Fracture System Screw, High Torque (HT),  2.0/2.4  Dia 2.4 x 20.0mm Lengths $62.00 Only to be funded where used in

 Mandibular Fracture System, Titanium a service for which a Medicare

 Benefit is payable

BI750 Mandibular Fracture System Plates, Angled or Curved, 2.0 Mandibular  4-10 hole $150.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI751 Mandibular Fracture System Screw, High Torque (HT), Lag, 2.0/2.4  2.4mm Dia, 24, 28, 32, 36,  $58.00 Only to be funded where used in

 Mandibular Fracture, Titanium 40mm Lengths a service for which a Medicare

 Benefit is payable

BI753 Mandibular Fracture System Plates, Matrix Shape, 2.0 Mandibular  2 x (2, 4, 6, 8) hole $207.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI754 Mandibular Fracture System Plates, Compression, 2.0 Mandibular  4 hole $173.00 Only to be funded where used in

 Fracture System, Titanium a service for which a Medicare

 Benefit is payable

BI755 Mandibular Fracture System Plates, Y Shapek, 2.0 Mandibular  5 hole long, 5 hole medium, 5  $142.00 Only to be funded where used in

 Fracture System, Titanium hole regular a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 611 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI756 Mandibular Fracture System Plates, Compression, 2.0 Mandibular  6 hole, 8 hole $210.00 Only to be funded where used in

 Fracture System, Titanium a service for which a Medicare

 Benefit is payable

BI759 Mandibular Fracture System Plates, Matrix Shape, 2.0 Mandibular  5 hole long, 5 hole medium, 5  $150.00 Only to be funded where used in

 Fracture System, Titanium hole regular a service for which a Medicare

 Benefit is payable

BI761 Mandibular Fracture System Plates, V Shape, 2.0 Mandibular Fracture  6-10 hole $152.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI762 Mandibular Fracture System Plates, 2.4 Mandibular Fracture System,  16 - 24 Hole $770.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI764 Mandibular Fracture System Plates, 2.4 Mandibular Fracture System,  4, 6, 8 hole $373.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI767 Mandibular Fracture System Plates, Straight, 2.0 Mandibular Fracture  4 hole, 6 hole, 8 hole $117.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd

ST369 Luhr Fixation System  Luhr Mandibular Compression System:  Curved: 30,38, 45mm, Straight:  $152.00 Only to be funded where used in

 curved, straight, metacarpal plate Vitallium 30, 40, 50, 60, 80mm,  a service for which a Medicare

 metacarpal: 41, 45mm Benefit is payable

ST378 Luhr Fixation System  Luhr Mandibular Compression and  2.7x6-34mm, emergency:  $113.00 Only to be funded where used in

 Reconstruction System Screws: self- 3.0x10-14mm a service for which a Medicare

 tapping and MCS emergency screws  Benefit is payable

ST390 Luhr Fixation System  Luhr Micro and Pan Fixation Systems:  40x60mm $700.00 Only to be funded where used in

 Micro mesh  Vitallium a service for which a Medicare

 Benefit is payable

ST391 Luhr Fixation System  Luhr Micro and Pan Fixation Systems:  60x100mm $1,550.00 Only to be funded where used in

 Micro mesh  Vitallium a service for which a Medicare

 Benefit is payable

ST392 Luhr Fixation System  Luhr Micro Fixation System: micro  6 holes, 6x7mm $105.00 Only to be funded where used in

 double-T-shape plate Vitallium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 612 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST393 Luhr Fixation System  Luhr Micro Fixation System: micro  7 holes, 10x10mm $105.00 Only to be funded where used in

 double-T-shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST394 Luhr Fixation System  Luhr Micro Fixation System: micro  11 holes, 10/18mm $130.00 Only to be funded where used in

 double-T-shape plate, Y-shape plate,  a service for which a Medicare

 ladder plate Vitallium Benefit is payable

ST395 Luhr Fixation System  Luhr Micro Fixation System: micro L- 5 holes, 14x2.5mm, 14x4mm, 7 $103.00 Only to be funded where used in

 shape plate Vitallium  holes, 22x4mm a service for which a Medicare

 Benefit is payable

ST396 Luhr Fixation System  Luhr Micro Fixation System: micro  4 holes, 14mm $89.00 Only to be funded where used in

 straight plate Vitallium a service for which a Medicare

 Benefit is payable

ST397 Luhr Fixation System  Luhr Micro Fixation System: micro  6 holes, 22mm $91.00 Only to be funded where used in

 straight plate Vitallium a service for which a Medicare

 Benefit is payable

ST398 Luhr Fixation System  Luhr Micro Fixation System: micro  8 holes, 30mm $99.00 Only to be funded where used in

 straight plate Vitallium a service for which a Medicare

 Benefit is payable

ST399 Luhr Fixation System  Luhr Micro Fixation System: micro  10 holes, 40mm $106.00 Only to be funded where used in

 straight plate  Vitallium a service for which a Medicare

 Benefit is payable

ST400 Luhr Fixation System  Luhr Micro Fixation System: micro  15 holes, 60mm $114.00 Only to be funded where used in

 straight plate Vitallium a service for which a Medicare

 Benefit is payable

ST401 Luhr Fixation System  Luhr Micro Fixation System: micro  22 holes, 90mm $130.00 Only to be funded where used in

 straight plate Vitallium a service for which a Medicare

 Benefit is payable

ST402 Luhr Fixation System  Luhr Micro Fixation System: micro T- 6 holes, 14mm, 8 holes, 22mm $103.00 Only to be funded where used in

 shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST403 Luhr Fixation System  Luhr Pan Fixation System: micro T-shape 6 holes $170.00 Only to be funded where used in

  plate, custom Vitallium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 613 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST404 Luhr Fixation System  Luhr Micro Fixation System: ladder plate  10 Holes, 6 x 8mm $121.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST405 Luhr Fixation System  Luhr Micro Fixation System: double-Y- 8 Holes, 22mm $121.00 Only to be funded where used in

 shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST406 Luhr Fixation System  Luhr Micro Fixation System: emergency  1.0x8-12mm Pack of 6 $51.84 Only to be funded where used in

 screws Vitallium a service for which a Medicare

 Benefit is payable

ST407 Luhr Fixation System  Luhr Micro Fixation System: cortical  0.8x2-8mm Pack of 6 $44.28 Only to be funded where used in

 screws Vitallium a service for which a Medicare

 Benefit is payable

ST408 Luhr Fixation System  Luhr Micro Fixation System: emergency  1.0x2-6mm $52.00 Only to be funded where used in

 screws Vitallium a service for which a Medicare

 Benefit is payable

ST409 Luhr Fixation System  Luhr Mini Fixation System: compression,  4 holesx22mm, 15 holesx45mm $82.00 Only to be funded where used in

 T-shape, zig-zag plate Vitallium a service for which a Medicare

 Benefit is payable

ST410 Luhr Fixation System  Luhr Mini Fixation System: compression  4 holes x 21mm, 5 holes x  $150.00 Only to be funded where used in

 mini curved plate Vitallium 27mm, 7 holes x 38mm, 9 holes a service for which a Medicare

 Benefit is payable

ST411 Luhr Fixation System  Luhr Mini Fixation System: compression  4 holes x 22mm, 4 holes x  $83.00 Only to be funded where used in

 mini T-shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST412 Luhr Fixation System  Luhr Pan Fixation System: condensed,  4 holes x 12mm, 6 holes x  $51.00 Only to be funded where used in

 straight plate Vitallium 18mm, 12 holes x 36mm a service for which a Medicare

 Benefit is payable

ST413 Luhr Fixation System  Luhr Pan Fixation System: double-T- 4 holes, 12mm $44.00 Only to be funded where used in

 shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST414 Luhr Fixation System  Luhr Pan Fixation System: ladder plate  10 holes, 39 x 9mm $165.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 614 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST415 Luhr Fixation System  Luhr Pan Fixation System: L-shape plate,  4 holes, 16 x 9mm, 22 x 9mm $58.00 Only to be funded where used in

 90 deg Vitallium a service for which a Medicare

 Benefit is payable

ST416 Luhr Fixation System  Luhr Pan Fixation System: L-shape plate,  4 holes, 16 x 9mm, 22 x 9mm $152.00 Only to be funded where used in

 110 deg Vitallium a service for which a Medicare

 Benefit is payable

ST417 Luhr Fixation System  Luhr Pan Fixation System: straight plate  4 holes, 21mm $46.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST418 Luhr Fixation System  Luhr Pan Fixation System: straight plate  6 holes, 33mm $60.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST419 Luhr Fixation System  Luhr Pan Fixation System: straight plate  8 holes, 45mm $71.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST420 Luhr Fixation System  Luhr Pan Fixation System: straight plate  16 holes, 93mm $100.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST421 Luhr Fixation System  Luhr Pan Fixation System: X-shape plate  4 holes, 18mm $72.00 Only to be funded where used in

  Vitallium a service for which a Medicare

 Benefit is payable

ST422 Luhr Fixation System  Luhr Pan Fixation System: Y-shape plate  4 holes, 16, 22mm $72.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST423 Luhr Fixation System  Luhr Pan Fixation System: T-shape plate  4 Holes, 22mm $155.00 Only to be funded where used in

 Vitallium a service for which a Medicare

 Benefit is payable

ST424 Luhr Fixation System  Luhr Mini Fixation System: mini curved  4 holes, 21mm $110.00 Only to be funded where used in

 plate Vitallium a service for which a Medicare

 Benefit is payable

ST425 Luhr Fixation System  Luhr Mini Fixation System: mini curved  5 holes, 27mm $120.00 Only to be funded where used in

 plate Vitallium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 615 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST426 Luhr Fixation System  Luhr Mini Fixation System: mini curved  7 holes, 38mm $150.00 Only to be funded where used in

 plate Vitallium a service for which a Medicare

 Benefit is payable

ST427 Luhr Fixation System  Luhr Mini Fixation System: mini curved,  11 holes, 50mm $180.00 Only to be funded where used in

 compression plate Vitallium a service for which a Medicare

 Benefit is payable

ST428 Luhr Fixation System  Luhr Mini Fixation System: mini double- 4 holes, 15mm $152.00 Only to be funded where used in

 T-shape plate, non-compression plate  a service for which a Medicare

 Benefit is payable

ST429 Luhr Fixation System  Luhr Mini Fixation System: mini double- 4 holes x 20mm $180.00 Only to be funded where used in

 T-shape plate, non-compression plate  a service for which a Medicare

 Benefit is payable

ST430 Luhr Fixation System  Luhr Mini Fixation System: Z shaped  4 holes x 25mm $100.00 Only to be funded where used in

 plate Vitallium a service for which a Medicare

 Benefit is payable

ST431 Luhr Fixation System  Luhr Mini Fixation System: mini double- 9 holes, 30mm $180.00 Only to be funded where used in

 T-shape plate, non-compression plate  a service for which a Medicare

 Benefit is payable

ST432 Luhr Fixation System  Luhr Mini Fixation System: mini  8 holes, 60mm $152.00 Only to be funded where used in

 fragmentation plate, non-compression  a service for which a Medicare

 plate Vitallium Benefit is payable

ST433 Luhr Fixation System  Luhr Mini Fixation System: mini  12 holes, 90mm $126.00 Only to be funded where used in

 fragmentation plate, non-compression  a service for which a Medicare

 plate Vitallium Benefit is payable

ST434 Luhr Fixation System  Luhr Mini Fixation System: non- 4 holes, 2.0x17.5mm,  $94.00 Only to be funded where used in

 compression mini L-shape plate,  a service for which a Medicare

 right/left, 90/110 deg Vitallium Benefit is payable

ST435 Luhr Fixation System  Luhr Mini Fixation System: compression  4 holes, 2.0x22mm $152.00 Only to be funded where used in

 mini L-shape plate, right/left,  90/110 deg  a service for which a Medicare

 Vitallium Benefit is payable

ST436 Luhr Fixation System  Luhr Mini Fixation System: non- 6 holes,  2.0x37mm $195.00 Only to be funded where used in

 compression mini L-shape plate, 90/110  a service for which a Medicare

 deg, right/left Vitallium Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 616 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST437 Luhr Fixation System  Luhr Mini Fixation System: compression  2.0 x 37mm $54.00 Only to be funded where used in

 mini L-shape plate, right/left,  90/110 deg  a service for which a Medicare

 Vitallium Benefit is payable

ST439 Luhr Fixation System  Luhr Mini Fixation System:  non- 4 holes, 2.0 x 21mm, 2.0 x  $124.00 Only to be funded where used in

 compression mini straight plate Vitallium 29mm, 2.0 x 37mm a service for which a Medicare

 Benefit is payable

ST440 Luhr Fixation System  Luhr Mini Fixation System: non- 4 holes, 2.0 x 22mm $76.00 Only to be funded where used in

 compression mini Y-shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST441 Luhr Fixation System  Luhr Mini Fixation System: non- 6 holes, 2.0 x 28mm $76.00 Only to be funded where used in

 compression mini Y-shape plate Vitallium a service for which a Medicare

 Benefit is payable

ST442 Luhr Fixation System  Luhr Mini Fixation System: non- 4 holes, 2.0 x 17mm, 2.0 x 22mm $99.00 Only to be funded where used in

 compression mini Z-shape plate  Vitallium a service for which a Medicare

 Benefit is payable

ST443 Luhr Fixation System  Luhr Mini Fixation System: emergency  6mm, 8mm, 10mm, 12mm  $50.00 Only to be funded where used in

 screws Vitallium Pack of 6 a service for which a Medicare

 Benefit is payable

ST444 Luhr Fixation System  Luhr Mini/ Pan Fixation System:  3-20mm. Pack of 6 $50.00 Only to be funded where used in

 emergency and standard screws Vitallium a service for which a Medicare

 Benefit is payable

ST445 Luhr Fixation System  Luhr Mini Fixation System: small  3, 4, 6, 8, 10, 12, 14, 16, 18,  $50.00 Only to be funded where used in

 fragment and emergency screws  20mm Pack of 6 a service for which a Medicare

 Benefit is payable

ST850 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 200 x 200mm for 1.0 -  $2,500.00 Only to be funded where used in

 the fixation of fractures 1.4mm screws a service for which a Medicare

 Benefit is payable

ST851 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.3 x 120 x 120mm for 1.0 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 1.4mm screws a service for which a Medicare

 Benefit is payable

ST852 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 120 x 120mm for 1.0 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 1.4mm screws a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 617 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST853 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.3 x 120 x 120mm for 1.7 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 1.9mm screws a service for which a Medicare

 Benefit is payable

ST854 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 120 x 120mm for 1.7 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 1.9mm screws a service for which a Medicare

 Benefit is payable

ST855 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.3 x 120 x 120mm for 2.0 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 2.3mm screws a service for which a Medicare

 Benefit is payable

ST856 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 120 x 120mm for 2.0 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 2.3mm screws a service for which a Medicare

 Benefit is payable

ST857 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 200 x 200mm for 1.7 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 1.9mm screws a service for which a Medicare

 Benefit is payable

ST858 Dynamic Mesh Titanium cranio maxillofacial mesh for  0.6 x 200 x 200mm for 2.0 -  $2,407.00 Only to be funded where used in

 the fixation of fractures 2.3mm screws a service for which a Medicare

 Benefit is payable

ST861 Auto Pilot Cross Pin Self-drilling screws Used for permanent fixation of cranial  Dia 1.9 x length 4mm $40.00 Only to be funded where used in

 bone flaps a service for which a Medicare

 Benefit is payable

ST862 Auto Pilot Cross Pin Self-drilling screws Used for permanent fixation of cranial  Dia 1.7 x length 4 - 7mm $40.00 Only to be funded where used in

 bone flaps a service for which a Medicare

 Benefit is payable

ST863 Auto Pilot Cross Pin Self-drilling screws Used for permanent fixation of cranial  Dia 2.0 x length 4 - 8mm $40.00 Only to be funded where used in

 bone flaps a service for which a Medicare

 Benefit is payable

ST864 Auto Pilot Cross Pin Self-drilling screws Used for permanent fixation of cranial  Dia 2.3 x lengths 4 and 6mm $140.00 Only to be funded where used in

 bone flaps a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 618 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Orthopedic Internal Fixation Systems, Other

 Biomet Australia Pty Ltd

BI348 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right.  2 x 2 hole, Mini or Low Profile $100.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI349 W Lorenz Osteosynthesis System Plate, Compression Straight, 2mm  4 hole $137.00 Only to be funded where used in

 System. Titanium a service for which a Medicare

 Benefit is payable

BI351 W Lorenz Osteosynthesis System L-Plate, 2mm System, Left or Right.  2 x 2 hole, long $168.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI353 W Lorenz Osteosynthesis System Plate, Burr Hole, 1mm, 1.5mm, 2mm  Small, Large $203.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI359 W Lorenz Osteosynthesis System Plate, Straight, mini, 2.0mm System,  4 - 8 hole $157.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI360 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive, Std  2.0mm x (4 - 7) mm $27.00 Only to be funded where used in

 or Self Drilling; Titanium a service for which a Medicare

 Benefit is payable

BI365 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.0mm x (9 - 19) mm $27.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI375 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.7mm x (8 - 18) mm $44.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI381 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.7mm x (22 - 40) mm $75.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 619 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI383 W Lorenz Osteosynthesis System Plate, Straight, 2.4mm, 2.7mm System;  4 hole (35mm) or 6 hole  $275.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI385 W Lorenz Osteosynthesis System Plate, Angled or Straight, 2.4mm or  4-8 hole $365.00 Only to be funded where used in

 2.7mm System, Titanium a service for which a Medicare

 Benefit is payable

BI390 W Lorenz Osteosynthesis System Plate, Angled 45 degrees, 2.4mm or  4 hole (35 or 40mm) $345.00 Only to be funded where used in

 2.7mm system, Titanium a service for which a Medicare

 Benefit is payable

BI392 Lactosorb Resorbable Craniomaxillofacial  Lactosorb Plates, 1.5mm System, All  4 - 20 hole $360.00 Only to be funded where used in

 Fixation System sizes, shapes PGA/PLA a service for which a Medicare

 Benefit is payable

BI428 Lorenz 2.4mm Locking Reconstruction  Add on Plate, Parallel, Arched, Y,  3 to 6 hole, 12x2 hole $245.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

BI435 Lorenz 2.4mm Locking Reconstruction  Holding Screw Head, 1.5mm Add-on  1.5mm $75.00 Only to be funded where used in

 System Plates. Titanium a service for which a Medicare

 Benefit is payable

BI436 Lorenz 2.4mm Locking Reconstruction  Holding Screw modular head, 1.5mm  2.4mm $65.00 Only to be funded where used in

 System Add-On plates. Titanium a service for which a Medicare

 Benefit is payable

BI439 Lorenz 2.4mm Locking Reconstruction  Plate, Low Profile, Angled, 2.4mm  5 x (22 -24) hole $1,318.00 Only to be funded where used in

 System System Titanium a service for which a Medicare

 Benefit is payable

BI440 Lorenz 2.4mm Locking Reconstruction  Plate, Angled, 2.4mm System Titanium 5 x 22 hole $1,268.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

BI443 Lorenz 2.4mm Locking Reconstruction  Plate, Low Profile, Angled, 2.4mm  5 x 11 hole $1,009.00 Only to be funded where used in

 System System Titanium a service for which a Medicare

 Benefit is payable

BI445 Lorenz 2.4mm Locking Reconstruction  Plate, Angled, 2.4mm System Titanium 5 x 11 hole $975.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 620 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI447 Lorenz 2.4mm Locking Reconstruction  Plate, Curved, Std Thickness, 2.4mm  8 or 20 hole $490.00 Only to be funded where used in

 System System, Titanium a service for which a Medicare

 Benefit is payable

BI448 Lorenz 2.4mm Locking Reconstruction  Plate, curved, std or low profile, 2.4mm  20 - 24 hole $927.00 Only to be funded where used in

 System system, titanium a service for which a Medicare

 Benefit is payable

BI450 Lorenz 2.4mm Locking Reconstruction  Plate, low profile. Curved. 2.4mm  8 hole $620.00 Only to be funded where used in

 System System. Titanium a service for which a Medicare

 Benefit is payable

BI452 Lorenz 2.4mm Locking Reconstruction  Plate, Straight, Std or low profile, 2.4mm 12 - 16 hole $606.00 Only to be funded where used in

 System  System, Titanium a service for which a Medicare

 Benefit is payable

BI454 Lorenz 2.4mm Locking Reconstruction  Plate, Straight, Std or low profile, 2.4mm 8 hole $454.00 Only to be funded where used in

 System  System, Titanium a service for which a Medicare

 Benefit is payable

BI455 Lorenz 2.4mm Locking Reconstruction  Plate, Double Angled, 2.4mm System,  5 x (22 or 24) x 5 hole $1,600.00 Only to be funded where used in

 System Titanium a service for which a Medicare

 Benefit is payable

BI457 Lorenz 2.4mm Locking Reconstruction  Screw, Locking Reconstruction Modular. 2.4 x (6-18)mm $95.00 Only to be funded where used in

 System  Titanium a service for which a Medicare

 Benefit is payable

BI464 Lorenz 2.4mm Locking Reconstruction  Screw, Locking Reconstruction Modular. 2.7 x (6-18)mm $95.00 Only to be funded where used in

 System  Titanium a service for which a Medicare

 Benefit is payable

BI471 Lorenz 2.4mm Locking Reconstruction  Screw Head, Plate Locking Modular 2.4mm $95.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

BI472 Lorenz Pectus Bar Pectus Bar, Stainless Steel 178-432mm $1,256.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI483 Lorenz Pectus Bar Stabilizer, Triangular or Elongated,  One size only $505.00 Only to be funded where used in

 Stainless Steel a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 621 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI485 Distraction Technology System Drive Screw with Flex Connect. Titanium 20 - 30mm $385.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI574 Distraction Technology System Distractor, Solid Shaft, Facial, Titanium 1- 2 inch $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI591 W Lorenz Osteosynthesis System Chin Plates, Paulus, 2mm System, Titanium 4 - 12mm $226.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI603 W Lorenz Osteosynthesis System Sheet, 1mm System Titanium 202x127x0.2mm $820.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI604 W Lorenz Osteosynthesis System Sheet, 1mm System. Titanium 85x50x0.2mm $312.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI605 W Lorenz Osteosynthesis System Plate, Matrix, 1.5mm System, Titanium 2 x 3 or 2 x 4 hole $127.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI617 W Lorenz Osteosynthesis System Plate, Straight, 1mm System. Titanium 4 hole $85.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI620 W Lorenz Osteosynthesis System Plate, Straight, low profile, 2.0mm  4 - 8 hole $98.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI621 W Lorenz Osteosynthesis System Plate, L , 2.5mm or 2m system, Titanium 2 x2 or 3x3 hole $115.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI622 W Lorenz Osteosynthesis System Z-Shape Plate, Left or Right, 1.5mm or  2 x 2 hole $133.00 Only to be funded where used in

 2mm System. Titanium a service for which a Medicare

 Benefit is payable

BI623 W Lorenz Osteosynthesis System T-Plate, Left or Right, 1.5mm System.  3x3 hole, 7x7 hole $193.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 622 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI624 W Lorenz Osteosynthesis System T-Plate 90 degrees, Left or Right, 2mm  2x5hole, 3x3hole, 2x3hole $150.00 Only to be funded where used in

 System. Titanium a service for which a Medicare

 Benefit is payable

BI625 W Lorenz Osteosynthesis System Plate, Y, Double Y, X, 1.5mm System or  One size only $112.00 Only to be funded where used in

 2.0mm System, Titanium a service for which a Medicare

 Benefit is payable

BI627 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System, Titanium 4 or 6 hole $107.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI628 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System or 2mm  16 hole $193.00 Only to be funded where used in

 System. Titanium a service for which a Medicare

 Benefit is payable

BI629 W Lorenz Osteosynthesis System Plate Straight, 1.0mm, 1.5mm, 2.0mm  24 hole $280.00 Only to be funded where used in

 System, Titanium a service for which a Medicare

 Benefit is payable

BI631 W Lorenz Osteosynthesis System L Plate, Left or Right, 1mm System.  5x3 hole $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI633 W Lorenz Osteosynthesis System T Plate 90 degrees, 1mm System, Titanium 5 hole, Regular $190.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI635 W Lorenz Osteosynthesis System Plate, DoubleT, Double Y; 1mm, 2mm  6,7,11 hole $185.00 Only to be funded where used in

 system, Titanium a service for which a Medicare

 Benefit is payable

BI636 W Lorenz Osteosynthesis System Plate, Y-Shape, 1mm System, 2mm  Regular, medium, long, xlong,  $190.00 Only to be funded where used in

 System .Titanium nasal. 6 hole a service for which a Medicare

 Benefit is payable

BI638 W Lorenz Osteosynthesis System Plate, Orbital. 1mm System, Titanium One size only $195.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI639 W Lorenz Osteosynthesis System Plate, Square. 1mm System. Titanium 4 hole $123.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 623 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI640 W Lorenz Osteosynthesis System Plate, Matrix. 1mm System. Titanium 2 x 3 hole $160.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI641 W Lorenz Osteosynthesis System Plate, Matrix.  1mm System, 1.5mm  2 x 4 hole $193.00 Only to be funded where used in

 System. Titanium a service for which a Medicare

 Benefit is payable

BI644 W Lorenz Osteosynthesis System Mesh panel, 1mm System. Titanium 83 x 51mm x 0.6mm $1,127.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI645 W Lorenz Osteosynthesis System Mesh panel. 1.5mm System Titanium 83 x 51mm x 0.3mm $987.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI656 W Lorenz Osteosynthesis System Plate, Orbital; 1.5mm, 2.0mm System;  6 or 8 hole $90.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI658 W Lorenz Osteosynthesis System Plate, Orbital. 1.5mm System, 2mm  10 hole $112.00 Only to be funded where used in

 System. Titanium a service for which a Medicare

 Benefit is payable

BI660 W Lorenz Osteosynthesis System Plate, H-Shape, 1.5mm System, Titanium One size only $160.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI662 W Lorenz Osteosynthesis System Mesh Panel, 1.5mm System. Titanium Small (85x53x0.6mm) $1,165.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI666 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  1.5mm x (3.5 - 15) mm $27.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI671 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  1.8mm x (3.5 - 7) mm $33.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI677 W Lorenz Osteosynthesis System Plate, Neuro Straight, 1.5mm System,  2 hole (medium or long) $65.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 624 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI681 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  1.0mm x (2 - 7) mm $54.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI684 W Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  1.2mm x (3 - 5) mm $55.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI733 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive,  1.5 mm (dia) x 6.0, 7.0mm  $50.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI734 W.Lorenz Osteosynthesis System Bone Screw, Self Drilling, Cross Drive,  1.5 mm (dia) x 3.5, 4.0, 5.0mm, $27.00 Only to be funded where used in

 Titanium  [lengths] a service for which a Medicare

 Benefit is payable

BI735 W.Lorenz Osteosynthesis System Bone Screw, Cross or Centre Drive;  2.3mm x (5 - 9) mm $32.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI738 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Large $1,128.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI739 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Medium $1,039.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BI740 W.Lorenz Osteosynthesis System Orbital Floor Plate (Small) or NOE plate,  Small or NOE plate $909.00 Only to be funded where used in

 1.5mm System, Titanium a service for which a Medicare

 Benefit is payable

BI774 W Lorenz Osteosynthesis System Lefort plate, 1.5mm system, 0.6mm  Flat, 2-11mm $360.00 Only to be funded where used in

 thickness, titanium a service for which a Medicare

 Benefit is payable.

BI784 Lorenz 2.4mm Locking Reconstruction  Condyle screw, titanium One size only $75.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable.

BI786 Lorenz 2.4mm Locking Reconstruction  Screw, bending inserts, titanium One size only $33.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 625 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI792 Lorenz 2.4mm Locking Reconstruction  Condyle left or right, chrome cobalt  One size only $1,377.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable.

 Medical & Optical  Instruments Australia Pty Ltd

MO001 Titan Mesh Mesh Panel, Titanium Thickness 0.1mm, 0.2mm,  $1,731.00 Only to be funded where used in

 0.3mm, 0.6mm a service for which a Medicare

 Benefit is payable

MO002 Martin Mandibular Fracture System Plate Straight, Titanium 8 to 16 hole $629.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO003 Martin Mandibular Fracture System Plate Angled - left and right, Titanium 5 + 8 hole to 5 + 16 hole $988.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO004 Martin Mandibular Fracture System Total Mandible, Titanium 5 + 17 + 5 hole $1,422.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO007 Champy Maxillo-Facial Osteosynthesis  L Plate Titanium 4 to 10 hole $127.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO009 Champy Maxillo-Facial Osteosynthesis  Orbital Plate Titanium 8 - 12 Hole $157.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO011 Champy Maxillo-Facial Osteosynthesis  Multi Fragment Plate Titanium 4 hole $120.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO012 Champy Maxillo-Facial Osteosynthesis  Sagittal Split Plate Titanium  4 hole $118.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO013 Champy Maxillo-Facial Osteosynthesis  Straight Plate Titanium 4 hole $85.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO014 Champy Maxillo-Facial Osteosynthesis  Straight Plate Titanium 6 hole $95.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 626 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO015 Champy Maxillo-Facial Osteosynthesis  Straight Plate Titanium 8 hole $145.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO016 Champy Maxillo-Facial Osteosynthesis  Straight Plate Titanium 16 hole $170.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO017 Champy Maxillo-Facial Osteosynthesis  T Plate, Double T Plate Titanium 4 to 6 hole $140.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO018 Champy Maxillo-Facial Osteosynthesis  Y Plate, Double Y Plate Titanium 4 to 6 hole $140.00 Only to be funded where used in

 System a service for which a Medicare

 Benefit is payable

MO023 Martin Microplate Osteosynthesis System Lindorf Plate 0 to11mm $423.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO024 Martin Mandibular Fracture System Condylar Implant - left or right 5cm $1,039.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO028 Martin Mandibular Fracture System Screw Titanium 2.7mm diameter,  5 to 12mm  $77.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO029 Martin Mandibular Fracture System Screw Titanium 2.7mm diameter, 14 to 16mm  $74.00 Only to be funded where used in

 length a service for which a Medicare

 Benefit is payable

MO030 Martin Mandibular Fracture System Screw Titanium 2.7mm diameter, 18 to 20mm  $85.00 Only to be funded where used in

 length a service for which a Medicare

 Benefit is payable

MO033 Martin Mandibular Fracture System Screw Titanium 2.7mm diameter, 22 - 30mm  $94.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO038 Martin Mandibular Fracture System Screw Titanium 2.3mm diameter, 5 - 13mm  $48.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 627 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO041 Martin Mandibular Fracture System Screw Titanium 2.3mm diameter, 14 - 32mm  $61.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO044 Martin Mandibular Fracture System Screw Titanium 2.5mm diameter, 9 - 17mm  $56.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO045 Martin Mandibular Fracture System Straight Plate Titanium 4 hole $145.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO046 Martin Mandibular Fracture System Straight Plate Titanium 6 hole $150.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO047 Martin Mandibular Fracture System Straight Plate Titanium 8 hole $220.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO048 Martin Mandibular Fracture System Straight Plate Titanium 16 hole $267.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO049 Martin Mandibular Fracture System Angled Plate Titanium 6 hole $163.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO050 Martin Mandibular Fracture System Angled Plate Titanium 8 hole $233.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO051 Martin Mandibular Fracture System Curved Plate Titanium 4 hole $149.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO052 Martin Miniplate Osteosynthesis System L Plate Titanium 4 to 6 hole, 1mm profile $130.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO053 Martin Miniplate Osteosynthesis System Multi Fragment 4 to 8 hole, 1mm profile $222.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 628 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO054 Martin Miniplate Osteosynthesis System Straight Plate Titanium 2 hole, 1mm profile $46.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO055 Martin Miniplate Osteosynthesis System Straight Plate Titanium 4 hole, 1mm profile $85.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO056 Martin Miniplate Osteosynthesis System Straight Plate Titanium 6 hole, 1mm profile $90.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO057 Martin Miniplate Osteosynthesis System Straight Plate Titanium 8 hole, 1mm profile $142.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO058 Martin Miniplate Osteosynthesis System Straight Plate Titanium 16 hole, 1mm profile $195.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO059 Martin Miniplate Osteosynthesis System H & Y Plate 4 to 6 hole $140.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO060 Martin Miniplate Osteosynthesis System T Plate Titanium 4 to 6 hole, 1mm profile $161.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO062 Martin Miniplate Osteosynthesis System X Plate Titanium 6 hole, 1mm profile $210.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO069 Martin Miniplate Osteosynthesis System Screw Titanium 2mm diameter, 4 to 10mm  $35.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO070 Martin Miniplate Osteosynthesis System Screw Titanium 2mm diameter, 11 - 14mm length $39.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO071 Martin Miniplate Osteosynthesis System Screw Titanium 2mm diameter, 15 to 19mm  $58.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 629 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO072 Martin Miniplate Osteosynthesis System Screw Drill Free Titanium 2mm diameter, 5 to 7mm length $39.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO073 Martin Miniplate Osteosynthesis System Straight Plate Low Profile Titanium 2 hole, 0.6mm profile $53.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO074 Martin Miniplate Osteosynthesis System Straight Plate Low Profile Titanium 4 hole, 0.6mm profile $85.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO075 Martin Miniplate Osteosynthesis System Straight Plate Low Profile Titanium 6 hole, 0.6mm profile $90.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO076 Martin Miniplate Osteosynthesis System Straight Plate Low Profile Titanium 8 hole, 0.6mm profile $130.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO077 Martin Miniplate Osteosynthesis System Straight Plate Low Profile Titanium 16 hole, 0.6mm profile $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO080 Martin Miniplate Osteosynthesis System L, H, T, Low Profile Plate Titanium 4 to 7 hole, 0.6mm profile $140.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO081 Martin Miniplate Osteosynthesis System Y Plate Low Profile Titanium 4 to 6 hole, 0.6mm profile $178.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO082 Martin Miniplate Osteosynthesis System Multi Fragment Plate Low Profile  10 to 12 hole, 0.6mm profile $335.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO083 Martin Miniplate Osteosynthesis System Z Plate Low Profile Titanium 4 hole, 0.6mm profile $90.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO084 Martin Miniplate Osteosynthesis System Orbital Plate Low Profile Titanium 6 hole, 0.6mm profile $165.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 630 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO085 Martin Miniplate Osteosynthesis System Orbital Plate Low Profile Titanium 8 hole, 0.6mm profile $184.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO086 Martin Miniplate Osteosynthesis System Burr Hole Cover 12 to 17mm , 0.6mm profile $355.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO087 Martin Miniplate Osteosynthesis System Chin Plate Titanium 2 to 8mm, 0.6mm profile $245.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO088 Martin Miniplate Osteosynthesis System Chin Plate Titanium 10 to14mm, 0.6mm profile $275.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO090 Martin Micro Plate Osteosynthesis  1mm Screw System Titanium 1mm diameter, 2-4mm length $77.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO092 Martin Micro Plate Osteosynthesis  1mm Screw System Titanium 1mm diameter, 5 - 6mm length $81.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO093 Martin Micro Plate Osteosynthesis  1mm system, Screw Titanium 1mm diameter, 7mm length $84.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO094 Martin Micro Plate Osteosynthesis  1mm system, Screw Emergency  1.2mm diameter,3 to 5mm  $85.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO095 Martin Micro Plate Osteosynthesis  1mm system, Straight Plate Titanium 4 hole 0.6mm profile $144.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO096 Martin Micro Plate Osteosynthesis  1mm system, Straight Plate Titanium 8 hole 0.6mm profile $195.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO097 Martin Micro Plate Osteosynthesis  1mm system, Straight Plate Titanium 12 hole 0.6mm profile $243.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 631 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO098 Martin Micro Plate Osteosynthesis  1mm system, Straight Plate Titanium 16 hole 0.6mm profile $292.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO099 Martin Micro Plate Osteosynthesis  1mm system, Straight Plate Titanium 24 hole 0.6mm profile $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO100 Martin Micro Plate Osteosynthesis  1mm system, Orbital Plate Titanium 8 hole 0.6mm profile $240.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO101 Martin Micro Plate Osteosynthesis  1mm System L, T, Y, Double Y Plate  5 to 8 hole 0.6mm profile $246.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

MO103 Martin Micro Plate Osteosynthesis  1mm system, H Plate Titanium 11 hole 0.6mm profile $330.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO105 Martin Micro Plate Osteosynthesis  1mm system, Burr Hole Cover Titanium 12 to 15mm, 0.3 - 0.6mm  $390.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO106 Martin Micro Plate Osteosynthesis  1mm system, Burr Hole Cover Titanium 17 to 20mm, 0.3 - 0.6mm  $410.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO107 Martin Micro Plate Osteosynthesis  1.5mm system L, Double L Plate  4 to 6 hole, 0.6mm profile $203.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO108 Martin Micro Plate Osteosynthesis  1.5mm system Orbital Plate Titanium 6 hole, 0.6mm profile $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO109 Martin Micro Plate Osteosynthesis  1.5mm system Orbital Plate Titanium 8 hole, 0.6mm profile $180.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO110 Martin Micro Plate Osteosynthesis  1.5mm system Orbital Plate Titanium 10 hole, 0.6mm profile $185.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 632 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO111 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 2 hole, 0.6mm profile $104.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO112 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 4 hole, 0.6mm profile $110.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO113 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 6 hole, 0.6mm profile $130.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO114 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 8 hole, 0.6mm profile $145.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO115 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 16 hole, 0.6mm profile $208.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO116 Martin Micro Plate Osteosynthesis  1.5mm system Straight Plate Titanium 20 hole, 0.6mm profile $263.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO117 Martin Micro Plate Osteosynthesis  1.5mm system T Plate Titanium 6 hole, 0.6mm profile $185.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO118 Martin Micro Plate Osteosynthesis  1.5mm system Y Plate Titanium 5 hole, 0.6mm profile $275.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO119 Martin Micro Plate Osteosynthesis  1.5mm system H Plate Titanium 12 - 32 hole, 0.6mm profile $320.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO120 Martin Micro Plate Osteosynthesis  1.5mm system X Plate Titanium 4 to 6 hole, 0.6mm profile $301.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO121 Martin Micro Plate Osteosynthesis  1.5mm system Burr Hole Cover Titanium 12 to 22mm, 0.3 - 0.6mm  $330.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 633 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO122 Martin Micro Plate Osteosynthesis  1.5mm Screw Titanium 1.5mm diameter, 3.5 to 8mm  $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO123 Martin Micro Plate Osteosynthesis  1.5mm Screw Titanium 1.5mm diameter, 9mm length $59.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO124 Martin Micro Plate Osteosynthesis  1.5mm Screw Titanium 1.5mm diameter, 11 to 13mm  $64.00 Only to be funded where used in

 length a service for which a Medicare

 Benefit is payable

MO125 Martin Micro Plate Osteosynthesis  1.5mm Screw Titanium 1.5mm diameter, 15mm length $71.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO126 Martin Micro Plate Osteosynthesis  1.5mm Screw Emergency Titanium 1.8mm diameter, 3 to 7mm  $52.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO127 Titan Mesh Mesh Sheet Titanium 13 hole 1, 1.5, 2mm $1,620.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO128 Titan Mesh Mesh Plates Titanium 2 hole strip 1, 1.5, 2mm $300.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO129 Titan Mesh Mesh Plates Titanium 1 x 2 holes 1, 1.5, 2mm $178.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO130 Titan Mesh Mesh Plates Titanium 2 x 2 holes 1, 1.5, 2mm $220.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO131 Titan Mesh Mesh Plates Titanium 3 x 2 holes 1, 1.5, 2mm $277.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO132 Titan Mesh Mesh Plates Titanium 4 x 2 holes 1, 1.5, 2mm $345.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 634 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO133 Titan Mesh Mesh Plates Titanium 6 x 4 holes 1, 1.5, 2mm $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MO197 Titan Mesh Orbital Floor Plate (Martin) Titan mesh - contoured orbital floor  1.5mm 0.3 profile; 6 hole large/  $800.00 Only to be funded where used in

 repair mesh plate 5 hole small a service for which a Medicare

 Benefit is payable

MO198 Titan Mesh (Martin) Mesh panel - titanium 4 x 2 hole mesh plate; 1.0, 1.5  $462.00 Only to be funded where used in

 and 2.0mm dia, 0.6 and 1.0  a service for which a Medicare

 Benefit is payable

MO199 Martin Mandibular Fracture System Insert spacer screw, titanium 2.7 x 3mm $81.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

 Medtronic Australasia Pty Ltd

MC512 TiMesh Maxillary Prosthesis One size only $1,990.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC513 TiMesh Full Mandible One size only $1,920.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC514 TiMesh Mandibular Angle, Left/Right One size only $1,010.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC515 TiMesh Hemimandible, Left/Right One size only $605.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC516 TiMesh Mandibular Symphysis One size only $1,212.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC517 TiMesh Mandibular "J" Plate One size only $402.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC518 TiMesh Titanium Mesh Panel 121 x 72mm - 125 x 125mm $572.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 635 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC519 TiMesh Squareplate 4 holes x 1mm - 4 holes x 2.2mm $113.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC520 TiMesh X Plate 4 holes x 1mm - 4 holes x 2.2mm $113.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC521 TiMesh Naso-Orbital-Ethmoid  1mm - 2.2mm;  Complex 1,  $506.00 Only to be funded where used in

 Complex 2, Complex 3 a service for which a Medicare

 Benefit is payable

MC522 TiMesh Curved Plate:  Standard, Rigid, Left, Right 1mm x 12 holes $206.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC523 TiMesh Square-rectangular Gridmesh Panel 1.0 x 4mm - 2.2 x 4mm $515.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC524 TiMesh Isogrid Panel One size only $392.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC525 TiMesh Sugar Mesh Panel / Grid 11 x 7.5cm $310.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC526 TiMesh Surgical Mesh:  Anterior, Posterior,  One size only $6,516.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC527 TiMesh Lateral Mesh:  Left, Right One size only $5,000.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC528 TiMesh Cranial Custom Mesh 121mm x 72mm - 152  x  $9,930.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC571 Timesh 12 Point Screws 3 - 20mm $145.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 636 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC572 Timesh Internal Drive Screws 3 - 6mm $87.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC573 Timesh Rescue Screws 3 - 7mm $110.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC574 Timesh X-Drive Screws 2 - 15mm $76.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC575 Timesh Rigid Straight Plates 1-20 Hole $805.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC576 Timesh Double Y Plates 3 Hole - 2.5mm - 7mm $900.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MC619 TiMesh Titanium Rigid Fixation Bone  FlexMesh 1.0mm system. Composition:  113mm x 77mm, 0.3mm.  $1,386.00 Only to be funded where used in

 Grafting and Plating System Titanium 113mm x 77mm, 0.6mm. a service for which a Medicare

 Benefit is payable

MC620 TiMesh Titanium Rigid Fixation Bone  FlexMesh 1.5mm System 148mm x 148mm, 0.6mm $1,786.00 Only to be funded where used in

 Grafting and Plating System a service for which a Medicare

 Benefit is payable

MC621 TiMesh  Titanium Rigid Fixation Bone  FlexMesh 1.5mm System. Composition:  50mm x 56mm, 0.3mm. 50mm  $700.00 Only to be funded where used in

 Grafting and Plating System Titanium x 56mm, 0.6mm a service for which a Medicare

 Benefit is payable

MC622 TiMesh Titanium Rigid Fixation Bone  FlexMesh 1.5mm System. Composition:  113mm x 77mm, 0.3mm.  $1,386.00 Only to be funded where used in

 Grafting and Plating System Titanium 113mm x 77mm, 0.6mm a service for which a Medicare

 Benefit is payable

MC623 TiMesh Titanium Rigid Fixation Bone  FlexMesh 2.2mm System. Composition:  114mm x 82mm, 0.6mm $1,450.00 Only to be funded where used in

 Grafting and Plating System Titanium. a service for which a Medicare

 Benefit is payable

MC624 TiMesh Titanium Rigid Fixation Bone  FlexMesh 2.2mm System. Composition:  154mm x 154mm, 0.6mm $2,243.00 Only to be funded where used in

 Grafting and Plating System Titanium. a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 637 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC625 Modified Dual TiMesh TiMesh Surgical Mesh Modified, includes 121mm x 77mm. 152mm x  $12,250.00 Only to be funded where used in

  two cranial plates. Composition:  a service for which a Medicare

 Benefit is payable

 National Surgical Corporation Pty Ltd

NI031 Medicon Ti Plates, Medicon Hein1 Mini  Plates TitaniumPlate - double-T.  .4mm - 2mm thickness X 5mm  $124.00 $140.00 Only to be funded where used in

 Plates and Screws, Medicon Hein1 Micro TitaniumPlate - Nasal. TitaniumPlate -  - 80mm, up 16 holes. a service for which a Medicare

  Plates and Screws, Medicon Salyer CMS Mandibular Angle. TitaniumPlate -  Benefit is payable

  System, Osteosynthesis system for Hand Orbital. TitaniumPlate - Str.

