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SCHEDULE 5 – PROSTHESES AND HUMAN TISSUES

    1. Subject to any indications on the Australian Register of Therapeutic Goods (ARTG) in relation to a prosthesis specified in Part A, this Schedule sets out the prostheses and human tissues provided to a private patient of a hospital or day hospital facility for which benefits must be paid. Clinical choice remains a matter between the doctor and the patient and is not to be influenced by the manufacturer, supplier or the registered health benefits organisation (RHBO).

    1. In this Schedule:

hospital” includes a day hospital facility;

human tissues” means the items included in Part B;

prostheses” means the items included in Part A; and

references to a manufacturer, supplier, hospital or a RHBO include any agent acting

on their behalf.

Prostheses

    1. Subject to any indications on the ARTG in relation to a prosthesis specified in Part A, the level of benefit payable in respect of a prosthesis specified in Part A is the fee or charge agreed between the RHBO and one only of the manufacturer, supplier or hospital.

Note: Other than the fees or charges permitted under clause 5.3, no additional charges can be imposed on a patient by a manufacturer, supplier, hospital or a RHBO.

    1. Where the fee or charge is agreed between the RHBO and either the manufacturer or supplier under paragraph 5.3, then the RHBO and the manufacturer or supplier must advise all hospitals of the fee or charge agreed within two weeks of the date of the agreement.

    1. Where the fee or charge for an item cannot be agreed between the RHBO and one of the manufacturer, supplier or hospital the relevant parties may agree to request the Department of Health and Ageing to appoint a conciliator to assist them to reach agreement on the fee or charge for the item for the purpose of paragraph 5.3. If the parties so request they shall, in equal measure, meet all of the costs incurred by the Department of Health and Ageing in arranging and facilitating this conciliation process.

    1. If an agreement on the fee or charge for an item cannot be reached, the Minister will exercise his/her powers under paragraph (bj) of Schedule 1 to the National Health Act 1953 to determine the minimum level of benefit payable for the item in dispute.

Human tissues

    1. The level of benefit payable in respect of a human tissue supplied by a particular facility is the amount specified in the “Amount” field of Part B.

Notes:

The organisations specified in the “Facility” field of Part B must comply with any applicable State and Territory laws governing harvesting and processing of human tissue items to be eligible for the payment of private health insurance benefits.

Other than the fees or charges permitted under clause 5.7, no additional charges can be imposed on a patient by a manufacturer, supplier, hospital or a RHBO.

PART A - Prostheses List by Category, Groups and Sponsor February 2005

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Annuloplasty Rings

Edwards Lifesciences Pty Ltd

EL028 Baxter Sterile Grafts, Implants & Carpentier-Edwards Classic Annuloplasty 24mm-40mm

Prostheses, Non-Animal Origin Ring. Composition: Titanium Alloy;

Annuloplasty: Ring-Mitral Ring with Silicone Rubber; Polyester Fabric

Holder; Mitral Cosgrove-Edwards Carpentier-Edwards Physio Annuloplasty

Annuloplasty System Model 4600; Classic Ring. Composition: Elgiloy Bands;

Polyester Film Strips; Silicone Rubber;

Polyester Cloth, Cosgrove-Edwards

Annuloplasty Band. Composition: Silicone

Rubber; Polyester Cloth. Carpentier-

Edwards Tricuspid Ring. Composition:

Titanium Alloy; Silicone Rubber;

EL049 Edwards Etlogix Annuloplasty Ring Titanium/silicon/dacron polyester 24mm/26mm/28mm/30mm/32mm/34mmd

cloth/plastic template Mitral valve annular

repair device designed specifically for

patients with Ischemic Mitral regurgitation

Medtronic Australasia Pty Ltd

MC005 Medtronic Posterior Annuloplasty Band; Annuloplasty Devices - Models 610B, Models 610B & 610R 25-35mm, Models

Medtronic Duran Annuloplasty Ring; 610R & 620B, 620R Silicone / Barium 620B & 620R 23-35mm, Model 638B -

Colvin - Galloway Future Band Model Sulphate, Dacron. Models 638B semi- 26-38mm

638B; Duran Ancore Band 620B; Duran rigid metal alloy core, silicone coating,

Ancore Ring 620R polyester knit fabric, kit includes - band,

malleable handle, template with suture

markers, sizers, molded tray.

