Private Health Insurance (Prostheses) Amendment Rules 2007 (No. 1)

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Private Health Insurance (Prostheses) Amendment Rules 2007 (No.1)
I, PENNY SHAKESPEARE, 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 14 June 2007  
 
 
____________________________________
Penny Shakespeare
 
Assistant Secretary
Private Health Insurance Branch,
Acute Care Division
Department of Health and Ageing
 
 
 
 
 

1.                      Name of Rules
These Rules are the Private Health Insurance (Prostheses) Amendment Rules 2007(No.1).
2.                      Commencement
These Rules commence on 1 July 2007.
3.                      Amendment of the Schedule to the Private Health Insurance (Prostheses) Rules 2007 (No.2)
These Rules amend the Schedule to the Private Health Insurance (Prostheses) Rules 2007 (No.2) dated 17 May 2007 and effective on 1 June 2007, as set out below:
3.1         Part A – Prostheses, at page 1 of 547, after billing code AY020 insert the Billing Code GU102; under the heading “Product Name” insert “Stents”; under the heading “Description” insert “ACS Multilink Coronary Stent, ACS Megalink Peripheral Stent, ACS RX Herculink Peripheral Stent, Stainless steel”; under the heading “Size” insert “1.5mm - 8.0mm”; and under the heading “Minimum Benefit” insert $1,248.00.
3.2         Part A – Prostheses, at page 1 of 547, after the Billing Code GU102 insert the Billing Code GU105; under the heading “Product Name” insert “Multilink Coronary Stent System”; under the heading “Description” insert “Stainless Steel”; under the heading “Size” insert “Length 1.5mm - 8.0mm”; and under the heading “Minimum Benefit" insert $1,248.00.
3.3         Part A – Prostheses, at page 1 of 547, for the Billing Code AB001, under the heading “Minimum Benefit” delete “$5,928.00” and insert “$6,800.00”.
3.4         Part A – Prostheses, at page 1 of 547, after the Billing Code AC022 insert the heading “Bio Excel Pty Ltd”.
3.5         Part A – Prostheses, at page 1 of 547, after heading Bio Excel Pty Ltd, insert the Billing Code DA001; under the heading ”Product Name” insert “S-Stent SRX1”; under the heading “Product Description” insert “316L Stainless Steel”; under the heading “Size” insert “SRX1 - 2510 2.5 x 8.5mm, SRX1 - 3010 3.0 x 8.5mm, SRX1 - 3510L 3.5 x 8.5mm, SRX1 - 4010L 4.0 x 8.5mm, SRX1- 2512 2.5 x 11mm, SRX1 23012 3.0 x 11mm, SRX1 - 3512L 3.5 x 11mm, SRX1 - 4012L 4.0 x 11mm, SRX1 - 2515 2.5 x 14.4mm, SRX1 - 3015 3.0 x 14.4mm”;  and under the heading “Minimum Benefit” insert $600.00.
3.6         Part A – Prostheses, at page 5 of 547, after the Billing Code GU079, delete the Billing Code GU102 and the contents of all fields associated with it.
3.7         Part A – Prostheses, at page 5 of 547, after the Billing Code GU102, delete the Billing Code GU105 and the contents of all fields associated with it.
3.8         Part A – Prostheses, at page 38 of 547, for the Billing Code BS117, under the heading “Product Name” delete “WallFlex Biliary RXC Stent” and insert “WallFlex Biliary RX Stent”.
3.9         Part A – Prostheses, at page 55 of 547, for the Billing Code BS103, under the heading “Maximum Benefit” delete $3,781.60.
3.10     Part A – Prostheses, at page 58 of 547, for the Billing Code GE007, under the heading “Maximum Benefit” delete $0.00.
3.11     Part A – Prostheses, at page 58 of 547, for the Billing Code GE008, under the heading “Maximum Benefit” delete $0.00.
3.12     Part A – Prostheses, at page 58 of 547, for the Billing Code GE009, under the heading “Maximum Benefit” delete $0.00.