  Surgery Compression. Titanium, Chin.

 TitaniumPositioning plates. Titanium, 4-

 Hole Compression Plate, 6-Hole Plate & T

  Plate, 4- 12 hole plates std and

NI032 Medicon Ti Plates and Screws Plates Titanium Plates, L-plate Plates,  Medium .5mm thickness X 4 -  $145.00 $169.00 Only to be funded where used in

 Orbital 6-Hole Compression, 7-Hole   12 holes a service for which a Medicare

 Compression Plate,  "Y12-Hole Plate  Benefit is payable

 "FIR", Condylar Bone Plate, 6-Hole

NI033 Medicon Ti Plates and Screws Plates Titanium Mini, .6mm thickness X 4 - 6  $65.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NI044 Medicon Ti Mesh Mesh, Titanium Small/Medium, .5mm thick X  $258.00 Only to be funded where used in

 8mm to 180mm wide or long. a service for which a Medicare

 Benefit is payable

NI048 Medicon Ti Mesh Mesh, Titanium Small, .5mm thickness X 5mm  $427.00 Only to be funded where used in

 to 180mm wide or long a service for which a Medicare

 Benefit is payable

NI051 Medicon Hein1 Mini Plates and Screws Mesh Performing, Titanium 0.2mm Thickness, 75 x 180mm $695.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NI079 Medicon Ti Plates Plates Titanium, Straight, angled L & R. Mini/Large, 2mm thick X  $475.00 Only to be funded where used in

 135mm - 180mm to 11 holes. a service for which a Medicare

 Benefit is payable

NI080 Medicon Leipzig Mandibular Plates and  Angled Plates Left and Right, Titanium 165mm, 2mm Thickness $600.00 Only to be funded where used in

 Screws  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 638 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NI082 Medicon Ti Plates Plates Titanium, Total Reconstruction Extra Large, 2mm thick X  $1,103.00 Only to be funded where used in

 100mm - 130mm. a service for which a Medicare

 Benefit is payable

NI083 Medicon Leipzig Mandibular Plates and  Condylar Implants: Short & Long. Titanium 40mm-48mm $794.00 Only to be funded where used in

 Screws  a service for which a Medicare

 Benefit is payable

NI087 Medicon Ti Plates Plates Titanium, Angled Plates Left and  Medium/Large, 1.7mm - 2mm  $403.00 $420.00 Only to be funded where used in

 Right, Straight and Fracture. thick X 105mm - 160mm to 16  a service for which a Medicare

 holes. Benefit is payable

NI102 Medicon Ti Plates Plates Titanium, straight, fracture, Double Medium/Small, .4mm - 2mm  $250.00 $280.00 Only to be funded where used in

 thick X 3 - 16 hole, To 100mm  a service for which a Medicare

 Benefit is payable

NI103 Medicon Ti Plates and Screws Plates Titanium, L-plate. T-short. Mini/Small, .4mm - 1mm  $95.00 Only to be funded where used in

 thickness x 4 hole and or 8mm - a service for which a Medicare

 Benefit is payable

NI112 Medicon Ti Plates Plates Titanium, Straight; Std, short and  Micro/Medium, .5mm - 2mm  $318.20 Only to be funded where used in

 long  Angled; Orbital, Fracture, Double Y  thick X 4 hole - 6 hole, 12mm -  a service for which a Medicare

 120mm length Benefit is payable

NI114 Medicon Ti Mesh Mesh, Titanium, Mesh Plates, Medium, .1mm - .5mm thick X  $398.00 $420.00 Only to be funded where used in

 2mm to 180mm wide or long. a service for which a Medicare

 Benefit is payable

NI115 Medicon Ti Mesh Mesh, Titanium, Mesh Plates Mini, .1mm - .5mm thick X  $605.00 Only to be funded where used in

 4mm to 180mm wide or long. a service for which a Medicare

 Benefit is payable

NI118 Medicon Ti Plates Plates Titanium, Osteosynthesis, Vario,  Mini/Medium, .4mm - 1.7mm  $202.00 Only to be funded where used in

 Fracture, L, T ,Y H, Double Y Plates. thick X 4 -16 holes, 8mm -  a service for which a Medicare

 Benefit is payable

NI121 Medicon Ti Screws Screws Titanium Mini/Small, .9mm - 2.7mm  $52.00 Only to be funded where used in

 thick X 2mm - 17mm. a service for which a Medicare

 Benefit is payable.

NI123 Medicon Ti Screws Bone Screws, Titanium, Condylar. Small/Medium, 2.7 - 6mm dia X $37.00 Only to be funded where used in

  7mm - 23mm length a service for which a Medicare

 Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 639 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NI126 Medicon Ti Screws Screws Titanium, Ti-Washers for  Small, 1.2 - 2.7mm dia X 2.7 -  $27.00 $41.00 Only to be funded where used in

 17mm length a service for which a Medicare

 Benefit is payable.

 Surgien Pty Ltd

BR001 OPRA System Central screw - titanium One size only $1,860.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BR002 OPRA System Healing cylinder - titanium One size only $3,150.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BR003 OPRA System Healing screw - titanium One size only $2,460.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BR004 OPRA System Fixture - titanium 16 - 20mm $36,900.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BR005 OPRA System Abutment - titanium Length 47 - 77mm $19,250.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

BR006 OPRA System Abutment screw - titanium Length 57 - 87mm $5,775.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 640 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Surgiplas Medical

SP013 Plates Micro, Midface & Mini Micro: Y Plate, Y Plate 11 Hole,  $120.00 Only to be funded where used in

 H Plate, 5 Hole Straight Plate,  a service for which a Medicare

 Quad Plate, Quad Plate - Short,  Benefit is payable

 13mm & 16mm L Plate - Left &

  Right, 19mm T Plate, X Plate,

 Straight 2 Hole

 Short/Medium/Long; Mini:

 10mm Square Plate; Midface:

 13mm, 15mm & 22mm L Plate

 - Left & Right, 9mm & 11mm

 ZED Plate - Left & Right, 4

 Hole I Plate, 18mm 4 Hole

 Straight Plate, Straight 2 Hole -

 Short/Medium/Long

SP014 Plates Micro, Midface, Mini, BSSO, TR BSSO Micro: 18 Hole Straight Plate, 12 $130.00 Only to be funded where used in

  Hole Curved Plate, 10 Hole  a service for which a Medicare

 Straight Plate, Calvarium Plate -  Benefit is payable

 Small & Large, Medium 2 x 4

 Hole Quad Plate, 4 & 6 Hole

 Straight Plate, 2 x 3 Hole Quad

 Plate; Mini: Calvarium Plate, X

 Plate, 8 Hole Straight Plate,

 1.0mm Thick; Midface: 15mm 5

  Hole Y Plate, 10 Hole Curved

 Plate, Double Y Plate, Straight

 Plate 5 & 10 Hole; 4 Hole BSSO

  Plate Short, Medium, Long; TR

  BSSO Plate, Short, Long;

SP015 Plates Micro, Mini, Maxi Micro: Mesh 50mm x 37mm;  $280.00 Only to be funded where used in

 Mini: 16 Hole Straight Plate,  a service for which a Medicare

 1.0mm thick; Maxi: 33mm &  Benefit is payable

 38mm 4 Hole EDC Plate, 48mm

  6 Hole EDC Plate, Angled EDC

 Plate, Angled Long EDC Plate,

 40mm 6 Hole Fracture Plate, 6

 Hole Curved EDC Plate; Gap

 Plates; Quad Plates; Burr Hole

 Plates;

Prostheses List by Category, Groups and Sponsor Page 641 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SP016 Plates Micro, Mini Micro: Mesh Sheet 100mm x  $506.00 Only to be funded where used in

 74mm, Orbital Plate, Orbital  a service for which a Medicare

 Plate Large; Mini: 40 Hole  Benefit is payable

 Straight Plate, Mesh 18 row;

 Mesh 36 x 50mm; Sub -

SP017 Plates Mini Mini: 15mm, 18mm & 23mm L  $113.00 Only to be funded where used in

 Plate Right & Left, 26mm Y  a service for which a Medicare

 Plate, Y Plate - 13 Hole, 15mm  Benefit is payable

 & 20mm Z Plate Right & Left,

 24mm Straight Plate, 16mm I

 Plate, 22mm T Plate, Mesh 1

 Row, 4 & 6 Hole Straight Plate

 1.0mm thick, Rigid 15mm,

 18mm & 23mm L Plate Right &

  Left, Rigid 26mm Y Plate,

 15mm & 20mm Z Plate Right &

  Left, Rigid 24mm Straight

 Plate, Rigid 16mm I Plate; Rigid

 Double Y Plate;

SP018 Plates Micro, Midface, Mini & Maxi Micro: 8 Hole Straight Plate,  $162.00 Only to be funded where used in

 Double Y Plate; Mini : 10 Hole  a service for which a Medicare

 Straight Plate, Extended Y Plate, Benefit is payable

  4 Hole Compression Plate,

 Rigid 10 Hole Straight Plate;

 Midface: 12 Hole Straight Plate;

 Maxi: Chin Plate 2, 3, 4, 6, 8, 10

SP019 Plates Mini & Maxi Mini: 16 & 18 Hole Straight  $204.00 Only to be funded where used in

 Plate, 5 Hole Compression Plate, a service for which a Medicare

  5, 7 & 9 Hole Curved Plate, 12  Benefit is payable

 Hole Straight Plate 1.0mm thick;

  Maxi: 33mm 4 Hole semi-comp

  Plate, 28mm 4 Hole Fracture

 Plate; Burr Hole Plate;

 Zygomatic Plates, Pyriform

 Plates, Orthognathic Y Plates

 and Orthognathic BSSO Plates

SP020 Plates Maxi Maxi: Angled Reconstruction  $392.00 Only to be funded where used in

 Left & Right, Straight  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 642 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SP023 OsteoMed Plating & Fixation System Plates - Reconstruction 4 x 12 Hole plate Right & Left;  $572.00 Only to be funded where used in

 14, 15 & 18 Hole Straight Plate a service for which a Medicare

 Benefit is payable.

SP024 OsteoMed Plating & Fixation System Plates - Reconstruction 5 x 16 Hole plate Right & Left $840.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

SP025 OsteoMed Plating & Fixation System Plates - Reconstruction 5 x 20 x 5 Hole Full Mandible  $1,100.00 Only to be funded where used in

 Plate; 5 x 16 x 5 Hole Full  a service for which a Medicare

 Mandible Plate; Osteoform  Benefit is payable.

 Mesh Malleable/Rigid, 74 x

 50mm, 111 x 191mm, 74 x

SP026 OsteoMed Plating & Fixation System Plates - Fracture Rigid Comminuted Fracture  $740.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

SP027 OsteoMed Plating & Fixation System Plates - Fracture 8 Hole Fracture Plate, 4 & 6  $460.00 Only to be funded where used in

 hole locking fracture plate. a service for which a Medicare

 Benefit is payable.

SP028 OsteoMed Plating & Fixation System Plates - Fracture 4 hole Fracture Plate 32 -37mm; $294.00 Only to be funded where used in

  EDC Plate 32mm & 34mm a service for which a Medicare

 Benefit is payable.

SP029 OsteoMed Plating & Fixation System Plates - Fracture; Screws - Cannulated Lag 6 Hole Fracture Plate 47 -  $330.00 Only to be funded where used in

 52mm; 2 x 2 Hole Angled  a service for which a Medicare

 Fracture Plate; 3 x 3 Hole  Benefit is payable.

 Angled Fracture Plate; 6.5mm x

 (30 -150)mm; 7.3mm x (30 -

SP030 OsteoMed Plating & Fixation System Screws Size $140.00 Only to be funded where used in

 2.4mm x (6 - 22)mm Locking  a service for which a Medicare

 Screws, locking screw inserts;  Benefit is payable.

 Quick-Fix MMF / Anchorage

 Screws 1.2 / 1.6 / 2.0mm

SP031 OsteoMed Plating & Fixation System Lag Screws - Micro, Mini 1.2mm x (6 - 16)mm; 1.6mm x  $79.00 Only to be funded where used in

 (10-12)mm; 2.0mm x (8 -  a service for which a Medicare

 Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 643 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SP032 OsteoMed Plating & Fixation System Lag Screws - Maxi, MMF, 3.0mm 2.4mm x (8 - 42)mm; 2.4 x (12  $80.00 Only to be funded where used in

 - 18)mm; 3.0mm x (12 -  a service for which a Medicare

 Benefit is payable.

SP033 OsteoMed Plating & Fixation System Compression Plates - Micro, Mini & Maxi Micro: 2 x 3 Hole Compression  $147.00 Only to be funded where used in

 T Plate, Oblique Left & Right  a service for which a Medicare

 Compression T Plate, 4 Hole  Benefit is payable.

 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 & Right Oblique L

 Plate, 2 x 4 T Plate, Left &

 Right Oblique 2 x 4 Hole T

 Plate, 3 x 4 T Plate, 2 x 1 x 4 T

 Plate, 3 x 4 Hole Y Plate, 4, 5 &

  6 Hole Straight Plate; Maxi: 4

 Hole Left & Right L Plate, 2 x 4

 Hole T Plate, 2 x 4 Hole Left &

 Right Oblique T Plate; Flap

 Fixation Disk Plate.

SP034 OsteoMed Plating & Fixation System Compression Plates - Maxi Maxi: 4, 5 & 6 Hole Straight Plate $290.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

SP035 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (6 - 16)mm; 2.4mm x  $220.00 Only to be funded where used in

 (6 - 20)mm a service for which a Medicare

 Benefit is payable.

SP036 OsteoMed Plating & Fixation System Screws - Cannulated Lag 2.0mm x (18 - 22)mm; 2.4mm  $260.00 Only to be funded where used in

 x (22 - 30)mm a service for which a Medicare

 Benefit is payable.

SP037 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (10 x 28)mm; 4.0mm  $210.00 Only to be funded where used in

 x (12 - 30)mm a service for which a Medicare

 Benefit is payable.

SP038 OsteoMed Plating & Fixation System Screws - Cannulated Lag 3.0mm x (30 x 40)mm; 4.0mm  $250.00 Only to be funded where used in

 x (32 - 52)mm a service for which a Medicare

 Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 644 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Synthes Australia Pty Ltd

SY348 Titanium Sternal Fixation System Locking Plate - H or Star 8 or 6 holes, small or large $1,200.00

Orthopedic Internal Fixation Systems, Spinal

 Medtronic Australasia Pty Ltd

MC387 TiMesh Rigid Fixation Bone Grafting and  Titanium, Square Grid Mesh Large $900.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC388 TiMesh Rigid Fixation Bone Grafting and  Titanium, Square Grid Mesh Medium $392.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC389 TiMesh Rigid Fixation Bone Grafting and  Titanium, Square Grid Mesh Small $123.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

Plates, Absorbable

 Medical & Optical  Instruments Australia Pty Ltd

MO185 Resorb-X Plates Resorb-X Osteosynthesis System,  4 - 8 hole $315.00 Only to be funded where used in

 Resorbable straight plate a service for which a Medicare

 Benefit is payable

MO186 Resorb-X Plates Resorb-X Osteosynthesis System,  L, Y, X, T, Orbital $404.00 Only to be funded where used in

 Resorbable shaped plate a service for which a Medicare

 Benefit is payable

MO187 Resorb-X Mesh Plate 25 x 25mm Resorb-X Osteosynthesis System,  25 x 25mm - 0.3, 0.6, 1.0mm  $756.00 Only to be funded where used in

 Resorbable mesh plate profile a service for which a Medicare

 Benefit is payable

MO188 Resorb-X Mesh Plate 50 x 50mm Resorb-X Osteosynthesis System,  50 x 50mm - 0.3, 0.6, 1.0mm  $1,775.00 Only to be funded where used in

 Resorbable mesh plate profile a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 645 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MO203 Resorb-X Plates Resorb-X Osteosynthesis System,  29 to 31 x 104 to 106mm Mesh  $1,330.00 Only to be funded where used in

 Resorbable Mesh Plate Plate a service for which a Medicare

 Benefit is payable

MO204 Resorb-X Plates Resorb-X Osteosynthesis System,  125 x 125mm $5,175.00 Only to be funded where used in

 Resorbable Mesh Plate a service for which a Medicare

 Benefit is payable

MO205 Resorb-X Plates Resorb-X Osteosynthesis System,  55mm diameter $2,230.00 Only to be funded where used in

 Resorbable Mesh Plate a service for which a Medicare

 Benefit is payable

MO206 Resorb-X Plates Resorb-X Osteosynthesis System,  22 Hole - Straight Resorbable  $567.00 Only to be funded where used in

 Resorbable Straight Plate a service for which a Medicare

 Benefit is payable

MO231 Resorb X Plates Various Sizes Resorb Osteosynthesis System resorbable 11 x 126mm $871.00 Only to be funded where used in

  mesh plate a service for which a Medicare

 Benefit is payable

Plates, Bone

 Aus Systems Pty Ltd

AU002 Aus Systems Titanium Miniplates (Bone  Low profile 2 & 4 hole Short, medium, long $51.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU005 Aus Systems Titanium Miniplates (Bone  Low profile condensed 8 hole $87.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU006 Aus Systems Titanium Miniplates (Bone  Low profile 19 hole $95.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU007 Aus Systems Titanium Miniplates (Bone  Low profile pre-shaped - Square, T, L, Y, Short, medium, Long, 4 & 5 hole $87.00 Only to be funded where used in

 Plates)  Y Double & X a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 646 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AU014 Aus Systems Titanium Miniplates (Bone  Low profile burr hole cover 10mm, 14mm, 18mm, 22mm $123.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU018 Aus Systems Titanium Miniplates (Bone  Strip plates, Titanium (M10 series) 1mm profile, 4 holes $56.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU019 Aus Systems Titanium Miniplates (Bone  16 & 19 hole 0.7mm & 1mm profile $95.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU022 Aus Systems Titanium Miniplates (Bone  Pre-shaped - L Small, Medium, Long $79.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU055 Aus Systems Titanium Miniplates (Bone  Pre-shaped - T, T Double, Y Small, Medium, Long, 4 & 5 hole $87.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

AU056 Aus Systems Titanium Miniplates (Bone  Pre-shaped - Y Double Small, Medium, Long $95.00 Only to be funded where used in

 Plates) a service for which a Medicare

 Benefit is payable

 Johnson & Johnson Medical Pty Ltd

JJ204 Bioplate Bone Plate  Titanium cranial fixation system - straight 1.5mm diam, 11mm length;  $43.00 Only to be funded where used in

  plate, 2 hole  pack of 5 a service for which a Medicare

 Benefit is payable

JJ205 Bioplate Bone Plate  Titanium cranial fixation system - straight 1.5mm diam, 19mm length $104.00 Only to be funded where used in

  plate, 4 hole  a service for which a Medicare

 Benefit is payable

JJ206 Bioplate Bone Plate  Titanium cranial fixation system - Y plate, 1.5mm diam, 17mm length $152.00 Only to be funded where used in

  5 hole a service for which a Medicare

 Benefit is payable

JJ207 Bioplate Bone Plate  Titanium cranial fixation system - X plate, 1.5mm diam, 17mm length $254.00 Only to be funded where used in

  6 hole a service for which a Medicare

 Benefit is payable

JJ208 Bioplate Bone Plate  Titanium cranial fixation system - T plate, 1.5mm diam, 15mm length $170.00 Only to be funded where used in

  5 hole a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 647 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ211 Bioplate Bone Plate  Titanium cranial fixation system - box  1.5mm diam, 10 x 10mm $192.00 Only to be funded where used in

 car, 4 hole a service for which a Medicare

 Benefit is payable

JJ212 Bioplate Bone Plate  Titanium cranial fixation system - box car 1.5mm diam, 8 x 17mm $231.00 Only to be funded where used in

  6 hole a service for which a Medicare

 Benefit is payable

JJ213 Bioplate Bone Plate  Titanium cranial fixation system - box  1.5mm diam, 10 x 24mm $281.00 Only to be funded where used in

 car, 8 hole a service for which a Medicare

 Benefit is payable

JJ214 Bioplate Bone Plate  Titanium mesh for cranial fixation  1.5mm diam, 32 x 44mm $500.00 Only to be funded where used in

 system, 48 holes a service for which a Medicare

 Benefit is payable

JJ216 Bioplate Bio-100 Plate  Titanium cranial fixation system, 2 hole 1.5mm diam; pack of 5 $27.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Medical & Optical  Instruments Australia Pty Ltd

MO210 Martin Mandibular Fracture System Pre-Formed Titanium Mandibular  2.3mm angled, symphysis and  $920.00 Only to be funded where used in

 Reconstruction Plate straight plate; 12-27 holes a service for which a Medicare

 benefit is payable

 Medtronic Australasia Pty Ltd

MC374 TiMesh Rigid Fixation Bone Grafting and  Titanium,  Plate Mesh, Fan blades 11 - 18mm,  $198.00 Only to be funded where used in

 Plating System Ohata 8.4 - 10mm a service for which a Medicare

 Benefit is payable

MC383 TiMesh Rigid Fixation Bone Grafting and  Titanium, Y Plate Double and Single 5 - 8 hole $433.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC385 TiMesh Rigid Fixation Bone Grafting and  Titanium, Straight Plate 2 - 20 hole $148.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC386 TiMesh Rigid Fixation Bone Grafting and  Titanium, T Plate 4 - 8 hole $250.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 648 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC391 TiMesh Rigid Fixation Bone Grafting and  Titanium, L Plate (Left and right  4 - 10 hole $392.00 Only to be funded where used in

 Plating System configurations) a service for which a Medicare

 Benefit is payable

MC392 TiMesh Rigid Fixation Bone Grafting and  Titanium, H Plate 6 - 11 hole $204.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC393 TiMesh Rigid Fixation Bone Grafting and  Titanium, Z Plate Left and Right 4 hole - 5mm, 9.5mm $392.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

MC678 TiMesh Rigid Fixation Bone Grafting and  Titanium, Universal Plate 12h $255.00 Only to be funded where used in

 Plating System a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd

ST076 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 4 holes $67.00 Only to be funded where used in

 mini bone plate  Titanium a service for which a Medicare

 Benefit is payable

ST077 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 6 holes $67.00 Only to be funded where used in

 mini bone plate  Titanium a service for which a Medicare

 Benefit is payable

ST078 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 16 holes $108.00 Only to be funded where used in

 mini bone plate  Titanium a service for which a Medicare

 Benefit is payable

ST079 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 5 holes $108.00 Only to be funded where used in

 mini compression plate  Titanium a service for which a Medicare

 Benefit is payable

ST080 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 4x2 holes $345.00 Only to be funded where used in

 mini 3D plate Titanium a service for which a Medicare

 Benefit is payable

ST081 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.0mm, 3x2 holes $267.00 Only to be funded where used in

 mini 3D plate Titanium a service for which a Medicare

 Benefit is payable

ST086 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $345.00 Only to be funded where used in

 straight plate, short  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 649 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST087 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $375.00 Only to be funded where used in

 straight plate, medium Titanium a service for which a Medicare

 Benefit is payable

ST088 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $415.00 Only to be funded where used in

 straight plate, long Titanium a service for which a Medicare

 Benefit is payable

ST089 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x6 holes $444.00 Only to be funded where used in

 straight plate, short Titanium a service for which a Medicare

 Benefit is payable

ST090 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x6 holes $475.00 Only to be funded where used in

 straight plate, medium Titanium a service for which a Medicare

 Benefit is payable

ST091 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x6 holes $515.00 Only to be funded where used in

 straight plate, long Titanium a service for which a Medicare

 Benefit is payable

ST092 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x8 holes $540.00 Only to be funded where used in

 straight plate Titanium a service for which a Medicare

 Benefit is payable

ST093 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x14 holes $629.00 Only to be funded where used in

 straight plate Titanium a service for which a Medicare

 Benefit is payable

ST094 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x6 holes $520.00 Only to be funded where used in

 angled plate Titanium a service for which a Medicare

 Benefit is payable

ST095 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $395.00 Only to be funded where used in

 C-shape plate Titanium a service for which a Medicare

 Benefit is payable

ST096 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $350.00 Only to be funded where used in

 straight EDCP plate, short Titanium a service for which a Medicare

 Benefit is payable

ST097 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x4 holes $315.00 Only to be funded where used in

 straight EDCP plate, medium Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 650 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST098 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.3x6-22mm $59.00 Only to be funded where used in

 screws Titanium a service for which a Medicare

 Benefit is payable

ST099 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.7mm, 8 holes $335.00 Only to be funded where used in

 bridging plate, straight Titanium a service for which a Medicare

 Benefit is payable

ST100 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.7mm, 11 holes $415.00 Only to be funded where used in

 bridging plate, straight Titanium a service for which a Medicare

 Benefit is payable

ST101 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.7mm, 14 holes $444.00 Only to be funded where used in

 bridging plate, straight a service for which a Medicare

 Benefit is payable

ST102 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  2.7mm, 17 holes $495.00 Only to be funded where used in

 bridging, plate, straight Titanium a service for which a Medicare

 Benefit is payable

ST103 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  4+ 8 holes $505.00 Only to be funded where used in

 bridging plate, angled, right/left Titanium a service for which a Medicare

 Benefit is payable

ST104 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  4+ 11 holes $548.00 Only to be funded where used in

 bridging plate, angled, right/left Titanium a service for which a Medicare

 Benefit is payable

ST105 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  4+ 14 holes $570.00 Only to be funded where used in

 bridging plate, right/left Titanium a service for which a Medicare

 Benefit is payable

ST106 Leibinger Titanium Implant System Leibinger COM/MAND Fixation System:  4 + 8 holes $415.00 Only to be funded where used in

 bridging plate, right Titanium a service for which a Medicare

 Benefit is payable

ST123 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  4 holes $126.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST124 Leibinger Titanium Implant System Leibinger Bone plate: LEAD plate  4 holes $145.00 $1,300.00 Only to be funded where used in

 Titanium Transport and base plate a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 651 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST125 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  6 holes $140.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST126 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  8 holes $160.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST127 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  12 holes $230.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST128 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  16 holes $280.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST129 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Straight  24 holes $410.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST130 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: straight,  5 holes $206.00 Only to be funded where used in

 L-shape, right/left Titanium a service for which a Medicare

 Benefit is payable

ST131 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: straight,  8 holes $225.00 Only to be funded where used in

 L-shape, right/left Titanium a service for which a Medicare

 Benefit is payable

ST132 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: T-shape, 5 holes $225.00 Only to be funded where used in

  90 deg Titanium a service for which a Medicare

 Benefit is payable

ST133 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: T-shape, 7 holes $235.00 Only to be funded where used in

  90 deg Titanium a service for which a Medicare

 Benefit is payable

ST134 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 7 holes $275.00 Only to be funded where used in

 T-shape Titanium a service for which a Medicare

 Benefit is payable

ST135 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 9 holes $290.00 Only to be funded where used in

 T-shape  Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 652 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST136 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 14 holes $350.00 Only to be funded where used in

 T-shape  Titanium a service for which a Medicare

 Benefit is payable

ST137 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: Y-shape  6 holes $230.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST138 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 6 holes $275.00 Only to be funded where used in

 Y-shape Titanium a service for which a Medicare

 Benefit is payable

ST139 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: double- 7holes $280.00 Only to be funded where used in

 Y-shape Titanium a service for which a Medicare

 Benefit is payable

ST140 Leibinger Titanium Implant System Leibinger Micro, Micro Plus and Low  8 holes $240.00 Only to be funded where used in

 Profile Bone plate: orbital plate, curved  a service for which a Medicare

 Benefit is payable

ST141 Leibinger Titanium Implant System Leibinger Burr Hole Cover: curved   7, 10, 14mm $176.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST142 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x2-6mm, 0.55mm height $51.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST143 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x7-10mm, 0.55mm height $54.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST144 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x11-12mm, 0.55mm height $58.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST151 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  4 holes, 0.55mm height $126.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

ST152 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: with 4 holes, 6mm, 8mm, 10mm bar, $126.00 Only to be funded where used in

  bar Titanium  0.55mm height a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 653 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST153 Leibinger Titanium Implant System Leibinger Steinhauser plate: long with bar  4 holes, 0.55mm height $126.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST154 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  6 holes, 0.55mm height $143.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

ST155 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone Plate: with 6 holes, 12mm, 0.55mm height $150.00 Only to be funded where used in

  bar Titanium a service for which a Medicare

 Benefit is payable

ST156 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  8 holes, 0.55mm height $175.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

ST157 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  16 holes, 0.55mm height $270.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

ST158 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  30 holes, 6mm bar, 0.55mm  $395.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

ST159 Leibinger Titanium Implant System LeibingerSteinhauser plate: regular Titanium 30 holes, 6mm bar, 0.55mm  $395.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST160 Leibinger Titanium Implant System Leibinger Mini Bone plate: regular, L- 4 holes, 0.55mm height $195.00 Only to be funded where used in

 shape, 90 deg, right/left Titanium a service for which a Medicare

 Benefit is payable

ST161 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 6mm bar, 0.55mm  $195.00 Only to be funded where used in

 shape, 90 deg, with bar, right/left Titanium a service for which a Medicare

 Benefit is payable

ST162 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 8mm bar, 0.55mm  $200.00 Only to be funded where used in

 shape, 90 deg, with bar, right/left Titanium a service for which a Medicare

 Benefit is payable

ST163 Leibinger Titanium Implant System Leibinger Steinhauser plate: L-shape,  5 holes, 8mm bar, 0.55mm  $200.00 Only to be funded where used in

 right/left, with bar Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 654 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST164 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 10mm bar, 0.55mm  $205.00 Only to be funded where used in

 shape, 90 deg, with bar, right/left Titanium a service for which a Medicare

 Benefit is payable

ST165 Leibinger Titanium Implant System Leibinger Steinhauser plate: L-shape,  7 holes, 10mm bar, 0.55mm  $215.00 Only to be funded where used in

 right/left, with bar Titanium a service for which a Medicare

 Benefit is payable

ST166 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 5 holes, 12mm bar, 0.55mm  $215.00 Only to be funded where used in

 shape, 90 deg, with bar, right/left Titanium a service for which a Medicare

 Benefit is payable

ST167 Leibinger Titanium Implant System Leibinger Steinhauser plate: L-shape,  9 holes, 12mm bar, 0.55mm  $210.00 Only to be funded where used in

 right/left, with bar Titanium a service for which a Medicare

 Benefit is payable

ST168 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: T- 4 holes, 8mm bar, 0.55mm  $227.00 Only to be funded where used in

 shape, narrow, with bar Titanium a service for which a Medicare

 Benefit is payable

ST169 Leibinger Titanium Implant System Leibinger Steinhauser plate: T-shape, with 4 holes, 8mm bar, 0.55mm  $222.00 Only to be funded where used in

  bar Titanium a service for which a Medicare

 Benefit is payable

ST170 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: T- 4 holes, with 12mm bar,  $227.00 Only to be funded where used in

 shape, narrow, with bar Titanium 0.55mm height a service for which a Medicare

 Benefit is payable

ST171 Leibinger Titanium Implant System Leibinger Steinhauser plate: T-shape, with 8 holes, 12mm bar, 0.55mm  $228.00 Only to be funded where used in

  bar Titanium a service for which a Medicare

 Benefit is payable

ST172 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  6 holes, 0.55mm height $246.00 Only to be funded where used in

 regular, T-shape Titanium a service for which a Medicare

 Benefit is payable

ST173 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate:  6 holes, 0.55mm height $246.00 Only to be funded where used in

 regular, T-shape Titanium a service for which a Medicare

 Benefit is payable

ST174 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: T- 5 holes, 10mm bar, 0.55mm  $246.00 Only to be funded where used in

 shape, with bar Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 655 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST175 Leibinger Titanium Implant System Non-compression Hand plate: regular, T- 5 holes, 10mm bar, 0.55mm  $246.00 Only to be funded where used in

 shape, 70 right/left Titanium a service for which a Medicare

 Benefit is payable

ST176 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  6 holes, 0.55mm height $248.00 Only to be funded where used in

 double-T-shape, narrow Titanium a service for which a Medicare

 Benefit is payable

ST177 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  5 holes, 0.55mm height $246.00 Only to be funded where used in

 regular, Y-shape Titanium a service for which a Medicare

 Benefit is payable

ST178 Leibinger Titanium Implant System Non-compression Hand plate: regular, Y- 5 holes, 0.55mm height $246.00 Only to be funded where used in

 shape, short, long a service for which a Medicare

 Benefit is payable

ST179 Leibinger Titanium Implant System Non-compression Hand plate: regular, Y- 5 holes, 0.55mm height $260.00 Only to be funded where used in

 shape, long, regular a service for which a Medicare

 Benefit is payable

ST180 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: Y- 5 holes, 8mm bar, 0.55mm  $246.00 Only to be funded where used in

 shape, with bar a service for which a Medicare

 Benefit is payable

ST181 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: Y- 5 holes, 12mm bar, 0.55mm  $248.00 Only to be funded where used in

 shape, with bar Titanium a service for which a Medicare

 Benefit is payable

ST182 Leibinger Titanium Implant System Leibinger Steinhauser plate: Y-  5 holes, 12mm bar, 0.55mm  $248.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST183 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  6 holes, 0.55mm height $255.00 Only to be funded where used in

 double-Y-shape, regular Titanium a service for which a Medicare

 Benefit is payable

ST184 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  6 holes, 8mm bar, 0.55mm  $265.00 Only to be funded where used in

 double-Y-shape, with bar Titanium a service for which a Medicare

 Benefit is payable

ST185 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  7 holes, 0.55mm height $285.00 Only to be funded where used in

 double-Y-shape, regular Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 656 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST186 Leibinger Titanium Implant System Leibinger Steinhauser plate: double-Y- 7 holes, 0.55mm height $285.00 Only to be funded where used in

 shape, with bar Titanium a service for which a Medicare

 Benefit is payable

ST187 Leibinger Titanium Implant System Leibinger E-Z Flap Bone Fixation plate  1.7mm for 7mm, 10mm, 14mm $325.00 Only to be funded where used in

 Titanium  burr holes, 2.0mm for 7mm,  a service for which a Medicare

 10mm burr holes, 0.55mm  Benefit is payable

ST188 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone  4 holes, 6mm bar, 0.55mm  $170.00 Only to be funded where used in

 plate: curved, with bar Titanium a service for which a Medicare

 Benefit is payable

ST189 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone  6 holes, 8mm bar, 0.55mm  $210.00 Only to be funded where used in

 plate: curved, with bar Titanium a service for which a Medicare

 Benefit is payable

ST190 Leibinger Titanium Implant System LeibingerSteinhauser Orbita Bone plate:  6 holes, 0.55mm height $205.00 Only to be funded where used in

 curved Titanium a service for which a Medicare

 Benefit is payable

ST191 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone  8 holes, 0.55mm height $242.00 Only to be funded where used in

 plate: curved Titanium a service for which a Medicare

 Benefit is payable

ST192 Leibinger Titanium Implant System Leibinger Steinhauser Orbita Bone plate:  8 holes, 0.55mm height $238.00 Only to be funded where used in

 curved Titanium a service for which a Medicare

 Benefit is payable

ST193 Leibinger Titanium Implant System Leibinger Mini Wurzburg Orbita Bone  10 holes, 0.55mm height $255.00 Only to be funded where used in

 plate: curved Titanium a service for which a Medicare

 Benefit is payable

ST194 Leibinger Titanium Implant System Leibinger Steinhauser Orbita Bone plate:  10 holes, 0.55mm height $253.00 Only to be funded where used in

 curved Titanium a service for which a Medicare

 Benefit is payable

ST195 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, 0.55mm height $195.00 Only to be funded where used in

 shape, 110 deg, regular, right/left Titanium a service for which a Medicare

 Benefit is payable

ST196 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 holes, with 6mm, 8mm,  $195.00 Only to be funded where used in

 shape, 110 deg, regular, with bar,   10mm bar, 0.55mm height a service for which a Medicare

 right/left Titanium Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 657 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST197 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate: L- 4 & 5 holes, with 12mm bar,  $219.00 Only to be funded where used in

 shape, 110 deg, regular, with bar,   0.55mm height a service for which a Medicare

 right/left Titanium Benefit is payable

ST198 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate:  2x2 holes, 0.55mm height $219.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST199 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate:  3x2 holes, 0.55mm height $332.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST200 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate:  4x2 holes, 0.55mm height $435.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST201 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate:  4x4 holes, 0.55mm, 0.55mm  $635.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST202 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Bone plate:  6x4 holes, 0.55mm height $950.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST203 Leibinger Titanium Implant System Leibinger Mini Wurzburg 3D Zygoma  4x2 holes, 0.55mm height $635.00 Only to be funded where used in

 Bone plate: rectangular Titanium a service for which a Medicare

 Benefit is payable

ST204 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone plate:  2 holes, 0.55mm height $95.00 Only to be funded where used in

 straight Titanium a service for which a Medicare

 Benefit is payable

ST231 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 4 holes $195.00 Only to be funded where used in

 shape, 110 deg, regular Titanium a service for which a Medicare

 Benefit is payable

ST232 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 4 holes, with 6mm, 8mm,  $195.00 Only to be funded where used in

 shape, 110 deg, right/left Titanium a service for which a Medicare

 Benefit is payable

ST233 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: L- 5 holes, with 12mm bar $213.00 Only to be funded where used in

 shape, 110 deg, right/left Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 658 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST234 Leibinger Titanium Implant System Leibinger Mini Wurzburg Compression  4 holes, with 6 x 1mm bar $170.00 Only to be funded where used in

 Bone plate: L-shape, C-shape Titanium a service for which a Medicare

 Benefit is payable

ST235 Leibinger Titanium Implant System Leibinger Mini Wurzburg Compression  6 holes, with 8 x 1mm bar $205.00 Only to be funded where used in

 Bone plate: L-shape, C-shape Titanium a service for which a Medicare

 Benefit is payable

ST245 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 12 x 0.5mm $315.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST246 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 75 x 18 x 0.5mm $365.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST247 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium .75 x 27 x 0.5mm $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST248 Leibinger Titanium Implant System Leibinger Mesh Implants Titanium 132.5 x 82.5 x 0.5mm $1,155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST249 Leibinger Titanium Implant System Leibinger Micro Mesh Implants Titanium 0.2 x 60 x 60mm, 0.1 x 60 x  $1,155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST250 Leibinger Titanium Implant System Leibinger Micro Mesh Implants Titanium 0.1 x 60 x 120mm, 0.2 x 60 x  $1,155.00 Only to be funded where used in

 120mm a service for which a Medicare

 Benefit is payable

ST251 Leibinger Titanium Implant System Leibinger Micro Mesh Implants Titanium 0.1x120x120mm,  $1,155.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST252 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants  0.3x40x40mm $1,155.00 Only to be funded where used in

 Titanium.  To be used with 1 - 1.4mm  a service for which a Medicare

 Benefit is payable

ST253 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants Titanium 0.3x85x85mm $2,407.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 659 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST254 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants  0.3x40x40mm $1,155.00 Only to be funded where used in

 Titanium.  To be used with 1.7 - 1.9mm  a service for which a Medicare

 Benefit is payable

ST255 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants  0.3x90x90mm $1,155.00 Only to be funded where used in

 Titanium. To be used with screw 1.7 -  a service for which a Medicare

 Benefit is payable

ST256 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants  0.3x40x40mm $1,155.00 Only to be funded where used in

 Titanium. To be used with screw 2 -  a service for which a Medicare

 Benefit is payable

ST257 Leibinger Titanium Implant System Leibinger Dynamic Mesh Implants  0.3x90x90mm, 0.6x90x90mm $1,155.00 Only to be funded where used in

 Titanium. To be used with screw 1 -  a service for which a Medicare

 Benefit is payable

ST311 Leibinger Titanium Implant System Plate - Leibinger Low Profile  4 holes $110.00 Only to be funded where used in

 Osteosynthesis System: mini, non- a service for which a Medicare

 compression / compression, straight,  Benefit is payable

 regular / extended, medium / long

ST312 Leibinger Titanium Implant System Plate - Leibinger Low Profile  8 holes $155.00 Only to be funded where used in

 Osteosynthesis System: mini, non- a service for which a Medicare

 compression, compression, straight,  Benefit is payable

 regular / extended, medium / long

ST313 Leibinger Titanium Implant System Plate - Leibinger Low Profile  16 holes $250.00 Only to be funded where used in

 Osteosynthesis System: mini, non- a service for which a Medicare

 compression, compression, straight,  Benefit is payable

 regular / extended, medium / long

ST314 Leibinger Titanium Implant System Leibinger Low Profile Osteosynthesis  4 holes $180.00 Only to be funded where used in

 System: L-shape, right/left, regular,  a service for which a Medicare

 medium, long Titanium Benefit is payable

ST315 Leibinger Titanium Implant System Leibinger Low Profile Osteosynthesis  5 holes $203.00 Only to be funded where used in

