Changed Items for Prostheses List December 2007
Billing Code Product Name Further Description Size Explanation of Change
Abbott Australasia Pty Ltd
Vascular
AY007 Jostent SelfX Expanding Stent Nitinol Shaft length 15 - 180cm, stent length 32 - 92mm Amended benefit.
AY008 Jostent Renal Premounted Balloon expandable Stent length 12 - 17mm, diameter 5 - 7 mm Amended benefit.
AY014 Abbott Vascular Balloon Deployable Stent Stainless Steel Dia 5 - 12mm, length 12 - 58mm Changed Product Name, Product Sub-Group,
Suffix.
Amended benefit.
AY015 Xact/ Xact Flex Carotid Stent Nitinol Self-Expanding stent on rapid exchange Diameter 7-10mm Length 20 + 30mm Straight; Amended benefit.
delivery system Diameter 8-6, 9-7, 10-8mm Length 20 + 30mm
AY016 Perclose Arterial Support and Closure System Suture to close femoral artery puncture sites following Closer S - 6-8Fr, Perclose AT - 6-8Fr, Prostar 8Fr, Amended benefit.
diagnostic and interventional procedures Prostar 10Fr
AY017 Starclose 6 Fr Exchange Sheath, Dilator, Guidewire, implantable 6 Fr Amended benefit.
nitinol clip pre-mounted on a Clip Applier
AY021 Nitinol Self Expanding Peripheral Stent Nitinol Diameter 3-10mm Changed Size.
Amended benefit.
AY022 Cobalt Chromium Balloon Expandable Peripheral Stent Cobalt Chromium Length 12-18mm, Diameter 4-7mm Amended benefit.
GU071 ACCULINK Peripheral Stent System Nickel-Titanium Intra-vascular stent 4-10mm diameter, 13-56mm length Amended benefit.
Ackermann Australia Pty Ltd
Vascular
AK001 Haemostatic Ligating Clips Titanium Ligating Clips small - large Changed Product Group.
Advanced Biomedical Pty Ltd
Cardio-thoracic
AB001 ATS Medical open pivot aortic valved graft model Pyrolythic Carbon, Double Velour Polyester, Titanium 21- 33mm Change.
502AG Amended benefit with $150.00 gap.
AB002 ATS medical open pivot heart valve model 500FA Pyrolythic Carbon, Double Velour Polyester, Titanium 16-33mm Change.
standard flexi-cuff aortic valve series, ATS medical Amended benefit with $200.00 gap.
open pivot heart valve model 500DM standard flexi-
cuff mitral valve series
AB064 ATS medical open pivot heart valve model 501DA Pyrolythic Carbon, Double Velour Polyester, Titanium 16-33mm Change.
advanced performance (AP) aortic valve series, ATS Amended benefit with $200.00 gap.
medical open pivot heart valve model 501DM
advanced performance (AP) mitral valve series
Advanced Neuromodulation Systems Australia Pty Ltd
Neurosurgical
AV002 ANS Spinal Cord Stimulation System (SCS) Octrode Lead. 8 Electrode (thoracic or cervical 30cm, 60cm, 90cm 110cm Changed Size.
placement).
Changed Items for Prostheses List Report Page 1 of 101
Billing Code Product Name Further Description Size Explanation of Change
AV003 ANS Spinal Cord Stimulation System (SCS) Quattrode Lead. 4 Electrode. 30cm, 60cm, 90cm 110cm Changed Size.
AV011 ANS Spinal Cord Stimulation System (SCS) Lamitrode Plate Electrode 60cm, 90cm, 110cm Changed Description, Size.
AV028 Lamitrode S Series Lamitrode S Series, 8 Channel, Model # 3286 Length = 60cm, 90cm, 110cm Changed Product Name, Size.
AV030 Lamitrode S Series Leads Lamitrode S Series, 4 Channel, Model # 3246 Length = 60cm, 90cm, 110cm Changed Size.
AV031 Lamitrode C Series Leads Lamitrode C Series, 8 Channel, Model # 3245 Length = 60cm, 90cm, 110cmm Changed Size.
Advanced Surgical Design & Manufacture Ltd
Neurosurgical
AE053 ASDM Bone Plates Custom Skull Mesh Plate, Titanium One size only Changed Product Group.
