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					                                Commonwealth of Australia

                              NATIONAL HEALTH ACT 1953

                     Determination under paragraph (bj) of Schedule 1

                                       (HIB 03/2005)



I, Linda Addison, delegate of the Minister for Health and Ageing, acting under paragraph (bj)
of Schedule 1 to the National Health Act 1953 (the Act):

     AMEND, with effect from 14 March 2005, the Determination made under paragraph
     (bj) of Schedule 1 to the Act dated 30 June 1999 (Determination Number IHS 7/1999)
     by OMITTING Schedule 5 of that Determination and SUBSTITUTING the attached
     Schedule 5.


Dated this             24    day of February 2005.



L Addison

Linda Addison
Assistant Secretary
Private Health Insurance Branch
Position No: 01202874
Delegate of the Minister for Health and Ageing
                                                                                  February 2005

                SCHEDULE 5 – PROSTHESES AND HUMAN TISSUES


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

5.2   In this Schedule:

       “hospital” includes a day hospital facility;

       “human tissues” means the items included in Part B;

       “prostheses” means the items included in Part A; and

       references to a manufacturer, supplier, hospital or a RHBO include any agent acting
       on their behalf.

Prostheses

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

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

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

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

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

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

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

               Other than the fees or charges permitted under clause 5.7, no additional charges can
               be imposed on a patient by a manufacturer, supplier, hospital or a RHBO.
                                                                                                                                                                         PART A
Prostheses List                        February 2005
CARDIO-THORACIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                             Description                        Size                                        Benefit   Benefit    Notation
Abbott Australasia Pty Ltd
      Stents, Vascular
AY006        Bio-Divysio Stent SV/OC/AS               Balloon expandable Phosophoryl-    Divysio Stent SV - Diameters: 2.0, 2.25,
                                                      Choline coated stainless-steel      2.5 Lengths: 7mm, 10mm, 15mm,
                                                      endovascular coronary stent        18mm, 21mm; Divysio Stent OC & AS
                                                                                         - Diameters: 2.75, 3.0, 3.5, 4.0 Lengths:
                                                                                         8mm, 11mm, 15mm, 18mm, 22mm, 28mm

      Stents, Vascular, Coronary
AY012        JoStent Coronary Stent Graft             Stainless Steel/PTFE               9 - 26 mm x 2.5 - 5 mm
AY013        JoStent Coronary Stent                   Stainless Steel                    9 - 26 mm x 2.5 - 4 mm
Advanced Biomedical Pty Ltd
      Prostheses, Cardiac Valve, Artificial
AB001        ATS medical open pivot aortic valved     Pyrolythic Carbon, Double Velour   21-33mm
             graft model 502AG                        Polyester, Titanium
AB002        ATS medical open pivot heart valve       Pyrolythic Carbon, Double Velour   16-33mm
             model 500FA standard flexi-cuff aortic   Polyester, Titanium
             valve series, ATS medical open pivot
             heart valve model 501DM advanced
             performance mitral valve series, ATS
             medical open pivot heart valve model
             501DA advanced performance aortic
             valve series, ATS medical open pivot
             heart valve model 500DM mitral
             standard valve series

Atrium Australia-Pacific Rim Pty Ltd
      Prostheses, Blood Vessel, Artificial
AC002        Atrium PTFE Vascular Graft               Straight PTFE Standard Wall        6mm x 10cm - 10mm x 90cm
      Stents, Vascular
AC022        Flyer RX Coronary Stent System           Stainless Steel Coronary Stent     Dia 2-5mm, Length 6-40mm



Prostheses List February 2005                                                                                                                            Page 1 of 700
CARDIO-THORACIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                           Description                                 Size                                   Benefit   Benefit    Notation
B Braun Australia Pty Ltd
      Filters, Vena Cava
BB105        Celsa Vena Cava Filter System          Phynox/ combination of various metals       One size, expands to Max length
                                                    inc. Nickel,Copper, Molubden,Steel          38mm/Max diameter 30mm
BB106        Celsa Temporary Vena Cava System       Phynox/ combination of various metals       One size, expands to Max length
                                                    inc. Nickel,Copper, Molubden,Steel          38mm/Max diameter 30mm
      Stents, Vascular, Coronary
BB171        Coroflex Coronary Stent System         Electropolished stainless steel 316L;       2.5 x 8mm; 3.0 x 8mm; 3.5 x 8mm; 4.0
                                                    Laser cut slotted tube. Product includes:   x 8mm; 2.5 x 13mm; 3.0 x 13mm; 3.5 x
                                                     Coronary stent mounted on delivery         13mm; 4.0 x 13mm; 2.5 x 16mm; 3.0 x
                                                    balloon catheter.                           16mm; 3.5 x 16mm; 4.0 x 16mm; 2.5 x
                                                                                                19mm; 3.0 x 19mm; 3.5 x 19mm; 4.0 x
                                                                                                19mm; 2.5 x 25mm; 3.0 x 25mm; 3.5 x
                                                                                                25mm; 4.0 x 25mm
BB172        Coroflex Theca Coronary Stent System   Electropolished Stainless Steel 316L;       Dia 2.5-4.0mm, length 8-25mm
                                                    Laser cut slotted tube, coated with
                                                    Polyzene-F; includes Coronary Stent
                                                    mounted on delivery balloon catheter.
BB173        Coroflex Delta Coronary Stent System   Electropolished Stainless Steel 316L;       Dia 2.5-4.0mm, length 8-25mm
                                                    Laser cut slotted tube, includes
                                                    Coronary Stent mounted on delivery
                                                    balloon catheter.
BB244        Coroflex Blue                          Cobalt Chromium Alloy L605                  2-4mm diameter, 8-25mm length
Bard Australia Pty Ltd
      Grafts, Vascular, Synthetic
BA089        Impra PTFE Vascular Grafts             ePTFE Cardiovascular Patch 0.4mm            20 x 90mm
BA090        Impra PTFE Vascular Grafts             ePTFE Cardiovascular, Patch 0.6mm,          100 x 150mm
                                                    Circular
BA091        Impra PTFE Vascular Grafts             ePTFE Cardiovascular, Patch 0.6mm,          50 x 75mm
                                                    Rectangular
BA092        Impra PTFE Vascular Grafts             ePTFE Cardiovascular, Patch 0.6mm,          50 x 150mm
                                                    Rectangular
BA093        Impra PTFE Vascular Grafts             ePTFE Cardiovascular, Patch 0.6mm,          30 x 30mm, 10 x 90mm, 30 x 60mm
                                                    Rectangular, Patch 0.4 Oval,
Prostheses List February 2005                                                                                                                              Page 2 of 700
CARDIO-THORACIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                         Description                                Size                                    Benefit   Benefit    Notation
BA095        Impra PTFE Vascular Grafts           ePTFE Cardiovascular, Patch 0.6mm,         25 x 150mm
                                                  Rectangular
Biotronik Australia Pty Ltd
      Defibrillators, Automatic, Implantable
BT042        Tachos Atx                           Implantable Cardioverter Defibrillator -   One Size Only
                                                  Atrial Therapy
BT043        Belos A+, Implantable Cardioverter   Single Chamber ICD, Rate Responsive        One Size Only
             Defibrillator                        Pacing, Dual Chamber Sensing
BT044        Belos VR (4085), Implantable         Single Chamber ICD, Rate Responsive        One Size Only
             Cardioverter Defibrillator           Pacing
BT045        Belos DR, Implantable Cardioverter   Dual Chamber ICD, Rate Responsive          One Size Only
             Defibrillator                        Pacing
BT052        Cardiac Airbag                       Single chamber ICD rate responsive         One size only.
                                                  pacing.
BT053        Lexos DR                             Dual chamber ICD, rate responsive          One size only.
                                                  pacing.
BT054        Lexos VR                             Single chamber ICD, Rate responsive        One size only.
                                                  pacing
BT055        Lexos A+                             Single chamber ICD, rate responsive        One size only.
                                                  pricing, dual chamber sensing.
      Leads, Implantable Defibrillator
BT014        Kainox RV 75                         Implantable Defibrillator endocardial      75 cms 100,18 cms 100,16 cms 100,13
                                                  shock lead with sensing and pacing. SL     cms 75,18 cms
                                                  100/18, SL 100/16, SL 100/13
BT049        Kentrox SL-S                         ICD Lead, Singel lead, Screw-in.           Tip to second shock coil 16 cms or 18
                                                                                             cms.
BT050        KAINOX A+                            ICD Lead, Single Pass.                     Atrial ring spacing 15, 17cms.
BT057        Kentrox SL                           ICD Lead, Single Lead                      65, 75 or 100cm length. Tip to second
                                                                                             shock coil 16cm or 18cm.
      Leads, Implantable Defibrillator/Pacemaker
BT048        Kentrox RV-S                         ICD lead, right ventricle, screw-in.       One size only.
BT051        KENTROX RV                           ICD Lead, right ventricle.                 65 or 75 cms

Prostheses List February 2005                                                                                                                            Page 3 of 700
CARDIO-THORACIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                           Description                            Size                                      Benefit   Benefit    Notation
      Leads, Pacemaker, Implantable Endocardial
BT007        Polyrox Leads - PX53-UP, PX60-UP,      Dual standard leads                    53 cm Ventricular, 60 cm Ventricular,
             PX53-BP, PX60-BP, PX53-JUP,                                                   53 cm Ventricular, 60 cm Ventricular,
             PX45-JBP, PX53-JBP, PX53/15-BP,                                               53 cm Atrial, 45cm Atrial, 53cm Atrial,
             PX60/15-BP                                                                    53/1.5cm Vent, 60/1.5cm Vent
BT009        SL Tripolar Lead - SL60/130,           Single pass lead                       130mm, 150mm, 110mm
             BP,SL60/150-BP, SL60/110-BP
BT010        Polyrox Leads - PX53-UP, PX60-UP,      Standard unipolar or biopolar lead     53 cm Ventricular, 60 cm Ventricular,
             PX53-BP, PX60-BP, PX53-JUP,                                                   53 cm Ventricular, 60 cm Ventricular,
             PX45-JBP, PX53-JBP, PX53/15-                                                  53 cm Atrial, 45cm Atrial, 53cm Atrial,
             BP,PX60/15-BP                                                                 53/1.5cm Vent, 60/1.5cm Vent
BT018        Merox Mex 53 JBP Pacemaker Lead        High Performance Lead, Model 124884,   53cm Atrial
                                                    one only
BT019        Merox Mex 60/15 BP Pacemaker Lead      High Performance Lead, Model 124962,   60cm Ventricular
                                                    one only
BT020        Merox Mex 53 JBP and Merox Mex         High Performance Lead, Model 124884    53cm Atrial and 60cm Ventricular
             60/15 BP Pacemaker Leads               and Model 124962, (used together)
BT041        Elox Ex Leads - EX 53-BP; EX 45-BP;    Endocardial Active Fixation            Length 53, 45, 60cm
             EX 60-BP
BT061        Corox OTW                              Coronary Sinus Lead for Left           75 or 85cm
                                                    Ventricular Pacing
BT063        Selox SR                               Lead, pacemaker, implantable,          45, 53, 60cm length
                                                    endocardial
      Pacemakers, Cardiac, Implantable
BT024        Philos DR Model 122450 Implantable     Multiprogrammable, rate responsive,    One size only
             Pacemaker                              DDDR
BT026        Philos D Model 122447 Implantable      Multiprogrammable, ventricula, rate    One size only
             Pacemaker                              responsive modes, DDDC
BT027        Philos SLR Model 122456 Implantable    Single pass, multiprogrammable, rate   One size only
             Pacemaker                              responsive, VDDR
BT028        Philos SR Model 122459 Implantable     Multiprogrammable, rate responsive,    One size only
             Pacemaker                              SSIR
BT029        Philos DR-A Model 122600 Implantable   Multiprogrammable, rate responsive,    5mm ports, One size only
             Pacemaker                              DDDR
Prostheses List February 2005                                                                                                                            Page 4 of 700
CARDIO-THORACIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                           Description                              Size                                Benefit   Benefit    Notation
BT030        Philos SR-B Model 122610 Implantable   Multiprogrammable, rate responsive,      5/6mm port, One size only
             Pacemaker                              SSIR
BT031        AXIOS D Implantable Cardiac Pulse      Multiprogrammable, DDD                   One size only
             Generator Cat No. 338 843
BT032        AXIOS DR Implantable Cardiac Pulse     Multiprogrammable, rate responsive,      One size only
             Generator Cat No. 338 845              DDDR
BT036        PHILOS S Implantable Cardiac Pulse     Multiprogrammable SSI                    One size only
             Generator Cat No 122 453
BT037        AXIOS S Implantable Cardiac Pulse      Multiprogrammable SSI                    One size only
             Generator Cat No 338 847
BT038        AXIOS SR Implantable Cardiac Pulse     Multiprogrammable, rate responsive,      One size only
             Generator Cat No 338 851               SSIR
BT039        AXIOS SLR Implantable Cardiac Pulse    Multiprogrammable, rate responsive,      One size only
             Generator Cat No 338 849               VDDR
BT046        Protos VR/CLS                          Single chamber rate responsive, closed   One size only
                                                    loop system.
BT047        Protos DR/CLS                          Dual chamber, rate responsive, closed    One size only.
                                                    loop system.
BT056        Stratos LV                             Multiprogrammable, Biventricular,        One size only
                                                    DDDRV
BT060        Philos II DR                           Multiprogrammable, rate responsive,      One size only
                                                    DDDR
BT062        Philos II SR                           Multiprogrammable, Rate Responsive,      One size only
                                                    SSIR pacemaker
      Stents, Vascular
BT040        Lekton                                 Intracoronary stent - balloon mounted    Dia 2.5-4mm, length 10-30mm
      Stents, Vascular, Coronary
BT058        Lekton Motion                          Coated flexible stent, Balloon mounted   Diameter 2.5mm to 4mm, Length 8 -
                                                                                             30mm
BT059        Astron                                 Flexible coated stent, Nitinol, self-    Diameter 7-12mm, Length 30-80mm
                                                    expanding



Prostheses List February 2005                                                                                                                        Page 5 of 700
CARDIO-THORACIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                           Description                               Size                                      Benefit   Benefit    Notation
Boston Scientific Pty Ltd
      Stents, Vascular
BS067        Symbiot Covered Stent System           A self-expending nitinol stent encased    Stent lengths: 20, 31 & 45 mm Stent
                                                    within an ePTFE covering, premounted      diameters: 4.0 & 5.0 mm
                                                    on a Monorail delivery catheter
BS069        Express 2/Liberte Coronary Stent       Consists of a balloon expandable stent,   Stent lengths: 8,12,16,20,24,28 & 32 mm
                                                    pre-mounted on a Maverick 2 Monorail       Stent diameters: 2.25, 2.5, 2.75, 3.0,
                                                    delivery catheter.                        3.5, 4.0, 4.5 & 5.0 mm
BS074        Taxus on Express2 Coronary Stent       balloon expandable stent with conformal   Length 8 - 32mm; Diameter 2.25 - 5.0mm
             System Models 38001-0822 to 0840;       polymer/drug matrix coating, pre-
             38001-1222 to 1250; 38001-1622 to      mounted on high pressure monorail
             1650;                                  delivery catheter
             38001-2022 to 2050; 38001-2422 to
             2450; 38001-2827 to 2850; 38001-3227
             to
             3250
Daralan Pty Ltd
      Stents, Vascular
DA001        S-Stent SRX1                           316L Stainless Steel                      SRX1-2510 2.5 x 8.5mm; SRX1-3010
                                                                                              3.0 x 8.5mm; SRX1-3510L 3.5 x
                                                                                              8.5mm; SRX1-4010L 4.0 x 8.5mm;
                                                                                              SRX1-2512 2.5 x 11mm; SRX1-3012
                                                                                              3.0 x 11mm; SRX1-3512L 3.5 x 11mm;
                                                                                               SRX1-4012L 4.0 x 11mm; SRX1-2515
                                                                                               2.5 x 14.4mm; SRX1-3015 3.0 x
                                                                                              14.4mm; SRX1-3515L 3.5 x 14.6mm;
                                                                                              SRX1-4015L 4.0 x 14.6mm; SRX1-
                                                                                              2520 2.5 x 18.7mm; SRX1-3020 3.0 x
                                                                                              18.7mm; SRX1-3520L 3.5 x 18.4mm;
                                                                                              SRX1-4020L 4.0 x 18.4mm; SRX1-
                                                                                              2525 2.5 x 24.5mm; SRX1-3025 3.0 x
                                                                                              24.5mm; SRX1-3525L 3.5 x 23.2mm;
                                                                                              SRX1-4025L 4.0 x 23.2mm; SRX1-
                                                                                              2530 2.5 x 28.9mm; SRX1-3030 3.0 x
                                                                                              28.9mm; SRX1-3530L 3.5 x 28.2mm;
                                                                                              SRX1-4030L 4.0 x 28.2mm



Prostheses List February 2005                                                                                                                               Page 6 of 700
CARDIO-THORACIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                            Description                               Size                             Benefit   Benefit    Notation
Edwards Lifesciences Pty Ltd
      Annuloplasty Rings
EL028        Baxter Sterile Grafts, Implants &       Carpentier-Edwards Classic                24mm-40mm
             Prostheses, Non-Animal Origin           Annuloplasty Ring. Composition:
             Annuloplasty: Ring-Mitral Ring with     Titanium Alloy; Silicone Rubber;
             Holder; Mitral Cosgrove-Edwards         Polyester Fabric Carpentier-Edwards
             Annuloplasty System Model 4600;         Physio Annuloplasty Ring. Composition:
             Classic Annuloplasty Ring-Tricuspid     Elgiloy Bands; Polyester Film Strips;
                                                     Silicone Rubber; Polyester Cloth,
                                                     Cosgrove-Edwards Annuloplasty Band.
                                                     Composition: Silicone Rubber; Polyester
                                                     Cloth. Carpentier-Edwards Tricuspid
                                                     Ring. Composition: Titanium Alloy;
                                                     Silicone Rubber; Polyester Fabric