 System: L-shape, right/left, long,  a service for which a Medicare

 extended Titanium Benefit is payable

ST324 Leibinger Titanium Implant System Leibinger Mandible Burr Hole Cover  1.7x14mm, 1.7x7mm $325.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 660 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST326 Leibinger Titanium Implant System Leibinger Micro 3D Plating System:  2x2 holes, 0.55mm profile $185.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST327 Leibinger Titanium Implant System Leibinger Micro 3D Plating System:  2x3 holes, 0.55mm profile $253.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST328 Leibinger Titanium Implant System Leibinger Micro 3D Plating System:  2x4 holes, 0.55mm profile $340.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST329 Leibinger Titanium Implant System Leibinger Micro 3D Plating System:  4x4 holes, 0.55mm profile $490.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST330 Leibinger Titanium Implant System Leibinger Micro 3D Plating System:  4x6 holes, 0.55mm profile $730.00 Only to be funded where used in

 square, rectangular Titanium a service for which a Medicare

 Benefit is payable

ST331 Leibinger Titanium Implant System Leibinger Micro Bone plate Titanium 4 holes, 0.55mm profile $110.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST332 Leibinger Titanium Implant System Leibinger Micro Bone plate Titanium 6 holes, 0.55mm profile $140.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST333 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 6 holes, 0.55mm profile $120.00 Only to be funded where used in

  titanium a service for which a Medicare

 Benefit is payable

ST334 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 8 holes, 0.55mm profile $160.00 Only to be funded where used in

  titanium a service for which a Medicare

 Benefit is payable

ST335 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 16 holes, 0.55mm profile $253.00 Only to be funded where used in

  titanium a service for which a Medicare

 Benefit is payable

ST336 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: straight 24 holes, 0.55mm profile $345.00 Only to be funded where used in

  titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 661 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST337 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: L- 5 holes, 0.55mm profile $170.00 Only to be funded where used in

 shape, right/left Titanium a service for which a Medicare

 Benefit is payable

ST338 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: L- 8 holes, 0.55mm profile $200.00 Only to be funded where used in

 shape, right/left Titanium a service for which a Medicare

 Benefit is payable

ST339 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: T- 5, 7, 9 holes, 0.55mm profile $185.00 Only to be funded where used in

 shape, double-T-shape, right/left, 90 deg  a service for which a Medicare

 Benefit is payable

ST340 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: X-shape 4, 8, 9 holes, 0.55mm profile $185.00 Only to be funded where used in

  Titanium a service for which a Medicare

 Benefit is payable

ST341 Leibinger Titanium Implant System Leibinger Micro Bone Plate: Y-shape,  6 holes, 0.55mm profile $205.00 Only to be funded where used in

 double-Y-shape Titanium a service for which a Medicare

 Benefit is payable

ST342 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: Y-shape 8 holes, 0.55mm profile $203.00 Only to be funded where used in

   Titanium a service for which a Medicare

 Benefit is payable

ST343 Leibinger Titanium Implant System Leibinger 3D Plating System: micro  3 holes $170.00 Only to be funded where used in

 triangular plate Titanium a service for which a Medicare

 Benefit is payable

ST344 Leibinger Titanium Implant System Leibinger 3D Plating System: micro  8 holes $465.00 Only to be funded where used in

 circular plate Titanium a service for which a Medicare

 Benefit is payable

ST352 Leibinger Titanium Implant System Leibinger Dumbach Mesh System: plain  132.5x82.5x 0.5mm,  $1,115.00 Only to be funded where used in

 mesh, mesh with small holes Titanium a service for which a Medicare

 Benefit is payable

ST353 Leibinger Titanium Implant System Leibinger Dumbach Mesh System: flat  0.2x120x120mm $1,035.00 Only to be funded where used in

 mesh micro Titanium a service for which a Medicare

 Benefit is payable

ST354 Leibinger Titanium Implant System Leibinger Dumbach Mesh System: flat  0.2x60x60mm $1,035.00 Only to be funded where used in

 mesh micro Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 662 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST356 Leibinger Titanium Implant System Paulus Chin plate Titanium 2, 4, 6, 8, 10, 12, 14mm bar,  $280.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST447 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 45  4 holes, 40mm $350.00 Only to be funded where used in

 deg plate Titanium a service for which a Medicare

 Benefit is payable

ST448 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate: 45  4 holes, 50mm $380.00 Only to be funded where used in

 deg Titanium a service for which a Medicare

 Benefit is payable

ST449 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate:  8 holes, 60mm $450.00 Only to be funded where used in

 straight Titanium a service for which a Medicare

 Benefit is payable

ST450 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate:  8 holes, 70mm $440.00 Only to be funded where used in

 straight Titanium a service for which a Medicare

 Benefit is payable

ST451 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate:  16 holes, 120mm $555.00 Only to be funded where used in

 straight Titanium a service for which a Medicare

 Benefit is payable

ST452 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate:  6 holes $420.00 Only to be funded where used in

 angled, 60 deg Titanium a service for which a Medicare

 Benefit is payable

ST476 Wurzburg Bone Plates Wurzburg  Mini Bone plate: straight,  4 holes $64.50 Only to be funded where used in

 medium/regular/long, with/without bar   a service for which a Medicare

 Titanium Benefit is payable

ST477 Wurzburg Bone Plates Wurzburg  Mini Bone plate: straight,  6 holes $64.50 Only to be funded where used in

 regular/long, with/without bar Titanium a service for which a Medicare

 Benefit is payable

ST478 Wurzburg Bone Plates Wurzburg  Mini Bone plate: straight, long  8 holes $97.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST479 Wurzburg Bone Plates Wurzburg  Mini Bone plate: straight,  16 holes $120.00 Only to be funded where used in

 regular Titanium a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 663 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST480 Wurzburg Bone Plates Wurzburg  Mini Bone plate: H and Y- 10, 12 holes $229.00 Only to be funded where used in

 shape nasal plate Titanium a service for which a Medicare

 Benefit is payable

ST481 Wurzburg Bone Plates Wurzburg Bone plate: double-T-shape,   4, 6 holes $125.00 Only to be funded where used in

 with/without bar, 90 deg, regular/short  a service for which a Medicare

 Titanium Benefit is payable

ST482 Wurzburg Bone Plates Wurzburg Bone plate: double-Y-shape ,  6, 8 holes $150.00 Only to be funded where used in

 with/without bar,  short/long/long  a service for which a Medicare

 extended Titanium Benefit is payable

ST483 Wurzburg Bone Plates Wurzburg Bone plate: double-Y-shape, no 7 holes $185.00 Only to be funded where used in

  bridge Titanium a service for which a Medicare

 Benefit is payable

ST484 Wurzburg Bone Plates Wurzburg Bone plate: L-shape,  4 holes $104.00 Only to be funded where used in

 regular/long/medium, right/left,  a service for which a Medicare

 with/without bar Titanium Benefit is payable

ST485 Wurzburg Bone Plates Wurzburg Bone plate: L-shape, long bar/  5 holes $104.00 Only to be funded where used in

 extended long, right/left Titanium a service for which a Medicare

 Benefit is payable

ST486 Wurzburg Bone Plates Wurzburg Bone plate: T-shape,  5, 6 holes $104.00 Only to be funded where used in

 with/without bar, 90 deg, regular/long  a service for which a Medicare

 Benefit is payable

ST487 Wurzburg Bone Plates Wurzburg Bone plate: T-shape, long, 80  5 holes $104.00 Only to be funded where used in

 deg, long, right/left Titanium a service for which a Medicare

 Benefit is payable

ST488 Wurzburg Bone Plates Wurzburg Bone plate: Y-shape plate,  5 holes $104.00 Only to be funded where used in

 regular/long Titanium a service for which a Medicare

 Benefit is payable

ST489 Wurzburg Bone Plates Wurzburg Bone plate: Z-shape plate,  4 holes $195.00 Only to be funded where used in

 100/110 deg, right/left Titanium a service for which a Medicare

 Benefit is payable

ST490 Wurzburg Bone Plates Wurzburg Bone Screws: self-tapping  2x4-19mm, 2.3x7-9mm. Pack  $27.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 664 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST491 Wurzburg Bone Plates Leibinger 3D Plating System: square  2x2 holes $215.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST492 Wurzburg Bone Plates Leibinger 3D Plating System: rectangular  2x2 holes, 1mm thick $215.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST493 Wurzburg Bone Plates Leibinger 3D Plating System:  square  3x2 holes, 1mm thick $305.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST494 Wurzburg Bone Plates Leibinger 3D Plating System:  square,  4x2 holes, 1mm thick $405.00 Only to be funded where used in

 rectangular Titanium a service for which a Medicare

 Benefit is payable

ST495 Wurzburg Bone Plates Leibinger 3D Plating System: rectangular  4x4 holes, 1mm thick $900.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST496 Wurzburg Bone Plates Leibinger 3D Plating System:  square,  6x4 holes, 1mm thick $900.00 Only to be funded where used in

 rectangular Titanium a service for which a Medicare

 Benefit is payable

ST497 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  2 holes $305.00 Only to be funded where used in

 Plating System: straight bridging plate  a service for which a Medicare

 Benefit is payable

ST498 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  3 holes $365.00 Only to be funded where used in

 Plating System: straight bridging plate  a service for which a Medicare

 Benefit is payable

ST499 Wurzburg Bone Plates Wurburg Mandibular Reconstruction  4 holes $415.00 Only to be funded where used in

 Plating System: straight bridging plate  a service for which a Medicare

 Benefit is payable

ST500 Wurzburg Bone Plates Wurburg Mandibular Reconstruction  5 holes $470.00 Only to be funded where used in

 Plating System: straight bridging plate  a service for which a Medicare

 Benefit is payable

ST501 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  6 holes $520.00 Only to be funded where used in

 Plating System: straight bridging plate  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 665 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST502 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  7 holes $572.00 Only to be funded where used in

 Plating System: straight  Titanium a service for which a Medicare

 Benefit is payable

ST503 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  3 holes $545.00 Only to be funded where used in

 Plating System: angled bridging plate,  a service for which a Medicare

 right/left Titanium Benefit is payable

ST504 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  5 holes $630.00 Only to be funded where used in

 Plating System: angled bridging plate,  a service for which a Medicare

 right/left Titanium Benefit is payable

ST505 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  7 holes $740.00 Only to be funded where used in

 Plating System: angled bridging plate,  a service for which a Medicare

 right/left Titanium Benefit is payable

ST506 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  9 holes $820.00 Only to be funded where used in

 Plating System: angled bridging plate,  a service for which a Medicare

 right/left Titanium Benefit is payable

ST507 Wurzburg Bone Plates Wurzburg Mandibular Reconstruction  9 holes $1,290.00 Only to be funded where used in

 Plating System: total mandible bridging  a service for which a Medicare

 plate Titanium Benefit is payable

ST516 Stryker Leibinger Resorbable Fixation  Resorbable plate: blank panel Tripolymer 55x55mm  $855.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST517 Stryker Leibinger Resorbable Fixation  Resorbable plate: box shape  Tripolymer 2x2 holes $187.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST518 Stryker Leibinger Resorbable Fixation  Resorbable plate: curved plate  8 holes $173.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST519 Stryker Leibinger Resorbable Fixation  Resorbable plate: L-shape plate, 110 deg,  7 holes $187.00 Only to be funded where used in

 right/left Tripoymer a service for which a Medicare

 Benefit is payable

ST520 Stryker Leibinger Resorbable Fixation  Resorbable plate: ladder shape plate  2x5 holes $340.00 Only to be funded where used in

 Tripolymer a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 666 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST521 Stryker Leibinger Resorbable Fixation  Resorbable plate: straight Tripolymer 14 holes $212.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST524 Stryker Leibinger Resorbable Fixation  Resorbable plate: Y-shape Tripolymer 6 holes $187.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST525 Stryker Leibinger Resorbable Fixation  Resorbable plate: Y-shape Tripolymer 8 holes $147.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd (2)

SK129 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Compression $520.00 Only to be funded where used in

 Universal Mandible Compression Plate fixation of mandibular fractures and   Plate, 4-6 Holes a service for which a Medicare

 Benefit is payable.

SK130 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Fracture  $620.00 Only to be funded where used in

 Universal Mandible Fracture Plate fixation of mandibular fractures and  Plate, 14 Holes a service for which a Medicare

 Benefit is payable.

SK131 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Fracture  $475.00 Only to be funded where used in

 Universal Mandible Fracture Plate fixation of mandibular fractures and  Plate, C-shaped, 4 holes a service for which a Medicare

 Benefit is payable.

SK132 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Fracture  $565.00 Only to be funded where used in

 Universal Mandible Fracture Plate fixation of mandibular fractures and  Plate, Angled Shaped, 6 holes,  a service for which a Medicare

 115-140 deg Benefit is payable.

SK133 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Fracture  $470.00 Only to be funded where used in

 Universal Mandible Fracture Plate fixation of mandibular fractures and  Plate, 4-6 holes with/without Bar a service for which a Medicare

 Benefit is payable.

SK134 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Mini Plate,  $130.00 Only to be funded where used in

 Universal Mandible Mini Plate fixation of mandibular fractures and  4-6 holes with/without Bar a service for which a Medicare

 Benefit is payable.

SK135 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Mini Plate,  $263.00 Only to be funded where used in

 Universal Mandible Mini Plate fixation of mandibular fractures and  16 holes a service for which a Medicare

 Benefit is payable.

SK136 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Primary  $1,465.00 Only to be funded where used in

 Universal Mandible Primary  fixation of mandibular fractures and  Reconstruction Plate, (Hemi)  a service for which a Medicare

 Reconstruction Plate Left and Right 5+17 holes, with  Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 667 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK137 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Primary  $1,100.00 Only to be funded where used in

 Universal Mandible Primary  fixation of mandibular fractures and  Reconstruction Plate, 11-17  a service for which a Medicare

 Reconstruction Plate holes, with template Benefit is payable.

SK138 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible  $2,010.00 Only to be funded where used in

 Universal Mandible Reconstruction Plate fixation of mandibular fractures and  Reconstruction Plate, (Full), 6 + a service for which a Medicare

  13 + 6 holes, with template Benefit is payable.

SK139 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible 3D Plate,  $305.00 Only to be funded where used in

 Universal Mandible 3D Plate fixation of mandibular fractures and  (Full), 6 x 2 Hole, Curved,  a service for which a Medicare

 Benefit is payable.

SK140 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible  $1,050.00 Only to be funded where used in

 Universal Mandible Reconstruction Plate fixation of mandibular fractures and  Reconstruction Plate, 11 - 17  a service for which a Medicare

 holes, straight with template Benefit is payable.

SK141 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible  $1,550.00 Only to be funded where used in

 Universal Mandible Reconstruction Plate fixation of mandibular fractures and  Reconstruction Plate, (Hemi),  a service for which a Medicare

 Right and Left, 6 + 17 holes  Benefit is payable.

SK142 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible  $2,030.00 Only to be funded where used in

 Universal Mandible Reconstruction Plate fixation of mandibular fractures and  Reconstruction Plate, (Full), 6 + a service for which a Medicare

  17 + 6 holes, with template Benefit is payable.

SK143 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible  $2,010.00 Only to be funded where used in

 Universal Mandible Reconstruction Plate fixation of mandibular fractures and  Reconstruction Plate, (Full), 6 + a service for which a Medicare

  15 + 6 holes, with template Benefit is payable.

SK144 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible 3D Plate, 4 x $305.00 Only to be funded where used in

 Universal Mandible 3D Plate fixation of mandibular fractures and   2 Hole Square a service for which a Medicare

 Benefit is payable.

SK145 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible 3D Plate, 3 x $305.00 Only to be funded where used in

 Universal Mandible 3D Plate fixation of mandibular fractures and   2 Hole Rectangle a service for which a Medicare

 Benefit is payable.

SK146 Leibinger Titanium Implant System -  Items used for reconstruction and  Universal Mandible Bi-concave  $54.00 Only to be funded where used in

 Universal Mandible Biconcave Washer fixation of mandibular fractures and  Washer a service for which a Medicare

 Benefit is payable.

SK218 Leibinger Titanium Implant System -  Items used for reconstruction following  Universal Mandible Condylar  $1,545.00 Only to be funded where used in

 Universal Mandible Condylar Device trauma or tumor resection of the  Device Left and Right a service for which a Medicare

 mandible. Included are 2x cross pin  Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 668 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK255 Leibinger Titanium Implant System -  Upperface Fixation Plates 24 Hole Straight Plate  $415.00 Only to be funded where used in

 Universal CMF Plate Upperface, malleable condensed; a service for which a Medicare

  24 Hole Straight Plate Upperface Benefit is payable.

SK257 Leibinger Titanium Implant System -  Upperface Fixation Plates 18 Hole Straight, Upperface,  $325.00 Only to be funded where used in

 Universal CMF Plate Malleable a service for which a Medicare

 Benefit is payable.

SK258 Leibinger Titanium Implant System -  Upperface Fixation Plates 10 Hole Curved Plate Upperface, $265.00 Only to be funded where used in

 Universal CMF Plate  malleable condensed; 10 hole  a service for which a medicare

 Curved plate, Upperface Benefit is payable

SK259 Leibinger Titanium Implant System -  Upperface Fixation Plates 7 Hole Double Y Plate  $285.00 Only to be funded where used in

 Universal CMF Plate Upperface, malleable; 7 Hole  a service for which a Medicare

 Double Y Plate, Upperface Benefit is payable

SK260 Leibinger Titanium Implant System -  Upperface Fixation Plates 2x2 Hole 3-D Plate Upperface,  $205.00 Only to be funded where used in

 Universal CMF Plate malleable; 2x2 Hole 3-D Plate,  a service for which a Medicare

 Upperface Benefit is payable

SK261 Leibinger Titanium Implant System -  Upperface Fixation Plates 6x2 Hole 3-D Plate Upperface,  $225.00 Only to be funded where used in

 Universal CMF Plate malleable; 6x2 Hole 3-D Plate,  a service for which a Medicare

 Upperface Benefit is payable

SK262 Leibinger Titanium Implant System -  Uppeface Fixation Plates 8 Hole L Plate 90 Degree Left,  $250.00 Only to be funded where used in

 Universal CMF Plate Upperface; 8 Hole L Plate 90  a service for which a Medicare

 Degree Right, Upperface Benefit is payable

SK263 Leibinger Titanium Implant System -  Upperface Fixation Plates 7 Hole T Plate, Upperface $238.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK264 Leibinger Titanium Implant System -  Upperface Fixation Plates 4 Hole Orbita Plate, Upperface $245.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK265 Leibinger Titanium Implant System -  Upperface Fixation Plates 6x6 Hole 3-D Plate, Upperface;  $295.00 Only to be funded where used in

 Universal CMF Plate 6x6 Hole 3-D Plate Upperface,  a service for which a Medicare

 malleable Benefit is payable

SK266 Leibinger Titanium Implant System -  Upperface Fixation Plates 10x10 Hole 3-D plate  $310.00 Only to be funded where used in

 Universal CMF Plate Upperface, malleable; 10x10  a service for which a Medicare

 Hole 3-D plate, Upperface Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 669 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK267 Leibinger Titanium Implant System -  Upperface Fixation Plates 1.2 Malleable Burr Hole Cover  $335.00 Only to be funded where used in

 Universal CMF Plate Plate 7, 10, 14, 20mm a service for which a Medicare

 Benefit is payable

SK268 Leibinger Titanium Implant System -  Upperface Fixation Plates 1.2 Burr Hole Cover Plate 7, 10, $325.00 Only to be funded where used in

 Universal CMF Plate  14mm a service for which a Medicare

 Benefit is payable

SK269 Leibinger Titanium Implant System -  Midface Fixation Plates 24 Hole Straight Plate Midface,  $420.00 Only to be funded where used in

 Universal CMF Plate malleable condensed; 20 Hole  a service for which a Medicare

 Straight Plate Midface,  Benefit is payable

 malleable; 24 Hole Straight Plate

SK270 Leibinger Titanium Implant System -  Midface Fixation Plates 4 Hole Straight Plate with Bar,  $160.00 Only to be funded where used in

 Universal CMF Plate Midface; 4 Hole Curved Plate  a service for which a Medicare

 with Bar, Midface Benefit is payable

SK271 Leibinger Titanium Implant System -  Midface Fixation Plates 10 Hole Curved Plate, Midface $295.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK272 Leibinger Titanium Implant System -  Midface Fixation Plates 5 Hole T Plate, Midface $250.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK273 Leibinger Titanium Implant System -  Midface Fixation Plates 5 Hole Y Plate with 4mm Bar,  $250.00 Only to be funded where used in

 Universal CMF Plate Midface a service for which a Medicare

 Benefit is payable

SK274 Leibinger Titanium Implant System -  Midface Fixation Plates 7 Hole Double Y Plate, Midface $295.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK275 Leibinger Titanium Implant System -  Malleable L Plates 5 Hole L Plate 2mm  $160.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 5 Hole L Plate 2mm  Benefit is payable

 Advancement 100 Degree Right,

SK276 Leibinger Titanium Implant System -  Malleable L Plates 5 Hole L Plate 5mm  $165.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 5 Hole L Plate 5mm  Benefit is payable

 Advancement 100 Degree Right,

Prostheses List by Category, Groups and Sponsor Page 670 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK277 Leibinger Titanium Implant System -  Malleable L Plates 6 Hole L Plate 8mm  $170.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 6 Hole L Plate 8mm  Benefit is payable

 Advancement 100 Degree 

SK278 Leibinger Titanium Implant System -  Malleable L Plates 6 Hole L Plate 12mm  $180.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 6 Hole L Plate 12mm  Benefit is payable

 Advancement 100 Degree Right,

  Midface

SK279 Leibinger Titanium Implant System -  Standard L Plates 5 Hole L Plate 2mm  $162.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface;  5 Hole L Plate 2mm  Benefit is payable

 Advancement 100 Degree Right,

SK280 Leibinger Titanium Implant System -  Standard L Plates 5 Hole L Plate 5mm  $170.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 5 Hole L Plate 5mm  Benefit is payable

 Advancement 100 Degree Right,

SK281 Leibinger Titanium Implant System -  Standard L Plates 6 Hole L Plate 8mm  $170.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 6 Hole L Plate 8mm  Benefit is payable

 Advancement 100 degree Right,

SK282 Leibinger Titanium Implant System -  Standard L Plates 6 Hole L Plate 12mm  $180.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface; 6 Hole L Plate 12mm  Benefit is payable

 Advancement 100 Degree Right,

  Midface

SK283 Leibinger Titanium Implant System -  Graduated Stability L Plates 5 Hole L Plate 2mm  $162.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface, GSP; 5 Hole L Plate  Benefit is payable

 2mm Advancement 100 Degree

SK284 Leibinger Titanium Implant System -  Graduated Stability L Plates 5 Hole L Plate 5mm  $170.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface, GSP; 5 Hole L Plate  Benefit is payable

 5mm Advancement 100 Degree

Prostheses List by Category, Groups and Sponsor Page 671 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK285 Leibinger Titanium Implant System -  Graduated Stability L Plates 6 Hole L Plate 8mm  $170.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface, GSP; 6 Hole L Plate  Benefit is payable

 8mm Advancement 100 Degree

SK286 Leibinger Titanium Implant System -  Graduated Stability L Plates 6 Hole L Plate 12mm  $180.00 Only to be funded where used in

 Universal CMF Plate Advancement 100 Degree Left,  a service for which a Medicare

 Midface, GSP; 6 Hole L Plate  Benefit is payable

 12mm Advancement 100

 Degree Right, Midface, GSP

SK287 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 16 Hole Straight Plate, Midface,  $312.00 Only to be funded where used in

 Universal CMF Plate locking a service for which a Medicare

 Benefit is payable

SK288 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 8 Hole Curved Plate, Midface,  $180.00 Only to be funded where used in

 Universal CMF Plate locking a service for which a Medicare

 Benefit is payable

SK289 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 2x2 Hole 3-D Plate, Midface,  $185.00 Only to be funded where used in

 Universal CMF Plate Locking a service for which a Medicare

 Benefit is payable

SK290 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 2x6 Hole 3-D Plate, Midface,  $185.00 Only to be funded where used in

 Universal CMF Plate Locking a service for which a Medicare

 Benefit is payable

SK291 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 5 Hole Y Plate with 4mm Bar,  $194.00 Only to be funded where used in

 Universal CMF Plate Midface, Locking; 5 Hole Y  a service for which a Medicare

 Plate with 8mm Bar, Midface,  Benefit is payable

SK292 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 7 Hole Double Y Plate, Midface, $195.00 Only to be funded where used in

 Universal CMF Plate  locking a service for which a Medicare

 Benefit is payable

SK293 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 8 Hole Y Plate, Midface, locking $205.00 Only to be funded where used in

 Universal CMF Plate a service for which a Medicare

 Benefit is payable

SK294 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 5 Hole L Plate 2mm  $185.00 Only to be funded where used in

 Universal CMF Plate Advancement, Midface, locking; a service for which a Medicare

  5 Hole L Plate 5mm  Benefit is payable

 Advancement, Midface, locking

Prostheses List by Category, Groups and Sponsor Page 672 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK295 Leibinger Titanium Implant System -  Mid-Face Fixation Plates, Locking 6 Hole L Plate 8mm  $205.00 Only to be funded where used in

 Universal CMF Plate Advancement, Midface, locking; a service for which a Medicare

  6 Hole L-Plate 12mm  Benefit is payable

 Advancement, Midface, locking

SK296 Leibinger Titanium Implant System -  Mandible Plates 4 hole 2.3mm Compression  $2,635.00 Only to be funded where used in

 Universal CMF Plate Plate; 6 Hole 2.3mm  a service for which a Medicare

 Benefit is payable

SK297 Leibinger Titanium Implant System -  Mandible Plates 16 Hole, Straight Plate, Locking, $2,635.00 Only to be funded where used in

 Universal CMF Plate  Condensed a service for which a Medicare

 Benefit is payable

SK298 Leibinger Titanium Implant System -  Mandible Plates 4-6 Hole, Straight Plate,  $2,165.00 Only to be funded where used in

 Universal CMF Plate with/without bar, locking a service for which a Medicare

 Benefit is payable

SK340 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 4 hole Z Plate,  $275.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Small, Left, Midface GSP.  a service for which a Medicare

 fractures or osteotomy performed for  Universal CMF 4 hole Z Plate,  Benefit is payable

 correction of facial deformity Small Right, Midface GSP

SK341 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 4 hole Z Plate,  $275.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Large, Left, Midface GSP.  a service for which a Medicare

 fractures or osteotomy performed for  Universal CMF 4 hole Z Plate,  Benefit is payable

 correction of facial deformity Large, Right, Midface GSP

SK342 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 11 hole Le Fort  $275.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  1 Plate, 0mm Advancement,  a service for which a Medicare

 fractures or osteotomy performed for  Left. Universal CMF 11 hole Le  Benefit is payable

 correction of facial deformity Fort 1 Plate, 0mm

SK343 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 11 hole Le Fort  $275.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  1 Plate, 3mm Advancement,  a service for which a Medicare

 fractures or osteotomy performed for  Left. Universal CMF 11 hole Le  Benefit is payable

 correction of facial deformity Fort 1 Plate, 3mm

SK344 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 11 hole Le Fort  $275.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  1 Plate, 4mm Advancement,  a service for which a Medicare

 fractures or osteotomy performed for  Left. Universal CMF 11 hole Le  Benefit is payable

 correction of facial deformity Fort 1 Plate, 4mm

Prostheses List by Category, Groups and Sponsor Page 673 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK345 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF Plate 11 hole Le  $287.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Fort 1 Plate, 6mm  a service for which a Medicare

 fractures or osteotomy performed for  Advancement, Left. Universal  Benefit is payable

 correction of facial deformity CMF Plate 11 hole Le Fort 1

 Plate, 6mm Advancement, Right

SK346 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 11 hole Le Fort  $287.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  1 Plate, 8mm Advancement,  a service for which a Medicare

 fractures or osteotomy performed for  Left. Universal CMF Plate 11  Benefit is payable

 correction of facial deformity hole Le Fort 1 Plate, 8mm

 Advancement, Right

SK347 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 11 hole Le Fort  $287.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  1 Plate, 10mm Advancement,  a service for which a Medicare

 fractures or osteotomy performed for  Left. Universal CMF 11 hole Le  Benefit is payable

 correction of facial deformity Fort 1 Plate, 10mm

SK348 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 4 hole chin plate, $185.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial   4mm. Universal CMF 4 hole  a service for which a Medicare

 fractures or osteotomy performed for  chin plate, 6mm. Universal CMF Benefit is payable

 correction of facial deformity  4 hole chin plate, 8mm.

 Universal CMF 4 hole chin plate,

  10mm. Universal CMF 4 hole

SK349 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 4 hole Z plate,  $220.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Small, Orthognathic, locking.  a service for which a Medicare

 fractures or osteotomy performed for  Universal CMF 4 hole Z plate,  Benefit is payable

 correction of facial deformity Large, Orthognathic, locking.

SK350 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 6 hole curved  $227.00 Only to be funded where used in

 Universal CMF Plates and fixation of craniomaxillofacial  Sagittal Split plate, 6mm bar,  a service for which a Medicare

 fractures or osteotomy performed for  locking Benefit is payable

 correction of facial deformity

SK351 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 6 hole curved  $220.00 Only to be funded where used in

 Universal CMF Plates and fixation of craniomaxillofacial  Sagittal Split plate, 12mm bar,  a service for which a Medicare

 fractures or osteotomy performed for  locking. Universal CMF 6 hole  Benefit is payable

 correction of facial deformity straight, Sagittal Split plate,

 12mm bar, locking.

Prostheses List by Category, Groups and Sponsor Page 674 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK352 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF 4 hole straight,  $210.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Sagittal Split plate, 6mm bar,  a service for which a Medicare

 fractures or osteotomy performed for  locking Benefit is payable

 correction of facial deformity

SK353 Leibinger Titanium Implant System -  Titanium plates used for reconstruction  Universal CMF Sliding Sagittal  $220.00 Only to be funded where used in

 Universal CMF Plate and fixation of craniomaxillofacial  Split plate, Small, locking.  a service for which a Medicare

 fractures or osteotomy performed for  Universal CMF Sliding Sagittal  Benefit is payable

 correction of facial deformity Split plate, Large, locking.

SK354 Universal Neuro Titanium Viper Self- Titanium self-drilling screws used for the  Diameter 1.5mm, Length 4 & 5  $46.00 Only to be funded where used in

 Drilling Screws fixation of cranial bone flaps a service for which a Medicare

 Benefit is payable

SK355 Universal Neuro Titanium Low Profile  Titanium Low Profile plates used for the  Small, large, 20mm burr hole,  $430.00 Only to be funded where used in

 fixation of cranial bone flaps 16 hole without bar a service for which a Medicare

 Benefit is payable

SK356 Universal Neuro Titanium Low Profile  Titanium Low Profile plates used for the  2-hole plate, 12mm bar, 16mm  $102.00 Only to be funded where used in

 fixation of cranial bone plates a service for which a Medicare

 Benefit is payable

SK359 Universal Neuro Titanium Low Profile  Titanium Low Profile plates used for the  4 hole 6mm Bar, 2 hole 12mm  $220.00 Only to be funded where used in

 fixation of cranial bone flaps bar with tab, 7-14mm burr hole  a service for which a Medicare

 Benefit is payable

SK362 Universal Neuro Screws Titanium screws used for the fixation of  Diameter 1.5mm, length 4- $53.50 Only to be funded where used in

 cranial bone flaps 6mm. Emergency Screws:  a service for which a Medicare

 Diameter 1.7mm, length 4mm. Benefit is payable

SK363 Universal Neuro Titanium Low Profile  Titanium Low Profile plates used for the  8 hole plate without bar,  2 x 2  $370.00 Only to be funded where used in

 fixation of cranial bone flaps box plate, double Y 6 hole 8mm a service for which a Medicare

 Benefit is payable

SK389 Universal System Condylar Prosthesis Left/Right $990.00

 Synthes Australia Pty Ltd

SY252 AO/ASIF Facio-Maxillary Plates Flapfix - Plates for fixation of cranial  10 - 20mm $195.00 Only to be funded where used in

 bone flaps a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 675 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 TiMax Surgical Pty Ltd

TI001 TiMax Titanium Plates Micro, Mini Standard - L (R & L), T & Y 4 - 24  holes $186.00 Only to be funded where used in

  Shapes, Straight Long.  Micro & Mini  a service for which a Medicare

 Square Triple Benefit is payable

TI009 TiMax Titanium Plates Micro & Mini Square Double 3 x 2 holes $168.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI010 TiMax Titanium Plates Micro, Mini & Standard - Double T & Y  4 to 9 holes $204.00 Only to be funded where used in

 Shape a service for which a Medicare

 Benefit is payable

TI012 TiMax Titanium Plates Fracture, Curved and Angled 4 - 6 holes $378.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI019 TiMax Titanium Plates Micro, Mini & Standard Straight Short 4-8 Holes $123.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI021 TiMax Titanium Plates Micro & Mini Square Single 2 x 2 holes $147.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI026 TiMax Titanium Plates Custom Mesh $6,104.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI033 TiMax Titanium Plates Mesh, Strap, J Plate Mesh 125 x 125mm $673.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

TI040 TiMax Titanium Plates Fracture Straight Short & Long 4 to 14 holes $231.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 676 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Plates, Cranioplasty

 Mondeal Medical Systems Pty Ltd

MD002 Mondeal Medical Systems Implant &  Plate Straight 2-6 hole $50.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD004 Mondeal Medical Systems Implant &  Plate Straight 8 hole $72.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD005 Mondeal Medical Systems Implant &  Plate Straight 16 hole $90.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD007 Mondeal Medical Systems Implant &  Plate L Shape Right & Left $80.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD008 Mondeal Medical Systems Implant &  Plate T Shape $98.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD009 Mondeal Medical Systems Implant &  Plate Y Shape $115.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD011 Mondeal Medical Systems Implant &  Plate T Shape $90.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD015 Mondeal Medical Systems Implant &  Plate Straight 4-6 hole $72.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD019 Mondeal Medical Systems Implant &  Plate Straight 8 hole & L Shape -  $121.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  Right & Left a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 677 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MD021 Mondeal Medical Systems Implant &  Plate T Shape $143.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD022 Mondeal Medical Systems Implant &  Plate Y Shape $170.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD024 Mondeal Medical Systems Implant &  Plate T, Y, Orbital Shape $140.00 Only to be funded where used in

 Prostheses, Mini 2000 Reconstruction  a service for which a Medicare

 Benefit is payable

MD038 Mondeal Medical Systems Implant &  Plate Straight 4 - 6 hole $82.00 Only to be funded where used in

 Prostheses, Mini 1700 Reconstruction  a service for which a Medicare

 Benefit is payable

MD041 Mondeal Medical Systems Implant &  Plate Straight 16 hole, Y Shape $178.00 Only to be funded where used in

 Prostheses, Mini 1700 Reconstruction  a service for which a Medicare

 Benefit is payable

MD042 Mondeal Medical Systems Implant &  Plate Orbital Shape $143.00 Only to be funded where used in

 Prostheses, Mini 1700 Reconstruction  a service for which a Medicare

 Benefit is payable

MD043 Mondeal Medical Systems Implant &  Plate T, Y, Z Shape $160.00 Only to be funded where used in

 Prostheses, Mini 1700 Reconstruction  a service for which a Medicare

 Benefit is payable

MD047 Mondeal Medical Systems Implant &  Plate L Shape Right & Left $132.00 Only to be funded where used in

 Prostheses, Mini 1700 Reconstruction  a service for which a Medicare

 Benefit is payable

MD058 Mondeal Medical Systems Implant &  Plate L, T Shape $129.00 Only to be funded where used in

 Prostheses, Micro 1200 Reconstruction  a service for which a Medicare

 System Benefit is payable

MD059 Mondeal Medical Systems Implant &  Plate L, Y Shape $147.00 Only to be funded where used in

 Prostheses, Micro 1200 Reconstruction  a service for which a Medicare

 System Benefit is payable

MD062 Mondeal Medical Systems Implant &  Plate H Shape $242.00 Only to be funded where used in

 Prostheses, Micro 1200 Reconstruction  a service for which a Medicare

 System Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 678 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MD070 Mondeal Medical Systems Implant &  Mesh Micro 50 x 30mm $103.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

MD071 Mondeal Medical Systems Implant &  Mesh Micro 100 x 60mm $330.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

MD072 Mondeal Medical Systems Implant &  Mesh Micro 100 x 30mm, 50 x 60mm $165.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

MD104 Mondeal Medical Systems Implant &  Chin Plate 4mm - 12mm $154.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

Prostheses, Chin

 Medical Device Alliance Pty Ltd

MP010 Facial Implant Chin Anotomical chin Small, medium, large/left, right $275.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP012 Facial Implant Chin Chin Small, medium, large/left, right $258.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

 Mentor Medical Systems

MN020 Implantech Facial Implants - Chin  Implantech Anatomical Chin;Flowers  Extra small, Small, Medium,  $420.00 Only to be funded where used in

 Mandibular Glove;Terino Extended  Large, Extra Large a service for which a Medicare

 Anatomical Chin;Terino Square Chin  Benefit is payable.

 Style I;Mittleman Pre-Jowl;Glasgold

 Wafer for Pre-Jowl Chin;Mittleman Pre-

 Jowl Chin;Glasgold Wafer for Extended

 Anatomical Chin;Silicone Chin;Terino

 Square Chin II Composition Implant

 Grade Silicone Elastomer

Prostheses List by Category, Groups and Sponsor Page 679 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Surgiplas Medical

SP004 Facial Prosthesis Silicone elastomer Small / Medium / Large / X- $286.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses, Dental, Implantable

 AstraZeneca Pty Ltd

AZ001 Astra Tech Cover Screws Cover Screw Diameter 3.5mm, 4.0mm,  $52.00 Only to be funded where used in

 4.5/5.0mm Short, 4.5/ 5.0mm  a service for which a Medicare

 Benefit is payable

AZ002 Astra Tech MicroThread Fixtures and  Titanium fixture with microthreaded  Diameter 3.5 - 5.0mm, Length  $467.00 Only to be funded where used in

 MicroThread Osseospeed Fixtures cervical neck 8-19mm a service for which a Medicare

 Benefit is payable

AZ003 Astra Tech Healing Abutments Healing Abutments, Healing Abutments  Zebra 1.5, 3.0, 4.5, 6.0mm;  $67.00 Only to be funded where used in

 Healing Abutment 5.5mm Ultra,  a service for which a Medicare

 Short, Long; 7.0mm Short,  Benefit is payable

 Long; ST Short, Long; ST

 5.5mm Short, Long; ST 7.0mm

 Short, Long; Temporary

 Abutment 3.5, 4.0 4.0/5.0mm

AZ004 Astra Tech Abutments Temporary Abutment Diam 3.5 - 5.0mm $96.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AZ005 Astra Tech Abutments PreFab Titanium Abutment,  Diam 3.5 - 5.0mm $96.00 Only to be funded where used in

 BiAbutment/Abutment Kit a service for which a Medicare

 Benefit is payable

AZ006 Astra Tech Abutments UniAbutment, Angled Abutment, Ball  Diam 3.5 - 7.0mm $96.00 Only to be funded where used in

 Abutment a service for which a Medicare

 Benefit is payable

AZ007 Astra Tech Abutments Ceramic Abutment Diam 4.5 - 5.0mm $136.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 680 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AZ008 AstraTech Cast to Abutment $160.00

AZ009 AstraTech Profile BI Abutment $160.00

 Halas Dental Pty Ltd

HD006 Dental Implants Titanium type 4 and 5 3.25 to 6.0mm diameter, 6.0 to  $96.00 $350.00 Only to be funded where used in

 52.5mm length a service for which a Medicare

 Benefit is payable

 Implant Innovations Australia Pty Ltd

NW001 3i Abutment Complete Titanium 3.25 - 6mm diameter $8.00 $60.00 Endosseous Implants -  (Not to

 be included for dental treatment

 except as a secondary procedure

 when partial or complete

 resection of a mandible or maxilla

  has been undertaken for removal

  of an extensive tumour or cyst.)

NW002 3i Self Tapping Threaded Implants and 3i  Osseotite/Ice 3.25 - 6mm diameter $52.00 $420.00 Endosseous Implants -  (Not to

 Coverscrew be included for dental treatment

 except as a secondary procedure

 when partial or complete

 resection of a mandible or maxilla

  has been undertaken for removal

  of an extensive tumour or cyst.)

 Neoss Australia Pty Ltd

NJ001 Neo Implant System Neo Implant System - including cover  Diameter 3.5, 4.0, 4.5, 5.5mm  $360.00 Only to be funded where used in

 screw and abutment in Lengths: 7, 9, 11, 13, 15,  a service for which a Medicare

 Benefit is payable

NJ002 Neo Implant System Titanium Prepable Abutment Straight or 15 degree including  $185.00 Only to be funded where used in

 Abutment Screw and  a service for which a Medicare

 Laboratory Screw Benefit is payable

NJ003 Neo Implant System Neo Abutment Titanium including  universal $175.00 Only to be funded where used in

 Abutment Screw, Laboratory Screw and  a service for which a Medicare

 16 preformed abutments Benefit is payable

NJ004 Neo Implant System Neo Abutment Gold-  including Abutment universal $220.00 Only to be funded where used in

  Screw, Laboratory Screw and 16  a service for which a Medicare

 preformed abutments Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 681 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NJ005 Neo Implant System Matrix Abutment Titanium Hex RP; Hex NP; C- Lect RP;  $115.00 Only to be funded where used in

 C-Lect NP; St. a service for which a Medicare

 Benefit is payable

NJ006 Neo Implant System Matrix Abutment Gold Hex RP; Hex NP; C- Lect RP;  $160.00 Only to be funded where used in

 C-Lect NP; St. a service for which a Medicare

 Benefit is payable

NJ007 Neo Implant System Neo Ball Abutment 1, 3 & 4.5mm $185.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NJ008 Neo Implant System Bar Abutment Titanium universal $85.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NJ009 Neo Implant System Healing Abutment with Screw universal $38.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Nobel Biocare

NR001 Branemark Abutments Abutment, complete 3.5, 4.5, 5.0, 6.0, 7.0mm  $96.00 $260.00 Endosseous Implants -  (Not to

 be included for dental treatment

 except as a secondary procedure

 when partial or complete

 resection of a mandible or maxilla

  has been undertaken for removal

  of an extensive tumour or cyst.)

NR002 Branemark Cover Screws Cover screw 3, 3.3, 3.75, 4, 4.3, 5, 5.5, 6mm $52.00 $70.00 Endosseous Implants -  (Not to

 be included for dental treatment

 except as a secondary procedure

 when partial or complete

 resection of a mandible or maxilla

  has been undertaken for removal

  of an extensive tumour or cyst.)

Prostheses List by Category, Groups and Sponsor Page 682 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

NR003 Branemark Fixtures Titanium Fixture 3, 4, 5mm $96.00 $507.00 Endosseous Implants -  (Not to

 be included for dental treatment

 except as a secondary procedure

 when partial or complete

 resection of a mandible or maxilla

  has been undertaken for removal

  of an extensive tumour or cyst.)