AE054 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Small, Single square plate 2x2 holes, T-shape, 90 deg, 5 Changed Product Group.
holes
AE055 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Medium, Double square plate, 3x2 holes; Double Y- Changed Product Group.
shape, 6 or 7 holes; Y-shape, 6 hole; Double T-shape, 9
hole;T-shape, 90 deg, 7 holes;L-shape, right or left, 5
hole;Straight Plate, 8 hole
AE056 ASDM Bone Plates Titanium 1.0mm MF Bone Plate Large, Triple square plate, 4x2 holes;Curved plate, 8 Changed Product Group.
hole;Straight plate, 24 hole;L-shape plate, right or left,
8 holes
AE057 ASDM Bone Plates Titanium 1.7mm MF Bone Plate, Titanium Small, Straight plate, 6-8mm, 4 hole;L-Shape, right or Changed Product Group.
left, 6mm, 4 hole;Curved plate, 6mm, 4 hole
AE058 ASDM Bone Plates Tiranium 1.7mm MF Bone Plate, Titanium Medium, L-Shape, right or left, 8mm, 4 hole;Y-Shape, Changed Product Group.
8mm, 5 hole;T-Shape, 10mm, 5 hole;L-shape, right or
left, 10-12mm, 4-5 holes;Straight Plate, 8 hole;Double
Y-Shape, 6-7 holes;Curved plate, 6-8 holes;Single
square plate, 2x2 holes
AE059 ASDM Bone Plates Titanium 1.7mm MF Bone Plate, Titanium Large, Triple square plate, 4x2 holes;Straight plate, 16 Changed Product Group.
hole
AE060 ASDM Bone Plates Titanium 2.0mm MF Bone Plate, Titanium Small, Straight plate, 9-13mm, 4 holes;Staright plate, 4 Changed Product Group.
holes;L-shape, right or left, 4 holes
AE061 ASDM Bone Plates Titanium 2.0mm MF Bone Plate, Titanium Medium, Y-Shape, 8 hole;Double Y-Shape, 6 hole;L- Changed Product Group.
Shape, right or left, 5 holes;L-Shape, right or left, 9-
13mm, 4 holes;Straight Plate, 6 hole;Curved plate, 6
hole
AE062 ASDM Bone Plates Titanium 2.0mm MF Bone Plate, Titanium Large, Double square plate, 3x2 holes;Curved plate, 10 Changed Product Group.
hole;Straight plate, 16 hole;L-shape plate, right or left,
9 holes
AE063 ASDM Bone Plates Titanium 2.2mm MF Bone Plate, Titanium Small, Straight plate, 8-14mm, 4 holes;Curved plate, Changed Product Group.
11mm, 4 holes
AE064 ASDM Bone Plates Titanium 2.2mm MF Bone Plate, Titanium Medium, Straight plate, 8-14mm, 6 holes Changed Product Group.
AE065 ASDM Bone Plates Titanium 2.2mm MF Bone Plate, Titanium Large, Straight plate, 11mm, 8 holes;Straight plate, 14 Changed Product Group.
holes;Angled plate, 6 holes
Orthopaedic
Changed Items for Prostheses List Report Page 2 of 101
Billing Code Product Name Further Description Size Explanation of Change
AE042 Active Knee System Bone Screw Titanium 20mm - 50mm Changed Product Group, Product Sub-Group.
Amended benefit.
AE051 ASDM Bone screw Titanium Dia 5 - 11 mm, length 20 - 50mm Changed Product Group, Product Sub-Group.
Amended benefit.
AE071 Active Knee Revision System - Tibial Full Block Wedge Posterior Femoral Block 1 - 5, 4 - 8mm Changed Product Group, Product Sub-Group.
AE072 Active Knee Revision System - Femoral Distal Spacer Distal Spacer 1 - 5, 4 - 8mm Changed Product Group, Product Sub-Group.
AE073 Active Knee Revision System Distal Posterior Spacer 1-5, 4 - 8mm Changed Product Group, Product Sub-Group.
AE074 Active Knee Revision System - Tibial Half Block Half Block Wedge 1-5, 5 - 10 Deg Changed Product Group, Product Sub-Group.
Spacer
AE075 Active Knee Revision System Revision Extension Stem 11 - 13 Dia, 60 - 100mm Changed Product Group, Product Sub-Group.
AE076 Active Knee Revision System - Tibial Full Block Wedge Full Block Wedge 1-5, 5 - 10 Deg Changed Product Group, Product Sub-Group.
AE077 Active Knee Revision System - Half Block Wedge Half Block Wedge 1-5, 5 - 10 Deg Changed Product Group, Product Sub-Group.
AE078 Active Knee Revision System Revision Stem Tibia 1-5, A & B Changed Product Group, Product Sub-Group.
Advanced Surgical Technologies
Orthopaedic
AD114 Transcend/Lineage Articulation System Metal femoral head CoCr 28 and 32mm, 4 lengths Changed Product Sub-Group.
Amended benefit.
AD118 Transcend/Lineage Articulation System Apical plug titanium One size only Changed Product Group, Product Sub-Group.
