KNEE 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
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
FEMORAL COMPONENT TOTAL ARTHROPLASTY
Group 1a - Cemented, Alloy, Posterior Cruciate Retaining
AD141 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr component PCR cemented $3,300.00
AD169 Advanced Surgical Technologies Advantim Total Knee System $1,450.00
Femoral Components CoCr Total Condylar (Non Porous Coated)
AE039 Australian Surgical Design & Manufacture Pty Ltd Active Knee System Active Knee - Cemented Femoral Component $2,200.00
BB205 B Braun Australia Pty Ltd Columbus TKS Femoral component $2,800.00
BI147 Biomet Australia Pty Ltd AGC Knee System Femoral Component, Anatomic, Chrome Cobalt $3,300.00
BI152 Biomet Australia Pty Ltd AGC Knee System Femoral Component, Universal, Chrome Cobalt $2,985.00
BI168 Biomet Australia Pty Ltd Maxim Complete Knee System Primary Anatomic Femoral, Cemented, Chrome Cobalt $3,300.00
BI790 Biomet Australia Pty Ltd Ascent Total Knee System cobalt
Femoral, cruciate retaining, anatomic, cemented, chrome $3,300.00
BI898 Biomet Australia Pty Ltd Vanguard Total Knee System Femoral Component, CR, Cemented, anatomic, CoCr. $3,300.00
CR013 Corin Australia Pty Ltd Rotaglide + Total Knee System, Femoral Component Pegged, Cemented $2,700.00
CR015 Corin Australia Pty Ltd Rotaglide + Total Knee System, Femoral Component Stemmed, Cemented $2,900.00
DP381 De Puy Australia AMK Total Knee system Cemented Femoral left and right $3,500.00
EK029 ESKA Australia Type ST Biocondylar Surface Replacement Fixed bearing left and right femoral components. Cemented$3,600.00
EK032 ESKA Australia Type RP Biocondylar Surface Replacement $3,600.00
Mobile bearing. Left and Right Femoral components. Cemented.
HW076 Howmedica Duracon Femoral Component - Cemented Cruciate Retaining $3,300.00
HW147 Howmedica Kinemax Knee Femoral: Condylar Beadless - Vitallium $2,267.00
MA108 Mathys Orthopaedics Pty Ltd Balansys Femoral Component Left & right $3,147.00
OH020 Orthotech Pty Ltd Optetrak Total Knee System Femoral Component $3,300.00
OH155 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 3,300.00
PL027 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Solution (Cemented) Fem $3,200.00
PL068 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Femoral Cemented $3,500.00
SK324 Stryker Australia Pty Ltd Triathlon Femoral Component - Cemented Cruciate Retaining $3,500.00
SK332 Stryker Australia Pty Ltd Scorpio NRG Cemented Femur Cruciate Retaining $3,500.00
SN321 Smith & Nephew Surgical Pty Ltd Genesis II Non Porous femoral $2,833.00
SN344 Smith & Nephew Surgical Pty Ltd Genesis Femoral Component: Cruciate Retaining: Non Porous: CoCr $2,672.00
ST023 Stryker Australia Pty Ltd Scorpio Cemented Femur Cruciate Retaining $3,300.00
ST634 Stryker Australia Pty Ltd Osteonics Knee System Femoral component cemented cobalt chrome $3,300.00
ZI420 Zimmer Natural Knee Primary Femur - Cemented - CoCr alloy $3,088.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 1
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 1b - Cemented, Alloy, Posterior Stabilised
AD133 Advanced Surgical Technologies Advance Total Knee System Femoral PS components CoCr $3,315.00
AD295 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr component PCR cemented $3,300.00
BB196 B Braun Australia Pty Ltd Emotion TKS Femoral Component-posterior stabilized $2,900.00
BB206 B Braun Australia Pty Ltd Columbus TKS Femoral component - posterior stabilized $2,900.00
BI150 Biomet Australia Pty Ltd AGC Knee System $3,300.00
Femoral Component, Anatomic, Post. Stabilised Chrome Cobalt
BI158 Biomet Australia Pty Ltd AGC Knee System $3,460.00
Femoral Prosthesis, Posterior Stabilised, Universal. Chrome Cobalt
BI178 Biomet Australia Pty Ltd Maxim Complete Knee System $3,300.00
Femoral Component, Posterior Stabilised Anatomic Chrome Cobalt
BI191 Biomet Australia Pty Ltd TRAC Knee System Femoral Component, Posterior Stabilised CoCr $3,500.00
BI195 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Femoral Component, Posterior Stabilised, Cemented, CoCr $3,300.00
BI795 Biomet Australia Pty Ltd Ascent Total Knee System $3,300.00
Femoral, anatomic, posterior stabilised, open box, cemented, chrome cobalt
BI897 Biomet Australia Pty Ltd Vanguard Total Knee System $3,300.00
Femoral Component, Posterior Stabilised, Cemented, anatomic, CoCr.
BI902 Biomet Australia Pty Ltd ROCC Knee Prosthesis Femoral Component, cemented, anatomic, CoCr $3,300.00
DP004 De Puy Australia LCS Complete System Femoral Cemented $3,061.00
DP149 De Puy Australia PFC Knee System Range PFC Sigma C/S $2,900.00
DP380 De Puy Australia AMK Total Knee system $5,701.00
Posterior or Congruency stabilised femoral or STD Femoral post Chrome cobalt
DY404 De Puy Australia RPF Cemented Femur $2,900.00
DY468 De Puy Australia AMK Total Knee system Cemented Femoral left and right $3,500.00
FI025 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System Femoral Component, CoChr Alloy, cemented $2,500.00
FI028 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Femoral Component, Cemented, CoChr Alloy $2,500.00
GO006 Global Orthopaedic Technology RBK Total Knee System Femoral Component, Primary, Mobile Bearing, Co Coatings $3,110.00
HW080 Howmedica Duracon Total Knee System Monolithic Stabiliser - Vitallium $3,300.00
HW396 Howmedica Duracon Femoral Component - Cemented Posterior Stabilised $3,300.00
LO037 Link Orthopaedic Australia Gemini MkII Knee Joint Prostheses System Femoral component, Standard, Microporous $2,400.00
OH212 Orthotech Pty Ltd Optetrak Total Knee System Femoral Component $4,100.00
OH221 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 3,300.00
SN327 Smith & Nephew Surgical Pty Ltd Genesis II/Profix PS Non Porous Femoral Component $3,300.00
SN660 Smith & Nephew Surgical Pty Ltd Profix Constrained Femur Cobalt Chromium $2,950.00
SR003 Stryker Australia Pty Ltd Scorpio NRG Cemented Femur Posterior Stabilised $3,500.00
SR005 Stryker Australia Pty Ltd Scorpio Cemented Femur Posterior Stabilised $3,300.00
SR009 Stryker Australia Pty Ltd Triathlon Femoral Component - Cemented Posterior Stabilised $3,500.00
SR019 Stryker Australia Pty Ltd Osteonics Knee System Femoral component cemented cobalt chrome $3,300.00
ZI119 Zimmer NexGen Knee Femoral Components PS Option - Co Cr $7,000.00
ZI421 Zimmer Natural Knee Primary Femur - Cemented P.S. - CoCr alloy $3,300.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 2
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 1c - Cemented, Alloy, Totally Constrained
BI180 Biomet Australia Pty Ltd Maxim Complete Knee System $5,200.00
Constrained Anatomic Femoral Component, Anatomic. Chrome Cobalt
BI799 Biomet Australia Pty Ltd Ascent Total Knee System $5,500.00
Femoral Anatomic, posterior stabilised or constrained, closed box, cemented, chrome cobalt
DP150 De Puy Australia PFC Knee System Range PFC Sigma TC3 Femur $3,475.00
HW149 Howmedica Kinemax Knee Femoral: Stabilizer Beadless - Vitallium $2,650.00
OH024 Orthotech Pty Ltd Optetrak Total Knee System CCK Femoral Component $6,000.00
SN315 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Non Porous Constrained Femoral Component $2,950.00
Group 1d - Cemented, Alloy, PMMA coating, Posterior Cruciate Retaining
ZI111 Zimmer NexGen Knee Femoral Components CR Precoat - Co Cr $3,300.00
ZI113 Zimmer NexGen Knee Femoral Components CRA Precoat - Co Cr $7,250.00
Group 1e - Cemented, Alloy, PMMA coating, Posterior Stabilised
OH233 Orthotech Pty Ltd Optetrak RBK Optetrak RBK Femoral Component Cemented $3,300.00
ZI063 Zimmer NexGen Femoral Components Cobalt Chrome $4,500.00
ZI117 Zimmer NexGen Knee Femoral Components PS Precoat - Co Cr $3,300.00
Group 1f - Cemented, Alloy, PMMA coating, Totally Constrained
SN814 Smith & Nephew Surgical Pty Ltd Genesis II Femoral Component Constrained Co Cr $2,950.00
Group 1g - Cemented, Non-Alloy, Posterior Cruciate Retaining
EA007 Endotec Australia Pty Ltd Ceramic Coated, Titanium $3,800.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile Polyethelene inserts, all polyethelene patella ceramic coated, titanium backed p
SN333 Smith & Nephew Surgical Pty Ltd Genesis II/Profix C/R Femoral Component, Oxinium $4,800.00
Group 1h - Cemented, Non-Alloy, Posterior Stabilised
DY371 De Puy Australia LCS Complete System PS Femur CoCr Cemented TiNi $4,989.00
DY374 De Puy Australia LCS Complete System Femoral Cemented TiNi $4,989.00
SN704 Smith & Nephew Surgical Pty Ltd Genesis II / Profix Posterior Stabilised Oxinium Femoral Components $4,989.00
SN779 Smith & Nephew Surgical Pty Ltd Renasys Knee Non Porous Femur $4,989.00
SN803 Smith & Nephew Surgical Pty Ltd Genesis II/Profix P/S Femoral Component, Oxinium $4,800.00
Group 1i - Cemented, Non-Alloy, Totally Constrained
SN736 Smith & Nephew Surgical Pty Ltd Legion Revision Constrained Oxinium Femoral Component $8,000.00
SN804 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Constrained Femoral Component, Oxinium $4,800.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 3
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 1j - Uncemented, Alloy, Posterior Cruciate Retaining
AD140 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr PCR component porous $3,990.00
AD168 Advanced Surgical Technologies Advantim Total Knee System Femoral Components CoCr Total Condylar (Porous Coated) $2,220.00
BI159 Biomet Australia Pty Ltd AGC Total Knee System Femoral Prostheses, Anatomic, Porous Coat, CoCr, Ti $3,600.00
BI167 Biomet Australia Pty Ltd Maxim Complete Knee System Primary Anatomic Femoral, Uncemented, Chrome Cobalt $3,600.00
BI794 Biomet Australia Pty Ltd Ascent Total Knee System $4,000.00
Femoral, cruciate retaining, anatomic, uncemented, chrome cobalt, titanium porous coat
BI886 Biomet Australia Pty Ltd Vanguard Total Knee System Femoral Component, CR, uncemented, anatomic, CoCr, Ti $4,000.00
CR012 Corin Australia Pty Ltd Rotaglide + Total Knee System, Femoral Component Pegged, Porous Coat $2,791.00
DP148 De Puy Australia PFC Knee System Range PFC Sigma C/R porous $2,550.00
DP237 De Puy Australia LCS Total Knee System Femoral Tray Chrome cobalt $3,283.00
EK030 ESKA Australia Type ST Biocondylar Surface Replacement $3,600.00
Fixed bearing left and right femoral components. Uncemented
EK033 ESKA Australia Type RP Biocondylar Surface Replacement $3,600.00
Mobile bearing. Left and Right Femoral components. Uncemented.
