Private Health Insurance (Prostheses) Amendment Rules 2013 (No. 4)
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 25 October 2013
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 2013
(No. 4).
2. Commencement
These Rules commence on 8 November 2013.
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Each instrument that is specified in a Schedule to this instrument is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this instrument has effect according to its terms.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 2013 (No. 1)
1 Schedule, Part A, Subgroup 10.2.5.2 - Multiple Branch, entry for billing code WC312
delete contents of columns headed “Description” and “Size”.
insert the contents of item 1 of the table in the columns indicated:
Item
Description
Size
1
The Zenith Universal Distal Body Endovascular Graft (Unibody) consists of a bifurcated graft loaded into the H&L-B One-Shot delivery system
Diameters: 22 – 24mm
Lengths: 81 – 32mm
2 Schedule, Part A, Subgroup 13.11.1.2 - Lumbar, after entry for billing code MC585
insert the subheading “Orthotech 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
OH467
LP-ESP Intervertebral Disc Prosthesis
Lumbar disc prosthesis
10-12mm thickness, 7/9/11 degrees
$9,550.00
3 Schedule, Part A, Subgroup 6.3.11.12 - Frame Component – Coupling Device, after entry for billing code SY091
delete the subheading:
3D
Stryker Australia Pty Ltd
delete the contents of item 1 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum benefit
1
HW517
HOFFMANN3 EXTERNAL FIXATION SYSTEM
MULTIPLANAR CLAMP PIN/ROD-ROD
STANDARD
$770.00
4 Schedule, Part A, Subgroup 6.3.11.14 - Frame Component – Pins, after entry for billing code ST884
delete the subheading “Standard”.
5 Schedule, Part A, Subgroup 6.3.11.3 - Frame Component - Monoplanar, Clamp, after entry for billing code SN966
insert the subheading:
3D
Stryker 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
HW517
HOFFMANN3 EXTERNAL FIXATION SYSTEM
MULTIPLANAR CLAMP PIN/ROD-ROD
STANDARD
$1,662.00
6 Schedule, Part A, Subgroup 6.3.3.39 – Periarticular anatomic – Tibia ≥7 to ≤15 holes, after entry for billing code BH309
insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum benefit
1
BH287
ALPS Anatomic Locked plating system
Distal and Proximal Tibial Plates, Titanium
7 to 15 holes
$1,574.00
7 Schedule, Part A, Subgroup 6.3.4.6 – Screw Washers, after entry for billing code BH280
insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum benefit
1
BH286
ALPS LFS
Flat and cupped Titanium washers
4.5-6.5mm
$103.00
8 Schedule, Part A, Group 14: Intramedullary Nails, after entry for billing code BH357
insert the subheading:
Group 14d: Other
Biomet 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
Maximum Benefit
1
BH264
Small Bone Fixation System – Small Bone Flexible Nail
Intramedullary Nail
1.6mm and 1.1mm
$700.00
$950.00
9 Schedule, Part B, Orthopaedic, after entry for billing code TBV54
insert the subheading “Bone - Demineralised Bone Matrix, DBX Putty, 5cc”
under that subheading insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Facility
Minimum benefit
1
SYN01
Synthes Australia Pty Ltd
$2,650.00
10 Schedule, Part B, Orthopaedic, above subheading “Bone – Milled 300cm² - acellular dermal matrix allograft from human origin”
under that subheading insert the contents of item 1 of the table in the columns indicated:
Item
Billing Code
Product
Minimum benefit
1
SYN07
Synthes Australia Pty Ltd
$27,000.00
16 Further amendments – Schedule, Part A, billing codes BI286, BI287 and BI264
delete the contents of items 1 to 3 of the table from the columns indicated:
Item
Billing Code
Product
Description
Size
Minimum benefit
1
BI286
Uniflex Tibial Nail
Tibial Nail, Titanium
8-14mm x 240-420mm
$1,335.00
2
BI287
Uniflex Tibial Nail
Tibial Nail Transverse Screw,
4.0, 5.0mm x (20-70mm)
$209.00
3
BI264
EBI XFIX Dynafix System
Distal Radius Fixator, Dimension, Stainless Steel, Aluminium
One size Only
$2,150.00
17 Further amendments – Schedule, Part A, minimum benefits
The entries in the column headed “Minimum benefit” for the billing codes listed in items 1 to 10 of the table are amended as set out in the table:
Item
Billing Code
Delete
Insert
1
BS082
$412.00
$145.00
2
MH014
$412.00
$145.00
3
MH015
$412.00
$145.00
4
BS171
$412.00
$145.00
5
OL009
$412.00
$145.00
6
WC213
$412.00
$145.00
7
OL010
$412.00
$145.00
8
ST884
$135.00
$149.00
9
BR005
$36,900.00
$19,250.00
10
BR006
$19,250.00
$5,775.00
18 Further amendments – Schedule, Part B, minimum benefits
The entries in the column headed “Minimum benefit” for the billing codes listed in items 1 to 3 of the table are amended as set out in the table:
Item
Billing Code
Delete
Insert
1
SHV01
$5,350.00
$6,842.00
2
SHV02
$5,350.00
$6,842.00
3
SHV03
$987.00
$1,263.00