NR004 Healing Abutment Complete Abutment Coping One Size Only $70.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NR006 Branemark Novum System Titanium - Kit Fixture System One size only $534.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

NR007 Branemark Titanium Fixture Zygomaticus Fixture 30, 35, 42.5, 40, 45, 47.5, 50,  $800.00 Only to be funded where used in

 52.5mm Length a service for which a Medicare

 Benefit is payable

NR009 NobelDirect Implant Dental Implant Endosseous incorporating  10mm, 13mm, 16mm $617.00 $625.00 To be funded only when used in

 abutment, Titanium MBS procedures relating to

 oncology

NR010 Replace Implant Dental Implant Endosseous, Titanium 10mm, 13mm, 16mm $96.00 $510.00 To be funded only when used in

 MBS procedures relating to

 oncology

NR011 NobelPerfect Implant Dental Implant Edosseous, Titanium 10mm, 13mm, 16mm $860.00 To be funded only when used in

 MBS procedures relating to

 oncology

 Straumann Pty Ltd

SB001 Straumann Pty Ltd Straumann Dental Implant NNI/RN/WNI Diameter 3.3 - 4.8mm Length 6  $260.00

 - 16mm

SB002 Straumann Pty Ltd Straumann Healing Cap NNI/RN/WNI Height 1.5 - 4.5 mm $50.00

Prostheses List by Category, Groups and Sponsor Page 683 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Ear

 Medical Device Alliance Pty Ltd

MP034 Facial Implant - Ear One size only $496.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

Prostheses, Finger/Thumb

 Medical Device Alliance Pty Ltd

MP011 Phalangeal Joint Implant Flexible monoblock implant to restore  00-7 $434.00 Only to be funded where used in

 finger articulation, 2001 a service for which a Medicare

 Benefit is payable.

Prostheses, Joint, Mandible

 Biomet Australia Pty Ltd

BI559 TMJ System Mandibular Component, Left or Right,  (40 - 60mm), 5-13 hole $6,875.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

BI569 TMJ System Fossa Component, Left or Right;  Small, Medium Large $5,850.00 Only to be funded where used in

 Titanium, UHMWPE a service for which a Medicare

 Benefit is payable

BI570 TMJ System Screw, Cross Drive, Fossa; Titanium (2.0 or 2.3) x (5 - 13) mm $75.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 684 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Joint, Mandibular Condyle

 Biomet Australia Pty Ltd

BI742 TMJ System Screw, Cross Drive Emergency,  3.2 mm (dia) x 8, 10, 12mm  $62.00 Only to be funded where used in

 Mandibular Component, Titanium (lengths) a service for which a Medicare

 Benefit is payable

BI745 TMJ System Screw, Cross Drive, Mandibular  2.7 mm (dia) x 8, 10, 12mm  $47.00 Only to be funded where used in

 Component, Titanium (lengths) a service for which a Medicare

 Benefit is payable

Prostheses, Mammary, Internal

 Device Technologies Australia Pty Ltd

DE100 McGhan Style 150 Biodimensional Biocell Full height, Short Height 9.5 - 16cm width x 8 - 17cm  $2,294.00 In strict accordance with the

  Textured Expand Gel/Saline Filled  height x 4.2 - 7.1cm projection requirements of the Medicare

 Mammary Implant, Low Pole Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE102 McGhan Style 110 & 120 Biocell  Round: Moderate or high profile 90 - 650 grams $732.00 In strict accordance with the

 Textured Gel-Filled Mammary Implant requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE104 McGhan Style 40 & 45 Intrashiel Gel- Round: standard or high profile 120 400 grams $610.00 In strict accordance with the

 Filled Round Mammary Implant requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 685 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DE106 CUI Type MLP, Microcell, DRIE Low  Low or High profile, textured surface 100 - 525 grams $685.00 In strict accordance with the

 Profile Gel-Filled  Mammary Implant;  requirements of the Medicare

 CUI Type MHP, Microcell, DRIE High  Benefits Schedule Items Number

 Profile Gel-Filled  Mammary Implant 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE120 McGhan Style 410 & 410 Soft Touch  Full, moderate or low height, Extra Full,  125 - 775 grams $1,200.00 In strict accordance with the

 Biodimensional Biocell Textured Cohesive Full, moderate or low projection requirements of the Medicare

  Gel-filled Mammary Implant Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

 Medical Device Alliance Pty Ltd

MP036 Infraclavicular Implant Infraclavicular Implant 14cc; 20cc; 38cc; 63cc; 122cc $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP037 Pectoral Implants Gel - Smooth surface 190cc - 300cc $950.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP038 Pectoral Implants Elastomer - Smooth surface 190cc - 300cc $950.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

MP039 Pectoral Implants Elastomer - Textured surface 190cc - 300cc $980.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 686 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mentor Medical Systems

MN018 Smooth High Profile Gel-filled Mammary  Mammary prostheses 125cc-Model 350-1254BC;  $610.00 In strict accordance with the

 Prostheses 150cc-Model 350-1504BC;  requirements of the Medicare

 175cc-Model 350-1754BC;  Benefits Schedule Items Number

 200cc-Model 350-2004BC;  45524, 45527, 45528, 45542,

 225cc-Model 350-2254BC;  45552, 45554, 45555 only.

 250cc-Model 350-2504BC;

 275cc-Model 350-2754BC;

 300cc-Model 350-3004BC;

 325cc-Model 350-3254BC;

 350cc-Model 350-3504BC;

 375cc-Model 350-3754BC;

 400cc-Model 350-4004BC;

 425cc-Model 350-4254BC;

 450cc-Model 350-4504BC;

 500cc-Model 350-5004BC;

 550cc-Model 350-5504BC,

 600cc-Model 350-6004BC;

 650cc-Model 350-6504BC;

 700cc-Model 350-7004BC;

 800cc-Model 350-8004BC

MN019 Siltex High Profile Gel-filled Mammary  Mammary Prostheses 125cc-Model 354-4125; 150cc- $750.00 In strict accordance with the

 Prostheses Model 354-4150; 175cc-Model  requirements of the Medicare

 354-4175; 200cc-Model 354- Benefits Schedule Items Number

 4200; 225cc-Model 354-4225;  45524, 45527, 45528, 45542,

 250cc-Model 354-4250; 275cc- 45552, 45554, 45555 only.

 Model 354-4275; 300cc-Model

 354-4300; 325cc-Model 354-

 4325; 350cc-Model 354-4350;

 375cc-Model 354-4375; 400cc-

 Model 354-4400; 425cc-Model

 354-4425; 450cc-Model 354-

 4450; 500cc-Model 354-4500;

 550cc-Model 354-4550; 600cc-

 Model 354-4600; 650cc-Model

 354-4650; 700cc-Model 354-

 4700; 800cc-Model 354-4800

Prostheses List by Category, Groups and Sponsor Page 687 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Mammary, Internal, Gel-Filled

 Device Technologies Australia Pty Ltd

DE109 CUI styles CML, CMM, CFM and CMH Silicone Cohesive Gel-Filled Breast  80 - 800 grams $750.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE110 CUI Type SLD, DRIE, Low Profile  Low or High Profile 100 - 800 grams $610.00 In strict accordance with the

 Smooth Silicone Gel-filled Mammary  requirements of the Medicare

 Implant; CUI Type SHD, DRIE, High  Benefits Schedule Items Number

 Profile Smooth Silicone Gel-filled  45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE219 CUI Style XML Round, Expandable, Microcell, DRIE,  180 -700grams $1,400.00 In strict accordance with the

 Silicone Gel/Saline Dual Lumen, Low  requirements of the Medicare

 Profile Breast Implant. Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

 Medical Vision Australia Pty Ltd

MF006 Pip Breast Implant Gel Filled Reconstruction Anatomical Textured 180cc to 600cc $610.00 $850.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF007 Pip Breast Implant Gel Filled Asymmetric Textured Right 200cc to 450cc $1,200.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF008 Pip Breast Implant Gel Filled Asymmetric textured Left 200cc to 450cc $1,200.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 688 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MF009 Pip Breast Implant Gel Filled Round Smooth Standard profile 85cc to 705cc $700.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF010 Pip Breast Implant Gel Filled Round Smooth High profile 90cc to 680cc $700.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF011 Pip Breast Implant Gel Filled Round textured Standard profile 85cc to 705cc $700.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF012 Pip Breast Implant Gel Filled Round Textured High profile 90cc to 680cc $610.00 $700.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF013 Pip Breast Implant Gel Filled Round Smooth Extra High profile 245cc to 495cc $750.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MF014 Pip Breast Implant Gel Filled Round Textured Extra High profile 245cc to 495cc $750.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

 Mentor Medical Systems

MN013 Mentor Siltex Becker Expander/Mammary 150, 200, 250, 300, 350, 400,  $2,294.00 In strict accordance with the

  Prostheses 500, 600, 700. 800cc requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 689 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MN014 Mentor Medical Systems Smooth Low  100,125,150,175,200,225,250,2 $610.00 In strict accordance with the

 Bleed Gel-Filled,  Mammary Prostheses  75,300,325,400,450,500,550,60 requirements of the Medicare

 Breast, Permanently Implantable 0,700,800cc Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN015 Mentor Siltex Low Bleed Gel-Filled  100,125,150,175,200,225,250,2 $685.00 In strict accordance with the

 (Moderate Profile) Mammary Prostheses  75,300,325,350,375,400,500,55 requirements of the Medicare

 Breast, Permanently Implantable 0,600,700,800cc Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN016 Mentor Siltex Low Bleed Gel-Filled (High  75, 200, 225, 250,  275, 300,  $685.00 In strict accordance with the

 Profile) Mammary Prostheses Breast,  325, 350, 400, 450, 500, 550cc requirements of the Medicare

 Permanently Implantable Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN017 Mentor Medical Systems Contour Profile  120,135,155,180,215,245,280,3 $1,200.00 In strict accordance with the

 Gel-filled Mammary Prostheses, Breast,  15,355,395,440,480,530,640,77 requirements of the Medicare

 Permanently Implantable Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN024 Round Cohesive Gel-Filled Mammary  Model 354-1009; Model 354-1259; Model 100cc, 125cc, 150cc, 175cc,  $730.00 Only to be funded where used in

 Prosthesis  354-1509; Model 354-1759; Model 354- 200cc, 225cc, 250cc, 275cc,  a service for which a Medicare

 2009; Model 354-2259; Model 354-2509;  300cc, 325cc, 350cc, 375cc,  Benefit is payable.

 Model 354-2759; Model 354-3009; Model 400cc, 450cc, 500cc, 550cc,

  354-3259; Model 354-3509; Model 354-

 3759; Model 354-4509; Model 354-5009;

 Model 354-5509; Model 354-6009; Model

  354-7009; Model 354-8009; Model 354-

 Surgiplas Medical

SP047 Gel Filled Mammary Prosthesis Models  Textured Round 80 to 800ml $715.00 In strict accordance with

 GFX-LP, GFX and GFX-EHP Medicare Benefits Schedule

 Items Number 45524, 45527,

 45528, 45542, 45552, 45554,

Prostheses List by Category, Groups and Sponsor Page 690 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SP048 Gel Filled Mammary Prosthesis Models  Smooth Round 80 to 800ml $610.00 In strict accordance with

 RGI-D and RGI-DH Medicare Benefits Schedule

 Items Number 45524, 45527,

 45528, 45542, 45552, 45554,

SP049 Gel Filled Mammary Prosthesis Models  CoGel High Cohesive 100 to 630gm $1,200.00 In strict accordance with

 CoGel-XR, CoGel- XM and CoGel XA Medicare Benefits Schedule

 Items Number 45524, 45527,

 45528, 45542, 45552, 45554,

 Technology For Life Pty Ltd

TE035 Eurosilicone Cristilline Paragel Mammary  Round high cohesive gel breast implants 60 - 500cc $610.00 $735.00 In strict accordance with the

 Implants requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only

Prostheses, Mammary, Internal, Inflatable

 Device Technologies Australia Pty Ltd

DE030 Style 468 Biodimensional Saline-filled  Silicone shell filled with saline 195 - 205 cm3 x 620 - 650 cm3 $1,040.00 In strict accordance with the

 Mammary Implant requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE031 Style 363 Biodimensional Low Anatomical Silicone shell filled with saline, for  230 - 240 cm3 x 650 - 685 cm3 $1,200.00 In strict accordance with the

  Saline-Filled Mammary Implant Reconstruction requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE032 Style 163 Biodimensional Full Anatomical  Silicone shell filled with saline, for  360 - 380 cm3 x 780 - 820 cm3 $1,200.00 In strict accordance with the

 Saline-Filled Mammary Implant Reconstruction requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 691 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

DE033 Style 168 Biocell Textured Mammary  Silicone shell filled with saline 120 - 150 cm3 x 510 - 540 cm3 $685.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE121 Mammary Prosthesis Smooth Surface - Saline 120 to 510cc $610.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

DE122 Mammary Prosthesis Textured Surface - Saline 90 to 510cc $610.00 In strict accordance with the

 requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

 Mentor Medical Systems

MN004 Mentor Siltex Spectrum Saline Tissue  Saline Mammary Prostheses Volume 275cc - 650cc $1,244.00 In strict accordance with the

 Expander requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN010 Mentor Saline-Filled Anterior Diaphragm  Mammary Prothesis - Smooth 125 to 700cc $610.00 In strict accordance with the

 Valve Mammary Prosthesis  requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

MN011 Mentor Saline Siltex Anterior Diaphragm  Mammary Prothesis - Textured 125 to 475cc $685.00 In strict accordance with the

 ValveMammary Prosthesis requirements of the Medicare

 Benefits Schedule Items Number

 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses List by Category, Groups and Sponsor Page 692 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MN023 Smooth Round High Profile Saline-Filled  Model 350-3170; Model 350-3190; Model 170cc, 190cc, 210cc, 230cc,  $610.00 Only to be funded where used in

 Mammary Prosthesis  350-3210; Model 350-3230; Model 350- 250cc, 270cc, 290cc, 310cc,  a service for which a Medicare

 3250; Model 350-3270; Model 350-3290;  330cc, 380cc, 420cc, 460cc,  Benefit is payable.

 Model 350-3310; Model 350-3330; Model

  350-3380; Model 350-3420; Model 350-

 3460; Model 350-3500; Model 350-3560;

 Model 350-3630

 Surgiplas Medical

SP011 Nagosil SFS-LP-Saline Filled Low Profile  Smooth surface 100 to 600cc $610.00 In strict accordance with the

 Smooth Surface Breast Prostheses,  requirements of the Medicare

 Nagosil SFS-HP-Saline Filled High Profile Benefits Schedule Items Number

  Smooth Surface Breast Prostheses 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

SP012 Nagotex SFX-LP-Saline Filled Low  Textured surface 100 to 600cc $715.00 In strict accordance with the

 Profile Textured Surface, Nagotex SFX- requirements of the Medicare

 HP-Saline Filled High Profile Textured  Benefits Schedule Items Number

 Surface Breast Prostheseses 45524, 45527, 45528, 45542,

 45552, 45554, 45555 only.

Prostheses, Maxillofacial

 Medical Device Alliance Pty Ltd

MP007 Facial Implant Malar Malar Small, medium, large/left or right $331.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP035 Facial Implant Malar Malar Anatomical Small, medium, large/left or right $330.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

 Mentor Medical Systems

MN003 Terino Malar Shell Implants Solid-silicone, Implantech Small, medium, large, xlarge $490.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 693 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Technology For Life Pty Ltd

TE015 Spectrum Designs Implantable Prosthesis Silicone implantable blocks Block I-IV, 12-17.5cm $2,500.00 $3,000.00 Only to be funded where used in

  Blocks a service for which a Medicare

 Benefit is payable.

Prostheses, Muscle

 Medical Device Alliance Pty Ltd

MP005 Calf Implants Asymmetrical shape, silicone gel smooth   85-180cc $517.00 Only to be funded where used in

 surface a service for which a Medicare

 Benefit is payable.

MP008 Calf Implant Silicone elastomer - smooth surface,  70-175cc $517.00 Only to be funded where used in

 asymmetrical shape, a service for which a Medicare

 Benefit is payable.

MP014 Calf Implant Silicone elastomer - smooth surface,  15-105cc $517.00 Only to be funded where used in

 symmetrical shape a service for which a Medicare

 Benefit is payable.

MP016 Calf Implants Symmetrical shape, silicone gel 12-140cc $455.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP017 Gluteal Implants filled with Gel Oval Shape, Silicone Gel, Smooth 100-300cc $620.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP018 Gluteal Implants filled with Gel Oval Shape, Silicone Gel, Textured  200-400cc $930.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP019 Gluteal Implants filled with Gel Round Shape, Silicone Gel, Smooth  200-300cc $579.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP020 Gluteal Implants filled with Elastomer Oval Shape, Silicone Elastomer, Smooth  95-260cc $620.00 Only to be funded where used in

 Surface a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 694 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MP021 Gluteal Implants filled with Elastomer Oval Shape, Silicone Elastomer, Textured 225-420cc $930.00 Only to be funded where used in

  Surface a service for which a Medicare

 Benefit is payable.

MP022 Gluteal Implants filled with Elastomer Round Shape, Silicone Elastomer,  250-340cc $641.00 Only to be funded where used in

 Smooth Surface a service for which a Medicare

 Benefit is payable.

MP032 Suspension Sheet for Mammoplasty Silicone sheet - textured 0.3mm, 29cm x 17cm; $250.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP033 Suspension Sheet for Mammoplasty Silicone sheet - polyurethane coated 3mm, 29cm x 17cm $250.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

Prostheses, Nasal, Dorsal

 Medical Device Alliance Pty Ltd

MP003 Facial Implant Nasal "L" Shaped White, pink 1.9 x 4.1 x 2.8cm, 1.8 x 4 x  $227.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP009 Facial Implant Nasal Nasal dorsum Small, large $279.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP013 Facial Implant Nasal Zygomatic Right, left $310.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

 Mentor Medical Systems

MN021 Implantech Facial Implants - Nasal  Implantech Shirakabe Nasal Implant;  Extra Small, Small, Medium,  $279.00 Only to be funded where used in

 Implantech Flowers Dorsal Nasal  Large, Extra Large a service for which a Medicare

 Implant; Implantech Dorsal Columella  Benefit is payable.

 Implant; Implantech Brink Peri-Pyriform

 Implant; Implantech Rizzo Dorsal Nasal

 Implant; Composition: Implant Grade

 Silicone Elastomer

Prostheses List by Category, Groups and Sponsor Page 695 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prostheses, Testicle

 Medical Device Alliance Pty Ltd

MP004 Testicular Implant Filled with Elastomer 5.3-45.8cc $480.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP006 Testicular Implant Silicone gel 3200 5-38cc $480.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP015 Testicular Implant Silicone with holes for fixation 3230 5-38cc $480.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

Reconstruction Sheeting, Plastic Surgery

 Austramedex (VIC) Pty Ltd

AR003 Enophthalmos Wedge Regular left and right. Large left and  Regular: 22 x 31 x 7mm. Large:  $460.00 Only to be funded where used in

 right. (Models 9541 - 9544) 28 x 40 x 7.5mm a service for which a Medicare

 Benefit is payable

AR004 Orbital rim Porus Polyethylene. Orbital rims, left and  47 x 40 mm $360.00 $450.00 Only to be funded where used in

 right extended. Models 9539, 9540 a service for which a Medicare

 Benefit is payable

AR005 Complete Orbital Shape Porus Polyethylene. Complete and 2 / 3  Inferior: 83 x 78mm $1,940.00 Only to be funded where used in

 orbit shapes. Inferior 2 / 3 left and right.  a service for which a Medicare

 Models 9567, 9568 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 696 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AR006 Chins Porus Polyethylene. Extended chin  Extended chin: small 45 x 47 x  $420.00 Only to be funded where used in

 implants: Round RZ (Models 8313 -  3mm, medium 45 x 47 x 5mm,  a service for which a Medicare

 8315) and extended square RZ (Models  large 45 x 47 x 7mm; Two  Benefit is payable

 8316, 8318). Two piece chin design  pidce chin: small 56 x 33 x

 (Models 8320 - 8322). Single piece chin  5mm, medium 56 x 33 x 7mm,

 design, contoured (Models 7520 - 7522).  large 56 x 33 x 9mm; Single

 Additional chin shapes (Models 6341 -  piece chin: small 65 x 37 x

 5mm, medium 65 x 37 x 7mm,

 large 65 x 37 x 10mm.

 Additional chins: 53 x 22 x

 13mm, 74 x 35 x 10 mm, 50 x

 28 x 7 mm, 40 x 23 x 4mm

AR007 Genioplasty Wedge Porus Polyethylene. Genioplasty wedges,  Small 60 x 25 x 5mm, medium  $420.00 Only to be funded where used in

 models 8340 - 8343 60 x 25 x 7.5mm, large 60 x 25  a service for which a Medicare

 x 10mm Benefit is payable

AR008 Prejowl Shape Porus Polyethylene. Model 8319 45 x 41 x 4mm $420.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR010 Malar Shape Porus Polyethylene. Design RZ malar  Design RZ malar shapes: super  $420.00 Only to be funded where used in

 shapes, super petite and petite, left and  petite 50 x 19 x 3mm, petite 50  a service for which a Medicare

 right (Models 9501 - 9504). Design M  x 19 x 5mm. Design malar  Benefit is payable

 malar shapes, left and right (Models 9507 shapes: small 64 x 19 x 3mm,

  - 9512). Additional malar shapes,  medium 64 x 19 x 4.5mm, large

 extended contoured left and right (Models  64 x 19 x 7mm.  Additional

 malar shapes: small 45 x 24 x

 3mm, medium 50 x 26 x 4mm,

AR011 Nasal Shape or Rhinoplasty Shape Porus Polyethylene. Nasal Arch shapes,  Nasal arch shapes: small 70 x 13 $350.00 Only to be funded where used in

 nasal arch and nasal sheet (Models 9533 -  x 2mm, medium 70 x 15 x  a service for which a Medicare

  9536). Nasal dorsum shapes, design A  2mm, large 70 x 15 x 2mm,  Benefit is payable

 and design B (Models 7516 - 7518).  sheet 40 x 9 x 1.1mm. Nasal

 Nasal valve support, lateral nasal valve  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

AR012 Micro Thin Sheet Porus Polyethylene. Model 8438 30 x 50 x 0.4mm $377.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 697 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AR013 Ultra Thin Sheet Porus Polyethylene. Models 7210 38 x 50 x 0.85mm $355.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR014 Sheet Porus Polyethylene. Models 6330, 6331,  Sheets: 38 x 50 x 1.5mm, 50 x  $800.00 Only to be funded where used in

 8662, 9562. Micro single channel sheet,  76 x 1.5mm, 76 x 127 x  a service for which a Medicare

 model 9528. Barrier microplate single  1.5mm, 38 x 50 x 3mm.  Benefit is payable

 channel sheet, model 9527 Microplate single channel: 38 x

 50 x 0.85mm. Barrier microplate

  single channel: 38 x 50 x 0.85mm

AR015 Barrier Sheet: Barrier Sheet - Orbital Floor Porus Polyethylene. Barrier  sheet -   Barrier  sheet - Rectangle: 50 x  $410.00 Only to be funded where used in

 Rectangle, models 8312 and 9312. Orbital 76  x 1mm, 50 x 76 x 1.6mm:  a service for which a Medicare

  floor implants, models 8305 and 9305 50 x 76 x 1mm, 50 x 76 x  Benefit is payable

 1.6mm.  Orbital Floor: 38 x 50 x

  1mm, 38 x 50 x 1.6mm

AR016 Block Porus Polyethylene. Models 6332 - 6340 13 x 38 x 3 - 9.5mm, 25 x 50 x  $878.00 Only to be funded where used in

 3 9.5mm, 38 x 63 x 3 - 9.5mm a service for which a Medicare

 Benefit is payable

AR017 Burr Hole Cover Porus Polyethylene. Burr hole cover,  Cover: 15 x 3 x 5mm, 29 x 7 x  $250.00 Only to be funded where used in

 models 7511 and 7512. Burr hole disk,  14mm. Disk 14 x 15mm a service for which a Medicare

 Benefit is payable

AR018 Flexblock TF2 Porus Polyethylene. Flexblock TF2  Flexblock TF2: small 61 x 78 x  $950.00 Only to be funded where used in

 implant, left and right, models 9857 - 9860 18mm, medium 74 x 93 x  a service for which a Medicare

 20mm, large 82 x 105 x 20mm Benefit is payable

AR019 Sphere Porus Polyethylene. Sphere, models  Sphere: 14 - 22mm. COI  $713.00 Only to be funded where used in

 6316, 6326, 6327, 6317 and 6322. COI  implant: 4 and 5mL. MCOI: 3,  a service for which a Medicare

 implant, models 7222 and 7223. MCOI  4.2 and 5.6mL, 16, 18 and  Benefit is payable

 implant, models 7207 - 7209

AR020 Ear Reconstruction Porus Polyethylene. Helical rim, models  Helical rim: 37 x 62mm $400.00 Only to be funded where used in

 8328 and 8329 a service for which a Medicare

 Benefit is payable

AR023 Complete Orbital Shape Complete left and right.  Models 9569,  Complete 61 x 76mm $2,315.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 698 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AR024 Mandibular angle Porus Polyethylene. RZ mandibular angles RZ mandibular angles: 65 x 35 x $1,485.00 Only to be funded where used in

  left and right (Models 9955 - 9960);   3 x 6.5 x 3 x 3mm, 65 x 35 x 7 a service for which a Medicare

 Porus Polyethylene. Contoured   x 6.5 x 3 x 3mm, 65 x 35 x 11  Benefit is payable

 mandibular angles left and right (Models  x 6.5 x 3 x 3mm. Contoured

 mandibular angles left and

 right:59 x 29 x 7 x 11mm.

AR025 Nasal Shape. Petite Nasal Dorsum. Porus Polyethylene. Petite Nasal Dorsum  Petite Nasal Dorsum: 4 x 4 x  $220.00 Only to be funded where used in

 ( Models 84000 - 84004). 45mm, 4 x 4 x 55mm, 5 x 5 x  a service for which a Medicare

 45mm, 5 x 5 x 55mm, 6 x 9 x  Benefit is payable

 55mm.

AR026 Nasal Valve Support. Lateral Nasal Valve, Model 7545. External Lateral Nasal Valve:13 x 3.5 x  $445.00 Only to be funded where used in

  Nasal Valve Batten, Model 7546. External 0.85mm, External Nasal Valve  a service for which a Medicare

  Nasal Valve Batten - Thin, Model 7167 Batten: 25 x 11 x 0.85mm,  Benefit is payable

 External Nasal Valve Batten -

 Thin: 24 x 11.5 x 0.6mm.

AR027 Nasal Sheet (Strut). Nasal Sheet (Strut). Model 9536 Nasal Sheet (Strut): 40 x 9 x  $135.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR028 Nasal Shell Shapes. Nasal Shell Shapes, Regular and Large  Regular: 38 x 21 x 17mm, Insert $490.00 Only to be funded where used in

 with Inserts Small and Large (included).   Small 30 x 4 x 9mm, Insert  a service for which a Medicare

 Models 9553 - 9554. Large 38 x 2.5 x 9mm. Large:  Benefit is payable

 40 x 20 x 18mm, Insert Small

 32 x 4 x 9mm, Insert Large 41

AR029 Ultra Thin Sheet Porus Polyethylene. Model 7212 50 x 76 x 0.85mm $450.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR030 Ultra Thin Sheet Porus Polyethylene. Model 7214 76 x 127 x 0.85mm $765.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR031 Ultra Thin Sheet Porus Polyethylene. Model 7216 127 x 178 x 0.85mm $820.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 699 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AR032 Sheet - Multi Channel, Barrier Channel. Porus Polyethylene. Miniplate channel  Miniplate channel: 40 x 52 x  $510.00 Only to be funded where used in

 sheet, model 9529. Microplate channel  2.3mm. Mircoplate channel: 40  a service for which a Medicare

 sheet, model 9530. Barrier Miniplate and  x 52 x 2.3mm. Barier Miniplate  Benefit is payable

 Microplate Channel Sheets, Models 9531  and Microplate Channel Sheets:

 40 x 52 x 2.3mm, 40 x 52 x

AR033 Sheet - Barrier Single Channel Sheet. Porus Polyethylene. Barrier Single  Barrier Single Channel: 38 x 50  $540.00 Only to be funded where used in

 Channel Sheet, Model 9527. x 0.85mm a service for which a Medicare

 Benefit is payable

AR034 Flexblock TF2 Porus Polyethylene. Flexblock TF2  Flexblock TF2: large 82 x 105 x $825.00 Only to be funded where used in

 implant, left and right, models 9861 - 9862  20mm. a service for which a Medicare

 Benefit is payable

AR035 Flexblock TF Porus Polyethylene. Flexblock TF  Flexblock TF: small 70 x 70 x  $825.00 Only to be funded where used in

 implant, models 9521 - 9522. 10mm, medium 88 x 86 x  a service for which a Medicare

 Benefit is payable

AR036 Flexblock TF Porus Polyethylene. Flexblock TF  Flexblock TF: large 98 x 95 x  $990.00 Only to be funded where used in

 implant, model 9523.  18mm. a service for which a Medicare

 Benefit is payable

AR037 Flexblock, Cranial Grid Porus Polyethylene.Flexblock cranial grid  Flexblock cranial grid: 97 x 107  $1,590.00 Only to be funded where used in

 implant, model 9524. x 6mm. a service for which a Medicare

 Benefit is payable

AR038 Flexblock Porus Polyethylene. Flexblock, model  Flexblock: 56 x 91 x 4mm. $825.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AR039 Ear Reconstruction Porus Polyethylene. Ear base left and  Ear base: 29 x 55 x 13mm, 32 x $777.00 Only to be funded where used in

 right, models 7542 and 7525  - 7527. Ear   65 x 16mm. Ear base extended: a service for which a Medicare

 base extended left and right, models 8330  30 x 60mm. Benefit is payable

  and 8331.

 Medical Device Alliance Pty Ltd

MP023 Silicone Sheets Sheet standard-small with reinforcement 100mm $80.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP024 Silicone Sheets Sheet standard - large with reinforcement 200mm $250.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 700 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MP025 Silicone Sheets Sheet standard - small without  100mm $80.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP026 Silicone Sheets Sheet standard - large without  200mm $250.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP027 Silicone Sheets Sheet extra strength small 100mm $100.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP028 Silicone Sheets Sheet extra strength large 200mm $500.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP029 Silicone Sheets Block standard super soft Soft, Medium, Hard $400.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP030 Silicone Sheets Block coloured, single consistency,  One size only $400.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable.

MP031 Silicone Sheets Block coloured, double consistency,  One size only $500.00 Only to be funded where used in

 white/pink a service for which a Medicare

 Benefit is payable.

Screws

 Biomet Australia Pty Ltd

BI397 Lactosorb Resorbable Craniomaxillofacial  Bone Screw, Lactosorb 1.5mm, 2mm  (1.5, 2.0, 2.5, 2.8) x (3 - 17mm) $360.00 Only to be funded where used in

 Fixation System system; pkt 2, PGA/PLA a service for which a Medicare

 Benefit is payable

BI399 Lactosorb Resorbable Craniomaxillofacial  Cover, solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $120.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 701 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI400 Lactosorb Resorbable Craniomaxillofacial  Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $680.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI401 Lactosorb Resorbable Craniomaxillofacial  Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $1,300.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI412 Lactosorb Resorbable Craniomaxillofacial  Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $1,750.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI413 Lactosorb Resorbable Craniomaxillofacial  Cover, Solid or Holed, PGA/PLA (0.25, 0.5, 0.75mm) x  $2,150.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI414 Lactosorb Resorbable Craniomaxillofacial  Lactosorb Plates, 2mm System, All sizes, 4 - 16 hole $304.00 Only to be funded where used in

 Fixation System  shapes PGA/PLA a service for which a Medicare

 Benefit is payable

BI415 Lactosorb Resorbable Craniomaxillofacial  Bone Screw,  2 Pack, Endobrow,  2 x 5mm $160.00 Only to be funded where used in

 Fixation System Lactosorb. PGA/PLA a service for which a Medicare

 Benefit is payable

BI416 Lactosorb Resorbable Craniomaxillofacial  Panel, Lactosorb. 2mm System.  42 x 42mm  (10x10 hole) $1,400.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI417 Lactosorb Resorbable Craniomaxillofacial  Panel, Lactosorb. 1.5mm System.  25 x 25mm (5 x 5 hole) $470.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI418 Lactosorb Resorbable Craniomaxillofacial  Panel, Lactosorb. 1.5mm System.  25 x 50mm (5 x 10hole) $875.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI419 Lactosorb Resorbable Craniomaxillofacial  Panel, Lactosorb. 1.5mm System.  50 x 50mm (10 x 10 hole) $1,400.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI424 Lactosorb Resorbable Craniomaxillofacial  Mesh, Mandibular Lactosorb 2.5mm  12x30mm, 12x35mm $345.00 Only to be funded where used in

 Fixation System System PGA/PLA a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 702 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BI426 Lactosorb Resorbable Craniomaxillofacial  Mesh, Mandibular Lactosorb 2.5mm  16 x 40mm $435.00 Only to be funded where used in

 Fixation System System. PGA/PLA a service for which a Medicare

 Benefit is payable

BI427 Lactosorb Resorbable Craniomaxillofacial  Mesh, Mandibular Lactosorb 2.5mm  42 x 42mm $1,367.00 Only to be funded where used in

 Fixation System System. PGA/PLA a service for which a Medicare

 Benefit is payable

BI598 Lactosorb Resorbable Craniomaxillofacial  Panel, Lactosorb, with strut, 2mm  (2-3) hole x (5-6) hole $455.00 Only to be funded where used in

 Fixation System System, 2.5mm System. PGA/PLA a service for which a Medicare

 Benefit is payable

BI602 Lactosorb Resorbable Craniomaxillofacial  Bone Screw, Lactosorb, 4 pack. PGA/PLA (1.5, 2.0mm) x (3, 4, 5 ,7mm) $444.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable

BI791 Lactosorb Resorbable Craniomaxillofacial  Screw, 1.5mm System, PLLA/PGA Length 3-5mm (pack 10) $910.00 Only to be funded where used in

 Fixation System a service for which a Medicare

 Benefit is payable.

 Medical & Optical  Instruments Australia Pty Ltd

MO189 Resorb-X Bone Screw Resorb-X Osteosynthesis System,  1.6, 2.1, 2.4mm Dia, 4 - 9mm  $161.00 Only to be funded where used in

 Resorbable bone screw lengths a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd

ST527 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 1.7x4-5mm Pack of 10 $95.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST528 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 1.7x3-6mm Pack of 2 $121.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST529 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 1.7x3-6mm Pack of 4 $111.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST530 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 2.2mm x 4mm - 6mm (pack of  $141.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 703 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST531 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 2.2mm x 4mm - 6mm (pack of  $121.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST532 Stryker Leibinger Resorbable Fixation  Resorbable Screws Trypolymer 2.2mm x 4mm - 6mm (pack of  $111.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST822 Delta Resorbable Plating System Resorbable plates and screw fixation  Mesh 55 x 55 (1mm thickness) $416.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST823 Delta Resorbable Plating System Resorbable plates and screw fixation  Ladder plate 2 x 5 holes $208.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST824 Delta Resorbable Plating System Resorbable plates and screw fixation  L plate 110 degree 9 hole right;  $177.00 Only to be funded where used in

 system for the fixation of facial fractures L plate 110 degree 9 hole left a service for which a Medicare

 Benefit is payable

ST825 Delta Resorbable Plating System Resorbable plates and screw fixation  Y plate 9 holes $250.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST826 Delta Resorbable Plating System Resorbable plates and screw fixation  Double Y plate 12 holes $218.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST827 Delta Resorbable Plating System Resorbable plates and screw fixation  Curved plate 8 holes $208.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST828 Delta Resorbable Plating System Resorbable plates and screw fixation  Straight plate 4 - 21 hole $208.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST829 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 4mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST836 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 6mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 704 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST837 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 8mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST838 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 10mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST839 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 8mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST840 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 10mm bone screw - 2 per  $121.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST841 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 6mm bone screw - 4 per  $111.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST842 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 8mm bone screw - 4 per  $111.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST843 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 4mm bone screw - 10 per  $95.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST844 Delta Resorbable Plating System Resorbable plates and screw fixation  2.2 x 6mm bone screw - 10 per  $95.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST845 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 4mm bone screw - 1 per  $141.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST846 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 6mm bone screw - 1 per  $141.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST847 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 8mm bone screw - 1 per  $141.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 705 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST848 Delta Resorbable Plating System Resorbable plates and screw fixation  2.6 x 10mm bone screw - 1 per  $141.00 Only to be funded where used in

 system for the fixation of facial fractures a service for which a Medicare

 Benefit is payable

ST849 Delta Resorbable Plating System Resorbable plates and screw fixation  Mesh and Panel 55 x 55 (1.4mm $177.00 Only to be funded where used in

 system for the fixation of facial fractures  thickness) a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd (2)

SK078 Stryker Leibinger Resorbable Fixation  Delta resorbable mesh for fixation of  122mm  x 122mm $1,456.00 Only to be funded where used in

 facial fractures and congenital deformity a service for which a Medicare

 Benefit is payable.

Screws, Bone

 Aus Systems Pty Ltd

AU035 Aus Systems Titanium Bone Screws  Screws 2mm & 2.3mm diameter 4mm - 15mm length $19.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

AU043 Aus Systems Titanium Bone Screws  Screws 1.5mm & 1.8mm diameter 3mm - 11mm length $20.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Johnson & Johnson Medical Pty Ltd

JJ201 Bioplate Bone Screw  Titanium cranial fixation system 1.5mm diam, 3-6mm length;  $34.50 Only to be funded where used in

 pack of 5 a service for which a Medicare

 Benefit is payable

JJ202 Bioplate Bone Screw  Titanium cranial fixation system 1.5mm diam; 10mm length;  $55.00 Only to be funded where used in

 pack of 5 a service for which a Medicare

 Benefit is payable

JJ203 Bioplate Bone Screw  Titanium cranial fixation system 1.5mm diam; 8mm length; pack  $26.77 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

JJ215 Bioplate Bio-100 Screw Titanium cranial fixation system 2.4mm diam; pack of 5 $25.65 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 706 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC390 TiMesh Rigid Fixation Bone Grafting and  Titanium, Screw - Cruciate Head, 12  Diameter 1.0mm - 2.4mm,  $66.00 Only to be funded where used in

 Plating System point Flat Head length 2 - 19mm a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd

ST082 Leibinger Screws  Leibinger IMF: cross-slot screws  2.0x8mm, 2.0x14mm, 2.0x20mm $57.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST083 Leibinger Screws  Leibinger Steinhauser Screw System:  2.0x4-12mm $35.00 $52.00 Only to be funded where used in

 cross-slot screws Titanium a service for which a Medicare

 Benefit is payable

ST084 Leibinger Screws  Leibinger Steinhauser Screw System:  2.0x13-22mm $40.00 $52.00 Only to be funded where used in

 cross-slot screws Titanium a service for which a Medicare

 Benefit is payable

ST085 Leibinger Screws  Leibinger COM/MAND Fixation System:  2.3x6-9mm $37.00 Only to be funded where used in

 emergency screws Titanium a service for which a Medicare

 Benefit is payable

ST107 Leibinger Screws  Micro Bone Screws: square fit, self- 1.0 x 2-9mm $68.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST108 Leibinger Screws  Micro Plus Bone Screws: square fit, self- 1.2 x 2-12mm $68.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST110 Leibinger Screws  Micro Plus Bone Emergency Screws:  1.4x3-11mm $70.00 Only to be funded where used in

 square fit, self-tapping Titanium a service for which a Medicare

 Benefit is payable

ST111 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  1.7x3-12mm $40.00 Only to be funded where used in

 square fit, self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST113 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  1.9x5mm, 1.9x7mm $40.00 Only to be funded where used in

 square fit, self-tapping Titanium  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 707 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST114 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  2.0x4-19mm $35.00 Only to be funded where used in

 square fit, self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST115 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  2.3x6-9mm $40.00 Only to be funded where used in

 square fit, self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST116 Leibinger Screws  Leibinger Wurzburg COM/MAND  2.7x6-16mm $106.00 Only to be funded where used in

 Fixation System: emergency screws  a service for which a Medicare

 Benefit is payable

ST117 Leibinger Screws  Leibinger Wurzburg COM/MAND  2.7x18-22mm $115.00 Only to be funded where used in

 Fixation System: emergency screws  a service for which a Medicare

 Benefit is payable

ST118 Leibinger Screws  Leibinger Wurzburg COM/MAND  3.0x8-22mm $117.00 Only to be funded where used in

 Fixation System: emergency screws  a service for which a Medicare

 Benefit is payable

ST145 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.2x2-6mm $60.00 Only to be funded where used in

 self tapping Titanium a service for which a Medicare

 Benefit is payable

ST146 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.2x7-10mm $65.00 Only to be funded where used in

 self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST147 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.2x11-12mm $65.00 Only to be funded where used in

 self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST148 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.4x3mm, 1.4x5mm $65.00 Only to be funded where used in

 self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST149 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.4x7mm, 1.4x9mm $65.00 Only to be funded where used in

 self-tapping Titanium  a service for which a Medicare

 Benefit is payable

ST150 Leibinger Screws  Leibinger Micro Plus Screws: cross-slot,  1.4x11mm $65.00 Only to be funded where used in

 self-tapping Titanium  a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 708 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST236 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  1.7 diameter X 3-4mm $43.00 Only to be funded where used in

 cross-fit, self-tapping Titanium a service for which a Medicare

 Benefit is payable

ST237 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws:  1.7 diameter X 5-6mm $43.00 Only to be funded where used in

 cross-fit, self-tapping Titanium a service for which a Medicare

 Benefit is payable

ST238 Leibinger Screws  Leibinger Autopilot Bone Screws  1.7x7-8mm $46.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST239 Leibinger Screws  Leibinger Mini Wurzburg Bone Screws  1.7x7-8mm $43.00 Only to be funded where used in

 Titanium a service for which a Medicare

 Benefit is payable

ST240 Leibinger Screws  Leibinger Mini Wurzburg Emergency  1.9 x 5mm $57.00 Only to be funded where used in

 Screws Titanium a service for which a Medicare

 Benefit is payable

ST241 Leibinger Screws  Leibinger Bone Screws: hex fit, self- 2.0 x 4-5mm $31.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST242 Leibinger Screws  Leibinger Bone Screws: hex fit, self- 2.0x 6-7mm $31.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST243 Leibinger Screws  Leibinger Bone Screws: hex fit, self- 2.0 x 9-10mm $31.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST244 Leibinger Screws  Leibinger Bone Screws: hex fit, self- 2.0 x 11mm $31.50 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST258 Leibinger Screws  Leibinger Dynamic bone Screws: self- 2.7 x 8mm, 12mm, 14mm $92.00 Only to be funded where used in

 tapping Titanium a service for which a Medicare

 Benefit is payable

ST325 Leibinger Screws  Leibinger Low Profile Screws: low profile 1.5x4-13mm, 2.0x4-20mm,  $43.20 Only to be funded where used in

  head, self-tapping screws Titanium.  2x21mm, 2x24mm.  Pack of 5 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 709 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST345 Leibinger Screws  Leibinger Micro Screws: cross-slot, self- 1.0x2-6mm $68.50 Only to be funded where used in

 tapping  Titanium a service for which a Medicare

 Benefit is payable

ST346 Leibinger Screws  Leibinger Micro Screws: cross-slot, self- 1.2x2mm, 1.2x5mm $65.00 Only to be funded where used in

 tapping  Titanium a service for which a Medicare

 Benefit is payable

ST358 Leibinger Screws  Leibinger - Salzburg Lag Screw System:  2 holes $86.00 Only to be funded where used in

 locking plate, Titanium, with biconcave  a service for which a Medicare

 washers Benefit is payable

ST359 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x7mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST360 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x9mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST361 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x11mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST362 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x13mm, 2x15mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST363 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x17mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST364 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x19mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST365 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x21mm.  Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST366 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x24mm. Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 710 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

ST367 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x30mm. Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST368 Leibinger Screws  Leibinger - Salzburg Lag Screws  2x33mm. Pack of 10 $50.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST377 Leibinger Screws  Leibinger Forefoot Screws: hexagonal fit, 2.3x16mm, 2.3x18mm,  $67.00 Only to be funded where used in

  self-tapping Titanium 2.3x20mm, 2.3x22mm a service for which a Medicare

 Benefit is payable

ST446 Wurzburg Bone Plates Wurzburg Mandibular Fracture plate:  4 hole x 35mm $295.00 Only to be funded where used in

 straight Titanium a service for which a Medicare

 Benefit is payable

ST510 Wurzburg Titanium Bone Screws Wurzburg Bone Screws Titanium 3.5x10mm Pack of 10 $51.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST511 Wurzburg Titanium Bone Screws Wurzburg Bone Screws Titanium 3.5x12mm Pack of 10 $53.00 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST512 Wurzburg Titanium Bone Screws Wurzburg Bone Screws Titanium 3.5x14mm Pack of 10 $56.16 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

ST513 Wurzburg Titanium Bone Screws Wurzburg Bone Screws Titanium 3.5x16mm Pack of 10 $59.40 Only to be funded where used in

 a service for which a Medicare

 Benefit is payable

 Stryker Australia Pty Ltd (2)

SK147 Leibinger Screw  - Universal Mandibular  Items used for reconstruction and  Universal Mandible Smartlock  $120.00 Only to be funded where used in

 Screws fixation of mandibular fractures and  Emergency Screws, 2.7mm  a service for which a Medicare

 Diameter, 8mm - 20mm length Benefit is payable.