FI026 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System Femoral Component, CoChr Alloy, uncemented $3,000.00
HW075 Howmedica Duracon Femoral Component - Cementless Cruciate Retaining $3,600.00
HW146 Howmedica Kinemax Knee Femoral: Condylar Beaded - Vitallium $3,310.00
LO049 Link Orthopaedic Australia LINK T.A.C.K. Knee Femoral Cementless $2,400.00
MA457 Mathys Orthopaedics Pty Ltd Balansys Femoral Component Left & right $3,147.00
OH213 Orthotech Pty Ltd Optetrak Total Knee System Femoral Component $3,300.00
OH222 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 3,600.00
PL053 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Femoral Cementless $4,000.00
SK387 Stryker Australia Pty Ltd Triathlon Total Knee System $3,800.00
Uncemented, porous beaded femoral component, cruciate retaining, left and right, cobalt chrome
SN326 Smith & Nephew Surgical Pty Ltd Genesis II Porous femoral $3,600.00
SN345 Smith & Nephew Surgical Pty Ltd Genesis Femoral: Cruciate Retaining: Porous: CoCr $2,550.00
SN375 Smith & Nephew Surgical Pty Ltd Profix Femoral Porous $3,000.00
ST033 Stryker Australia Pty Ltd Scorpio Femoral Component - Cementless Cruciate Retaining $3,700.00
ZI109 Zimmer NexGen Knee Femoral Components CR Porous - Co Cr $3,600.00
ZI418 Zimmer Natural Knee Primary Femur - Porous - Ti/CoCr alloy $3,600.00
Group 1k - Uncemented, Alloy, Posterior Stabilised
AD186 Advanced Surgical Technologies Ortholoc Modular Total Condylar $4,152.00
Femoral components CoCr Posterior Stabilised (Porous Coated)
AD300 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr PCR component porous and HA $3,990.00
BI165 Biomet Australia Pty Ltd AGC Total Knee System $4,100.00
Femoral Prostheses, Posterior Stabilised, Uncemented, Chrome Cobalt
BI174 Biomet Australia Pty Ltd Maxim Complete Knee System $4,800.00
Femoral Component, Posterior Stabilised, Porous, Chrome Cobalt
BI192 Biomet Australia Pty Ltd TRAC Knee System Femoral Component, Porous, Posterior Stabilised CoCr, Ti $4,800.00
BI796 Biomet Australia Pty Ltd Ascent Total Knee System $4,800.00
Femoral, anatomic, posterior stabilised, open box, uncemented, chrome cobalt, titanium porous coat
BI910 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Femoral Component, Posterior Stabilised, Porous, CoCr, Ti$4,800.00
DP003 De Puy Australia LCS Complete System Femoral Porocoat $3,584.00
DP268 De Puy Australia SROM Knee System Femoral Component $3,855.00
DP518 De Puy Australia LCS Universal Knee LCS Ultra Femorals Chrome cobalt $3,420.00
FI029 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Femoral Component, cementless, CoChr Alloy $3,000.00
HW397 Howmedica Duracon Femoral Component - Cementless Posterior Stabilised $3,600.00
OH214 Orthotech Pty Ltd Optetrak Total Knee System Femoral Component $3,600.00
OH223 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 4,100.00
OH234 Orthotech Pty Ltd Optetrak RBK Optetrak RBK Femoral Component Uncemented $4,000.00
PL077 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System TC Plus Solution, Femur PS $4,800.00
SK386 Stryker Australia Pty Ltd Triathlon Total Knee System $3,800.00
Uncemented, porous beaded femoral component, posterior stabilized, left and right cobalt chrome
SN328 Smith & Nephew Surgical Pty Ltd Genesis II/Profix PS Porous Femoral Component $4,100.00
SN815 Smith & Nephew Surgical Pty Ltd Profix Femoral Porous $3,000.00
SR007 Stryker Australia Pty Ltd Scorpio Femoral Component - Cementless Posterior Stabilised $3,700.00
ZI115 Zimmer NexGen Knee Femoral Components PS Porous - Co Cr $4,100.00
ZI419 Zimmer Natural Knee Primary Femur - Porous P.S. - Ti/CoCr alloy $4,400.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 4
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 1l - Uncemented, Alloy, Totally Constrained
SN383 Smith & Nephew Surgical Pty Ltd Profix Porous Femoral with Taper $4,056.00
Group 1m - Uncemented, Alloy, HA coating, Posterior Cruciate Retaining
AD194 Advanced Surgical Technologies Ortholoc Advantim HA Porous Coated Knee System Femoral components CoCr HA coated femoral components $2,800.00
AD275 Advanced Surgical Technologies Advance HA Coated Femoral Component HA Coated Femoral Component $4,250.00
AD301 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr PCR component porous and HA $3,990.00
AE041 Australian Surgical Design & Manufacture Pty Ltd Active Knee System Active Knee - Cementless Femoral Component $3,250.00
BB232 B Braun Australia Pty Ltd Emotion TKS Femoral Component - Cementless $3,250.00
BB234 B Braun Australia Pty Ltd Columbus TKS Femoral Component - Cementless $3,400.00
CR011 Corin Australia Pty Ltd Rotaglide + Total Knee System, Femoral Component Pegged, Hap Coat $3,982.00
CR014 Corin Australia Pty Ltd Rotaglide + Total Knee System, Femoral Component Stemmed, HAP Coat $4,000.00
GO007 Global Orthopaedic Technology RBK Total Knee System - Femoral Component Porous coating $3,120.00
HW077 Howmedica Duracon Femoral Component - Cementless with PA Cruciate Retaining $4,000.00
JJ462 De Puy Australia LCS Complete DuoFix Femur fixation
CoCr femur with PoroCoat and HA coating for cementless$4,000.00
LO054 Link Orthopaedic Australia LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): femoral component $2,900.00
PL028 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Solution (Cementless) Fem $4,000.00
SK325 Stryker Australia Pty Ltd Triathlon Femoral Component - Cementless Cruciate Retaining $4,100.00
SK334 Stryker Australia Pty Ltd Scorpio NRG Cementless Femur Cruciate Retaining $4,100.00
SN332 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Femoral Component HA Coated Co Cr $4,000.00
ST030 Stryker Australia Pty Ltd Scorpio Femoral Component - cementless with PA Cruciate Retaining $4,000.00
ZI110 Zimmer NexGen Knee Femoral Components CR Porous HA/TCP - Co Cr $4,250.00
Group 1n - Uncemented, Alloy, HA coating, Posterior Stabilised
AD299 Advanced Surgical Technologies Advance HA Coated Femoral Component HA Coated Femoral Component $4,250.00
AD302 Advanced Surgical Technologies Advance Total Knee System Femoral CoCr PCR component porous and HA $3,990.00
AD306 Advanced Surgical Technologies Advance HA Coated Femoral Component HA Femoral Component $4,250.00
BI887 Biomet Australia Pty Ltd ROCC Knee Prosthesis CoCr, HA
Femoral Component, uncemented, anatomic, HA Coated, $4,100.00
BI911 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System $4,500.00
Femoral Component, Posterior Stabilised, Porous, HA Coated, CoCr, Ti, HAP
HW398 Howmedica Duracon Femoral Component - Cementless with PA Posterior Stabilised $4,000.00
LO128 Link Orthopaedic Australia Gemini MkII Knee Joint Prostheses System Femoral Component, Standard, HX Coating $900.00
SR004 Stryker Australia Pty Ltd Scorpio NRG Cementless Femur Posterior Stabilised $4,100.00
SR006 Stryker Australia Pty Ltd Scorpio Femoral Component - cementless with PA Posterior Stabilised $4,000.00
SR011 Stryker Australia Pty Ltd Triathlon Knee System $
HA Coated femoral component left and right cobalt chrome4,100.00
SR024 Stryker Australia Pty Ltd Triathlon Femoral Component Posterior Stabilised $4,100.00
ZI062 Zimmer NexGen Flex Femoral Component - Porous HATCP Cobalt Chrome $4,561.00
Group 1o - Uncemented, Alloy, HA coating, Totally Constrained
TO018 Tornier Pty Ltd HLS Noetos Total Knee Replacement - Femur Femur Cementless $4,500.00
Group 1p - Uncemented, non-Alloy, Posterior Cruciate Retaining
EA006 Endotec Australia Pty Ltd Ceramic Coated, Titanium $4,700.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile Polyethylene inserts, all polyethylene patella ceramic coated, titanium backed po
Group 1q - Uncemented, non-Alloy, Posterior Stabilised
DY373 De Puy Australia LCS Complete System Femoral Porocoat TiNi $3,900.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 5
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
FEMORAL COMPONENT: UNI-COMPARTMENTAL KNEE REPLACEMENT
Group 2a - Cemented, Alloy
AD205 Advanced Surgical Technologies Advance-Unicondylar Knee System Femoral component - cobolt chrome $2,600.00
AE066 Australian Surgical Design & Manufacture Pty Ltd Active Uni Compartmental Knee $2,200.00
Uni compartmental knee resurfacing prostheses, consisting of a Femoral component manufactured from Chrome Cobalt Molybdenum alloy, and a Tibia
BI031 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Femoral Component, Chrome Cobalt, Cemented $2,279.00
BI203 Biomet Australia Pty Ltd Repicci II Unicondylar Knee System Femoral Component, Cemented, Chrome Cobalt $2,600.00
DY112 De Puy Australia Preservation Miu Knee System MIU Cemented Femoral $1,900.00
DY471 De Puy Australia PFC Knee System Range PFC Sigma C/R porous $2,550.00
GO032 Global Orthopaedic Technology CoCrMo
Global re-surfacing uni-compartmental knee femoral implant $3,200.00
LO059 Link Orthopaedic Australia LINK Endo-Model SLED Prosthesis: Femoral Component $2,200.00
MA451 Mathys Orthopaedics Pty Ltd balanSys UNI Femoral component, cemented CoCrMo $3,000.00
PL050 Plus Orthopedics Australia Pty Ltd UC-PLUS Solution Knee System Unicompartmental Femur Cemented $2,000.00
SN338 Smith & Nephew Surgical Pty Ltd Genesis Uni Femoral Component CoCr $1,900.00
ST055 Stryker Australia Pty Ltd EIUS Femoral Component Cobalt Chrome $2,000.00
TO007 Tornier Pty Ltd HLS Uni Evolution - Uni Knee Replacement - Femur Femoral Component - Cemented $2,200.00
ZI401 Zimmer Allegretto Unicompartmental Knee Femur - CoCr alloy $2,462.00
Group 2b - Cemented, Alloy, PMMA coating
BB197 B Braun Australia Pty Ltd Emotion TKS Femoral Component $2,015.00
OH230 Orthotech Pty Ltd Optetrak Uni Knee Uni Femoral Component $2,079.00 $2,400.00 $321.00
ZI106 Zimmer Miller Galante Unicompartmental Femoral Component - Co Cr $2,079.00
Group 2c - Cemented, non-Alloy
CR059 Corin Australia Pty Ltd AMC Uni Condylar, Cemented Femur $2,015.00
Cemented Femur, Cobalt Chrome with Titanium Nitrite Coating
SN710 Smith & Nephew Surgical Pty Ltd Genesis Uni Femoral Component, Oxinium $3,000.00
Group 2d - Uncemented, Alloy
DY113 De Puy Australia Preservation Miu Knee System MIU Porous Femoral $2,190.00
ZI428 Zimmer Natural Knee Unicompartmental - Femur - Ti/CoCr alloy $2,079.00
Group 2e - Uncemented, Alloy, HA coating
BI859 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Femur, Porous or HA Coated, CoCr, Ti, HA. $2,600.00
ST655 Stryker Australia Pty Ltd Unicompartmental Knee (Femoral Component) Femoral component cobalt chrome with HA coating $2,023.00
TB304 Taylor Bryant Pty Ltd HemiCAP Contoured Articular Knee System Articular Component - Cobalt Chrome $2,600.00 $3,900.00 $1,300.00
TB305 Taylor Bryant Pty Ltd HemiCAP Contoured Articular Knee System Fixation Screw - Titanium $1,500.00
Group 2f - Uncemented, non-Alloy
CR058 Corin Australia Pty Ltd AMC Uni Condylar, Femur Component, Bonit Coat $2,550.00
Femoral Component, Cobalt Chrome, Titanium Nitrate Ceramic Coated, Bonit (Calcium Phosphate) ingrowth surface
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 6
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
TIBIAL TRAY COMPONENT: TOTAL KNEE ARTHROPLASTY
Group 3a - Cemented, all polyethylene
AD170 Advanced Surgical Technologies Advantim Total Knee System All Poly Tibial UHMWPE $990.00