St. Jude Medical Australia Pty Ltd

SJ034 SJM Seguin Annuloplasty Ring Semi Rigid 24mm - 40mm

SJ035 SJM Tailor Annuloplasty Ring Fully Flexible 25mm - 35mm

Tag Medical

TM001 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm

PART A - Prostheses List by Category, Groups and Sponsor Page 1 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Catheters, Angioplasty, Laser

Pacing Importers Pty Ltd

PI002 Excimer Laser Stent Polyester Fibre optic fibre catheter 0.457mm, 0.9mm, 1.4mm, 1.7mm and

Coronary Stents

Drug Eluting Stents

Boston Scientific Pty Ltd

BS074 Taxus on Express2 Coronary Stent balloon expandable stent with conformal Length 8 - 32mm; Diameter 2.25 -

System Models 38001-0822 to 0840; polymer/drug matrix coating, pre-

38001-1222 to 1250; 38001-1622 to mounted on high pressure monorail

1650;

38001-2022 to 2050; 38001-2422 to

2450; 38001-2827 to 2850; 38001-3227

Johnson & Johnson Medical Pty Ltd

JJ302 CYPHER Sirolimus-Eluting Stent & Stainless steel coronary stent with Diameter 2.25 - 5.0mm, length 8-33mm

Delivery System Model CRS - 23300, Rapamycin (an immunosuppressive and

08225, 08250, 08275, 08300, 28225, antiproliferative drug) bound to the stent

28250, 28275, 28300, 33225, 33250,

33275, 33300, 13225, 13250, 13275,

18225, 18250, 18275, 18300, 23225,

23250, 23275, 23350, 23400, 08350,

08400, 28350, 28400, 33350, 33400,

13300, 13350, 13400, 18350, 18400,

23450, 23500, 28450, 28500, 33450,

33500, 08450, 13450, 18450, 18500

General Purpose Bare Metal Stents

Abbott Australasia Pty Ltd

AY006 Bio-Divysio Stent SV/OC/AS Balloon expandable Phosophoryl-Choline Divysio Stent SV - Diameters: 2.0, 2.25,

coated stainless-steel endovascular 2.5 Lengths: 7mm, 10mm, 15mm,

coronary stent 18mm, 21mm; Divysio Stent OC & AS -

Diameters: 2.75, 3.0, 3.5, 4.0 Lengths:

8mm, 11mm, 15mm, 18mm, 22mm, 28mm

AY013 JoStent Coronary Stent Stainless Steel 9 - 26 mm x 2.5 - 4 mm

PART A - Prostheses List by Category, Groups and Sponsor Page 2 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Atrium Australia-Pacific Rim Pty Ltd

AC022 Flyer RX Coronary Stent System Stainless Steel Coronary Stent Dia 2-5mm, Length 6-40mm

B Braun Australia Pty Ltd

BB171 Coroflex Coronary Stent System Electropolished stainless steel 316L; Laser 2.5 x 8mm; 3.0 x 8mm; 3.5 x 8mm; 4.0

cut slotted tube. Product includes: x 8mm; 2.5 x 13mm; 3.0 x 13mm; 3.5 x

Coronary stent mounted on delivery 13mm; 4.0 x 13mm; 2.5 x 16mm; 3.0 x

16mm; 3.5 x 16mm; 4.0 x 16mm; 2.5 x

19mm; 3.0 x 19mm; 3.5 x 19mm; 4.0 x

19mm; 2.5 x 25mm; 3.0 x 25mm; 3.5 x

BB172 Coroflex Theca Coronary Stent System Electropolished Stainless Steel 316L; Dia 2.5-4.0mm, length 8-25mm

Laser cut slotted tube, coated with

Polyzene-F; includes Coronary Stent

mounted on delivery balloon catheter.

