Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2) (Australia)

Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2)

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Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2)
I, PETER WOODLEY, delegate of the Minister for Health and Ageing, make these Rules under item 4 of the table in section 333-20 of the Private Health Insurance Act 2007.
Dated      2 September 2011

________________________
Peter Woodley

Assistant Secretary
Private Health Insurance Branch
Medical Benefits Division
Department of Health and Ageing

1            Name of Rules
These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2011 (No. 2).
2              Commencement
These Rules commence on 5 September 2011.
3                 Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2011 (No. 2)
These Rules amend the Schedule to the Private Health Insurance (Prostheses) Rules 2011 (No. 2), as set out below:

3.1               Part A – Prostheses, at page 34 of 913, for the Billing Code SN273, under the heading “Size” delete “135mm - 235mm” and insert “135-200mm”.
3.2               Part A – Prostheses, at page 34 of 913, for the Billing Code SN271, under the heading “Description” delete “Cobal Chrome, beaded, HA, long with Calcar” and insert “Revision Hip Stem – Non-porous”; under the heading “Size” delete “Left/Right, 15 and 30mm, Sizes 11-22” and insert “225mm-300mm”.
3.3               Part A – Prostheses, at page 57 of 913, for the Billing Code WR132, under the heading “Product Name” delete “Profemur Total Hip System” and insert “Profemur R Hip System”.
3.4               Part A – Prostheses, at page 82 of 913, after the Billing Code EK066 insert the subheading “11.2.6 - Bipolar/Multipolar”.
3.5               Part A – Prostheses, at page 83 of 913, after Billing Code MU021; insert the subheading “Oceania Orthopaedics”; after the subheading, under the heading “Billing Code” insert “OO035”; under the heading “Product Name” insert “Bi-polar head”; under the heading “Description” insert “Bipolar head”; under the heading “Size” insert “44, 46, 48, 50, 52, 54, 56, 58, 60mm”; under the heading “Minimum Benefit” insert “$857.00”.
3.6               Part A – Prostheses, at page 83 of 913, after Billing Code OO035; insert the subheading “Orthotech Pty Ltd”; after the subheading, under the heading “Billing Code” insert “OH398”; under the heading “Product Name” insert “Furlong Hemi Range”; under the heading “Description” insert “Bipolar head”; under the heading “Size” insert “40-58mm”; under the heading “Minimum Benefit” insert “$857.00”.
3.7               Part A – Prostheses, at page 84 of 913, delete the subheading “11.2.6 - Bipolar/Multipolar”; delete the subheading “11.2.6.1 – Bipolar”; delete the subheading “Oceania Orthopaedics”; delete the Billing Code OO035       and the contents of all fields associated with it.
3.8               Part A – Prostheses, at page 85 of 913, delete the subheading “Orthotech Pty Ltd”; delete the Billing Code OH398 and the contents of all fields associated with it.
3.9               Part A – Prostheses, at page 121 of 913, delete the subheading “Global Orthopaedic Technology”; delete the Billing Code GO019 and the contents of all fields associated with it.
3.10           Part A – Prostheses, at page 121 of 913, after Billing Code ZI567, insert the heading “11.4.12 - Nut”; under the heading insert the subheading “Global Orthopaedic Technology”after the subheading, under the heading “Billing Code” insert “GO019”; under the heading “Product Name” insert “UniSyn Hip Connecting Nut”; under the heading “Description” insert “Titanium, locking nut, supplied separately”; under the heading “Size” insert “short & long”; under the heading “Minimum Benefit” insert “$204.00”.
3.11           Part A – Prostheses, at page 142 of 913, delete Billing Code SN814 and the contents of all fields associated with it.
3.12           Part A – Prostheses, at page 146 of 913, under the subheading “12.1.3.3 - Totally Constrained”, delete the subheading “REV” and insert “Revision”.
3.13           Part A – Prostheses, at page 146 of 913, after Billing Code OO016, delete the subheading “Revision”.
3.14           Part A – Prostheses, at page 148 of 913, after Billing Code ZI591 insert the subheading “Ceramic Surface”; under the subheading, insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA006”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision)”; under the heading “Description” insert “Ceramic Coated, Titanium Femoral and Tibial components with mobile Polyethylene inserts, all polyethylene patella ceramic coated, titanium backed polyethylene mobile patella”; under the heading “Size” insert “BP TKR Ultracoat Primary Femoral sizes 1-6(inc) Left & Right”; under the heading “Minimum Benefit” insert “$3,850.00”.
3.15           Part A – Prostheses, at page 148 of 913, after Billing Code EA006; under the heading “Billing Code” insert “EA013”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Femoral Component”; under the heading “Description” insert “Femoral Component, Titanium, uncemented, beaded, TiNi articular and bone surface treatment”; under the heading “Size” insert “1-6(inc) Left & Right”; under the heading “Minimum Benefit” insert “$3,850.00”.