AE048 Australian Surgical Design & Manufacture Pty Ltd Other Active Knee Components All Polyethylene Tibial Implant $977.00
DP285 De Puy Australia AMK All Poly Tibia All Poly Tibial tray $900.00
HW095 Howmedica Duracon Total Knee System Tibial Baseplate All Polyethylene - Polyethylene $1,200.00
SN322 Smith & Nephew Surgical Pty Ltd Genesis II/Profix All Poly Tibial Base $977.00
ST647 Stryker Australia Pty Ltd Osteonics Knee System Tibial component All polyethylene cobalt chrome $1,200.00
ZI127 Zimmer NexGen Knee Tibial Components Stemmed All Poly - Ti $1,200.00
Group 3b - Cemented, Alloy, Modular
AD135 Advanced Surgical Technologies Advance Total Knee System Tibial base CoCr cemented $1,640.00
AD172 Advanced Surgical Technologies Advantim Total Knee System Tibial Primary Smooth/Finned Titanium CoCr $575.00
AD173 Advanced Surgical Technologies Advantim Total Knee System Tibial Primary Smooth/Finned Titanium CoCr $527.00
AD192 Advanced Surgical Technologies Ortholoc Modular Total Condylar $1,230.00
Tibial Components Modular Stem Base (Non Porous Coated) CoCr
AD218 Advanced Surgical Technologies ADVANCE Total Knee System Offset tibial base - nonporous $4,200.00
AE040 Australian Surgical Design & Manufacture Pty Ltd Active Knee System Tibial Component Cemented $1,320.00
BI169 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Plate Primary, Cemented, Titanium $2,050.00
BI177 Biomet Australia Pty Ltd Maxim Complete Knee System One Piece Revision Tibial Plate and Stem Boss, Ti $2,500.00
CR010 Corin Australia Pty Ltd Rotaglide + Total Knee System, Tibial Component Latched, Cemented $2,650.00
DP130 De Puy Australia PFC Knee System Range PFC CK cemented or Modular Tibial Tray $2,050.00
DP444 De Puy Australia AMK Chrome CobaltTray Cemented CoCr Keeled tray and Porous Coated trays $3,470.00
DP889 De Puy Australia AMK Chrome CobaltTray Cobalt Chrome Tibial TEX or TX FX Tray $4,488.00
DY378 De Puy Australia LCS Complete System Cemented Keeled or Cemented Tibial Tray TiNi $2,050.00
EK025 ESKA Australia Type ST Biocondylar Surface Replacement Tibial Tray Component - cemented $2,250.00
FI010 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Tibial Tray Component cemented, CoChr Alloy $2,050.00
HW087 Howmedica Duracon Total Knee System Tibial Baseplate Cemented - Vitallium $2,050.00
HW093 Howmedica Duracon Total Knee System Tibial Baseplate Universal - Cemented - Vitallium $2,255.00
HW154 Howmedica Kinemax Knee Tibial Component: Beadless - Vitallium $1,659.00
JJ510 Johnson & Johnson Medical Pty Ltd PFC Sigma Modular Tibial Tray Cemented - CoCr $2,050.00
PFC Sigma CoCr Tray with highly polished surface cemented
MA109 Mathys Orthopaedics Pty Ltd Balansys Tibial Base Plate Metal back $2,050.00
OH021 Orthotech Pty Ltd Optetrak Total Knee System Tibial Component $2,050.00
PL069 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibia Cemented $2,050.00 $2,500.00 $450.00
SK327 Stryker Australia Pty Ltd Triathlon Knee System Cemented tibial baseplate cobalt chrome $2,050.00
SN309 Smith & Nephew Surgical Pty Ltd Genesis II Tibial Base Non Porous Titanium $2,050.00
SN354 Smith & Nephew Surgical Pty Ltd Genesis Tibial Base: Non Porous $1,635.00
SN390 Smith & Nephew Surgical Pty Ltd Profix Tibial Non Porous $2,050.00
ST066 Stryker Australia Pty Ltd Scorpio Tibial Tray Cemented $2,050.00
TO019 Tornier Pty Ltd HLS Noetos Total Knee Replacement - Tibial Tray $
Tibial Tray, Cemented, fixed & mobile bearing components 2,000.00
ZI435 Zimmer SAL Knee Tibial Baseplate - CoCr alloy $2,200.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 7
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 3c - Cemented, Alloy, Modular, PMMA coating
BB204 B Braun Australia Pty Ltd Columbus TKS Tibial component $2,150.00
PL029 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Tibial Cementless $3,105.00
ZI073 Zimmer Insall-Burstein II Femoral Component Tibial Tray - Ti $2,163.00
ZI102 Zimmer Miller Galante II Stemmed Tibial Tray:Precoat - Ti $2,163.00
ZI122 Zimmer NexGen Knee Tibial Components Pegged Precoat - Titanium $2,163.00
ZI125 Zimmer NexGen Knee Tibial Components Stemmed Precoat - Titanium $2,163.00
ZI126 Zimmer NexGen Knee Tibial Components Stemmed Precoat AP Wedge - Ti $2,163.00
ZI130 Zimmer NexGen Knee Tibial Components Stemmed Fluted - Ti $2,163.00
ZI413 Zimmer Natural Knee Primary Tibial Baseplate -with Stem Cemented - Ti alloy $2,126.00
Group 3d - Cemented, Alloy, Moulded polyethylene
BI148 Biomet Australia Pty Ltd AGC Knee System Cobalt, UHMWPE
Tibial Component, High Post Posterior Stabilised, Chrome$2,100.00
BI153 Biomet Australia Pty Ltd AGC Knee System Tibial Component, Moulded, V2, UHMWPE, Chrome Cobalt $2,100.00
BI810 Biomet Australia Pty Ltd Maxim Complete Knee System $3,750.00
Tibial bearing & tray, ' Pop Top' Cruciate Retaining, CoCr UHMWPE
Group 3f - Cemented, Alloy, for mobile insert
AE044 Australian Surgical Design & Manufacture Pty Ltd Active Mobile Bearing Tibial Tray - Cemented $1,390.00
BB253 B Braun Australia Pty Ltd Columbus Tibia Plateau Rotating Platform Cemented $2,750.00
BI196 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Tibial Component, Chrome Cobalt $2,600.00
BI906 Biomet Australia Pty Ltd TRAC Knee System Tibial Tray CoCr $2,600.00
DP032 De Puy Australia LCS Complete System MBT Cemented Keeled or Cemented Tibial Tray $2,850.00
DP235 De Puy Australia LCS Knee system $2,070.00
Textured PCR or Rotating Platform or PCR tibial tray Chrome cobalt
DP240 De Puy Australia LCS Total Knee system Cemented Cruciate retention Tibial Chrome cobalt $2,070.00
DP519 De Puy Australia LCS Universal Knee LCS Ultra Tibial Chrome cobalt $2,600.00
DY370 De Puy Australia LCS Complete System MBT DuoFix CoCr or Universal Tibial Trays HA on Porocoat $3,950.00
DY470 De Puy Australia AMK Chrome CobaltTray Cemented CoCr Keeled tray and Porous Coated trays $3,470.00
EA009 Endotec Australia Pty Ltd Ceramic Coated, Titanium $2,600.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EK050 ESKA Australia Tibial Component Cemented RP Tibial Tray Cemented CoCr $2,900.00
FI007 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System Tibial Tray Component cemented $2,500.00
GO003 Global Orthopaedic Technology RBK Total Knee System - Tibial Base No coatings $3,550.00
LO055 Link Orthopaedic Australia T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining, Without HX Coating$1,800.00
LO129 Link Orthopaedic Australia Gemini MkII Knee Joint Prostheses System Tibial Component, Microporous/ HX TM Coating $2,900.00
MA312 Mathys Orthopaedics Pty Ltd Balansys Mobile Base Plate Tibial Base Plate Mobile Bearing $2,425.00
PL071 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibia SB cemented $3,000.00
SN369 Smith & Nephew Surgical Pty Ltd Mobile Bearing Knee Tibial Base Non Porous Titanium $2,070.00
SR030 Stryker Australia Pty Ltd Triathlon Mobile Bearing Knee System Mobile bearing knee, cemented, baseplate $2,800.00
ST069 Stryker Australia Pty Ltd Scorpio Tibial Tray Mobile Bearing Cemented $1,877.00
ST913 Stryker Australia Pty Ltd Duracon Total Knee System Duracon ISA Mobile-Bearing CoCr Tibial Baseplate $1,877.00
TO008 Tornier Pty Ltd HLS Noetos Total Knee Replacement - Femur Femur Cemented $2,000.00
Group 3g - Cemented, Alloy, for mobile insert, PMMA coating
OH236 Orthotech Pty Ltd Optetrak RBK Optetrak RBK Mobile Tibia $2,500.00
PL030 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint System Tibial Tray Cemented Mobile Bearing $2,150.00
ZI061 Zimmer Titanium
NexGen Tibial Components Stemmed - Fluted Mobile Option $2,668.00
ZI129 Zimmer NexGen Knee Tibial Components Stemmed MBK - Co Cr $2,668.00
ZI415 Zimmer Natural Knee $2,327.00
Primary Tibial Baseplate - Mobile Bearing Non Porous - CoCr alloy
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 8
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 3h - Uncemented, Alloy, Modular
AD183 Advanced Surgical Technologies Advance Total Knee System Tibial base porous or HA titanium or CoCr $3,690.00
AD193 Advanced Surgical Technologies Ortholoc Modular Total Condylar $1,770.00
Tibial Components Stemless or W/Modular Stem Base (Porous Coated) Titanium
BI170 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Plate Primary, Uncemented, Titanium $2,210.00
DP259 De Puy Australia SROM Knee System Noiles Modular Tibial Base $2,685.00
DY505 De Puy Australia AMK Chrome CobaltTray Cemented CoCr Keeled tray and Porous Coated trays $3,470.00
FI011 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Tibial Tray Component cementless, CoChr Alloy $3,000.00
HW086 Howmedica Duracon Total Knee System Tibial Baseplate Cementless - Vitallium $2,185.00
MA458 Mathys Orthopaedics Pty Ltd Balansys Femoral Component Left & right $3,147.00
PL070 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibia cementless $3,200.00
SK388 Stryker Australia Pty Ltd Triathlon Total Knee System $2,550.00
Uncemented, porous beaded tibial baseplate, primary, cobalt chrome
SN311 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Porous Tibial Base Plate $2,210.00
SN356 Smith & Nephew Surgical Pty Ltd Genesis Tibial Base: Porous $2,114.00
ST029 Stryker Australia Pty Ltd Scorpio Tibial Tray Cementless $2,185.00
ZI086 Zimmer Stemmed Tibial Tray:Porous Ti $2,210.00
ZI103 Zimmer Miller Galante II Other Tibial Tray:Porous Wedged - Ti $3,472.00
ZI120 Zimmer NexGen Knee Tibial Components Pegged Porous - Titanium $2,210.00
ZI123 Zimmer NexGen Knee Tibial Components Stemmed Porous - Titanium $2,210.00
ZI412 Zimmer Natural Knee Primary Tibial Baseplate with Stem Porous - Ti alloy $2,210.00
Group 3i - Uncemented, Alloy, Modular, HA coating
AD189 Advanced Surgical Technologies Ortholoc Advantim HA Porous Coated Knee System Tibial base HA Ti Components $2,079.00
AD276 Advanced Surgical Technologies Advance HA Coated Tibial Base Titanium HA Coated Tibial Base $3,105.00
AE043 Australian Surgical Design & Manufacture Pty Ltd Active Knee System Tibial Component Cementless $2,200.00
BB231 B Braun Australia Pty Ltd Columbus TKS Tibial Component - Cementless $2,550.00
BI186 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Tray, HA Coated, Ti $3,105.00
DP891 De Puy Australia AMK Chrome CobaltTray Duofix Cobalt Chrome tibial Tray HA coated $3,738.00
EK026 ESKA Australia Type ST Biocondylar Surface Replacement Tibial Tray Component - uncemented $2,580.00
GO005 Global Orthopaedic Technology RBK Total Knee System - Tibial base Porous and hydroxyapatite coating $3,950.00
HW088 Howmedica Duracon Total Knee System $2,550.00
Tibial Baseplate Cementless with PA - Vitallium with PA coating
HW094 Howmedica Duracon Total Knee System Tibial Baseplate Universal - Cementless - Vitallium $2,550.00
PL101 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Tibial Cementless $3,105.00
SK326 Stryker Australia Pty Ltd Triathlon Knee System HA coated tibial baseplate $2,550.00
SN312 Smith & Nephew Surgical Pty Ltd Genesis II/Profix HA coated, Porous Tibial Baseplate $2,200.00
ST031 Stryker Australia Pty Ltd Scorpio Tibial Tray PA $2,550.00
ST648 Stryker Australia Pty Ltd Osteonics Knee System Tibial component H/A cobalt chrome with HA coating $2,550.00
ZI121 Zimmer NexGen Knee Tibial Components Pegged Porous HA/TCP - Titanium $2,580.00
ZI124 Zimmer NexGen Knee Tibial Components Stemmed Porous HA/TCP - Titanium $2,580.00
