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
These Rules are the Private Health Insurance (Prostheses) Rules 2007.
These Rules commence:
(a) if the Rules are registered before the Act commences―at 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.
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.
For item 4 of the table in subsection 72-1 (2) of the Act:
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.
(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
(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
(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 2007―see paragraph 121-10 (3) (a) of the Act.
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.
(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
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 ˆ
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