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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 February 2015 Prostheses List. The February 2015 Prostheses List has a commencement date of 18 March 2015.

    The February 2015 Prostheses List will have 10,880 products – 10,580 in Part A, 286 in Part B and 14 in Part C.

    The February 2015 Prostheses List and associated reports are available further down below this page.


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

    The February 2015 Prostheses List (Part A) contains the following changes:

    • 526 new billing codes (306 for new products, 30 resulting from expansions, 133 resulting from transfers, 22 resulting from compressions and 35 resulting from duplications).
    • 115 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups.
    • 425 billing codes were deleted (194 at the request of the sponsor and 231 that were expanded, compressed or transferred).

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

    The February 2015 Prostheses List (Part B) has no new products listed and changes in benefits for 54 products and no change of listing details in products.

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

    There was a suffix change to one product 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 February 2015 Prostheses List will be the August 2015 Prostheses List.


    Benefits Payable In Respect of Prostheses and Human Tissues List – February 2015

     

    Relevant Circulars
    File Size
    PHI 41/15 Amendment to February 2015 Prostheses List 396.48 KB
    PHI 35/15 Critical dates for August 2015 Prostheses List 115.34 KB
    PHI 23/15 Amendment to February 2015 Prostheses List 165.17 KB
    PHI 15/15 Prostheses List Advisory Committee Appointments 119.60 KB
    PHI 14/15 February 2015 Prostheses List 114.43 KB

     

    Databases
    File Size
    February 2015 Prostheses List – MS Access 8.81 MB
    February 2015 Prostheses List Part A (Prostheses) – PDF Version 3.82 MB
    February 2015 Prostheses List Part A (Prostheses) – MS Excel Version 3.35 MB
    February 2015 Prostheses List Part B (Human Tissue List) – PDF Version 179.62 KB
    February 2015 Prostheses List Part B (Human Tissue List) – MS Excel Version 135 KB
    February 2015 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – PDF Version 144.06 KB
    February 2015 Prostheses List Part C (Insulin infusion pumps and cardiac event recorders) – MS Excel Version 107 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 2015 Prostheses List User Manual – PDF Version 230.27 KB

     

    Associated Reports from the February 2015 Prostheses List
    File Size
    New Items for Prostheses List – PDF Version 396.08 KB
    New Items for Prostheses List – MS Excel Version 148 KB
    Changed Items for Prostheses List – PDF Version 183.29 KB
    Changed Items for Prostheses List – MS Excel Version 55.50 KB
    Deleted Items for Prostheses List – PDF Version 299.60 KB
    Deleted Items for Prostheses List – MS Excel Version 122.50 KB

     

     


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