Group 3j - Uncemented, Alloy, Moulded polyethylene
BI863 Biomet Australia Pty Ltd AGC Knee System $2,790.00
Tibial Component, Moulded, V2 Porous coated UHMWPE, Chrome Cobalt, Ti
DY462 De Puy Australia SROM Knee System Noiles Modular Tibial Base $2,685.00
ZI295 Zimmer NexGen TM Monoblock Tibial Component $4,190.00
Trabecular Meta (Tantalum) and Ultrahigh Molecular Weight Polyethylene
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 9
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 3l - Uncemented, Alloy, for mobile insert
BB254 B Braun Australia Pty Ltd Columbus Tibia Plateau Rotating Platform Uncemented $2,950.00
BI771 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Tibial component, Porous, CoCr, Ti $3,750.00
BI908 Biomet Australia Pty Ltd TRAC Knee System Tibial Tray, Porous CoCr $4,800.00
DP031 De Puy Australia LCS Complete System MBT Porocoat Keeled or Porocoat Tibial Tray $3,750.00
DP163 De Puy Australia PFC Knee System Range Tray
PFC Sigma Knee Offset Tibial Tray or Modular Plus tibial $3,755.00
DY377 De Puy Australia LCS Complete System MBT Porocoat Keeled or Porocoat Tibial TiNi $3,750.00
DY461 De Puy Australia SROM Knee System Noiles Modular Tibial Base $2,685.00
DY466 De Puy Australia LCS Knee system $2,070.00
Textured PCR or Rotating Platform or PCR tibial tray Chrome cobalt
DY469 De Puy Australia PFC Knee System Range PFC Sigma CVD or PLI Poly tibial $950.00
DY504 De Puy Australia AMK Chrome CobaltTray Cemented CoCr Keeled tray and Porous Coated trays $3,470.00
EA008 Endotec Australia Pty Ltd Ceramic Coated, Titanium $3,750.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EK045 ESKA Australia Tibial Component Cementless RP Tibial Tray Cementless CoCr MO $2,900.00
FI008 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System Tibial Tray Component, cementless $3,000.00
MA460 Mathys Orthopaedics Pty Ltd Balansys Mobile Base Plate Tibial Base Plate Mobile Bearing $2,425.00
OH156 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 3,500.00
PL048 Plus Orthopedics Australia Pty Ltd Ti-Plasma
PLUS SB Total Knee Replacement - Uncemented Tibial Component Sprayed Tibial Component $3,750.00
PL072 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibia SB Cementless $3,750.00
SN370 Smith & Nephew Surgical Pty Ltd Mobile Bearing Knee Tibial Base Porous Titanium $2,176.00
ST067 Stryker Australia Pty Ltd Scorpio Tibial Tray Mobile Bearing Cementless $2,646.00
ZI414 Zimmer Natural Knee $2,465.00
Primary Tibial Baseplate - Mobile Bearing Porous - CoCr alloy
Group 3m - Uncemented, Alloy, for mobile insert, HA coating
AE045 Australian Surgical Design & Manufacture Pty Ltd Active Mobile Bearing Tibial Tray - Cementless $2,310.00
BB233 B Braun Australia Pty Ltd Emotion TKS Tibial Component - Cementless $2,250.00
BI900 Biomet Australia Pty Ltd ROCC Knee Prosthesis $3,462.00
Tibial Baseplate, uncemented, HA coated or Porous HA coated, CoCr, Ti, HA, UHMWPE
BI909 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Tibial Component, Porous, HA Coated, CoCr, Ti, HAP $3,750.00
CR009 Corin Australia Pty Ltd Rotaglide + Total Knee System, Tibial Component Latched, HAP Coat $3,950.00
DP035 De Puy Australia LCS Complete System MBT DuoFix or Universal Tibial Trays HA on Porocoat $3,950.00
DY379 De Puy Australia LCS Complete System $3,950.00
MBT DuoFix or Universal Tibial Trays HA on Porocoat TiNi
DY495 De Puy Australia LCS Complete System $3,950.00
MBT DuoFix CoCr or Universal Tibial Trays HA on Porocoat
LO052 Link Orthopaedic Australia LINK T.A.C.K. Knee Tibial cementless $2,550.00
LO127 Link Orthopaedic Australia T.A.C.K. Cementless Knee Joint System Tibial Components, Cruciate Retaining, with HX Coating $2,550.00
SN368 Smith & Nephew Surgical Pty Ltd Mobile Bearing Knee Tibial Base HA Coated Porous Titanium $3,216.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 10
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
TIBIAL TRAY COMPONENT: UNI_COMPARTMENTAL ARTHROPLASTY
Group 4a - Cemented, all polyethylene
AD206 Advanced Surgical Technologies Advance-Unicondylar Knee System All poly tibial component $1,325.00
AE067 Australian Surgical Design & Manufacture Pty Ltd Active Uni Compartmental Knee $1,200.00
Uni compartmental knee resurfacing prostheses, consisting of a Femoral component manufactured from Chrome Cobalt Molybdenum alloy, and a Tibia
CR091 Corin Australia Pty Ltd Uniglide All Polyethylene Fixed Tibial Component All polyethylene $1,200.00
DY114 De Puy Australia Preservation Miu Knee System MIU All Poly Tibials RM/LL and LM/RL $1,198.00
GO031 Global Orthopaedic Technology Global re-surfacing uni-compartmental knee tibial implant $1,300.00
Uni-compartmental knee, tibial tray component, cemented, moulded, polyethylene
OH231 Orthotech Pty Ltd Optetrak Uni Knee Uni Tibial Component $1,325.00 $1,800.00 $475.00
SN337 Smith & Nephew Surgical Pty Ltd Genesis Uni Tibial Base UHMWPE $1,185.00
ST054 Stryker Australia Pty Ltd EIUS Tibial Component Polyethylene $1,200.00
ZI108 Zimmer Miller Galante Unicompartmental All Poly Tibial Tray - UHMWPE $1,325.00
ZI402 Zimmer Allegretto Unicompartmental Knee Tibia Allpoly - PE $1,325.00
Group 4b - Cemented, Alloy, modular
AD200 Advanced Surgical Technologies Advance-Unicondylar Knee System Metal-backed tibial component $1,530.00
BI204 Biomet Australia Pty Ltd Repicci II Unicondylar Knee System Tibia Plate, Modular, Cemented, Titanium $1,426.00
DY118 De Puy Australia Preservation Miu Knee System $1,434.00
MIU Fixed Tibial Tray Porous or Mobile RM/LL and LM/RL
MA452 Mathys Orthopaedics Pty Ltd balanSys UNI Tibial component - fixed bearing $1,600.00 $2,250.00 $650.00
PL130 Plus Orthopedics Australia Pty Ltd UC-PLUS Solution Knee System Unicompartmental Tibial Tray Cemented $1,500.00
SN336 Smith & Nephew Surgical Pty Ltd Genesis Uni Tibial base Titanium Alloy $1,434.00
TO017 Tornier Pty Ltd HLS Uni Evolution - Uni Knee Replacement - Tibia Tibial Insert (Polyethylene/Metal Back) - Cemented $1,530.00
ZI107 Zimmer Miller Galante Unicompartmental Tibial Tray - Ti $1,530.00
Group 4d - Cemented, Alloy, moulded polyethylene
BI871 Biomet Australia Pty Ltd Vanguard unicondylar Knee System Tibial Component, CoCr UHMWPE $2,200.00
LO060 Link Orthopaedic Australia LINK Endo-Model SLED Knee Prosthesis Tibial Plateaus, Metal Backed, Polyethylene $1,841.00
ZI403 Zimmer Allegretto Unicompartmental Knee Tibial Baseplate Monoblock - Ti alloy / PE $1,900.00
Group 4f - Cemented, Alloy, for mobile insert
BI033 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Tibial Tray, Chrome Cobalt, Cemented $1,665.00
CR061 Corin Australia Pty Ltd AMC Uni Condylar, Cemented Tibial Base Plate $1,665.00 $2,172.00 $507.00
AMC Uni Condylar Tibial Component (CoCr) Cemented with Titanium Nitrite Ceramic Coating
DY117 De Puy Australia Preservation Miu Knee System MIU Fixed or mobile Tibial Tray Cemented RM/LL and LM/RL$1,500.00
MA453 Mathys Orthopaedics Pty Ltd balanSys UNI Tibial component - mobile $1,600.00 $2,250.00 $650.00
ZI502 Zimmer Natural Knee $2,327.00
Primary Tibial Baseplate - Mobile Bearing Non Porous - CoCr alloy
Group 4g - Cemented, Alloy, for mobile insert, PMMA coating
BB201 B Braun Australia Pty Ltd Emotion TKS Tibial component $2,200.00
Group 4i - Uncemented, Alloy, modular, HA coating
SK329 Stryker Australia Pty Ltd Unix unicompartmental knee system HA tibial tray, unicompartmental $1,700.00
SN335 Smith & Nephew Surgical Pty Ltd Genesis Uni Tibial Base HA coated $1,244.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 11
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 4l - Uncemented, Alloy, for mobile insert
ZI430 Zimmer Natural Knee Unicompartmental -Tibia Baseplate - Ti alloy $1,586.00
Group 4m - Uncemented, Alloy, for mobile insert, HA coating
BI860 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Tibial Tray, HA or Porous coated, CoCr, HA, Ti. $2,427.00
CR057 Corin Australia Pty Ltd AMC Uni Condylar Tibial Component - Bonit Coat $2,427.00 (Calcium $414.00
Tibial Base Plate, Cobalt Chrome, Titanium Nitrate Ceramic Coated, Bonit$2,841.00 Phosphate) Ingrowth Surface
TIBIAL INSERT: TOTAL KNEE ARTHROPLASTY
Group 5a - Posterior Cruciate Retaining, fixed
AD138 Advanced Surgical Technologies Advance Total Knee System Traditional tibial insert $880.00
AD139 Advanced Surgical Technologies Advance Total Knee System Metal pivot UHMWPE tibial $1,490.00
AD171 Advanced Surgical Technologies Advantim Total Knee System Tibial Inserts Total Condylar UHMWPE $670.00
AD280 Advanced Surgical Technologies Advance Double High Tibial Insert Double-High Tibial Insert - UHMWPE $1,490.00
AE049 Australian Surgical Design & Manufacture Pty Ltd Other Active Knee Components Meniscal Insert $825.00
BI149 Biomet Australia Pty Ltd AGC Total Knee System Tibial Bearing, 'Tradition' Cruciate Retaining, UHMWPE $1,100.00
BI172 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Bearing Primary, UHMWPE $1,100.00
BI798 Biomet Australia Pty Ltd Ascent Total Knee System Tibial bearing, cruciate retaining, UHMWPE, curved or lipped$1,100.00
BI801 Biomet Australia Pty Ltd Ascent Total Knee System Tibial bearing, posterior or anterior stabilised, UHMWPE $1,350.00
BI888 Biomet Australia Pty Ltd Vanguard Total Knee System Tibial Bearing, CR, curved or lipped, UHMWPE $1,100.00
DP162 De Puy Australia PFC Knee System Range PFC Sigma Knee Duofix insert $880.00
DY481 De Puy Australia PFC Knee System Range PFC Sigma CVD or PLI Poly tibial $950.00
EK022 ESKA Australia Type ST Biocondylar Surface Replacement Polymer articulating components $1,100.00
HW091 Howmedica Duracon Total Knee System Tibial Insert - AP Lipped - Polyethylene $1,200.00
HW160 Howmedica Kinemax Knee Tibial Insert: Low Stress, Duration - Vitallium $711.00
HW162 Howmedica Kinemax Knee Tibial Insert: All Poly, Duration - Vitallium $711.00
HW174 Howmedica Kinemax Knee Tibial Insert: KMS - Vitallium $711.00
JJ509 Johnson & Johnson Medical Pty Ltd PFC Sigma Curved X-Linked Insert PFC Sigma Curved X-Linked Inserts $1,100.00
MA110 Mathys Orthopaedics Pty Ltd Balansys Tibial Component Tibial insert $787.00
PL049 Plus Orthopedics Australia Pty Ltd UC-PLUS Tibial Component All Poly Tibial Component All Poly $785.00
PL082 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibial Insert Standard $790.00
SK328 Stryker Australia Pty Ltd Triathlon Tibial Insert Cruciate Retaining $1,375.00
SK333 Stryker Australia Pty Ltd NRG Knee System Tibial inserts, cruciate retaining and posterior stabilised $1,375.00
SN310 Smith & Nephew Surgical Pty Ltd Genesis II Inserts Deep dished $1,100.00
SN317 Smith & Nephew Surgical Pty Ltd Genesis II Inserts Articulating $799.00
SN348 Smith & Nephew Surgical Pty Ltd Genesis Insert: Articular: Cruciate Retaining: UHMWPE $658.00
SN372 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Cruciate Retaining Insert $1,071.00
SN389 Smith & Nephew Surgical Pty Ltd Profix Tibial Insert $702.00
ST608 Stryker Australia Pty Ltd Scorpio Tibial Insert Cruciate Retaining $1,200.00
ST643 Stryker Australia Pty Ltd Osteonics Knee System Tibial insert primary polyethylene $1,100.00
ZI077 Zimmer Miller Galante I Articulating Surface - UHMWPE $896.00
ZI088 Zimmer Miller Galante II Articulating Surface - UHMWPE $896.00
ZI134 Zimmer NexGen Knee Articulating Surfaces Standard - UHMWPE $770.00
