Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 3) (Australia)

Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 3)

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Private Health Insurance (Prostheses) Amendment Rules 2014 (No. 3)
I, Shane Porter, 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   nineteenth                        November 2014
Shane Porter
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 2014 (No. 3).
2.               Commencement
These Rules commence on 6 December 2014.
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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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 2014 (No. 2)
[1]         Schedule, Part A, SubGroup 02.01.04.02 – Osseointegration, entry for Billing Code CO068
omit “$895.00” from the column “Minimum Benefit”, substitute “$1,115.00”.
[2]         Schedule, Part A, SubGroup 03.02.03.04 – Other Pharmacology, after entry for Billing Code AH004
insert the subheading “ClaveGuard 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
CJ011
AutoMed Infusion Pump – 3300, 3400
Ambulatory infusion pump
One size only
$4,950.00

[3]         Schedule, Part A, SubGroup 03.02.06.01 – Single Units, after entry for Billing Code ET052
insert the subheading “N Stenning & Co 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
NG068
Embozene Tandem Microspheres
Embozene TANDEM Microspheres are spherical tightly calibrated, biocompatible, non-resorbable, hydrogel microspheres with an inorganic polyzene-F coating, colour coded to indicate microsphere size. Each 20mL syringe is filled with 2 ml of product suspended in a non-pyrogenic physiological slaine transport solution. Embozene TANDEM Microspheres may be loaded with Doxirubican-HCl and Irinotecan-HCl up to 50mg/ml which can elute local, controlled, sustained doses of drugs to targeted tumour sites after embolization.
Tandem 2ml 40 ± 10 µm
Tandem 2ml 75 ± 15 µm
Tandem 2ml 100 ± 25 µm
$1,950.00

under that entry insert the subheading “3 ml”
under that subheading insert the subheading “N Stenning & Co 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
NG069
Embozene Tandem Microspheres
Embozene TANDEM Microspheres are spherical tightly calibrated, biocompatible, non-resorbable, hydrogel microspheres with an inorganic polyzene-F coating, colour coded to indicate microsphere size. Each 20mL syringe is filled with 2 ml of product suspended in a non-pyrogenic physiological slaine transport solution. Embozene TANDEM Microspheres may be loaded with Doxirubican-HCl and Irinotecan-HCl up to 50mg/ml which can elute local, controlled, sustained doses of drugs to targeted tumour sites after embolization.
Tandem 2ml 40 ± 10 µm
Tandem 2ml 75 ± 15 µm
Tandem 2ml 100 ± 25 µm
$2,476.00

[4]         Schedule, Part A, SubGroup 03.08.02.04 – Adhesive Accessory, after the subheading “Complex Delivery Device”
insert the subheading “Johnson & Johnson 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
JJ962
EVICEL Airless Spray Device
Airless Spray Device
One size only
$62.00

[5]         Schedule, Part A, SubGroup 03.08.05.01 - ≤ 200cm2, after entry for Billing Code JJ416
insert the subheading “Coated, Contoured”
under that subheading insert the subheading “Alliance 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
AA016
4D – DOME SEMI ABSORBABLE HERNIA MESH
4D DOME semi absorbable bio mesh for abdominal reinforcement inguinal, femoral and incisional hernias
2.4, 9 x 5 cm
3.0, 9 x 5 cm
3.8, 9 x 5 cm
$350.00

[6]         Schedule, Part A, SubGroup 03.08.06.01 - ≤200cm², entry for Billing Code AS203
omit “$570.00” from the column “Minimum Benefit”, substitute “$600.00”.
[7]         Schedule, Part A, SubGroup 03.08.06.02 - 201-400cm², entry for Billing Code AS204
omit “$979.00” from the column “Minimum Benefit”, substitute “$1,009.00”.
[8]         Schedule, Part A, SubGroup 06.03.02.01 – Intramedullary nail lag screw, entry for Billing Code OU003
delete the contents of item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
OU003
K-WIRE DOUBLE TROCAR
K-WIRE DOUBLE TROCAR
1.1mm x 150mm
1.6mm x 125mm
2.0mm x 150mm
0.6-0.8DIA up to 150mm
0.9-1.4DIA up to 230mm
1.6-1.8DIA up to 400mm
2.0-2.3DIA up to 310mm
$209.00

[9]         Schedule, Part A, SubGroup 06.03.03.44 – Periarticular anatomic – Foot, after entry for OU039
insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
OU047
UltOS straight plates
General fusion straight plates
2 hole, 4 hole
$730.00

