Private Health Insurance (Prostheses) Rules (No. 3) 2019
made under the item 4 of the table in section 333-20 of the
Private Health Insurance Act 2007
Compilation No. 1
Compilation date: 1 November 2019
Includes amendments up to: F2019L01380
Registered: 15 November 2019
This compilation is in 6 volumes
Volume 1: rules 1–13
Volume 2: Schedule 1, Part 1 - Prostheses List - Part A
Volume 3: Schedule 1, Part 2 - Prosthesis List - Part B
Volume 4: Schedule 1, Part 3 - Prostheses List - Part C
Volume 5: Schedule 2—Repeals
Volume 6: Endnotes
About this compilation
This compilation
This is a compilation of the Private Health Insurance (Prostheses) Rules (No. 3) 2019 that shows the text of the law as amended and in force on 1 November 2019 (the compilation date).
The notes at the end of this compilation (the endnotes) include information about amending laws and the amendment history of provisions of the compiled law.
Uncommenced amendments
The effect of uncommenced amendments is not shown in the text of the compiled law. Any uncommenced amendments affecting the law are accessible on the Legislation Register (www.legislation.gov.au). The details of amendments made up to, but not commenced at, the compilation date are underlined in the endnotes. For more information on any uncommenced amendments, see the series page on the Legislation Register for the compiled law.
Application, saving and transitional provisions for provisions and amendments
If the operation of a provision or amendment of the compiled law is affected by an application, saving or transitional provision that is not included in this compilation, details are included in the endnotes.
Editorial changes
For more information about any editorial changes made in this compilation, see the endnotes.
Modifications
If the compiled law is modified by another law, the compiled law operates as modified but the modification does not amend the text of the law. Accordingly, this compilation does not show the text of the compiled law as modified. For more information on any modifications, see the series page on the Legislation Register for the compiled law.
Self-repealing provisions
If a provision of the compiled law has been repealed in accordance with a provision of the law, details are included in the endnotes.
Schedule 1 |
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Part 3 - Prostheses List - Part C |
3 Prostheses List - Part C |
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03 - General Miscellaneous
Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
03.02 - DRUG DELIVERY DEVICES
03.02.03 - Infusion Pumps, Battery Powered
03.02.03.02 - Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and active insulin
DE, SS
AN011 | Animas Vibe/One Touch Vibe Plus Insulin Pump | Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability | 8.26 x 5.08 x 2.18cm | $8,502.00 | |
AN014 | t:slim X2 Insulin Pump | Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability | One size only. | $8,502.00 | |
DF002 | DANAR Insulin Pump | The DANAR Insulin Pump is a small device about the size of a pager. It holds up to 300 units of insulin, which is delivered continuously through a small tube to the patient. The DANAR Insulin Pump also has an integrated blood glucose meter and remote control via bluetooth communication. | 75 x 45 x 19mm, 60grams | $8,502.00 | |
DF003 | DANA RS Diabecare insulin pump | DANA RS insulin pump is a BLE (bluetooth low energy) insulin pump which can be connected to and controlled from a BLE Smart Phone. Smart Phone connection is via a secure (alpha-numeric) pairing code, creating a large easy to read display for set-up and control of the DANA RS insulin pump. | 75mm x 45mm x 19mm (63grams) | $8,502.00 | |
RB001 | Accu-Chek Combo System | Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided. | The Accu-Chek Combo System is only available in one size. | $8,502.00 | |
RB002 | ACCU-CHEK Insight System | Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided. | No variable sizes offered. Only one system provided. | $8,502.00 | |
DE, SS, MP