ZI135 Zimmer NexGen Knee Articulating Surfaces Ant. Constr. - UHMWPE $770.00
ZI139 Zimmer NexGen Knee Articulating Surfaces Anatomically Rotated - UHMWPE $1,015.00
ZI291 Zimmer NexGen Prolong Articulating Surface $1,100.00
Highly Crosslinked - Ultra High Molecular Weight Polyethylene $1,350.00 $250.00
ZI410 Zimmer Natural Knee PE Tibial Baseplate Insert - Congruent $772.00
ZI411 Zimmer Natural Knee PE Tibial Baseplate Insert - Ultra Congruent $1,015.00
ZI450 Zimmer Natural Knee PE Insert Highly crossed linked Durasul PE $1,100.00 $1,350.00 $250.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 12
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 5b - Posterior Cruciate Retaining, mobile
AE046 Australian Surgical Design & Manufacture Pty Ltd Active Mobile Bearing Meniscal Insert $880.00
BB255 B Braun Australia Pty Ltd Columbus Tibia Plateau Rotating Platform - Tibial Insert $1,000.00
BI197 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Tibial Bearing, UHMWPE $1,250.00
CR007 Corin Australia Pty Ltd Rotaglide + Total Knee System, Tibial Insert UHMWPE Mobile $825.00
CR008 Corin Australia Pty Ltd Rotaglide + Total Knee System, Tibial Insert UHMWPE Fixed $825.00
DP008 De Puy Australia LCS Complete System APG Insert or APG Guide Arm $1,165.00
DP026 De Puy Australia LCS Complete System RP Tibial Insert $1,077.00
DP238 De Puy Australia LCS Total Knee System $1,077.00
Meniscal or Rotating Platform Bearings Standard and Deep Dish
DP273 De Puy Australia SROM Knee System PROM Insert Curved & Stabilised (Noiles) $900.00
DP521 De Puy Australia LCS Universal Knee LCS Ultra inserts $1,165.00
DY369 De Puy Australia LCS Complete System Tibial Inserts $1,165.00
DY375 De Puy Australia LCS Complete System APG Insert or APG Guide Arm TiNi $1,165.00
DY376 De Puy Australia LCS Complete System RP Tibial Insert for TiNi $1,165.00
EA010 Endotec Australia Pty Ltd Ceramic Coated, Titanium $1,250.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EK044 ESKA Australia Tibial Plateau RP/B Polymer Articulating Component $1,100.00
EK048 ESKA Australia Tibial Plateau RP/A Polymer Articulating Component $1,100.00
FI006 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System $850.00
Tibial Insert, Polyethylene, Mobile Bearing, posterior cruciate retaining
GO002 Global Orthopaedic Technology RBK Total Knee System - Tibial insert Polyethylene $1,030.00
LO050 Link Orthopaedic Australia LINK T.A.C.K. Knee Rotating Platform $900.00
LO053 Link Orthopaedic Australia LINK T.A.C.K. Knee Bridging Articulating Surface $900.00
LO131 Link Orthopaedic Australia Gemini MkII Knee Joint Prostheses System $2,550.00
OH022 Orthotech Pty Ltd Optetrak Total Knee System Insert $1,250.00
OH157 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 1,250.00
PL031 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Tibial Insert Mobile Bearing C.R./C.S. $979.00
SN320 Smith & Nephew Surgical Pty Ltd Genesis II Mobile Bearing Standard Insert $877.00
SN378 Smith & Nephew Surgical Pty Ltd Profix Mobile Bearing Stabilised Insert $987.00
SN379 Smith & Nephew Surgical Pty Ltd Profix Mobile Bearing Standard Insert $805.00
SN699 Smith & Nephew Surgical Pty Ltd Profix Mobile bearing stabilised insert $1,165.00
SR031 Stryker Australia Pty Ltd Triathlon Mobile Mearing Knee System Mobile bearing knee, cruciate retaining, tibial insert $1,350.00
ST032 Stryker Australia Pty Ltd Scorpio Tibial Insert Mobile Bearing $1,350.00
ST912 Stryker Australia Pty Ltd Duracon Total Knee Tibial Insert Duracon ISA Mobile-Bearing PE Tibial Insert $1,250.00
ZI138 Zimmer NexGen Knee Articulating Surfaces MBK - UHMWPE $900.00
ZI408 Zimmer Natural Knee PE Insert Mobile Bearing $1,015.00
ZI434 Zimmer SAL Knee PE Insert - Mobile Bearing $900.00
ZI503 Zimmer Natural Knee $2,327.00
Primary Tibial Baseplate - Mobile Bearing Non Porous - CoCr alloy
ZI515 Zimmer NexGen Prolong CR Mobile Bearing Articulating Surface NexGen Prolong CR Mobile Bearing Aticulating Surface $1,100.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 13
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 5c - Posterior Stabilised, fixed
ZI136 Zimmer NexGen Knee Articulating Surfaces PS - UHMWPE $770.00
AD136 Advanced Surgical Technologies Advance Total Knee System PS Tibial UHMWPE $1,430.00
AE047 Australian Surgical Design & Manufacture Pty Ltd Other Active Knee Components Posterior Stabilised Meniscal Insert $880.00
BI179 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Bearing, Posterior Stabilised UHMWPE $1,350.00
BI905 Biomet Australia Pty Ltd AGC Total Knee System Tibial Bearing 'Tradition' Posterior Stabilised, UHMWPE $1,221.00
FI027 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Tibial Insert, Polyethylene $850.00
HW092 Howmedica Duracon Total Knee System Tibial Insert - Stabilised - Polyethylene $1,350.00
JJ508 Johnson & Johnson Medical Pty Ltd PFC Sigma Stab X-Linked Insert PFC Sigma Stab X-Linked Inserts $1,100.00
PL075 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibial Insert Substituted $1,189.00
PL078 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System TC Plus Solution, Tibial Insert PS $1,150.00
SN331 Smith & Nephew Surgical Pty Ltd Genesis II Inserts Inserts PS $1,032.00
SN349 Smith & Nephew Surgical Pty Ltd Genesis Insert: PS Articular: UHMWPE $785.00
SN392 Smith & Nephew Surgical Pty Ltd Profix Tibial PS Insert $1,118.00
SN727 Smith & Nephew Surgical Pty Ltd Genesis II High Flex PS Insert, UHMWPE $1,297.00
SN780 Smith & Nephew Surgical Pty Ltd Renasys Knee P/S Insert $1,500.00
SR002 Stryker Australia Pty Ltd Triathlon Tibial Insert Posterior Stabilised $1,375.00
SR008 Stryker Australia Pty Ltd Scorpio Tibial Insert Posterior Stabilised $1,200.00
SR012 Stryker Australia Pty Ltd NRG Knee System Tibial inserts, cruciate retaining and posterior stabilised $1,375.00
SR020 Stryker Australia Pty Ltd Osteonics Knee System Tibial insert primary polyethylene $1,100.00
ST644 Stryker Australia Pty Ltd Osteonics Knee System Tibial insert posterior stabilised - PSI polyethylene $1,350.00
ST645 Stryker Australia Pty Ltd Osteonics Knee System Tibial insert posterior stabilised - PSII polyethylene $1,350.00
ST646 Stryker Australia Pty Ltd Osteonics Knee System Tibial insert posterior stabilised - PSIII polyethylene $1,350.00
ST925 Stryker Australia Pty Ltd Scorpio Tibial Bearing Insert $1,350.00
Scorpio tibial insert - superflex. Composition - N2VAC UHMWPE
ZI057 Zimmer NexGen Articulating Surfaces LPS Flex Polyethylene $900.00
ZI066 Zimmer Insall-Burstein II Articulating Surface PSK - UHMWPE $896.00
ZI409 Zimmer Natural Knee PE Tibial Baseplate Insert - P.S. $1,015.00
ZI521 Zimmer NexGen LPS Prolong Articulating Surface NexGen LPS Prolong Aticulating Surface $1,100.00
Group 5d - Posterior Stabilised, mobile
BI885 Biomet Australia Pty Ltd ROCC Knee Prosthesis Rotating Platform Bearing, ARCOM UHMWPE $1,719.00
BI894 Biomet Australia Pty Ltd ROCC Knee Prosthesis Tibial Baseplate, Cemented, Chrome Cobalt, UHMWPE $2,600.00
BI907 Biomet Australia Pty Ltd TRAC Knee System Bearing Posterior Stabilised UHMWPE $1,719.00
DP166 De Puy Australia PFC Knee System Range PFC Sigma Knee PR Insert $1,077.00
DP270 De Puy Australia SROM Knee System NPS Tibial Plateau $1,816.00
DP388 De Puy Australia AMK Total Knee system $1,077.00
Posterior stabilised or Tibial or Congruency or Constrained insert
DY372 De Puy Australia LCS Complete System PS Tibial Insert - Mobile $1,077.00
DY405 De Puy Australia RPF PS Tibial Inserts $1,500.00
DY457 De Puy Australia PFC Knee System Range PFC Sigma C/S $2,900.00
DY459 De Puy Australia SROM Knee System PROM Insert Curved & Stabilised (Noiles) $900.00
DY465 De Puy Australia LCS Total Knee System Meniscal or Rotating Platform Bearings Standard and Deep Dish$1,077.00
DY476 De Puy Australia LCS Complete System RP Tibial Insert $1,077.00
FI024 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System $850.00
Tibial Insert, Polyethylene, Mobile Bearing, posterior stabilised
OH215 Orthotech Pty Ltd Optetrak Total Knee System Insert $1,250.00
OH224 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 1,250.00
OH235 Orthotech Pty Ltd Optetrak RBK Optetrak RBK Mobile Insert $1,350.00 $1,500.00 $150.00
PL066 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Tibial Insert Ultra Congruent $979.00
PL067 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Tibial Insert SB $1,200.00
SR013 Stryker Australia Pty Ltd Scorpio Tibial Insert Mobile Bearing $1,350.00
SR032 Stryker Australia Pty Ltd Triathlon Mobile Bearing Knee System Mobile bearing knee, posterior stabilised, tibial insert $1,350.00
TO020 Tornier Pty Ltd HLS Noetos Total Knee Replacement - Tibial Insert UHMWPE $1,077.00
ZI058 Zimmer NexGen Articulating Surface LPS Mobile Articulating surface Polyethylene $900.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 14
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
Group 5e - Totally Constrained, fixed
BB207 B Braun Australia Pty Ltd Columbus TKS Gliding Surface $780.00
BB209 B Braun Australia Pty Ltd Columbus TKS Gliding Surface with Screw $800.00
BI181 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Bearing, Contrained. UHMWPE $1,500.00
BI802 Biomet Australia Pty Ltd Ascent Total Knee System Tibial bearing, constrained, UHMWPE $1,500.00
BI904 Biomet Australia Pty Ltd Vanguard Total Knee System Tibial Bearing, PS, UHMWPE $1,500.00
DP145 De Puy Australia PFC Knee System Range PFC Sigma PLI or CVD or CS inserts or TCS $800.00
HW161 Howmedica Kinemax Knee Tibial Insert: Stabilizer - Vitallium $875.00
MA459 Mathys Orthopaedics Pty Ltd Balansys Tibial Component Tibial insert $787.00
OH025 Orthotech Pty Ltd Optetrak Total Knee System CCK Tibial Insert with Screw $1,500.00
SN313 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Constrained Insert $1,075.00
SN340 Smith & Nephew Surgical Pty Ltd Genesis Constrained Articular $800.00
Group 5f - Totally Constrained, mobile
BB198 B Braun Australia Pty Ltd Emotion TKS Articulating surface $810.00
DP257 De Puy Australia SROM Knee System NRH Tibial Plateau size $3,763.00
DY367 De Puy Australia PFC Knee System Range PFC Sigma RP TC3 $1,700.00
MA311 Mathys Orthopaedics Pty Ltd Balansys Mobile Insert Tibial Polyethylene Component Mobile Bearing $787.00
SR033 Stryker Australia Pty Ltd Triathlon Mobile Bearing Knee System $1,400.00
Mobile bearing knee, cruciate supplementing or constrained, tibial insert
TIBIAL INSERT: UNI-COMPARTMENTAL KNEE ARTHROPLASTY
Group 6a - Fixed bearing
AD307 Advanced Surgical Technologies Advance-Unicondylar Knee System Poly insert for metal-backed tibial component $833.00
BB203 B Braun Australia Pty Ltd Emotion Unicondylar Uni gliding surface $500.00
BI202 Biomet Australia Pty Ltd Repicci II Unicondylar Knee System Tibial Component, Cemented, UHMWPE $1,200.00
BI205 Biomet Australia Pty Ltd Repicci II Unicondylar Knee System Tibial Bearing, Modular, UHMWPE $615.00
DY115 De Puy Australia Preservation Miu Knee System MIU Fixed or Mobile Bearing Inserts RM/LL and LM/RL $833.00
MA454 Mathys Orthopaedics Pty Ltd balanSys UNI PE insert - fixed bearing $787.00
PL131 Plus Orthopedics Australia Pty Ltd UC-PLUS Solution Knee System Unicomprtmental Tibia Insert Cemented $750.00
SN334 Smith & Nephew Surgical Pty Ltd Genesis Uni Articular Insert UHMWPE $704.00