BB173 Coroflex Delta Coronary Stent System Electropolished Stainless Steel 316L; Dia 2.5-4.0mm, length 8-25mm

Laser cut slotted tube, includes Coronary

Stent mounted on delivery balloon

BB244 Coroflex Blue Cobalt Chromium Alloy L605 2-4mm diameter, 8-25mm length

Biotronik Australia Pty Ltd

BT040 Lekton Intracoronary stent - balloon mounted Dia 2.5-4mm, length 10-30mm

BT058 Lekton Motion Coated flexible stent, Balloon mounted Diameter 2.5mm to 4mm, Length 8 -

BT059 Astron Flexible coated stent, Nitinol, self- Diameter 7-12mm, Length 30-80mm

Boston Scientific Pty Ltd

BS069 Express 2/Liberte Coronary Stent Consists of a balloon expandable stent, Stent lengths: 8,12,16,20,24,28 & 32 mm

pre-mounted on a Maverick 2 Monorail Stent diameters: 2.25, 2.5, 2.75, 3.0, 3.5,

delivery catheter. 4.0, 4.5 & 5.0 mm

PART A - Prostheses List by Category, Groups and Sponsor Page 3 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Daralan Pty Ltd

DA001 S-Stent SRX1 316L Stainless Steel 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; SRX1-3012

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; SRX1-3515L 3.5 x 14.6mm;

SRX1-4015L 4.0 x 14.6mm; SRX1-2520

2.5 x 18.7mm; SRX1-3020 3.0 x

18.7mm; SRX1-3520L 3.5 x 18.4mm;

SRX1-4020L 4.0 x 18.4mm; SRX1-2525

2.5 x 24.5mm; SRX1-3025 3.0 x

24.5mm; SRX1-3525L 3.5 x 23.2mm;

SRX1-4025L 4.0 x 23.2mm; SRX1-

2530 2.5 x 28.9mm; SRX1-3030 3.0 x

28.9mm; SRX1-3530L 3.5 x 28.2mm;

Guidant Australia Pty Ltd

GU102 Stents ACS Multilink Coronary Stent; ACS 1.5mm - 8.0mm

Megalink Peripheral Stent; ACS RX

Herculink Peripheral Stent. Stainless steel

GU105 Multilink Coronary Stent System Stainless Steel Length 1.5mm - 8.0mm

GU127 Multilink Coronary Stent System - Frontier 316L Stainless steel stent Length 1.5 - 8.0mm

GU128 Multilink Coronary Stent System - Vision Cobalt chrome stent Length 1.5 - 8.0mm

Johnson & Johnson Medical Pty Ltd

JJ026 BX Velocity with Hepacoat System Balloon expandable, stainless steel,

heparin coated

JJ200 BX Velocity Stent and Delivery System Stainless steel stent Diameter: 2.25-5.0 mm; Length 8 - 33

JJ239 BX Sonic Stainless steel coronary stent mounted on Dia 2.25 - 4.0mm, lengths 8 - 33mm

a balloon delivery system

Medical Vision Australia Pty Ltd

MF004 Vivant Z Stent Coronary stent made of alloyed medical Dia 2.5 - 4.0mm, length 9 - 28mm

grade stainless steel

Medtel Australia Pty Ltd

ME050 Antares Coronary Stent System Stent Length: 8mm - 32mm Diameter: 2.5mm -

4.0mm

PART A - Prostheses List by Category, Groups and Sponsor Page 4 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

ME071 Antares Starflex Coronary System Stainless steel Bare stent lengths 8, 12, 16, 20, 24,

32mm; Expansion range 2.5 - 4.0mm

Stent Delivery System, stent lengths

8mm, 12mm, 16mm, 20mm, 24mm,

32mm

ME073 Lunar Starflex Coronary Stent System Niobium alloy stent coated with layer of Balloon 2.25-4.0mm, stent 8-20mm

homogenous iridiumoxide (IrOx)

Medtronic Australasia Pty Ltd

MC197 Medtronic AVE S660 Coronary Stents, Stainless Steel S660 Coronary Stent - Diameter (2.5mm-

S670 Coronary Stents, S7 Coronary 2.75mm), Length (9mm-24mm); S670 &

Stents, BeStent2, S7 Coronary Stent - Diameter (3mm-

4mm), Length (9mm-30mm); BeStent2 -

Diameter (2.5mm-4mm), Length (9mm-

MC329 Medtronic Driver, Micro Driver Coronary Cobalt Alloy Driver Stent: diameter (2.25 - 4.5mm),

Stent System length (8-30mm); Micro-Driver Stent:

diameter (2.25 - 2.75mm), length (8 -

Pacing Importers Pty Ltd

PI003 Med-X-Flexy Stent Tubular Stent, Stainless steel 316L, Gold Dia 5 - 9mm length: 20 - 100mm

markers

Terumo Corporation Australia

TU001 Intra Coronary Stent Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, Length 10mm