RB006 | Accu-Chek Solo micropump - starter kit | Starter kit supply of insulin pump system to accommodate first year of use of Accu-Chek Solo micropump system. Starter kit includes insulin pump base components, blood glucose monitoring system handset control with integrated insulin bolus advisor (diabetes manager) and accessory pack. | Micropump: 68 x 40 x 15 mm Handset control (diabetes manager): 124 x 64 x 17 mm | $2,500.00 | |
SS
YA001 | mylife™ YpsoPump Insulin Pump System | Battery-operated, programmable ambulatory insulin infusion pump system | One size only | $7,362.00 | |
03.02.03.03 - Device has capability to automatically adjust the insulin delivery based on continuous glucose monitoring data
DE, SS
MC839 | Medtronic MiniMed Insulin Infusion Pump | Paradigm Veo Model MMT-554. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control. | 5.1 x 7.6 x 2.0cm | $9,025.00 | |
MC840 | Medtronic MiniMed Insulin Infusion Pump | Paradigm Veo Model MMT-754. 'Smart' Insulin Pump with REAL-Time continuous glucose monitoring capability, incorporating a low glucose suspend and with remote control. | 5.1 x 9.4 x 2.0cm | $9,025.00 | |
MI150 | MiniMed 640G Insulin Pump | MiniMed 640G Insulin Pump with SmartGuard Technology and continuous glucose monitoring capability, designed to automatically suspend insulin delivery before dangerous lows occur, and automatically resume after levels recover. | 1.8ml and 3.0ml | $9,025.00 | |
DE, SS, ABD
MI290 | Medtronic MiniMed 670G Insulin Pump | MiniMed 670G Insulin Pump with SmartGuard Hybrid Closed Loop (HCL) technology and continuous glucose monitoring (CGM) capability which can be programmed to automatically adjust delivery of basal insulin based on CGM, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values. | One size only | $9,025.00 | |
03.02.03.06 - Insulin Infusion Pump - accessories subsequent annual supply
RB005 | Accu-Chek Solo micropump subsequent supply | Subsequent supply of replaceable components of Accu-Chek Solo insulin pump system to accommodate a subsequent year usage after the initial year of use of Accu-Chek Solo (via Accu-Chek Solo micropump starter kit). | Micropump: 68 x 40 x 15 mm | $2,000.00 | |
03.02.05 - Infusion Pump Accessories
03.02.05.04 - Administration Set
AN015 | Autosoft, Varisoft, TruSteel Infusion Set | For use with insulin infusion pump | 6 - 17mm | $7.00 | |
08 - Cardiac
Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
08.14 - Implantable Cardiac Event Recorders
08.14.01 - Implantable Cardiac Event Recorders
SJ152 | SJM Confirm Model DM2102 | Implantable cardiac monitor with atrial fibrillation monitoring. | 6.5cc, 12g | $3,120.00 | |
MC763 | Reveal XT | Reveal XT Insertable Cardiac Monitor | 61 x 19 x 8 mm with a volume of 9cc | $3,120.00 | |
i
SJ390 | Confirm RX | Insertable Cardiac Monitor | 5cm X 0.95cm X 0.33cm | $3,120.00 | |
BT186 | BioMonitor 2-AF Implantable Cardiac Monitor | Implantable cardiac monitor for continuous remote monitoring of patients with Atrial Fibrillation (AF) or unexplained syncope | 88.4 mm x 15.2 mm x 6.2 mm , 10.1g , 5cm3 | $3,120.00 | |
MI141 | Reveal LINQ | Insertable Cardiac Monitor | 45 x 7 x 3.5mm, 1.18cc | $3,120.00 | |
08.16 - Remote Monitoring System
08.16.01 - Remote Monitoring System
SJ369 | Merlin@Home wireless | Home cardiac monitor (RF) with landline, cellular and broadband connectivity | one size | $1,568.00 | |
SJ370 | Merlin@Home Inductive | Home cardiac monitor (inductive) with landline, cellular and broadband connectivity | one size | $1,568.00 | |
BT179 | Cardio Messenger II-S 3G | Bedside/Remote transmitter w/ ICD device life network access to Biotronik standard home monitoring data management service. | Bedside Device - 203 x 136mm x 80mm, 450 grams | $1,568.00 | |
BT187 | CardioMessenger Smart 3G | Bedside/Remote transmitter w/ pacemaker/ICD device life network access to Biotronik standard home monitoring data management service. | Length - 130mm, Width - 65mm, Height - 13mm Weight - 75g | $1,568.00 | |
BS294 | Latitude Communicator | Remote patient management system for implanted cardiac devices | One size only | $1,568.00 | |
MI180 | MyCareLink Patient Monitor | Electronic cellular patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment. | One size | $1,568.00 | |