3.13     Part A – Prostheses, at page 59 of 547, for the Billing Code GE010, under the heading “Maximum Benefit” delete $0.00.
3.14     Part A – Prostheses, at page 76 of 547, for the Billing Code SE001, under the heading “Minimum Benefit” delete $7,222.00 and insert $7,650.00.
3.15     Part A – Prostheses, at page 146 of 547, for the Billing Code OH255, under the heading “Minimum Benefit” delete $136.00 and insert $140.00.
3.16     Part A – Prostheses, at page 146 of 547, for the Billing Code OH260, under the heading “Maximum Benefit” insert $580.00.
3.17     Part A – Prostheses, at page 146 of 547, for the Billing Code OH264, under the heading “Minimum Benefit” delete $3,364.00 and insert $2,000.00; and under the heading “Maximum Benefit” insert $3,250.00.
3.18     Part A – Prostheses, at page 146 of 547, for the Billing Code OH265, under the heading “Minimum Benefit” delete $5,826.00 and insert $2,500.00; and under the heading “Maximum Benefit” insert $5,250.00.
3.19     Part A – Prostheses, at page 147 of 547, for the Billing Code OH266, under the heading “Minimum Benefit” delete $804.00 and insert $825.00.
3.20     Part A – Prostheses, at page 147 of 547, for the Billing Code OH267, under the heading “Minimum Benefit” delete $1,027.00 and insert $1,055.00.
3.21     Part A – Prostheses, at page 147 of 547, for the Billing Code OH268, under the heading “Minimum Benefit” delete $1,239.00 and insert $1,273.00.
3.22     Part A – Prostheses, at page 147 of 547, for the Billing Code OH269, under the heading “Minimum Benefit” delete $1,471.00 and insert $1,427.00.
3.23     Part A – Prostheses, at page 147 of 547, for the Billing Code OH270, under the heading “Minimum Benefit” delete $1,972.00 and insert $1900.00.
3.24     Part A – Prostheses, at page 147 of 547, for the Billing Code OH271, under the heading “Minimum Benefit” delete $2,316.00 and insert $2,250.00.
3.25     Part A – Prostheses, at page 147 of 547, for the Billing Code OH272, under the heading “Minimum Benefit” delete $2,700.00 and insert $2,650.00.
3.26     Part A – Prostheses, at page 147 of 547, for the Billing Code OH273, under the heading “Minimum Benefit” delete $2,980.00 and insert $2,900.00.
3.27     Part A – Prostheses, at page 147 of 547, for the Billing Code OH274, under the heading “Minimum Benefit” delete $3,473.00 and insert $3,300.00.
3.28     Part A – Prostheses, at page 157 of 547, for the Billing Code SY250, under the heading “Maximum Benefit” delete $2,565.00.
3.29     Part A – Prostheses, at page 159 of 547, for the Billing Code SY365, under the heading “Maximum Benefit” delete $2,524.00.
3.30     Part A – Prostheses, at page 160 of 547, for the Billing Code SY382, under the heading “Maximum Benefit” delete $1,250.00.
3.31     Part A – Prostheses, at page 160 of 547, for the Billing Code SY383, under the heading “Maximum Benefit” delete $240.00.
3.32     Part A – Prostheses, at page 165 of 547, for the Billing Code TB363, under the heading “Maximum Benefit” delete $2,600.00.
3.33     Part A – Prostheses, at page 165 of 547, for the Billing Code TB364, under the heading “Maximum Benefit” delete $400.00.
3.34     Part A – Prostheses, at page 170 of 547, for the Billing Code AL021, under the heading “Minimum Benefit” delete $364.00 and insert $385.00.
3.35     Part A – Prostheses, at page 176 of 547, delete the Billing Code CY001 and the contents of all fields associated with it.
3.36     Part A – Prostheses, at page 176 of 547, after the Billing Code CS008 delete the heading “Cytosol Ophthalmics Australia Pty Ltd”.