- 30mm length

Woodstock Biomedical Pty Ltd

WO031 Duraflex Coronary Stent System 316L Medical Grade Stainless Steel Stent Length 8, 11, 14, 18, 21, 25mm x

Premounted on Rail Design Catheter Diameter 2.5, 2.75, 3.0, 3.5, 4.0mm

Zynergy Medical Pty Limited

ZY001 Carbostent Coronary stent - includes Carbostent Dia 2.5mm x Length 9, 12, 15, 19,

Syncro & Carbostent Sirius 25mm; Dia 3.0mm x Length 9, 12, 15,

19, 25, 32mm; Dia 3.5mm x Length 9,

12, 15, 19, 25, 32mm; Diameter 4.0mm x

Length 9, 12, 15, 19, 25, 32mm

Special Purpose Stents

Abbott Australasia Pty Ltd

AY012 JoStent Coronary Stent Graft Stainless Steel/PTFE 9 - 26 mm x 2.5 - 5 mm

PART A - Prostheses List by Category, Groups and Sponsor Page 5 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Boston Scientific Pty Ltd

BS067 Symbiot Covered Stent System A self-expending nitinol stent encased Stent lengths: 20, 31 & 45 mm Stent

within an ePTFE covering, premounted diameters: 4.0 & 5.0 mm

on a Monorail delivery catheter

CRT Pacemakers

Generation 1

Guidant Australia Pty Ltd

GU087 Contak TR Model 1241 Pacemaker Titanium 3.2mm/IS-1

GU143 Contak Renewal TR CRT -P Model Implantable cardiac pacemaker 45x54x8.5mm, 14cc, 26gm

H220, Model H225

Medtronic Australasia Pty Ltd

MC006 InSync model 8040 Stimulator Titanium 14.4cc

St. Jude Medical Australia Pty Ltd

SJ040 Frontier 3x2 Model 5510 Biventricular Stimulation Device with AF Height 48mm, Length 52mm, Depth 6mm

suppression

Generation 2

Biotronik Australia Pty Ltd

BT056 Stratos LV Multiprogrammable, Biventricular, DDDRV One size only

Guidant Australia Pty Ltd

GU142 Contak Renewal TR2 CRT - P Model Implantable Cardiac pacemaker 45x54x8.5mm, 14cc, 26gm

H240, Model H245

Medtronic Australasia Pty Ltd

MC226 Medtronic Insync III Triple Chamber Titanium One size only

Pacemaker Model 8042

Dual Chamber ICDs

Generation 1

Biotronik Australia Pty Ltd

BT042 Tachos Atx Implantable Cardioverter Defibrillator - One Size Only

Atrial Therapy

PART A - Prostheses List by Category, Groups and Sponsor Page 6 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Generation 2

Biotronik Australia Pty Ltd

BT045 Belos DR, Implantable Cardioverter Dual Chamber ICD, Rate Responsive One Size Only

Defibrillator

Medtronic Australasia Pty Ltd

MC202 Medtronic Gem III DR Model 7275 Titanium One size only, 39.5cc

Implantable Cardioverter Defibrillator

Progressive Medical

PG004 Alto II DR Dual Chamber Implantable One size only

Cardioverter Defibrillator

St. Jude Medical Australia Pty Ltd

SJ009 Photon Micro DR Model V-232 37cc

Defibrillators/Cardioverters

Generation 3

Biotronik Australia Pty Ltd

BT053 Lexos DR Dual chamber ICD, rate responsive One size only.

Guidant Australia Pty Ltd

GU111 Ventak Prizm II DR Model 1861, titanium, dual chamber, One size only

adaptive rate

GU132 Vitality DR Model 1871 This device acts to defibrillate the heart Model 1871 Vitality DR Dual Chamber

chambers when the patient enters into an Rate Responsive Pacemaker/Defibrillator

arrhythmia or uses shocks or anti tachy

pacing to revert Ventricular Tachycardia

(VT) or Ventricular Fibrillation (VF).

