INTRAOCULAR LENS SPECIALTY SHEET
(Prostheses List, February 2006 - Effective 14th March 2006)
Please Note: Items with gaps generally have low utilisation on a national basis Highlighted Items may attract a potential gap payment
Billing Minimum Maximum Potential
Sponsor Product Name Description Suffix
Code Benefit Benefit Gap
ANTERIOR CHAMBER
Group 1 - Anterior Chamber, aphakic, rigid lenses
AL003 Alcon Laboratories (Aust.) Pty Ltd MTAU1-MTAU-7 PMMA $150.00
AO001 Advanced Medical Optics Australia Pty Ltd Intraocular Lens: Model AC 51B Duralens PMMA, Anterior Chamber IOL $150.00 Surface Modification Suffix
AO011 Advanced Medical Optics Australia Pty Ltd Anterior chamber heparin $190.00 $200.00 352C.
Anterior Chamber IOL; Pharmacia Heparin Surface Modified AC IOL Model 352C coated PMMA lenses 352C. Models 812C, 722C, 757C, 808C &$10.00 Surface Modification Suffix
AO019 Advanced Medical Optics Australia Pty Ltd Verisyse AC IOL Aphakic Model $150.00 $400.00 $250.00
BL005 Bausch & Lomb Surgical Anterior Chamber Lens
Storz (Coburn) Intraocular Lens 121UV; L122UV PMMAAPMMA Anterior Chamber Intraocular lens 1 piece $150.00
EG009 Emagin Pty Ltd Artisan Anterior Chamber Intraocular Lens Aphakia Model $150.00 $253.00 $103.00
Group 2a - Anterior Chamber: phakic, rigid lenses.
AO016 Advanced Medical Optics Australia Pty Ltd Verisyse AC IOL $653.40
Phakic Intraocular Lens: Model Myopia. Composition: PMMA $700.00 $46.60
AO017 Advanced Medical Optics Australia Pty Ltd Verisyse AC IOL $653.40
Phakic Intraocular Lens: Model Hyperopia. Composition: PMMA $700.00 $46.60
AO018 Advanced Medical Optics Australia Pty Ltd Verisyse AC IOL Phakic Intraocular Lens: Model Toric $853.40 $1,400.00 $546.60 Toric Suffix
EG006 Emagin Pty Ltd Artisan Anterior Chamber Intraocular Lens Phakic Intraocular Lens: Model MyopiaComposition: PMMA $653.40
EG007 Emagin Pty Ltd Artisan Anterior Chamber Intraocular Lens $653.40
Phakic Intraocular Lens: Model HyperopiaComposition: PMMA
EG008 Emagin Pty Ltd Artisan Anterior Chamber Intraocular Lens Phakic Intraocular Lens: Model ToricComposition: PMMA $853.40 $1,286.68 $433.28 Toric Suffix
Group 2b - Anterior Chamber: phakic foldable lenses
EG010 Emagin Pty Ltd Artiflex Anterior Chamber Intraocular Lens Optic: Hydrophobic Polysiloxane. Haptic: PMMA $723.00 $880.00 $157.00
POSTERIOR CHAMBER
Group 3 - Posterior Chamber: aphakic, rigid lenses
AL002 Alcon Laboratories (Aust.) Pty Ltd Other:PMMA $150.00
Intraocular Lens: MODIFIED C PMMA PC IOL MODEL MZ60BD, MODIFIED PMMA PC IOL Model MZ20BD, CANTILEVER PMMA PC IOL MODEL CVC1U, Modified PMMA PC IOL Model MZ30BD, PMMA PC, IO
AO003 Advanced Medical Optics Australia Pty Ltd Duralens, PMMA, Posterior Chamber IOL
Intraocular Lens: Allergan AMO Duralens Posterior Chamber IOL Model PS42ANB, PS53ANB, PS60ANB, PS59NB,$150.00PS60AMB $190.00 $40.00
AO022 Advanced Medical Optics Australia Pty Ltd CeeOn IOL Model 352C $190.00 $200.00 $10.00 Surface Modification Suffix
Posterior Chamber IOL; Pharmacia Heparin Surface Modified AC Posterior chamber, heparin coated , PMMA lenses, One piece, biconvex. 812C, 722C, 757C, 808C CeeOn
BL006 Bausch & Lomb Surgical PMMA Posterior Chamber Piece, model $150.00
Posterior chamber IOLS model P359 UV, P399 UV, 68 UV, 95 BUV, or lolab PC Onelens 1 piece; 6741B, 8591B, 8191B; Model EZE-Fit 65
Group 4a - Posterior Chamber: aphakic, foldable, no edge modification, haptic plate lenses
BL010 Bausch & Lomb Surgical Chiroflex Model C11UB $270.00
Intraocular Lens Foldable Plate Haptic Silicone Posterior Chamber Foldable Plate Haptic Lens 1 piece
CS001 ConceptVision Australia Pty Ltd Model AA4204VF; AA4204VL;
Staar foldable silicone intraocular lens: Model AA4203VF; Plate haptics 6.0mm; Polymide haptics 5.5 or 6.3mm optic; $270.00 $285.00 $15.00
CS002 ConceptVision Australia Pty Ltd Plate haptics 6.0mm optic
Staar Toric foldable silicone intraocular lens: Model AA4203TF; Model AA4203TL $395.00 Toric Suffix