3.37     Part A – Prostheses, at page 179 of 547, after the Billing Code IS001 insert the Billing Code IS007; under the heading “Product Name” insert “OII PMMA Capsular Tension Ring”; under the heading “Description” insert “Capsular Tension Ring – PMMA”; under the heading “Size” insert “12mm and 13mm”; and under the heading “Minimum Benefit” insert $135.00.
3.38     Part A – Prostheses, at page 225 of 547, for the Billing Code CR100, under the heading “Product Name” delete “Integrate Modular Stem” and insert “Integrale Modular Stem”.
3.39     Part A – Prostheses, at page 291 of 547, for the Billing Code LO127, under the heading “Minimum Benefit” delete $0.00 and insert $2,652.00.
3.40     Part A – Prostheses, at page 297 of 547, for the Billing Code MA422, under the heading “Minimum Benefit” delete $5,650.00 and insert $1,525.00.
3.41     Part A – Prostheses, at page 318 of 547, for the Billing Code PL106, under the heading “Size” delete “46 – 48” and insert “46 - 68mm”.
3.42     Part A – Prostheses, at page 339 of 547, for the Billing Code SN727, under the heading “Maximum Benefit” delete $1,163.00.
3.43     Part A – Prostheses, at page 370 of 547, for the Billing Code SR052, under the heading “Minimum Benefit” delete $228,800 and insert $2,370.00.
3.44     Part A – Prostheses, at page 370 of 547, for the Billing Code SR053, under the heading “Minimum Benefit” delete $1,248.00 and insert $1,430.00.
3.45     Part A – Prostheses, at page 383 of 547, for the Billing Code TB064, under the heading “Maximum Benefit” delete $1,000.00.
3.46     Part A – Prostheses, at page 384 of 547, for the Billing Code TB204, under the heading “Minimum Benefit” delete $1,334.00 and insert $2,208.00; under the heading “Maximum Benefit” delete $2,208.00.
3.47     Part A – Prostheses, at page 387 of 547, after the Billing Code TB342 insert the Billing Code TB343; under the heading “Product Name” insert “Precifix”; under the heading “Description” insert “Titanium”; under the heading “Size” insert “Diameter: 2-2.5mm, Length 22-40mm”; and under the heading “Minimum Benefit” insert $390.00.
3.48     Part A – Prostheses, at page 393 of 547, for the Billing Code ZI104, under the heading “Maximum Benefit” delete $3,325.00.
3.49     Part A – Prostheses, at page 394 of 547, for the Billing Code ZI137, under the heading “Maximum Benefit” delete $1,277.00.
3.50     Part A – Prostheses, at page 394 of 547, for the Billing Code ZI140, under the heading “Maximum Benefit” delete $1,541.00.
3.51     Part A – Prostheses, at page 395 of 547, for the Billing Code ZI141, under the heading “Maximum Benefit” delete $1,541.00.
3.52     Part A – Prostheses, at page 395 of 547, for the Billing Code ZI142, under the heading “Maximum Benefit” delete $1,541.00.
3.53     Part A – Prostheses, at page 395 of 547, for the Billing Code ZI143, under the heading “Maximum Benefit” delete $1,541.00.
3.54     Part A – Prostheses, at page 395 of 547, for the Billing Code ZI144, under the heading “Maximum Benefit” delete $1,277.00.
3.55     Part A – Prostheses, at page 395 of 547, for the Billing Code ZI145, under the heading “Maximum Benefit” delete $1,277.00.
3.56     Part A – Prostheses, at page 398 of 547, for the Billing Code ZI266, under the heading “Maximum Benefit” delete $3,264.00.
3.57     Part A – Prostheses, at page 399 of 547, for the Billing Code ZI305, under the heading “Maximum Benefit” delete $15,302.00.
3.58     Part A – Prostheses, at page 399 of 547, for the Billing Code ZI307, under the heading “Maximum Benefit” delete $1,588.00.