EL049        Edwards Etlogix Annuloplasty Ring       Titanium/silicon/dacron polyester         24mm/26mm/28mm/30mm/32mm/34mmd
                                                     cloth/plastic template Mitral valve
                                                     annular repair device designed
                                                     specifically for patients with Ischemic
                                                     Mitral regurgitation
      Grafts, Dura, Biological
EL033        Baxter Augmentation / Substitution      Edwards Pericardial Patch. Bovine         10cm x 16cm
             Material, Human or Animal Origin,       Pericardium.
             Sterile Pericardial Patch.
      Prostheses, Cardiac Valve, Artificial
EL029        SE SIL Ball Valve Aortic Models         Starr Edwards - Silastic Ball Valve.      16mm-34mm
             1200/1260, SE SIL Ball Valve Mitral     Composition: Stellite Alloy No. 21;
             Model 6120                              Polytetrafluroethelyne; polypropylene
                                                     cloth; Silicone rubber (contains 2% by
                                                     weight barium sulphate for radiopacity)
      Prostheses, Cardiac Valve, Biological
EL030        CE Supra Annular Aortic Valve Model     Carpentier-Edwards SAV                    19mm-33mm
             2650 Carpentier-Edwards S.A.V           Bioprosthesis. Composition: Porcine
             Bioprosthesis Model 6650 Mitral Valve   Valve; Elgiloy Alloy; Silicone Rubber,
                                                     Polytetrafluoroethylene




Prostheses List February 2005                                                                                                                       Page 7 of 700
CARDIO-THORACIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                           Description                                  Size                                    Benefit   Benefit    Notation
EL031        Carpentier-Edwards Perimount           Carpentier-Edwards Pericardial               Models 2900/6900 19-33mm, Model
             Pericardial Bioprosthesis - Models     Bioprosthesis. Composition: Bovine           6900P 25, 27, 29, 31, 33mm
             2900/6900 Carpentier-Edwards           Pericardium; Elgiloy Alloy; Silicone
             Perimount Plus Pericardial             Rubber, Polytetrafluoroethylene
             Bioprosthesis Mitral - Model 6900P
EL032        Baxter Edwards Prima Plus Stentless    Edwards Prima Plus. Porcine Valve;           19mm-29mm
             Bioprosthesis Model 2500P Prosthetic   Woven Polyester Cloth.
             Heart Valve
EL039        Edwards Perimount Magna Model 3000     Carpentier-Edwards Perimount Magna           19MM Aortic Pericardial Tissue Valve;
                                                    composition: Glutaraldehyde treated           21MM Aortic Pericardial Tissue
                                                    bovine pericardium/elgiloy wireform          Valve; 23MM Aortic Pericardial Tissue
                                                    stent/polyester band/silicone rubber          Valve; 25MM Aortic Pericardial
                                                    suture ring/polytetrafluoroethylene          Tissue Valve; 27MM Aortic Pericardial
                                                    cloth/polyester cloth.                        Tissue Valve; 29MM Aortic
Guidant Australia Pty Ltd
      Defibrillator/Pacemakers, Implantable
GU132        Vitality DR Model 1871                 This device acts to defibrillate the heart   Model 1871 Vitality DR Dual Chamber
                                                    chambers when the patient enters into        Rate Responsive
                                                    an arrhythmia or uses shocks or anti
                                                    tachy pacing to revert Ventricular
                                                    Tachycardia (VT) or Ventricular
                                                    Fibrillation (VF). While also acting as a
                                                    dual chamber pacemaker.
GU133        Vitality VR Model 1870                 This device acts to defibrillate the heart   Model 1870 Vitality VR Single
                                                    chambers when the patient enters into        Chamber Rate Responsive
                                                    an arrhythmia or uses shocks or anti
                                                    tachy pacing to revert Ventricular
                                                    Tachycardia (VT) or Ventricular
                                                    Fibrillation (VF). While also acting as a
                                                    single chamber pacemaker.
GU134        Contak Renewal 2                       This device acts to defibrillate the heart   One Size Only
                                                    chambers when the patient enters into
                                                    an arrhythmia or uses shocks or anti
                                                    tachy pacing to revert Ventricular
                                                    Tachycardia (VT) or Ventricular
                                                    Fibrillation (VF). While also acting as a
                                                    dual or single chamber pacemaker.

Prostheses List February 2005                                                                                                                                Page 8 of 700
CARDIO-THORACIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                                 Size                              Benefit   Benefit    Notation
GU137        Vitality AVT                          Dual or single chamber pacemaker            One size only
      Defibrillators, Automatic, Implantable
GU107        Ventak Prizm HE DR                    Model 1853 & Model 1858, titanium,          One size only
                                                   dual chamber, adaptive rate
GU110        Ventak Prizm II VR                    Model 1860, titanium, single chamber,       One size only
                                                   adaptive rate
GU111        Ventak Prizm II DR                    Model 1861, titanium, dual chamber,         One size only
                                                   adaptive rate
GU119        Contak Renewal Model H135             Composition - titanium, indicated for       One size only
                                                   patients with symptomatic hear failure.
                                                   Provides cardiac resynchronisation
                                                   therapy by providing electrical
                                                   stimulation to synchronize left and right
                                                   ventricular contractions. These devices
                                                    also provide defibrillation back up.
GU144        Contak Renewal 4 HE CRT-D Model       Implantable dual-chamber defibrillator      one size only
             H197, Model H199
GU147        Contak Renewal 4 CRT-D Model          Implantable dual-chamber defibrillator      One size only
             H190, Model H195
GU148        Vitality 2 EL VR - Model T177         Implantable Cardiac Defibrillator           35cc 90g
GU149        Vitality 2 DR - Model T165            Implantable Cardiac Defibrillator           30cc ; 82g
GU150        Vitality 2 EL Dr - Model T167         Implantable cardiac Defibrillator           35cc ; 90g
GU151        Vitality 2 VR - Model T 175           Implantable cardiac defibrillator           30cc; 82g
GU154        Contak Renewal 4 AVT CRT -D -         Implantable Cardioverter Defibrillator      37cc; 89g
             Model M170 and M175                   with Cardiac Resynchronisation
GU155        Contak Renewal 4 AVT HE CRT - D -     Implantable Cardioverter Defibrillator      40cc; 89g
             Model M177, M179                      with cardiac resynchronisation Therapy
      Leads, Implantable Defibrillator
GU135        Perimeter CS Defibrillation Lead -    The Perimeter CS Lead is a flexible coil    Model 0202 - 59cm; Model 0203 -
             Model 0202, Model 0203 & Model 0204    lead designed to be placed in the          64cm; Model 0204 - 80cm
                                                   coronary sinus and connected to an
                                                   implantable defibrillator and delivers
                                                   energy to the atrium.
GU152        Easytrak IS-1 Lead, Models 4535 to    Implantable left ventricular lead           80 - 90cm
Prostheses List February 2005                                                                                                                        Page 9 of 700
CARDIO-THORACIC                                                                                                                Minimum   Maximum
Billing Code Product Name                           Description                                Size                            Benefit   Benefit    Notation
GU153        Easytrak 2 Is-1 Lead - Models 4542,    Implantable left ventricular lead          80 to 100cm
             4543 & 4544
GU156        Easytrak 3 Lead - Models 4521, 4522,   Implantable left ventricular pacemaker     80 t0 100cm
             4523, 4524, 4525, 4526 and 2527        lead
      Leads, Implantable Defibrillator/Pacemaker
GU031        Sweet Picotip RX Lead                  Model 4050, Model 4051, Model 4052,        45cm, 52cm, 59cm, 45cm & 59cm
                                                    Model 4053, Model 4054 & Model 4055
GU118        Endotak Endurance EZ Leads Model       Defibrillation lead, steroid eluting,      64, 70, 100cm
             0154, Model 0155, Model 0156           trilumen lead body contains one
                                                    conductor for pacing/sensing and two
                                                    conductors for defibrillation. The helix
                                                    is composed of platinum iridium.
GU145        Endotak Reliance G Lead Model 0164,    Implantable defibrillator/pacemaker lead   Lead Lengths: 59 - 90cm
             Model 0165, Model 0166, Model 0167
GU146        Endotak Reliance SG Lead Model 0160,   Implantable defibrillator/pacemaker lead   Lead Lengths: 59 - 90cm
             Model 0161, Model 0162, Model 0163
      Leads, Pacemaker
GU122        Flextend Lead Models 4086, 4087 &      Bipolar, steroid eluting, transvenous      45,52,59cm
             4088                                   silicon pace/sense leads with an
                                                    extendable/retractable active fixation
                                                    for implantation into the atrium or
      Leads, Pacemaker, Implantable Endocardial
GU002        Guidant Aust Selute Atrial J Lead      Model 4293, Model 4294
GU009        Fineline II Sterox IROX Lead           Model 4458, Model 4459                     52cm, 58cm
GU011        Fineline II Sterox IROX Lead           Model 4456, Model 4457                     52cm, 58cm
GU012        Fineline II Sterox IROX Lead           Model 4479, Model 4480                     45cm, 52cm
GU013        Fineline II EZ Sterox IROX Lead        Model 4472, Model 4473 & Model 4474        45cm, 52cm, 58cm
GU016        Fineline II EZ Sterox IROX Lead        Model 4469, Model 4470 & Model 4471        45cm, 52cm, 58cm
GU023        Guidant Aust Selute Picotip Steroid    Model 4033, Model 4034, Model 4035,        45cm , 52cm, 59cm
             Eluting Bipolar Lead                   Model 4063, Model 4064
GU028        Guidant Aust Selute Picotip VDD Lead   Model 4340, Model 4341, Model 4342
                                                    & Model 4343


Prostheses List February 2005                                                                                                                      Page 10 of 700
CARDIO-THORACIC                                                                                                  Minimum   Maximum
Billing Code Product Name                         Description                                 Size               Benefit   Benefit    Notation
GU056        Easytrak Lead                        Model 4510, Model 4511, Model 4512          65cm, 72cm, 80cm
                                                  Transvenous Coronary Sinus Lead
GU082        Selute Lead Model 4285               Silicone                                 45, 52, 59cm
GU112        Endotak Reliance S Lead              Model 0127 & Model 0128, defibrillation 59cm, 64cm
                                                   lead, 9fr introducer (silicone coated),
                                                  steroid eluting, high impedence

GU115        Endotak Reliance Lead                Model 0147, Model 0148 & Model              59cm, 64cm, 90cm
                                                  0149, defibrillation lead, 9fr introducer
                                                  (silicone coated), steroid eluting, high
                                                  impedence
GU123        Endotak SQ Array XP Lead Model       Endotak SQ Array XP Lead Model              70 cm
                                                  0085 is used in addition to an Endotak
                                                  endocardial leads for patients with a
                                                  high DFT (Defibrillation Threshold)
GU138        Easytrak 2, Model 4514,4515, 4516,   The Easytrak 2 lead is a dual electrode
             4517, 4518, 4519, 4520               version of the Easytrak lead. The
                                                  Easytrak 2 lead is a coronary sinus lead,
                                                   steroid eluting, dual electrode,
                                                  pace/sense lead. The lead provides
                                                  chronic pacing and sensing of the left
                                                  ventricle by placement in the coronary
                                                  venous vasculature.
      Leads, Pacemaker, Implantable Myocardial
GU037        Myocardial Pacing Lead               Model 4312 and 4316                         54cm and 35cm
      Pacemaker Lead Adapters, Implantable
GU129        LV-1 Lead Adaptor to IS-1            Connects Left ventricular leads to IS-1     One size only
                                                  ports in pacemakers and defibrillators to
                                                   replace abnormal cardiac excitation
GU130        Y Adaptor                            Connects multiple defibrillator             One size only
                                                  electrodes to a common port, enabling
                                                  the use of shocks to revert Ventricular
                                                  Tachycardia and normal cardiac
                                                  function to return



Prostheses List February 2005                                                                                                        Page 11 of 700
CARDIO-THORACIC                                                                                                         Minimum   Maximum
Billing Code Product Name                             Description                             Size                      Benefit   Benefit    Notation
      Pacemakers, Cardiac, Implantable
GU045        Pulsar Max II Pacemaker DDDR             Model 1280
GU067        Pulsar Max II Pacemaker SSIR             Model 1180, Model 1181
GU079        Pulsar Model VDD 870                     Titanium                                3.2mm/IS-1
GU087        Contak TR Model 1241 Pacemaker           Titanium                                3.2mm/IS-1
GU120        Insignia Plus DR Model 1297, Insignia    Dual Chamber Rate Responsive            One size only
             Plus DR Model 1298                       Permanent Pacemaker
GU121        Insignia Entra DR Models                 Dual Chamber Rate Responsive            One size only
             1294,1295,1296                           Permanent Pacemaker
GU124        Insignia Entra SR Models 1195 & 1198     Single Chamber Rate Responsive          One size only
                                                      Permanent Pacemaker
GU126        Insignia Plus SR Model 1194              Single Chamber Rate Responsive          One size only
                                                      Permanent Pacemaker
GU139        Insignia Ultra SR Lodel 1190             Implantable Cardiac Pacemaker           One size only
GU140        Insignia Ultra DR Model 1291             Implantable Cardiac Pacemaker           One size only
GU141        Insignia Ultra DR Model 1290             Implantable Cardiac Pacemaker           One size only
GU142        Contak Renewal TR2 CRT - P Model         Implantable Cardiac pacemaker           45x54x8.5mm, 14cc, 26gm
             H140, Model H145
GU143        Contak Renewal TR CRT -P Model           Implantable cardiac pacemaker           45x54x8.5mm, 14cc, 26gm
             H120, Model H125
      Stents, Vascular
GU102        Stents                                   ACS Multilink Coronary Stent; ACS       1.5mm - 8.0mm
                                                      Megalink Peripheral Stent; ACS RX
                                                      Herculink Peripheral Stent. Stainless
GU105        Multilink Coronary Stent System          Stainless Steel                         Length 1.5mm - 8.0mm
GU127        Multilink Coronary Stent System -        316L Stainless steel stent              Length 1.5 - 8.0mm
             Frontier
GU128        Multilink Coronary Stent System - Vision Cobalt chrome stent                     Length 1.5 - 8.0mm




Prostheses List February 2005                                                                                                               Page 12 of 700
CARDIO-THORACIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                            Description                                  Size                                   Benefit   Benefit    Notation
Hjorth Health Pty Limited
        Prostheses, Cardiac Valve, Artificial
HH001        Omnicarbon 4000 4523 Mitral UPP         Pure pyrolitic carbon mono-leaflet           Aortic - Sizes 19mm - 27mm; Mitral -
             SupraAnnular and Omnicarbon 4000        prosthetic heart valve                       Sizes 27mm - 33mm
             4313 Aortic UPP
Johnson & Johnson Medical Pty Ltd
        Stents, Vascular
JJ026        BX Velocity with Hepacoat System        Balloon expandable, stainless steel,
                                                     heparin coated
        Stents, Vascular, Coronary
JJ200        BX Velocity Stent and Delivery System   Stainless steel stent                        Diameter: 2.25-5.0 mm; Length 8 - 33
                                                                                                  mm
JJ239        BX Sonic                                Stainless steel coronary stent mounted       Dia 2.25 - 4.0mm, lengths 8 - 33mm
                                                     on a balloon delivery system
JJ302        CYPHER Sirolimus-Eluting Stent &        Stainless steel coronary stent with          Diameter 2.25 - 5.0mm, length 8-33mm
             Delivery System Model CRS - 23300,      Rapamycin (an immunosuppressive and
             08225, 08250, 08275, 08300, 28225,      antiproliferative drug) bound to the stent
             28250, 28275, 28300, 33225, 33250,       struts
             33275, 33300, 13225, 13250, 13275,
             18225, 18250, 18275, 18300, 23225,
             23250, 23275, 23350, 23400, 08350,
             08400, 28350, 28400, 33350, 33400,
             13300, 13350, 13400, 18350, 18400,
             23450, 23500, 28450, 28500, 33450,
             33500, 08450, 13450, 18450, 18500

Medical Vision Australia Pty Ltd
        Stents
MF004        Vivant Z Stent                          Coronary stent made of alloyed medical       Dia 2.5 - 4.0mm, length 9 - 28mm
                                                     grade stainless steel
Medtel Australia Pty Ltd
        Occluders
ME068        Amplatzer PFO Occluder                  Nitinol Wire Mesh                            25mm & 35mm



Prostheses List February 2005                                                                                                                                Page 13 of 700
CARDIO-THORACIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                             Description                                   Size                                    Benefit   Benefit    Notation
      Occluders, Vascular
ME065        Amplatzer Duct Occluder                  Nitinol Wire Mesh                             5 - 24mm
ME066        Amplatzer Septal Occluder                Nitinol Wire Mesh                             4mm - 40mm
ME067        Amplatzer Muscular VSD Occluder          Nitinol Wire Mesh                             4 - 24mm
ME074        Amplatzer Membranous VSD Occluder        Nitinol wire mesh, double disc occluder       4-24mm, Length 7-10mm
                                                      and delivery system
      Stents, Vascular
ME050        Antares Coronary Stent System            Stent                                         Length: 8mm - 32mm Diameter: 2.5mm
                                                                                                    -4.0mm
ME071        Antares Starflex Coronary System         Stainless steel                               Bare stent lengths 8, 12, 16, 20, 24,
                                                                                                    32mm; Expansion range 2.5 - 4.0mm
                                                                                                    Stent Delivery System, stent lengths
                                                                                                    8mm, 12mm, 16mm, 20mm, 24mm,
                                                                                                    32mm
                                                                                                    Balloon 2.5mm, 3.0mm, 3.5mm, 4.0mm
      Stents, Vascular, Coronary
ME073        Lunar Starflex Coronary Stent System     Niobium alloy stent coated with layer of      Balloon 2.25-4.0mm, stent 8-20mm
                                                      homogenous iridiumoxide (IrOx)
Medtronic Australasia Pty Ltd
      Annuloplasty Rings
MC005        Medtronic Posterior Annuloplasty Band;   Annuloplasty Devices - Models 610B,           Models 610B & 610R 25-35mm,
              Medtronic Duran Annuloplasty Ring;      610R & 620B, 620R Silicone / Barium           Models 620B & 620R 23-35mm, Model
             Colvin - Galloway Future Band Model      Sulphate, Dacron. Models 638B semi-           638B - 26-38mm
             638B; Duran Ancore Band 620B;            rigid metal alloy core, silicone coating,
             Duran Ancore Ring 620R                   polyester knit fabric, kit includes - band,
                                                      malleable handle, template with suture
                                                      markers, sizers, molded tray.
      Catheters, Vessel Dilation Balloon
MC197        Medtronic AVE S660 Coronary Stents,      Stainless Steel                               S660 Coronary Stent - Diameter
             S670 Coronary Stents, S7 Coronary                                                      (2.5mm-2.75mm), Length (9mm-
             Stents, BeStent2,                                                                      24mm); S670 & S7 Coronary Stent -
                                                                                                    Diameter (3mm-4mm), Length (9mm-
                                                                                                    30mm); BeStent2 - Diameter (2.5mm-
                                                                                                    4mm), Length (9mm-30mm);

