Changed Benefit Items for Prostheses List July 2007 Attachment 4
Billing Code Product Name Further Description Size Explanation of Change
Advanced Biomedical Pty Ltd
Cardio-thoracic
AB001 ATS Medical open pivot aortic valved graft model Pyrolythic Carbon, Double Velour Polyester, 21- 33mm Benefit changed to correct an
502AG Titanium administrative error.
Alcon Laboratories (Aust.) Pty Ltd
Ophthalmic
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with Blue +16.0 D to +26.0 D Benefit changed to correct an
Light Protection and Aspheric Correction administrative error
Boston Scientific Pty Ltd
General/Miscellaneous
BS103 Dynamic (Y) Stent Bifurcated Tracheobronchial stent. Bronchial Stent inner diameters up to 15mm, stent Sponsor previously requested removal of
Limbs made of silicone and tracheal stem made limb lengths up to 110mm gap.
of silicone with embedded stainless steel c-
shape rings.
Genzyme Australasia Pty Ltd
General/Miscellaneous
GE007 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 3 x 6 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
GE008 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 4 x 8 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
GE009 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 6 x 8 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
Changed Benefit Items for Prostheses List Report Page 1 of 6
Billing Code Product Name Further Description Size Explanation of Change
GE010 SEPRAMesh IP Bioresorbable Coating/Permanent Polypropylene & polyglycolic acid polymer 8 x 12 inch Removal of MaxBenefit to correct an
Mesh mesh coated with a biopolymer: a bioresorbable administrative error
coating of modified sodium hyaluronate,
carboxymethylcellulose & polyethylene glycol
based hydrogel.
Johnson & Johnson Medical Pty Ltd
Vascular
JJ485 Trufill DCS Orbit detachable coil Helical Fill 2mm - 12mm, 2cm - 30cm Sponsor previously requested removal of
gap.
JJ486 Trufill DCS Orbit detachable coil Complex Standard 6mm - 20mm, 15cm - 30cm Sponsor previously requested removal of
gap.
JJ487 Trufill DCS Orbit detachable coil Complex Mini 2mm - 12mm, 1.5cm - 30cm Sponsor previously requested removal of
gap.
Link Orthopaedic Australia
Orthopaedic
LO127 T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining, with Small 1, Small 2, Large 1, Large2 Benefit changed to correct an
HX Coating administrative error.
Mathys Orthopaedics Pty Ltd
Orthopaedic
MA422 Articula Shoulder Prosthesis Articula Humeral Head Bionit Ceramic (A1203) 44mm, 46mm, 48mm Benefit changed to correct an
administrative error as advised by
Orthotech Pty Ltd
Neurosurgical
OH255 Hartshill Cancellous bone screws for 6.5mm diam - 25 - 30mm length, 5.5mm Orthotech submitted an application to
Horseshoes/STALIF each diam - 25 - 30mm length transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
OH260 Hartshill Wire (packet 10) stainless steel 1.2mm diam & 0.9mm diam Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent for two
identical products
Changed Benefit Items for Prostheses List Report Page 2 of 6
Billing Code Product Name Further Description Size Explanation of Change
OH264 Hartshill: Ransford Occipito-cervical - Titanium loop 100 degree 9mm - 20mm Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH265 Hartshill: Ransford Extra long cross linked - titanium loop 100 degree 45cm x 15mm Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH266 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 3-5cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH267 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 6 - 8cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH268 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 9 - 11cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH269 Hartshill Rectangle Stainless steel posterior lumbar fusion system 5mm diam 12 - 14cm length Orthotech submitted an application to
transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
Changed Benefit Items for Prostheses List Report Page 3 of 6
Billing Code Product Name Further Description Size Explanation of Change
OH270 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 15 - 19cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH271 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 20 - 24cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH272 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 25 - 30cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH273 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 31 - 36cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
OH274 Hartshill Rectangle Stainless steel posterior thoracic/thoracolumbar 6mm diam 37 - 44cm length Orthotech submitted an application to
fusion system transfer products from Surgical House.
Dual suppy has been accepted for these
products as Surgical House have not
terminated their billing codes.
Benefit changed to be consistent
between two identical products
Sirtex Medical Limited
General/Miscellaneous
SE001 SIR-Spheres including Delivery Apparatus Biocompatible microspheres 20-60mm (microns) One size only Benefit changed as a result of the June
in diameter containing yttrium-90. Delivery 2007 review.
apparatus is PVC tubing, ABS stopcocks,
acrylic holders and stainless steel needles with
Smith & Nephew Surgical Pty Ltd
Orthopaedic
Changed Benefit Items for Prostheses List Report Page 4 of 6
Billing Code Product Name Further Description Size Explanation of Change
SN727 Genesis II High Flex PS Insert, UHMWPE 1-8, 9-25mm thickness Sponsor previously requested removal of
gap.