3.59     Part A – Prostheses, at page 399 of 547, for the Billing Code ZI308, under the heading “Maximum Benefit” delete $3,144.00.
3.60     Part A – Prostheses, at page 399 of 547, for the Billing Code ZI309, under the heading “Maximum Benefit” delete $4,793.00.
3.61     Part A – Prostheses, at page 403 of 547, for the Billing Code ZI404, under the heading “Maximum Benefit” delete $1,082.00.
3.62     Part A – Prostheses, at page 403 of 547, for the Billing Code ZI416, under the heading “Maximum Benefit” delete $3,457.00.
3.63     Part A – Prostheses, at page 403 of 547, for the Billing Code ZI417, under the heading “Maximum Benefit” delete $1,689.00.
3.64     Part A – Prostheses, at page 404 of 547, for the Billing Code ZI422, under the heading “Maximum Benefit” delete $5,410.00.
3.65     Part A – Prostheses, at page 404 of 547, for the Billing Code ZI423, under the heading “Maximum Benefit” delete $5,410.00.
3.66     Part A – Prostheses, at page 404 of 547, for the Billing Code ZI424, under the heading “Maximum Benefit” delete $3,104.00.
3.67     Part A – Prostheses, at page 404 of 547, for the Billing Code ZI426, under the heading “Maximum Benefit” delete $307.00.
3.68     Part A – Prostheses, at page 404 of 547, for the Billing Code ZI427, under the heading “Maximum Benefit” delete $307.00.
3.69     Part A – Prostheses, at page 446 of 547, for the Billing Code MP041, under the heading “Description” delete “Double Chanber, Smooth, Remote port, Model # 730” and insert “Double Chamber, Smooth, Remote port, Model # 730”.
3.70     Part A – Prostheses, at page 518, after the Billing Code AY022 insert the Billing Code GU058; under the heading “Product Name” insert “Dynalink Peripheral Self Expanding Stent System”; under the heading “Size” insert “Lengths 80cm and 120cm, Sizes range  from 5mm x 28mm to 10mm x 56mm”; under the heading “Minimum Benefit” insert $1,600.00.
3.71     Part A – Prostheses, at page 518, after the Billing Code GU058 insert the Billing Code GU071; under the heading “Product Name” insert “ACCULINK Peripheral Stent System”; under the heading “Description” insert “Nickel-Titanium Intra-vascular stent”; under the heading “Size” insert “4-10mm diameter, 13-56mm”; under the heading “Minimum Benefit” insert $1,800.00; and under the heading “Maximum Benefit” insert $2,200.00.
3.72     Part A – Prostheses, at page 530 of 547, after the Billing Code FC001 delete the heading “Guidant Australia Pty Ltd”.
3.73     Part A – Prostheses, at page 530 of 547, delete the Billing Code GU058 and the contents of all fields associated with it.
3.74     Part A – Prostheses, at page 530 of 547, delete the Billing Code GU071 and the contents of all fields associated with it.
3.75     Part A – Prostheses, at page 531 of 547, for the Billing Code JJ485, under the heading “Maximum Benefit” delete $1,446.00.
3.76     Part A – Prostheses, at page 531 of 547, for the Billing Code JJ486, under the heading “Minimum Benefit” delete $1,250.00 and insert $1,505.00; and under the heading “Maximum Benefit” delete $1,555.00.
3.77     Part A – Prostheses, at page 531 of 547, for the Billing Code JJ487, under the heading “Maximum Benefit” delete $1,555.00.
3.78     Part B – Human Tissue List, at page 1 of 16, after the Billing Code TBV02, delete the heading “Human Coronary Arteries”.
3.79     Part B – Human Tissue List, at page 1 of 16, delete the Billing Code SHV03 and the contents of all fields associated with it.
3.80     Part B – Human Tissue List, at page 1 of 16, after the Billing Code QHV09 insert the heading “Arterial Graft/Conduit”.