ST656 Stryker Australia Pty Ltd Unicompartmental Knee (Tibial Bearing) Tibial insert polyethylene $1,400.00
TO016 Tornier Pty Ltd HLS Uni Evolution - Uni Knee Replacement - Tibia Tibial Insert (All Polyethylene) - Cemented $1,900.00
ZI105 Zimmer Miller Galante Unicompartmental Articulating Surface - UHMWPE $644.00
ZI429 Zimmer Natural Knee Unicompartmental - Tibia PE Insert $750.00
Group 6b - Mobile bearing
BI032 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Tibial Bearing , UHMWPE $760.00
BI861 Biomet Australia Pty Ltd Oxford Meniscal Knee System Mark III Tibial Bearing, Anatomic, UHMWPE. $800.00
CR060 Corin Australia Pty Ltd AMC Uni Condylar, Tibial Insert Bearings UHMWPE Bearings $556.00
DP351 De Puy Australia LCS UNI Knee system AP GLIDE Tibial Porocoat Chrome cobalt $760.00
DY472 De Puy Australia PFC Knee System Range PFC Sigma PLI or CVD or CS inserts or TCS $800.00
MA455 Mathys Orthopaedics Pty Ltd balanSys UNI PE insert - mobile $787.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 15
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
PATELLO FEMORAL REPLACEMENT FEMORAL COMPONENT
Group 7 - Patello femoral replacement femoral component
DY111 De Puy Australia LCS Patellofemoral Joint Prosthesis LCS PFJ Trochlear Components Right and Left $2,855.00
GO035 Global Orthopaedic Technology RBK Total Knee System - Femoral Component Trochlear Component, no coating CoCrMo $3,500.00
LO058 Link Orthopaedic Australia LINK Lubinus Total Patella Glide Replacement Femoral Component $1,948.00
OH152 Orthotech Pty Ltd Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear Component & Patellar $2,855.00
OH153 Orthotech Pty Ltd Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear Component & Patellar $1,029.00
SN371 Smith & Nephew Surgical Pty Ltd MOD III Femoral Component $1,620.00
ST600 Stryker Australia Pty Ltd Avon Patello-femoral Prostheses Vitallium $2,855.00
PATELLO FEMORAL REPLACEMENT PATELLAR COMPONENT
Group 8 - Patello femoral replacement patellar component
DY484 De Puy Australia LCS Patellofemoral Joint Prosthesis LCS PFJ Trochlear Components Right and Left $2,855.00
OH225 Orthotech Pty Ltd Themis Patellar Femoral Polyethylene, CoCr, incl Trochlear Component & Patellar $1,029.00
SK314 Stryker Australia Pty Ltd Avon Patello Femoral Prosthesis Polyethylene patella button $657.00
SN394 Smith & Nephew Surgical Pty Ltd Patella Femoral Resurfacing System $1,261.00
PATELLAR COMPONENTS
Group 9a - Cemented, all polyethylene
AD137 Advanced Surgical Technologies Advance Total Knee System All poly patella UHMWPE $440.00
AD174 Advanced Surgical Technologies Advantim Total Knee System Patellae All Poly UHMWPE $530.00
AE050 Australian Surgical Design & Manufacture Pty Ltd Other Active Knee Components Patella $410.00
BB202 B Braun Australia Pty Ltd Emotion TKS Patella - 1 - Peg and 3 - Pegs $590.00
BB208 B Braun Australia Pty Ltd Columbus TKS Patellar Components, 3 pegs $590.00
BI176 Biomet Australia Pty Ltd Maxim Complete Knee System Patella Button, UHMWPE $590.00
BI194 Biomet Australia Pty Ltd Oxford Tricompartmental Knee System Patella Button, UHMWPE, Chrome Cobalt $590.00
BI899 Biomet Australia Pty Ltd ROCC Knee Prosthesis Patella Component, all PE, cemented, 1 peg, UHMWPE $590.00
CR005 Corin Australia Pty Ltd Rotaglide + Total Knee System, Patella UHMWPE Asymmetric $500.00
CR006 Corin Australia Pty Ltd Rotaglide + Total Knee System, Patella UHMWPE Dome $500.00
DP152 De Puy Australia PFC Knee System Range PFC Sigma Patella or Universal insert patella $450.00
DP264 De Puy Australia SROM Knee System Noiles UHMWPE & Poly Patella $450.00
DP377 De Puy Australia AMK Total Knee system Poly Patella $450.00
DP524 De Puy Australia LCS 3 Pegged Patella All Poly & all Poly 3peg Patella $590.00
EA012 Endotec Australia Pty Ltd Ceramic Coated, Titanium $590.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EK024 ESKA Australia Type RP Biocondylar Surface Replacement Patella Component 3 peg cemented or cementless $450.00
FI009 Finsbury Orthopaedics Australia Pty Ltd DBK Total Knee System Patella Component $450.00
FI012 Finsbury Orthopaedics Australia Pty Ltd MRK Total Knee System Patella Component, polyethylene, cemented $450.00
GO001 Global Orthopaedic Technology RBK Total Knee System - Patellar component Polyethylene $570.00
HW105 Howmedica Duracon Total Knee System Patella - all polyethylene $500.00
HW140 Howmedica Kinematic Rotating Knee Patella - Polyethylene $500.00
HW182 Howmedica PCA Knee Patella: All Poly - Vitallium $500.00
LO042 Link Orthopaedic Australia LINK Endo Model Rotational Knee System Patella Component $590.00
LO051 Link Orthopaedic Australia LINK T.A.C.K. Knee Patella cemented $410.00
LO057 Link Orthopaedic Australia LINK Lubinus Total Patella Glide Replacement Patella Component $590.00
MA111 Mathys Orthopaedics Pty Ltd Balansys Patella Component Polyethylene $590.00
OH023 Orthotech Pty Ltd Optetrak Total Knee System Patella $590.00 $1,029.00 $439.00
OH158 Orthotech Pty Ltd Academia Knee $
CoCr, Titanium, Femoral, Tibial, Bearing, Stems & Patellar 590.00 $1,029.00 $439.00
PL032 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System TC-PLUS Patella $590.00
PL073 Plus Orthopedics Australia Pty Ltd Plus Knee Joint Prostheses System Patella $590.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 16
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
SK323 Stryker Australia Pty Ltd Triathlon Knee System Patella Component - all poly $500.00
SN323 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Cemented All Poly Patella $590.00
SN350 Smith & Nephew Surgical Pty Ltd Genesis Cemented All Poly Patella $410.00
SN382 Smith & Nephew Surgical Pty Ltd Profix Patella, Inset and Onset $549.00
SN781 Smith & Nephew Surgical Pty Ltd Renasys knee Patella Biconvex and Resurfacing $590.00
ST636 Stryker Australia Pty Ltd Osteonics Knee System Patella polyethylene $500.00
TO009 Tornier Pty Ltd HLS System Total Knee Prostheses (HLS II) UHMWPE Patella Component $500.00
ZI071 Zimmer Insall-Burstein II Femoral Component Patella Button - UHMWPE $590.00
ZI093 Zimmer Miller Galante II Patella Button: Poly -UHMWPE $590.00
ZI148 Zimmer NexGen Knee Patella Button Polyethylene $433.00
ZI432 Zimmer Natural Knee Patella -PE $581.00
Group 9b - Cemented, polyethylene metal backed, mobile
BI903 Biomet Australia Pty Ltd ROCC Knee Prosthesis UHMWPE
Patella Component, rotating, cemented, 3 pegged, CoCr, $1,100.00
DP523 De Puy Australia LCS 3 Pegged Patella Cemented & Textured or porous coated 3 peg Patella $1,300.00
Group 9c - Cemented, polyethylene metal backed, moulded
ST609 Stryker Australia Pty Ltd Osteonics Knee System Scorpio resurfaced patella components cobalt chrome $500.00
ZI431 Zimmer Natural Knee Patella -Metal Back - PE / Ti alloy $500.00
ZI454 Zimmer Natural Knee Patella Titanium metal backed, Durasul UHMWPE $500.00 $1,100.00 $600.00
Group 9d - Uncemented, polyethylene metal backed, mobile
BI901 Biomet Australia Pty Ltd ROCC Knee Prosthesis $1,300.00
Patella Component, rotating, uncemented, 3 pegged, HA or Porous HA, CoCr, UHMWPE, Ti, HA
DP520 De Puy Australia LCS Universal Knee LCS Ultra Patella $1,150.00
DY502 De Puy Australia LCS 3 Pegged Patella Cemented & Textured or porous coated 3 peg Patella $1,300.00
EA011 Endotec Australia Pty Ltd Ceramic Coated, Titanium $1,300.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
GO008 Global Orthopaedic Technology RBK Total Knee System - Patella component Polyethylene/metal/hydroxyapatite coating $1,300.00
Group 9e - Uncemented, polyethylene metal backed, moulded
AD175 Advanced Surgical Technologies Advantim Total Knee System Patellae Metal Backed $944.00
HW108 Howmedica Duracon Total Knee System $735.00
Patella - Periapatite - Insert - Polyethylene and Vitallium coated with PA
ZI147 Zimmer NexGen Knee Patella Button TM Porous Patella $1,100.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 17
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
SPECIAL INDICATIONS
Group 10 - Special Indications
AD241 Advanced Surgical Technologies Repiphysis non invasive expandable custom designed Tibial Extension. Comprised of tibial base, axial bushing, axial pin - CoCr, Titanium, UHMWPE
Limb Salvage System for the skeletally immature - Repiphysis $65,000.00
AD242 Advanced Surgical Technologies Repiphysis non invasive expandable custom designed Distal Hinge Femoral Extension. Distal hinge femur, stem fixation pin, spring housing tube, anti-r
Limb Salvage System for the Skeletally Immature - Repiphysis $65,000.00
AD243 Advanced Surgical Technologies Guardian Limb Salvage System Titanium
Guardian Femoral Neck & Mid-Section - Standard Taper -$2,845.00
AD244 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Distal Femur $4,655.00
AD245 Advanced Surgical Technologies Guardian Limb Salvage System $3,890.00
Guardian Tibial Hinge Assembly With/Without Rotational Stop Pin - CoCr
AD246 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Distal Femur Quick Snap Axial Pin - CoCr, Titanium $2,180.00
AD248 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Tibial Sleeve $4,790.00
AD249 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Duramer Tibial Sleeve Spacer - UHMWPE $2,380.00
AD250 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Male-Male Mid-Section Taper - Titanium $3,530.00
AD251 Advanced Surgical Technologies Guardian Limb Slavage System Guardian Non Porous Femoral Stem Straight/Tapered - Titanium $2,630.00
AD252 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Proximal Tibia - Titanium $6,900.00
AD253 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Resurfacing Femur - CoCr, Titanium $7,250.00
AD254 Advanced Surgical Technologies Guardian Limb Salvage System Guardian femoral Stem Straight With Plasma Collar - Titanium $3,490.00
AD255 Advanced Surgical Technologies Guardian Limb Salvage System - Titanium
Guardian porous Collared Femoral Stem Straight/Tapered$3,560.00
AD256 Advanced Surgical Technologies Guardian Limb Salvage System Guardian Femoral Stem Straight - Titanium $2,590.00
BI864 Biomet Australia Pty Ltd Orthopaedic Salvage System Stem, Cemented or Porous, Ti $2,920.00
BI865 Biomet Australia Pty Ltd Orthopaedic Salvage System Femoral Component, Resurfacing or Segmental, CoCr,Ti $7,895.00
BI866 Biomet Australia Pty Ltd Orthopaedic Salvage System Femoral or Tibial Augment, Ti $2,055.00
BI867 Biomet Australia Pty Ltd Orthopaedic Salvage System $5,200.00
Femoral/Tibial Interlocking devices:Locking Pin, Femoral and Tibial Bushings, Tibial Bearing, Axle, Reinforced Yoke, Locking Screws. CoCr, Ti
BI868 Biomet Australia Pty Ltd Orthopaedic Salvage System $4,240.00
Diaphyseal Segment or Diaphyseal Coupler, Stacking Adapter and Locking Screws, Ti
BI869 Biomet Australia Pty Ltd Orthopaedic Salvage System $7,790.00
Tibial Component, Resurfacing or Segmental, Modular and non Modular, CoCr, Ti
BI890 Biomet Australia Pty Ltd Rotating Hinge Knee (RHK) Augments, Femoral and Tibial, CoCr, Ti $1,800.00
BI891 Biomet Australia Pty Ltd Rotating Hinge Knee (RHK) Resurfacing Tibial Tray, Modular and Stemmed $6,900.00
BI892 Biomet Australia Pty Ltd Rotating Hinge Knee (RHK) Femoral Component, Resurfacing, cemented,anatomic, CoCr $7,100.00