Prostheses List February 2005                                                                                                                                   Page 14 of 700
CARDIO-THORACIC                                                                                                                Minimum   Maximum
Billing Code Product Name                             Description                                Size                          Benefit   Benefit    Notation
      Defibrillators
MC306        InSync III Marquis Model 7279            Titanium                                   One size only - Volume 38cc
      Defibrillators, Automatic, Implantable
MC019        Medtronic Gem DR Model 7271              Titanium                                    62cc
MC020        Medtronic Gem Model 7227Cx; Gem          Titanium                                   49cc, 40cc
             Model 7227 Implantable Cardioverter
             Defibrillator
MC201        Medtronic A/Asia Gem III VR Model        Titanium                                   One size only, 39.2cc
             7231CX
MC202        Medtronic Gem III DR Model 7275          Titanium                                   One size only, 39.5cc
             Implantable Cardioverter Defibrillator
MC227        Medtronic Gem III AT Model 7276          Titanium                                   39.5cc
             Implantable Cardioverter Defibrillator
MC237        Gem Model 7227B Implantable              Titanium, "B" Style Connector              56cc
             Cardioverter Defibrillator
MC238        Gem Model 7227D Implantable              Titanium, "D" style connector              53cc
             Cardioverter Defibrillator
MC239        Gem Model 7227EImplantable               Titanium, "E" style connector              55cc
             Cardioverter Defibrillator
MC245        Marquis DR Model 7274 Implantable        Titanium                                   36cc
             Cardioverter Defibrillator
MC252        Medtronic InSync Marquis Implantable     Titanium                                   Volume 38cc
             Cardioverter Defibrillator Model 7277
MC253        Medtronic Marquis VR 7230CX              Titanium, Sterile, Single Chamber          Volume 36cc
             Implantable Cardioverter Defibrillator
MC317        Maximo VR Model 7232Cx                   Titanium                                   One size only 38.5cc
MC318        Maximo DR Model 7278                     Titanium                                   One size only 38.9cc
MC325        InSync Sentry Model 7298                 Defibrillator, Titanium                    40cc
      Leads
MC301        Model 3830 PACING LEADS                  Active fixation pacemaker lead             59 - 75 cm
                                                      Composition: Insulation is polyurethane,
                                                      Electrodes are Titanium Nitride coated
                                                      Platinum, the screw is steriod-coated
Prostheses List February 2005                                                                                                                      Page 15 of 700
CARDIO-THORACIC                                                                                                          Minimum   Maximum
Billing Code Product Name                             Description                            Size                        Benefit   Benefit    Notation
      Leads, Implantable Defibrillator
MC002        Medtronic Sprint Quattro Lead Model      Silicone and polyurethane              65-100cm
             6944RV/SVC 65cm; Model
             6944RV/SVC 75cm; or Model
             6944RV/SVC 100cm; Medtronic Sprint
             Quattro Lead Model 6944RV/SVC
MC026        Medtronic Transvene SVC Lead Model       Model 6937-35, Model 6937-52, Model    35 - 110cm x 660mm                               Also grouped in
             6937;                                    6937-58, Model 6937-110; Silicone;                                                      ICD Lead Group
MC027        Model 6721 Unipolar Epicardial Patch     Model 6721S-50, Model 6721M-50,        370, 660, 840mm
             Leads S/M/L                              Model 6721L-50; Silicone
MC251        Implantable Subcutaneous Defibrillator   Silicone and Platinum Alloy            Lengths 41-85cm inclusive
             Lead Model 6996SQ 41cm, 58cm, 85cm
      Leads, Implantable Defibrillator/Pacemaker
MC018        Medtronic Sprint Lead Model              Model 6942-65, Model 6942-75, Model    65 - 100cm                                       Also grouped in
             6942RV/SVC                               6942-100; Silicone                                                                      ICD Lead Group
MC025        Medtronic Sprint Lead Model 6932RV       Model 6932-65, Model 6932-75, Model    65 - 100cm                                       Also grouped in
                                                      6932-100; Silicone                                                                      ICD Lead Group
MC208        Medtronic Sprint Quattro Secure Lead     Leads, Defibrillator, Implantable,     58-100cm
             Model 6947 58cm; Model 6947 65cm;        Silicone, polyurethane, platinized
             Model 6947 75cm; Model 6947 100cm        tantalum coils, steroid eluting tip
MC331        Medtronic Sprint Lead Model 6943         Model 6943-58, Model 6943-65, Model    58 - 100cm
                                                      6943-75, Model 6943-100; Silicone
MC341        Medtronic Sprint Lead Model 6945         Model 6945-58, Model 6945-65;          58 - 100cm
                                                      Silicone, Model 6945-75, Model 6945-
                                                      100; Silicone




Prostheses List February 2005                                                                                                                Page 16 of 700
CARDIO-THORACIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                            Description                                      Size                                Benefit   Benefit    Notation
      Leads, Pacemaker, Implantable Endocardial
MC008        Medtronic Capsurefix Model 6940,        Silicone Polyurethane                            30 - 85cm                                                Also grouped in
             Pacing Lead; Medtronic Tined IS-1                                                                                                                 Pacemaker Lead
             Model 4557M; Medtronic Capsurefix                                                                                                                 Group 8
             Model 4067/8/4568 Pacing Leads;
             Medtronic Capsurefix Model 5067
             Pacing Leads; Medtronic Capsurefix
             Model 5068 Pacing Leads; Medtronic
             Capsurefix Model 5568 Pacing Leads;
             Capsure SP Novus Pacing Lead Model
             4092; Capsure SP Novus Pacing Lead
             Model 4592

MC010        Medtronic Capsure SP Novus Model        Silicone Polyurethane                            45 -110cm
             5092; Capsure SP Novus Lead Model
             5592; Medtronic Capsure Model 4023
             Lead; Medtronic Capsure Model 4024
             Lead (med.dexamethasone) Medtronic
             Capsure Model 4523(MED) Medtronic
             Capsure Model 4524 Lead; Medtronic
             Capsure Model 5023M Lead;
             Medtronic Model 5024M Capsure
             Lead; Medtronic Model 5024M
             Capsure Lead; Medtronic Capsure
             Model 5524M SP Bipolar Lead
MC037        Medtronic Attain Cardiac Vein Pacing    Polyurethane; 4 FR Polyurethane, 5 FR            58 - 75cm: 85cm/75cm/110cm or 75-
             Lead Model 2187; Medtronic Coronary     Electrode Tip, Kit Includes: Stylet x 3,         110cm; 75cm/85cm
             Sinus Pacing Lead Model 2188;           Valve lifter, Attain Lead & Anchoring
             Medtronic Attain SD Model 4189;         Sleeve; 4 FR Polyurethane Body, 6.1FR
             Medtronic Attain Side-Wire Model 4191   Electrode Tip
MC052        Medtronic Capsure VDD2 Model 5038       Silicone; Contents: 1 x lead with                11.5cm, 13.5cm, 15.5cm                                   Also grouped in
             AV Pacing Lead                          anchoring sleeve, stylet & guide, 1 x                                                                     Pacemaker Lead
                                                     vein lifter, 2 x fixation tools, extra stylets                                                            Group 9
MC216        Vitatron Excellence PS+Model IMK 49B Pacemaker Leads, Titanium,                          52-65cm
                                                  Polyurethane
MC217        Vitatron Excellence SS+Model IML        Pacemaker Leads, Titanium,                       52-65cm
                                                     Polyurethane
MC218        Vitatron Excellence PS+Model IMK        Pacemaker Leads, Titanium,                       45-53cm
             49JB                                    Polyurethane

Prostheses List February 2005                                                                                                                                 Page 17 of 700
CARDIO-THORACIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                             Description                                      Size                                 Benefit   Benefit    Notation
MC219        Vitatron Excellence SS+Model IML 49JB Pacemaker Leads, Titanium,                          45-53cm
                                                   Polyurethane
MC220        Vitatron Brilliant S+Model IMW           Pacemaker Leads, Vitatron Brilliant              52-65cm
             Pacemaker                                S+Models IMW 14Q, IMW 15Q, IMW
                                                      16Q, IMW 17Q, IMW 18Q, titanium,
                                                      polyurethane
MC221        Vitatron Crystalline Actfix Model        Pacemaker Leads, Titanium,                       52-65cm
             ICF09 Pacemaker                          Polyurethane
MC225        Attain Over the Wire Model 4193          Titanium, polyurethane                           78-88cm
MC229        Medtronic Capsure SP Novus Model         Silicone, platinum                               30-100cm
             5594 Lead 30cm
MC231        Vitatron Crystalline Lead Model          Titanium, polyurethane                           30-53cm Lengths
             ICL08JB Leads, Pacemaker 30cm,
             45cm, 53cm
MC232        Vitatron Crystalline Lead Model ICL08    Titanium, polyurethane                           52-65cm Lengths
             Leads, Pacemaker 52cm, 58cm, 65cm
MC233        Vitatron Crystalline Lead Model          Titanium, polyurethane                           52-65cm Lengths
             ICL08B Leads, Pacemaker 35cm,
             45cm, 52cm, 58cm, 65cm
MC254        CapSure Sense pacemaker lead Models      Titanium Nitride                                 CapSure Sense Lead Model 4073 -                           Also grouped in
             4073, 4074 & 4574                                                                         30cm to 85cm; CapSure Sense Lead                          Pacemaker Lead
                                                                                                       Model 4074 - 30cm to 85cm; CapSure                        Group 8
                                                                                                       Sense Lead Model 4574 - 30cm to
MC336        Medtronic Capsure Z Novus Model          Silicone; Contents: 1 x lead with                45-58cm
             5054 Pacing Lead                         anchoring sleeve, stylet & guide, 1 x
                                                      vein lifter, 2 x fixation tools, extra stylets
MC337        Medtronic Capsure Z Novus Model          Silicone; Contents: 1 x lead with                45-58cm
             5554 Pacing Lead                         anchoring sleeve, stylet & guide, 1 x
                                                      vein lifter, 2 x fixation tools, extra stylets
MC338        Medtronic Capsurefix Novus Model         Silicone; Contents: 1 x lead with                45-85cm
             5076 Pacing Lead                         anchoring sleeve, stylet & guide, 1 x
                                                      vein lifter, 2 x fixation tools, extra stylets
      Leads, Pacemaker, Implantable Myocardial
MC009        Medtronic Epicardial Pacing Leads IS-1   Silicone                                         35 - 53cm
             Model 5071
Prostheses List February 2005                                                                                                                                   Page 18 of 700
CARDIO-THORACIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                             Description                              Size                                       Benefit   Benefit    Notation
MC011        Capsure EPI steroid eluting bipolar      Silicone                                 25 - 60cm
             epicardial lead Model 4968 - ventricle
MC053        Capsure EPI steroid eluting unipolar     Silicone                                 25 - 50cm
             epicardial lead Model 4965 ventricle
      Pacemaker Lead Adapters, Implantable
MC035        Medtronic lead Extender Kit Model:       Silicone                                 14 - 50cm
             6984M, 6981M, 6985M, 5866-24M,
             5866-38M, 5866-40M, 6986M, 5866-
             37M; Bipolar Lead Adaptor Kit Model
             2872
MC036        Medtronic Lead End Cap Kit Model:        Silicone or Polyurethane; Plug to Seal   10 - 25mm, IS-1 Pin Plug - One Size only
             5867-3M; Medtronic Adaptor Kit Line      IS-1 connector in a pacemaker or
             5866-23; Connector Sleeve 5866-45;       defibrillator, Silicone
             Metronic lead sleeve kit model: 5866-
             46; Medtronic Pinplug kit. Model 6719,
             IS-1 Pin Plug
MC246        DF-I Y-Adaptor/Extender Model 6726       Silicone                                 Lengths 25cm, 37cm
             25cm & 37cm
      Pacemakers, Cardiac, Implantable
MC006        InSync model 8040 Stimulator             Titanium                                 14.4cc
MC029        Medtronic Kappa 400 pacemaker            Titanium                                 13.9cc
             Model KDR401
MC030        Medtronic Kappa 400 Pacemaker            Titanium                                 11.6cc, 11.7cc
             Model KSR401
MC031        Medtronic Kappa 700 Pacemakers           Titanium                                 10.9cc - 14.2cc
             Model: KDR700, KDR701, KDR720,
             KDR721, KDR721C, KDR730,
             KDR731, KDR733
MC032        Medtronic Kappa 700 Pacemaker            Titanium                                 11.9cc, 14.2cc
             Model KD700, KD701
MC033        Medtronic Kappa 700 Pacemaker            Titanium                                 10.9cc, 11.1cc
             Model KVDD700/701
MC034        Medtronic Kappa 700 Pacemaker            Titanium                                 9.7cc, 11.0cc
             Model KSR700/701/701C/703/706;

Prostheses List February 2005                                                                                                                                 Page 19 of 700
CARDIO-THORACIC                                                                                       Minimum   Maximum
Billing Code Product Name                            Description              Size                    Benefit   Benefit    Notation
MC200        Medtronic A/Asia AT500 DDDRP            Titanium, silicone       One size only, 14.9cc
             Pacing System Model AT501
MC209        Medtronic Vitatron Clarity DDDR         Titanium, polyurethane   One size only
             Model 862
MC210        Medtronic Vitatron Clarity DDDR         Titanium, polyurethane   One size only
             Model 860
MC211        Medtronic Vitatron Clarity DDDR         Titanium, polyurethane   One size only
             Model 865
MC212        Medtronic Vitatron Clarity VDDR         Titanium, polyurethane   One size only
             Model 660
MC213        Medtronic Vitatron Clarity SSIR Model   Titanium, polyurethane   One size only
             560
MC214        Medtronic Vitatron Clarity SSIR Model   Titanium, polyurethane   One size only
             565
MC215        Medtronic Vitatron Clarity SSIR Model   Titanium, polyurethane   One size only
             562
MC222        Medtronic Vitatron Diamond 3 DDDR       Titanium, polyurethane   One size only
             Model 840 Pacemaker
MC223        Medtronic Vitatron Topaz 3 SSIR         Titanium, polyurethane   One size only
             Model 540 Pacemaker
MC224        Medtronic Vitatron Jade 3 SSI Model     Titanium, polyurethane   One size only
             340 Pacemaker
MC226        Medtronic Insync III Triple Chamber     Titanium                 One size only
             Pacemaker Model 8042
MC230        Vitatron Selection Model 9000           Titanium, polyurethane   One size only
             Pacemaker
MC234        Vitatron Vita 2 SSI Model 230,          Titanium, polyurethane   One size only
             Implantable Cardiac Pacemaker
MC235        Vitatron Vita 2 VDD Model 630,          Titanium, polyurethane   One size only
             Implantable Cardiac Pacemaker
MC236        Vitatron Vita 2 SSIR Model 530,         Titanium, polyurethane   One size only
             Implantable Cardiac Pacemaker
MC240        Vitatron Vita 2 DDDR Model 830,         Titanium, Polyurethane   One size only
             Implantable Cardiac Pacemaker
Prostheses List February 2005                                                                                             Page 20 of 700
CARDIO-THORACIC                                                                                                   Minimum   Maximum
Billing Code Product Name                           Description                                Size               Benefit   Benefit    Notation
MC241        Medtronic Kappa Pacemaker Model        Cardiac Pacemaker, Titanium                13.9cc
             KDR 933
MC242        Medtronic Kappa KSR 900 Model KSR      Cardiac Pacemaker, Titanium                9.7,10.5,11.0 cc
             901,903, 906
MC243        Medtronic Kappa KVDD 900 Model         Cardiac Pacemaker, Titanium                11.1cc
             KVDD 901
MC250        Medtronic Kappa Pacemaker Model        Cardiac Pacemaker, Titanium                One size only
             KD901 and Model KD903, Model
             KD906,
MC287        Vitatron C10S Pacemaker                Titanium, polyurethane                     one size only
MC288        Vitatron C20SR Pacemaker               Titanium, polyurethane                     one size only
MC289        Vitatron C60 DR Pacemaker              Titanium, polyurethane                     one size only
MC290        Vitatron C50 D Pacemaker               Titanium, polyurethane                     one size only
MC319        EnPulse VDD; Model E2VDD01             EnPulse VDD pacemaker with IS1             One size only
                                                    connector. Titanium silicone
MC320        EnPulse D Series: Model E2D01, Model   EnPulse DDD-Pacemakers - with IS1          One size only
             E2D03                                  connector; with 3.2mm low profile
                                                    connector. Titanium and silicone
MC321        EnPulse SR Series: Model E2SR01,       EnPulse SR - Pacemakers - with IS1         One size only
             Model E2SR03, Model E2SR06             connector; with 3.2mm low profile
                                                    connector; with 5mm connector.
                                                    Titanium and silicone.
MC322        EnPulse DR Series: Model E2DR01,       EnPulse DDDR Pacemakers - with IS1         one size only
             Model E2DR03, Model E2DR06, Model       connector and normal battery size; with
             E2DR21, Model E2DR31, Model             3.2mm low profile connector and
             E2DR33                                 normal battery size; with 5/6 mm
                                                    connector and normal battery size; with
                                                    IS1 connector and small battery size;
                                                    with IS1 connector and large battery
                                                    size; with 3.2mm low profile connector
                                                    and large battery size. Titanium and
MC326        PreventAF Model 920                    Pacemaker, Cardiac, Implantable,           24.7g , 12.1cm3
                                                    Titanium, Polyurethane, and Silicone
                                                    Rubber


Prostheses List February 2005                                                                                                         Page 21 of 700
CARDIO-THORACIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                             Description                            Size                                Benefit   Benefit    Notation
MC330        Medtronic Kappa 400 Pacemaker            Titanium                               11.6cc, 11.7cc
             Model KSR 403
MC332        Medtronic Kappa Pacemaker KDR 903        Cardiac Pacemaker, Titanium            13cc, 14.2cc
             and KDR 906
MC333        Medtronic Kappa Pacemaker Model          Cardiac Pacemaker, Titanium            12.1cc, 11.1cc, 13.1cc
             KDR 901, KDR921 and KDR931
MC334        Medtronic Kappa Pacemaker Model          Cardiac Pacemaker, Titanium            One size only
             KD906
MC335        Medtronic Kappa 700 Pacemaker            Titanium                               10.9 - 14.2cc
             Models KD703 and KD706
MC339        Medtronic Kappa 700 Pacemakers           Titanium                               10.9cc - 14.2cc
             Model: KDR703 and KDR706
MC340        Medtronic Kappa 400 pacemaker            Titanium                               13.9cc
             Model KDR403
      Prostheses, Cardiac Valve, Artificial
MC013        Medtronic Hall Heart Valve Aortic        A7700/M7700 Titanium. Pyrolite.        A7700 - Diameter 20-31mm, M7700 -
             Model A7700, Medtronic Hall Heart        Dacron, A7700EZ/M7700EZ Titanium.      Diameter 23-33mm, A7700EZ -
             Valve Mitral Model M7700, Hall Easy      Pyrolite. PET                          Diameter 19-29mm, M7700EZ -
             Fit Aortic Heart Valve Model A7700,                                             Diameter 23-31mm
             Hall Easy Fit Mitral Heart Valve Model
             M7700
MC198        Medtronic Hall rotatable aortic valved   Titanium, pyrolite, dacron             20 - 33mm
             collagen impregnated conduit Model
             R7700
MC292        Advantage Heart Valve - Aortic Model     A7760 - Pyrolytic carbon, PET          Diameter 19-31 mm
             A7760
MC324        Advantage Supra Aortic Heart Valve       Mechanical Heart Valve Pyrolite        Diameter (mm): 19 - 25
                                                      Carbon leaflets Pyrolite carbon ring
      Prostheses, Cardiac Valve, Biological
MC012        Medtronic Hancock Valved Conduit         Porcine bioprosthesis, dacron          12, 14, 16, 18, 20, 22, 25, 30mm.
             Model 100/150