SK148 Leibinger Screw - Universal Mandibular  Items used for reconstruction and  Universal Mandible Screws,  $95.00 Only to be funded where used in

 Screws fixation of mandibular fractures and  Emergency, 2.7mm Diameter,  a service for which a Medicare

 8-20mm Length Benefit is payable.

Prostheses List by Category, Groups and Sponsor Page 711 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK149 Leibinger Screw  - Universal Mandibular  Items used for reconstruction and  Universal Mandible Screws,  $74.00 Only to be funded where used in

 Screws fixation of mandibular fractures and  2.0mm Dia, 4-14mm Length;  a service for which a Medicare

 Universal Mandible Screws,  Benefit is payable.

 2.3mm Dia, 4-14mm Length

SK150 Leibinger Screw - Universal Mandibular  Items used for reconstruction and  Universal Mandible Smartlock  $110.00 Only to be funded where used in

 Screws fixation of mandibular fractures and  Screws, 2.0mm Diameter,  a service for which a Medicare

 16mm-20mm Length; Universal  Benefit is payable.

 Mandible Smartlock Screws,

 2.3mm Diameter, 18mm-20mm

SK151 Leibinger Screw - Universal Mandibular  Items used for reconstruction and  Universal Mandible Screws,  $105.00 Only to be funded where used in

 Screws fixation of mandibular fractures and  2.0mm Diameter, 16mm-20mm  a service for which a Medicare

 Length; Universal Mandible  Benefit is payable.

 Screws, 2.3mm Diameter,

 16mm-20mm Length

SK152 Leibinger Screw - Universal Mandibular  Items used for reconstruction and  Universal Mandible Lag Screws, $155.00 Only to be funded where used in

 Screws fixation of mandibular fractures and   2.0mm Diameter, 24mm-42mm a service for which a Medicare

  Length Benefit is payable.

SK153 Leibinger Screw - Universal Mandibular  Items used for reconstruction and  Universal Mandible Smartlock  $88.50 Only to be funded where used in

 Screws fixation of mandibular fractures and  Screws, 2.0mm Diameter,  a service for which a Medicare

 4mm-14mm Length; Universal  Benefit is payable.

 Mandible Smartlock Screws,

 2.3mm Diameter, 4mm-16mm

SK299 Leibinger Screw (Various) - Universal  1.2mm Diameter, 3-12mm  $68.50 Only to be funded where used in

 CMF Screws Length; 1.4mm Diameter 3- a service for which a Medicare

 Benefit is payable

SK300 Leibinger Screw (Various) - Universal  Self Drilling, 1.2mm Diameter,  $68.50 Only to be funded where used in

 CMF Screws 3-4mm Length a service for which a Medicare

 Benefit is payable

SK301 Leibinger Screw (Various) - Universal  1.7mm Diameter, 3-12mm  $46.00 Only to be funded where used in

 CMF Screws Length; 1.9mm Diameter, 3- a service for which a Medicare

 Benefit is payable

SK302 Leibinger Screw (Various) - Universal  Self Drilling, 1.7mm Diam; 3- $46.00 Only to be funded where used in

 CMF Screws 6mm Length a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 712 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SK303 Leibinger Screw (Various) - Universal  Locking, 1.7mm Diameter, 4- $46.00 Only to be funded where used in

 CMF Screws 6mm Length; Locking 1.9mm  a service for which a Medicare

 Diameter, 5mm Length Benefit is payable

SK385 Universal System Condyle Fastening Screws One size only $88.00

 Surgiplas Medical

SP021 Screws Micro, Maxi & Self Drilling Size $42.00 Only to be funded where used in

 1.2mm x (2 - 14)mm,  a service for which a Medicare

 1.5mm/1.9mm/2.7mm safety,  Benefit is payable

 2.4mm x (4 - 22)mm, 2.7mm x

 (8 - 20)mm safety, 1.6mm x (4

 - 8)mm self drilling, 2.0mm x (4

  - 8)mm self drilling;1.2mm

 self-drilling screws;

SP022 Screws Mini 2.0mm x (4-22)mm; Guidewire  $34.00 Only to be funded where used in

 (0.8 - 3.0)mm x (100 - 300)mm a service for which a Medicare

 Benefit is payable

 TiMax Surgical Pty Ltd

TI002 TiMax Titanium Bone Screws Self-tapping 1 - 2.7mm Diameter, 2 - 22mm  $25.00 Only to be funded where used in

 Length a service for which a Medicare

 Benefit is payable

Screws, Cranioplasty Plate

 Medical & Optical  Instruments Australia Pty Ltd

MO258 Resorb x SonicWeld Rx Osteosynthesis  SonicWeld Rx Bone Pin Screw 1.6 - 2.1mm diameter, 4 - 9mm $180.00

 System Bone Screw/Pin

 Mondeal Medical Systems Pty Ltd

MD029 Mondeal Medical Systems Implant &  Screw 2000 Standard 4mm - 19mm $16.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

MD035 Mondeal Medical Systems Implant &  Screw 2000 Cross Fit, Lock Drive 4mm -  $20.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

Prostheses List by Category, Groups and Sponsor Page 713 of 784


PLASTIC AND RECONSTRUCTIVE

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MD051 Mondeal Medical Systems Implant &  Screw 1700 Cross Fit, Lock Drive 3mm -  $28.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

MD066 Mondeal Medical Systems Implant &  Screw 1000/1200 Cross Fit, Lock Drive 3mm -  $46.00 Only to be funded where used in

 Prostheses a service for which a Medicare

 Benefit is payable

Tissue Reconstructive Materials

 Global Scientific Pty Ltd

GS204 Integra Artificial Skin - Medium - 10 x 25cm $2,900.00

GS205 Integra Artificial Skin - Small - 10 x 12.5cm $1,900.00

GS206 Integra Artificial Skin - Large - 20 x 25cm $5,634.00

Prostheses List by Category, Groups and Sponsor Page 714 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheterization Kits

 Applied Medical Australia Pty Ltd

MH003 Acucise RP35 Procedural Pack Composition: Polypropylene & Titanium One size only $2,860.00 Temporary approval

MH007 Acucise RP35 Procedural Starter Pack Polypropylene and Titanium One Size Only $3,328.00 Temporary approval

Group 1- Urogenital - Incontinence Products

 Group 1a - Incontinence: inflatable

 American Medical Systems

AM001 AMS 800 Artificial Urinary Sphincter  Occlusive Cuff Size: 4, 4.5, 5, 5.5, 6, 6.5, 7,  $2,560.00

 7.5, 8, 9, 10, 11cm

AM002 Acticon Artificial Bowel Sphincter Cuff Occlusive Cuff 9, 10, 11, 12, 13, 14cm  $3,500.00

 (available in both 2.0cm &

AM021 AMS 800 Artificial Urinary Sphincter  Silicone cuff for artificial urinary  4.0cm - 11.0cm (increases in  $2,560.00

 sphincter. For the implantation of the  0.5cm sizes)

 second cuff for the AMS 800.

AM028 AMS 800 Artificial urninary sphincter  Pressure Regulating Balloon 51 - 60cm, 61 -70cm, 71 -  $2,015.00

 Pressure Regulating Balloon

AM029 AMS 800 Artificial Urinary Sphincter  Control Pump One size $4,845.00

AM030 AMS 800 Artificial Urinary Sphincter  Accessory Kit One Size $675.00

 Accessory Kit

AM031 AMS 800 Artificial Urinary Sphincter  Implantable plugs x 3 & straight connector One Size $132.00

 Deactivation Package

AM032 Acticon Artificial Bowel Sphincter Pump Control Pump One Size $6,300.00

AM033 Acticon Artificial Bowel Sphincter  Pressure Regulating Balloon 81-90cm, 91-100cm, 101- $3,500.00

 Pressure Regulating Balloon 110cm, 111-120cm

AM034 Acticon Artificial Bowel Sphincter  Accessory Kit One Size $675.00

 Accessory Kit

Prostheses List by Category, Groups and Sponsor Page 715 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AM035 Acticon Artificial Bowel Sphincter  Implantable plugs x 3 & straight connector One Size $132.00

 Deactivation Package

 Medical Device Alliance Pty Ltd

MP001 Inflatable Periurethral Constrictor Consists of a membrane, filler product  One size only $1,200.00

 and silicone tube

 Group 1b - Incontinence: adjustable balloon

 Medtronic Australasia Pty Ltd

MC323 Adjustable Continence Therapy for Women ACT Device: Prosthesis designed for the  6,7,8 & 9cm $4,060.00

 treatment of female SUI comprising of a

 single silicone balloon attached via a

 conduit to titanium and rubber ports

 allowing for post operative adjustment.

MC327 Adjustable Continence Therapy device for ACT Device: prosthesis designed for the  6, 7, 8 & 9cm $8,000.00

  women treatment of female SUI comprising of

 silicone balloons x 2 attached via a

 conduit to titanium and rubber ports

 allowing for post operative adjustment.

MC342 Adjustable Continence Therapy for Men ProACT Device: prosthesis designed for  12 & 14cm $8,000.00

 the treatment of male SUI comprising of

 silicone balloons x2 attached via a conduit

  to titanium and rubber ports allowing for

 post operative adjustment.

MC368 Adjustable Continence Therapy for Men ProACT Device: Prosthesis designed for  12 & 14cm $4,060.00

 the treatment of male SUI comprising of

 a single silicone balloon attached via a

 conduit to titanium and rubber ports

 allowing for post operative adjustment.

 Group 1c - Incontinence: sling, male, synthetic

 American Medical Systems

AM017 InVance Male Sling System Kit includes inserter with shaft, 6 bone  One Size $5,600.00

 screws with suture and silicone-coated

 sling surgical mesh

Prostheses List by Category, Groups and Sponsor Page 716 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Endotherapeutics Pty Ltd

ET050 ARGUS Adjustable Male Sling made of silicone  One size only $5,500.00

 adjustable self fixating columns and

 urethral cushion

 Group 1e - Incontinence: sling, female, synthetic

 American Medical Systems

AM014 Sparc Sling System Polypropylene mesh sling, two needles  One size only $850.00 $920.95

 with rotating handles, two cystoscopy aids

AM016 In-Fast Kit and InteMesh Sling System Items included in kit - inserter, 2 screws  One size only $850.00 $3,284.80

 with sutures, silicone coated sling mesh

AM019 MONARC Sling System Product includes - mesh and two needles  One Size Only $850.00 $990.00

 with handles attached

AM024 BioArc TO Subfascial Hammock sterile, single use procedure kit with two  One size $850.00 $990.00

 stainless steel curved needle passers and

 two y-mesh assemblies.  Polypropylene.

AM025 BioArc SP Sling Kit sterile, single use procedure kit with two  One size $750.00

 stainless steel curved needle passers and

 two y-mesh assemblies.  Polypropylene.

 Auto Suture Company, Australia T/A Tyco Healthcare Pty Ltd

AS093 IVS Tunneller Stainless steel tunneller and woven  One size only $540.00

 synthetic tape

AS111 IVS Tunneller System Consists of a tunneller, 2 stylets and one  One size $636.00

 50cm length of polypropylene mesh in a

 sterile blister pack

AS112 IVS Tunneller System Consists of a tunneller, 2 stylets and two  One size $789.00

 50cm lengths of polypropylene mesh in a

 sterile blister pack.

AS120 IVS Tunneller-Intravaginal Tunneller  IVS Tunneller System Trans Obuturator  50 cm (mesh) $850.00 $950.00

 with two stylets and polypropylene mesh

Prostheses List by Category, Groups and Sponsor Page 717 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Boston Scientific Pty Ltd

BS078 Advantage Transvaginal Mid-Urethral  Polypropylene smooth mesh material One size only $800.00

 Sling System, Lynx Suprapubic Mid-

 Urethral Sling System, Obtryx

 Transoburator Mid-Urethral Sling System

BS096 Lynx Suprapubic Mid-Urethral Sling  Polypropylene smooth mesh material One size only $800.00

BS097 Obtryx Transoburator Mid-Urethral Sling  Polypropylene smooth mesh material One size only $800.00

 System

 Endotherapeutics Pty Ltd

ET043 Safyre Autofixation System Urinary incontenence sling made of  One size only $850.00

 polydimethysiloxane and polyproplene

 Gytech Pty Ltd

GP001 Cousin Biotech Intramesh L.I.F.T Polypropylene Mesh One size only $540.00

 Jecoli Pty Ltd

JO009 T-Sling / Uromesh Polypropylene Sling 1.1 x 45cm $540.00

 Johnson & Johnson Medical Pty Ltd

JJ070 TVT (Tension-Free Vaginal Tape) Single  Undyed Prolene (polypropylene)  11 x 450mm $850.00

 use device nonabsorbable tape

JJ442 Gynecare TVT-O Items included are: Gynecare TVT  1.1x45 cm $850.00

 Obturator device, Two Gynecare TVT

 Helical Passers and a Gynecare TVT

 Atraumatic Winged Guide.  The device

 component of the system consists of

 undyed or blue Prolene Polypropylene

 Kvinno Centre Pty Ltd

KV001 Tissue Fixation System (TFS) One Size Only $540.00

 Mentor Medical Systems

MN009 CINCH Bladder Neck Suspension Anchor Anchor fixation device 4mm Anchors $540.00

 Southern Surgical Distribution Pty Ltd

DS001 Serasis TO Stress Incontinence system Blue Polypropylene monofilament tape  55 cm tape $685.00

 (Trans obturator approach) with looped edges. Tape only

Prostheses List by Category, Groups and Sponsor Page 718 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 1f - Incontinence: sling, female, biological

 William A Cook Aust Pty Ltd

WC179 Stratasis Urethral Sling Urethral Sling for Urinary Incontinence  Length 10cm, Width 2cm $425.00

 constructed from Sub-Intestinal

 Submucosa (SIS)

WC215 Stratasis-TF Urethral Sling Kit Tension free sling made from SIS (sub- 2cm x 40cm $1,080.00

 intestinal mucosa).  One SIS sling with

 attached ligatures and two ligature

 carriers with removable handles

 P

 William A Cook Aust Pty Ltd

WC180 Stratasis Urethral Sling Urethral Sling for Urinary Incontinence  Length 30cm, Width 2cm $690.00

 constructed from Sub-Intestinal

 Submucosa (SIS)

 Group 1g - Incontinence: injectable, synthetic

 Bard Australia Pty Ltd

BA176 Tegress Endoscopic injectable, hydrophilic urethal 2.8mm vial $1,490.00

  bulking agent for female stress urinary

 incontinence

 Endotherapeutics Pty Ltd

ET011 Macroplastique Sterile, textured, highly cross linked  1.3 ml & 2.5 ml $988.00

 polydimethylsiloxane elastomer implants

 suspended in a bio-excretable carrier gel.

 Incision Pty Ltd

IP004 Durasphere SUI Injectable Bulking agent for Stress  1ml $520.00

 Urinary Incontinence

IP009 Durasphere SUI Injectable Bulking agent for Stress  3ml $1,560.00

 Urinary Incontinence

Prostheses List by Category, Groups and Sponsor Page 719 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 A

 Mentor Medical Systems

MN008 Urethrin Teflon Paste Kit Female or male kit One size only $1,560.00

 Group 1h - Incontinence: injectable, biological

 Bard Australia Pty Ltd

BA041 Contigen Cross Linked Collagen  Contigen Bard Collagen Implant for  2.5cc per syringe $655.00

 Stress Urinary Incontinence

Group 2 - Urogenital - Ureteric Stents

 Group 2a - Ureteric stents: fixed length, polyurethane

 William A Cook Aust Pty Ltd

WC027 Polyurethane Double Pigtail Stent Set 4 - 8Fr, Length 8 - 30cm $176.00

 P

 William A Cook Aust Pty Ltd

WC022 C-Flex Double Pigtail Ureteric Stent Set Set includes: Stent, Wire, Positioner 4.7fr, 12cm and 3.7fr, 16 -  $176.00

 Sp

 William A Cook Aust Pty Ltd

WC018 C-Flex Endoureteratomy Stent Set 6 - 7Fr, Length 22 - 28cm $236.00

 T

 N Stenning  & Co Pty  Ltd

NG030 Paediatric Ureteric Valve Stent Set Open end with introducer and guidewire,  12 - 22cm $195.00 $288.00

 Polyurethane

NG031 Paediatric Ureteric Integral Stent Set Open end with introducer and guide wire, 12 - 22cm Per pack of 5 $195.00

  Polyurethane

NG032 DD Ureteric Stent Set Open end with introducer and guide wire 22 - 30cm Per pack of 2 $235.00

NG046 Paediatric Ureteric Valve Stent Set Fixed length wirthan stent 12 - 22cm $195.00 $288.00

Prostheses List by Category, Groups and Sponsor Page 720 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 William A Cook Aust Pty Ltd

WC214 Cook Ureteral Stents Amplatz Ureteral Stent Set, Ultrathane RB 8.5Fr - 12,20,22,24,26,28cm  $238.00

  Design Radioplaque Band and AQ  and 10.2Fr - 22,24,26,28cm

 Hydrophilic Coating Set includes one

 stent positioner with flexible stent

 introducer catheter

 Group 2b - Ureteric stents: fixed length, other synthetic

 Applied Medical Australia Pty Ltd

MH005 Ureteral Stents Composition - Soft vertex, hydrophilically Outer dia 5F, length 14, 16, 18,  $120.00

  coated with radiopaque markers 20, 22, 24, 26, 28cm;  Outer dia

  6F, length 22, 24, 26, 28,

 30cm;  Outer dia 7F, length 22,

 24, 26, 28, 30cm;  Outer dia 8F,

  length 22, 24, 26, 28, 30cm

MH010 Silhouette Ureteral Stent The Silhouette Ureteric Stent is  Size: 4F, 14cm to 30cm in 2cm  $120.00 $140.00

 manufactured with a soft material that  increments

 provides superior comfort.  It has

 superior column strength through a coil-

 reinforced body providing effortless

 placement.  The tight coils prevent

 migration.  The smaller outside diameter

 of 4F with inner diameter comparable to

 6F standard stents provides exceptional

 drainage.  SL-6 hydrophilic coating

 further facilitates placement.

MH011 Silhouette Ureteral Stent The Silhouette Ureteric Stent is  4F, 10cm - 12 cm in 2cm  $140.00

 manufactured with a soft material that  increments

 provides superior comfort. It has superior 10 cm - Part No. B3829

  column strength through a coil- 12 cm - Part No. B3830

 reinforced body providing effortless

 placement. The tight coils prevent

 migration. The smaller outside diameter

 of 4F with inner dianmeter comparable to

  6F standard stents provides exceptional

 drainage. SL-6 hydrophilic coating further

  facilitates placement.

Prostheses List by Category, Groups and Sponsor Page 721 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Boston Scientific Pty Ltd

BS038 Polaris Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

 attached suture and a stent positioner.  to 95cm

BS086 Polaris Ultra Ureteral Stent This ureteral stent is made from  Sizes up to 7Fr, lengths up to  $315.00

 Percuflex material with a Hydro Plus

BS091 Percuflex; Percuflex Plus; Percuflex Tail; Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

  Percuflex Tail Plus Ureteral Stents. attached suture and stent positioner  to 95cm

BS093 Retromax Plus Ureteral Stent Each Stent contains a uretera stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

 attached suture and stent poitioner.  to 95cm

 Gyrus Australasia Pty Ltd

GY086 Ureteral Stents  Diversion Stent, silicone 7 - 8.5 F x 90cm $165.00

 Sp

 Applied Medical Australia Pty Ltd

MH002 Ureteral Stents Soft vertex, hydrophilically coated with  7/10F only, length 20, 22, 24,  $290.00

 radiopaque markers 26, 28, 30cm

 William A Cook Aust Pty Ltd

WC024 Ultrathane Endoureteratomy Stent Set 6, 7Fr, Length 18 - 26cm $229.00

 T

 Boston Scientific Pty Ltd

BS092 Contour Ureteral Stents Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

 attached suture and a stent positioner .  If  to 95cm

  packaged as a set, the set will contain the

  ureteral stent, stent positionerand

 N Stenning  & Co Pty  Ltd

NG028 DD Ureteric Tumor Stent Set Open/Closed end with introducer and  20 - 28cm $120.00 $359.00

 guide wire, Polyurethane

NG029 DD Ureteric Valve Stent Set Open end with introducer and guide wire, 22 - 30cm $139.00

  Polyurethane

Prostheses List by Category, Groups and Sponsor Page 722 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 2c - Ureteric stents: fixed length, other synthetic thermosensitive

 William A Cook Aust Pty Ltd

WC130 Cook Ureteral Stent Endo-Sof Double Pigtail Stent with  French 5, 6, 7, 8 - 20, 22, 24,  $256.00

 AQ(R) Hydrophilic Coating 26, 28cm Long

WC131 Cook Ureteral Stent Endo-sof double pigtail stent with  French 5 - 7, length 20 - 28cm $256.00

WC170 Urinary Tract Stent set Endo-Sof Double Pigtail Ureteral Stent  5, 6, 7 fr, Length: 22, 24, 26,  $180.00

 and Positioner Only

WC172 Urinary Tract Stent set Endo-Sof Double Pigtail Stent Set 5, 6, 7 fr, Length: 22, 24, 26,  $200.00

 Group 2d - Ureteric stents: fixed length, metal

 Endovision Pty Ltd

ED002 Memokath Ureteric Stent Model 051CW, Thermoexpandable,  Lengths 30mm - 100mm $2,450.00 $3,980.00

 Nickel - Titanium

ED006 Memokath Ureteric Stent Model 051CW, Thermoexpandable,   Length 100mm - 200mm $3,700.00

 Nickel-Titanium

 T

 William A Cook Aust Pty Ltd

WC226 RESONANCE Metallic Ureteral Stent Set Set consists of: 1. Metallic double pigtail  Stent - 6.0Fr.,  20-30cm long $1,620.00

 stent - stainless stel - 6.0 Fr. 20-30cm.

 2. Pigtail straightener.

 3. Outer sheath.

 4. Urenteral catheter,.

 5 With or without a positioning catheter,

 and 6. With or without guide wire

Prostheses List by Category, Groups and Sponsor Page 723 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 2e - Ureteric stents: multilength polyurethane

 Bard Australia Pty Ltd

BA044 Ureteral Stent Bard Inlay Hydrophilic coated Pigtail  (Inlay) 4.7Fr 14, 20, 22, 24, 26, $195.00

 Ureteric stent without guidewire; Bard   28cm.  6Fr- 14, 20, 22, 24, 26,

 Flouro 4 Silicone Multilength ureteric   28cm  7Fr 14, 20, 22, 24, 26,

 stent with guidewire; Urinary Diversion  28cm  8Fr- 14, 20, 22, 24, 26,

 Stent All Silicone 28cm. (Flouro) Multilength 

 4,6,7,and 8fr. (Diversion)  7Fr x

   90cm  &  8Fr  x 90cm.

 William A Cook Aust Pty Ltd

WC020 Towers Peripheral Ureteral Stent Set 6, 7Fr, Length 20, 22 - 32cm $210.00

WC125 Cook Ureteral Stent Towers peripheral ureteral stent and  French 6 - 7, length 22 - 32cm $210.00

 positioner only

 P

 William A Cook Aust Pty Ltd

WC021 C-Flex Double Pigtail Stent Set with  Set includes Paediatric Stent & Positioner 3.7fr Paediatric, 12cm $190.00

  Only

WC218 C-Flex Multilength Ureteric Stent Set Set includes: Paediatric Stent, Wire,  3.7fr Paediatric, Length 22- $249.00

 Positioner 32cm or 8 -20cm

WC219 C-Flex Double Pigtail Ureteric Stent Set Set includes: Paediatric Stent, Wire,  3.7fr Paediatric, Length 8 - 14cm $249.00

 Positioner 3..7fr Paediatric, Length 8 -

 Group 2f - Ureteric stents: multilength other synthetic

 Boston Scientific Pty Ltd

BS094 Contour VL; Stretch VL Flexima; Ureteral Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

  Stents attached suture and a stent positioner  to 95cm

 Gyrus Australasia Pty Ltd

GY084 Ureteral Stents  Single J Ureteric Stent, silicone 7 - 8.5 F x 90cm $175.00

GY085 Ureteral Stents Double J Ureteric Stent, silicone 6-8.5 F, 12 - 24 cm $194.00 $221.00

Prostheses List by Category, Groups and Sponsor Page 724 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GY087 Ureteral Stents Nephro Stent, silicone 6 - 8.5 F, 25-58cm $210.00 $425.00

GY089 Quadra-Coil Multi Length Ureteral Stent Tecoflex polymer, hydrophilic  4.5F-8.5F x length 22 - 28cm $126.00 $214.00

 coating/PTFE coating

 William A Cook Aust Pty Ltd

WC002 Sof-Flex Multilength Ureteric Stent Set Set includes Stent, Wire, Positioner 4.7fr - 8Fr, Length 22 - 32cm $194.00

WC003 Sof-Flex Multilength Ureteric Stent with  Stent, Positioner 4.7 - 8Fr, Length 22 - 32cm $194.00

 Set Variations

WC009 Sof-Flex Double Pigtail & Multilength  Set includes Aqueous Coated (AQ) or  5 - 7fr $194.00

 Ureteric Stent Sets with Slipcoat Wire Standard Stent, Slipcoat Wire & Positioner

WC023 Greene Renal Transplant Stent Set 5 - 8.5Fr, Length 8 - 20, 32cm $238.00

WC029 Black Silicone Double Pigtail Stent Set 6 - 8Fr, Length 20 - 30cm $210.00

WC034 Sof-Flex AQ Double Pigtail Stent Set 4.7 - 7Fr, Length 22 - 32cm;  $194.00

 multi-lengths 22 -32 cm

WC104 Cook Ureteral Stent - Sof-Flex Double  Radiopaque Sof-Flex Stent, Stainless  French 4.7, 6, 7, length 8- $223.00

 Pigtail Stent Set - Special Steel Wire Guide, Radiopaque  22cm, 4-12cm

 Polyurethane Catheter and Radiolucent

WC140 Cook Ureteral Stent Filiform Multilength  Stent, Wire, Positioner 5-8 fr 8-20cm; 5-8 fr 22-32cm $260.00

 Silicone Stent Set

WC147 Cook Ureteral Stent Kwart Retro-Inject  Stent, Wire, Inserter, Release Sleeve 4.7-8 fr, length 22-32cm $194.00

 Stent Set

WC149 Sof-Flex Double Pigtail Ureteric Stent  Stent, Positioner 4.7 - 10Fr, Length 12 - 30cm $194.00

 with Set Variations

WC150 Sof-Flex Double Pigtail Ureteric Stent Set Set includes: Stent, Wire, Positioner 4.7fr - 7fr and 10fr, 10 - 28cm $194.00

 P

 William A Cook Aust Pty Ltd

WC217 Sof-Flex Multilength Ureteric Stent Set Set includes: Paediatric Stent, Wire,  3fr Paediatric, Length 8 - 12cm $254.00

 Positioner

WC220 Sof-Flex Double Pigtail Ureteric Stent Set Set includes: Paediatric Stent, Wire,  3fr Paediatric, Length 8 - 14cm $254.00

 Positioner

Prostheses List by Category, Groups and Sponsor Page 725 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 T

 William A Cook Aust Pty Ltd

WC028 Black Silicone Stent Set with Options 6 - 8Fr, Length 20 - 30cm $210.00

WC138 Cook Ureteral Stent Filiform Double  Stent, Wire, Positioner 6-8 fr 20-30cm $260.00

 Pugtail Silicone Stent Set

WC143 Cook Ureteral Stent Filiform Double  Stent and Positioner 6-8 fr 20-30cm $260.00

 Pigtail Silicone Stent and Positioner Only

 Group 2g - Ureteric stents: multilength other synthetic thermosensitive

 William A Cook Aust Pty Ltd

WC035 Multi-length Endosof Ureteral Stent Set Set includes Hydrophilic Coated  5 - 8fr, 22-32cm $256.00

 Stent,Wire and Positioner

WC169 Urinary Tract Stent set Endo-Sof Multilength Stent Set 5, 6, 7 fr, Length: 22-32cm $200.00

WC171 Urinary Tract Stent set Endo-Sof Multilength Ureteral Stent and  5, 6, 7 fr, Length: 22-32cm $180.00

 Positioner Only

 Group 2i - Ureteric stents: urinary diversion

 Boston Scientific Pty Ltd

BS095 Urinary Diversion Stents Each Stent contains a ureteral stent with  Size: 4Fr to 14Fr, Length: 10cm $210.00

 attached suture and a stent positioner  to 95cm

 Endotherapeutics Pty Ltd

ET012 Optimed Ureteric Stents Soft-Polyurethane. Ureteral. Paediatric  Ureteral 4.5 x 28,30,32 cm; 6 x  $210.00

 Ureteral. Renal Transplantation. Urinary  26,28,30,32 cm; 7 x

 Diversion. 26,28,30,32 cm. Paediatric

 Ureteral 8 x 28,30,32 cm. Renal

 Transplantation 4 x 10,12,14,16

 cm; 6 x 12,14,16 cm; 7 x

 12,14,16 cm. Urinary Diversion

 8 x 12,14,16 cm.

 William A Cook Aust Pty Ltd

WC031 Bander Ureteral Diversion Stent Set Left, right 7, 8Fr, Length 75, 90cm $129.00

Prostheses List by Category, Groups and Sponsor Page 726 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC128 Cook Ureteral Stent Bander ureteral diversion left and right  French 4.7 - 8, length 75cm $210.00

Group 3 - Urogenital - Urethral Stents

 Group 3a - Urethral stents : Metal, expandable

 American Medical Systems

AM003 Urolume Plus TM Endo Urethral  Endourethral wall stent for urethral  Range: 1.5 - 4.0cm $2,450.00 $3,922.37 When provided in association

 prostheses                                             strictures, DESD and BPH with Medicare Benefits Schedule

                                                             Item Number 36811 only.

 Bard Australia Pty Ltd

BA042 Memotherm Prostatic Stents Memotherm Prostatic Urethral wall Stent 36Fr, 20mm to 60mm in 5mm  $2,450.00 When provided in association

 increments; 42Fr, 20mm to  with Medicare Benefits Schedule

 60mm in 5mm increments Item Number 36811 only.

 Endovision Pty Ltd

ED003 Memokath Urethral Stent Dual Expansion.  Models 045T, 045W,  Lengths 5mm - 90mm $2,450.00

 045TTW, Thermoexpandable, Nickel -

 titanium

ED004 Memokath Urethral Stent - Single  Models: 028S, 028SW (Flexible  Length 15 - 90mm $2,450.00

ED007 Memokath Urethral Stent - Single  Models 044T, 044TW, 028T, 028TW  Lengths 15 - 90mm $2,450.00

 (Rigid telescope)

Group 4 - Urogenital - Reconstructive Material

 Group 4a - Urogenital Reconstructive Material : synthetic

 American Medical Systems

AM012 Triangle Sling Gelatin Coated Polyester sling, used in  18 x 55 mm $663.00

 sling procedures for treatment of stress

 urinary incontinence.

AM013 Triangle Sling with surgical mesh Silicone Coated sling with surgical mesh,  10 x 10cm - 144 x 144cm $663.00

 used in sling procedures for treatment of

 stress urinary incontinence.

AM018 Straight-In Sacral Colpopexy System Kit includes inserter, 2 x loop screws, "Y" Shaft 28cm $1,295.00 $3,810.10

  shaped sling graft

Prostheses List by Category, Groups and Sponsor Page 727 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AM023 IntePro Large Pore Polypropylene Y-Sling Large pore polypropylene mesh One size $663.00

AM026 Perigee Transobturator Anterior Prolapse  4 helical shaped needles with handles, 4  One size $1,325.00

 Repair System synthetic graft arms enclosed in plastic

 with a centre "cape" mesh.

AM027 Apogee Vault Suspension System 2 stainless steel curved needles with  One size $1,295.00

 handles, a large pore polypropylene mesh

 attached in the centre of a polypropylene

 mesh enclosed in plastic sheaths and two

 Johnson & Johnson Medical Pty Ltd

JJ476 Gynecare Prolift Pelvic Floor Repair  Pre-cut gynemesh PS and single use  PFRT01 $2,489.00

 instruments for mesh placement

JJ478 Gynecare Prolift Pelvic Floor Repair  Pre-cut gynemesh PS and single use  PFRP01 $1,295.00

 instruments for mesh placement

 Group 4b - Urogenital Reconstructive Material : biological

 Bard Australia Pty Ltd

BA149 Pelvicol natural implant Flexible Flat sheet of acellular porcine  4 x 18cm x 1.0mm $729.00

 dermal collagen and elastin fibres

BA150 Pelvicol natural implant Flexible Flat sheet of acellular porcine  4 x 7cm x 1.0mm $399.00

 dermal collagen and elastin fibres

BA151 Pelvicol natural implant Flexible Flat sheet of acellular porcine  2 x 12cm x 1.0mm $369.00

 dermal collagen and elastin fibres

BA152 Pelvicol natural implant Flexible Flat sheet of acellular porcine  2 x 20cm x 1.0mm $489.00

 dermal collagen and elastin fibres

BA153 Pelvicol natural implant Flexible Flat sheet of acellular porcine  4 x 12cm x 1.0mm $549.00

 dermal collagen and elastin fibres

BA154 Pelvicol natural implant Flexible Flat sheet of acellular porcine  8 x 12cm x 1.0mm $924.00

 dermal collagen and elastin fibres

BA155 Pelvicol natural implant Flexible Flat sheet of acellular porcine  2 x 4cm x 1.0mm $249.00

 dermal collagen and elastin fibres

BA156 Pelvicol natural implant Flexible Flat sheet of acellular porcine  2 x 7cm x 1.0mm $293.00

 dermal collagen and elastin fibres

Prostheses List by Category, Groups and Sponsor Page 728 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA172 Pelvisoft PelviSoft Acellular Collagen BioMesh 4 x 7 cm $399.00 $458.00

BA173 Pelvisoft PelviSoft Acellular Collagen BioMesh 8 x 12 cm $924.00 $1,295.00

BA174 Pelvisoft PelviSoft Acellular Collagen BioMesh 6 x 8 cm $549.00 $660.00

 William A Cook Aust Pty Ltd

WC177 Surgisis Soft Tissue Graft Surgical Mesh composed of Sub- Length- 10cm, Width- 7cm $770.00

 Intestinal Submucosa (SIS)

WC178 Surgisis Soft Tissue Graft Surgical Mesh composed of Sub- Length- 20cm, Width- 7cm $950.00

 Intestinal Submucosa (SIS)

 Group 4c - Urogenital Reconstructive Material : bone and ligament fixation

 American Medical Systems

AM010 Influence Bone Screw Bone screw with pre-attached  5.5 x 1.7 mm $685.00

 polypropylene monofilament suture. For

 incinsionless tranvaginal sling procedure.

 Loop Screw Bone Screw

AM011 Influence Bone Screw Bone screw with pre-attached  5.5 x 1.7 mm $685.00

 polypropylene monofilament suture. For

 incinsionless tranvaginal sling procedure.

 In-Fast Bone Screw

Group 5 - Urogenital - Penile Prostheses

 Group 5a - Penile : malleable

 American Medical Systems

AM005 Penile Implant - Malleable AMS 600M, AMS 650 Cylinders range: 12 -20cm $3,305.40 When provided in association

 with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

AM020 DURA II, Positionable Penile Prosthesis Concealable penile prosthesis Diameter 10mm and 12mm;  $5,300.00 $5,386.00

 Proximal tip lengths 1-9cm;

 Distal tip lengths 1-9cm

Prostheses List by Category, Groups and Sponsor Page 729 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medical Device Alliance Pty Ltd

MP002 Malleable Penile Implant Consists of a membrane, filler product  14-23cm $800.00 When provided in association

 and silicone tube with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

 Mentor Medical Systems

MN006 Malleable Penile Prostheses Malleable rod implant 9ml,11ml and 13ml $2,020.00 When provided in association

 with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

 A

 Mentor Medical Systems

MN025 Acu-form Malleable Penile Prostheses Malleable rod implant 9ml,11ml and 13ml $2,020.00 $3,200.00 When provided in association

 with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

 Group 5b - Penile : inflatable, two component

 American Medical Systems

AM047 AMS Ambicor AMS Ambicor Inflatable Penile  12.5mm in 14, 16 & 18cm  $10,000.00

 length, 14mm in 16, 18 & 20cm

  length, 15.5mm in 18, 20 &

 Mentor Medical Systems

MN005 Inflatable Penile Prostheses-Implant Start- Saline filled penile implant 10cm,12,14,16,18,20,22. $8,000.00 When provided in association

 Up Pack with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

 A

 American Medical Systems

AM041 AMS Ambicor AMS Ambicor Inflatable Penile  AMS Ambicor Inflatable Penile  $10,200.00

 Prostheses 12.5mm in 14, 16 &

 18cm length, 14mm in 16, 18 &

  20cm length, 15.5mm in 18, 20

  & 22cm length

Prostheses List by Category, Groups and Sponsor Page 730 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mentor Medical Systems

MN022 Titan Inflatable Penile Prosthesis with  Saline-Filled Penile Implant 10cm, 12cm, 14cm, 16cm,  $10,200.00 $10,350.00

 18cm, 20cm, 22cm Cylinder

 Group 5c - Penile : inflatable, three component

 American Medical Systems

AM022 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone) 12, 14, 15, 16, 18, 21cm $3,448.00 When provided in association

 Prostheses Cylinders with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

AM042 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone) One Size $4,201.00

 Prostheses Pump

AM043 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone) 12, 14, 15, 16, 18, 21cm $7,653.00

 Prostheses Pump & Cylinders

AM044 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone)  50, 65, 100ml $1,757.00

 Prostheses Reservoir non Inhibizone

AM045 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone) One Size $675.00

 Prostheses Accessory Kit

AM046 AMS 700 Series Inflatable Penile  700 Series (Non InhibiZone) One Size $135.00

 Prostheses Deactivation Package

 A

 American Medical Systems

AM004 AMS 700 Series Inflatable Penile  700 Series with InhibiZone 12, 14, 15, 16, 18, 21cm $3,750.00 When provided in association

 Prostheses with Inhibizone Cylinders with Medicare Benefits Schedule

 Item 37429, 37426 or 37432

AM036 AMS 700 Series Inflatable Penile  700 Series with InhibiZone One Size $4,570.00

 Prostheses with InhibiZone Pump

AM037 AMS 700 Series Inflatable Penile  700 Series with InhibiZone 12, 14, 15, 16, 18, 21cm $8,324.00

 Prostheses with InhibiZone Pump &

 Cylinders Preconnected

AM038 AMS 700 Series Inflatable Penile  700 Series with InhibiZone  50, 65, 100ml $1,940.00

 Prostheses with InhibiZone Reservoir

Prostheses List by Category, Groups and Sponsor Page 731 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AM039 AMS 700 Series Inflatable Penile  700 Series with InhibiZone One Size $675.00

 Prostheses with InhibiZone Accessory Kit

AM040 AMS 700 Series Inflatable Penile  700 Series with InhibiZone One Size $135.00

 Prostheses with InhibiZone Deactivation

 Mentor Medical Systems

MN027 Titan Inflatable Penile Prosthesis with  Saline-Filled Penile Implant 10cm, 12cm, 14cm, 16cm,  $10,200.00 $10,500.00

 18cm, 20cm, 22cm Cylinder

Group 6 - Urogenital - Testicular

 American Medical Systems

AM015 AMS Testicular Prostheses Solid silicone elastomer with suture hole Small, Medium, Large $640.00 When provided in association

 with Medicare Benefits Schedule

 Item 45051 preparatory to a

 subsequent surgical service not

 precluded from attracting

 Surgiplas Medical

SP002 Testicular Implant Silicone Elastomer Small / Medium / Large $640.00 When provided in association

 with Medicare Benefits Schedule

 Item 45051.