BI893 Biomet Australia Pty Ltd Rotating Hinge Knee (RHK) Femoral Bushings, Axle, Axle Locking Pin, UHMWPE, Ti, CoCr
Interlocking Components: Bearing Insert, Yoke, Tibial and$4,655.00
DP255 De Puy Australia SROM Knee System $130.00
Noiles Replacement Bumper Noiles Modular or Replacement Hinge Bearing
DP262 De Puy Australia SROM Knee System Noiles Cap with Screw for Tibial Base $301.00
EK017 ESKA Australia ESKA Tumor Revision System MML Total femoral implant $11,000.00
EK018 ESKA Australia ESKA Tumor Revision System MML Distal femoral implant $11,000.00
HW141 Howmedica HMRS Tibial Baseplate Cobalt Chrome $3,400.00
HW143 Howmedica HMRS Femoral Component Cobalt Chromium $6,300.00
HW144 Howmedica Kinematic Rotating Knee Tibial Component - Vitallium $2,820.00
HW145 Howmedica Kinematic Rotating Knee Axles, Bumpers, Bushings - Vitallium $700.00
HW202 Howmedica Howmedica Modular Resection System Wedge - Vitallium $203.00
HW231 Howmedica Howmedica Modular Resection System Tibial Rotating Component - Vitallium $3,320.00
HW232 Howmedica Howmedica Modular Resection System Tibial Insert - Polyethylene $1,990.00
HW233 Howmedica Howmedica Modular Resection System Tibial Sleeve - Vitallium $755.00
HW234 Howmedica Howmedica Modular Resection System Tibial Stemmed Tray - Vitallium $8,435.00
HW248 Howmedica HMRS Tibial Insert Polyethylene $2,045.00
LO041 Link Orthopaedic Australia LINK Endo Model Rotational Knee System $16,347.00
Intracondylar total rotation knee join with Anti Lux device: with patella flange
LO043 Link Orthopaedic Australia LINK Endo Model Rotational Knee System Tibial Spacers $506.00
LO044 Link Orthopaedic Australia LINK Endo-Model Rotational Knee System $16,347.00
Total Rotational Knee Joint with Anti Lux Device, with Patella Flange and Replacement of Femoral and/or Tibial Bone Structures, Distal femur
LO046 Link Orthopaedic Australia LINK Endo Model Rotational Knee System $19,986.00
Total Rotational Knee Joint with Anti Lux Device, with Patella Flange and Replacement of Femoral and/or Tibial Bone Structures, distal femur & proxim
LO047 Link Orthopaedic Australia LINK Endo Model Rotational Knee System Total hinge knee: without patella flange $10,014.00
LO048 Link Orthopaedic Australia LINK Endo Model Rotational Knee System Total hinge knee: with patella flange $10,868.00
SK156 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Proximal Tibial Component, Cast Chrome Cobalt $7,725.00
SK157 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Distal Femoral Component, Cast Chrome Cobalt $7,700.00
SK158 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Proximal Femoral Component, Cast Chrome Cobalt $8,140.00
SK159 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS (HMRS+) Curved Anchorage Stems, Cobalt Chrome $4,840.00
SK161 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Extension Piece, Titanium/Cobalt Chrome $4,400.00
SK162 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Connection Piece, Titanium/Cobalt Chrome $4,325.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 18
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
SK166 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Press fit stems long bowed 200mm $4,840.00
SK168 Stryker Australia Pty Ltd Howmedica Modular Resection System GMRS Press fit stems straight fluted $4,325.00
SK330 Stryker Australia Pty Ltd Modular Replacement System MRS femoral stems with female taper $6,500.00
SK331 Stryker Australia Pty Ltd Modular Rotating Hinge Knee System $3,050.00
MRH HDP ASSEMBLY PACK, consisting of 1 x polyethylene tibial sleeve, 1 x polyethylene bumper insert and 2 x polyethylene femoral bushing compo
SN694 Smith & Nephew Surgical Pty Ltd Knee Component Femoral, tiabial or insert $6,150.00
SU189 Surgical House METS Modular Total Femur $33,600.00
Modular system, comprising Trochanters, Total Femoral Links, Shafts, Femoral Knees (condyles), Tibial Knees, Tibial Plateaus, Femoral Heads
SU192 Surgical House METS Modular Distal Femur Shaft Extension, Femoral Knees (condyles), Tibial Knees, Tibial Plateaus
Modular system, comprising Stems, Stem Collars, Shafts,$26,500.00
ZI425 Zimmer Natural Knee Revision - Femoral Spacers Non Porous - metal alloy $2,060.00
REVISIONS
Group 11 - Revisions
AD142 Advanced Surgical Technologies Advance Revision Knee System Femoral Augments titanium $620.00
AD143 Advanced Surgical Technologies Advance Revision Knee System Femoral component CoCr $4,260.00
AD144 Advanced Surgical Technologies Advance Revision Knee System Femoral stem titanium $2,150.00
AD145 Advanced Surgical Technologies Advance Revision Knee System PS and CCK Insert UHMWPE $1,450.00
AD146 Advanced Surgical Technologies Advance Revision Knee System Tibial augments/wedges titanium $850.00
AD147 Advanced Surgical Technologies Advance Revision Knee System Tibial component titanium, non porous $3,515.00
AD148 Advanced Surgical Technologies Advance Revision Knee System Tibial stem titanium, non cemented $1,890.00
AD149 Advanced Surgical Technologies Advance Revision Knee System Bone screw titanium $256.00
AD185 Advanced Surgical Technologies Ortholoc 11 Revision Knee Femoral components CoCr Revision (Porous Coated) $5,540.00
AD187 Advanced Surgical Technologies Ortholoc 11 Revision Knee Tibial Revision Smooth/Finned Titanium $1,140.00
AD188 Advanced Surgical Technologies Ortholoc 11 Revision Knee Tibial inserts posterior stabilised UHMWPE $1,068.00
AD190 Advanced Surgical Technologies Ortholoc 11 Revision Knee Tibial Components Modular Stem Thick Base (Porous Coated) $3,040.00
AD191 Advanced Surgical Technologies Ortholoc 11 Revision Knee $2,864.00
Tibial Components Modular Stem Wedged Base (Porous Coated) Titanium
AD195 Advanced Surgical Technologies Ortholoc 11 Revision Knee Femoral stems titanium $1,208.00
AD214 Advanced Surgical Technologies ADVANCE Total Knee System Stemmed condylar femoral medial pivot component - porous $4,750.00
AD217 Advanced Surgical Technologies ADVANCE Total Knee System Offset tibial Block Augments $1,200.00
AD219 Advanced Surgical Technologies ADVANCE Total Knee System Stemmed condylar femoral medial pivot component - nonporous $4,500.00
BI146 Biomet Australia Pty Ltd AGC Knee System $11,545.00
Revision System consisting of : Femoral Component; Femoral Stem, Femoral & Tibial Augmentation; Tibial Component., UHMW
BI171 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Stem, Titanium $985.00
BI182 Biomet Australia Pty Ltd Maxim Complete Knee System One Piece Tibial Plate and Stem, CoCr. $2,790.00
BI183 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial Femoral Wedge or Augmentation Block, Titanium $1,200.00
BI184 Biomet Australia Pty Ltd Maxim Complete Knee System Tibial or Femoral Stem, Modular, Titanium $1,760.00
BI201 Biomet Australia Pty Ltd AGC Total Knee System - Dual Articular Knee System Femoral, Tibial, Bearing, Stems, Chrome Cobalt, UHMWPE $15,490.00
BI789 Biomet Australia Pty Ltd Ascent Knee System Femoral augmentation block, posterior or distal, titanium $1,318.00
BI800 Biomet Australia Pty Ltd Ascent Total Knee System Femoral revision stem w/screw, coronal slot, titanium $2,810.00
BI811 Biomet Australia Pty Ltd Maxim Complete Knee System $4,050.00
Offset tibial tray & adapter, fixation screws, chrome cobalt, titanium
BI821 Biomet Australia Pty Ltd AGC Total Knee System Tibial augments, titanium $1,215.00
CR003 Corin Australia Pty Ltd Rotaglide + Total Knee System, Stem Extensions Cobalt chrome $825.00
CR004 Corin Australia Pty Ltd Rotaglide + Total Knee System Tibial Augmentation Blocks $515.00
DP143 De Puy Australia PFC Knee System Range PFC Flute Tib Rod & Extension $1,500.00
DP151 De Puy Australia PFC Knee System Range PFC Sigma CVD or PLI Poly tibial $950.00
DP153 De Puy Australia PFC Knee System Range PFC Sigma ROD or FC femoral $2,055.00
DP154 De Puy Australia PFC Knee System Range PFC Sigma FEM AUG $1,439.00
DP155 De Puy Australia PFC Knee System Range PFC Sigma Femoral stem / Bolt / Collar $500.00
DP158 De Puy Australia PFC Knee System Range PFC Sigma Femoral Distal or Post Augments or Combo augments $1,449.00
DP161 De Puy Australia PFC Knee System Range $1,642.00
PFC Mod PL TB WDG Types Hemi/ Stp / Full or Augmented tibial wedges
DP254 De Puy Australia SROM Knee System Noiles Hinge Femoral Comp $4,692.00
DP260 De Puy Australia SROM Knee System SROM Noiles Tibial Augments $890.00
DP261 De Puy Australia SROM Knee System Noiles Modular Tibial Sleeve $2,332.00
DP266 De Puy Australia SROM Knee System SROM Noiles Femoral Extension with screws $1,681.00
DP267 De Puy Australia SROM Knee System PLUG Modular Sleeve with Screw $121.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 19
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
DP269 De Puy Australia SROM Knee System SROM Noiles Femoral Augmentation Blocks $1,339.00
DP271 De Puy Australia SROM Knee System Noiles Femoral Sleeve Por Coated $2,535.00
DP272 De Puy Australia SROM Knee System Noiles Femoral Stem Extn/Screw $1,666.00
DP287 De Puy Australia AMK Coordinate Revision Knee System Revision Tibial tray or Full wedge Tray Chrome cobalt $3,600.00
DP290 De Puy Australia AMK Coordinate Revision Knee System $2,189.00
Cemented stem 10mm Chrome cobalt or Fluted stem STD - Revision
DP294 De Puy Australia AMK Coordinate Revision Knee System Insert 4 and 10mm Thick Tibial inserts $3,600.00
DP378 De Puy Australia AMK Total Knee system Co ordinate Femoral wedge DIS / Post Chrome cobalt $594.00
DP383 De Puy Australia AMK Total Knee system Revision Pin Tibial Chrome cobalt $318.00
DP570 De Puy Australia AMK Coordinate Revision Knee System $1,700.00
Tibial Ultra or STD Tibial or Varus Valgus Constrained Inserts
DP821 De Puy Australia LCS Revision Knee system Revision Femoral Chrome cobalt $5,896.00
DP822 De Puy Australia LCS Revision Knee system Revision tibial Tray Chrome cobalt $3,800.00
DP823 De Puy Australia LCS Revision Knee system Stem Extension Chrome cobalt $2,204.00
DP824 De Puy Australia LCS Revision Knee system LCS DIST or Post or BLK Femoral Augments Chrome cobalt $640.00
DP825 De Puy Australia LCS Revision Knee system LCS Revision Bearings $1,660.00
DP826 De Puy Australia LCS Revision Knee system Revision Textured Tibial Tray Chrome cobalt $3,708.00
DP827 De Puy Australia LCS Revision Knee system Revision Textured femoral Chrome cobalt $3,500.00
DY148 De Puy Australia LCS Complete Revision System LCS Complete Revision Femoral Cemented Right and Left $5,075.00
DY149 De Puy Australia LCS Complete Revision System LCS Complete Revision Femoral Porocoat Right and Left $5,499.00
DY151 De Puy Australia LCS Complete Revision System MBT Revision Trays Cemented or porocoat $3,490.00
DY153 De Puy Australia LCS Complete Revision System LCS Complete Revision Femoral Distal or Posterior Augments$1,600.00
DY156 De Puy Australia LCS Complete Revision System LCS Complete PFC Sigma Revision Femoral Sleeves Porocoat $2,600.00
DY157 De Puy Australia LCS Complete Revision System MBT Revision Tibial Sleeve Porous Coated $2,600.00
DY158 De Puy Australia LCS Complete Revision System LCS Complete Revision Insert $1,155.00
DY159 De Puy Australia LCS Complete Revision System MBT Step Wedge or revision Tibial Augment $1,375.00
DY368 De Puy Australia LCS Complete System Modular Femur Cemented CoCr $7,139.00