MI196 | MyCareLink Smart Patient Reader | Electronic cellular patient reader which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment. | One size only | $1,568.00 | |
MI296 | MyCareLink Relay Home Communicator | Electronic cellular (optional wifi) patient monitor which gathers and transmits cardiac information from an implanted cardiac device (CIED) to your health care professional for assessment | One size | $1,568.00 | |
08.18 - Cardiac Ablation
08.18.01 - Radio frequency (RF) Ablation
08.18.01.01 - Ablation Catheter
Abbott
SJ409 | FlexAbility Ablation Catheter | Sensor Enabled and Non-Sensor Enabled | D, F, J, D-F, F-J, D-D, F-F, J-J | $3,500.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
SJ410 | TactiCath™ Contact Force Ablation Catheter | Sensor Enabled and Non-Sensor Enabled catheter | DD, DF, FF, FJ, JJ, D, F. | $3,500.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Biotronik
BT221 | AlCath Force | Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection with Optical Contact Force Sensor | 7F, 110cm , 3.5mm tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
BT222 | AlCath G FullCircle | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Standard or Long Tip. | 7F, 110cm , 4 mm Tip Gold (G) and 8mm (LT) Long Tip Gold(G) | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
BT223 | AlCath Flux G eXtra | Mapping and Ablation Cardiac Catheter, Advanced 3D irrigation (eXtra), Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection | 7F , 110cm , 3.5mm irrigated gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
BT224 | AlCath Flutter Flux G eXtra | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, Advanced 3D irrigation (eXtra), FullCircle Deflection, Optimised stability,control & length for flutter | 7F ,95cm , 3.5mm Gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
BT225 | AlCath Flutter LT G | Mapping and Ablation Cardiac Catheter, Gold Tip(G) High Thermal Conduction Ablation, FullCircle Deflection, Long 8mm Tip (LT), Optimised stability,control & length for flutter | 7F , 95cm , 8mm(LT) gold tip | $3,280.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Boston Scientific
BS361 | IntellaNav™ MiFi™ Open-Irrigated Ablation Catheter | IntellaNav™ Open-Irrigated, MiFi™ Mini-electrode Technology, Nav-abled | 110cm, shaft size 7.5F | $2,700.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Johnson and Johnson
MN238 | CARTO: SMARTTOUCH/ SMARTTOUCH SF | Contact Force Sensing Catheter: with/without Porous Tip | One size only | $3,700.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Medtronic, single unit
MI300 | PVAC Gold Phased RF catheter | The Pulmonary Vein Ablation Catheter (PVAC) Gold is a three-dimensional, anatomically designed, multi-electrode phased RF catheter used to map, pace, and ablate the pulmonary veins. | 9Fr | $6,399.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
08.18.01.02 - Patch
Abbott
SJ408 | EnSite Patch | Surface Electrodes | Patch/Kit | $350.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Boston Scientific
BS360 | Rhythmia™ Location Reference Patch Kit | Rhythmia™ Location Reference Patch Kit (Box of 1) | 50mm diameter | $299.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Johnson and Johnson
MN239 | CARTO Reference | External Reference | One size only | $499.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
08.18.01.03 - Mapping Catheter
Abbott
SJ404 | Inquiry Optima Diagnostic Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
SJ405 | Reflexion Spiral Variable Radius Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
SJ406 | Advisor mapping catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
SJ407 | Afocus II EB Inquiry Steerable Catheter | mapping catheter | 5F-8F | $2,549.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Boston Scientific
BS359 | IntellaMap Orion High Resolution Mapping Catheter | High resolution 64-electrode steerable mapping catheter | 8.5F, 115cm | $3,400.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
Johnson and Johnson
MN240 | LASSO/ PENTARAY | Circular/High Density | Various | $2,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