3.81     Part B – Human Tissue List, at page 1 of 16, after the heading “Arterial Graft/Conduit” insert the Billing Code SHV03; under the heading “Facility” insert “Sydney Heart Valve Bank, Darlinghurst NSW”; and under the heading “Minimum Benefit” insert $987.00.
3.82     Part B – Human Tissue List, at page 5 of 16, after the Billing Code TBV08 delete the heading “Cancellous Bone Matrix (CBM)” and insert the heading “Cancellous Bone Matrix (CBM) - 40cc”.
3.83     Part B – Human Tissue List, at page 5 of 16, delete the Billing Codes VIM01 and VIM02 and the contents of all fields associated with these two Billing Codes.  
3.84     Part B – Human Tissue List, at page 5 of 16, after the heading Cancellous Bone Matrix (CBM) - 40cc, insert the Billing Code TBV52; under the heading “Facility” insert “Victorian Institute of Forensic Medicine”; and under the heading “Minimum Benefit” insert $556.00.
3.85     Part B – Human Tissue List, at page 5 of 16, after the Billing Code TBV52 insert the heading “Cancellous Bone Matrix (CBM) - 80cc”.
3.86     Part B – Human Tissue List, at page 5 of 16, after the heading “Cancellous Bone Matrix (CBM) - 80cc” insert the Billing Code TBV53; under the heading “Facility” insert “Victorian Institute of Forensic Medicine”; and under the heading “Minimum Benefit” insert $1,110.00.
3.87     Part B – Human Tissue List, at page 5 of 16, after the Billing Code TBV53 insert the heading “Cancellous Crunch - 15cc”.
3.88     Part B – Human Tissue List, at page 5 of 16, after the heading “Cancellous Crunch – 15cc” insert the Billing Code NBB62; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $795.00.
3.89     Part B – Human Tissue List, at page 5 of 16, after the Billing Code NBB62 insert the heading “Cancellous Crunch - 30cc”.
3.90     Part B – Human Tissue List, at page 5 of 16, after the heading “Cancellous Crunch – 30cc” insert the Billing Code NBB61; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $1,450.00.
3.91     Part B – Human Tissue List, at page 5 of 16, after the Billing Code NBB61 insert the heading “Cancellous Crunch - 60cc”.
3.92     Part B – Human Tissue List, at page 5 of 16, after the heading “Cancellous Crunch – 60cc” insert the Billing Code NBB60; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $2,200.00.
3.93     Part B – Human Tissue List, at page 5 of 16, after the Billing Code QBB03 insert the heading “Cortico-Cancellous Crunch (40/60) - 15cc”.
3.94     Part B – Human Tissue List, at page 5 of 16, after the heading “Cortico-Cancellous Crunch (40/60) - 15cc” insert the Billing Code       NBB65; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $795.00.
3.95     Part B – Human Tissue List, at page 5 of 16, after the Billing Code NBB65 insert the heading “Cortico-Cancellous Crunch (40/60) - 30cc”.
3.96     Part B – Human Tissue List, at page 5 of 16, after the heading “Cortico-Cancellous Crunch (40/60) - 30cc” insert the Billing Code       NBB64; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $1,450.00.
3.97     Part B – Human Tissue List, at page 5 of 16, after the Billing Code NBB64 insert the heading “Cortico-Cancellous Crunch (40/60) - 60cc”.
3.98     Part B – Human Tissue List, at page 5 of 16, after the heading “Cortico-Cancellous Crunch (40/60) - 60cc” insert the Billing Code       NBB63; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $2,200.00.
3.99     Part B – Human Tissue List, at page 8 of 16, after the Billing Code TBV23 insert the heading “Femur – Hemicondyle”.
3.100 Part B – Human Tissue List, at page 8 of 16, after the heading “Femur – Hemicondyle” insert the Billing Code NBB59; under the heading “Facility” insert “New South Wales Bone Bank”; and under the heading “Minimum Benefit” insert $2,000.00.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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