[10]      Schedule, Part A, SubGroup 06.03.04.03 – Mini (2.01 – 2.7 mm), entry OU029
delete contents of column headed “Description”.
insert the contents of item 1 of the table in the column indicated:

Item
Description

1
11 mm TWIST-OFF SCREW2.5MM Cancellous thread
12 mm TWIST-OFF SCREW2.5MM Cancellous thread
13 mm TWIST-OFF SCREW2.5MM Cancellous thread
14 mm TWIST-OFF SCREW2.5MM Cancellous thread
15 mm TWIST-OFF SCREW2.5MM Cancellous thread
17 mm TWIST-OFF SCREW2.5MM Cancellous thread
TWIST-OFF SCREWS10mm (1.5mm Shank)
TWIST-OFF SCREWS11mm (1.5mm Shank)
TWIST-OFF SCREWS12mm (1.5mm Shank)
TWIST-OFF SCREWS13mm (1.5mm Shank)
TWIST-OFF SCREWS14mm (1.5mm Shank)
TWIST-OFF SCREWS15mm (1.5mm Shank)
TWIST-OFF SCREWS16mm (1.5mm Shank)
TWIST-OFF SCREWS17mm (1.5mm Shank)
TWIST-OFF SCREWS18mm (1.5mm Shank)
TWIST-OFF SCREWS10mm
TWIST-OFF SCREWS11mm
TWIST-OFF SCREWS12mm
TWIST-OFF SCREWS13mm
TWIST-OFF SCREWS14mm
TWIST-OFF SCREWS15mm
TWIST-OFF SCREWS16mm
TWIST-OFF SCREWS17mm
TWIST-OFF SCREWS18mm

[11]      Schedule, Part A, SubGroup 06.03.04.06 – Screw Washers, after entry for Billing Code MO158
insert the subheading “Ortho Solutions 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
OU048
Cannulated Bone Screw Washers
Washers
4.0mm Cannulated screw plain washer
4.0mm Cannulated screw cup washer
5.0mm Cannulated screw plain washer
5.00mm Cannulated screw cup washer
6.5mm Titanium flat washer
8.0mm titanium flat washer
FPS 3.5mm washer
$103.00

[12]      Schedule, Part A, SubGroup 06.03.05.02 – Pins, after entry for Billing Code OU001
insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
OU003
K-WIRE DOUBLE TROCAR
K-WIRE DOUBLE TROCAR
1.1mm x 150mm
1.6mm x 125mm
2.0mm x 150mm
0.6-0.8DIA up to 150mm
0.9-1.4DIA up to 230mm
1.6-1.8DIA up to 400mm
2.0-2.3DIA up to 310mm
$30.00

[13]      Schedule, Part A, SubGroup 06.03.15.01 – Ceramic, 0-5cc, after entry for Billing Code BX315
insert the contents of item 1 of the table in the columns indicated:

Item
Billing Code
Product
Description
Size
Minimum Benefit

1
BX320
ACTIFUSE GRANULES – BONE MATRIX IMPLANT ARTIFICIAL
A silicate substituted synthetic bone graft
5mL
$1,080.00

[14]      Schedule, Part A, SubGroup 06.03.15.02 – Ceramic, >5cc – 10cc, after entry for Billing Code BX309
insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
BX312
Actifuse ABX Easyfill Putty
Actifuse ABX EasyFill Putty – A silicate substituted synthetic bone
10ml
$2,300.00

[15]      Schedule, Part A, SubGroup 06.03.15.03 – Ceramic, >10cc – 20cc, entry for Billing Code BX312
delete the contents of item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
BX312
Actifuse ABX Easyfill Putty
Actifuse ABX EasyFill Putty – A silicate substituted synthetic bone
10ml
$4,600.00

[16]      Schedule, Part A, SubGroup 06.03.15.03 – Ceramic, >10cc – 20cc, after entry for Billing Code BX318
delete the contents of item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
BX320
ACTIFUSE GRANULES – BONE MATRIX IMPLANT ARTIFICIAL
A silicate substituted synthetic bone graft
5mL
$4,600.00