Prostheses List February 2005                                                                                                                        Page 22 of 700
CARDIO-THORACIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                            Description                                 Size                                     Benefit   Benefit    Notation
MC015        Medtronic Freestyle modified            Models FR995MS, FR995 - Porcine             19 - 27mm, 19 - 29mm, 19 - 35mm, 21 -
             subcoronary aortic root bioprosthesis   Bioprosthesis, dacron, Models 305,           33mm
             (Model 995MS); Medtronic Freestyle      305C, 310, T505, T510 - Porcine
             aortic root bioprosthesis (Model        bioprosthesis, polyester
             FR995); Medtronic Mosaic Aortic
             heart Valve Model 305; Medtronic
             Mosaic Mitral heart Valve Model 310;
             Medtronic Hancock II heart valve
             model T510 Mitral; Medtronic
             Hancock II heart valve model T505
             Aortic
      Recorders, Long Term, ECG, Implantable
MC028        Medtronic Reveal ILR Model 9525,        Titanium                                    8cc
             Implantable Cardiogram Recorder;
             Reveal Plus Implantable Loop Recorder
              Model 9526
      Stents, Vascular
MC329        Medtronic Driver, Micro Driver          Cobalt Alloy                                Driver Stent: diameter (2.25 - 4.5mm),
             Coronary Stent System                                                               length (8-30mm); Micro-Driver Stent:
                                                                                                 diameter (2.25 - 2.75mm), length (8 -
                                                                                                 24mm)
Pacing Importers Pty Ltd
      Catheters, Angioplasty, Laser
PI002        Excimer Laser Stent                     Polyester Fibre optic fibre catheter        0.457mm, 0.9mm, 1.4mm, 1.7mm and
                                                                                                 2.0mm
      Stents, Vascular
PI003        Med-X-Flexy Stent                       Tubular Stent, Stainless steel 316L, Gold   Dia 5 - 9mm length: 20 - 100mm
                                                     markers
Progressive Medical
      Defibrillator/Pacemakers, Implantable
PG001        Alto II VR Single Chamber ICD           Debrillator, implantable, automatic
PG004        Alto II DR Dual Chamber Implantable                                                 One size only
             Cardioverter Defibrillator
      Leads, Pacemaker, Implantable Endocardial
PG003        Swift 4040 1CT pacemaker lead                                                       length 58 cm - 69 cm
Prostheses List February 2005                                                                                                                                 Page 23 of 700
CARDIO-THORACIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                           Description                                   Size                               Benefit   Benefit    Notation
      Pacemakers, Cardiac, Implantable
PG002        Talent II DR Pacemaker Model 233       Dula Chamber Pacemaker. 99%                   57.5 x 37.2 x 8mm
PG005        Symphony DR 2550                       Active Implantable pacemaker                  1 size only
Reid Healthcare
      Prostheses, Cardiac Valve, Artificial
RH001        Aortic On-X Prosthetic Heart Valve                                                   27-29mm, 19mm, 21mm, 23mm, 25mm,
             Models ONXA-19; ONXA-21; ONXA-                                                       25-33mm, 27-29mm, 31-33mm, 23mm,
             23; ONXA-25; ONXA-27/29; ONXM-                                                       25mm
             23; ONXM-25; ONXM-27/29;
             ONXM31/33; ONXMC25/33
St. Jude Medical Australia Pty Ltd
      Annuloplasty Rings
SJ034        SJM Seguin Annuloplasty Ring           Semi Rigid                                    24mm - 40mm
SJ035        SJM Tailor Annuloplasty Ring           Fully Flexible                                25mm - 35mm
      Defibrillators, Automatic, Implantable
SJ009        Photon Micro DR Model V-232                                                          37cc
             Defibrillators/Cardioverters
SJ010        Photon Micro VR Model V-194                                                          36cc
             Defibrillators/Cardioverters
SJ011        Atlas DR Model V-240                   Dual chamber implantable cardioverter         37cc
                                                    defibrillator with rate response
SJ012        Atlas VR Model V-199                   Single chamber implantable cardioverter       36cc
                                                    defibrillator with rate response
SJ048        Epic Plus VR Model V-196 Implantable   Single Chamber sensing and                    32cc
             Cardioverter Defibrillator             bradycardia pacing
SJ049        Epic Plus DR Model V-236 Implantable   Dual Chamber sensing, bradycardia             33cc
             Cardioverter Defibrillator             pacing with atrial fibrillation suppression
SJ058        St Jude Medical Australia Ventritex    Contour MD Models V - 175 AC, V-              57-65cc, 109 - 118g
             Contour MD Models V-175AC, V-          175C and V-175D Single chamber
             175D and V- 175C                       Defibrillators/Cardioverters




Prostheses List February 2005                                                                                                                            Page 24 of 700
CARDIO-THORACIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                             Description                                Size                               Benefit   Benefit    Notation
SJ062        Epic HF Model V-339 Implantable          Cardioverter/defibrillator with dual       One size only
             Cardiac Defibrillator                    chamber (atrial and RV) sensing and
                                                      bradycardia pacing with ventricular
                                                      resynchronisation
SJ063        Atlas DR Model V-242 ICD                 Implantable Dual Chamber Cardio-           38cc/78g
                                                      verter Defibrillator
SJ064        Atlas + HF Model V - 341 ICD -           Atlas + HF ICD is a cardioverter           40cc/81g
             Defibrillator, Implantable, automatic,   defibrillator with dual chamber (atrial
             dual-chamber                             and RV) sensing and bradycardia
                                                      Pacing with ventricular
                                                      resynchronisation therapy.
SJ065        Atlas + VR Model V-193 ICD               Single chamber implantable cardio-         38cc, 77g
                                                      verter defibrillator
SJ066        Atlas + VR - C Model V-193C ICD          Single chamber implantable cardio-         38cc, 77g
                                                      verter defibrillator
SJ067        Epic + HF Model V-350 ICD                Epic + HF V-350 ICD is a cardioverter      36cc / 73g
                                                      defibrillator with dual chamber (atrial
                                                      and RV) sensing and bradycardia
                                                      pacing with ventricular
                                                      resynchronisation therapy.
SJ068        Atlas + DR Model V-243 ICD               Implantable Dual Chamber Cardio-           38cc, 78g
                                                      verter Defibrillator
SJ070        Epic + DR Model V-233 ICD                Dual Chamber Implantable Cardio-           33cc 70g
                                                      verter Defibrillator
      Leads, Implantable Defibrillator
SJ016        Riata Transvenous Tachyarrhythmia        Quadripolar, dual-coil, steroid eluting,   One size only                                           Also grouped in
             Lead Model 1580, Model 1581, Model       active fixation tachyarrhythmia leads                                                              ICD Lead Group
             1570, Model 1571
      Leads, Pacemaker, Implantable Endocardial
SJ013        Transvenous Superior Vena Cava Lead      TVL lead system models SV01, SV02,         SV01- 100cm; SV02 - 45cm; SV03 -
             Model SV01, Transvenous Superior         SV03 transvenous leads                     55cm
             Vena Cava Lead Model SV02,
             Transvenous Superior Vena Cava Lead
             Model SV03



Prostheses List February 2005                                                                                                                           Page 25 of 700
CARDIO-THORACIC                                                                                                                Minimum   Maximum
Billing Code Product Name                           Description                                  Size                          Benefit   Benefit    Notation
SJ023        TENDRIL SDX 1488T, 1388T               Single, Active Fixation, Steroid Eluting,    46cm-58cm
                                                    Low Polarisation Lead, IS-1
SJ024        PASSIVE PLUS DX 1342T, 1343K,          Single, passive fixation, steroid eluting,   46-58cm
             1345K, 1346T                           low polarisation lead; Models: Bipolar
                                                    Atrial Lead, IS-1 Unipolar Atrial Lead,
                                                    IS-1 Unipolar Ventricular Lead, IS-1 or
                                                    Bipolar Ventricular Lead, IS-1
SJ033        Aescula LV Model 1055K                 Left Ventricular Pacing Lead                 75cm
      Pacemakers, Cardiac, Implantable
SJ017        AFFINITY SR 5130L, 5130R, 5131M/S      Single chamber, rate responsive,             10.4cc, 22-23gm
                                                    autocapture, left sided/right sided, IS-1
                                                    Single chamber, rate responsive,
                                                    extended diagnostics, 5/6mm
SJ018        AFFINITY DR 5330L, 5330R,              Dual chamber, rate responsive,               11cc, 23-23.5gm
                                                    autocapture, left sided/right sided, IS-1
                                                    Dual chamber, rate responsive,
                                                    extended diagnostics, 5/6mm
SJ019        REGENCY SC 2406L, SCX 2408L, SC        Single Chamber, Standard VVIC, IS-           8.6cc, 18.5-19gm
             2407M/S                                1/5-6mm
SJ020        REGENCY SC+ 2402L                      Single Chamber, VVI, Autocapture,            8.6cc, 18.5gm
                                                    IS-1
SJ022        REGENCY SR+ 2400L                      Single Chamber, Rate Response,               8.6cc, 18.5gm
                                                    Autocapture, IS-1
SJ025        St Jude Medical Integrity SR5142       Single chamber, rate responsive              Volume 10.4cc, weight 23gm
             Pacemaker, Cardiac Implantable         pacemaker
SJ026        St Jude Medical Integrity AFX DR5346   Dual chamber, rate responsive                Volume 11cc, weight 23.5gm
             Pacemaker, Cardiac, Implantable
SJ027        St Jude Medical Microny II SR+ Model   Single Chamber Rate Responsive               Volume 5.9cc, Weight 12.8gm
             2525T Pacemaker                        Pacemaker
SJ028        Integrity Micro DR 5336 Pacemaker      Dual Chamber Rate Responsive                 Volume 8cc, Weight 18gm
                                                    Pacemaker
SJ029        Integrity Micro SR 5136 Pacemaker      Single Chamber Rate Responsive               Volume 8cc, weight 18gm
                                                    Pacemaker



Prostheses List February 2005                                                                                                                      Page 26 of 700
CARDIO-THORACIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                         Description                             Size                                  Benefit   Benefit    Notation
SJ030        Identity SR 5172                     Single Chamber Rate Responsive          Volume 8cc, Weight 17gm
                                                  Pacemaker
SJ031        Identity XL DR 5376                  Dual Chamber Rate Responsive            Volume 11cc, Weight 23.5gm
                                                  Pacemaker
SJ032        Identity DR 5370                     Dual Chamber Rate Responsive            Volume 8cc, Weight 18gm
                                                  Pacemaker
SJ040        Frontier 3x2 Model 5510              Biventricular Stimulation Device with   Height 48mm, Length 52mm, Depth 6mm
                                                  AF suppression
SJ050        Verity ADx Model XL DC 5256 Dual -   Dual Chamber multi-programmable         11cc, 23.5g
             Chamber pacemaker                    rate-adaptive pacing devices with
                                                  extended longevity
SJ051        Verity Adx Implantable Pacemaker,    Dual - Chamber, multi-programmable,     45x52x6mm,11cc, 23g, 5mm or 6mm M/S
             Models XL DR 5356 and XL DR          rate-responsive pacemaker withAF
             5357M/S                              suppression
SJ052        Verity Adx Models XL SR 5156 and     Single Chamber multi-programmable       11cc, 23g                                                  Also grouped in
             XL SR 5157 M/S implantable pacemaker rate-adaptive pacing devices with                                                                  Single Chamber
                                                  extended longevity                                                                                 Pacemaker
                                                                                                                                                     Generation 3
SJ053        Verity Adx Model XL SC 5056          Single Chamber multi-programmable       10.5cc, 23g
             implantable pacemaker                rate-adaptive pacing device with
                                                  extended longevity
SJ054        Identity ADx Model VDR 5480          Single Chamber multi-programmable       8cc, 18g
             implantable pacemaker                rate-adaptive pacing device with
                                                  extended longevity
SJ055        Integrity ADx Model SR 5160          Single Chamber multi-programmable       8cc, 17g
             implantable pacemaker                rate-adaptive pacing device
SJ056        Integrity ADx Model DR 5360 and XL   Dual-Chamber, multi-programmable,       Model DR 5360 - 8cc, 18g, Model XL
             DR 5366                              rate-responsive pacemaker with AF       DR 5366 - 11cc, 23.5g
                                                  suppression
SJ057        Verity ADx Model XL VDR 5456         Single Chamber multi-programmable       11cc, 23.5g
             implantable pacemaker                rate-adaptive pacing device with
                                                  extended longevity
SJ059        Identity ADx Models DR 5380 and XL   Dual-Chamber, multi-programmable,       ADx DR 5380: 43x44x6mm, 18g and
             DR 5386                              rate-adaptive pacing devices with AF    8cc
                                                  suppression                             ADx XL DR 5386: 44x52x6mm, 23.5g

Prostheses List February 2005                                                                                                                       Page 27 of 700
CARDIO-THORACIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                             Description                              Size                                     Benefit   Benefit    Notation
SJ060        Identity ADx Model SR 5180               Single Chamber multi-programmable        8cc, 18g
             implantable pacemaker                    rate-adaptive pacing device
SJ061        Identity Adx Model XL DC 5286 Dual       Identity ADx Model XL DC Model           11cc, 23.5g
             Chamber Pacemaker                        5286 is an implantable, multi-
                                                      programmable rate-adaptive pacing
                                                      device with AF suppression
      Prostheses, Cardiac Valve, Artificial
SJ036        St Jude Medical Coated Aortic Valved     Coated Aortic Valved Graft               21mm - 33mm
             Graft
SJ037        St Jude Medical Aortic Expanded Cuff     Aortic Expanded Cuff, Aortic             Aortic Expanded 19 -31mm, Aortic
             Heart Valve; St Jude Medical Aortic      Hemodynamic Plus Cuff, Mitral            Hemodynamic 17 - 27mm, Mitral
             Hemodynamic Plus Cuff Heart Valve;       Hemodynamic Cuff, Aortic & Mitral        Hemodynamic 17 -27mm, Rotatable 17
             St Jude Medical Mitral Hemodynamic       Rotatable Cuff                           - 33mm
             Plus Cuff Heart Valve; St Jude Medical
             Mechanical Heart Valve Masters Series
SJ039        St Jude Medical Regent Prosthetic        Standard Cuff - Model 17AGN-751 -        Standard cuff - 17-29mm, Flex cuff -
             Heart Valves                             29AGN-751, Flex Cuff - Model             17-29mm
                                                      17AGFN-756 - 29AGFN-756
      Prostheses, Cardiac Valve, Biological
SJ038        St Jude Medical Toronto SPV Valve        Tissue Heart Valves, Bioimplant          TSPV: 21 - 29mm, Bioimplant Aortic:
             Model SPA-101, St Jude Medical                                                    21-27mm, Bioimplant Mitral: 27-32mm
             Bioimplant Heart Valve
SJ069        St Jude Medical Biocor Porcine           St Jude Medical Biocor Porcine           Aortic Valves - Tissue Annulus
             Prosthetic Heart Valve                   Prosthetic Heart Valve is manufactured   Diameter - 21-29mm, Implant Height -
                                                       from selected procine aortic valve      11-15c; Mitral Valves - Tissue Annulus
                                                      cusps that have been cross-linked with    Diameter - 25-35mm, Implant Height -
                                                      a glutaraldehyde solution                8-10mm
Tag Medical
      Annuloplasty Rings
TM001        AnnuloFlo Annuloplasty System            Annuloflex Ring or AnnuloFlo Ring        26-36mm




Prostheses List February 2005                                                                                                                               Page 28 of 700
CARDIO-THORACIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                             Description                          Size                                 Benefit   Benefit    Notation
      Prostheses, Cardiac Valve, Artificial
TM002        CarboSeal Ascending Aortic Prosthesis,   Mechanical Conduit                   AP 21-33mm
             sterile, CarboSeal Ascending Aortic
             Prosthesis with Handle Model AP21,
             Model AP23, Model AP25, Model
             AP27, Model AP29, Model AP31,
             Model AP33
TM003        SuMit - Supra-Annular Mitral Valve:      Mechanical Valve                     16mm to 33mm
             Carbomedics Aortic Model S500 Supra
             Annular Prosthetic Heart Valve:
             Carbomedics Model 700 Mitral
             Prosthetic Heart Valve: CarboMedics
             Aortic Model A500 Prosthetic Heart
             Valve: CarboMedics Aortic Model
             R500 Reduced Tissue Annulus
             Diameter Prosthetic Heart Valve