 Group 6 - Testicular prostheses

 Endotherapeutics Pty Ltd

ET028 Promedon Testicular Prosthesis Silicone Elastomer Small - 31 x 23 mm,  Medium -  $640.00 When provided in association

 37 x 28 mm,  Large - 42 x 32  with Medicare Benefits Schedule

 mm,  Xlarge Item 45051 preparatory to a

 subsequent surgical service not

 precluded from attracting

Prostheses List by Category, Groups and Sponsor Page 732 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Mentor Medical Systems

MN007 # Testicular Prosthesis Saline and gel filled implant Small, Medium, Large $640.00 When provided in association

 with Medicare Benefits Schedule

 Item 45051 preparatory to a

 subsequent surgical service not

 precluded from attracting

MN026 Silicone Elastomer Testicular Prosthesis Saline and gel filled implant Small, Medium, Large $640.00 $800.00 When provided in association

 with Medicare Benefits Schedule

 Item 45051 preparatory to a

 subsequent surgical service not

 precluded from attracting

 Technology For Life Pty Ltd

TE003 # Micro Textured Testicular Implant Silicone Enhanced Small, Medium, Large, Ex-large $640.00 $1,050.00 When provided in association

 with Medicare Benefits Schedule

 Item 45051.

Group 7 - Urogenital - Stimulators

 Medtronic Australasia Pty Ltd

MC180 Sacral Nerve Stimulation Unilateral Interstim  stimulation lead Models 3080 & 28 cm $3,330.00

  3886. Platinum / Iridium, polyurethane.

MC185 Sacral Nerve Stimulation Unilateral Interstim Temporary test stimulation lead. One size only $385.00 When used in pain therapy - to

  Model 3065U. This model is temporary  be funded when the patient has

 for patient trial. Platinum / Iridium,  undergone a multi-disciplinary

 assessment and trial of

MC186 Sacral Nerve Stimulation Accessories Model 041827-002 Auxiliary screener  One size only;  9-12.5cm $128.00 Only to be used with Medtronic

 cable kit. Polypropylene. OR Model  Itrel II pulse generator, model

 041828-002 Foramen Needle (box of 6).

 Sterile individual units. Stainless steel.

MC188 Sacral Nerve Stimulation Unilateral Activator. Model 3031. Polycarbonate. One size only $1,318.00 Only to be used with Medtronic

 Itrel II pulse generator, model

Prostheses List by Category, Groups and Sponsor Page 733 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC291 Sacral Nerve Stimulation Lead Model  4 electrode tined lead - platinum iridium,  28 CM $4,330.00

 3093 TINED LEAD electrodes 0, 2, 3 are 3mm,electrode 1 is

 10mm and coiled, spacing is 1.5mm

 Group 7 - Stimulators

 Medtronic Australasia Pty Ltd

MC175 Neo-anal sphincter stimulator implant Implantable intramuscular assist lead,  35-50 cm $4,330.00

 Dynamic Graciloplasty Lead. Platinum

 iridium, polyurethane, polypropylene.

Group 8 - Urogenital - Tubal Obstruction Devices

 Group 8a - Tubal obstruction : extraluminal

 Endocorp Pty Ltd

EC001 Hulka Clip - $76.00

 Femcare Australia Pty Ltd

FE001 Filshie Clip Titanium One size only $155.00 $170.00

FE002 Fallopian Tube Rings (Pair) Silicone One size only $76.00 $120.00

 Gyrus Australasia Pty Ltd

GY088 Falope-Ring Bands Fallopian Tube Clip (each) 5mm - 12mm $38.00 $70.00

 Group 8b - Tubal obstruction : intraluminal

 N Stenning  & Co Pty  Ltd

NG045 Essure System Stainless steel, polyester fibre One size only, 2 per pack $1,240.00 $1,344.00 Only to be funded when provided

  in a hospital/day hospital.  To be

  reviewed in three years (2004)

 to assess whether the place of

 insertions is still consistent.

Prostheses List by Category, Groups and Sponsor Page 734 of 784


UROGENITAL

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Stents

 William A Cook Aust Pty Ltd

WC126 Cook Urethral Stents Firlit-Kluge uretheral stent French 8 - 10, length 30cm $57.00

WC136 Cook Urethral Stent Kaontz urethral stent French 8 - 10, length 12cm $48.00

WC137 Cook Ureteral Stent Pediatric Urethral C- Stent, Stylet 10 fr 15cm; 13 fr 15cm $48.00

WC162 Cook Ureteral Stent - Tarkington Urethral Stent, Wire 8 fr $79.00

  Stent

Stimulators, Neuromuscular, Functional

 Medtronic Australasia Pty Ltd

MC719 InterStim Neurostimulator Model 3023 Titanium 42g $9,350.00

Prostheses List by Category, Groups and Sponsor Page 735 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheterization Kits, Central Venous

 Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd

KA007 Mahurkar Subclavian Catheter Kit Chronic haemodialysis, long term  36, 40cm $178.96

 vascular access for haemodialysis and

 apheresis. Constructed of radiopaque

 silicone rubber.  Kit contains: Catheter,

 18ga Introducer Needle, J/Straight 0.038"

  Guidewire, 10cc Syringe, Tunnelling

 Stylet, Pull-Apart Sheath/Dilator, (4)

 Gauze Sponges, (2) Wound Dressings,

KA012 Mahurkar Subclavian Catheter Kit Acute haemodialysus, short term vascular 11.5 Fr, 13.5cm Straight  $126.87

  access. Catheters constructed of  Extension, 11.5 Fr, 16cm

 radiopaque polyurethane. Tips are made  Straight Extension, 11.5 Fr

 of polyvinyl chloride and are more  19.5cm Straight Extension, 10

 radiopaque than the rest of the catheter.  Fr 12cm Curved Extension, 10

 Kit contains: 10 or 11.5 Fr Catheter, 18ga Fr 15cm Curved Extension,

  Introducer Needle, J/Straight Guidewire,  11.5 Fr 16cm Curved

 10 Fr Dilator, 12 Fr Dilator, 2 x Adhesive Extension, 11.5 Fr 16cm

Catheters, Angioplasty, Laser

 Pacing Importers Pty Ltd

PI001 Excimer Laser Stent Polyester Fibre optic catheter 2.5 and 2.2mm $6,800.00

Prostheses List by Category, Groups and Sponsor Page 736 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Catheters, Hemodialysis

 Bard Australia Pty Ltd

BA140 HemoGlide Long Term Haemodialysis  Kit contents: 14.5fr catheter, 18g  15, 19, 23 & 27cm straight kit;  $350.00

 Catheter guidewire introducer needle, 0.038" 70cm 19 & 23cm Pre-curved kit; 19,

  J-wire guidewire, 15fr PTFE introducer  24 & 28cm  and 31cm Pre-

 sheath, 8" tunnelling device, 10-12fr  curved jugular kit.

 dualator vessel dilator, 2 adhesive

 dressings, 2 injections caps, silicone

 attachable suture wing, heparin label and

BA159 HemoSplit Long Term Haemodialysis  HemoSplit is a carbothane long term dual  Standard Kit (straight15cm  $475.00

 lumen catheter used to provide vascular  to42cm and pre-curved 19cm

 access for haemodialysis. It comprises of to31cm), Microintroducer Kits

  a double D lumen configuration catheter  (straight 19cm to 42cm & pre-

 each lumen having an ID of 2.3mm) with curved 19cm to 31cm)

  a fixed split tip (to 7.5cmm) which

 enables blood flow rates as high as

 500mls/minute.  The catheter shaft has a

 tissue ingrowth cuff to assist tissue

 anchoring.

 Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd

KA008 Single Lumen Right Atrial Catheter Central Venous Catheters constructed of  84cm, 1.3mm OD, 94cm  $52.51

 radiopaque silicone rubber 2.2mm OD, 94cm 3.2mm OD

KA009 RAAF Dual Lumen Catheter Central Venous Catheter constructed of  4.5mm (Catheter), 95cm  $135.11

 radiopaque silicone rubber (Catheter Overall Length);

 3.2mm (Catheter), 102cm

KA010 Triple Lumen Right Arterial Catheter Central Venous Catheter constructed of  3.9mm $202.91

 radiopaque silicone rubber

Prostheses List by Category, Groups and Sponsor Page 737 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

KA011 Permcath Dual Lumen Catheter Chronic Haemodialysis, long term  36cm, 40cm $324.45

 vascular access for haemodialysis and

 aphaeresis.  Constructed of radiopaque

 silicone rubber. Kit contains: Catheter,

 18ga Introducer Needle, J/Straight 0.038"

  Guidewire, 10cc Syringe, 10Fr. Dilator

 (28cm only), 12Fr. Dilator (except

 28cm), #11 Scalpel, Tunnelling Stylet,

 Oval Pull-Apart Sheath/Dilator, (4) Gauze

  Sponges, (2) Wound Dressing, (2)

 Injection Sealing Caps.

KA013 Permcath Dual Lumen Catheter Chronic haemodialysis, long term  28, 36, 40cm $283.97

 vascular access for haemodialysis and

 aphaeresis.  Constructed of radiopaque

 Tekmed Pty Ltd

TK005 Medcomp Long Term Catheter sets for  ASH, TESIO-BioFlex with cuff 10, 14 French   24,28,32 &  $450.00

 Haemodialysis 36cm lengths

TK006 Medcomp Long Term Catheter sets for  HemoFlow HFS-Carbothane with cuff 14.5 French   24,28,32 & 36cm $295.00

 Haemodialysis  lengths

Clips, Vascular

 B Braun Australia Pty Ltd

BB016 Challenger Clip Vessel clip Medium-large $65.00 Temporary Approval

Embolization Prostheses, Intravascular

 Endotherapeutics Pty Ltd

ET006 Embospheres - 2ml per implant $610.00

 Medical Vision Australia Pty Ltd

MF005 Nit-Occlud Coil System System for transcatheter occlusions of  Dia 4 x 4mm - 14 x 6mm $4,500.00

 PDA with spiral coils.  Includes Nit-

 Occlud spiral coil with deployment handle

Prostheses List by Category, Groups and Sponsor Page 738 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Grafts, Vascular, Synthetic

 B Braun Australia Pty Ltd

BB018 Vascular Uni - Graft   Vascular graft 100cm $910.00

BB020 Vascular Uni - Graft    Vascular graft 50cm $605.00

BB128 Vascugraft Straight Standard Wall with Helix Support Dia 6mm x  length 100cm $2,038.00

BB129 Vascugraft Straight Standard Wall with Helix Support Dia 5 - 8mm, length 80 - 90cm $2,091.00

BB132 Vascugraft Thin Wall Centre Helix Dia 6mm, length 45cm $1,150.00

BB137 Vascugraft Standard with Centred Helix Dia 4 - 8mm, length 70 - 90cm $1,500.00

BB139 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 80cm $1,603.00

BB143 Vascugraft Easy Glide - Standard Wall with Helix  Dia 6 - 8mm, length 40 - 70cm $1,125.00

 Short Taper

Group 1- Bare Metal Stents

 Group 1a - Balloon expandable, pre-mounted

 Abbott Australasia Pty Ltd

AY008 Jostent Renal Premounted Balloon expandable Stent length 12 - 17mm,  $1,350.00

 diameter 5 - 7 mm

AY014 Jostent Wavemax Stainless Steel Dia 5 - 12mm, length 12 -  $1,000.00

 B Braun Australia Pty Ltd

BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm  $1,000.00

 Bard Australia Pty Ltd

BA002 Pura Vario Stent Saxx balloon expandable stainless steel  3mm - 14mm diameter, 13mm - $1,350.00

  80mm length

BA003 Saxx Premounted Balloon Expandable  Pura vario stainless steel stent 3mm - 16mm diameter, 13mm - $1,648.00

  80mm length

Prostheses List by Category, Groups and Sponsor Page 739 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Biotronik Australia Pty Ltd

BT073 Motion Explorer Motion explorer silicon carbide coated  Dia:  2.5 - 3.5mm.  Len: 15 -  $1,500.00

 stainless steel balloon expandable

 peripheral stent system 0.014 compatible

 Boston Scientific Pty Ltd

BS059 Express Vascular LD Stent; Express  316L stainless steel stent mounted on a  Diameter 4mm - 10mm, Length  $1,800.00

 Vascular SD Stent balloon.  The balloon shaft is  14mm - 60mm

 polyurethane with coextrusion balloon on

 a distal end where stent is crimped to.

 Device Technologies Australia Pty Ltd

DE213 IntraStent Expandable Stent Stainless Steel  2.8 x 10,16,26,36,56, 76 mm $1,800.00

 Edwards Lifesciences Pty Ltd

EL040 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 15mm - 18mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.035 compatible

 balloon, stent and deployment system

EL041 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 19mm - 27mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.035 compatible

 balloon, stent and deployment system

EL042 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 28mm - 37mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.035 compatible

 balloon, stent and deployment system

EL043 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 38mm - 56mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.035 compatible

 balloon, stent and deployment system

EL044 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 15mm - 18mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.018 compatible

 balloon, stent and deployment system

EL046 Lifestent - Peripheral Stent Stent: Stainless Steel Composition. Items  Stent Length  28mm - 37mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.018 compatible

 balloon, stent and deployment system

EL047 Lifestent - Peripheral Stent Stent: Stainless Steel Composition. Items  Stent Length 38mm - 56mm,  $1,800.00 $2,150.00

 included in delivery system: nylon  0.018 compatible

 balloon, stent and deployment system

Prostheses List by Category, Groups and Sponsor Page 740 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Johnson & Johnson Medical Pty Ltd

JJ304 Palmaz Genesis Peripheral Stent and  Stainless steel balloon expandable stent  Diameter 4-8mm, length 12- $1,800.00 $2,050.00

 Delivery System on Slalom mounted on a slalom balloon

JJ305 Palmaz Genesis Peripheral Stent and  Stainless steel balloon expandable stent  Diameter 4-8mm, length 12- $1,800.00 $2,158.83

 Delivery System on Opta Pro mounted on an Opta Pro Balloon

JJ567 PALMAZ® BLUE™ .018 Peripheral Stent L605 Cobalt Chromium Alloy Balloon  12, 15, 18, 24mm length 4, 5, 6, $1,800.00 $2,450.00

  System Expandable Stent  7mm diameter

 Medical Vision Australia Pty Ltd

MF017 CP Stent CP Stent Uncovered, mounted on BIB  16, 22, 28, 24, 39 & 45mm  $1,800.00 $3,400.00

MF018 CP Stent CP Stent Covered, mounted on BIB balloon 16, 22, 28, 24, 39 & 45mm  $1,800.00 $3,800.00

 Medtronic Australasia Pty Ltd

MC328 Racer Renal Stent System Cobalt Alloy Diameter: 4-7mm; Lengths: 12  $1,800.00 Temporary approval, pending

 &18mm review of product group

MC702 Bridge SE-Self Expanding Stents; Bridge  Stainless Steel, Nitinol Diameter: 6 - 10mm, Length: 20 $1,800.00

 Assurant Stents; Aurora Stents  - 80mm

MC703 Bridge X3 Stents; Bridge Stents; Extra  Stainless Steel Diameter: 5 - 7mm, Length: 9 -  $1,800.00

 Support Renal Plus Bridge Stent 17mm

 Group 1b - Balloon expandable, un-mounted

 Edwards Lifesciences Pty Ltd

EL045 Lifestent - Peripheral Stent Stent: Stainless Steel composition. Items  Stent Length 19mm - 27mm,  $2,533.33

 included in delivery system: nylon  0.018 compatible

 balloon, stent and deployment system

EL048 Lifestent Peripheral Stent Stent: Nitinol composition with tanilum  6-8mm Diameter, length 20- $2,250.00

 markers, Items included in the delivery

 system: Stent, deployment system

 Johnson & Johnson Medical Pty Ltd

JJ057 Palmaz Balloon Expandable Stent Stainless steel stent Diameter 4-12mm, length 20- $1,570.00

JJ058 Palmaz Balloon Expandable Stent Stainless steel stent Extra-large $1,800.00

JJ306 Palmaz Genesis Peripheral Stent Stainless steel peripheral stent Diameter 4-12mm, length 11- $1,780.00

Prostheses List by Category, Groups and Sponsor Page 741 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medical Vision Australia Pty Ltd

MF015 CP Stent CP Stent Uncovered 16, 22, 28, 24, 39 & 45mm  $1,570.00 $2,500.00

MF016 CP Stent CP Stent Covered 16, 22, 28, 24, 39 & 45mm  $1,570.00 $2,900.00

 Group 1c - Self expandable, pre-mounted

 Abbott Australasia Pty Ltd

AY007 Jostent SelfX Expanding Stent Nitinol Shaft length 15 - 180cm, stent  $1,400.00

 length 32 - 92mm

AY015 Xact/ Xact Flex Carotid Stent Nitinol Self-Expanding stent on rapid  Diameter 7-10mm Length 20 +  $1,800.00

 exchange delivery system 30mm Straight; Diameter 8-6,

 9-7, 10-8mm Length 20 +

 30mm Tapered

AY019 Xceed Self-expanding Stent System Nitinol vascular stent and freestyle  Diameter: 5 to 10mm. Length:  $1,800.00

 technology delivery system 20 to 120mm

 Bard Australia Pty Ltd

BA001 Memotherm Vascular Stents  Memotherm nitinol self-expanding stent 4mm - 20mm diameters, 2cm -  $1,900.00

 12 cm lengths

BA178 Luminex Vascular Stent Luminex nitinol self-expanding stent 4mm - 20mm diameters, 2cm -  $1,900.00

 12cm lengths

 Biotronik Australia Pty Ltd

BT072 Astron Peripheral self expanding nitinol, coated  Dia: 6 - 12mm, Len: 30 -  $1,800.00

 Boston Scientific Pty Ltd

BS013 Symphony Nitinol Stent Self-expanding stents with radiopaque  Diameter x Length: 6-14mm x  $1,600.00

 markers 22-60mm

BS056 Carotid Wall Stent Model SCH64371, SCH64377,  Fully open diameter 6.0 -  $1,800.00

 SCH64378, SCH64379, SCH64382,  10.0mm, Fully open length 22 -

 SCH64383, SCH64384, Elgiloy (cobalt

 chromium), flexible low profile, self

Prostheses List by Category, Groups and Sponsor Page 742 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BS063 Wallstent RP; 7Fr Placehit Wallstent Wallstent TIPS endoprosthesis, wallstent  Diameter 6mm - 24mm, Length  $1,800.00

 biliary endoprosthesis, wallstent iliac  18mm - 90mm

 endoprosthesis, wallstent endoprosthesis

 tracheobronchial  with unistep plus

 delivery sytem, 7Fr Placehit Wallstent. 

 Stent composition - biomedical superalloy

  wire, braided in mesh, unistep delivery

 system composition - blue polyimid

 material, stainless steel

BS077 Sentinol Nitinol Vascular Stent System Implantable metallic stent and Uniflex  Diameter: 5 to 10mm. Length:  $1,800.00

 delivery system 20 to 120mm

 Device Technologies Australia Pty Ltd

DE212 Intracoil Stent Nickel titanium alloy 40 x 4,5,6,7,8 mm $1,800.00

 Endotherapeutics Pty Ltd

ET025 Optimed Iliac Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm $1,800.00 $2,200.00

ET026 Optimed Femoral Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm $1,800.00 $2,200.00

 ev3 Australia Pty Ltd

EE005 Protégé Nitinol Stent Carotid stent Tapered 8 - 6, 9 - 6, 10 - 7mm;  $1,800.00

 Straight 6-10mm

EE006 Protégé Nitinol Stent Peripheral stent Straight 6 - 14mm $1,800.00

EE015 Protégé RX Stent Peripheral Stent Straight 6-12mm $1,800.00

EE016 Protégé RX Stent Crotid Stent Tapered 8-6, 9-6, 10-7mm  $1,800.00

 Straight 6-10mm

 Guidant Australia Pty Ltd

GU058 Dynalink Peripheral Self Expanding Stent  - Lengths 80cm and 120cm, Sizes $1,600.00

 System  range  from 5mm x 28mm to

 10mm x 56mm

GU071 ACCULINK Peripheral Stent System Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm  $1,800.00 $2,200.00

 Johnson & Johnson Medical Pty Ltd

JJ068 SMART .018" Peripheral Stent System Nitinol carotid stent and delivery system 6 - 10 mm $1,900.00

Prostheses List by Category, Groups and Sponsor Page 743 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

JJ235 SMART Peripheral stent system Laser cut nitinol tube.  Available in long  Dia 6 - 8mm, length 120mm $1,900.00

 stents to treat large vessel lesions.

JJ419 SMART Control Peripheral Stent System SMART Control is a laser cut nitinol self  Dia 6-10mm; Length 20, 40, 60, $2,400.00

 expanding stent, used to treat peripheral   80, 100mm

 vessel disease.

 Medical Vision Australia Pty Ltd

MF019 EVO Nitinol Stent EVO Nitinol Stent 6, 7, 8, 9 & 10mm diameter; 20, $1,800.00 $2,300.00

  40, 60 & 80mm length

 Medtronic Australasia Pty Ltd

MC146 Exponent RX Self Expanding Carotid  Nitinol Diameter: 6 - 10mm, Length: 20 $1,800.00

 Stent Delivery System  - 40mm

 Pacing Importers Pty Ltd

PI004 Stentself Stent Phynox construction, adapted sizes &  Dia 5 - 9mm  Length: 20 - 100mm $1,800.00

 diameters

 William A Cook Aust Pty Ltd

WC055 Peripheral Vascular Stent (ZA Stent);  Vascular Stent Introducer Catheter Length 60 -  $1,535.00

 Zilver Stent 80 cm, Diameter 6 - 10 mm,

 Length 1 - 8cm

WC168 Zilver Stent Vascular Design Vascular/Biliary self expanding stent 5Fr 80/125cm delivery system,  $1,800.00

 5-9mm diameter, 3-6cm length.

  6Fr 80/125cm delivery system,

 5-14mm diameter, 2-8cm length

WC175 Cook Z Stent Gianturco Vena Caval and Venous Design Double Stent - 20, 30, 40mm  $1,230.00

 Diameters, 50mm Length

WC176 Cook Z Stent Gianturco Vena Caval and Venous Design Triple Stent - 20, 30, 40mm  $1,465.00

 Diameters, 75mm Length

WC189 Cook Z Stent Gianturco Vena Caval and Venous Design Single Stent - 15, 20, 30mm  $990.00

 diameters; 25mm length

Prostheses List by Category, Groups and Sponsor Page 744 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 2 - Stent Grafts

 Group 2a - Tube

 Abbott Australasia Pty Ltd

AY010 JOStent Peripheral Stent Graft Stainless Steel/PTFE 4 - 12 mm x 12 - 58m mm $2,850.00

 Atrium Australia-Pacific Rim Pty Ltd

AC023 Advant PTFE V12 Stent Graft System Balloon Expandable PTFE Encapsulated  5mm - 12mm Diameter $4,025.00

 Stainless Steel Peripheral Vascular Stent

 Bard Australia Pty Ltd

BA004 Encapsulated Carbon Lined Stent Graft  AV access PTFE covered nitinol self- 4mm - 10mm diameter, 3cm -  $2,800.00

 expanding stent 8cm length

BA005 Encapsulated Carbon Lined Stent Graft Iliac / SFA PTFE covered nitinol self- 4mm - 10mm diameter, 3cm -  $2,800.00

 expanding stent 12cm length

 Boston Scientific Pty Ltd

BS036 Schneider Endovascular Grafts: Straight A self expanding, flexible endoprosthesis,  Size: 6-16mm, 30-90mm $2,750.00

 made of medium porosity PET graft

 material with radiopaque tracer wire

BS060 Transhepatic Biliary Permalume Covered  Elgiloy (cobalt chromium), permalume  8 x 60mm, 8 x 80mm, 10 x  $2,200.00

 Wallstent (silicone coating), self expanding, flexible, 40mm, 10 x 60mm, 10 x 80mm

  Model numbers: 4356, 4357, 4358, 4359

 Five Corners Pty Ltd

FC001 Endoluminal Stent Graft and Delivery  Multiple sizes of stent graft on pre-loaded Dia 15-27mm, Length 87- $10,000.00

  catheter shaft for delivery and

 deployment, comprised of Pet & Nitinol

 Medtronic Australasia Pty Ltd

MC145 Medtronic Aust Stents, Sterile Medtronic AneuRx Aortic or Iliac Cuff  12-16mm x 5.5/8.5/11.5mm,  $3,300.00

 Stent  - Nitinol / Polyester. 20-28mm x 3.75mm

MC152 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Straight  50-180mm $8,650.00 $9,018.00

 Abdominal Aortic Custom System. 

 Nitinol / Polyester, FreeFlow/Open Web.

 Custom Sizing

Prostheses List by Category, Groups and Sponsor Page 745 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

MC153 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Aorto- 16-50mm $13,050.00

 Unilliac Tapered Custom System.  Nitinol

 / Polyester. Custom Sizing

MC155 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft  50-180mm $10,900.00 $11,372.00

 Descending Thoracic Aortic Custom

 System.  Nitinol / Polyester, FreeFlow /

 Open Web. Custom Sizing

MC157 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Trombone 16-50mm $15,000.00 $15,744.00

  Aortic Custom System.  Nitinol /

 Polyester. Free Flo/Open Web. Custom

MC158 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System   18 - 36mm x 28 - 32mm long  $3,761.90

 Nitinol / Polyester (60mm)

MC159 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System   26 - 46mm x 80 - 90mm $4,863.50

 Nitinol / Polyester;  Talent Endoluminal

 Stent Graft System  FreeFlow, Open

 Web. Nitinol / Polyester

MC160 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft System   8-26mm x 75-200mm $4,049.00

 Nitinol / Polyester. Open Web

MC203 Talent Occluder System Nitinol stents attached to polyester graft  Standard Sizes, 8 - 24mm x 31 - $2,170.00

 sealed both ends  35mm

MC206 Medtronic Aust Stents Sterile Talent thoracic stent graft system,  22-46mm x 22-46mm x 130mm $11,055.00

 FreeFlow / Open Web, bare spring,

 Terumo Corporation Australia

TU003 Anaconda Endovascular Graft System Aortic Extension Cuff, Polyester/Nitinol 18 - 32mm $2,710.00

TU004 Anaconda Endovascular Graft System Iliac Extension Cuff, Polyester/Nitinol 8 - 16mm $2,980.00

TU005 Anaconda Endovascular Graft System Iliac Leg, Polyester/Nitinol 8 - 16mm $3,450.00

 W L Gore & Associates

GT020 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm  $3,270.00

 Diameter, 5cm Length;

 Hemobahn 6 - 13mm Diameter,

Prostheses List by Category, Groups and Sponsor Page 746 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT021 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm  $3,995.00

 Diameter, 10cm Length;

 Hemobahn 6 - 13mm Diameter,

GT022 Viabahn/Hemobahn Endoprosthesis Endoluminal Graft System Viabahn 2.5mm - 8mm  $4,530.00

 Diameter, 15cm Length;

 Hemobahn 6 - 11mm Diameter,

GT023 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE 26-40mm Diameter x 15-20cm  $14,500.00

 Lengths

GT029 Gore Tips Endoprosthesis ePTFE 8-12mm Diameter 4-8cm Graft- $4,120.00

 Lined Length 2cm Unlined Length

GT189 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 23 - 28.5mm, Length  $3,100.00

  Aortic Extender 3.3cm

GT190 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 10 - 14.5mm, Length  $3,700.00

  Iliac Extender

GT191 Excluder Endovascular Prostheses Thoracic Stent Graft Nitinol & ePTFE Diameter 26-40mm x  10cm  $13,400.00

 William A Cook Aust Pty Ltd

WC042 Zenith AAA Endovascular Graft - Custom AAA Aorto Uni Iliac (AUI) Graft Neck 20-32mm Length 74- $10,200.00

  Craft

WC045 Cook H & L-B - Endostent  Converter Diameter 20 thru 36 Length 80- $817.88

WC047 Cook H & L-B - Endostent  Leg Extensions  Diameter 18 thru 24 Length 55 $2,750.00

WC048 Cook H & L-B - Endostent  Body Extensions Diameter 22 thru 36 $2,750.00

WC051 Cook H & L-B - Endostent - Tri-Fab Leg Extension Diameter  10-12 Length 36-71 $2,750.00

WC103 Zenith Iliac Plug Zenith AAA Endovascular Graft Diameter 14, 16, 18, 20, 22,  $2,750.00

WC157 Zenith TAA Endovascular Graft Thoracic - TX2 One size only $17,600.00

WC159 Zenith TAA Endovascular Graft Thoracic - TX1 One size only $10,800.00

Prostheses List by Category, Groups and Sponsor Page 747 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC160 Zenith TAA Endovascular Graft Thoracic Proximal Extension Dia 22 Length 77; Dia 24  $6,150.00

 Length 77;Dia 26 Length 77;

 Dia 28 Length 80; Dia 30

 Length 80; Dia 32 Length 80;

 Dia 34 Length 77; Dia 36

 Length 77; Dia 38 Length 77;

 Dia 40 Length 81

WC186 ZenithThoracic Endovascular Graft Thoracic Proximal Graft 22mm to 42mm diameter;  $8,800.00

 115mm to 216mm length

WC187 Zenith Thoracic Endovascular Graft Thoracic Distal Graft 26mm to 42mm diameter;  $8,800.00

 127mm to 207mm length

WC188 Zenith Thoracic Endovascular Graft Thoracic Body Extension 22mm to 42mm diameter;  $6,000.00

 77mm to 81mm length

WC209 Zenith Composite AAA Endovascular  Proximal Composite Body 1 or 2 internal Stents, 24-36mm  $4,700.00

 diameter, 73-129mm Length

WC211 Zenith Fenestrated AAA Endovascular  Proximal Fenestrated Body 1 or 2 internal Stents, 24-36mm  $8,525.00

 Diameter, 73-129mm Length

 Group 2b - Bifurcated

 Medtronic Australasia Pty Ltd

MC143 Medtronic Stents, Sterile Medtronic AneuRx Aortic / Illiac Stent  -  20-28mm x 12-16mm x 13- $12,150.00

 Nitinol / Polyester:                                

                                     

MC148 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated 18-36 x 8-18 x 140-170mm $12,150.00

  System. Nitinol / Polyester

MC150 Medtronic Aust Stents, Sterile Talent Endoluminal Stent Graft Bifurcated 16-50mm $12,915.00 $13,561.00

  System. Nitinol / Polyester, FreeFlow /

 Open  Web.  Custom Sizing

 Terumo Corporation Australia

TU002 Anaconda Endovascular Graft System Bifurcated Aortic System,  18 - 32mm $12,150.00

Prostheses List by Category, Groups and Sponsor Page 748 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 W L Gore & Associates

GT024 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - 23-28.5mm Diameter, 14-18cm  $7,440.00

  Trunk - Ipsilateral Leg Length

GT188 Excluder Endovascular Prostheses Abdominal Stent Graft Nitinol & ePTFE - Diameter 12 - 14.5mm x 10 x  $5,300.00

  Contralateral Leg 14cm Length

 William A Cook Aust Pty Ltd

WC049 Cook H & L-B - Endostent - Tri-Fab Body Extension  Diameter 22-32 mm Length  $4,770.00

 112-239mm

WC133 Zenith Flex AAA Endovascular Graft -  Stainless steel Dia 22 - 32mm, length 82 -  $5,675.00

 body only

WC153 Zenith AAA Endovascular Graft Composite One size only $12,500.00

WC156 Zenith AAA Endovascular Graft ZFEN-1000 Fenestrated One size only $15,800.00

WC210 Zenith Fenestrated AAA Endovascular  Distal Fenestrated Body Diameter 12-24mm, 1st length  $4,700.00

 28-62mm, 2nd length 76-

Group 3 - Grafts

 Group 3a - Tube

 Advanced ORT Pty Ltd

OA004 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 40cm $1,250.00

 Vascular Access Graft

OA005 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 50cm $1,250.00

 Vascular Access graft

OA006 Thoratec, Vectra Vascular Graft -  Vectra, Biocompatible Polyurethane  Length 20cm $834.00

 Vascular Access Graft

 Atrium Australia-Pacific Rim Pty Ltd

AC001 Atrium PTFE Vascular Graft Radially Supported (Ringed) PTFE  4mm x 10cm - 10mm x 100cm $1,688.00

 Standard Wall

AC002 Atrium PTFE Vascular Graft Straight PTFE Standard Wall 6mm x 10cm - 10mm x 90cm $1,648.00

AC004 Atrium PTFE  Vascular Graft Vascular Access Graft PTFE Standard  4mm x 10cm - 10mm x 100cm $1,218.00

AC012 Atrium PTFE Vascular Graft Radially Supported (Ringed) PTFE Thin  4mm x 10cm - 10mm x 100cm $3,275.00

Prostheses List by Category, Groups and Sponsor Page 749 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

AC013 Atrium PTFE Vascular Graft Straight PTFE Thin Wall 6mm x 10cm - 10mm x 90cm $2,175.00

AC015 Atrium PTFE Vascular Graft Vascular Access Graft PTFE Thin Wall 4mm x 10cm - 10mm x 100cm $1,805.00

AC018 Atrium Ultramax PET Grafts Straight Polyster Graft 6mm x 15cm  - 24mm  x 30cm $1,087.00

AC019 Atrium Ultramax PET Grafts Straight Polyster Graft 6mm x 40cm  - 8mm  x 100cm $1,215.00

AC020 Atrium Hybrid PTFE Vascular Graft Vascular Access Graft PTFE Thin Wall  6mm x 10cm - 10mm x 100cm $3,525.00

 (Ringed)

AC021 Atrium Hybrid PTFE Vascular Graft Radially Supported PTFE Thin Wall 4mm x 100cm - 10mm x  $3,925.00

 100cm;  16mm - 24mm x 30cm

  length (Straight);  12mm -

 24mm x 6mm - 12mm Length -

 B Braun Australia Pty Ltd

BB019 Vascular Uni - Graft   Vascular graft 60cm $665.00

BB021 Vascular Uni - Graft   Vascular graft 40cm $645.00

BB022 Vascular Uni - Graft  Vascular graft 30cm $520.00 $595.00

BB023 Vascular Uni - Graft   Vascular graft 20cm $470.00 $649.00

BB024 Vascular Uni - Graft   Vascular graft 15cm $391.00 $430.00

BB025 Vascular Uni - Graft   Vascular graft 10cm $392.00

BB120 Vascugraft Straight Standard Wall with Helix Support Dia 6 - 10mm, length 10 - 50cm $1,300.00

BB121 Vascugraft Straight Standard Wall with Helix Support Dia 6 - 10mm, length 60 - 80cm $1,663.00

BB122 Vascugraft Straight Standard Wall with Helix Support Dia 5 - 8mm, length 90cm $2,000.00

BB123 Vascugraft PTFE - Straight Standard Wall Dia 5 - 10mm, length 80cm $1,430.00

BB124 Vascugraft PTFE - Straight Standard Wall Dia 5 - 8mm, length 90 - 100cm $1,800.00

BB125 Vascugraft Thin Wall Straight Dia 3 - 8mm, length 70 - 100cm $2,000.00

BB126 Vascugraft Thin Wall Straight Dia 3 - 8mm, length10 - 40cm $1,019.00

BB127 Vascugraft Thin Wall Straight Dia 3 - 8mm, length 10 - 40cm $1,019.00

BB130 Vascugraft Straight Standard Wall with Helix Support Dia 4 - 6mm, length 50 - 70cm $1,300.00

BB133 Vascugraft Thin Wall Centre Helix Dia 5 - 6mm, length 45 - 50cm $1,125.00 $1,200.00

Prostheses List by Category, Groups and Sponsor Page 750 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BB134 Vascugraft Thin Wall Centre Helix Dia 4 - 8mm, length 70 - 80cm $1,708.00

BB141 Vascugraft Easy Glide - Standard Wall Straight Dia 6mm, length 70 - 80cm $1,195.00 $1,240.00

BB142 Vascugraft Easy Glide - Standard Wall Straight Dia 6mm, length 40 - 60cm $1,010.00 $1,100.00

BB144 Vascugraft Easy Glide - Thin Wall Straight Dia 6 - 8mm, length 40 - 70cm $1,295.00

BB146 Vascugraft Easy Glide - Thin Wall Straight with Helix Dia 6 - 8mm, length 40 - 80cm $1,588.00

  Support

 Bard Australia Pty Ltd

BA011 Grafts Vascular Polyester soft-woven graft - bifurcated 13mm - 25mm diameter aortic  $855.00

 diameter, 6.5mm - 12.5 mm

 Iliac/Femoral diameter

BA012 Grafts Vascular Polyester knitted grafts - bifurcated 12mm - 24mm Aortic diameter,  $1,100.00

 6mm - 12mm Iliac/Femoral

 diameter

BA014 Grafts Vascular Axillo-bifemoral polyester graft 8mm-10mm diameter, 50cm-  $1,350.00

 100cm length

BA015 Grafts Vascular Intraluminal polyester graft 20mm - 29mm diameter, 4cm -  $1,700.00

 8cm length

BA017 Grafts Vascular Polyester grafts - straight 5mm - 25mm diameter, 50cm- $700.00

 75cm length

BA018 Exs Bionit Vascular Grafts Polyester graft - EXS 8mm - 10mm diameter, 35cm  $1,648.00

BA019 Impra PTFE Vascular Grafts  ePTFE graft - radially supported, thin  4mm - 8mm diameter $1,700.00

 wall, 10 - 50cm long

BA020 Impra PTFE Vascular Grafts  ePTFE graft - thin wall, 10 - 50cm long 3mm - 10mm diameter $1,081.00

BA021 Impra PTFE Vascular Grafts ePTFE graft - radially supported, thin  4 - 8mm diameter $2,300.00

 wall, greater than 50cm long

BA022 Impra PTFE Vascular Grafts ePTFE graft - radially supported, regular  4 - 19mm diameter $1,600.00

 wall, 10-50cm long

BA023 Impra PTFE Vascular Grafts ePTFE graft - radially supported, regular  4 - 10mm diameter $2,000.00

 wall, greater than 50cm long

BA025 Impra PTFE Vascular Grafts ePTFE graft - regular wall, 10-50cm long 3 - 19mm diameter $1,040.00

Prostheses List by Category, Groups and Sponsor Page 751 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA026 Impra PTFE Vascular Grafts ePTFE graft - regular wall, greater than  3 - 10mm diameter $1,450.00

 50cm long

BA027 Impra PTFE Vascular Grafts  Distaflo ePTFE graft with preformed cuff 6-10mm diameter, 40 - 80cm  $1,700.00

BA028 Impra PTFE Vascular Grafts Distaflo ePTFE graft with preformed cuff 6-10mm diameter, 40 - 80cm  $2,250.00

  and flex support

BA029 Impra PTFE Vascular Grafts  Venaflo ePTFE graft with preformed cuff 4mm - 8mm diameter, 10cm -  $1,260.00

 50cm length

BA030 Impra PTFE Vascular Grafts Venaflo ePTFE graft with preformed cuff 4mm - 8mm diameter, 10cm -  $1,500.00

  and flex support 50cm length

BA171 Dynaflo AK Bypass Graft PTFE Graft 7 & 8mm diameter. 50, 60, 70,  $2,270.00

 80cm lengths

 Edwards Lifesciences Pty Ltd

EL001 PTFE Vascular Graft Expanded, reinforced  5-10mm x 10cm $210.00 $350.00

 Polytetrafluoroethylene. Straight, Regular

EL002 PTFE Vascular Graft Expanded, reinforced  5-10mm x 20cm $335.00 $450.00

 Polytetrafluoroethylene. Straight, Regular

EL003 PTFE Vascular Graft Expanded, reinforced  5-10mm x 50cm $840.00 $950.00

 Polytetrafluoroethylene. Straight, Regular

EL004 PTFE Vascular Graft Expanded, reinforced  5-10mm x 80cm $1,160.00

 Polytetrafluoroethylene. Straight, Regular

EL007 PTFE Vascular Graft Expanded, reinforced  5-10mm x 50cm $910.00 $1,100.00

 Polytetrafluoroethylene. Straight, Regular

 Wall, Spiral Externally Supported

EL008 PTFE Vascular Graft Expanded, reinforced  5-10mm x 80cm $1,240.00 $1,500.00

 Polytetrafluoroethylene. Straight, Regular

 Wall, Spiral Externally Supported

EL009 PTFE Vascular Graft Expanded, reinforced  5-10mm x 10cm $215.00 $235.00

 Polytetrafluoroethylene. Straight, Thin

EL010 PTFE Vascular Graft Expanded, reinforced  5-10mm x 20cm $335.00 $345.00

 Polytetrafluoroethylene. Straight, Thin

EL011 PTFE Vascular Graft Expanded, reinforced  5-10mm x 50cm $865.00 $885.00

 Polytetrafluoroethylene. Straight, Thin

Prostheses List by Category, Groups and Sponsor Page 752 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EL012 PTFE Vascular Graft Expanded, reinforced  5-10mm x 80cm $1,120.00 $1,200.00

 Polytetrafluoroethylene. Straight, Thin

EL015 PTFE Vascular Graft Expanded, reinforced  5-10mm x 50cm $910.00 $1,100.00

 Polytetrafluoroethylene. Straight, Thin

 Wall, Spiral Externally Supported

EL016 PTFE Vascular Graft Expanded, reinforced  5-10mm x 80cm $1,240.00 $1,500.00

 Polytetrafluoroethylene. Straight, Thin

 Wall, Spiral Externally Supported

 Incision Pty Ltd

IP012 Jotec Flowline Bipore Vascular Graft Thin Wall 40 & 50cm $1,100.00

IP014 Jotec Flowline Bipore Vascular Graft Standard Wall 80cm $850.00

IP015 Jotec Flow Weave Vascular Graft Flow Weave 30cm $550.00

IP016 Jotec Flow Weave Vascular Graft Flow Weave 60cm $700.00

IP017 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 15cm $600.00

IP018 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 30cm $750.00

IP019 Jotec Flow Weave Vascular Graft Flow Weave BioSeal 60cm $1,000.00

IP024 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes up to 50cm in Length $870.00

 Graft, Straight, Thin Wall structure.  Thin Wall

IP025 Jotec Flowline Bipore ePTFE Vascular  ePTFE Vascular Graft with microporous  All sizes at over 50cm in length $1,100.00

 Graft, Straight, Thin Wall structure.  Thin Wall

IP026 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are  For all diameters in 30cm lengths $430.00

  Grafts, Straight Grafts texturised exterior yarns for superior

 tissue incorporation and healing

 characteristics, with the new Bioseal

 impregnation to make the grafts blood

IP027 Jotec Flow Nit Bioseal Polyester Vascular Flow Nit Bioseal Straight grafts are  For all diameters in 15cm lengths $540.00

  Grafts, Straight Grafts texturised exterior yarns for superior

 tissue incorporation and healing

 characteristics, with the new Bioseal

 impregnation to make the grafts blood

Prostheses List by Category, Groups and Sponsor Page 753 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

IP034 Jotec Flowline Bipore, thin wall with  ePTFE thin wall with spiral reinforcement 50cm $865.00

 spiral reinforcement with Heparin  with Heparin (vascular graft, synthetic)

IP035 Jotec Flowline Bipore, thin Wall with  ePTFE thin wall with Heparin (vascular  80cm $1,120.00

 graft, synthetic)