Amended benefit with $106.00 gap.
AD120 Transcend/Lineage Articulation System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm increments long Changed Product Group, Product Sub-Group.
Amended benefit with $35.00 gap.
AD131 WMT Perfecta Hip System PMMA cement spacer/Bone Plug 9 - 21mm in 1mm increments Changed Product Group, Product Sub-Group.
Amended benefit with $110.00 gap.
AD139 Advance Total Knee System Medial pivot UHMWPE tibial 0, 1, 2, 3, 4, 5, 6 in 10 - 25mm thicknesses Changed Description.
AD142 Advance Revision Knee System Femoral Augments titanium 1 - 5, 5mm thick, 10mm thick, posterior and distal Changed Product Group, Product Sub-Group.
AD143 Advance Revision Knee System Femoral component CoCr 1, 2, 3, 4, 5 Changed Product Group, Product Sub-Group,
Suffix.
Amended benefit.
AD144 Advance Revision Knee System Femoral stem titanium 11 - 22mm in 1mm increments, 100 & 140mm lengths Changed Product Group, Product Sub-Group.
Amended benefit.
AD145 Advance Revision Knee System PS and CCK Insert UHMWPE 1, 2, 3, 4, 5, 6 in 10 - 30mm in 2mm increments Changed Product Group, Product Sub-Group.
AD146 Advance Revision Knee System Tibial augments/wedges titanium 15 degree, sizes 1, 2/1+, 3/2+, 4/3+, 5/4+, 6/5+, Blocks Changed Product Group, Product Sub-Group.
5mm, 10mm, 15mm
AD147 Advance Revision Knee System Tibial component titanium, non porous 0+, 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6 Changed Product Group, Product Sub-Group,
Suffix.
AD148 Advance Revision Knee System Tibial stem titanium, non cemented & cemented 10, 12,14, 16, 18 x 65mm, 15 x 30mm Changed Description, Product Group, Product
Sub-Group.
AD149 Advance Revision Knee System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm increments long Changed Product Group, Product Sub-Group.
AD176 Advantim Total Knee System Cortical Bone Screws, Femoral, Titanium 4.5mm x 2.0 - 7.5cm in 0.5cm increments long Changed Product Group, Product Sub-Group.
Amended benefit.
Changed Items for Prostheses List Report Page 3 of 101
Billing Code Product Name Further Description Size Explanation of Change
AD185 Ortholoc/Advantim Revision Knee Femoral components CoCr Revision (Porous Coated) Small, Medium, Large, Xlarge Changed Product Name, Product Group, Product
Sub-Group, Suffix.
AD187 Ortholoc 11 Revision Knee Tibial Revision Smooth/Finned Titanium 6" Length in Small - Xlarge Changed Product Group, Product Sub-Group.
AD188 Ortholoc 11 Revision Knee Tibial inserts posterior stabilised UHMWPE Small, Medium, Large, X-Large - 10 to 35mm in 2mm Changed Product Group, Product Sub-Group.
increments Amended benefit.
AD190 Ortholoc 11 Revision Knee Tibial Components Modular Stem Thick Base (Porous Small, Small Plus, Medium, Medium Plus, Large, Large Changed Product Group, Product Sub-Group,
Coated) Plus, Xlarge Suffix.
Amended benefit.
AD191 Ortholoc 11 Revision Knee Tibial Components Modular Stem Wedged Base (Porous Small, Small Plus, Medium, Medium Plus, Large, Large Changed Product Group, Product Sub-Group,
Coated) Titanium Plus, Xlarge Suffix.
Amended benefit.
AD195 Ortholoc 11 Revision Knee Femoral stems titanium 5 Degree 6", 7 Degree 6" Changed Product Group, Product Sub-Group.
AD214 ADVANCE Total Knee System Stemmed condylar femoral medial pivot component - 1, 2, 3, 4, 5, All in left & right Changed Product Group, Product Sub-Group,
porous Suffix.
Amended benefit.
AD217 ADVANCE Total Knee System Offset tibial Block Augments 1, 2/1, 3/2, 4/3, 5/4, 6/5, All in 5mm, 10mm, 15mm Changed Product Group, Product Sub-Group.
Amended benefit.
AD218 ADVANCE Total Knee System Offset tibial base - nonporous 1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+ in Left & Right Changed Suffix.
AD219 ADVANCE Total Knee System Stemmed condylar femoral medial pivot component - 1, 2, 3, 4, 5 All in Left & Right Changed Product Group, Product Sub-Group,
nonporous Suffix.
Amended benefit.
AD230 Profemur Total Hip System Titanium uncemented proximal body X-small, Small, Standard 1, Standard 2, Standard 3, Changed Suffix.