Terumo Corporation Australia
      Stents, Vascular, Coronary
TU001        Intra Coronary Stent                     Stainless Steel mounted on balloon   Diameter 2.0mm - 4.0mm, Length
                                                      catheter                             10mm - 30mm length
W L Gore & Associates
      Mesh, Polymeric
GT128        Helex Septal Occluder                    ePTFE                                15-35mm
      Patches, Myocardial
GT117        Gore-Tex - Cardiovascular Patch          ePTFE                                0.4mm Thickness 2 x 9cm
GT118        Gore-Tex - Cardiovascular Patch          ePTFE                                0.4mm - 3 x 6cm
                                                                                           0.6mm - 2.5cm x 15cm & 5cm x 7.5cm
GT120        Gore-Tex Cardiovascular Patch            ePTFE                                0.6mm Thickness 5 x 15cm
GT121        Gore-Tex Cardiovascular Patch            ePTFE                                0.6mm Thickness 10 x 15cm
GT122        Preclude Pericardial Membrane            ePTFE                                0.1mm Thickness 6 x 12cm
GT123        Preclude Pericardial Membrane            ePTFE                                0.1mm Thickness 8 x 16cm
GT124        Preclude Pericardial Membrane            ePTFE                                0.1mm Thickness 12 x 12cm
GT125        Preclude Pericardial Membrane            ePTFE                                0.1mm Thickness 15 x 20cm
Prostheses List February 2005                                                                                                                       Page 29 of 700
CARDIO-THORACIC                                                                                                                       Minimum   Maximum
Billing Code Product Name                            Description                               Size                                   Benefit   Benefit    Notation
GT126        Acuseal Cardiovascular Patch Vascular   ePTFE                                     0.5mm Thickness 1 x 9cm; 0.8 x 7.5cm
GT127        Acuseal Cardiovascular Patch Cardiac    ePTFE                                     0.5mm Thickness 3 x 6cm & 5 x 7.5cm
William A Cook Aust Pty Ltd
      Embolization Prostheses, Intravascular
WC076        Flipper-Patient Ducts Arteriosus-       Detachable Coil for PDA Closure           Coil Diameter 3,5,6.5 & 8 mm Number
             Occluding System                                                                  of Loops (3,4,5)
Woodstock Biomedical Pty Ltd
      Grafts
WO033        Endofit Endoluminal Stent Graft         Tapered Thoracic Endoluminal Stent        Max Dia. 42mm, Min Dia. 14mm,
                                                     Graft with external fixation              Length 12-26cm
WO034        Endofit Endoluminal Stent Graft         Occluder Endoluminal Stent Graft          Max Dia. 42mm, Min Dia. 14mm,
                                                                                               Length 2 or 3.5cm
WO035        Endofit Endoluminal Stent Graft         Extender Endoluminal Stent Graft,         Max Dia. 42mm, Min Dia. 14mm,
                                                     abdominal and thoracic, Preloaded         Length 4-12cm
WO036        Endofit Endoluminal Stent Graft         Extender Endoluminal Stent Graft,         Max Dia. 42mm, Min Dia. 14mm,
                                                     abdominal and thoracic, Cartridge         Length 4-12cm
WO037        Endofit Endoluminal Stent Graft         Endoluiminal Cuff Stent Graft with        Max Dia. 42mm, Min Dia. 24mm,
                                                     external fixation, abdominal and          Length 5 or 7cm
                                                     thoracic, Cartridge
WO038        Endofit Endoluminal Stent Graft         Endoluminal Cuff Stent Graft with         Max Dia. 42mm, Min Dia. 24mm,
                                                     external fixation, abdominal and          Length 5 or 7cm
                                                     thoracic, Preloaded
WO039        Endofit Endoluminal Stent Graft         Aortomonoiliac Endoluminal Stent Graft    Max Proximal Dia. 38mm, Min Distal
                                                     with external fixation                    Dia. 14mm, Length 14 - 26cm
WO040        Jotech Flowline Bipore Vascular Graft   Thin Wall with Spiral Reinforcement       40 & 50cm
WO041        Jotech Flowline Bipore Vascular Graft   Thin Wall                                 40 & 50cm
WO042        Jotech Flowline Bipore Vascular Graft   Standard Wall with Spiral Reinforcement   70 & 80cm
WO043        Jotech Flowline Bipore Vascular Graft   Standard Wall                             80cm
WO044        Jotech Flow Weave Vascular Graft        Flow Weave                                30cm
WO045        Jotech Flow Weave Vascular Graft        Flow Weave                                60cm
WO046        Jotech Flow Weave Vascular Graft        Flow Weave BioSeal                        15cm

Prostheses List February 2005                                                                                                                             Page 30 of 700
CARDIO-THORACIC                                                                                                                    Minimum   Maximum
Billing Code Product Name                             Description                              Size                                Benefit   Benefit    Notation
WO047        Jotech Flow Weave Vascular Graft         Flow Weave BioSeal                       30cm
WO048        Jotech Flow Weave Vascular Graft         Flow Weave BioSeal                       60cm
      Grafts, Vascular, Synthetic
WO049        Jotec Flowline Bipore Heparin ePTFE      ePTFE Vascular Graft with                All sizes up to 50cm in length
             Vascular Graft Straight, Standard Wall   microporous structure. Standard Wall
WO050        Jotec Flowline Bipore Heparin ePTFE      ePTFE Vascular Graft with                All sizes at over 50cm in length
             Vascular Graft Straight, Standard Wall   microporous structure. Standard Wall
WO051        Jotec Flowline Bipore Heparin ePTFE      ePTFE Vascular Graft with                All sizes up to 50cm Length
             Vascular Graft Straight, Standard Wall   microporous structure. Standard Wall
             with Reinforcement                       with Heparin and Reinforcement
WO052        Jotec Flowline Bipore Heparin ePTFE      ePTFE Vascular Graft with                All sizes at over 50cm in Length
             Vascular Graft Straight, Standard Wall   microporous structure. Standard Wall
             with Reinforcement                       with Heparin and Reinforcement
WO053        Jotec Flowline Bipore ePTFE Vascular     ePTFE Vascular Graft with                All sizes up to 50cm in Length
             Graft, Straight, Thin Wall               microporous structure. Thin Wall
WO054        Jotec Flowline Bipore ePTFE Vascular     ePTFE Vascular Graft with                All sizes at over 50cm in length
             Graft, Straight, Thin Wall               microporous structure. Thin Wall
WO055        Jotec Flow Nit Bioseal Polyester         Flow Nit Bioseal Straight grafts are     For all diameters in 30cm lengths
             Vascular Grafts, Straight Grafts         texturised exterior yarns for superior
                                                      tissue incorporation and healing
                                                      characteristics, with the new Bioseal
                                                      impregnation to make the grafts blood
                                                      tight.
WO056        Jotec Flow Nit Bioseal Polyester         Flow Nit Bioseal Straight grafts are     For all diameters in 15cm lengths
             Vascular Grafts, Straight Grafts         texturised exterior yarns for superior
                                                      tissue incorporation and healing
                                                      characteristics, with the new Bioseal
                                                      impregnation to make the grafts blood
                                                      tight.
WO057        Jotec Flow Nit Bioseal Polyester         Flow Nit Bioseal Straight grafts are     For all diameters in 60 and 100cm
             Vascular Grafts, Straight Grafts         texturised exterior yarns for superior   lengths
                                                      tissue incorporation and healing
                                                      characteristics, with the new Bioseal
                                                      impregnation to make the grafts blood
                                                      tight.

Prostheses List February 2005                                                                                                                          Page 31 of 700
CARDIO-THORACIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                           Description                              Size                                   Benefit   Benefit    Notation
WO058        Jotec Flowline Bipore ePTFE Vascular   ePTFE Vascular Graft with                All sizes up to 50cm in Length
             Graft, Straight, Standard Wall With    microporous structure, Straight,
             Reinforcement                          Standard Wall with Reinforcement
WO059        Jotec Flowline Bipore ePTFE Vascular   ePTFE Vascular Graft with                All sizes at over 50cm in Length
             Graft, Straight, Standard Wall With    microporous structure, Straight,
             Reinforcement                          Standard Wall with Reinforcement
WO060        Jotec Flowline Bipore ePTFE Vascular   ePTFE Vascular Graft with                All sizes up to 50cm in Length
             Graft, Straight, Thin Wall with        microporous structure. Thin Wall with
             Reinforcement                          spiral reinforcement
WO061        Jotec Flowline Bipore ePTFE Vascular   ePTFE Vascular Graft with                All sizes at over 50cm in Length
             Graft, Straight, Thin Wall with        microporous structure. Thin Wall with
             Reinforcement                          spiral reinforcement
WO062        Jotec Flow Nit Bioseal Polyester       Flow Nit Bioseal Bifurcated grafts are   45 cm length, 12x6mm, 14x7mm,
             Vascular Grafts, Bifurcated Grafts     texturised exterior yarns for superior   16x8mm, 18x9mm, 20x10mm,
                                                    tissue incorporation and healing         22x11mm, 24x12mm
                                                    characteristics, with the new Bioseal
                                                    impregnation to make the grafts blood
                                                    tight
      Stents
WO031        Duraflex Coronary Stent System         316L Medical Grade Stainless Steel       Length 8, 11, 14, 18, 21, 25mm x
                                                    Stent Premounted on Rail Design          Diameter 2.5, 2.75, 3.0, 3.5, 4.0mm
                                                    Catheter
Zynergy Medical Pty Limited
      Stents, Vascular, Coronary
ZY001        Carbostent                             Coronary stent - includes Carbostent     Dia 2.5mm x Length 9, 12, 15, 19,
                                                    Syncro & Carbostent Sirius               25mm; Dia 3.0mm x Length 9, 12, 15,
                                                                                             19, 25, 32mm; Dia 3.5mm x Length 9,
                                                                                             12, 15, 19, 25, 32mm; Diameter 4.0mm
                                                                                             x Length 9, 12, 15, 19, 25, 32mm




Prostheses List February 2005                                                                                                                           Page 32 of 700
EAR, NOSE & THROAT                                                                                                                      Minimum   Maximum
Billing Code Product Name                              Description                                Size                                  Benefit   Benefit    Notation
BR & CT Enterprises Pty Ltd
      Prostheses, Ossicular
BC001        Titanium Head                                                                        To suit blue or grey implants
BC003        Tympanic Cavity Partial Implant           Hydroxylapartite, 90 degree and 75         Total length 3.75mm - 5.00mm; Head
                                                       degree                                     diameter 2.50mm - 4.00mm
BC004        Titanium PORP with Fixed Bell and                                                    Maximum lengths of 5.0mm (grey) and
             Removable Head                                                                       5.5mm (blue) - adjustable in 1mm
                                                                                                  increments; 0.3mm diameter
BC006        Tympanic Cavity Total Implant             Hydroxylapartite, 90 degree and 75         Total length - 8mm; Head diameter -
                                                       degree                                     3.5mm, 3.6mm
      Prostheses, Ossicular, Incus and Stapes
BC002        Platinum - Teflon Piston with flat band                                              Diameter 0.4mm - 0.6mm; Functional
             wire                                                                                 length 3.00mm - 6.00mm
      Prostheses, Ossicular, Total
BC007        Titanium Middle Ear Total Implant with                                               Maximum lengths of 7.0mm (grey) and
             Removable Shoe or Head                                                               7.5mm (blue) - adjustable in 1mm
                                                                                                  increments; 0.3mm and 0.4mm in
                                                                                                  diameter
BC008        Titanium Middle Ear Total Implant with                                               Maximum lengths of 7.0mm (grey) and
             Adjustable Head                                                                      7.5mm (blue) - adjustable in 1mm
                                                                                                  increments; 0.4mm diameter
BC009        Titanium Shoe                             to suit Titanium Middle Ear Implants       To suit blue or grey implants
      Tubes, Myringotomy
BC010        Ventilation tube                          Ventilation tube - Silicone - T-tube, T-   1.1mm; 1.27mm lumen
                                                       tube grommet
BC011        Ventilation Tubes - Collar Button         Teflon, w/o wire                           1.10mm, 1.25mm, 1.50mm lumen
BC012        Ventilation Tubes - Collar Button         Teflon w/wire, and titanium w/o wire       0.76mm, 1.00mm, 1.25mm, 1.50mm
                                                                                                  lumen
BC013        Ventilation Tubes - Collar Button         Titanium w wire                            1.00mm, 1.25mm, 1.50mm lumen
BC014        Ventilation Tubes - Shepherd              Teflon, w or w/o wire                      1.15mm lumen
BC015        Ventilation Tubes - Shepherd              Titanium, w/o wire                         1.00mm, 1.25mm lumen
BC016        Ventilation Tubes - Shepherd              Titanium with wire                         1.00mm, 1.25mm lumen
Prostheses List February 2005                                                                                                                               Page 33 of 700
EAR, NOSE & THROAT                                                                                                                     Minimum   Maximum
Billing Code Product Name                           Description                               Size                                     Benefit   Benefit    Notation
BC017        Ventilation Tubes - Silicone           Armstrong Grommet, Donaldson w &          1.1mm & 1.5mm lumen
                                                    w/o Tab, Paparella 1 and Paparella 2
                                                    (1.5mm)
Cochlear Limited
      Cochlear Implants
CO012        SPrint Speech Processor (INITIAL)      Consists of: SPrint Speech Processor -    Processor: One Size Only, Transmit
                                                    body worn speech processor to suit        Cable, 8-28cm, Headset Cable 45-
                                                    Nucleus 24 cochlear implant system;       100cm, Headset: 0.5-4.0 magnet
                                                    transmit cable; headset cable; headset;   strength, Hook small and large
                                                    battery case - double; batteries - AA;
                                                    microphone cover; belt clip; and hook
CO015        Spectra Speech Processor               Conists of: Spectra - body worn speech    Processor: One Size Only, Transmit
             (REPLACEMENT)                          processor for Nucleus 22 system;          Cable: 8- 28cm Headset Cable: 45 -
                                                    transmit cable; headset cable; and        100cm Headset: 0.5-4.0 magnet strength
CO017        SPrint Speech Processor                Consists of: SPrint Speech Processor -    Processor: One Size Only, Transmit
             (REPLACEMENT)                          body worn speech processor to suit        Cable, 8-28cm, Headset Cable 45-
                                                    Nucleus 24 cochlear implant system;       100cm, Headset: 0.5-4.0 magnet
                                                    transmit cable; headset cable; headset;   strength, Hook small and large
                                                    battery case - double; batteries - AA;
                                                    microphone cover; belt clip; and hook
CO018        ESPrit 3G Speech Processor - Initial   Includes speech processor with titanium   Cable lengths: 6, 8, 10, 20, 28cm
                                                     ear hook, 6 high powered zinc air
                                                    batteries, cleaning brush, microphone
                                                    puffer, earmould compatible earhook,
                                                    soft earhook cover, magnet, drying
                                                    capsules, accessory adaptor and socket
                                                    covers, signal check, coil/cable (x2),
                                                    document pack
CO019        ESPrit 3G Speech Processor -           Includes speech processor with titanium   Cable lengths: 6, 8, 10, 20, 28cm
             Replacement                             ear hook, 6 high powered zinc air
                                                    batteries, cleaning brush, microphone
                                                    puffer, earmould compatible earhook,
                                                    soft earhook cover, magnet, drying
                                                    capsules, accessory adaptor and socket
                                                    covers, signal check, coil/cable (x2),
                                                    document pack



Prostheses List February 2005                                                                                                                              Page 34 of 700
EAR, NOSE & THROAT                                                                                                                       Minimum   Maximum
Billing Code Product Name                          Description                                Size                                       Benefit   Benefit    Notation
      Stimulators, Auditory
CO013        Nucleus 24k Cochlear Implant          Model CI24R (ST)                           One size only
CO014        Nucleus Contour Cochlear Implant;     Model CI24R (CS); Model CI24R (CA)         One size only
             Nucleus 24 Contour Advance Cochlear
             Implant
CO016        ESPrit 22 Beige/Brown/Black           Consists of: ESPrit 22 Speech              Processor: One Size Only, Transmit
             Z88105/6/7, ESPrit 22 Cable, Coil,    Processor, consisting of: body             Cable: 8-28cm, Headset: 0.5-4.0 magnet
             Magnet, Beige/Brown/Black             (Z88105/6/7) and headset of cable, coil    strength
             Z88136/7/8 (REPLACEMENT)              & magnet (Z88136/7/8); colour
                                                   combination to suit recipient
      Telephone Aids, Hearing-Impaired
CO006        Nucleus 24 Cochlear Implant System    Set of assistive listening & maintenance   Lapel Microphone: 40-150cm, Personal
             Accessories for SPrint Adult           devices, consisting of: Lapel             Audiocable - one size only, Battery
                                                   Microphone; Personal Audiocable;           Charger - one size only, Pouch (adult
                                                   Battery Charger; Pouch (adult style),      style), Ear Hook (small and large)
                                                   Ear Hook; Battery case; Mic Lock;          Battery case - single, Mic Lock - one
                                                   Lapel clip; TV/Hi-Fi Cable; Mic sleeve;    size only, Lapel clip - one size only,
                                                    Dry pack; Accessory case; AC              TV/Hi-Fi Cable - one size only Mic
                                                   adaptor; Telecoil; and Mic clip            sleeve - one size only, Dry pack - one
                                                                                              size only Accessory case - one size
                                                                                              only, AC adaptor - one size only,
                                                                                              Telecoil - one size only, Mic clip - one
                                                                                              size only

CO007        Nucleus 24 Cochlear Implant System    Set of assistive listening & maintenance   Lapel Microphone: 40-150cm, Personal
             Accessories for SPrint Child           devices, consisting of: Lapel             Audiocable - one size only,Battery
                                                   Microphone: 40-150cm, Personal             Charger - one size only, Pouch (adult
                                                   Audiocable; Battery Charger; Pouch         style), Ear Hook (small and large),
                                                   (adult style), Ear Hook; Battery case;     Battery case - single, Mic Lock - one
                                                   Mic Lock; Lapel clip; TV/Hi-Fi Cable;      size only, Lapel clip - one size only,
                                                   Mic sleeve; Dry pack; Accessory case;      TV/Hi-Fi Cable - one size only, Mic
                                                    AC adaptor; Telecoil; Mic clip; and FM    sleeve - one size only, Dry pack - one
                                                    Cable                                     size only, Accessory case - one size
                                                                                              only, AC adaptor - one size only,
                                                                                              Telecoil - one size only, Mic clip - one
                                                                                              size only, FM Cable - to suit Sonic Air
                                                                                              Easy Listener



Prostheses List February 2005                                                                                                                                Page 35 of 700
EAR, NOSE & THROAT                                                                                                                       Minimum   Maximum
Billing Code Product Name                           Description                                Size                                      Benefit   Benefit    Notation
CO020        Nucleus Cochlear Implant Accessory     Accessory set consists of accessory        Lapel microphone comes in lengths of
             Kit - ESPrit 3G Speech Processor       adapter cable, lapel microphone & lapel    40-150cm
                                                    clip, battery cover set and accessory
Device Technologies Australia Pty Ltd
      Cannulae, Eye, Lacrimal
DE191        Canaliculus Intubation Sets            Silicone, SS & Nylon                       17.7 x .064 x 29cm, 15.5 x .051 x 33cm
Endocorp Pty Ltd
      Drains, T
EC013        Campbell Endolymphatic T-Shunt         Silicone rubber                            0.125 mm dia
      Prostheses, Ear
EC008        Exmoor Middle Ear Prostheses -         Consists of three components: a dense      Mushroom = 3.0 mm flange dia; 1.5mm
             Causse Universal HA Prosthesis         hydroxylapatite white mushroom; a          length. Clear tube = 20.0mm length x
                                                    clear teflon tube & a white teflon plug.   1.32 dia o.d. White plug = 5.0mm
                                                                                               length x 0.4 dia o.d.
EC009        Exmoor Middle Ear Prostheses - Mills   Hydroxylapatite                            2.0 mm dia od x 1.0mm dia id x 3.5 mm
             Incus HA Sleeve                                                                   length
EC010        Exmoor Middle Ear Prostheses - Mills   Hydroxylapatite                            2.0 mm dia od x 1.0mm dia id x 2.0 mm
             Incus HA Sleeve                                                                   length
EC011        Exmoor Middle Ear Prostheses - Mills   Teflon                                     0.5/1.0 mm dia
             Columella
EC012        Exmoor Middle Ear Prostheses - Attic   Silicone rubber                            0.125 mm dia
             to Antrum Implant
EC014        Exmoor Middle Ear Prostheses -         Silicone rubber                            0.125 mm dia
             Middle Ear Aeration Sheeting
EC015        Exmoor Middle Ear Prostheses -         Hydroxylapatite                            0.6 mm dia od x 0.7 mm dia id x 6.1 mm
             Teflon Loop                                                                        length
EC016        Exmoor Middle Ear Prostheses -         Hydroxylapatite                            0.4 mm dia od x 0.7mm dia id x 6.1 mm
             Teflon Loop                                                                       length
      Tubes, Myringotomy
EC017        Exmoor Plastics Ear Vent Drains -      With hole, teflon                          1.14 mm lumen dia x 2.54 mm inner
             Reuter Bobbin                                                                     flange dia x 2.54 mm outer flange dia x
                                                                                               0.76 inter flange. 1.52mm total length