DY460 De Puy Australia SROM Knee System Noiles Cap with Screw for Tibial Base $301.00
DY463 De Puy Australia SROM Knee System $130.00
Noiles Replacement Bumper Noiles Modular or Replacement Hinge Bearing
DY467 De Puy Australia PFC Knee System Range Tray
PFC Sigma Knee Offset Tibial Tray or Modular Plus tibial $3,755.00
EA013 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,200.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA014 Endotec Australia Pty Ltd Ceramic Coated, Titanium $4,420.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA015 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,230.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial Components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA016 Endotec Australia Pty Ltd Ceramic Coated, Titanium $4,510.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA017 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,700.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA018 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,230.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA019 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,410.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA020 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,230.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA021 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,700.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA022 Endotec Australia Pty Ltd Ceramic Coated, Titanium $5,230.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
EA023 Endotec Australia Pty Ltd Ceramic Coated, Titanium $1,200.00
Buechel-Pappas Ultracoat Total Knee Replacement System (Primary and Revision) Femoral and Tibial components with mobile polyethelene inserts all polyethelene patella ceramic coated, titanium backed po
GO113 Global Orthopaedic Technology RBK Total Knee System Revision Femoral Component, CrCo $5,500.00
GO114 Global Orthopaedic Technology RBK Total Knee System Tibial and Femoral Stems, Titanium $2,189.00
GO115 Global Orthopaedic Technology RBK Total Knee System Revision Tibial Tray, CrCo $3,600.00
GO116 Global Orthopaedic Technology RBK Total Knee System Tibial Inserts, Titanium $3,000.00
GO117 Global Orthopaedic Technology RBK Total Knee System Posterior stabilised tibial insert, UHMWPE $1,000.00
GO118 Global Orthopaedic Technology RBK Total Knee System Femoral Inserts, Titanium $590.00
GO119 Global Orthopaedic Technology RBK Total Knee System Rotating Hinge Bushing Mechansim $4,540.00
HW082 Howmedica Duracon Total Knee System Augmentation Femoral Spacers - Vitallium $1,515.00
HW084 Howmedica Duracon Total Knee System Augmentation Locking Screw - Vitallium $177.00
HW085 Howmedica Duracon Total Knee System Augmentation Modular Stabiliser Box - Vitallium $590.00
HW097 Howmedica Duracon Total Knee System Tibial Baseplate Screw - Vitallium $187.00
HW098 Howmedica Duracon Total Knee System Augmentation Stem Extension Cementless - Vitallium $1,110.00
HW099 Howmedica Duracon Total Knee System Augmentation Tibial Wedge - Vitallium $1,005.00
HW102 Howmedica Duracon Total Knee System Tibial Insert - Revision (crossover) - Polyethylene $1,170.00
HW153 Howmedica Kinemax Knee Femoral Augmentation Cobalt Chromium $865.00
HW167 Howmedica Kinemax Knee Tibial: Fixation Peg - Vitallium $320.00
HW168 Howmedica Kinemax Knee Tibial: Wedge Full - Vitallium $770.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 20
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
HW169 Howmedica Kinemax Knee Tibial: Wedge - Vitallium $485.00
HW170 Howmedica Kinemax Knee Tibial : Block - Vitallium $390.00
HW171 Howmedica Kinemax Knee Femoral/Tibial: Extension Stem - Vitallium $760.00
HW401 Howmedica Kinemax Knee Femoral: Condylar Beaded - Vitallium $3,310.00
OH026 Orthotech Pty Ltd Optetrak Total Knee System CCK Tibial Augmentation Block $735.00 $1,290.00 $555.00
OH027 Orthotech Pty Ltd Optetrak Total Knee System CCK Tibial & Femoral Stems $2,895.00
OH029 Orthotech Pty Ltd Optetrak Total Knee System CCK Femoral Augmentation Block $1,565.00
OH056 Orthotech Pty Ltd Optetrak Total Knee System Tibial Stem Screw $735.00 $1,039.00 $304.00
OH057 Orthotech Pty Ltd Opetrak Total Knee System Femoral Stem Extension Adapter $735.00 $1,299.00 $564.00
PL083 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented $1,920.00
PL084 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Tibial Augments $1,390.00
PL085 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Stems Cemented $2,100.00
PL086 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Stems Cementless $2,100.00
PL087 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Stems cementless valgus $2,200.00
PL088 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Tibial insert substituted $1,150.00
PL089 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Femur $7,200.00
PL091 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem cemented $2,100.00
PL092 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Femur $5,850.00
PL093 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented $2,250.00
PL094 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Stem uncemented $2,700.00
PL095 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Femoral augments $1,365.00
PL096 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibial augments $1,365.00
PL097 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibial insert with clamp $1,890.00
PL098 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Screws and clamp $850.00
PL099 Plus Orthopedics Australia Pty Ltd PLUS Knee Prostheses System RT PLUS Hinged Knee - Tibia $3,400.00
PL107 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Femoral Augments $1,100.00
PL109 Plus Orthopedics Australia Pty Ltd PLUS Knee Joint Prostheses System Revision - Tibia $3,400.00
SN314 Smith & Nephew Surgical Pty Ltd Genesis II Conversion module $1,122.00
SN316 Smith & Nephew Surgical Pty Ltd Genesis II Femoral/tibial long stems $1,173.00
SN330 Smith & Nephew Surgical Pty Ltd Genesis II $710.00
Wedge Full Tibial, Distal Femoral, Stacked Femoral L, Posterior Femoral, Angled Hemi, Stepped Hemi, Medial Lateral
SN341 Smith & Nephew Surgical Pty Ltd Genesis Constrained Conversion Module: CoCr $2,255.00
SN351 Smith & Nephew Surgical Pty Ltd Genesis PS Conversion Module Resurfacing: Co Cr $741.00
SN353 Smith & Nephew Surgical Pty Ltd Genesis Revision Articular Insert $1,953.00
SN358 Smith & Nephew Surgical Pty Ltd Genesis Wedge $437.00
SN381 Smith & Nephew Surgical Pty Ltd Profix Non Porous Wedge, Distal and L-Wedge $621.00
SN384 Smith & Nephew Surgical Pty Ltd Profix Porous wedge $874.00
SN715 Smith & Nephew Surgical Pty Ltd Genesis II Long Stem Tibial Components $1,900.00
SN717 Smith & Nephew Surgical Pty Ltd Genesis II/Profix Offset Couplers $2,014.00
SN802 Smith & Nephew Surgical Pty Ltd Genesis II Patella Biconvex UHMWPE Revision $590.00
SN805 Smith & Nephew Surgical Pty Ltd Profix Constrained Femur Insert, UHMWPE Revision $1,075.00
SN821 Smith & Nephew Surgical Pty Ltd Legion Revision Legion Femoral Augment $1,180.00
SN822 Smith & Nephew Surgical Pty Ltd Legion Revision Legion Tibial Augment $1,410.00
SN823 Smith & Nephew Surgical Pty Ltd Legion Revision Legion stem extension $1,810.00
SN824 Smith & Nephew Surgical Pty Ltd Legion Revision Legion revision baseplate $2,950.00
SR034 Stryker Australia Pty Ltd Triathlon Revision Knee System Revision, cemented, stemmed baseplate $3,500.00
SR035 Stryker Australia Pty Ltd Triathlon Revision Knee System Revision, cemented, tibial stems $1,600.00
SR036 Stryker Australia Pty Ltd Triathlon Revision Knee System Revision, cemented, side specific, half tibial augments $1,300.00
ST018 Stryker Australia Pty Ltd Scorpio Augmentation Femoral / Tibial Cobalt Chrome $970.00
ST024 Stryker Australia Pty Ltd Scorpio Tibial Insert Revision $1,770.00
ST026 Stryker Australia Pty Ltd Scorpio Offset Adaptor Cobalt Chrome $1,179.00
ST034 Stryker Australia Pty Ltd Scorpio Tibial Tray Revision $2,493.00
ST061 Stryker Australia Pty Ltd Scorpio Femoral Component Revision $5,100.00
ST601 Stryker Australia Pty Ltd Duracon total knee system Tibial insert stabiliser revision vitallium $1,535.00
ST602 Stryker Australia Pty Ltd Duracon total knee system Femoral component stabiliser revision vitallium $5,700.00
ST603 Stryker Australia Pty Ltd Duracon total knee system Augmentation offset adaptor vitallium $1,270.00
ST604 Stryker Australia Pty Ltd Duracon total knee system Augmentation revision vitallium $1,010.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 21
Minimum Maximum Potential
Billing Code Sponsor Product Name Description Suffix
Benefit Benefit Gap
ST606 Stryker Australia Pty Ltd Duracon total knee system Stem fluted - femoral/tibia vitallium $1,410.00
ST658 Stryker Australia Pty Ltd Osteonics Knee System Augmentation - Fem/Tib cobalt chrome $700.00
ZI064 Zimmer Insall-Burstein II Articulating Surface CCK - UHMWPE $910.00
ZI065 Zimmer Insall-Burstein II Articulating Surface CCK (extra thick) - UHMWPE $2,041.00
ZI067 Zimmer Insall-Burstein II Augmentation Distal - TI, Co Cr $1,210.00
ZI072 Zimmer Insall-Burstein II Femoral Component Tibial/Femoral Stem - Ti $1,015.00
ZI075 Zimmer Insall-Burstein II Wedge Full - Ti $1,590.00
ZI095 Zimmer Miller Galante II Stem: Long - Ti $955.00
ZI096 Zimmer Miller Galante II Stem: Regular - Ti $505.00
ZI104 Zimmer Miller Galante II Other Tibial Tray:Porous Flat (revision) - Ti $3,150.00
ZI137 Zimmer NexGen Knee Articulating Surfaces CCK - UHMWPE $1,210.00
ZI140 Zimmer NexGen Knee Tibial Augments Half Wedge - Ti $1,460.00
ZI141 Zimmer NexGen Knee Tibial Augments Full Wedge - Ti $1,460.00
ZI142 Zimmer NexGen Knee Tibial Augments One Third Wedge - Ti $1,460.00
ZI143 Zimmer NexGen Knee Tibial Augments Half Block - Ti $1,460.00
ZI144 Zimmer NexGen Knee Femoral Augments Dist.,Ant or Post - Ti $1,210.00
ZI145 Zimmer NexGen Knee Femoral Augments Dist + Post $1,210.00
ZI146 Zimmer NexGen Knee Stem Extensions Titanium $1,210.00
ZI266 Zimmer Continuum knee system Hedrocel augment - patella prosthesis $3,092.00
ZI305 Zimmer Nexgen Rotating Hinge Femur $14,496.00
Cobalt chrome femoral component for rotating hinge knee, available left to right
ZI307 Zimmer Nexgen Rotating Hinge Articulating Surface $1,505.00
Ultra high molecular weight polyethylene articulating tibial insert
ZI308 Zimmer Nexgen Rotating Hinge Tibia Cobalt chrome rotating platform tibial plate $2,950.00
ZI309 Zimmer Nexgen Rotating Hinge Replacement Hinge Rotating hinge replacement bushing for hinge $4,540.00
ZI404 Zimmer Natural Knee System Tibial Spacers - special metal alloy $1,025.00
ZI416 Zimmer Natural Knee Revision -Tibial Baseplate - Ti alloy $3,275.00
ZI417 Zimmer Natural Knee Revision -Tibial Stem - Ti alloy $1,600.00
ZI422 Zimmer Natural Knee Femoral Spacer Lug - Ti alloy $5,125.00
ZI423 Zimmer Natural Knee Revision - Femur Porous -Ti/CoCr alloy $5,125.00
ZI424 Zimmer Natural Knee Revision - Femur Stem, Ti alloy $2,940.00
ZI426 Zimmer Natural Knee Femoral Stem Screw - metal alloy $290.00
ZI427 Zimmer Natural Knee Revision Posterior Stabilising Bar - CoCr alloy $290.00
ZI504 Zimmer Natural Knee Revision - Femoral Spacers Non Porous - metal alloy $2,060.00
Knee - Specialty Sheet
(Prostheses List, February 2006) Page 22