[17]      Schedule, Part A, SubGroup 07.05.02.01 – Skin or Mammary, after entry for Billing Code DE337
insert the subheading “Emergo Asia Pacific 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
ER198
Aeroform Patient Controlled Tissue Expander
Aeroform Patient Controlled Tissue Expander; Multichamber, textured, CO2 filled
width (12.5, 14, 15.5 cm) x height (11, 12.5, 14 cm) x projection (8, 9.5, 10.5 cm); volume 400, 600 and 800 cc
$1,050.00

[18]      Schedule, Part A, SubGroup 07.05.02.02 – Orbital, after entry for Billing Code SO041
insert the subheading “07.07.02.03 – External Component”
under that subheading insert the subheading “Patient Controller”
under that subheading insert the subheading “Emergo Asia Pacific 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
ER199
AeroForm Tissue Expander System Dosage Controller
AeroForm Tissue Expander System Dosage Controller
N/A
$1,400.00

[19]      Schedule, Part A, Group 13.03.02 – Offset, entry for Billing Code MC668
delete contents of columns headed “Product” and “Description”.
insert the contents of item 1 of the table in the columns indicated:
Item
Product
Description

1
CD HORIZON Spinal System - Lateral Connector
Lateral connector

[20]      Schedule, Part A, SubGroup 13.05.01.01 - Cervical, after the subheading “Zimmer Pty Ltd”
delete the contents of Item 1 of the table from the columns indicated.
insert the contents of Item 2 of the table in the columns indicated.
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
ZI489
Trinica Select Anterior Cervical Plate
Titanium plate for anterior cervical spine. Used to assist spinal fusion. Attached to the bone using screws.
Plates for 1 or 2 levels are from 22 to 52mm long in 2mm increments; Plates for 3 levels are from 51 – 72mm long in 3mm increments
$1,400.00

2
ZI896
Trinica/InVizia Anterior Cervical Plates
Titanium plate for anterior cervical spine
≤55mm
$1,400.00

[21]      Schedule, Part A, SubGroup 13.05.01.01 - Cervical, after entry for Billing Code ZI489
delete the subheading “>55m”
under that subheading, delete the subheading “Nuvasive Australia and NZ Pty Ltd”
under that subheading delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
NV092
Helix-T (Plate 56 – 110mm)
Anterior cervical plate
56-110mm
$1,700.00

[22]      Schedule, Part A, SubGroup 13.05.01.01 - Cervical, after entry for Billing Code NV069
insert the contents of Item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum Benefit

1
NV092
Helix-T (Plate 56 – 110mm)
Anterior cervical plate
56-110mm
$1,700.00

[23]      Schedule, Part A, SubGroup 13.05.01.01 - Cervical, after entry for Billing Code SY519
insert the subheading “Zimmer 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
ZI897
Trinica/InVizia Anterior Cervical Plates
Titanium plate for anterior cervical spine.
>55mm
$1,700.00

[24]      Schedule, Part B, Group Bone – Cancellous Bone Matrix, Lypholised 40cc, entry for Billing Code TBV52
omit “Victorian Institute of Forensic Medicine” from the column “Facility”, substitute “Donor Tissue Bank of Victoria”.
[25]      Schedule, Part B, Group Bone – Cancellous Bone Matrix, Lypholised 80cc, entry for Billing Code TBV53
omit “Victorian Institute of Forensic Medicine” from the column “Facility”, substitute “Donor Tissue Bank of Victoria”.
[26]      Schedule, Part B, Group Femoral Head, after entry for Billing Code ACT01
delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Facility
Minimum Benefit

1
APH01
The Avenue Private Hospital Bone Bank
$1,131.00

[27]      Schedule, Part B, Group Femoral Head, after entry for Billing Code DHR01
delete the contents of Items 1, 2 and 3 of the table from the columns indicated:
Item
Billing Code
Facility
Minimum Benefit

1
HBB01
The Hobart Private Hospital Bone Bank
$2,113.00

2
LPH01
Lingard Private Hospital Bone Bank
$1,103.00

3
MMH01
Mater Misericordiae Hospital Bone Bank Theatres
$400.00

[28]      Schedule, Part B, Group Femoral Head, after entry for Billing Code RBN01
delete the contents of Item 1 of the table from the columns indicated:
Item
Billing Code
Facility
Minimum Benefit

1
SVN01
Mater Hospital
$731.00

[29]      Schedule, Part B, Group Cornea for Endothelial Keratoplasty, before entry for Billing Code LEW03
insert the contents of Item 1 of the table in the columns indicated:
Item
Billing Code
Facility
Minimum Benefit

1
LEN04
Lions NSW Eye Bank
$2,695.00