Stryker Australia Pty Ltd (3)
Orthopaedic
SR052 Active Uni Compartmental Knee Uni compartmental knee resurfacing prostheses, All sizes for Femoral Component Benefit changed to correct an
consisting of a Femoral component administrative error.
manufactured from Chrome Cobalt
SR053 Active Uni Compartmental Knee Uni compartmental Knee resurfacing prostheses, All sizes for Tibial Component Benefit changed to correct an
consisting of a Femoral component administrative error.
manufactured from Chrome Cobalt
Synthes Australia Pty Ltd
Neurosurgical
SY250 Universal Spine System Low Profile Transconnector 18-83mm length Sponsor previously requested removal of
gap.
SY365 Cervical Spine Locking Plate (CSLP) System VA Plate Length 23 - 109mm Sponsor previously requested removal of
gap.
SY382 Axon Occipital Fusion System Occipital Clamp Titanium Alloy 1 or 2 holes Sponsor previously requested removal of
gap.
SY383 Synmesh Locking Screw, Low Profile, For Synmesh End Small, Large Sponsor previously requested removal of
Rings gap.
Taylor Bryant Pty Ltd
Neurosurgical
TB363 Unity Lumbar Plate Unity Plate 17-28mm Sponsor previously requested removal of
gap.
TB364 Unity Lumbar Plate Unity Bone Screw 6-7mm Sponsor previously requested removal of
gap.
Orthopaedic
TB064 Groupe Lepine Bipolar Heads 42 - 60mm in 1mm increments Sponsor requested removal of gap.
TB204 Ulnar Head Implants Ulna Head - CoCr Stem: 2,3,4 Head: 2,3,4 Benefit reviewed as a result of sponsor
submission.
Zimmer
Orthopaedic
ZI104 Miller Galante II Other Tibial Tray:Porous Flat (revision) - Ti A - K Sponsor previously requested removal of
gap.
Changed Benefit Items for Prostheses List Report Page 5 of 6
Billing Code Product Name Further Description Size Explanation of Change
ZI137 NexGen Knee Articulating Surfaces CCK - UHMWPE 10 - 35mm Sponsor previously requested removal of
gap.
ZI140 NexGen Knee Tibial Augments Half Wedge - Ti 1 - 10 Sponsor previously requested removal of
gap.
ZI141 NexGen Knee Tibial Augments Full Wedge - Ti 1 - 10 Sponsor previously requested removal of
gap.
ZI142 NexGen Knee Tibial Augments One Third Wedge - Ti 1 - 10 Sponsor previously requested removal of
gap.
ZI143 NexGen Knee Tibial Augments Half Block - Ti 1 - 10 Sponsor previously requested removal of
gap.
ZI144 NexGen Knee Femoral Augments Dist.,Ant or Post - Ti A - H Sponsor previously requested removal of
gap.
ZI145 NexGen Knee Femoral Augments Dist + Post 1 - 10 Sponsor previously requested removal of
gap.
ZI266 Continuum knee system Hedrocel augment - patella prosthesis Small, medium, large and x-large Sponsor previously requested removal of
gap.
ZI305 Nexgen Rotating Hinge Femur Cobalt chrome femoral component for rotating B-F Sponsor previously requested removal of
hinge knee, available left to right gap.
ZI307 Nexgen Rotating Hinge Articulating Surface Ultra high molecular weight polyethylene 12-26mm, sizes B-F Sponsor previously requested removal of
articulating tibial insert gap.
ZI308 Nexgen Rotating Hinge Tibia Cobalt chrome rotating platform tibial plate 1-6 Sponsor previously requested removal of
gap.
ZI309 Nexgen Rotating Hinge Replacement Hinge Rotating hinge replacement bushing for hinge B-F Sponsor previously requested removal of
gap.
ZI404 Natural Knee System Tibial Spacers - special metal alloy 4 to 8mm Size 00 to 5 Sponsor previously requested removal of
gap.
ZI416 Natural Knee Revision -Tibial Baseplate - Ti alloy 0 to 5 Sponsor previously requested removal of
gap.
ZI417 Natural Knee Revision -Tibial Stem - Ti alloy 60 to 215mm Sponsor previously requested removal of
gap.
ZI422 Natural Knee Femoral Spacer Lug - Ti alloy 4 to 12mm Sponsor previously requested removal of
gap.
ZI423 Natural Knee Revision - Femur Porous -Ti/CoCr alloy Size 00 to 4 (left & right), Sponsor previously requested removal of
gap.
ZI424 Natural Knee Revision - Femur Stem, Ti alloy 10.5mm/125mm to 16.5mm/250mm Sponsor previously requested removal of
gap.
ZI426 Natural Knee Femoral Stem Screw - metal alloy One size only Sponsor previously requested removal of
gap.
ZI427 Natural Knee Revision Posterior Stabilising Bar - CoCr alloy One size only Sponsor previously requested removal of
gap.
Changed Benefit Items for Prostheses List Report Page 6 of 6