While also acting as a dual chamber

GU149 Vitality 2 DR - Model T165 Implantable Cardiac Defibrillator 30cc ; 82g

GU150 Vitality 2 EL Dr - Model T167 Implantable cardiac Defibrillator 35cc ; 90g

Medtronic Australasia Pty Ltd

MC245 Marquis DR Model 7274 Implantable Titanium 36cc

Cardioverter Defibrillator

MC318 Maximo DR Model 7278 Titanium One size only 38.9cc

PART A - Prostheses List by Category, Groups and Sponsor Page 7 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

St. Jude Medical Australia Pty Ltd

SJ049 Epic Plus DR Model V-236 Implantable Dual Chamber sensing, bradycardia 33cc

Cardioverter Defibrillator pacing with atrial fibrillation suppression

SJ070 Epic + DR Model V-233 ICD Dual Chamber Implantable Cardio-verter 33cc 70g

Defibrillator

SJ071 Epic + DR Model V-239 ICD Dual chamber implantable cardio-verter 33cc 70g $0.00

defibrillator

Dual Chamber ICDs with CRT

Generation 1

Guidant Australia Pty Ltd

GU119 Contak Renewal Model H235 Composition - titanium, indicated for One size only

patients with symptomatic hear failure.

Provides cardiac resynchronisation

therapy by providing electrical stimulation

to synchronize left and right ventricular

contractions. These devices also provide

defibrillation back up.

Medtronic Australasia Pty Ltd

MC252 Medtronic InSync Marquis Implantable Titanium Volume 38cc

Cardioverter Defibrillator Model 7277

Generation 2

Guidant Australia Pty Ltd

GU134 Contak Renewal 2 This device acts to defibrillate the heart One Size Only

chambers when the patient enters into an

arrhythmia or uses shocks or anti tachy

pacing to revert Ventricular Tachycardia

(VT) or Ventricular Fibrillation (VF).

While also acting as a dual or single

GU147 Contak Renewal 4 CRT-D Model H290, Implantable dual-chamber defibrillator One size only

Model H295

Medtronic Australasia Pty Ltd

MC306 InSync III Marquis Model 7279 Titanium One size only - Volume 38cc

MC325 InSync Sentry Model 7298 Defibrillator, Titanium 40cc

PART A - Prostheses List by Category, Groups and Sponsor Page 8 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

St. Jude Medical Australia Pty Ltd

SJ062 Epic HF Model V-339 Implantable Cardioverter/defibrillator with dual One size only

Cardiac Defibrillator chamber (atrial and RV) sensing and

bradycardia pacing with ventricular

SJ067 Epic + HF Model V-350 ICD Epic + HF V-350 ICD is a cardioverter 36cc / 73g

defibrillator with dual chamber (atrial and

RV) sensing and bradycardia pacing with

ventricular resynchronisation therapy.

Dual Chamber Pacemakers

Generation 1

Biotronik Australia Pty Ltd

BT026 Philos D Model 122447 Implantable Multiprogrammable, ventricula, rate One size only

Pacemaker responsive modes, DDDC

BT031 AXIOS D Implantable Cardiac Pulse Multiprogrammable, DDD One size only

Generator Cat No. 338 843

Guidant Australia Pty Ltd

GU079 Pulsar Model VDD 870 Titanium 3.2mm/IS-1

Medtronic Australasia Pty Ltd

MC033 Medtronic Kappa 700 Pacemaker Model Titanium 10.9cc, 11.1cc

KVDD700/701

MC235 Vitatron Vita 2 VDD Model 630, Titanium, polyurethane One size only

Implantable Cardiac Pacemaker

MC243 Medtronic Kappa KVDD 900 Model Cardiac Pacemaker, Titanium 11.1cc

KVDD 901

MC290 Vitatron C50 D Pacemaker Titanium, polyurethane one size only

MC319 EnPulse VDD; Model E2VDD01 EnPulse VDD pacemaker with IS1 One size only

connector. Titanium silicone

MC320 EnPulse D Series: Model E2D01, Model EnPulse DDD-Pacemakers - with IS1 One size only

E2D03 connector; with 3.2mm low profile

connector. Titanium and silicone

St. Jude Medical Australia Pty Ltd

SJ050 Verity ADx Model XL DC 5256 Dual - Dual Chamber multi-programmable rate- 11cc, 23.5g

Chamber pacemaker adaptive pacing devices with extended

longevity

PART A - Prostheses List by Category, Groups and Sponsor Page 9 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

