Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1)

Link to law: https://www.comlaw.gov.au/Details/F2015L00540

 
 
Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1)
I, Lyndall Moore, delegate of the Minister for Health, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007. 
Dated   15th        April 2015
Lyndall Moore
 
 
Lyndall Moore
Acting Assistant Secretary
Private Health Insurance Branch
Medical Benefits Division
Department of Health

Contents
 
PART 1                  PRELIMINARY
 
1.                             Name of Rules  3
2.                             Commencement 3
3.                             Authority                                                                                              3
4.                             Schedules  3
 
 
SCHEDULE – AMENDMENTS                                                                                      4
 
 
 
 
Part 1        Preliminary
1.               Name of Rules
These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2015 (No. 1).
2.               Commencement
These Rules commence on 1 May 2015.
3.               Authority
These Rules are made under the Private Health Insurance Act 2007.
4.               Schedules
Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.  
 
Schedule – Amendments
Private Health Insurance (Prostheses) Rules 2015 (No. 1)
[1]         Schedule, Part A, Group 01.09.06 – Intraocular Silicone Oils, after entry for Billing Code SO053
insert the heading “01.10.01 – Foldable”
under that heading insert the subheading “Spectrum Surgical”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
SO076
HumanOptics Artificial Iris
 
One sterile, foldable Artificial Iris made of silicone, with or without fibre and custom made specific to the patient.
 
Custom made
 
$6,213.00

[2]         Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, entry for Billing Code CO073
delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
CO073
Cochlear™ Baha® 4 Sound Processor
The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction
One size.
$6,500.00

[3]         Schedule, Part A, SubGroup 02.01.04.01 - Sound Processor, after entry for Billing Code OI029
insert the subheading “Programmable, Wireless enabled”
under that subheading insert the subheading “Cochlear Limited”
under that subheading insert the contents of Item 1of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
CO073
Cochlear™ Baha® 4 Sound
The Cochlear Baha 4 Sound Processor is a wireless-enabled, fully programmable head-worn digital sound processor for the Baha Implantable Bone Conduction
One size
$6,825.00

[4]         Schedule, Part A, Group 05.04.01.02 - ≥ 500 sq cm, after entry for CT020
insert the subheading “Johnson & Johnson Medical Medical Pty Ltd”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
JJ789
GYNECARE GYNEMESH
Pelvic floor reconstructive material, lightweight mesh
25 x 25 cm
$677.00

[5]         Schedule, Part A, Group 06.03.15.03 – Ceramic, >10cc – 20cc, after entry for Billing Code ER159
delete the subheading “Eupharma”
delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
EH004
ELIZ Bone Graft Substitute
Synthetic HA / TCP Bone graft Substitute
Granules (1.0 - 4.0 mm) (0.8 - 1.5mm) (0.5 - 1.0mm)
Volume / Vial ( 15.0 cc to 20.0cc)
$1,500.00

[6]         Schedule, Part A, SubGroup 06.03.15.04 – Ceramic, >20cc, after entry for Billing Code ER160
delete the subheading “Eupharma”
delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
EH005
ELIZ Bone Graft Substitute
Synthetic HA / TCP Bone Graft
Granules (1.0 - 4.0 mm) (0.8 - 1.5mm)(0.5 - 1.0mm)
Volume / Vial (25.0 cc to 30.0cc)
$1,560.00

[7]         Schedule, Part A, Group 09.02.03 – Non-Stented, after entry for Billing Code MC015
insert the heading “09.02.04 - Rapid Deployment Aortic Valve with dedicated single use tools”
under that heading insert the subheading “b”
under that subheading insert the subheading “Sorin Group Australia Pty Ltd”
under that subheading insert the contents of Item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
SA170
Perceval S Sutureless Aortic Heart Valve
 
Sutureless Aortic Pericardial Heart Valve
 
S (19-21mm), M (21-23mm), L (23-25mm), XL (25-27mm)
 
$9,450.00

 
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