CS006 ConceptVision Australia Pty Ltd 5.5mm optic
Staar foldable silicone IOLs: Model KS-1 (AS-110NV) preloaded Intraocular lens $290.00 $305.00 $15.00 PP
IQ001 IQ Medical UltraChoice 1.0 Rollable Thinlens Model PHC001 $360.00 $650.00 accommodating intraocular lens withSuffix
Acrylic, single piece, rollable, refractive multifocal with monofocal function meniscus optic, $290.00 Aberration Technology 50 micron edge
Group 4b - Posterior Chamber: aphakic, foldable, no edge modification lenses
AO005 Advanced Medical Optics Australia Pty Ltd PhacoFlex II SI-30NB Silicone or PC IOL $270.00
Intraocular Lens: Allergan Model SI-30NB Silicone PC IOL; or AMO model SI-40NB SiliconePhacoFlex II SI-40NB Silicone; Foldable IOL
AO015 Advanced Medical Optics Australia Pty Ltd CEEON R Intraoccular Lens $220.00
Foldable intraocular lenses - ultraviolet light absorbing posterior chamber intraocular lenses
BL007 Bausch & Lomb Surgical Hydroview Intraocular lens Model H60M $270.00
Foldable Hydrogel Lens Hydrogel Posterior Chamber Foldable lens 1 piece
BL009 Bausch & Lomb Surgical Foldable Intraocular Lens Silicone Posterior Chamber Foldable Lens 3 piece
Soflex UV Absorbing Silicone Posterior Chamber IOL Model LI61U $270.00
CS003 ConceptVision Australia Pty Ltd Staar foldable silicone intraocular lens: Model AQ 5010V Polyimide haptics 6.3mm optic - low diopters $220.00
Group 4c - Posterior Chamber: aphakic, foldable, posterior edge modification lenses
AL004 Alcon Laboratories (Aust.) Pty Ltd Foldable Acrylic Multi-piece Lens $300.00
Intraocular Lens: Alcon Acrysof Model MA60BM PC IOL, Alcon Acrysof Model MA30BA PC IOL, Alcon Acrysof model MA50BM PC IOL, ACRYSOF IOL MODEL MA60MA
AL012 Alcon Laboratories (Aust.) Pty Ltd Foldable acrylic multi-piece lens, asymmetric optic/consistent edge
Alcon Acrysof Model MA30AC PC IOL, Alcon Acrysof Model MA60AC PC IOL $300.00
DE253 Device Technologies Australia Pty Ltd MicroSil Toric IOL $500.00 steps with $216.00 to
Silicone Lens (MS6116TU) Standard Range -3.00 to 31.00 Dioptres in 0.5 $716.00 cylinder from 2.00 T 12.00 Dioptres
DE254 Device Technologies Australia Pty Ltd MicroSil Toric IOL $500.00 $958.00 $458.00 T
Silicone Lens (MS6116TU) Semi-Custom Range -3.00 to 31.00 Dioptres with 1.0 steps, Cylinder from 3.0 - 14.0 Dioptres
DE255 Device Technologies Australia Pty Ltd MicroSil Toric IOL $500.00 $1,537.00
Silicone Lens (MS6116TU) Custom made range: -28 to +31 Sphere and up to 30D cylinder$1,037.00 T
Intraocular Lens - Specialty Sheet
(Prostheses List, February 2006) Page 1
Billing Minimum Maximum Potential
Sponsor Product Name Description Suffix
Code Benefit Benefit Gap
Group 4d - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification lenses
AL011 Alcon Laboratories (Aust.) Pty Ltd Foldable Acrylic Single-piece Intraocular Lens; optic/consistent edge
$310.00
Intraocular Lens: Alcon Acrysof Model SA30AL, Alcon Acrysof Model SA60AT, SA30ATLens, asymmetric Alcon Acrysof PC IOL Model SA65AT
AL016 Alcon Laboratories (Aust.) Pty Ltd Alcon Acrysof Natural Model SN60AT $350.00
Foldable Acrylic Single-piece Lens, asymmetric optic/consistent edge, with blue light protection Blue Light Filter Suffix
AL019 Alcon Laboratories (Aust.) Pty Ltd AcrySof Model SN60AS $370.00
Foldable Acrylic Single-piece lens, in cartridge, with blue light protection Blue Light Filter, Pre-Packaged Suffix
AL021 Alcon Laboratories (Aust.) Pty Ltd Alcon AcrySof SN60WF $370.00
Foldable Acrylic Single-piece Lens with Blue Light Protection and Aspheric Correction Blue Light Filter, Aberration Tech Suffix
AL023 Alcon Laboratories (Aust.) Pty Ltd Alcon AcrySof Toric PC IOL Models $540.00 with blue $150.00
Posterior chamber, UV absorbing, foldable, acrylic, toric, single piece lens $690.00 light protection T,BLF
AL024 Alcon Laboratories (Aust.) Pty Ltd AcrySof SN60WS $390.00
Foldable Acrylic Single-piece Lens with Blue light protection and aspheric correction, in cartridge.