Prostheses List February 2005                                                                                                                                Page 36 of 700
EAR, NOSE & THROAT                                                                                                                   Minimum   Maximum
Billing Code Product Name                        Description                               Size                                      Benefit   Benefit    Notation
EC018        Exmoor Plastics Ear Vent Drains -   Without hole, teflon                      1.14 mm lumen dia x 2.54 mm inner
             Reuter Bobbin                                                                 flange dia x 2.54 mm outer flange dia x
                                                                                           0.76 inter flange. 1.52mm total length
EC019        Exmoor Plastics Ear Vent Drains -   Teflon                                    1.14 mm lumen dia x 2.24 mm inner
             Collar Button                                                                 flange dia x 2.24 mm outer flange dia x
                                                                                           1.27 inter flange. 1.78 mm total length
EC020        Exmoor Plastics Ear Vent Drains -   Teflon                                    1.14 mm lumen dia x 3.0 mm inner
             Collar Button                                                                 flange dia x 3.0 mm outer flange dia x
                                                                                           1.27 inter flange. 1.78 mm total length
EC021        Exmoor Plastics Ear Vent Drains -   Teflon                                    1.4 mm lumen dia x 2.55 mm inner
             Collar Button                                                                 flange dia x 2.55 mm outer flange dia x
                                                                                           0.85 inter flange. 1.35 mm total length
EC022        Exmoor Plastics Ear Vent Drains -   Teflon                                    1.75 mm lumen dia x 2.85 mm inner
             Collar Button                                                                 flange dia x 2.85 mm outer flange dia x
                                                                                           0.95 inter flange. 1.46 mm total length
EC023        Exmoor Plastics Ear Vent Drains -   Teflon Shephards Drain with wire          1.14 mm lumen dia x 2.36 mm inner
             Shepards Drain                                                                flange dia x 2.36 mm outer flange dia x
                                                                                           1.42 inter flange. 2.41 mm total length
EC024        Exmoor Plastics Ear Vent Drains -   Teflon Shephards Drain                    1.14 mm lumen dia x 2.36 mm inner
             Shepards Drain                                                                flange dia x 2.36 mm outer flange dia x
                                                                                           1.42 inter flange. 2.41 mm total length
EC025        Exmoor Plastics Ear Vent Drains -   Teflon Shephards Drain with wire          0.97 mm lumen dia x 2.08 mm inner
             Teflon Shephards Drain                                                        flange dia x 2.08 mm outer flange dia x
                                                                                           1.42 inter flange. 2.41 mm total length
EC026        Exmoor Plastics Ear Vent Drains -   Teflon Shephards Drain with wire          0.97 mm lumen dia x 2.08 mm inner
             Teflon Shephards Drain with wire                                              flange dia x 2.08 mm outer flange dia x
             grasping feature                                                              1.42 inter flange. 2.41 mm total length
EC027        Exmoor Plastics Ear Vent Drains -   High density polyethylene Shephards       0.97 mm lumen dia x 2.08 mm inner
             Shephards Drain                     Drain with tab                            flange dia x 2.08 mm outer flange dia x
                                                                                           1.42 inter flange. 2.41 mm total length
EC028        Exmoor Plastics Ear Vent Drains -   Silicone rubber Shepards Drain with tab   0.97 mm lumen dia x 2.08 mm inner
             Shephards Drain                      - Pack of 25                             flange dia x 2.08 mm outer flange dia x
                                                                                           1.42 inter flange. 2.41 mm total length
EC029        Exmoor Plastics Ear Vent Drains -   Titanium                                  1.35 mm lumen dia x 2.75 mm inner
             Burns Titanium Grommet                                                        flange dia x 2.75 mm outer flange dia x
                                                                                           0.95 inter flange. 1.13 mm total length
Prostheses List February 2005                                                                                                                            Page 37 of 700
EAR, NOSE & THROAT                                                                                                                        Minimum   Maximum
Billing Code Product Name                             Description                               Size                                      Benefit   Benefit    Notation
EC030        Exmoor Plastics Ear Vent Drains -        Silicone rubber                           1.1 mm lumen dia x 2.25 mm inner
             Donaldson Grommet                                                                  flange dia x 2.25 mm outer flange dia x
                                                                                                0.76 inter flange. 2.25 mm total length
EC031        Exmoor Plastics Ear Vent Drains -        With tab, silicone rubber                 1.1 mm lumen dia x 2.25 mm inner
             Donaldson Grommet                                                                  flange dia x 2.25 mm outer flange dia x
                                                                                                0.76 inter flange. 2.25 mm total length
EC032        Exmoor Plastics Ear Vent Drains -        High density polyethylene                 1.0 mm lumen dia x 3.3 mm inner flange
             Reddy Grommet                                                                       dia x 3.0 mm outer flange dia x 1.2
                                                                                                inter flange. 2.43 mm total length
EC033        Exmoor Plastics Ear Vent Drains -        Teflon                                    0.85 mm lumen dia x 2.3 mm inner
             Shah Mini Grommet                                                                  flange dia x 1.92 mm outer flange dia x
                                                                                                1.0 inter flange. 1.52 mm total length
EC034        Exmoor Plastics Ear Vent Drains -        Full length, silicone rubber              1.14 mm lumen dia x 8.2 mm inner
             Exmoor T-Tube                                                                      flange dia. Outer flange - none. 12.5
                                                                                                mm total length
EC035        Exmoor Plastics Ear Vent Drains -        Reduced length, silicone rubber           1.14 mm lumen dia x 8.2 mm inner
             Exmoor T-Tube                                                                      flange dia. Outer flange - none. 6.0 mm
                                                                                                 total length
EC036        Exmoor Plastics Ear Vent Drains -        Long wings, silicone rubber               1.14 mm lumen dia x 9.5 mm inner
             Exmoor T- Tube                                                                     flange dia. Outer flange - none. 12.5
                                                                                                mm total length
EC037        Exmoor Plastics Ear Vent Drains - Tiny   Silicone rubber                           0.75 mm lumen dia x 7.5 mm inner
             T-Tube                                                                             flange dia. 5.7 mm total length
EC038        Exmoor Plastics Ear Vent Drains -        With mirror image flanges, high density   1.0 mm lumen dia x 3.0 mm inner flange
             Addenbrooke's/Owa Ventilation Tube       polyethylene.                              dia x 3.0 mm outer flange dia x 1.5
                                                                                                inter flange. 2.0 mm total length
EC039        Exmoor Plastics Ear Vent Drains -        Bell shape, high density polyethylene     1.05 mm lumen dia x 2.95 mm inner
             Bel-Air Ventilation Tube                                                           flange dia x 2.95 mm outer flange dia x
                                                                                                1.45 inter flange. 1.65 mm total length
EC040        Exmoor Plastics Ear Vent Drains -        Teflon                                    0.97 mm lumen dia x 2.34 mm inner
             Cylindrical Ventilation Tube                                                       flange dia. Outer flange - none. 7.11
                                                                                                mm total length
EC041        Exmoor Plastics Ear Vent Drains -        Teflon                                    1.14 mm lumen dia x 2.45 mm inner
             Cylindrical Ventilation Tube                                                       flange dia. Outer flange - none. 7.11
                                                                                                mm total length

Prostheses List February 2005                                                                                                                                 Page 38 of 700
EAR, NOSE & THROAT                                                                                                                    Minimum   Maximum
Billing Code Product Name                        Description                                Size                                      Benefit   Benefit    Notation
EC042        Exmoor Plastics Ear Vent Drains -   With wire, teflon                          1.14 mm lumen dia x 3.61 mm inner
             Shah Ventilation Tube                                                          flange dia x 2.59 mm outer flange dia x
                                                                                            1.42 inter flange. 2.41 mm total length
EC043        Exmoor Plastics Ear Vent Drains -   Teflon                                     1.14 mm lumen dia x 3.61 mm inner
             Shah Ventilation Tube                                                          flange dia x 2.59 mm outer flange dia x
                                                                                            1.42 inter flange. 2.41 mm total length
EC044        Exmoor Plastics Ear Vent Drains -   Bevelled flange, silicone rubber           1.14 mm lumen dia x 5.2 mm inner
             Shah Permavent                                                                 flange dia. Outer flange - none. 6.0
                                                                                            mm total length
Endotherapeutics Pty Ltd
      Cement
ET031        Serenocem Cement                    Reaction bonded polymer composite          One size only - box of 2
                                                 formed by the neutralisation gelletation
                                                 of a basic inorganic ionomer
ET032        Serenocem Granules                  Reaction bonded polymer composite          0.5 - 1mm granules, 1gm or 5gm; 2 -
                                                 formed by the neutralisation gelletation   3mm granules, 1gm or 5gm - 3 pouches
                                                 of a basic inorganic ionomer
      Prostheses, Larynx
ET040        Vox Implants                        Vox Implants are solid, irregularly        One size only
                                                 textured, medical grade
                                                 Polydimethylsiloxane Elastomer
                                                 implants suspended in a hydrogel carrier
Enta Surgical Pty Ltd
      Tubes, Myringotomy
ES001        Trocar Myringotomy Tube             Myringotomy Tube with Trocar - Gold        One Size Only
                                                 Coated Silver; Myringotomy Tube with
                                                 Trocar - Titanium; Myringotomy Tube
                                                 with Trocar, with wire - Gold Coated
                                                 Silver; Myringotomy Tube with Trocar,
                                                 with wire - Titanium
Global Scientific Pty Ltd
      Nasal Septum Buttons
GS070        Septal Button                       Plastipore                                 One size only


Prostheses List February 2005                                                                                                                             Page 39 of 700
EAR, NOSE & THROAT                                                                                                                          Minimum   Maximum
Billing Code Product Name                              Description                               Size                                       Benefit   Benefit    Notation
      Prostheses, Ear
GS019        Canal Wall Prosthesis                     Grote, HA                                 Small - Large
      Prostheses, Larynx
GS124        Vocal Cord Medialisation Implant          Vocom Larynx Medial Implant -             3 - 7mm Head
                                                       Hydroxylapatite
GS125        Vocal Cord Medialisation Implant          Vocom Shim for Medial Implant -           1mm - 3mm Offset
                                                       Hydroxylapatite
      Prostheses, Ossicular, Incus and Stapes
GS020        Ossicular Prosthesis Malleus, Incus and   Goldenberg Footplate - HA                 One size only
             Stapes
GS021        Ossicular Prosthesis                      Attic Defect Plate, HA                    7-14mm
GS022        Ossicular Prosthesis Incus                a) Applebaum HA, b) Goldenberg HA,        a) small - large, b) one size only, c)
                                                        c) Kartusch HA , d) Grote HA, e)         short, medium, long, d) 7-10mm, e)
                                                       Wehrs (single & double notched) HA        short, average, medium, long
GS023        Ossicular Prosthesis - PORP               Sheehy plastipore, Drum to stapes,        One size only
                                                       Grote Malleus to stapes, modified,
                                                       centered or offcentered
GS032        Ossicular Prosthesis - PORP/TORP          Goldenberg Malleable/HA                   One Size Only
GS033        Ossicular Prosthesis Incus                a) Grote HA, b) Wehrs (single &           a) one size only, b) Short, medium, long
                                                       double notched) HA
GS042        Piston: Stapes Prosthesis                 a) Schuknecht Malleus att Piston.         a) 0.6x5.5mm-0.8x6.5, b) 0.3x0.8x3.5-
                                                       Stainless steel, b) Cawthorne.            0.3x0.8x6mm, c) 0.6x0.6x3.5-
                                                       Fluoroplastic, c) Fluoroplastic, d)       0.8x0.6x6mm,
                                                       Schuknecht. Stainless steel, e) Causse.   d) 0.4x3.5-0.5x5mm, e) one size only
                                                       Fluoroplastic
GS056        Piston: Stapes Prosthesis                 a) Armstrong. Platinum, b) McGee.         a) 0.6x3.5-0.8x5mm, b) 0.6x3.25-
                                                       Stainless steel, c) Richards. Teflon &    0.8x5.5mm,
                                                       platinum                                  c) 0.4x4-0.4x5mm
GS058        Piston: Stapes Prosthesis                 Fisch-Type Platinum or Stainless Steel    0.4mm x 6mm
GS060        Piston: Stapes Prosthesis                 Bucket Handle Fluoroplastic and           0.4 x 1 x 3.5mm - 0.6 x 1 x 5mm
                                                       stainless steel
GS061        Piston: Stapes Prosthesis                 Platinum Fluoroplastic                    0.6x3.5mm - 0.8x5mm
GS062        Piston: Stapes Prosthesis                 Platinum Fluoroplastic                    0.6x3mm - 0.8x5.75mm
Prostheses List February 2005                                                                                                                                   Page 40 of 700
EAR, NOSE & THROAT                                                                                                            Minimum   Maximum
Billing Code Product Name                 Description                                  Size                                   Benefit   Benefit    Notation
GS064        Piston: Stapes Prosthesis    McGee Shepherd's Crook - Stainless           0.6x3.5mm - 0.6x5.5mm
                                          Steel
GS127        Wehrs II Stapes Prostheses   Wehrs HAPEX Incus Prostheses,                0.6 - 1.57mm Shaft Dia
                                          Single & Double Notch
GS131        Dornhoffer Prostheses        Hydroxyapetite head/HAPEX shaft              0.8mm Shaft Dia TORP, 1.3mm Shaft
                                          PORP and TORP                                Diameter PORP
GS197        Ossicular Chain Prosthesis   Micron adjustable TORP/PORP.                 2-10mm, 2-5mm
                                          Titanium
GS198        Piston: Stapes Prosthesis    Smart: Nitinol/Flouroplastic                 0.5, 0.6, 0.8 x 3.75-4.75mm
      Prostheses, Ossicular, Total
GS043        Ossicular Prosthesis -TORP   a) black spanner strut HA, b) black oval     a) one size only, b) 7-10mm, c) 0.5-
                                           top TORP HA, c) black oval top              0.7mm
                                          PORP, universal, HA/fluoroplastic
GS045        Ossicular Prosthesis -TORP   Fisch plastipore, Causse modified            One size only
                                          plastipore, Shea modified plastipore/
                                          fluoroplastic, Austin modified plastipore,
                                           Tilt top plastipore
GS050        Ossicular Prosthesis -TORP   a) Shea malleable, HA/plastipore, b)         a) one size only, b) 4-8mm
                                          Shea plastipore
      Tubes, Myringotomy
GS071        Ventilation Tube             Shepard grommet, fluoroplastic or            1.02 -1.14mm
                                          silicon, vent tube w/wire.
GS072        Ventilation Tube             Shepard, fluoroplastic, w/Tab & wire         1.02 -1.14mm
GS073        Ventilation Tube             Shepard, Ultrasil Silicon & Blue Poly        1.02 - 1.14mm
GS074        Ventilation Tube             Lindeman-Silverstein - Fluorplastic          One size only
GS075        Ventilation Tube             Moretz (angled Spoon Bobbin style),          One size only
                                          Fluoroplastic
GS076        Ventilation Tube             Moretz (angled Spoon Bobbin Style)           One size only
                                          Titanium
GS077        Ventilation Tube             Grommet - Pope - Fluorplastic                One size only
GS078        Ventilation Tube             Rock Paediatric - Fluorplastic               One size only
GS079        Ventilation Tube             T-Tube Richards Silicon, Soft Silicon,       1.14mm
                                          Ultrasil
Prostheses List February 2005                                                                                                                     Page 41 of 700
EAR, NOSE & THROAT                                                                                                       Minimum   Maximum
Billing Code Product Name       Description                               Size                                           Benefit   Benefit    Notation
GS080        Ventilation Tube   T-Tube Richards Modified Silicon &        1.32mm
                                Ultrasil
GS081        Ventilation Tube   T-Tube Richards Modified Soft Silicon     1.32mm
GS082        Ventilation Tube   Butterfly T-Tube Silicon & Ultrasil       Silicon - one size only. Ultrasil - one size
                                                                           only.
GS083        Ventilation Tube   Micron Plus - Titanium                    One size only
GS084        Ventilation Tube   Armstrong Beveled Grommet Ultrasil        1.14mm
                                Silicon w/Tab
GS085        Ventilation Tube   Grommet - Sha Mini. Teflon                0.76mm
GS086        Ventilation Tube   Shah. Teflon, Silicon                     5.1mm
GS087        Ventilation Tube   Shah. Teflon, Fluorplastic w/Wire         1.14mm
GS088        Ventilation Tube   Shah. Teflon, Fluorplastic without Wire   1.14mm
GS089        Ventilation Tube   Armstrong Beveled Plain End               One size only
                                Fluoroplastic
GS090        Ventilation Tube   Armstrong Beveled Plain End Silcon        One size only
GS091        Ventilation Tube   Bobbin - Reuter Stainless Steel           1mm
GS092        Ventilation Tube   Bobbin - Reuter Stainless Steel           Without Wire 1.14-1.27mm, w/wire
GS093        Ventilation Tube   Bobbin - Reuter Fluoroplastic 1mm I.F     1mm
                                Without Holes
GS094        Ventilation Tube   Bobbin - Reuter Fluoroplastic 1mm I.F     1.14mm
                                Without Holes
GS095        Ventilation Tube   Bobbin - Reuter Fluoroplastic 1mm I.F     1.14mm
                                w/wire
GS096        Ventilation Tube   Bobbin - Reuter Fluoroplastic 1mm I.F     1.14mm
GS097        Ventilation Tube   Bobbin - Reuter Fluoroplastic 0.5mm       1.27mm
GS098        Ventilation Tube   Bobbin Micron Titanium                    1.14mm
GS099        Ventilation Tube   Bobbin Spoon 'V' - Titanium               One size only
GS100        Ventilation Tube   Collar Bobbin Fluoroplastic               1.27mm
GS101        Ventilation Tube   Collar Bobbin Fluoroplastic               0.75mm
GS102        Ventilation Tube   Collar Bobbin Fluoroplastic               1.14mm