Standard 4, Large Amended benefit.
AD231 Profemur Total Hip System Titanium tapered Splined or Cylindrical Straight Stem Length 95 - 135mm, Diameter 10 - 22.5mm Changed Suffix.
Amended benefit.
AD232 Profemur Total Hip System Titanium E Stem - without HA Plasma Spray 1 Standard - 9 Standard Changed Product Sub-Group, Suffix.
Amended benefit.
AD234 Profemur Total Hip System Titanium uncemented proximal body - HA Plasma X-Small, Small, Standard 1, Standard 2, Standard 3, Changed Suffix.
sprayed Standard 4, Large Amended benefit.
AD235 Profemur Total Hip System Titanium tapered Splined or Cylindrical Bowed Stem Length 175 - 215mm, Diameter 10 - 22.5mm Changed Suffix.
Amended benefit.
AD236 Profemur Total Hip System Titanium Femoral Necks Length 27 - 38.5mm; Neutral to Ante/Retro - Varus Changed Product Group, Product Sub-Group.
Valgus 2 Amended benefit.
AD237 Profemur Total Hip System Anca-fit Femoral Stem with 1/3 proximal HA Plasma 9.5, 11, 12, 13, 14, 15, 16, 17.5, left and right Changed Product Sub-Group, Suffix.
Spray Amended benefit.
AD238 Profemur Total Hip System Profemur Z, Titanium Tapered Femoral Stem Standard Length Sizes 1 - 9 Changed Product Sub-Group, Suffix.
Amended benefit.
AD278 Profemur Total Hip System Titanium Tapered Stem - HA Plasma Spray Sizes 9 to 18 in 1 mm increments Changed Product Sub-Group, Suffix.
Amended benefit.
AD279 Profemur Total Hip System Titanium Stem with HA Plasma Spray, standard & Size 10 -18 Changed Description, Size, Sub Group, Suffix.
reduced flare Amended benefit.
AD288 Transcend/Lineage Articulation System Metal femoral head CoCr 36mm, 4 lengths Changed Product Sub-Group.
Amended benefit.
AD308 Transcend/Lineage Articulation System Metal femoral head CoCr 32mm, 4 lengths Changed Size, Product Sub-Group.
Amended benefit.
Changed Items for Prostheses List Report Page 4 of 101
Billing Code Product Name Further Description Size Explanation of Change
AD310 Charlotte Foot & Ankle System High demand compression screw, cannulated, stainless 6.5mm& 7.0mm dia, 40-110mm lengths in 5mm Changed Size.
steel increments
AD318 Profemur Xm Femoral Stem Femoral Stem, CoCr, Cemented, Polished 0, 1, 2, 3, 4 Changed Product Name, Suffix.
Amended benefit.
AD319 Profemur Total Hip System Revision Hip Proximal Body Extension Piece, Sm - Lg L26 x D19mm, D21mm & D23mm; Sm - Lg Changed Suffix.
L52 x D21mm; ExSM L26 x D19mm Amended benefit.
AD320 Profemur Total Hip System Revision Hip Proximal Body Extension Piece, Sm - Lg L26 x D19mm, D21mm & D23mm; Sm - Lg Changed Suffix.
L52 x D21mm; ExSM L26 x D19mm Amended benefit.
AD322 Quadra-Fix Acetabular Shell Quadra-Fix Double threaded, 6.5mm Cancellous Screw 35mm - 80mm in 5mm increments Changed Product Sub-Group.
Amended benefit with $145.00 gap.
AD326 Calcaneal Step OSStaple Dynamic Compression Implant, Calcaneal Step 2mm, 4mm, 6mm 9mm & 12mm offsets Changed Size.
OSStaple, Nitinol Memory Alloy
Alcon Laboratories (Aust.) Pty Ltd
Ophthalmic
AL004 Acrysof Multipiece Models MA60BM, MA30BA, Foldable Acrylic Multi-piece Lens -5 D to +30 D Compressed from AL004, AL012.
MA50BM, MA60MA, MA30AC, MA60AC
AL021 Alcon AcrySof SN60WF Foldable Acrylic Single-piece Lens with Blue Light + 6.0 D to +30.0 D Changed Size, Product Sub-Group, Suffix.
Protection and Aspheric Correction
AL025 AcrySof Multipiece Models MN60MA, MN60AC Foldable Acrylic multi-piece Lens with Blue light - 5 D to + 30 D Compressed from AL025, AL026.
Protection
American Medical Systems
Urogenital
AM001 AMS 800 Artificial Urinary Sphincter Cuff Occlusive Cuff Size: 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 9, 10, 11cm Amended benefit.