AL025 Alcon Laboratories (Aust.) Pty Ltd AcrySof MN60MA Foldable Acrylic multi-piece Lens with Blue light Protection$340.00
AL026 Alcon Laboratories (Aust.) Pty Ltd AcrySof MN60AC Foldable Acrylic multi-piece Lens with Blue light Protection$340.00
AO002 Advanced Medical Optics Australia Pty Ltd Soft Acrylic, Foldable, UV
Sensar AR40 Monofocal Acrylic IOL, Sensar OptiEdge AR40e Foldable Acrylic IOL Absorbing, Posterior $310.00 $360.00 $50.00
AO006 Advanced Medical Optics Australia Pty Ltd Clariflex, Model CLRFLXB Posterior Chamber Intraocular Lens Foldable Silicone IOL with OptiEdge design $310.00 $360.00 $50.00
AO013 Advanced Medical Optics Australia Pty Ltd Silicon, foldable, $300.00
Ceeon Model 911A Edge Foldable UV Absorbing Posterior Chamber IOL UV absorbable intraocular lens with equibiconvex design and square optic edge
AO014 Advanced Medical Optics Australia Pty Ltd Tecnis TM Intraocular Lens $350.00 intraocular lenses, Silicone/Acrylic
Foldable Intraocular Lenses - Ultraviolet light absorbing posterior chamber$400.00 $50.00 Aberration Technology Suffix
BL019 Bausch & Lomb Surgical Composition: Hydrophilic acrylic polymer. Packaged in lens folding device in a sterile vial. Modified C-Loop design
Akreos Fit acrylic foldable posterior chamber intraocular lens $310.00
BL020 Bausch & Lomb Surgical Composition: Hydrophilic acrylic polymer. Packaged in lens folding device in a sterile vial. Four haptic design
Akreos Adapt acrylic foldable posterior chamber intraocular lens $310.00
BL021 Bausch & Lomb Surgical SoflexSE, Intraocular lenses, Posterior Chamber $310.00
Composition: silicone, Lenses - foldable, posterior chamber intraocular lenses
BL022 Bausch & Lomb Surgical SofPort Advanced Optic (AO) $350.00 AT
Posterior chamber, foldable silicone IOL with anterior optic-haptic square edge, posteriof optic-haptic square edge, 360-degree optic square edge and aspe
BL023 Bausch & Lomb Surgical Akreos Advanced Optic $350.00 AT
Posterior chamber, foldable acrylic IOL, with anterior optic-haptic square edge, posterior optic-haptic square edge, 360 degree optic square edge and asph
CS005 ConceptVision Australia Pty Ltd Staar foldable silicone intraocular lens: KS-3 Model AS310NVSilicone, foldable, polyamide haptics $290.00 $305.00 $15.00 PP
CS007 ConceptVision Australia Pty Ltd and AO2003V
Staar foldable silicone IOLs: Models AQ2010V, AQ2017V Plate haptics 6.0mm; Polymide haptics 5.5 or 6.3mm optic; $270.00 $285.00 $15.00
CS008 ConceptVision Australia Pty Ltd Preloaded Aspheric Intraocular Lens Silicone intraocular lens $345.00 AT, PP
IQ003 IQ Medical Tetraflex $350.00 $1,200.00 $850.00 AT
Acrylic single piece, foldable accommodating intraocular lens with sqare edge design, custom control precision and closed loop haptic design
IQ004 IQ Medical Softec and posterior optic-haptic square edge, 360 degree optic square edge design, precision power ca
Acrylic, single piece, foldable intraocular lens with anterior $350.00 $420.00 $70.00 AT
KG001 Kevin Grundy (IBD) Pty Ltd Rayner C-Flex Hydrophilic HEMA-MMA copolymer, foldable with injector $310.00
KG002 Kevin Grundy (IBD) Pty Ltd Superflex Hydrophilic HEMA-MMA copolymer, foldable with injector $310.00
KG003 Kevin Grundy (IBD) Pty Ltd Rayner Standard Toric C-Flex Hydrophilic HEMA-MMA copolymer, foldable with injector $510.00 $900.00 $390.00 Toric Suffix
