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  • 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 August 2014 Prostheses List. The August 2014 Prostheses List has a commencement date of 7 September 2014.

    The August 2014 Prostheses List will have 10,345 products – 10,042 in Part A, 290 in Part B and 13 in Part C.

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


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

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

    • 449 new billing codes (302 for new products, 44 resulting from expansions, 80 resulting from transfers, 19 resulting from compressions and 4 resulting from duplications).
    • 312 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups.
    • 447 billing codes were deleted (296 at the request of the sponsor and 151 that were expanded, compressed or transferred).

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

    The August 2014 Prostheses List (Part B) has 3 new products listed and changes in benefits for 90 products and change of listing details in 1 product.

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

    There were no changes to products in 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 10,000 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 August 2014 Prostheses List will be the February 2015 Prostheses List, scheduled to commence on 28 February 2015.


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

     

    Relevant Circulars
    File Size
    PHI 52/14 August 2014 Prostheses List 117.27 KB

     

    Databases
    File Size
    August 2014 Prostheses List – MS Access 8.69 MB
    August 2014 Prostheses List Part A (Prostheses) – PDF Version 3.75 MB
    August 2014 Prostheses List Part A (Prostheses) – MS Excel Version 3.29 MB
    August 2014 Prostheses List Part B (Human Tissue List) – PDF Version 179.77 KB
    August 2014 Prostheses List Part B (Human Tissue List) – MS Excel Version 136.00 KB
    August 2014 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – PDF Version 143.71 KB
    August 2014 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – MS Excel Version 106.50 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
    August 2014 Prostheses List User Manual – PDF Version 230.27 KB

     

    Associated Reports from the August 2014 Prostheses List
    File Size
    New Items for Prostheses List – PDF Version 313.77 KB
    New Items for Prostheses List – MS Excel Version 134.00 KB
    Changed Items for Prostheses List – PDF Version 299.75 KB
    Changed Items for Prostheses List – MS Excel Version 105.50 KB
    Deleted Items for Prostheses List – PDF Version 263.04 KB
    Deleted Items for Prostheses List – MS Excel Version 131.50 KB

     

     


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