Current Prostheses List

The Prostheses List, which lists the no-gap and gap-permitted prostheses and the benefits payable for them is released twice per year.

The current version of the List is known as the February 2014 Prostheses List. The February 2014 Prostheses List has a commencement date of 28 February 2014.

The February Prostheses List will have 10,351 products – 10,053 in Part A, 287 in Part B and 11 in Part C.

The February 2014 Prostheses List and associated reports are available further down below this page.


Variations from the previous Prostheses List – Part A (Prostheses)

The February 2014 Prostheses List (Part A) contains the following changes:

  • 539 new billing codes (388 for new products, 45 resulting from expansions, 61 resulting from transfers, 10 resulting from compressions and 35 resulting from duplications).
  • 189 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups.
  • 173 billing codes were deleted.

Variations from the previous Prostheses List – Part B (Human Tissue)

The February 2014 Prostheses List (Part B) has four (4) new products listed.

Variations from the previous Prostheses List – Part C (Other Prostheses)

One product was deleted from Part C.

No-gap Prostheses products

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”. No-gap prostheses are listed with a single benefit, and patients will have no out-of-pocket expenses for these prostheses. Assuming the conditions for the insured patient above are met, health insurers are required to pay this benefit. For each Medicare Benefit Schedule (MBS) item, it is aimed to have at least one no-gap prosthesis available.

Gap permitted Prostheses products

Gap-permitted prostheses have both a minimum and maximum benefit listed. For these prostheses private health insurers are required to pay at least the minimum benefit.

Patients may incur an out-of-pocket expense for these prostheses, which, at a maximum, will be the difference between the minimum and the maximum benefit.

Currently, there are more than 9,000 products on the Prostheses List including cardiac pacemakers and defibrillators, cardiac stents, hip and knee replacements and intraocular lenses, as well as human tissues such as human heart valves, corneas, bones (part and whole) and muscle tissue. The List does not include external legs, external breast prostheses, wigs and other such devices, only surgically implanted prostheses.

The next list to be published after the February 2014 Prostheses List will be the August 2014 Prostheses List.


Benefits Payable In Respect of Prostheses and Human Tissues List – February 2014

Relevant Circulars
File Size
PHI 11/14 February 2014 Prostheses List 100.29 KB
PHI 13/14 Amendment to the Private Health Insurance (Prostheses) Rules 2014 (No. 1) 118 KB
PHI 17/14 Change To Paying Application Fees For The Prostheses List 93 KB

 

Databases
File Size
February 2014 Prostheses List – MS Access 8.68 MB
February 2014 Prostheses List Part A (Prostheses) – PDF Version 3.72 MB
February 2014 Prostheses List Part A (Prostheses) – MS Excel Version 3.28 MB
February 2014 Prostheses List Part B (Human Tissue List) – PDF Version 179.25 KB
February 2014 Prostheses List Part B (Human Tissue List) – MS Excel Version 133 KB
February 2014 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – PDF Version 143.71 KB
February 2014 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – MS Excel Version 104 KB

Note: Due to limitations with Excel – cell height cannot be greater than 256 pixels – some cells in the spreadsheet may contain incomplete information. You are advised to reference another version of the Prostheses List if you find incomplete information.

Public User Guide
File Size
February 2014 Prostheses List User Manual – PDF Version 230.27 KB

 

Associated Reports from the February 2014 Prostheses List
File Size
New Items for Prostheses List – PDF Version 340.90 KB
New Items for Prostheses List – MS Excel Version 159 KB
Changed Items for Prostheses List – PDF Version 256.55 KB
Changed Items for Prostheses List – MS Excel Version 72.50 KB
Deleted Items for Prostheses List – PDF Version 311.64 KB
Deleted Items for Prostheses List – MS Excel Version 74 KB

 

 


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