3.16           Part A – Prostheses, at page 160 of 913, after Billing Code CR104, insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA023”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Femoral and Tibial Stems”; under the heading “Description” insert “Femoral and Tibial stems, titanium, TiNi surface treatment, uncemented”; under the heading “Size” insert “BP TKR Revision stems 9mm - 20mm (inc)” and under the heading “Minimum Benefit” insert “$1,258.00”.
3.17           Part A – Prostheses, at page 162 of 913, after Billing Code SM077, under the heading “Billing Code” insert “SM079”; under the heading “Product Name” insert “TC (Tri Compartment) PLUS Knee System Femoral and Tibial Stems”; under the heading “Description” insert “Femoral and Tibial Stems, Cemented, CoCr”; under the heading “Size” insert “80-150” and under the heading “Minimum Benefit” insert “$1,258.00”.
3.18           Part A – Prostheses, at page 170 of 913, after Billing Code AE042, insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA024”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Rebar Screws”; under the heading “Description” insert “Screws used for augmentation of bone defects and reinforcement of PMMA, TiNi surface treatment”; under the heading “Size” insert “BP Rebar screws 15mm-50mm (inc)” and under the heading “Minimum Benefit” insert “$140.00”.
3.19           Part A – Prostheses, at page 181 of 913, after Billing Code HW141, delete the subheading “Rivision”; and insert “Revision”.
3.20           Part A – Prostheses, at page 186 of 913, delete Billing Code SN356 and the contents of all fields associated with it.
3.21           Part A – Prostheses, at page 188 of 913, after Billing Code ZI416, delete the subheading “Rivision”; and insert “Revision”.
3.22           Part A – Prostheses, at page 190 of 913, under the subheading “12.3.7 – Uncemented, Alloy, for Mobile Insert” insert “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA008”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Tibial Baseplate ”; under the heading “Description” insert “Tibial Baseplate, uncemented, beaded, Titanium, TiNi Insert and bone ingrowth surface treated, for a mobile insert”; under the heading “Size” insert “1-6(inc)” and under the heading “Minimum Benefit” insert “$2,950.00”.
3.23           Part A – Prostheses, at page 191 of 913, after Billing Code BB254 insert “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA015”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Tibial Baseplate ”; under the heading “Description” insert “Tibial Baseplate, uncemented, beaded, Titanium, TiNi Insert and bone ingrowth surface treated, for a mobile insert”; under the heading “Size” insert “1-6(inc)” and under the heading “Minimum Benefit” insert “$4,300.00”.
3.24           Part A – Prostheses, at page 194 of 913, delete Billing Code SM048 and the contents of all fields associated with it.
3.25           Part A – Prostheses, at page 197 of 913, delete “Smith & Nephew Surgical Pty Ltd”; delete Billing Code SN335 and the contents of all fields associated with it.
3.26           Part A – Prostheses, at page 199 of 913, after Billing Code DD021 insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA010”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Tibial Insert”; under the heading “Description” insert “Tibial Insert, UHMWPE, mobile bearing”; under the heading “Size” insert “1-6(inc)”; under the heading “Minimum Benefit” insert “$1,140.00”.
3.27           Part A – Prostheses, at page 202 of 913, after the Billing Code OH331, delete the subheading “Smith & Nephew Pty Limited”; insert the subheading “Smith & Nephew Surgical Pty Limited”.
3.28           Part A – Prostheses, at page 208 of 913, after the Billing Code OH333, delete the subheading “Smith & Nephew Pty Limited”; insert the subheading “Smith & Nephew Surgical Pty Limited”.
3.29           Part A – Prostheses, at page 208 of 913, delete Billing Code SN852 and the contents of all fields associated with it.
3.30           Part A – Prostheses, at page 215 of 913, after Billing Code LO058, delete the subheading “Smith & Nephew Surgical Pty Ltd”; delete Billing Code SN371 and the contents of all fields associated with it.
3.31           Part A – Prostheses, at page 216 of 913, after Billing Code DD022 insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA012”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Patellar Component ”; under the heading “Description” insert “All poly patella, cemented, 3 pegs”; under the heading “Size” insert “1-6(inc)”; under the heading “Minimum Benefit” insert “$600.00”.