SJ061 Identity Adx Model XL DC 5286 Dual Identity ADx Model XL DC Model 5286 11cc, 23.5g

Chamber Pacemaker is an implantable, multi-programmable

rate-adaptive pacing device with AF

Generation 2

Biotronik Australia Pty Ltd

BT027 Philos SLR Model 122456 Implantable Single pass, multiprogrammable, rate One size only

Pacemaker responsive, VDDR

BT039 AXIOS SLR Implantable Cardiac Pulse Multiprogrammable, rate responsive, One size only

Generator Cat No 338 849

Medtronic Australasia Pty Ltd

MC212 Medtronic Vitatron Clarity VDDR Model Titanium, polyurethane One size only

St. Jude Medical Australia Pty Ltd

SJ054 Identity ADx Model VDR 5480 Single Chamber multi-programmable rate- 8cc, 18g

implantable pacemaker adaptive pacing device with extended

longevity

SJ057 Verity ADx Model XL VDR 5456 Single Chamber multi-programmable rate- 11cc, 23.5g

implantable pacemaker adaptive pacing device with extended

longevity

Generation 3

Biotronik Australia Pty Ltd

BT024 Philos DR Model 122450 Implantable Multiprogrammable, rate responsive, One size only

Pacemaker

BT029 Philos DR-A Model 122600 Implantable Multiprogrammable, rate responsive, 5mm ports, One size only

Pacemaker

BT032 AXIOS DR Implantable Cardiac Pulse Multiprogrammable, rate responsive, One size only

Generator Cat No. 338 845

BT047 Protos DR/CLS Dual chamber, rate responsive, closed One size only.

loop system.

BT060 Philos II DR Multiprogrammable, rate responsive, One size only

Guidant Australia Pty Ltd

GU045 Pulsar Max II Pacemaker DDDR Model 1280

GU120 Insignia Plus DR Model 1297, Insignia Dual Chamber Rate Responsive One size only

Plus DR Model 1298 Permanent Pacemaker

PART A - Prostheses List by Category, Groups and Sponsor Page 10 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

GU121 Insignia Entra DR Models Dual Chamber Rate Responsive One size only

Permanent Pacemaker

GU140 Insignia Ultra DR Model 1291 Implantable Cardiac Pacemaker One size only

GU141 Insignia Ultra DR Model 1290 Implantable Cardiac Pacemaker One size only

Medtronic Australasia Pty Ltd

MC210 Medtronic Vitatron Clarity DDDR Model Titanium, polyurethane One size only

MC222 Medtronic Vitatron Diamond 3 DDDR Titanium, polyurethane One size only

Model 840 Pacemaker

MC230 Vitatron Selection Model 9000 Pacemaker Titanium, polyurethane One size only

MC240 Vitatron Vita 2 DDDR Model 830, Titanium, Polyurethane One size only

Implantable Cardiac Pacemaker

MC289 Vitatron C60 DR Pacemaker Titanium, polyurethane one size only

MC333 Medtronic Kappa Pacemaker Model KDR Cardiac Pacemaker, Titanium 12.1cc, 11.1cc, 13.1cc

901, KDR921 and KDR931

Progressive Medical

PG002 Talent II DR Pacemaker Model 233 Dula Chamber Pacemaker. 99% titanium 57.5 x 37.2 x 8mm

PG005 Symphony DR 2550 Active Implantable pacemaker 1 size only

St. Jude Medical Australia Pty Ltd

SJ026 St Jude Medical Integrity AFX DR5346 Dual chamber, rate responsive pacemaker Volume 11cc, weight 23.5gm

Pacemaker, Cardiac, Implantable

SJ028 Integrity Micro DR 5336 Pacemaker Dual Chamber Rate Responsive Volume 8cc, Weight 18gm

SJ031 Identity XL DR 5376 Dual Chamber Rate Responsive Volume 11cc, Weight 23.5gm

SJ032 Identity DR 5370 Dual Chamber Rate Responsive Volume 8cc, Weight 18gm

SJ051 Verity Adx Implantable Pacemaker, Dual - Chamber, multi-programmable, 45x52x6mm,11cc, 23g, 5mm or 6mm M/S

Models XL DR 5356 and XL DR 5357M/S rate-responsive pacemaker withAF

SJ056 Integrity ADx Model DR 5360 and XL Dual-Chamber, multi-programmable, rate- Model DR 5360 - 8cc, 18g, Model XL