Prostheses List February 2005                                                                                                                Page 42 of 700
EAR, NOSE & THROAT                                                                                                       Minimum   Maximum
Billing Code Product Name                    Description                               Size                              Benefit   Benefit    Notation
GS103        Ventilation Tube                Collar Bobbin Fluoroplastic               1.27x0.5mm
GS104        Ventilation Tube                Collar Button Ultrasil Silicon            1.27mm
GS105        Ventilation Tube                Collar Button Fluoroplastic Blue          1.27mm
GS106        Ventilation Tube                Collar Button Fluoroplastic w/Wire        1.27mm
GS107        Ventilation Tube                Collar Button Silicon                     1.27mm
GS108        Ventilation Tube                Collar Button Titanium                    1.14mm
GS109        Ventilation Tube                Collar Button Titanium                    1.27mm
GS110        Ventilation Tube                Donaldson Silicon                         1.14mm
GS111        Ventilation Tube                Donaldson Soft Silicon                    1.14mm
GS112        Ventilation Tube                Donaldson Silicon w/Tab                   1.14mm
GS113        Ventilation Tube                Donaldson Fluoroplastic                   1.14mm
GS114        Ventilation Tube                Donaldson Ultrasil Silicon                1.14mm
GS115        Ventilation Tube                Duravent Silicon                          1.27mm
GS116        Ventilation Tube                Duravent Blue Ultrasil                    1.27mm
GS117        Ventilation Tube                Paparella w/tab Fluoroplastic, Silicon,   1.02 - 2.03mm
                                             Soft Silicon, Ultrasil
GS118        Ventilation Tube                Per-Lee - Silicone                        One size only
GS119        Ventilation Tube                Shea w/Tab - Silicone                     0.76mm
GS120        Ventilation Tube                Shea Parasol w/Tab Small Flange -         1.02mm
                                             Silicone
GS121        Ventilation Tube                Shea Parasol w/Tab - Silicone             1.02mm
GS122        Ventilation Tube                Shea Parasol w/Tab - Silicone             1.52mm
GS123        Ventilation Tube                Straight Fluoroplastic or Polyethylene    0.89 x 12mm, 0.86 x 7mm, 1.14 x
                                                                                       12mm, 1.14 x 7mm
GS128        Venturi Plus Ventilation Tube   Hydromer coated titanium                  1.27mm ID
GS129        Jahn Ventilation Tube           Hydroxyapetite, or HA with                9mm length, 1-1.27mm diameter
                                             fluoroplastic liner
GS130        Canale Ventilation Tube         Silicone                                  1.14mm
GS132        Rube Ventilation Tubes          Silicone                                  1.14mm ID

Prostheses List February 2005                                                                                                                Page 43 of 700
EAR, NOSE & THROAT                                                                                                                 Minimum   Maximum
Billing Code Product Name                        Description                                Size                                   Benefit   Benefit    Notation
Med-Chem Pty Ltd
      Tubes, Myringotomy
ML001        Aero-Tymp Ventilation Tubes         Bevel Bobbin Ventilation Tube PE           1.15mm ID, 1.10mm ID, 1.25mm ID,
                                                 (Poly Ethylene);Reuter Bobbin              1.14mm ID
                                                 Ventilation Tube PTFE (Poly Tetra
                                                 Fluoro Ethylene);Sheehy Type Collar
                                                 Button PE (Poly Ethylene);Shepard
                                                 Ventilation Tube PE (Poly Ethylene),
ML002        Aero-Tymp Ventilation Tubes         Sterile - Donaldson Silicone Ventilation   1.10mm
                                                 Tube; Armstrong Bevelled Ventilation
                                                 Tube PE (Poly Ehtylene); Bx/10
ML003        Aero-Tymp Ventilation Tubes         Sterile - Goode T Tube Silicone; Goode     1.3mm ID x 12.0mm long, 1.3mm ID x
                                                 T Tube Silicone; Bx/10                     6.0mm long
Medical Vision Australia Pty Ltd
      Stents
MF001        Endoxane                            Silicone tracheal and bronchial stents -   10 - 20mm diameter, 20 - 60mm length
                                                 Dumon
      Stents, Bronchial
MF002        Tracheobronxane Silmet              Nitinol wire - tracheal and bronchial      12 - 20mm diameter, 20 - 90mm length
                                                 stenets - Dumon
Medtel Australia Pty Ltd
      Caps, Bone
ME078        BAHA - Bone Anchored Hearing Aids   Cover screw unigrip                        One size only




Prostheses List February 2005                                                                                                                          Page 44 of 700
EAR, NOSE & THROAT                                                                                                      Minimum   Maximum
Billing Code Product Name                         Description                              Size                         Benefit   Benefit    Notation
      Hearing Aids
ME176        BAHA - Bone Anchored Hearing Aid -   The BAHA Hearing Aids (Compact,                                                            To be claimed
             Various Models                       Classic 300 & Cordelle II in various                                                       only for patients
                                                  colours) are the external hearing                                                          with deafness
                                                  processors which are attached to the                                                       who have
                                                  implanted titanium fixture by a snap                                                       problems using air
                                                  coupling. This allows the sound                                                             conduction or
                                                  transmission using bone conduction for                                                     conventional
                                                  patients where conventional hearing                                                        hearing aids which
                                                  devices are not indicted.                                                                   is made worse
                                                                                                                                             when a hearing
                                                                                                                                             aid mould is worn.
      Plugs
ME075        BAHA - Bone Anchored Hearing Aids    Abutment Snap Coupling                   5.5mm
      Screws, Bone
ME076        BAHA - Bone Anchored Hearing Aids    Flange fixture                           3mm
ME077        BAHA - Bone Anchored Hearing Aids    Flange fixture                           4mm
ME137        BAHA - Bone Anchored Hearing Aids    Flange Fixture - Titanium                Self Tapping 3mm
ME138        BAHA - Bone Anchored Hearing Aids    Flange Fixture - Titanium                Self Tapping 4mm
ME139        BAHA - Bone Anchored Hearing Aids    Flange Fixture - Titanium                Self Tapping 3mm with BAHA
ME140        BAHA - Bone Anchored Hearing Aids    Flange Fixture - Titanium                Self Tapping 4mm with BAHA




Prostheses List February 2005                                                                                                               Page 45 of 700
EAR, NOSE & THROAT                                                                                                                   Minimum   Maximum
Billing Code Product Name                            Description                           Size                                      Benefit   Benefit    Notation
Medtronic Australasia Pty Ltd
      Middle Ear Analyzers
MC256        Pressure Pulse Generator Meniett 20     Composition - Polycarbonate           One size only                                                  To be claimed
                                                                                                                                                          only where
                                                                                                                                                          medical therapy
                                                                                                                                                          such as lifestyle
                                                                                                                                                          (general health
                                                                                                                                                          assessment and
                                                                                                                                                          stress reduction)
                                                                                                                                                          and oral
                                                                                                                                                          medications
                                                                                                                                                          (diuretics, anti-
                                                                                                                                                          emetics, anti-
                                                                                                                                                          vertigo and
                                                                                                                                                          steriods) have
                                                                                                                                                          been unsuccessful

      Nasal Septum Buttons
MC264        Septal Button                           Silicone                              3cm
      Prostheses, Ossicular, Incus and Stapes
MC258        Ossicular, Incus and Stapes             Flex H/A, Dense H/A, Titanium, SS,    0.4 - 1.17mm x 2.0 - 4.0mm x 4.25 -
                                                     Fluroplastic, Polycel                 10.2mm
MC259        Ossicular, Incus and Stapes             Flex H/A, Polycel, SS                 Small, Medium, Large, 0.6 x 2.2 x
MC260        Ossicular, Incus and Stapes             H/A, Polycel, SS                      0.6 - 0.8mm x 3.0 - 4.0mm x 7.0 - 8.0mm
MC261        Ossicular, Incus and Stapes             Polycel, SS, Fluroplastic             0.6 - 1.17mm x 0.3 - 4.0mm x 4.75 -
                                                                                           8.0mm
MC262        Ossicular, Incus and Stapes             Platinum, Fluroplastic, SS, Polycel   0.4 - 1.17mm x 2.2 - 8.8mm x 3.5 -
                                                                                           10.0mm
MC263        Ossicular, Incus and Stapes             SS, Fluroplastic, Polycel             0.5 - 0.6mm x 3.5 - 6.0mm and One
                                                                                           Size Only
MC266        Prostheses Ossicular Incus and Stapes   H/A, Polycel, SS                      0.6 - 4.0mm x 2.7 - 5.0mm x 1.5 -
                                                                                           10.0mm
      Prostheses, Ossicular, Total
MC267        Ossicular, Incus and Stapes             Universal Middle Ear Prosthesis,      Round 2.5 x 10mm, Cam 4.0 x 2.7 x
                                                     titanium round and cam head design    10.0mm

Prostheses List February 2005                                                                                                                            Page 46 of 700
EAR, NOSE & THROAT                                                                                                                     Minimum   Maximum
Billing Code Product Name                              Description                            Size                                     Benefit   Benefit    Notation
      Reconstruction Blocks, Plastic Surgery
MC255        Medtronic Xomed Australia Material        ePTFE - expanded                       0.75cm x 40cm x 0.6mm; 0.4cm x 20cm
             Implantable Sterile - Gore Thyroplasty    polytetrafluroethyelene                 x 0.6mm; 0.6cm x 20cm x 0.6mm
MC265        Silicone Blocks                           Netterville Phonoform Block - Right,   Right - One size only, Left - One size
                                                       Left, Wedge & Strip                    only, Wedge - One size only & Strip -
                                                                                              One size only
      Tubes, Myringotomy
MC268        Activent Antimicrobial Ventilation Tube   Silicone, Silver Oxide, Fluroplastic   0.76 - 1.52mm x 2.1 - 9.5mm x 1.0 -
                                                                                              12.0mm
MC269        Activent Antimicrobial Ventilation Tube   Silicone, Silver Oxide, Fluroplastic   1.02 - 1.27mm x 0.9 - 2.4mm
MC270        Activent Antimicrobial Ventilation Tube   Silicone & Silver Oxide. Sheehy        1.27 x 2.9 x 1.3mm
MC271        Vent Tube                                 Silicone, Fluroplastic, Titanium, SS   1.02 - 1.27mm, 1.58 - 2.7mm
MC272        Vent Tube                                 Silicone, Fluroplastic                 1.02 - 1.52mm x 0.9 - 4.45mm
MC273        Vent Tube                                 Silcone Fluroplastic                   1.02 - 1.27mm x 1.3 - 3.0mm
MC274        Vent Tube                                 Titanium, Fluroplastic                 1.02 - 1.27mm x 1.0 - 3.5mm
MC275        Vent Tube                                 Fluroplastic, Silicone                 1.14 - 1.27mm x 0.9 - 3.0mm
MC276        Vent Tube                                 Silicone, Fluroplastic, H/C Flex       0.76 - 1.27mm x 1.0 - 7.5mm
MC277        Vent Tube                                 Silicone, Fluroplastic, C-Flex         0.89 - 1.52mm x 2.3 - 12.0mm
MC278        Vent Tube                                 Silicone, Fluroplastic                 0.76 - 1.27mm x 1.5 - 12.0mm
MC279        Vent Tube                                 Microgel, Titanium, SS                 1.02 - 1.27mm x 2.7 - 9.1mm
MC280        Vent Tube                                 Silicone, Fluroplastic                 1.02 - 1.52mm x 1.3 - 12.0mm
Morton Surgical Pty Ltd
      Tubes, Myringotomy
MG003        Micromedics Ventilation Tubes                                                    Micromedics;Shepard;1.0mm / 1.14mm
                                                                                              lumen;Fluroplastic / Silicone;w.tab /
                                                                                              w.wire;box of 6 / box of 50
MG011        Micromedics Ventilation Tubes                                                    Micromedics; Donaldson; 1.14mm
                                                                                              lumen; Silicone / Fluroplastic; w.tab;
                                                                                              box of 6 / box 50




Prostheses List February 2005                                                                                                                              Page 47 of 700
EAR, NOSE & THROAT                                                                                                             Minimum   Maximum
Billing Code Product Name                       Description                        Size                                        Benefit   Benefit    Notation
MG012        Micromedics Ventilation Tubes                                         Micromedics; Paparella-I / Paparella-II;
                                                                                    1.14mm / 1.42mm lumen; Silicone; box
                                                                                   of 6 / box of 50
MG013        Micromedics Ventilation Tubes                                         Micromedics; T-tubes;
                                                                                   (12x10)/(5x8)/(5x4)/(8x5.5); 1.14mm /
                                                                                   1.27mm / 1.4mm lumen ; silicone; box
                                                                                   of 6 / box of 50;
MG014        Micromedics Ventilation Tubes                                         Micromedics; Armstrong; bevelled
                                                                                   straight / grommit / w.wire; 7mm /
                                                                                   7.5mm / 1.14mm; silicone / fluroplastic;
                                                                                   box of 6 / box of 50
MG015        Micromedics Ventilation Tubes                                         Micromedics; Collar Button; 1.27mm
                                                                                   lumen; fluroplastic; box of 6 / box of 50
MG016        Micromedics Ventilation Tubes                                         Micromedics;Reuter Bobbin;1.0mm /
                                                                                   1.14mm lumen; fluroplastic; box of 6 /
                                                                                   box of 50
MG017        Micromedics Ventilation Tubes                                         Micromedics; Shah with wire; mini
                                                                                   0.76mm lumen; fluroplastic; box of 6 /
                                                                                   box of 50
O R Paradigm Pty Ltd
      Prostheses, Ossicular
OS002        Ossicular Prostheses - PORP        ALTO (adjustable Length Titanium   Head Size 2.5mm x 3.5mm; Length
                                                Ossicular) Partial                 2.0mm - 5.6mm; Distal Diameter
                                                                                   1.2mm (Cup)
OS004        Ossicular Prostheses - TORP/PORP   OtoSil Universal                   Head Size 3.5mm; Length 8.0mm; Shaft
                                                                                   Diameter 1.0mm
OS005        Ossicular Prostheses - PORP        OtoSil Partial                     Head Size 3.0mm - 4.0mm; Length
                                                                                   6.0mm; Cannulation Diameter 1.12mm
OS007        Ossicular Prostheses - PORP        Dense HA Partial                   Head Size 3.0mm - 4.0mm; Length
                                                                                   5.0mm; Cannulation Diameter 1.17mm
OS008        Ossicular Prosthese - PORP         Dense HA Footplate Shoe            Width 2.0mm; Height 1.32mm
OS010        Ossicular Prostheses - PORP        Dense HA Partial Incus Strut       Length 5.0mm; Cannulation Diameter
                                                                                   1.17mm



Prostheses List February 2005                                                                                                                      Page 48 of 700
EAR, NOSE & THROAT                                                                                                          Minimum   Maximum
Billing Code Product Name                  Description                               Size                                   Benefit   Benefit    Notation
OS011        Ossicular Prostheses - PORP   Gator Stapes                              Shaft Diameter 0.6mm; Length 3.5mm -
                                                                                     5.5mm
OS012        Ossicular Prostheses - PORP   Titanium Bucket                           Shaft Diameter 0.4mm - 0.8mm; Length
                                                                                     4.0mm - 5.0mm
OS013        Ossicular Prostheses - PORP   Causse Type Fluoroplastic Stapes          Shaft Diameter 0.4mm - 0.8mm; Length
                                                                                     3.5mm - 6.0mm; Loop Diameter
      Prostheses, Ossicular, Total
OS001        Ossicular Prostheses - TORP   ALTO (Adjustable Length Titanium          Head Size 2.5mm x 3.5mm; Length
                                           Ossicular) Total                          3.0mm - 8.0mm; Distal Diameter
OS003        Ossicular Prostheses - TORP   OtoSil total                              Head Size 3.0mm - 4.0mm; Length
                                                                                     8.0mm; Shaft Diameter 1.0mm
OS006        Ossicular Prostheses - TORP   Dense HA Total                            Head Size 3.0mm - 4.0mm; length
                                                                                     4.0mm - 8.0mm; Shaft Diameter 0.8mm
OS009        Ossicular Prostheses - TORP   Dense HA Total Incus - Stapes Strut       Length 8.0mm; Shaft Diameter 0.8mm
      Prosthesis, Internal, Tube, Tympanostomy
OS014        Tympanostomy Tube             Titanium                                  0.78mm - 1.27mm diameter
OS015        Tympanostomy Tube             Collar Button & Straight                  0.90mm-1.27mm diameter
OS016        Tympanostomy Tube             Paparella Types (Paparella, Tapered       1.00mm-2.03mm diameter
                                           Lumen, Bevelled Armstrong, Sheehy)
OS017        Tympanostomy Tube             Grommet - Types (Shepard, Bobbin,         1.02mm - 1.27mm diameter
                                           Donaldson)
OS018        Tympanostomy Tube             T-Tube & Modified T-Tube                  5mm - 12mm long; 1.14mm - 1.35mm
                                                                                     diameter
Pacific Medical
      Ear/Nose/Throat Treatment Units
PM065        Tympo Vent                    Otological ventilation tubes, short       Length 2.2
                                           medium term, Donaldson
                                           fluoroplastic/blue
PM066        Tympo Vent                    Otological ventilation tubes, straight tube Length 7.0 - 7.2mm
PM068        Tympo Vent                    Otological ventilation tubes, short         Length 2.8
                                           medium term, star tube, silicone