 St. Jude Medical Australia Pty Ltd

SJ041 Intergard W Woven Straight 6mm x 30cm  -  38mm x 30cm $1,055.00

SJ044 Intergard K Knitted Straight 6mm x 40cm - 24mm x 40cm $950.00

SJ046 Intergard K Knitted Radially Supported 6mm x 70cm - 8mm x 60cm $1,550.00

 Terumo Corporation Australia

TU006 Twillweave Graft Straight, Polyester, Woven, Unsealed 6-24mm x 50-60cm $640.00

TU008 Fluoropassiv Graft Straight Graft - Thin Wall, Crimped.  6 to10mm x 30cm $1,199.00

 Fluoropolymer/polyester, Knitted

TU009 Fluoropassiv Graft Straight Graft - Thin Wall, Crimped.  6 to10mm x 40 to 70cm $1,669.00

 Fluoropolymer/polyester, Knitted

TU010 Fluoropassiv Graft Straight Graft, Thin Wall, Externally  6 to10mm x 30cm $1,420.00

 Reinforced. Fluoropolymer/polyester,

TU011 Fluoropassiv Graft Straight Graft, Thin Wall, Externally  6 to10mm x 40 to 70cm $1,842.00

 Reinforced. Fluoropolymer/polyester,

TU015 Gelsoft Plus Graft Polyester, Externally Reinforced, Knitted 6 to 10mm x 40cm $1,155.00

TU016 Gelsoft Plus Graft Polyester, Externally Reinforced, Knitted 6 to 10mm x 75m $1,515.00

TU017 Gelsoft Plus Graft Polyester, Externally Reinforced, Knitted 6 to 10mm x 100cm $1,635.00

TU019 Gelsoft Plus Graft Femorofemoral, Polyester, Knitted 6mmx30cm to  8mmx40cm $900.00 $930.00

TU020 Gelsoft Plus Graft Straight, Polyester, Knitted 6 - 24mm x 12.5 - 30cm $675.00 $725.00

TU021 Gelsoft Plus Graft Straight, Polyester, Knitted 6-24mm x 50-60cm $720.00 $770.00

TU022 Gelweave Graft Straight, Polyester, Woven 10-34mm x 20-30cm $695.00 $725.00

TU023 Gelweave Graft Straight, Polyester, Woven 10-34mm x 40-60cm $740.00 $770.00

TU025 SEALPTFE Graft Thin Wall, Straight, Sealed, PTFE 6 to 8mm x 10 to 40cm $1,110.00

TU026 SEALPTFE Graft Thin Wall, Straight, Sealed, PTFE 6 to 8mm x 50 to 80cm $1,720.00

Prostheses List by Category, Groups and Sponsor Page 754 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TU027 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 6 to 8mm x 10 to 40cm $950.00

TU028 SEALPTFE Graft Standard Wall, Straight, Sealed, PTFE 6 to 8mm x 50 to 70cm $1,250.00

TU029 SEALPTFE Graft Standard Wall, Straight, Sealed,  6 to 10mm x 10 to 40cm $1,340.00

 Externally Reinforcement, PTFE

TU030 SEALPTFE Graft Standard Wall, Straight, Sealed,  6 to 10mm x 50 to 70cm $1,600.00

 Externally Reinforcement, PTFE

TU031 SEALPTFE Graft Thin Wall, Straight, Sealed, Externally  6 to 10mm x 10 to 40cm $1,593.00

 Reinforced, PTFE

TU032 SEALPTFE Graft Thin Wall, Straight, Sealed, Externally  6-10mm x 60-80cm $2,000.00

 Reinforced, PTFE

TU035 SEALPTFE Graft Thin Wall, Straight, Sealed externally  6 - 10mm x 50cm $1,759.00

 Reinforced, Vascular Artificial

 Arteries/Prostheses of PTFE, Sealed with

  Gelatin

TU036 Gelweave Valsalva Graft Woven vascular prosthesis, polyester,  Diameter 26 - 32 mm, Overall  $3,250.00 $3,528.50

 gelatin sealed length 18.6 - 19.2 cm

TU039 Rapidax™ Rapid Access Haemodialysis Triple layered self sealing haemodialysis  6mm x 20-50cm $1,300.00 $1,400.00

 Access Graft. ePTFE internal and

 external layer with proprietary elastomer

 inner layer - Straight

TU040 Rapidax™ Rapid Access Haemodialysis Triple layered self sealing haemodialysis  6mm x 30-50cm $1,300.00 $1,400.00

 Access Graft. ePTFE internal and

 external layer with proprietary elastomer

 inner layer - Per-curved

 W L Gore & Associates

GT007 Gore-Tex Vascular Ring Graft Ringed Grafts Fixed THIN WALL  6-10mm Diameter x 30-70cm  $1,610.00

 STRETCH (ePTFE) Lengths - Ringed Section 20-

 50cm Lengths

GT008 Gore-Tex Vascular Ring Graft Ringed Grafts REMOVABLE THIN  6-8mm Diameter x 80cm  $2,080.00

 WALL STRETCH (ePTFE) Length - Ringed Section 70cm

GT009 Gore-Tex Vascular Grafts Vascular Grafts - Aorto -Pulmonary &  3.5-5mm Diameter x 15-20cm  $320.00

 Systemic-Pulmonary Shunts (ePTFE) Length

Prostheses List by Category, Groups and Sponsor Page 755 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT011 Diastat Vascular Access Graft Dyalysis Grafts (ePTFE) 4-7mm & 6mm Diameter x 40- $1,051.00

 45cm Lengths

GT131 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 70cm $960.00

GT132 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 4 - 8mm, Length  $194.00

GT133 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 20 - $452.00

  30cm

GT134 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 50cm $690.00

GT135 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 60cm $750.00

GT136 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 80cm $1,120.00

GT137 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 90 - $1,230.00

  100cm

GT138 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 8mm, Length  $191.00

GT139 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 20 - $450.00

  30cm

GT140 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 40cm $625.00

GT141 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 50cm $700.00

GT142 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 60cm $810.00

GT143 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 70cm $825.00

GT144 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 80cm $1,120.00

GT145 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 90 - $1,260.00

  100cm

GT146 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length  $412.00

GT147 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length  $525.00

GT148 Gore-tex Vascular Grafts Standard Wall Grafts Stretch (ePTFE) Diameter 12 - 24mm, Length  $775.00

GT149 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 10cm $232.00

GT150 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 20cm $322.00

GT151 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 30cm $500.00

Prostheses List by Category, Groups and Sponsor Page 756 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT152 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 40cm $705.00

GT153 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 50cm $885.00

GT154 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 60cm $1,091.00

GT155 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 70cm $1,185.00

GT156 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 80cm $1,340.00

GT157 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 90 - $1,450.00

  100cm

GT158 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 4 - 10mm, Length 10cm $250.00

GT159 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 20cm $355.00

GT160 Gore-tex Vascular Grafts Thin Wall Grafts Stretch (ePTFE) Diameter 6 - 10mm, Length 30cm $556.00

GT161 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 6 - 10mm, Length 40cm $655.00

GT162 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 50cm $830.00

GT163 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 3 - 10mm, Length 60cm $950.00

GT164 Gore-Tex Vascular Grafts Thin wall grafts (ePTFE) Dia 3 - 10mm, length 70cm $1,112.00

GT165 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 80cm $1,255.00

GT166 Gore-tex Vascular Grafts Thin Wall Grafts (ePTFE) Diameter 4 - 10mm, Length 90 - $1,400.00

  100cm

GT167 Gore-tex Vascular Grafts Vascular Grafts - Aorto-Pulmonary &  Diameter 3.5 - 5mm, Length  $216.00

 Systemic-Pulmonary Shunts (ePTFE)

 Stretch & Non Stretch

GT168 Gore-tex Vascular Grafts Vascular Grafts - Aorto-Pulmonary &  Diameter 3.5 - 5mm, Length  $257.00

 Systemic-Pulmonary Shunts (ePTFE)

 Stretch & Non Stretch

GT176 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Standard & Thin  Diameter 6 - 10mm x 30 - 70cm $1,215.00

 Wall (ePTFE)  Length ,Ringed Section 20 -

 50cm Lengths

GT177 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Thin Wall & Ringed  Diameter 6 - 10mm x 30 - 70cm $1,555.00

 Standard Wall (ePTFE)  Length,  Ringed Section 20 -

 50cm Lengths

Prostheses List by Category, Groups and Sponsor Page 757 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT178 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6 - 8mm x 60 - 70cm  $1,570.00

 Length,  Ringed Section 30cm

 Length

GT179 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 5 - 6mm x 70cm  $1,870.00

 Length,  Ringed Section 60cm

GT180 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 5 - 6mm x 80cm  $2,000.00

 Length, Ringed Section 60cm

GT181 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Standard Wall &  Diameter 6 - 10mm x 30 - 70cm $1,535.00

 Stretch  Standard Wall (ePTFE)  Lengths, Ringed Section 20 -

 50cm Lengths

GT182 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6mm, Lengths 80 - 90 $2,175.00

  cm, Ringed Section 60cm

GT183 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 8mm, Lengths 80 - 90 $2,220.00

  cm, Ringed Section 70cm

GT184 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6 - 8mm x 70cm  $1,590.00

 Stretch (ePTFE) Length, Ringed Section 30cm

GT185 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6mm x 80cm Length,  $1,745.00

 Stretch (ePTFE) Ringed Section 30cm Length

GT186 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6mm x 70cm Length,  $1,880.00

 Stretch (ePTFE) Ringed Section 60cm Length

GT187 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall  Diameter 6 - 8mm x 70cm  $1,995.00

 Stretch (ePTFE) Length, Ringed Section 60 -

GT193 Gore-tex Vascular Grafts Standard  Wall Grafts (ePTFE) 6-10mm Diameter x 40cm  $589.00

GT195 Gore-tex Vascular Graft Standard wall grafts (ePTFE) Diameter 6mm x 20cm length $314.00

GT196 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin wall  Diameter 4-6mm x 10-15cm,  $670.00

 (ePTFE) ringed section 2.5-5cm lengths

GT197 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin wall  Diameter 8mm x 30cm, ringed  $830.00

 (ePTFE) section 20cm length

GT198 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin wall  Diameter 5-8mm x 60-70cm,  $1,420.00

 (ePTFE) ringed section 20-30cm lengths

GT199 Gore-tex Vascular Ring Graft Ringed grafts fixed thin wall stretch  Diameter 6-8mm x 60-80cm,  $1,555.00

 ringed section 20-30cm lengths

Prostheses List by Category, Groups and Sponsor Page 758 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT200 Gore-tex Vascular Graft Standard wall grafts stretch (ePTFE) Diameter 6-12mm x 20cm  $314.00

GT211 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of a  Dia 6-8mm, 40cm radial  $1,650.00

 stretch thin walled graft supported length x 40cm length

GT212 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of a  Dia 6-8mm, 60cm radial  $1,980.00

 stretch thin walled graft supported length x 60cm length

GT213 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of a  Dia 6-8mm, 80cm radial  $2,220.00

 stretch thin walled graft supported length x 80cm length

GT215 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall of a  Dia 6mm, 5cm radial supported  $825.00

 stretch and non-stretch walled graft length x 45cm length - non-

GT218 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6mm diameter 30cm Removable $1,870.00

  Ring - 70cm length

GT219 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6mm diameter 60cm Removable $2,210.00

  Ring - 70cm length

GT220 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6-8mm diameter 60-70  $1,920.00

 Removable Ring - 80cm length

GT221 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6-8mm diameter Non-Ringed  $840.00

 40cm length

GT222 Gortex Propaten Vascular Graft Stretch Thin Wall Graft (ePTFE) 6-8mm diameter Non-Ringed  $1,260.00

 80cm length

 Heparin

 Incision Pty Ltd

IP020 Jotec Flowline Bipore Heparin ePTFE  ePTFE Vascular Graft with microporous  All sizes up to 50cm in length $950.00

 Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin

IP021 Jotec Flowline Bipore Heparin ePTFE  ePTFE Vascular Graft with microporous  All sizes at over 50cm in length $1,300.00

 Vascular Graft Straight, Standard Wall structure. Standard Wall with Heparin

 Reinforced

 Incision Pty Ltd

IP013 Jotec Flowline Bipore Vascular Graft Standard Wall with Spiral Reinforcement 70 & 80cm $1,300.00

Prostheses List by Category, Groups and Sponsor Page 759 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Reinforced, Heparin

 Incision Pty Ltd

IP022 Jotec Flowline Bipore Heparin ePTFE  ePTFE Vascular Graft with microporous  All sizes up to 50cm Length $1,100.00

 Vascular Graft Straight, Standard Wall  structure. Standard Wall with Heparin and

 with Reinforcement  Reinforcement

IP023 Jotec Flowline Bipore Heparin ePTFE  ePTFE Vascular Graft with microporous  All sizes at over 50cm in Length $1,500.00

 Vascular Graft Straight, Standard Wall  structure. Standard Wall with Heparin and

 with Reinforcement  Reinforcement

 Reinforcing

 Incision Pty Ltd

IP011 Jotec Flowline Bipore Vascular Graft Thin Wall with Spiral Reinforcement 40 & 50cm $1,700.00

 Group 3b - Bifurcated

 Atrium Australia-Pacific Rim Pty Ltd

AC016 Atrium Ultramax PET Grafts Bifurcate Polyster Graft 12mm x 24mm - 6mm x 12mm  $942.00 $1,440.00

 x 40cm

 B Braun Australia Pty Ltd

BB027 Vascular Uni - Graft - Bifurcated Vascular graft 12x7 to 12x12 $375.00

 St. Jude Medical Australia Pty Ltd

SJ042 Intergard W Woven Bifurcated 18mm x 9mm  -  24mm x  $1,000.00

SJ045 Intergard K Knitted Bifurcated 12mm x 6mm - 24mm x 12mm $1,000.00

 Terumo Corporation Australia

TU007 Twillweave Graft Bifurcate, Polyester, Woven, Unsealed 12mm x 6mm x 45cm to 24mm $885.00

  x 12mm x 45cm

TU013 Gelweave Graft Bifurcated, Polyester, Woven 12mmx 6mmx 45 cm to  $942.00

 24mmx12mm x 45cm

TU014 Gelsoft Plus Graft Bifurcated, Polyester, Knitted 12mmx6mmx45cm to  $942.00

 24mmx12mmx45cm

Prostheses List by Category, Groups and Sponsor Page 760 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

TU018 Gelsoft Plus Graft Axillofemoral, Polyester, Knitted 8x8mm/100x60cm;  $1,900.00

 8x7mm/90x40cm;

 10x8mm/90x40cm

 W L Gore & Associates

GT002 Gore-Tex Axillo-Bifemoral Vascular Graft ePTFE 70 - 40cm Length 8 x 8mm  $1,900.00

 Diameter

GT003 Gore-Tex Axillo-Bifemoral Vascular Graft ePTFE 70 - 40cm Length 8 x 8mm  $1,900.00

  with Removable Rings  Diameter

GT006 Gore-Tex Bifurcated Graft ePTFE 12x6mm to 24x12mm 40-50cm  $930.00

 long

 Group 3c - Branched or Fenestrated

 Atrium Australia-Pacific Rim Pty Ltd

AC017 Atrium Ultramax PET Grafts Axillo-bifemoral Polyster Graft 8mm - 10mm  100 x 60cm $1,950.00 $2,250.00

 St. Jude Medical Australia Pty Ltd

SJ043 Intergard W Woven Aortic Arch 24mm x 10mm x 8mm x 8mm  $1,950.00

 x 50cm - 30mm x 10mm x

 8mm x 8mm

SJ047 Intergard K Knitted Axillobifemoral Diameter (mm) Length (cm) 8 x $1,950.00

  8 100/60; 10 x 10 100/60; 8 x 6

  x 6 85/55; 8 x 8 85/55; 8 x 8

 Terumo Corporation Australia

TU037 Gelweave Plexus Graft Multi Branched, for Aortic Arch  22 - 34 mm x 40 cm $2,100.00

 reconstruction, Polyester, Woven, gelatin

 sealed

 W L Gore & Associates

GT216 Gore-tex Axillobifemoral Vascular Graft Stretch vascular graft with removable  Diameter 8mm $1,950.00

 rings (ePTFE)

Prostheses List by Category, Groups and Sponsor Page 761 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 3d - Tapered (modified)

 Atrium Australia-Pacific Rim Pty Ltd

AC003 Atrium PTFE  Vascular Graft Tapered PTFE Standard Wall 4-6mm x 30cm - 6-8mm x  $1,320.00

AC014 Atrium PTFE Vascular Graft Tapered PTFE Thin Wall 4-6mm x 30cm - 6-8mm x  $1,600.00 $2,350.00

 B Braun Australia Pty Ltd

BB026 Vascular Uni - Graft - Tapered Vascular graft 12x6 to 24x12 $702.00

BB119 Vascugraft PTFE, Straight Standard Wall Dia 4 - 10mm, length 40 - 50cm $995.00

BB131 Vascugraft Thin Wall Tapered Dia 4 - 8mm, length 40 - 90cm $1,600.00 $1,750.00

BB136 Vascugraft Standard Tapered Dia 4 - 8mm, length 70 - 90cm $1,269.00

BB138 Vascugraft Standard with Short Taper Dia 4 - 8mm, length 30 - 70cm $1,300.00

BB145 Vascugraft Thin Wall Centred Helix Tapered Dia 4 - 7mm, length 70cm $1,600.00 $1,996.00

BB155 Vascugraft Standard Tapered Dia 4 - 7mm, length 30 - 70cm $916.00

BB156 Vascugraft Standard Wall with Tapered Centre Helix Dia 4 - 8mm, length 40 - 45cm $1,300.00 $1,385.00

BB157 Vascugraft Standard Wall Stepped Taper Dia 4 - 8mm, length 40 - 45cm $995.00 $1,050.00

 Bard Australia Pty Ltd

BA024 Impra PTFE Vascular Grafts ePTFE graft - thin wall, greater than  3 - 10 diameter $1,600.00

 50cm long

 Edwards Lifesciences Pty Ltd

EL017 PTFE Vascular Graft Expanded, reinforced  4-7mm x 50cm $1,200.00

 Polytetrafluoroethylene. Regular Wall,

EL018 PTFE Vascular Graft Expanded, reinforced  4-7mm x 50cm $1,200.00 $1,300.00

 Polytetrafluoroethylene. Regular Wall,

EL019 PTFE Vascular Graft Expanded, reinforced  4-7mm x 50cm $1,300.00 $1,400.00

 Polytetrafluoroethylene. Regular Wall,

EL020 PTFE Vascular Graft Expanded, reinforced  4-7mm x 40cm $1,200.00

 Polytetrafluoroethylene. Regular Wall,

Prostheses List by Category, Groups and Sponsor Page 762 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EL021 PTFE Vascular Graft Expanded, reinforced  4-7mm x 50cm $1,200.00

 Polytetrafluoroethylene. Regular Wall,

EL022 PTFE Vascular Graft Expanded, reinforced  4-7mm x 45cm $1,300.00 $1,400.00

 Polytetrafluoroethylene. Regular Wall,

 Quick Taper - 5cm Center Spiral

EL023 PTFE Vascular Graft Expanded, reinforced  4-7mm x 45cm $1,300.00 $1,550.00

 Polytetrafluoroethylene. Regular Wall,

EL025 PTFE Vascular Graft Expanded, reinforced  4-7mm x 70cm $1,300.00

 Polytetrafluoroethylene. Regular Wall,

EL026 PTFE Vascular Graft Expanded, reinforced  4-7mm x 70cm $1,300.00

 Polytetrafluoroethylene. Thin Wall,

 Terumo Corporation Australia

TU033 SEALPTFE Graft Standard Wall, Tapered, Sealed, PTFE 4 to 7mm Taper x 40 to 50cm $890.00

TU034 SEALPTFE Graft Standard Wall, Tapered, Sealed, Central  4 to 7mm Taper x 40 to 50cm $890.00 $990.00

 Reinforced, PTFE

 W L Gore & Associates

GT010 Gore-Tex  Vascular Graft THIN Wall Grafts TAPERED (ePTFE) 4.5-6.5 & 6-8mm Diameter x  $1,320.00

 80-90cm Lengths

GT169 Diastat Vascular Access Graft Dialysis Grafts - Standard & Stretch  6mm diameter x 45-50cm length $761.00

 Ringed (ePTFE)  Std & Stretch ringed dialysis

 graft/6mm diameter 5-10cm

 radial support length 20cm length

GT170 Diastat Vascular Access Graft Dialysis Grafts  (ePTFE) Diameter 4 - 7mm, Length 30 -  $816.00

 35cm

GT171 Gore-tex Vascular Grafts Standard Wall Grafts Stretch Tapered  Diameter 4-6mm & 4-7 mm,  $822.00

 Length 45 - 48cm

GT172 Gore-tex Vascular Grafts Standard Wall Grafts Stretch Tapered  Diameter 4-7 mm, Length 70cm $1,103.00

GT173 Gore-tex Vascular Grafts Standard Wall Grafts Tapered (ePTFE) Diameter 4-7 mm & 6-8mm,   $753.00

 Length 40 - 60cm

GT174 Gore-tex Vascular Grafts Ringed Grafts Removable Standard  4-7 mm x 45cm - Rings 10cm   $854.00

 Wall/Stretch Wall Tapered (ePTFE) Length

Prostheses List by Category, Groups and Sponsor Page 763 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT175 Gore-tex Vascular Grafts Ringed Grafts Removable Standard Wall  4-7 mm x 70cm - Rings 30cm   $1,300.00

 Tapered (ePTFE) Length

GT192 Gore-tex Vascular Grafts Standard Wall Grafts Tapered (ePTFE) 4.5-6.5mm & 6-8mm Diameter  $1,025.00

 x 70-90cm Lengths

GT194 Gore-tex Vascular Graft Standard wall grafts, tapered (ePTFE) Diameter 4.5-7mm, lengths 40- $590.00

 50cm

GT214 Gore-Tex Intering Vascular Graft Internally radially supported vascular  4-6 tapered diameter 38cm  $825.00

 graft (ePTFE) radial support length 45cm

 length; 4-7 tapered diameter

 38cm radial support length

 45cm length; 6mm diameter

 40cm radial support length

Group 4 - Patches

 Atrium Australia-Pacific Rim Pty Ltd

AC025 Atrium Ultramax Patches Knitted Double Velour Vascular Patch.   Size range 8mm x 75mm to  $266.00

 Composition is polyester impregnated  50mm x 152mm

 with absorbable gelatin

 B Braun Australia Pty Ltd

BB017 Vascular Patch Vascular patch 12x9 to 3x4 $205.00

 Bard Australia Pty Ltd

BA031 Grafts Vascular Polyester soft tissue patch 1mm thick  5cm x 10cm $150.00

BA032 Grafts Vascular Polyester soft tissue patch 1mm thick  10cm x 15cm $280.00

BA033 Grafts Vascular Polyester soft tissue patch 1mm thick  15cm x 20cm $380.00

BA035 Grafts Vascular PTFE Felt 2mm thick 5cm x 10cm $150.00

BA036 Grafts Vascular PTFE Felt 2mm thick 10cm x 15cm $280.00

BA037 Grafts Vascular PTFE Felt 2mm thick 15cm x 20cm $380.00

BA038 Grafts Vascular PTFE Felt 2mm thick 20cm x 30cm $450.00

Prostheses List by Category, Groups and Sponsor Page 764 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA039 Grafts Vascular Polyester pledgets Rectangle, Oval, Circle, Square  $85.00

 2.9mm-8mm x 6mm - 9.5mm

BA089 Impra PTFE Vascular Grafts  ePTFE Cardiovascular Patch 0.4mm Oval 20 x 90mm $199.00

BA090 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  100 x 150mm $748.00

BA091 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  50 x 75mm $364.00

 Rectangular

BA092 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  50 x 150mm $364.00

 Rectangular

BA093 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  30 x 30mm, 10 x 90mm, 30 x  $1,560.00

 Rectangular, Patch 0.4 Oval, Rectangular 60mm

BA095 Impra PTFE Vascular Grafts  ePTFE Cardiovascular, Patch 0.6mm,  25 x 150mm $307.00

 Rectangular

 Terumo Corporation Australia

TU012 Fluoropassiv Patch Thin wall, Fluoropolymer/polyester,  0.6 x 7.5cm to 1.5 x 7.5cm $245.00

TU024 Gelsoft Patch Polyester, Knitted 0.5 x 1.5cm to 10 x 1.5cm $182.00

Group 5 - Vessel Band

 Group 5a - Vessel Band

 Imthage Pty Ltd

IM001 Venous Valve Ring Dacron/silicone variable diameter ring 52mmx15mmx0.09 mm $900.00

Group 6 - Embolic Protection Device

 Group 6a - Venous, Retrievable

 B Braun Australia Pty Ltd

BB106 Temporary Vena Cava System Phynox/ combination of various metals  One size, expands to Max length $1,377.00

 inc. Nickel,Copper, Molubden,Steel  38mm/Max diameter 30mm

Prostheses List by Category, Groups and Sponsor Page 765 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Bard Australia Pty Ltd

BA009 Simon Filter Femoral - 2110F, Simon  Nitinol self expanding vena cava filter -  28mm Filter, 7Fr delivery $2,022.00

 Filter Jugular - 2210J, Simon Filter  "Simon Nitinol Filter"

 Anticubital - 2310A

BA010 Recovery Filter Femoral System Nitinol self expanding vena cava filter -  28mm Filter, 7Fr delivery $2,022.00 $3,300.00

 "Recovery Vena Cava Filter"

 Johnson & Johnson Medical Pty Ltd

JJ423 OPTEASE retrievable vena cava filter OPTEASE is a laser cut nitinol vena cava  Suitable for vessels up to 30mm $2,300.00

 filter, used to treat patients at high risk of

 pulmonary embolisation

 Medtronic Australasia Pty Ltd

MC715 Interceptor Plus Filter System Braided Nitol Filter: 3.5 - 6.5mm; Length:  $2,022.00

 180cm; Profile: 0.032 - 0.036"

 William A Cook Aust Pty Ltd

WC096 Cook Vena Cava Filter Universal Femoral and Jugular Filter Maximum Diameter 30mm,  $2,300.00

 Length 45mm

 Group 6b - Venous, Non-retrievable

 B Braun Australia Pty Ltd

BB169 Vena Cava Filter System PHYNOX Introducer system, 'J'  Diameter 28 mm $1,860.00 $2,022.00

 Guidewire, Seldinger needle, disposable

 William A Cook Aust Pty Ltd

WC043 Inferior Vena Cava Filter Birds Nest Vena Cava Filter Filter Catheter French Size 11.0  $1,962.00

 Length 40, 75 cm Introducer

 Sheath Assembly French Size

 12.0 Femoral/Jugular Approach

Prostheses List by Category, Groups and Sponsor Page 766 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 6c - Arterial

 Abbott Australasia Pty Ltd

AY018 Emboshield Embolic Protection Device, including  Filters 3, 4, 5, and 6mm, Large  $2,100.00 Temporary Approval pending

 delivery system, device specific  and Small.. Two wire lengths:  review of product group

 procedural wire, filter for capturing  190cm for Monorail systems

 embolic matter and retrieval system and 315cm for Over the Wire

 Boston Scientific Pty Ltd

BS084 Filterwire EZ Stainless steel wire 0.014", either 190cm  3.5mm - 5.5mm on 190cm  $2,100.00 Temporary Approval pending

 or 300cm long, radiopaque nose cone  delivery system review of product group

 from sheath - 6.5mm long and composed

  of pebax, polyurethane 110micron pore

 filter 1.5cm long, suspended nitinol loop,

 articulating and radiopaque, 3.2F sheath,

BS085 Filterwire EZ Stainless steel wire 0.014", either 190cm  3.5mm - 5.5mm on 190cm  $2,100.00 Temporary Approval pending

 or 300cm long, radiopaque nose cone  delivery system. 3.5mm -  review of product group

 from sheath - 6.5mm long and composed 5.5mm on 300cm delivery

  of pebax, polyurethane 110micron pore

 filter 1.5cm long, suspended nitinol loop,

 articulating and radiopaque, 3.2F sheath,

 ev3 Australia Pty Ltd

EE004 SpideRX Embolic Protection Device SpideRX Embolic Protection Device 3, 4, 5, 6, 7mm $2,100.00

 Johnson & Johnson Medical Pty Ltd

JJ445 ANGIOGUARD XP Emboli Capture  Distal protection device and delivery system Length: 300cm, diameter: 0.014, $2,100.00 Temporary Approval, pending

 Guidewire System  Basket sizes 4mm, 5mm, 6mm, review of product group

  7mm, and 8mm

JJ480 Angioguard RX Emboli Capture  Distal protection device and delivery system Length 180cm, Diameter  $2,100.00 $2,619.75 Temporary Approval pending

 Guidewire System 0.014"; basket sizes 4mm,  review of product group

 5mm, 6mm, 7mm and 8mm

Prostheses List by Category, Groups and Sponsor Page 767 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Medtronic Australasia Pty Ltd

MC370 GuardWire Plus Temporary Occlusion  GuardWire temporary occlusion balloon,  Length 200 and 300cm; Balloon  $2,100.00 Temporary Approval pending

 and Aspiration System MicroSeal adaptor, EZ Flator, Export  Occlusion Diameter: 3.0- review of product group

 Aspiration Catheter and filter. Materials:  6.0mm; Distal Tip Length:

 nitinol hypotube, a soft elastic polymer,  2.5cm; Guard Wire Shaft O.D:

 polycarbonate, polyurethane, stainless

 St. Jude Medical Australia Pty Ltd

SJ080 Proxis Embolic Protection System Proximal embolic protection device and  7F and 8F $2,100.00 Temporary listing pending review

 delivery system  of distal protection devices

Group 7 - Arterial Closure Devices

 Abbott Australasia Pty Ltd

AY016 Perclose Arterial Support and Closure  Suture to close femoral artery puncture  Closer S - 6-8Fr, Perclose AT -  $390.00

 sites following diagnostic and  6-8Fr, Prostar 8Fr, Prostar 10Fr

 interventional procedures

AY017 Starclose 6 Fr Exchange Sheath, Dilator,  6 Fr $390.00

 Guidewire, implantable nitinol clip pre-

 mounted on a Clip Applier

 Ackermann Australia Pty Ltd

AK001 Haemostatic Ligating Clips Titanium Ligating Clips small - large $7.80

 Medtel Australia Pty Ltd

ME107 Superstitch Suture Mediated Closure Device Sheath sizes: 6F and 8F $390.00 Temporary Approval

 Medtronic Australasia Pty Ltd

MC679 AngioLink Vascular Closure Device Titanium staple 6F - 8F $390.00

 St. Jude Medical Australia Pty Ltd

SJ014 Angio-Seal Vascular Closure Device -  Angio-Seal Haemostatic Puncture Closure 6F $400.00 Temporary approval

 STS Platform and STS Plus  Device, Models 6F-STS Platform and 6F

  STS Plus

Prostheses List by Category, Groups and Sponsor Page 768 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

SJ015 Angio-Seal Vascular Closure Device -  Angio-Seal Haemostatic Puncture Closure 8F $400.00 Temporary approval

 STS Platform and STS Plus  Device, Models 8F-STS Platform and 8F

  STS Plus

Group 8 - Occlusion Devices

 Bard Australia Pty Ltd

BA034 Grafts Vascular Polyester soft tissue patch 1mm thick  20cm x 30cm $450.00

 Group 8a - Particles

 Boston Scientific Pty Ltd

BS031 PVA/Contour SE for embolization and  Polyvinyl alcohol foam and delivery  45-150 micron, 150-250  $200.00

 delivery system system; Microcatheter for PVA delivery;  micron, 250-355 micron, 355-

 Delivery systems with nitinol braid,  500 micron, 500-710 micron,

 Polypropylene promixal, Polyethylene  710-1000 micron, 1000-1180

 distal. Contour Embolisation Particles,  micron, 150-175cm/3-25cm

 FasTracker, Tracker, TurboTracker,

BS034 PVA Particles (contour embolisation,  Polyvinyl alcohol foam with a hydrophilic 45-150 micron, 150-250  $200.00

 Contour SE   spherical shape for delivery improvements micron, 250-355 micron, 355-

 500 micron, 500-710 micron,

 710-1000 micron, 1000-1180

 Endotherapeutics Pty Ltd

ET007 Embospheres - 1ml per implant $200.00 $540.00

ET008 Embospheres - .5ml per implant $150.00 $342.00

 William A Cook Aust Pty Ltd

WC044 PVA Embolisation particles Embolization & Occlusion Particle Size Ranges (microns)  $200.00

 50-100, 100-200, 200-300,300-

 500, 500-700, 700-1000, 1000-

 1500, 1500-2000, 2000-2800

Prostheses List by Category, Groups and Sponsor Page 769 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Group 8b - Coils, Peripheral

 Boston Scientific Pty Ltd

BS021 Fibred Platinum Coils, Braided Occlusion  Platinum coil covered with dacron fibres.  Delivery device lengths up to  $1,250.00

 Device (BOD), Vortx Coils, Excelsior,  Delivery systems with nitinol braid,  175cm.  Sizes of coils Diameter

 Tracker, FasTracker, Turbotracker,  Polypropylene proximal, Polyethylene  2mm - 30mm and lengths 2mm

 Renegade, Spinnaker Elite - 100mm.

BS026 Braided Occlusion Device (BOD) Fibered  Platinum coil covered with dacron fibres Coils 2-30mm x3-60mm $140.00

 Platinum Coil

BS028 GDC Delivery Catheters Delivery systems with nitinol  braid,  150-175cm/3-25cm $700.00 Only to be funded when used

 Polypropylene promixal, Polyethylene  with a coil

 distal; Tracker 10 Unibody Infusion

 Catheter,  Fasttracker Vascular Access

 System, Turbo Tracker Infusion

 Catheter; Fastracker Vascular Access

 System; Turbo Tracker Infusion

 Catheters; Tracker Excel Microcatheter; 

 Renegade Fibre Braided Microcatheter; 

 Excelsior 1018 Microcatheter.

BS100 Matrix Detachable Coils Platinum/Tungsten alloy coils covered  Length: 2cm to 40cm, Diameter: $1,850.00

 with an absorbable PGLA copolymer   2mm to 24mm

 (90% Polyglycolic acid/ 10% Polylactic

 ev3 Australia Pty Ltd

EE007 Nexus Detachable Coils Nexus Tetris Diam 3-19mm, Length 4-29cm $1,850.00

EE008 Nexus Detachable Coils Nexus Multi Diameter Diam 2-10mm, Length 1-30cm $1,850.00

 William A Cook Aust Pty Ltd

WC037 Coil - Embolisation MWCE Standard Stainless Steel Diameters: .025, .035, .038 and  $111.00

 .052, Extended Lengths: 1cm to

 20cm, Coil Taper Diameters:

 2mm to 10mm

WC038 Coil - Embolisation Coils MWCE- Tornado Platinum Diameters: .018, .035 and .038,  $214.00

 TORNADO Coil Taper Diameters: 2mm to

 10mm

Prostheses List by Category, Groups and Sponsor Page 770 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC039 Cook Embolization Coil Hilal Platinum Diameters: .018, Extended  $204.00

 Lengths: .5cm to 6cm, Coil

 Diameters: Straight to 10mm

WC061 Detachable Coil System Microembolisation Coils - Platinum 011/018 2-20mm diameter, 2 -  $785.90

 50cm length

WC076 Flipper-Patient Ducts Arteriosus- Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm  $233.95

 Occluding System  Number of Loops (3,4,5)

WC173 Cook Embolisation Coils Nester Platinum Diameters: .018 and .035,  $241.85

 Extended Lengths: 14cm, Coil

 Diameters: 3mm to 10mm

WC190 Detachable Mreye Embolization Coils Standard Mreye Diameters: .035 and .038,  $65.00

 Extended Lengths: 1cm to

 20cm, Coil Diameters: 3mm to

WC191 Cook Intravascular Embolization  Hilal Platinum (Soft) Diameters: .018; Extended  $149.00

 Lengths: 5cm to 3cm, Coil

 Diameters: Straight to 10mm

WC192 Detachable Mreye Embolization Coils Jackson Mreye Diameters: .035 and .038  $133.90

 Extended Lengths:  4cm to 6cm

 Coil Diameters: 3mm to 12mm

 Group 8c - Coils, Neuro-inteventional

 Boston Scientific Pty Ltd

BS027 Guglielmi Detachable Coil (GDC) Platinum Coil.  2-20mm x 4-30cm $1,400.00

BS058 GDC Trispan 3 nitinol loops (or petal) with platinum  Dia 6 - 10, 12, 14, 16mm $1,800.00

 wire wrapped around each petal, a 018

 catheter delivery wire

BS072 Matrix Detachable Coils Platinum coils covered with an absorbable Length: 1 to 30cm; Diameter: 2  $1,750.00

  copolymer to 20mm

BS079 Neuroform 2 Microdelivery Stent System Self-expanding nitinol stent, 3fr delivery  Diameter: 2.5-4.5mm, Length:  $7,500.00

 catheter, peelable sheath, 2fr stabilising  10mm-30mm

 catheter, rotating haemostasis valve (x2)

Prostheses List by Category, Groups and Sponsor Page 771 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BS080 Matrix SR Detachable Coils Matrix SR Detachable Coils are  Length: 2cm to 30cm, Diameter: $1,850.00

 Platinum/Tungsten alloy coils covered   2mm to 10mm

 with an absorbable PGLA copolymer

 (90% Poly-glycolic acid/ 10% Poly-lactic

BS081 GDC 360 Shaped Detachable Coil Bare platinum coil- the first 1.5 loops are  Length: 5cm to 40cm; Diameter: $1,640.00

 25% smaller than the stated helical coil   2mm to 24mm

 diameter which provides for greater

 aneurysm framing, packing and finishing

 Device Technologies Australia Pty Ltd

DE192 Dendron Coil Micro coils, straight, eight shape, pretzel  Micro coils, straight dia 0.26  $1,495.00

 shape, loop shape, helix shape, cyclone;  and 0.38mm, length 1-5mm;

 micro meshes; jet coils; electrolytically  eight shape dia 2mm, length

 detachable coils, helix and cyclone 10mm; pretzel shape dia 3-

 5mm, length 25-45mm; loop

 shape dia 5mm, length 50mm;

 helix shape dia 2-8mm, length

 20-100mm; cyclone dia 3/6mm,

  length 22-85mm; micro meshes

  dia 0.15mm, length 1-2mm; jet

 coils dia 0.22, 0.36mm, length

 0.3-5cm; EDC dia 2-20mm,

 length 1-30cm

DE193 Dendron Detachable Coils Electrolytically detachable coil, helix,  Dia 2mm x length 1, 2, 3, 4, 6,  $1,495.00

 curved tip, multi diameter 8, 10, 22, 42, 60, 85cm;

 diameter 2.5mm x length 15cm;

 diameter 3mm x length 3, 4, 6,

 8, 10, 12cm; diameter 4mm x

 length 4, 6, 8, 10, 12, 15cm;

 diameter 5mm x length 5, 8, 10,

  12, 15, 20, 25, 30cm; diameter

 6mm x length 10, 15, 20cm;

 diameter 7mm x length 10, 20,

 30cm; diameter 8mm x length

 10, 20, 25cm; diameter 10mm x

  length 30cm; diameter 12mm x

 length 20cm; diameter 15mm x

 length 20, 30cm; diameter

 20mm x length 15cm;

Prostheses List by Category, Groups and Sponsor Page 772 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Johnson & Johnson Medical Pty Ltd

JJ485 Trufill DCS Orbit detachable coil Helical Fill 2mm - 12mm, 2cm - 30cm $1,400.00

JJ486 Trufill DCS Orbit detachable coil Complex Standard 6mm - 20mm, 15cm - 30cm $1,505.00

JJ487 Trufill DCS Orbit detachable coil Complex Mini 2mm - 12mm, 1.5cm - 30cm $1,505.00

 Medtel Australia Pty Ltd

ME070 Micrus ACT Platinum Microcoil Delivery  Platinum Coil Helical Stretch Resistant - 2mm  $1,400.00

 System x 1cm  - 10mm x 30cm

ME085 Micrus ACT Platinum Microcoil Delivery  Platinum Coil Helical - 2mm x 2cm - 10mm x  $1,700.00

 System 30cm

ME086 Micrus ACT Platinum Microcoil Delivery  Platinum Coil Helical Soft Stretch Resistant -  $1,700.00

 System 2mm x 1cm - 4mm x 8cm

ME087 Micrus ACT Platinum Microcoil Delivery  Platinum Coil Spherical - 2mm x 2.5cm -  $1,545.00

 System 19mm x 30cm

ME088 Micrus ACT Platinum Microcoil Delivery  Platinum Coil Straight - 4mm x 10cm - 6mm  $1,445.00

 System x 30cm

ME133 Micrus ACT Platinum Microcoil Delivery  Cerecyte Helical Cerecyte - 2mm x 2cm - $1,850.00 $1,950.00

 System  10mm x 30cm

ME134 Micrus ACT Platinum Microcoil Delivery  Cerecyte Helical Soft Stretch Resistant  $1,850.00 $1,950.00

 System Cerecyte - 2mm x 1cm - 4mm x

  8cm

ME135 Micrus ACT Platinum Microcoil Delivery  Cerecyte Spherical Cerecyte - 2mm x  $1,850.00 $1,950.00

 System 2.5cm - 19mm x 30cm

ME136 Micrus ACT Platinum Microcoil Delivery  Cerecyte Straight Cerecyte - 4mm x  $1,850.00 $1,950.00

 System 10cm - 6mm x 30cm

 Group 8d - Polymer

 Device Technologies Australia Pty Ltd

DE006 Onyx System DSMO/Liquid Embolic Material 18, 20, 34 (formulations) $2,300.00

DE175 Onyx System DSMO Liquid Embolic Material 500 Formulation $4,950.00

Prostheses List by Category, Groups and Sponsor Page 773 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Group 9 - Vascular Access

 Group 9a - Precut Catheters

 Bard Australia Pty Ltd

BA040 VitaCuff, Hickman Catheter  Dialysis/Apheresis catheter, dual lumen,  36-45cm overall length $342.00

 silicone

BA048 VitaCuff, Broviac Catheters Silicone, with VitaCuff 2.4 - 6.6 French Catheter $342.00

BA049 Broviac Catheters Without VitaCuff, silicone 2.4 - 6.6 French Catheter $175.00 $275.00

BA050 Hickman Catheters Single Without VitaCuff, silicone   7 - 14.4F French Catheter $247.00

BA051 Hickman Catheters Dual Without VitaCuff, silicone   7 -  9 French Catheter $343.00

BA052 Hickman Catheters Triple Without VitaCuff, silicone   13.5 French Catheter $406.00

BA053 Vitacuff, Hickman Single Lumen Catheters Silicone, with VitaCuff   7 - 14.4F French Catheter $342.00

BA054 Vitacuff, Hickman Dual Lumen Catheters Silicone, with VitaCuff   7 -  9 French Catheter $406.00

BA055 Vitacuff, Hickman Triple Catheters Silicone, with VitaCuff   13.5 French Catheter $496.00

BA125 Groshong Catheter Groshong Valved - Closed ended  Single Lumen, sizes 3fr-8fr $316.00

 catheter, may also include Introducer,

 guidewire, tunneller, drape, gloves,

 needles, scissors, syringes, gauze pads

BA126 Groshong Catheter Groshong Valved - Closed ended  Dual Lumen, sizes 5fr-9.5fr $368.00

 catheter, may also include Introducer,

 guidewire, tunneller, drape, gloves,

 needles, scissors, syringes, gauze pads

BA129 Vascular Catheter PICC - may include a Groshong Valved -  Single Lumen 3Fr - 6Fr $170.00

 Closed ended PICC, may also include,

 Introducer, guidewire, tunneller, drape,

 gloves, needles, scissors, syringes, gauze

BA130 Vascular Catheter PICC- may include a Groshong Valved -  Dual Lumen 4Fr - 7Fr $205.00

 Closed ended PICC, may include,

 Introducer, guidewire, tunneller, drape,

 gloves, needles, scissors, syringes, gauze

Prostheses List by Category, Groups and Sponsor Page 774 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

BA167 Poly RadPICC Catheters Single lumen open-ended Polyurethane,  3, 4, 5Fr with 70cm guide wire $126.00 Temporary approval pending

 Modified Seldinger PICC kit, includes  review of catheters

 platinum tip guide wire, PTFE Peel Apart

 Introducer & dilator, hydroglide insertion

 stylet.  Trimmable.