DR 5366 responsive pacemaker with AF DR 5366 - 11cc, 23.5g

SJ059 Identity ADx Models DR 5380 and XL Dual-Chamber, multi-programmable, rate- ADx DR 5380: 43x44x6mm, 18g and 8cc

DR 5386 adaptive pacing devices with AF

ADx XL DR 5386: 44x52x6mm, 23.5g

PART A - Prostheses List by Category, Groups and Sponsor Page 11 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

Generation 4

Medtronic Australasia Pty Ltd

MC322 EnPulse DR Series: Model E2DR01, EnPulse DDDR Pacemakers - with IS1 one size only

Model E2DR03, Model E2DR06, Model connector and normal battery size; with

E2DR21, Model E2DR31, Model E2DR33 3.2mm low profile connector and normal

battery size; with 5/6 mm connector and

normal battery size; with IS1 connector

and small battery size; with IS1

connector and large battery size; with

3.2mm low profile connector and large

battery size. Titanium and silicone.

Embolization Prostheses, Intravascular

William A Cook Aust Pty Ltd

WC076 Flipper-Patient Ducts Arteriosus- Detachable Coil for PDA Closure Coil Diameter 3,5,6.5 & 8 mm Number

Occluding System of Loops (3,4,5)

Filters, Vena Cava

B Braun Australia Pty Ltd

BB105 Celsa Vena Cava Filter System Phynox/ combination of various metals One size, expands to Max length

inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm

BB106 Celsa Temporary Vena Cava System Phynox/ combination of various metals One size, expands to Max length

inc. Nickel,Copper, Molubden,Steel 38mm/Max diameter 30mm

Grafts

Woodstock Biomedical Pty Ltd

WO033 Endofit Endoluminal Stent Graft Tapered Thoracic Endoluminal Stent Max Dia. 42mm, Min Dia. 14mm, Length

Graft with external fixation 12-26cm

WO034 Endofit Endoluminal Stent Graft Occluder Endoluminal Stent Graft Max Dia. 42mm, Min Dia. 14mm, Length

2 or 3.5cm

PART A - Prostheses List by Category, Groups and Sponsor Page 12 of 666

CARDIO-THORACICMinimum Maximum

Benefit Benefit

Billing CodeProduct NameDescriptionSizeLevelLevelNotation

WO035 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. 14mm, Length

abdominal and thoracic, Preloaded 4-12cm

WO036 Endofit Endoluminal Stent Graft Extender Endoluminal Stent Graft, Max Dia. 42mm, Min Dia. 14mm, Length

abdominal and thoracic, Cartridge 4-12cm

WO037 Endofit Endoluminal Stent Graft Endoluiminal Cuff Stent Graft with Max Dia. 42mm, Min Dia. 24mm, Length

external fixation, abdominal and thoracic, 5 or 7cm

WO038 Endofit Endoluminal Stent Graft Endoluminal Cuff Stent Graft with Max Dia. 42mm, Min Dia. 24mm, Length

external fixation, abdominal and thoracic, 5 or 7cm

WO039 Endofit Endoluminal Stent Graft Aortomonoiliac Endoluminal Stent Graft Max Proximal Dia. 38mm, Min Distal

with external fixation Dia. 14mm, Length 14 - 26cm

WO040 Jotech Flowline Bipore Vascular Graft Thin Wall with Spiral Reinforcement 40 & 50cm

WO041 Jotech Flowline Bipore Vascular Graft Thin Wall 40 & 50cm

WO042 Jotech Flowline Bipore Vascular Graft Standard Wall with Spiral Reinforcement 70 & 80cm

WO043 Jotech Flowline Bipore Vascular Graft Standard Wall 80cm

WO044 Jotech Flow Weave Vascular Graft Flow Weave 30cm

WO045 Jotech Flow Weave Vascular Graft Flow Weave 60cm

WO046 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 15cm

WO047 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 30cm

WO048 Jotech Flow Weave Vascular Graft Flow Weave BioSeal 60cm

Grafts, Dura, Biological

Edwards Lifesciences Pty Ltd

EL033 Baxter Augmentation / Substitution Edwards Pericardial Patch. Bovine 10cm x 16cm

Material, Human or Animal Origin, Sterile Pericardium.

Pericardial Patch.



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