3.32           Part A – Prostheses, at page 220 of 913, after Billing Code BI901 insert the subheading “Endotec Australia Pty Ltd”; after the subheading, under the heading “Billing Code” insert “EA011”; under the heading “Product Name” insert “Buechel-Pappas Ultracoat Total Knee Replacement System Patellar Component”; under the heading “Description” insert “Patellar component, metal backed, uncemented, beaded, Titanium, TiNi surface treatment for bone and mobile patella poly”; under the heading “Size” insert “1-6(inc)”; under the heading “Minimum Benefit” insert “$1,352.00”.
3.33           Part A – Prostheses, at page 261 of 913, for the Billing Code JJ833, under the heading “Description” delete “Modular metaphyseal section HA coated” and insert “Modular metaphyseal cemented component”.
3.34           Part A – Prostheses, at page 262 of 913, for the Billing Code JJ834, under the heading “Description” delete “Cementless Epiphysis INOX/ ST. Steel + Aluminia+HAC” and insert “Modular metaphyseal component HA coated”.
3.35           Part A – Prostheses, at page 263 of 913, for the Billing Code DP956, under the heading “Description” delete “Modular metaphyseal section HA coated” and insert “Modular diaphyseal stem HA coated”.
3.36           Part A – Prostheses, at page 276 of 913, for the Billing Code SX051, under the heading “Maximum Benefit” delete “$1,800.00”.
3.37           Part A – Prostheses, at page 276 of 913, delete Billing Code JJ736 and the contents of all fields associated with it.
3.38           Part A – Prostheses, at page 278 of 913, after the Billing Code JJ583, under the heading “Billing Code” insert “JJ736”; under the heading “Product Name” insert “Confidence Spinal cement system”; under the heading “Description” insert “Spinal Bone Cement PMMA and Percutaneous Administration Kit”; under the heading “Size” insert “11cc” and under the heading “Minimum Benefit” insert “$500.00”.
3.39           Part A – Prostheses, at page 337 of 913, delete Billing Code SN063 and the contents of all fields associated with it.
3.40           Part A – Prostheses, at page 640 of 913, for the Billing Code DY556, under the heading “Size” delete “4.35 - 11mm 20 - 100mm” and insert “4.35 - 11mm x 20 - 100mm”.
3.41           Part A – Prostheses, at page 721 of 913 delete the heading “ORTHOPAEDIC”; delete the subheading “Knee – Accessories”; delete the subheading “Group 13b - Stems - Straight or offset”, delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA023 and the contents of all fields associated with it.
3.42           Part A – Prostheses, at page 721 of 913, delete the subheading “Group 13z - Others”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA024 and the contents of all fields associated with it.
3.43           Part A – Prostheses, at page 721 of 913 delete subheading “Knee - Femoral Component Total Arthroplasty”; delete the subheading “Group 1j - Uncemented, Alloy, Minimally Stabilised”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA006 and the contents of all fields associated with it.
3.44           Part A – Prostheses, at page 721 of 913 delete subheading “CS, Rev”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA013 and the contents of all fields associated with it.
3.45           Part A – Prostheses, at page 721 of 913 delete subheading “Knee - Patellar Components”; subheading “Group 9a - Cemented, all polyethylene”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA012 and the contents of all fields associated with it.
3.46           Part A – Prostheses, at page 722 of 913 delete heading “ORTHOPAEDIC”; delete the subheading “Group 9d - Uncemented, polyethylene metal backed, mobile”; delete the subheading “CS”; delete the subheading “Endotec Australia Pty Ltd and delete the billing code EA011 and the contents of all fields associated with it.
3.47           Part A – Prostheses, at page 722 of 913 delete subheading “Knee - Tibial Insert: Total Knee Arthroplasty”; delete the subheading “Group 5b - Minimally Stabilised, mobile”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA010 and the contents of all fields associated with it.
3.48           Part A – Prostheses, at page 722 of 913 delete subheading “Knee - Tibial Tray Component: Total Knee Arthroplasty”; delete the subheading “Group 3l - Uncemented, Alloy, for mobile insert”; delete the subheading “CS”; delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA008 and the contents of all fields associated with it.
3.49           Part A – Prostheses, at page 722 of 913 delete the subheading “Rev”, delete the subheading “Endotec Australia Pty Ltd” and delete the billing code EA015 and the contents of all fields associated with it.
3.50           Part A – Prostheses, at page 851 of 913, after the Billing Code BS195, under the heading “Billing Code” insert “BS198”; under the heading “Product Name” insert “Uphold™ LITE Vaginal Support System”; under the heading “Description” insert “Synthetic polypropylene mesh assemblies and fixation device”; under the heading “Size” insert “One Configuration”; under the heading “Minimum Benefit” insert “$1,322.00” and under the heading “Maximum Benefit” insert “$1,333.00”.

Note
1.       All legislative instruments and compilations are registered on the Federal Register of Legislative Instruments kept under the Legislative Instruments Act 2003. See www.frli.gov.au