BA168 Poly RadPICC Catheters Single Lumen open-ended Polyrethane,  4, 5Fr with 135cm guide wire $126.00 Temporary approval pending

 Seldinger PICC kit, includes platinum tip  review of catheters

 guide wire, PTFE Peel Apart Introducer

 & dilator, hydroglide insertion stylet. 

 Trimmable.

BA169 Poly RadPICC Catheters Double Lumen open-ended Polyrethane  4, 5, 6Fr with 70cm guide wire $145.00 Temporary approval pending

 Modified Seldinger PICC kit, inlcudes  review of catheters

 platinum tip guide wire, PTFE Peel Apart

 Introducer & dilator, hydroglide insertion

 stylet. Trimmable.

BA170 Poly RadPICC Catheters Double Lumen open-ended, Polyurethane, 5, 6Fr with 135cm guide wire $145.00 Temporary approval pending

  Seldinger PICC Kit, includes platinum tip review of catheters

  guide wire, PTFE Peel Apart Introducer

 & dilator, hydroglide insertion stylet. 

 Trimmable.

BA175 HemoGlide Long Term Haemodialysis  14.5Fr Double D stepped tip cuffed  31cm PC2 Jugular Kit $320.00

 Catheter catheter. Kit also includes 18g guidewire

 introducer needle, 0.038" 70cm J-wire

 guidewire, 15F PTFE introducer sheath,

 8" tunneling device, 10-12F Dualator

 vessel dilator, 2 adhesive dressing, 2

 injection caps, suture wing, heparin label

 Baxter Healthcare Pty Ltd

BX255 Mahurkar 12Fr Triple Lumen Catheter Mahurkar 12Fr Triple Lumen Catheter  12Fr - 13cm, 16cm, 19cm &  $230.00 Temporary approval pending

 Curved Extension Kit 24cm lengths available review of catheters

BX256 Mahurkar 13.5Fr Q-Plus Dual Lumen  Mahurkar 13.5Fr Q-Plus Curved  13.5Fr - 13.5cm, 16cm, 19cm  $123.00 Temporary approval pending

 Catheter Extension Double Lumen Catheter Kit & 24cm lengths available review of catheters

BX257 Mahurkar 13.5Fr Q-Plus Dual Lumen  Mahurkar 13.5Fr Q-Plus Straight  13.5Fr - 13.5cm, 16cm, 19cm  $123.00 Temporary approval pending

 Catheter Extension Double Lumen Catheter Kit & 24cm lengths available review of catheters

Prostheses List by Category, Groups and Sponsor Page 775 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Boston Scientific Pty Ltd

BS065 Vaxcel Implantable Vascular Access  Polyurethane Catheter Material with dual  16 French catheter tapering to a  $330.00

 lumens and a staggered distal tip;  14 French, lengths 19, 23,

 polyester cuff which provides catheter

 security and tissue growth; clear

 extension tubes with clamps

BS087 Vaxcel PASV PICC Single lumen catheters 3, 4, 5 & 6 Fr $175.00 Temporary approval pending

 review of catheters

BS088 Vaxcel PASV PICC Dual lumen catheters 3, 4, 5 & 6Fr $210.00 Temporary approval pending

 review of catheters

 Medical Specialties  Australia Pty Ltd

MS009 Catheterisation kits(Horizon Medical) Central Venous Catheter - right atrial  2.7 -14F $408.00

 catheter, silicone

MS010 Catheterisation kits(HDC corp) Central Venous Catheter - right atrial  2 - 12F $397.00

 catheter, silicone

 William A Cook Aust Pty Ltd

WC111 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter Fr 3, 4, 5 and Length 50 and  $132.55

  set, includes catheter, needle, J-wire and

 introducer

WC112 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted  Fr 6, 7 and Length 50cm $199.50

 catheter set, includes catheter, needle,

 wire or J-wire and introducer

WC113 Cook Central Venous Catheterisation Kit Single lumen peripherally inserted catheter Fr 3, 4, 5 and Length 50 and  $114.00

  set, includes catheter, needle, J-wire,

 MPIS wire and introducer

WC114 Cook Central Venous Catheterisation Kit Double lumen peripherally inserted  Fr 6, 7 and Length 58 and 60cm $145.00

 catheter set, includes catheter, needle, J-

 wire, MPIS wire and introducer

WC201 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central  4Fr - 60cm and 5Fr - 60cm $132.55

 Venous Catheter Set, Single Lumen

 Polyurethane with Micropuncture Peel-

 Away Sheath Introducer and Wire Guide

Prostheses List by Category, Groups and Sponsor Page 776 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC202 Cook Central Venous Catheterisation Kits Turbo-Flo Peripherally Inserted Central  5Fr - 60cm $121.00

 Venous Catheter Set, Single Lumen

 Polyurethane with Peel Away Sheath

 Introducer and Wire Guide

WC203 Cook Central Venous Catherisation Kits Turbo-Flo Peripherally Inserted Central  5Fr - 60cm $145.00

 Venous Catheter Set, Dual Lumen

 Polyurethane with Peel-Away Sheath

 Introducer and Wire Guide

WC204 Cook Central Venous Catheterisation Kits Turbo-Flo Over-The-Wire Peripherally  4Fr - 60cm and 5Fr -60cm $132.55

 Inserted Central Venous Catheter Set,

 Single Lumen Polyurethane with

 Micropuncture Peel-Away Sheath

WC205 Cook Central Venous Catheterisation Kits Turbo-Flo Over-The Wire Peripherally  5Fr - 60cm $145.00

 Inserted Central Venous Catheter Set,

 Dual Lumen Polyurethane with

 Micropuncture Peel-Away Sheath

WC206 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central  3Fr - 50cm and 4Fr and 5Fr -  $238.99

 Venous Catheter Set, Single Lumen

 Silicone with Micropuncture Peel-Away

 Sheath Introducer and Nitinol Wire Guide

WC207 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central  3Fr - 50cm and 4Fr and 5Fr -  $132.55

 Venous Catheter Set, Catheter without

 Clamp, Single Lumen Silicone with

 Micropuncture Peel-Away Sheath

WC208 Cook Central Venous Catheterisation Kits PICC Peripherally Inserted Central  4Fr - 60cm and 5Fr - 60cm $241.25

 Venous Catheter Set, Catheter without

 Clamp, Single Lumen Silicone with

 Micropuncture Peel-Away Sheath

 Introducer and Nitinol Wire Guide

WC221 Cook Spectrum Silicone Long Term  Single lumen catheter CVC impregnated  4Fr, 5Fr $190.00 Temporary approval pending

 Catheter Set with antibiotic with or without clamp review of catheters

WC222 Cook Spectrum Silicone Long Term  Dual lumen catheter CVC impregnated  7Fr $208.00 Temporary approval pending

 Catheter Set with antibiotic with or without clamp review of catheters

WC223 Cook Spectrum Silicone Long Term  Triple lumen catheter CVC impregnated  8Fr $253.00 Temporary approval pending

 Catheter Set with antibiotic with or without clamp review of catheters

Prostheses List by Category, Groups and Sponsor Page 777 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

WC224 Cook Spectrum PICC Set / Line Single lumen PICC catheter with  4fg, and 5fg 60cm $165.00 Temporary approval pending

 antibiotic impregnation review of catheters

WC225 Cook Spectrum PICC Set / Line Dual lumen PICC catheter with antibiotic  6fr and 60cm $220.00 Temporary approval pending

 impregnation review of catheters

WC227 Peripherally Inserted C/V catheter with  Micropuncture Single Lumen PICC with  4/5Fr single lumen ABRM  $238.99 Temporary Listing pending

 Antibiotic Impregnation ABRM impregnated silicone central  review of catheters

 venous catheter set with

 micropuncture introducer kit.

 6/7Fr double lumen ABRM

 impregnated silicone central

 venous catheter set with

 micropuncture introducer kit,

 Group 9b - Infuser Ports

 Bard Australia Pty Ltd

BA056 Subcutaneous Ports Hickman open-ended catheter, single  8 - 9.6 French Catheter $490.00 $715.64

BA057 Groshong Subcutaneous Ports Single or dual lumen catheter 8 - 9.6 French Catheter $510.00 $727.82

BA059 Dual Lumen Subcutaneous Ports Silicone, Polyurethane or ChronoFlex  7 - 10 French Catheter $788.00

 Open-ended Catheter

BA060 Hickman Subcutaneous Ports Low-Profile 6 - 6.6 French Catheter $640.00

BA177 SlimPort Ultra Low Profile Implanted  Ultra SlimPort Low Profile  Port: 16.9 x 22.7mm (W) x  $530.00 $615.00

 Plastic/Titanium port with attachable  9.2mm (H); 2.9g Wt 6 Fr

 Chronoflex® single lumen catheter

 Medical Specialties  Australia Pty Ltd

MS014 Injection/Infusion Ports Sterile Plastic/titanium, single lumen 5-15F $755.00

MS015 Injection/Infusion Ports Sterile Plastic/titanium, dual lumen 10, 10.5, 12F $770.00

MS016 Injection/Infusion Ports Sterile Plastic/titanium, paediatric 5, 6, 7,8, 9.6F $755.00

Prostheses List by Category, Groups and Sponsor Page 778 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 William A Cook Aust Pty Ltd

WC093 Cook Implantable Injection/Infusion Ports Standard Single Chamber Polysulfone  5fr, 6.5fr, 7.5fr, 9.5fr Pre- $490.00

 with Standard Introducer Set, Petite  attached or Detached Catheter

 Single Chamber Polysulfone with

 Standard Introducer Set, Petite Single

 Chamber Polysulfone with Micropuncture

  Introducer Set

WC094 Cook Implantable Injection/Infusion Ports Mini Single Chamber Titanium with  5.0fr, 6.5fr, 7.5fr, 8.5fr Pre- $523.00

 Standard Introducer Set; Petite Single  attached or Detached Catheter

 Chamber Titanium with Standard

 Introducer Set; Petite Single Chamber

 Titanium with Micropuncture Introducer

 Set; Standard Single Chamber Titanium

 with Standard Introducer Set

WC115 Cook Implantable Injection/Infusion Port Mini Single Chamber Titanium with  5.2fr Detached Catheter $639.00

 Micropuncture Introducer Set

WC164 Cook Implantable Injection/Infusion Ports Dual Chamber Titanium Port 7.5 fr, 11.5 fr Pre-Attached or  $746.00

 Detached Catheter with

 Standard or Micropuncture

Injection/Infusion Ports, Implantable

 B Braun Australia Pty Ltd

BB170 Celsite Access Port for pain relief Composition - polysulphone.  Kit includes Diameter of septum:11.7mm.   $495.00

  tunnelling rod, filter, connectors,  Height: 11.5mm.  Dimension:

 needles, syringe, tuohy needle 25.8 x 37.8mm

Prostheses List by Category, Groups and Sponsor Page 779 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Occluders, Vascular

 Johnson & Johnson Medical Pty Ltd

JJ223 TruFill DCS Detachable coil Platinum detachable coil of complex and  Size .012" outer diameter.   $1,400.00

 helical shapes.  Embolic coil and delivery  Complex shape - 2 -12mm (dia),

 tube.  2 - 30cm lengths; helical shape

 - 2 - 30mm (dia), lengths 2 -

JJ224 TruFill Pushable coil Platinum pushable  coil of 1. Straight, 2.  Size .014" outer diameter.  Size  $33.25

 C, 3. Flat spiral and 4. Complex shapes.   2 - 10mm and length 2 - 100mm

 Embolic coil and delivery tube.

Procedure Trays, Surgical

 Kendall Australasia Pty Ltd T/A Tyco Healthcare Pty Ltd

KA014 Mahurkar Maxid Catheters Catheters constructed of radiopaque  Size, 38, 43, 48, 53cm $298.70

 polyurethans, high kink resistant.  The

 arterial lumen is shorter than the venous

 lumen at the catheter's distal end in order

 to reduce recirculation during

Prostheses, Blood Vessel, Artificial

 Edwards Lifesciences Pty Ltd

EL005 PTFE Vascular Graft Expanded, reinforced  5-10mm x 10cm $190.00 $325.00

 Polytetrafluoroethylene. Straight, Regular

 Wall, Spiral Externally Supported

EL006 PTFE Vascular Graft Expanded, reinforced  5-10mm x 20cm $190.00 $325.00

 Polytetrafluoroethylene. Straight, Regular

 Wall, Spiral Externally Supported

Prostheses List by Category, Groups and Sponsor Page 780 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

EL013 PTFE Vascular Graft Expanded, reinforced  5-10mm x 10cm $190.00 $325.00

 Polytetrafluoroethylene. Straight, Thin

 Wall, Spiral Externally Supported

EL014 PTFE Vascular Graft Expanded, reinforced  5-10mm x 20cm $190.00 $325.00

 Polytetrafluoroethylene. Straight, Thin

 Wall, Spiral Externally Supported

EL024 PTFE Vascular Graft Expanded, reinforced  4-7mm x 70cm $1,285.00

 Polytetrafluoroethylene. Regular Wall,

EL027 PTFE Vascular Graft Expanded, reinforced  4-7mm x 70cm $1,285.00

 Polytetrafluoroethylene. Thin Wall,

 Terumo Corporation Australia

TU038 Gelweave Graft Straight Thoracic Graft, with antiflo side  22-34 mm x 20-40 cm $1,677.00 $1,744.00

 branch, Polyester, woven, gelatin sealed

Prostheses, Blood Vessel, Biological

 Bio Nova International Pty Ltd

BN001 Bio Nova Vascular Graft Flonova One size only $4,032.00

BN002 Omniflow II Vascular Prosthesis -  - 5 - 10 mm x 65 cm $3,891.00

BN003 Omniflow II Vascular Prosthesis -  - 5 - 10 mm x 55 cm $3,357.00

BN004 Omniflow II Vascular Prosthesis -  - 3 - 4 mm x 20 cm $2,283.00

BN005 Omniflow II Vascular Prosthesis -  Vascular Patch One size only $672.00

Prosthesis, Internal, Embolisation, Vascular

 Medtel Australia Pty Ltd

ME182 Amplatzer Vascular Plug Self expandable nitinol wire mesh Diameter 4mm - 16mm, Length  $1,900.00

 7 & 8mm

Prostheses List by Category, Groups and Sponsor Page 781 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

Prosthesis, Internal, Stent

 Johnson & Johnson Medical Pty Ltd

JJ463 PRECISE RX Nitinol Stent System Nitinol self expandable stent and repid  Stent Lengths 20, 30, 40mm;  $2,420.00

 exchange delivery system Stent Diameter: 5, 6, 7, 8, 9,

Spring Infusor, Ambulatory

 Tuta Healthcare Pty Ltd

TT001 Paragon Ambulatory Drug Infusion System The top of the Paragon infuser is made of Infuser - 100mL Administration  $988.00

  acetyl with stainless steel parts; the  Sets - 0.50mL, 1mL, 2mL,

 bottom is made of clear polycarbonate.  4mL, 10mL, 50mL, 100mL, or

 Diam: 10cm Height: 5.8cm. 

 Administration Sets - made from PVC

TT003 Sidekick Ambulatory Disposable Delivery  Spring infusor made from high impact  Infuser - 50mL or 100mL,  $467.00

 System plastics.  Administration Sets - made  Administration Sets - 50mL,

 from PVC and acrylic components. 100mL or 200mL/hr

Stents, Vascular

 Bard Australia Pty Ltd

BA006 Endologix Endoluminal Prostheses Power link endoliminal stent graft 25mm - 32mm Proximal  $12,500.00

 diameter, 16 - 20mm Limb

 diameter, 130mm - 220mm

BA007 Endologix Endoluminal Prostheses Power link limb extension 16mm x 55mm, 16mm x  $2,500.00

 88mm, 20mm x 55mm

BA008 Endologix Endoluminal Prostheses Power link proximal cuff 25mm x 55mm, 28mm x  $2,500.00

 55mm, 28mm x 75mm (55mm

Prostheses List by Category, Groups and Sponsor Page 782 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

 Biotronik Australia Pty Ltd

BT035 PEIRON Flexible coated stent with delivery system Dia 5-8mm, length 18-38mm $2,500.00

 Boston Scientific Pty Ltd

BS035 Expandable Endovascular Wallstent Wallstent - Easy Wallstent, Iliac Wallstent Stent Diameter x Stent Length:  $1,800.00

  (A self-expanding stent that has a  6-16mm x 18-70mm

 cylindrical braided structure composed of

  24 wires with core of either tantalum or

 Endotherapeutics Pty Ltd

ET030 Aspire Covered Stent Expandible Nitinol Stent covered with  Dia 6-14mm, Length 2.5-10cm $5,000.00

ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol stent Dia 6-16mm, length 22-77mm $2,500.00

 Johnson & Johnson Medical Pty Ltd

JJ064 Duo Via Main Endograft Leg and Delivery Nitinol abdominal aortic aneurysm device  13F, 16-28 mm $2,163.00

  System leg extension

JJ065 Duo Via Bioseal and Delivery System Nitinol abdominal aortic aneurysm device 13F, 16-28 mm $1,648.00

 Medtronic Australasia Pty Ltd

MC205 Cerebrence Over-the-Wire Neurovascular Stainless Steel 2.5-4mm x 6-25mm $1,700.00

  Stent System

Stents, Vascular, Peripheral

 Johnson & Johnson Medical Pty Ltd

JJ479 PALMAZ GENESIS on CORDIS AMIIA  Peripheral balloon expandable stent and  Lengths: 12, 15, 18, 24mm.  $2,300.00

 RX .014 Delivery System rapid exchange delivery system Diameter: 4, 4.5, 5, 5.5, 6, 6.5,

 7mm

Tissue Reconstructive Materials, Solid

 W L Gore & Associates

GT012 Soft Tissue Patch ePTFE 1mm Thickness 5 x 10cm $220.00

Prostheses List by Category, Groups and Sponsor Page 783 of 784


VASCULAR

 Minimum  Maximum

Billing Code Product Name Description Size Benefit   Benefit  Notations

GT013 Soft Tissue Patch ePTFE 1mm Thickness 10 x 15cm $647.00

GT014 Soft Tissue Patch ePTFE 1mm Thickness  15 x 20cm $1,167.00

GT015 Soft Tissue Patch ePTFE 1mm Thickness 20 x 30cm $2,040.00

GT016 Soft Tissue Patch ePTFE 2mm Thickness 5 x 10cm $361.00

GT017 Soft Tissue Patch ePTFE 2mm Thickness 10 x 15cm $876.00

GT018 Soft Tissue Patch ePTFE 2mm Thickness 15 x 20cm $1,596.00

GT019 Soft Tissue Patch  ePTFE 2mm Thickness 20 x 30cm $2,750.00

Vascular Prostheses, Human or Animal Origin

 Bio Nova International Pty Ltd

BN006 Omniflow II Vascular Prosthesis -  AV Access One size only $2,403.00

BN007 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 5cm x 10cm $311.00

BN008 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 10cm x 15cm $776.00

BN009 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 15cm x 20cm $1,403.00

BN010 Bio Nova Omniflow II Soft Tissue Patches 2mm thick 20cm x 30cm $2,466.00

 Grand Total: 9372 Records

Prostheses List by Category, Groups and Sponsor Page 784 of 784

PART B - Human Tissue List November 2006

 CARDIO-THORACIC

 Billing Code Facility Minimum Benefit

 Aortic Valved Conduit Patch

 QHV09 Queensland Heart Valve Bank $4,706.00

 Heart Valve - Aortic

 QHV01 Queensland Heart Valve Bank $4,706.00

 RPH01 Royal Perth Hospital $3,833.00

 SHV01 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00

 TBV01 Donor Tissue Bank of Victoria $5,663.00

 Heart Valve - Pulmonary

 QHV02 Queensland Heart Valve Bank $4,706.00

 RPH02 Royal Perth Hospital $3,833.00

 SHV02 Sydney Heart Valve Bank, Darlinghurst NSW $5,350.00

 TBV02 Donor Tissue Bank of Victoria $5,663.00

 Mitral Valve Patch

 QHV03 Queensland Heart Valve Bank $985.00

 Pericardium

 TBV50 Donor Tissue Bank of Victoria $421.00

 Pericardium Patch

 QHV05 Queensland Heart Valve Bank $985.00

 Pulmonary Conduit

 TBV03 Donor Tissue Bank of Victoria $869.00

 Pulmonary Conduit - Large

 QHV07 Queensland Heart Valve Bank $985.00

 Pulmonary Conduit - Small

 QHV06 Queensland Heart Valve Bank $985.00

 Pulmonary Valved Conduit For Patch use

 QHV08 Queensland Heart Valve Bank $4,706.00

 Tricuspid Valve Patch

 QHV04 Queensland Heart Valve Bank $985.00

 Page 1 of 16


 OPHTHALMIC

 Billing Code Facility Minimum Benefit

 Cornea

 LEM01 Lions Eye Bank - Melbourne $1,300.00

 LEN01 Lions NSW Eye Bank $1,000.00

 LEW01 The Lions Eye Bank of WA $2,000.00

 QEB01 Queensland Eye Bank $850.00

 SAE01 The Eye Bank of SA $840.00

 TBV04 Donor Tissue Bank of Victoria $800.00

 Cornea For Lamellar

 LEN03 Lions NSW Eye Bank $600.00

 Cornea for Sclera

 LEM02 Lions Eye Bank - Melbourne $150.00

 LEN02 Lions NSW Eye Bank $150.00

 SAE02 The Eye Bank of SA $60.00

 Human Amniotic Membrane for Transplantation

 LEM03 Lions Eye Bank - Melbourne $321.00

 SCLERA

 LEW02 The Lions Eye Bank of WA $200.00

 QEB02 Queensland Eye Bank $150.00

 Page 2 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 Achilles Tendon

 NBB01 New South Wales Bone Bank $1,560.00

 QBB01 Queensland Bone Bank $1,560.00

 TBV05 Donor Tissue Bank of Victoria $864.00

 Achilles Tendon with Bone Plug

 NBB02 New South Wales Bone Bank $1,900.00

 PBT01 Perth Bone & Tissue Bank $1,900.00

 TBV06 Donor Tissue Bank of Victoria $1,760.00

 Anterior Cruciate Ligament Unit

 PBT02 Perth Bone & Tissue Bank $1,700.00

 Anterior Tibialis Tendon

 PBT46 Perth Bone & Tissue Bank $1,300.00

 Autologous Chondrocyte Transplantation

 MTE01 Mercy Tissue Engineering Pty Ltd $9,996.00

 MTE03 Mercy Tissue Engineering Pty Ltd $11,349.00

 MVS22 Institute of Medical & Veterinary Science, SA $9,538.00

 VAP01 Verigen Australia Pty Ltd $9,556.00

 Autologous Chondrocytes

 MTE02 Mercy Tissue Engineering Pty Ltd $2,509.00

 VAP03 Verigen Australia Pty Ltd $2,593.00

 Autologous Chrondocyte Transplantation

 MUA01 Monash University, Dept of Surgery, Alfred Hospital, Tissue Culture Laboratory $8,694.43

 Autologous Skull Flap

 MVS23 Institute of Medical & Veterinary Science, SA $1,396.00

 Bone - Chips/cubes 40cc

 TBV09 Donor Tissue Bank of Victoria $836.00

 Bone - Chips/cubes 80cc

 TBV10 Donor Tissue Bank of Victoria $1,590.00

 Bone Plug/Dowel - Cancellous

 PBT03 Perth Bone & Tissue Bank $500.00

 Page 3 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 TBV07 Donor Tissue Bank of Victoria $583.00

 Bone Plug/Dowel - Tricortical

 TBV08 Donor Tissue Bank of Victoria $643.00

 Cancellous Crunch - 15cc

 NBB62 New South Wales Bone Bank $795.00

 Cancellous Crunch - 30cc

 NBB61 New South Wales Bone Bank $1,450.00

 Cancellous Crunch - 60cc

 NBB60 New South Wales Bone Bank $2,200.00

 Cartilage (costal) segments

 PBT11 Perth Bone & Tissue Bank $300.00

 QBB12 Queensland Bone Bank $200.00

 TBV17 Donor Tissue Bank of Victoria $335.00

 Cortical Struts  (Freeze Dried) 1 strut

 QBB02 Queensland Bone Bank $600.00

 Cortical Struts (1 strut)

 TBV14 Donor Tissue Bank of Victoria $655.00

 Cortical Struts (2 struts)

 TBV13 Donor Tissue Bank of Victoria $1,310.00

 Cortical Struts 10-15cm

 PBT06 Perth Bone & Tissue Bank $1,450.00

 Cortical Struts>15 - 20cm

 PBT07 Perth Bone & Tissue Bank $1,850.00

 Cortical struts>20cm

 PBT48 Perth Bone & Tissue Bank $2,100.00

 Cortico - Cancellous Freeze Dried 20g

 QBB03 Queensland Bone Bank $1,740.00

 Cortico-Cancellous Crunch (40/60) - 15cc

 NBB65 New South Wales Bone Bank $795.00

 Page 4 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 Cortico-Cancellous Crunch (40/60) - 30cc

 NBB64 New South Wales Bone Bank $1,450.00

 Cortico-Cancellous Crunch (40/60) - 60cc

 NBB63 New South Wales Bone Bank $2,200.00

 Disc - Freeze Dried

 QBB04 Queensland Bone Bank $650.00

 Dowel Plug

 NBB05 New South Wales Bone Bank $1,080.00

 QBB13 Queensland Bone Bank $1,080.00

 Elbow - joint

 QBB14 Queensland Bone Bank $2,100.00

 TBV18 Donor Tissue Bank of Victoria $4,710.00

 Fascia Lata

 TBV21 Donor Tissue Bank of Victoria $692.00

 Fascia Lata - Large (15cm x 10cm)

 PBT15 Perth Bone & Tissue Bank $1,300.00

 Fascia Lata - Small (>10cm x >5cm)

 NBB09 New South Wales Bone Bank $800.00

 Fascia Lata - Small (10cm x 5cm)

 PBT16 Perth Bone & Tissue Bank $800.00

 Fascia Lata (per sq cm)

 QBB11 Queensland Bone Bank $5.00

 Fascia Lata (per squared cm)

 NBB08 New South Wales Bone Bank $4.00

 Femoral Condyle

 PBT21 Perth Bone & Tissue Bank $1,800.00

 Femoral Head

 ACT01 ACT Bone Bank $1,638.00

 APH01 The Avenue Private Hospital Prahan Victoria $1,131.00

 CSA01 Central Sydney Area Health t/a Rachel Forster Bone Bank $802.00

 Page 5 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 DHR01 The Douglas Hocking Research Institute - Bone Bank $1,060.00

 HBB01 The Hobart Private Hospital Bone Bank $1,400.00

 LPH01 Lingard Private Hospital $1,103.00

 MMH01 Mater Misericordiae Hospital North Sydney $400.00

 MVS05 Institute of Medical & Veterinary Science, SA $1,595.00

 NBB16 New South Wales Bone Bank $1,750.00

 PBT22 Perth Bone & Tissue Bank $1,800.00

 QBB27 Queensland Bone Bank $1,775.00

 RNB01 The Royal Newcastle Hospital Bone Bank $1,619.00

 SVN01 St Vincent's Private Hospital (NSW) $731.00

 TBV26 Donor Tissue Bank of Victoria $2,020.00

 Femoral Head - Half (Freeze Dried)

 QBB29 Queensland Bone Bank $500.00

 Femoral Head - Whole (Freeze Dried)

 QBB28 Queensland Bone Bank $800.00

 Femoral Rings

 NBB17 New South Wales Bone Bank $1,400.00

 PBT24 Perth Bone & Tissue Bank $1,400.00

 QBB30 Queensland Bone Bank $1,260.00

 Femoral Rings - (Freeze Dried)

 QBB31 Queensland Bone Bank $650.00

 Femur - > 15cm

 QBB19 Queensland Bone Bank $1,460.00

 Femur - Cortical Portions < 15cm

 QBB17 Queensland Bone Bank $1,560.00

 Femur - Cortical portions> 1/3

 QBB18 Queensland Bone Bank $1,100.00

 Femur - Distal (Shaft & Condyles)

 MVS02 Institute of Medical & Veterinary Science, SA $2,290.00

 PBT17 Perth Bone & Tissue Bank $2,850.00

 TBV22 Donor Tissue Bank of Victoria $3,308.00

 Page 6 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 Femur - Distal Half

 NBB10 New South Wales Bone Bank $2,370.00

 Femur - Distal half > 15cm

 QBB20 Queensland Bone Bank $2,370.00

 Femur - Distal third

 NBB11 New South Wales Bone Bank $1,144.00

 Femur - Distal third < 15cm

 QBB21 Queensland Bone Bank $2,270.00

 Femur - Entire

 MVS03 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB12 New South Wales Bone Bank $5,539.00

 PBT18 Perth Bone & Tissue Bank $4,900.00

 QBB22 Queensland Bone Bank $3,685.00

 TBV23 Donor Tissue Bank of Victoria $5,539.00

 Femur - Hemicondyle

 NBB59 New South Wales Bone Bank $2,000.00

 Femur - Middle third

 NBB13 New South Wales Bone Bank $2,250.00

 QBB23 Queensland Bone Bank $1,865.00

 TBV24 Donor Tissue Bank of Victoria $1,804.00

 Femur - Proximal   (shaft,trochanter, neck)

 PBT20 Perth Bone & Tissue Bank $2,850.00

 TBV25 Donor Tissue Bank of Victoria $3,283.00

 Femur - Proximal (shaft & trachanter, neck)

 MVS04 Institute of Medical & Veterinary Science, SA $2,290.00

 Femur - Proximal half

 NBB15 New South Wales Bone Bank $2,570.00

 Femur - Proximal half > 15cm

 QBB25 Queensland Bone Bank $2,570.00

 Femur - Proximal third

 Page 7 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 NBB14 New South Wales Bone Bank $1,040.00

 Femur - Proximal third < 15cm

 QBB24 Queensland Bone Bank $2,120.00

 Femur - Segment

 NBB56 New South Wales Bone Bank $1,500.00

 Femur - Shaft Half

 NBB57 New South Wales Bone Bank $2,200.00

 Femur - Shaft Third

 NBB55 New South Wales Bone Bank $1,500.00

 Femur - Trochanter Milled

 QBB26 Queensland Bone Bank $800.00

 Femur- 1 Condyle only

 TBV46 Donor Tissue Bank of Victoria $1,018.00

 Femur-Proximal(Shaft, trochanter, neck and head)

 TBV51 Donor Tissue Bank of Victoria $3,185.00

 Fibula - Entire

 MVS07 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB18 New South Wales Bone Bank $3,200.00

 PBT25 Perth Bone & Tissue Bank $2,000.00

 QBB32 Queensland Bone Bank $2,220.00

 TBV27 Donor Tissue Bank of Victoria $5,775.00

 Fibula - Segment

 NBB54 New South Wales Bone Bank $1,925.00

 Fibula - Segment (12cm)

 MVS14 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB20 New South Wales Bone Bank $1,881.00

 TBV29 Donor Tissue Bank of Victoria $891.00

 Fibula - Segment (6cm)

 MVS13 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB19 New South Wales Bone Bank $1,300.00

 Page 8 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 TBV28 Donor Tissue Bank of Victoria $583.00

 Fibula - Shaft

 TBV30 Donor Tissue Bank of Victoria $1,881.00

 Fibula segment (prox / distal)

 PBT28 Perth Bone & Tissue Bank $1,100.00

 Fibular Strut < 10cm:

 QBB06 Queensland Bone Bank $1,210.00

 Fibular Strut > 10cm:

 QBB07 Queensland Bone Bank $1,335.00

 Freeze Dried Milled Bone <30gm

 PBT37 Perth Bone & Tissue Bank $750.00

 Freeze Dried Milled Bone 30 - 50gm

 PBT38 Perth Bone & Tissue Bank $900.00

 Freeze-dried Cancellous Cubes (6)

 QBB09 Queensland Bone Bank $1,335.00

 Freeze-Dried Cancellous Strips (2)

 QBB10 Queensland Bone Bank $650.00

 Hemipelvis - Acetabulum

 NBB21 New South Wales Bone Bank $2,568.00

 PBT29 Perth Bone & Tissue Bank $2,400.00

 QBB33 Queensland Bone Bank $2,320.00

 TBV31 Donor Tissue Bank of Victoria $2,568.00

 Hemipelvis - Complete

 MVS08 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB24 New South Wales Bone Bank $5,825.00

 PBT30 Perth Bone & Tissue Bank $4,500.00

 QBB37 Queensland Bone Bank $3,685.00

 TBV32 Donor Tissue Bank of Victoria $5,825.00

 Hemipelvis - IIliac crest

 NBB22 New South Wales Bone Bank $2,321.00

 Page 9 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 PBT31 Perth Bone & Tissue Bank $1,100.00

 QBB34 Queensland Bone Bank $2,060.00

 TBV33 Donor Tissue Bank of Victoria $2,321.00

 Hemipelvis - Tricortical wedge

 QBB35 Queensland Bone Bank $1,005.00

 Hemipelvis - Tricortical wedge (Freeze Dried)

 QBB36 Queensland Bone Bank $700.00

 Hemipelvis -Tricortical iliac wedge

 NBB23 New South Wales Bone Bank $1,005.00

 PBT32 Perth Bone & Tissue Bank $600.00

 TBV34 Donor Tissue Bank of Victoria $880.00

 Humeral Head

 QBB44 Queensland Bone Bank $1,350.00

 TBV37 Donor Tissue Bank of Victoria $1,419.00

 Humeral Head Addition

 NBB26 New South Wales Bone Bank $1,419.00

 Humerus - Cortical portions/blocks < 10cm

 QBB38 Queensland Bone Bank $1,110.00

 Humerus - Cortical portions/blocks > 10cm

 QBB39 Queensland Bone Bank $1,330.00

 Humerus - Distal

 MVS19 Institute of Medical & Veterinary Science, SA $2,290.00

 TBV49 Donor Tissue Bank of Victoria $1,892.00

 Humerus - Distal half

 NBB25 New South Wales Bone Bank $1,200.00

 Humerus - Entire

 MVS20 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB29 New South Wales Bone Bank $2,828.00

 QBB43 Queensland Bone Bank $2,570.00

 Humerus - Proximal half

 Page 10 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 NBB27 New South Wales Bone Bank $1,658.00

 QBB40 Queensland Bone Bank $1,260.00

 Humerus - Proximal half with rotator cuff

 NBB28 New South Wales Bone Bank $2,500.00

 QBB41 Queensland Bone Bank $2,245.00

 Humerus - Proximal with rotator cuff

 MVS09 Institute of Medical & Veterinary Science, SA $2,290.00

 PBT34 Perth Bone & Tissue Bank $2,500.00

 TBV35 Donor Tissue Bank of Victoria $2,233.00

 Humerus - Proximal w'out rotator cuff

 PBT35 Perth Bone & Tissue Bank $1,100.00

 QBB42 Queensland Bone Bank $1,260.00

 TBV36 Donor Tissue Bank of Victoria $2,376.00

 Humerus - Ring

 NBB53 New South Wales Bone Bank $1,300.00

 Humerus - Segment

 NBB52 New South Wales Bone Bank $1,400.00

 Humerus - Shaft Half

 NBB51 New South Wales Bone Bank $1,500.00

 Humerus - Shaft Whole

 NBB50 New South Wales Bone Bank $2,750.00

 Humerus - Whole

 PBT33 Perth Bone & Tissue Bank $3,000.00

 Humerus - Whole with rotator cuff

 NBB30 New South Wales Bone Bank $2,941.00

 Matrix and Autologous Chondrocytes Implant

 ORT01 Orthogen Australia Pty Ltd $11,400.00

 Medial Ligament

 NBB31 New South Wales Bone Bank $1,529.00

 TBV38 Donor Tissue Bank of Victoria $1,529.00

 Page 11 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 Meniscal Graft

 PBT47 Perth Bone & Tissue Bank $1,800.00

 Meniscus

 QBB05 Queensland Bone Bank $1,160.00

 Meniscus with Ligaments

 TBV39 Donor Tissue Bank of Victoria $1,842.00

 Meniscus without Ligaments

 TBV40 Donor Tissue Bank of Victoria $1,000.00

 Milled Bone - 15cc

 NBB58 New South Wales Bone Bank $720.00

 Milled Bone - 30gm

 NBB03 New South Wales Bone Bank $1,050.00

 Milled Bone - 40cc

 TBV11 Donor Tissue Bank of Victoria $1,000.00

 Milled Bone - 60gm

 NBB04 New South Wales Bone Bank $1,675.00

 Milled Bone - 80cc

 TBV12 Donor Tissue Bank of Victoria $1,788.00

 Milled Bone (60cc)

 QBB45 Queensland Bone Bank $1,675.00

 Milled Bone (60g max)

 QBB46 Queensland Bone Bank $1,200.00

 Milled Bone <30gr

 PBT08 Perth Bone & Tissue Bank $1,500.00

 Milled Bone >50gr

 PBT10 Perth Bone & Tissue Bank $2,250.00

 Milled Bone 30 - 50gr

 PBT09 Perth Bone & Tissue Bank $1,950.00

 Milled Bone 40cc

 Page 12 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 TBV15 Donor Tissue Bank of Victoria $760.00

 Milled Bone 80cc

 TBV16 Donor Tissue Bank of Victoria $1,445.00

 Patella

 NBB32 New South Wales Bone Bank $875.00

 QBB47 Queensland Bone Bank $750.00

 TBV41 Donor Tissue Bank of Victoria $875.00

 Patella tendon

 QBB48 Queensland Bone Bank $1,715.00

 Patella Tendon and Patella

 TBV42 Donor Tissue Bank of Victoria $1,842.00

 Patella tendon with Bone Plugs

 NBB33 New South Wales Bone Bank $1,357.00

 Patellar unit whole with tibial block

 PBT40 Perth Bone & Tissue Bank $2,000.00

 Primary MACI plus 1/2

 VAP02 Verigen Australia Pty Ltd $10,891.00

 Proximal Third Tibia with - Patella Tendon

 QBB08 Queensland Bone Bank $2,370.00

 Radius

 MVS18 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB06 New South Wales Bone Bank $2,673.00

 PBT13 Perth Bone & Tissue Bank $1,800.00

 QBB15 Queensland Bone Bank $1,865.00

 TBV19 Donor Tissue Bank of Victoria $2,673.00

 Radius - Ring

 NBB49 New South Wales Bone Bank $1,680.00

 Radius - Segment

 NBB48 New South Wales Bone Bank $1,925.00

 Radius - Shaft

 Page 13 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 NBB47 New South Wales Bone Bank $2,750.00

 Rib (5cm)

 MVS21 Institute of Medical & Veterinary Science, SA $382.00

 PBT41 Perth Bone & Tissue Bank $300.00

 TBV43 Donor Tissue Bank of Victoria $418.00

 Scaphoid

 QBB49 Queensland Bone Bank $900.00

 Shaft - Femur / Tibia Middle third

 PBT19 Perth Bone & Tissue Bank $2,400.00

 Tibia - Condyles only

 TBV47 Donor Tissue Bank of Victoria $1,425.00

 Tibia - Cortical < 15cm

 QBB50 Queensland Bone Bank $1,275.00

 Tibia - Cortical > 15 cm

 QBB51 Queensland Bone Bank $1,560.00

 Tibia - Distal

 MVS17 Institute of Medical & Veterinary Science, SA $2,290.00

 TBV48 Donor Tissue Bank of Victoria $1,837.00

 Tibia - Middle third seg

 NBB34 New South Wales Bone Bank $1,400.00

 QBB53 Queensland Bone Bank $900.00

 Tibia - Plateau (prox 1/3)

 NBB35 New South Wales Bone Bank $2,065.00

 Tibia - Proximal third < 15cm

 QBB54 Queensland Bone Bank $2,065.00

 Tibia - Proximal with Patella Tendon

 NBB46 New South Wales Bone Bank $3,647.00

 Tibia - Proximal:  without Patella

 PBT45 Perth Bone & Tissue Bank $1,100.00

 Tibia - Proximal: 16-25cm

 Page 14 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 TBV45 Donor Tissue Bank of Victoria $2,118.00

 Tibia - Proximal: 7-15cm

 TBV44 Donor Tissue Bank of Victoria $2,198.00

 Tibia - Proximal: half

 MVS11 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB36 New South Wales Bone Bank $2,290.00

 Tibia - Proximal: with Patella & Tendon

 PBT44 Perth Bone & Tissue Bank $1,900.00

 Tibia - Ring

 NBB45 New South Wales Bone Bank $1,300.00

 Tibia - Shaft Half

 NBB43 New South Wales Bone Bank $2,200.00

 Tibia - Shaft Third

 NBB42 New South Wales Bone Bank $2,065.00

 Tibia - Shaft Whole

 NBB41 New South Wales Bone Bank $2,750.00

 Tibia - Strut

 QBB52 Queensland Bone Bank $400.00

 Tibia - Whole

 MVS16 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB37 New South Wales Bone Bank $3,685.00

 QBB55 Queensland Bone Bank $3,685.00

 Tibia - Whole with Patella Tendon

 NBB44 New South Wales Bone Bank $5,042.00

 Ulna

 MVS15 Institute of Medical & Veterinary Science, SA $2,290.00

 NBB07 New South Wales Bone Bank $2,464.00

 PBT14 Perth Bone & Tissue Bank $1,500.00

 QBB16 Queensland Bone Bank $1,865.00

 TBV20 Donor Tissue Bank of Victoria $2,464.00

 Page 15 of 16


 ORTHOPAEDIC

 Billing Code Facility Minimum Benefit

 Ulna - Ring

 NBB40 New South Wales Bone Bank $1,680.00

 Ulna - Segment

 NBB39 New South Wales Bone Bank $1,925.00

 Ulna - Shaft

 NBB38 New South Wales Bone Bank $2,200.00

 Page 16 of 16