• Contacts for Providers
• National Private Patient Hospital Claim Form
• Current Prostheses List
  • February 2012 Prostheses List Online Database
  • Past Prostheses Lists
• Common Acute Care Certificate
• Second Tier Hospitals List
• Exceptional Drugs List
• Presenting Illness Codes
• Hospital Code of Conduct

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 2012 Prostheses List. The February 2012 Prostheses List has a commencement date of 3rd March 2012.

The February 2012 Prostheses List and associated reports are available further down below this page.

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

The February 2012 Prostheses List (Part A) contains the following changes:

• 1274 new billing codes (411 for new products, 611 resulting from expansions, 150 resulting from transfers, 83 resulting from compressions and 19 resulting from duplications).

• 1352 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups.

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

The February 2012 Prostheses List (Part B) includes the following changes:

• 38 existing products have had benefit amendments; and

• 4 products have been deleted.

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

The February 2012 Prostheses List (Part C) includes the following change:

• 1 new billing code (1 new product).

Conditionally listed products

• Billing code CT016 - the provision of the prosthesis is associated with the service described in item 35597 of the general medical services table prescribed under section 4 of the Health Insurance Act 1973; and

• Billing code SO041 - a benefit for the provision of this prosthesis is payable for a child under 18 years of age.

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. 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.

Note: The next list to be published after the February 2012 Prostheses List will be the August 2012 Prostheses List, which is scheduled to commence Mid August 2012.

Benefits Payable In Respect of Prostheses and Human
Tissues List - February 2012

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.

Past Prostheses List Documents >>

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