08.18.01 - Cryoablation
08.18.02.01 - Ablation Catheter
Medtronic Australasia Pty Ltd
MI301 | Arctic Front Advance Cardiac CryoAblation Catheter / Pro | A flexible, over-the-wire balloon catheter used to ablate cardiac tissue A flexible, over-the-wire balloon catheter used to ablate cardiac tissue | 23mm, 28mm | $5,100.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
08.18.02 - Cryoablation
08.18.02.02 - Mapping Catheter
MI302 | Achieve / Achieve Advance Mapping Catheter | Intra-cardiac electrophysiology circular mapping catheter | 15mm, 20mm, 25mm | $1,299.00 | The prosthesis is only to be used in a surgical procedure described in item 38290 OR 38287 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018, AND where the procedure is for the treatment of atrial fibrillation. |
09 - Cardiothoracic
Billing Code | Product Name | Description | Size | Minimum Benefit | Condition |
09.14 - Surgical cardiac ablation
09.14.01 - RF Ablation
09.14.01.01 - Monopolar
Medtronic
MI309 | Cardioblate® Surgical Ablation Pen XL | The Cardioblate® Surgical Ablation Pen XL facilitates cardiac ablation in areas that are difficult to ablate with a bipolar device. | One size only | $2,876.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
09.14.01.02 - Bipolar
AA-Med - Isolator Synergy
ZZ055 | ATRICURE ISOLATOR SYNERGY RF CLAMPS | Surgical Radio Frequency (RF) Clamps for Atrial Fibrillation surgery | Short, Long | $4,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
ZZ056 | Isolator Synergy Access | Articulating Surgical Radio Frequency (RF) Clamp for Atrial Fibrillation Surgery | One size only | $4,200.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
Medtronic
MI308 | Cardioblate BP2 RF Surgical Ablation Device | The Cardioblate BP2 RF Surgical Ablation devices feature dual electrodes for the delivery of irrigated RF energy. iRF technology combines saline to facilitate treatment | Standard, Low Profile | $3,523.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
09.14.01.03 - System
Medtronic - Cardioblate BP2
MI312 | Cardioblate® BP2 RF Surgical Ablation System | The Cardioblate® BP2 RF Surgical Ablation system features dual electrodes for the delivery of irrigated RF energy. iRF technology combines saline to facilitate treatment | One size only | $4,614.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
Medtronic - Cardioblate Gemini
MI310 | Cardioblate® Gemini® Surgical Ablation System | The Cardioblate® Gemini® Surgical Ablation System is designed for minimally invasive ablation procedures. Gemini-s combines the efficacy of irrigated RF energy through a bipolar jaw, to facilitate deeper energy penetration, with real time measured customised energy delivery for greater confidence in achieving transmural cardiac lesions. | One size only | $6,040.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
09.14.02 - Cryoablation
09.14.02.01 - Probe
AA-Med cryoICE
ZZ057 | cryoICE Cryoablation Surgical Probes | Surgical Cryoablation probes for atrial fibrillation surgery | One size only | $3,800.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
Medtronic - CryoFlex
MI311 | CryoFlex™ Surgical Ablation Probe | The CryoFlex™ Surgical Ablation Probe utilises a gas for freezing cells in the surgical treatment of cardiac arrhythmias. | One size only | $4,695.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
Medtronic - SurgiFrost 10
MI307 | SurgiFrost 10 | SurgiFrost 10 is a malleable, single-use cryosurgical device developed to treat cardiac arrhythmias during heart surgery. Freezing preserves tissue integrity. SurgiFrost10 features a malleable shaft and flexible tip with adjustable insulation sleeve. | One size ony | $4,095.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |
09.14.02.02 - System
Medtronic
MI306 | CryoFlex™ Surgical Clamp and Probe | The CryoFlex™ Surgical Clamp and Probe combines the utility of the CryoFlex™ Probe with the delivery of a clamp. | One size only | $5,095.00 | The prosthesis is only to be used in a surgical procedure described in item 38512 or 38515 in Group T8 of the Health Insurance (General Medical Services Table) Regulations 2018. |