KG004 Kevin Grundy (IBD) Pty Ltd Rayner Premium Toric C-Flex HEMA-MMA copolymer, foldable with injector $510.00 $1,800.00 $1,290.00 Toric Suffix
SO028 Spectrum Ophthalmics IOLTECH Intraocular Lens: Model Bigbag $310.00 edge design, UV blocker
IOLTECH Hydrophilic acrylic, foldable, PC, single piece, Tri-haptic, square$450.00 $140.00
SO031 Spectrum Ophthalmics IOLTECH Intraocular Lens, Model Stabibag, Model XL Stabi $310.00 $340.00 $30.00
IOLTECH hydrophilic acrylic, foldable, CP, single piece, square edge design, UV blocker, Tri-haptic
SO032 Spectrum Ophthalmics IOLTECH hydrophilic acrylic, foldable, CP, single piece, square edge design, UV blocker, Tri-haptic, Ready to use single use pre-loaded
IOLTECH Intraocular Lens, Model Stabibag RTU, Model XL Stabi RTU $330.00 $360.00 $30.00 PP
Group 5a - Posterior Chamber: aphakic, foldable, multifocal/bifocal lenses
AO004 Advanced Medical Optics Australia Pty Ltd Array Multifocal SA40N, Silicone, Foldable SA-40N
Intraocular Lens: Allergan AMO Array Multifocal UV Absorbing Silicone Posterior Chamber IOL ModelIOL $320.00 $360.00 $40.00
AO020 Advanced Medical Optics Australia Pty Ltd ReZoom Acrylic Multifocal Intraocular Lens Acrylic, foldable, posterior chamber, intraocular lens $320.00 $420.00 $100.00
Group 5b - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification, multifocal/bifocal lenses.
AL017 Alcon Laboratories (Aust.) Pty Ltd Alcon AcrySof ReSTOR PC Diffractive IOL Model SA60D3 piece lens apodised $200.00
Posterior Chamber, UV absorbing, foldable, acrylic, single$750.00 with $950.00 diffractive optic
AL022 Alcon Laboratories (Aust.) Pty Ltd SN60D3 piece lens apodised $250.00 blue
Alcon AcrySof ReSTOR PC Diffractive IOL Natural Model Posterior Chamber, UV absorbing, foldable, acrylic, single$790.00 with $1,040.00diffractive optic andBLF light protection.
AL027 Alcon Laboratories (Aust.) Pty Ltd PC IOL acrylic mutli-piece lens with apodised diffractive optic and blue light protection
ReSTOR multipiece apodised diffractive blue light filtering FoldableModel MN60D3 $780.00 BLF
AO023 Advanced Medical Optics Australia Pty Ltd Tecnis Multifocal Intraocular Lens $750.00 $950.00 $200.00
Tecnis Multifocal foldable Posterior Chamber Diffractive Intraocular Lens Model ZM900. Posterior Chamber lens with UV light-absorbing, foldable, siicone,
SO029 Spectrum Ophthalmics IOLTECH Intraocular Lens: Model MF4 piece, Tri-haptic, square edge design, UV blocker
Multifocal IOLTECH hydrophilic acrylic, foldable, PC single$650.00
Group 5c - Posterior Chamber: aphakic, foldable, multifocal, accommodative lenses.
CS004 ConceptVision Australia Pty Ltd Eyeonics Inc Crystalens $650.00
Silicon Multipiece Folding Accommodating Intraocular Lens
DE260 Device Technologies Australia Pty Ltd ICU Akkomodative® IOL $650.00
ICU Akkomodative IOL- Acrylic lens Range 15-35 Dioptres in 0.5 steps $950.00 $300.00
Group 6b - Posterior Chamber: Pseudo-phakic, piggy back, multifocal
SO030 Spectrum Ophthalmics IOLTECH Intraocular Lens: Model ACOR $500.00 $680.00 $180.00
Pseudo Phakic IOL, IOLTECH hydrophilic acrylic, foldable, PC, single piece, square edges, UV blocker
Intraocular Lens - Specialty Sheet
(Prostheses List, February 2006) Page 2