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 2015 Prostheses List. The August 2015 Prostheses List has a commencement date of 8 September 2015. Amendments to the August 2015 Prostheses List were made on 9 November 2015 with an effective date of 27 November 2015.
The August 2015 Prostheses List has 11,017 products – 10,709 in Part A, 290 in Part B and 18 in Part C.
The August 2015 Prostheses List and associated reports are available further down below this page.
Variations from the previous Prostheses List – Part A (Prostheses)
The August 2015 Prostheses List (Part A) contains the following changes:
- 554 new billing codes (317 for new products, 31 resulting from expansions, 187 resulting from transfers, 7 resulting from compressions and 12 resulting from duplications).
- 149 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups.
- 477 billing codes were deleted (258 at the request of the sponsor and 219 that were expanded, compressed or transferred).
Variations from the previous Prostheses List – Part B (Human Tissue)
The August 2015 Prostheses List (Part B) has four new products listed and no changes in products.
Variations from the previous Prostheses List – Part C (Other Prostheses)
The August 2015 Prostheses List (Part C) has four new product listing.
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 2015 Prostheses List will be the February 2016 Prostheses List. The February 2016 Prostheses List has an expected commencement date of 25 March 2016.
Benefits Payable In Respect of Prostheses and Human Tissues List – August 2015
|PHI 83/15 Prostheses List Guide and Updated Website||116.19 KB|
|PHI 81/15 Prostheses List February 2016 – Critical Dates||115.75 KB|
|PHI 80/15 Prostheses List Management System||109.37 KB|
|PHI 78/15 Prostheses List – Applications For 2016||132.51 KB|
|PHI 75/15 Amendments To August 2015 Prostheses List||138.38 KB|
|PHI 72/15 Prostheses List – Listing of OP-1 Implant||128.21 KB|
|PHI 68/15 Prostheses List Management System||110.83 KB|
|PHI 61/15 Prostheses List Management System||333.81 KB|
|PHI 55/15 August 2015 Prostheses List||125.20 KB|
|PHI 45/15 Prostheses List Management System||395.77 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
|August 2015 Prostheses List User Manual – PDF Version||230.27 KB|
Associated Reports from the August 2015 Prostheses List
|New Items for Prostheses List – PDF Version||354.75 KB|
|New Items for Prostheses List – MS Excel Version||179.50 KB|
|Changed Items for Prostheses List – PDF Version||244.32 KB|
|Changed Items for Prostheses List – MS Excel Version||67.50 KB|
|Deleted Items for Prostheses List – PDF Version||331.50 KB|
|Deleted Items for Prostheses List – MS Excel Version||150.50 KB|
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