Prostheses List February 2005                                                                                                                   Page 49 of 700
EAR, NOSE & THROAT                                                                                        Minimum   Maximum
Billing Code Product Name              Description                                 Size                   Benefit   Benefit    Notation
PM072        Tympo Vent                Otological ventilation tubes, short         Length 12.4
                                       medium term, shepard with tail,
                                       silicone/blue
PM074        Tympo Vent                Otological ventilation tubes, paparella     Length 2.2mm
                                       with tab
PM075        Tympo Vent                Otological ventilation tubes, collar        Length 1.5mm
                                       button, tubingen type gold, gilded silver
PM079        Tympo Vent                Otological ventilation tubes, t-tube        Length 6 - 12mm
PM083        Tympo Vent                Otological ventilation tubes, long term,    Length 1.5
                                       collar button - tubingen type, titanium
PM086        Tympo Vent                Otological ventilation tubes, short         Length 1.6
                                       medium term, reuter bobbin without
                                       holes, titanium
PM087        Tympo Vent                Otological ventilation tubes, short         Length 1.5
                                       medium term, reuter bobbin with holes,
                                       stainless steel
PM088        Tympo Vent                Otological ventilation tubes, donaldson,    Length 1.5mm - 9.8mm
                                       reuter bobbin, shepard
PM089        Tympo Vent                Otological ventilation tubes, short         Length 1.8
                                       medium term, bevel bobbin,
                                       fluoroplastic/blue
PM090        Tympo Vent                Otological ventilation tubes, armstrong     Length 3.8 - 10.0mm
PM091        Tympo Vent                Otological ventilation tubes, short         Length 2.0
                                       medium term, collar button,
                                       fluoroplastic/blue
      Grafts
PM107        Laryngeal Keel                                                        12-16mm Keel
      Larynxes, Artificial
PM057        Provox Voice Prosthesis   Long term indwelling; Silicone              4.5,6,8,10,12.5mm                           Only able to be
                                                                                                                               claimed once for
                                                                                                                               the initial implant
      Prostheses, Ear
PM028        Stapes                    Bell/Aerial/Angular Prosthesis/Piston -     1.75 - 7.00mm
                                       Gold/Titanium
Prostheses List February 2005                                                                                                 Page 50 of 700
EAR, NOSE & THROAT                                                                                                                    Minimum   Maximum
Billing Code Product Name                          Description                              Size                                      Benefit   Benefit    Notation
PM032        K-Piston                              Gold/Titanium                            ID 0.4,0.6mm
      Prostheses, Larynx
PM033        Montgomery Thyroplasty Implant System Silicone                                 6,7,8,9,10,11,12
      Tubing
PM102        Tracheal Cannula System               Short and long term Cannula (Medical     Diameter 9-13mm; Length 37m &
                                                   Grade Silicone)                          101mm
PM103        Tracheal Cannula System               Cannula Speaking Valves (Medical         4-10                                                           Only able to be
                                                   Grade Plastic)                                                                                          claimed once for
                                                                                                                                                           the intial implant
PM104        Montgomery Safe-T-Tube                Paediatric, Standard, Thoracic, Extra-   Paediatric/Standard - Clear/Radioplaque
                                                   Long, Tapered and Hebeler in clear and
                                                   radiopaque
PM106        Montgomery Safe-T-Tube                Paediatric, Standard, Thoracic, Extra-   ID 8/10, 10/13, 12, 15, 18mm; Length
                                                   Long, Tapered, Hebeler and HMS, in       76, 77, 79, 159, 163mm
                                                   clear and radiopaque
PM115        Montgomery Safe-T-Tube                Paediatric, Standard, Thoracic, Extra-   ID 7, 9, 11mm; Length 100, 110mm
                                                   Long, Tapered, Hebeler and HMS
Pacing Importers Pty Ltd
      Stimulators, Auditory
PI005        Combi C40+ Implantable Auditory                                                One Size Only
             Stimulator
PI006        Tempo+ Auditory Implant Speech        Tempo+ Auditory Implant Speech           One Size Only
             Processor                             Processor
Precise Medical Supplies
      Tubes, Myringotomy
PR001        Medasil Teflon Aural Grommets         Teflon grommets                          Shepard with wire
PR002        Medasil Teflon Aural Grommets         Teflon grommets                          Shepard without wire
PR003        Medasil Teflon Aural Grommets         Teflon grommets                          Shah with wire
PR004        Medasil Teflon Aural Grommets         Teflon grommets                          Shah without wire
PR005        Medasil Teflon Aural Grommets         Teflon grommets                          Collar button
PR006        Medasil Teflon Aural Grommets         Teflon grommets                          Reuter bobbin

Prostheses List February 2005                                                                                                                             Page 51 of 700
EAR, NOSE & THROAT                                                                                                               Minimum   Maximum
Billing Code Product Name                       Description                               Size                                   Benefit   Benefit    Notation
Stryker Australia Pty Ltd
      Prostheses, Ossicular, Total
ST795        Titanium Middle Ear Prostheses     Fisch Incus Prostheses: short, medium,    2x3mm, 2x4mm, 2 x 5mm
                                                large, Titanium
ST796        Titanium Middle Ear Prostheses     Fisch Neomalleus Prostheses, Titanium     1.1x5mm
ST797        Titanium Middle Ear Prostheses     Fisch Stapes Prostheses: short, medium,   0.4x7mm, 0.4x8.5mm, 0.4x10mm
                                                long, Titanium
ST798        Titanium Middle Ear Prostheses     Fisch Total Prostheses: with foot,        0.6x10mm
                                                Titanium
Technology For Life Pty Ltd
      Stents, Tracheal
TE010        Tracheal/Broncheal Stent           Silicone, Dumon                           10/20 to 18/80
TE011        Bronchial Tracheal Stent           Silicone, Dumon                           10/20 to 18/80
TE012        Harrell Y Stent Tracheal           Silicone, Dumon                           10/10/20 to 16/16/70
TE013        Westaby T Y Stent Tracheal         Silicone, Dumon                           10/10/20 to 16/16/90
William A Cook Aust Pty Ltd
      Stents
WC074        SONG-Nasolacrimal Duct Stent Set   Nasolacrimal Stent                        Stent 6Fr, 35mm, Stent Oval or Acute
             (SNDS)                                                                       Angle, Radiopaque proximal tip 0.5mm
                                                                                          or Entended proximal tip.
      Stents, Tracheal
WC073        Tracheal/broncheal stent           Gianturco-Rosch Trancheobronchial         Expanded Diameter 15-40 mm Length
                                                Stent                                     5cm




Prostheses List February 2005                                                                                                                        Page 52 of 700
ENDOSCOPIC PRODUCTS                                                                                                                    Minimum   Maximum
Billing Code Product Name                           Description                               Size                                     Benefit   Benefit    Notation
Auto Suture Company, Australia T/A Tyco
      Accessories, Endoscopes
AS045        STAT TACK* and Endoscopic Tacker       Endoscopic TACKER*; Titanium;             20 tacks; 30 tacks; 5mm; 4mm, 4.8mm                           Temporary
             Device; PROTACK* Hernia Stapling       Titanium Surgical Stapler.                (10 staples).                                                 Approval
             Product; ENDO UNIVERSAL*
AS073        ENDOCLIP*; Acuclip Single use          Titanium Surgical Stapler                 5mm (12 clips); One size only.                                Temporary
             Endoscopic Multiple Clip Applier.                                                                                                              Approval
AS074        ENDOCLIP*                              Titanium Surgical Stapler                 10mm (ML, M, L)-(20 clips)                                    Temporary
                                                                                                                                                            Approval
      Clip Appliers
AS001        Endoclip Disposable Loading Unit;      Single use loading unit with 8 titanium   One size only                                                 Temporary
             MultApplier Disposable loading unit.   clips; Disposable clip cartridge with 8                                                                 Approval
                                                    titanium clips
      Staples, Tissue
AS046        Endo GIA* Universal Stapling System;   Multifire 30 disposable stapler with      12mm; One size only.                                          Temporary
             Versafire GIA*.                        titanium staples; Disposable surgical                                                                   Approval
                                                    stapling instruments or cartridges.
AS076        ENDO TA* reloading unit                Titanium Surgical Stapler DLU             30mm -2.5, 30mm-3.5                                           Temporary
                                                                                                                                                            Approval
AS077        ENDO GIA*                              Titanium Surgical Stapler                 30 - 35mm                                                     Temporary
                                                                                                                                                            Approval
AS081        ENDO GIA* reloading unit               Titanium Surgical Stapler DLU             30 - 35mm; 45mm; 60mm.                                        Temporary
                                                                                                                                                            Approval
AS092        ENDO - Herna reloading unit; VERSA     Titanium Surgical Stapler DLU             4mm, 4.8mm (10 staples).                                      Temporary
             TACK* reloading unit.                                                                                                                          Approval
AS095        STAT TACK* and Endoscopic Tacker       STAT TACK*                                One size only                                                 Temporary
             Device                                                                                                                                         Approval
Bard Australia Pty Ltd
      Stents, Biliary
BA124        Memotherm Biliary Stent                Nitinol. Includes deployment system       Sizes - Diameter 8 - 10mm, Length 40 -
                                                                                              100mm



Prostheses List February 2005                                                                                                                              Page 53 of 700
ENDOSCOPIC PRODUCTS                                                                                                                            Minimum   Maximum
Billing Code Product Name                               Description                                 Size                                       Benefit   Benefit    Notation
Boston Scientific Pty Ltd
      Device Kits With Drugs
BS064        Enteryx Procedure Kit                      Enteryx is supplied as a kit that is made   Solution 10ml, DMSO 10ml, syringes
                                                        up of Enteryx solution, DMSO (dimethyl      1ml (2), needles 18 gauge x 1 1/2
                                                         sulfoxide) a primer solution, Enteryx
                                                        injection catheters, syringes and needles
      Stents
BS071        Ultraflex Precision Colonic Stent System   The Ultraflex Precision Colonic Stent       Dia 25mm along body and 30mm at
                                                        System consists of a self-expanding         flared distal section. Stent Length 60 -
                                                        metal stent and a delivery catheter.        120mm
      Stents, Biliary
BS066        Biliary Drainage Stent, Amsterdam          The Biliary Stent is supplied with a push   French Size 7Fr to 12Fr, Length
             Biliary Stent                              catheter and possibly a guide catheter.     between pigtails/barbs: 5cm to 15cm
BS070        Wallstent RX Biliary Endoprosthesis        Self-expanding metal stent constructed      Diameter: Up to 10mm, Stent Length:
             with Unistep Plus delivery System          from a biomedical Cobalt-based super        Up to 100mm
                                                        alloy wire, Eligiloy, with a tantalum
                                                        core. The stent is either bare or
                                                        covered with silicone. The stent is
                                                        mounted on a delivery catheter.
Endotherapeutics Pty Ltd
      Stents, Esophageal
ET035        Sinus-Esophageal Stent                     Self expanding stent made of nickel -       Diameter 24-18-24mm, length
                                                        titanium alloy                              50,70,90,120mm; Diameter 26-20-26,
                                                                                                    length 50,70,90,120mm
ET045        Boubella Esophageal Stent                  Self expandable stainless steel wire        Length 90 - 195mm
                                                        stent with anti-reflux valve
      Stents, Vascular
ET038        SX-Ella Biliary Stent                      Uncovered, self-expanding nitinol stent     Dia 8-12mm, length 50-77mm
ET039        SX-Ella Tips Stent                         Uncovered, self-expanding nitinol stent     Dia 10-14mm, length 52-77mm




Prostheses List February 2005                                                                                                                                      Page 54 of 700
ENDOSCOPIC PRODUCTS                                                                                                                             Minimum   Maximum
Billing Code Product Name                               Description                                 Size                                        Benefit   Benefit    Notation
Incision Pty Ltd
        Prostheses, Gastroesophageal Antireflux
IP005        Durasphere GR                              Composition: Pyrolitically carbon coated    Syringe 1 ml
                                                        silica bead in an aqueous gel. Injectable
                                                        bulking agent for the treatment of
                                                        GERD (Reflux Disease). Syringe plus
IP006        Durasphere GR                              Composition: Pyrolitically carbon coated    Syringe 3ml
                                                        silica bead in an aqueous gel. Injectable
                                                        bulking agent for the treatment of
                                                        GERD (Reflux disease). Syringe plus
Johnson & Johnson Medical Pty Ltd
        Fixation Device
JJ435        EndoANCHOR                                 EndoANCHOR System with Nitinal              Device Length 482; Device Shaft
                                                        Anchors                                     Length 360mm; Shaft Diameter 5mm;
                                                                                                    Implantable Construct Width 6.7mm,
                                                                                                    Implantable Construct length 5.9mm
Linvatec Australia
        Accessories, Endoscopes
LV076        Richard Allan Endoscopic Accessories       Titanium endoscopic clips with applier      Medium-Large, 9mm closed. 20 clips                               Temporary
                                                                                                                                                                     Approval
LV079        Articulator 35 Articulating Stapler/Cutter Dual triple staggered rows of 54            33mm cut length, 37mm staple line (2 x                           Temporary
                                                        titanium staples                            triple rows of staples), Regular or Short                        approval
                                                                                                    shaft, 1.5 or 2.5mm staple.
LV080        Articulator 35 Cartridge                   Dual triple staggered rows of 54            33mm cut length, 37mm staple line (2 x                           Temporary
                                                        titanium staples                            triple rows of staples), Regular or Short                        approval
                                                                                                    shaft, 1.5 or 2.5mm staple.
LV081        Open Clip Applier                          Titanium                                    25 medium size titanium clips                                    Temporary
                                                                                                                                                                     approval
Medtel Australia Pty Ltd
        Prosthesis, Internal, Stent
ME124        Emphasys Endobronchial Valve               One way valve                               Small, Medium, Large




Prostheses List February 2005                                                                                                                                       Page 55 of 700
ENDOSCOPIC PRODUCTS                                                                                                                        Minimum   Maximum
Billing Code Product Name                             Description                                Size                                      Benefit   Benefit    Notation
Monarch Medical
      Clip Appliers
MH008        Applied Medical Laparoscopic Clip        Disposable Clip Applier made from          Medium - large - 20 clips per device                           Temporary
             Applier - Disposable Cartridge - CA001   polycarbonate, nylon, stainless steel,                                                                    Approval, pending
             Box of 10                                liquid crystal polymer, bone wax,                                                                         review of product
                                                      titanium clip. The disposable cartridge                                                                   group
                                                      is used in conjunction with a reuseable
                                                      handle.
MH009        Applied Medical Laparoscopic Clip        Disposable Clip Applier made from          Medium - large, 20 clips per device                            Temporary
             Applier - Disposable CA080 Box of 6      polycarbonate, nylon, stainless steel,                                                                    Approval, pending
                                                      liquid crystal polymer, bone wax,                                                                         review of product
                                                      titanium clip                                                                                             group
      Clips, Vascular
MH001        Clips                                    Haemostatic Clips                          10-mm, 14 med/lrg                                              Temporary
                                                                                                                                                                approval
MH004        Applied TiGold Laparoscopic              Polypropylene, stainless steel, titanium   11 mm, 14 med/lrg clips                                        Temporary
             Disposable Multifire Clip Applier                                                                                                                  approval
Nutricia Australia
      Enteral Feeding Kits
NF002        Flocare Percutaneous Endoscopic          The Flocare PEG set is for endoscopic      various sizes - charriere 10, 14 and 18
             gastrostomy (PEG) set                    placement of a gastrostomy tube, based
                                                      on the "Pull" technique.
      Tubes, Gastrostomy, Other
NF001        Flocare Gastrostomy tube (G-tube)        The Flocare Gastrostomy tube can be        Ch10, 14, 18, 20
                                                      used as a replacement of an existing
                                                      gastrostomy tube (PEG or G-tube) or as
                                                       an initial gastrostomy tube during a
                                                      surgical intervention. This balloon tube
                                                      is made of Carbothane, which ensures a
                                                       longer life than tubing made of PUR or
                                                      silicone.




Prostheses List February 2005                                                                                                                                  Page 56 of 700
ENDOSCOPIC PRODUCTS                                                                                                                        Minimum   Maximum
Billing Code Product Name                            Description                             Size                                          Benefit   Benefit    Notation
Olympus Australia
      Accessories, Endoscopes
OL001        Individual Ligating Clip                Rotatable Clip Fixing Device. Pack of   MD-59 - 90 degree, standard; MD-850                                Temporary
                                                     50 clips                                - 135 degree, standard; HX-600-090 -                               Approval
                                                                                             standard, sterile; HX-600-135 -
                                                                                             standard, sterile
OL002        Individual Ligating Clip                Rotatable Clip Fixing Device. Pack of   MH-858 - 90 degree, long. MH-859 -                                 Temporary
                                                     50 clips                                90 degree, short. MAJ-458 - 90 degree,                             Approval
                                                                                             short. MAJ-459 -135 degree, short.
OL006        Individual Ligating Clip                Ligating Device - loops. Pack of 10     MAJ-254-30mm loop; MAJ-339-                                        Temporary
                                                     loops.                                  13mm loop; MAJ-340 -20 mm loop                                     Approval
William A Cook Aust Pty Ltd
      Anchor, Fixation
WC014        Cope Gastrointestinal Suture Anchor                                             Standard, pediatric
             Set (GIAS)
      Catheterization Kits, Central Venous
WC195        Cook Central Venous Catheterisation     Long Term Drug Infusion Catheter        Triple Lumen 12.5fr
             Kits                                    With or Without Clamp and Cuff
      Clips
WC213        Endoscopic Clipping Device              TriClip Endoscopic Clipping Device      7Fr - 3 Prong 12mm, 8Fr - 3 prong 12mm
      Prostheses, Bile Duct
WC166        Cook Bile Duct Prostheses               Solus Double Pigtail Stent Set with     10 fr, Length: 3, 4, 5, 7, 9, 10, 12, 15 cm
                                                     Introducer
      Prosthesis, Internal, Stent, Pancreatic
WC212        Pancreatic Stent Sets                   Zimmon Pancreatic Stent without         3Fr -4,6,8,10,12cm
                                                     Ductal Flap, Pigtail with Radiopaque
      Stents, Biliary
WC174        Zilver Stent Expandable Metal Biliary                                           Diameters: 6, 8, 10cm; Lengths: 4,6,8cm
             Stent System
WC200        Zilver Stent Expandable Metal Biliary   Zilver Biliary Stent with Fusion        6mm, 8mm & 10mm; Cm length: 4cm,
             Stent System                            Introducer System                       6cm & 8cm


Prostheses List February 2005                                                                                                                                  Page 57 of 700
ENDOSCOPIC PRODUCTS                                                                                              Minimum   Maximum
Billing Code Product Name                         Description               Size                                 Benefit   Benefit    Notation
      Stents, Esophageal
WC144        Cook Gianturco-Rosch Covered         Stent and Introducer      Medial Diam 17mm, Distal Diam 25mm
             Esophageal Z-Stent Extension
      Stents, Pancreatic
WC194        Johlin Pancreatic Wedge Stent with   Johlin Pancreatic Stent   8.5 and 10fr, 8cm - 16cm
             Wedge Stent Introduction




Prostheses List February 2005                                                                                                        Page 58 of 700
GENERAL/MISCELLANEOUS                                                                                                                           Minimum   Maximum
Billing Code Product Name                               Description                                  Size                                       Benefit   Benefit    Notation
Abbott Australasia Pty Ltd
      Enteral Feeding Kits
AY002        Flexiflo inverta PEG kit Basic, Flexiflo   Composition - biocompatible silicone         20F
             inverta PEG kit with snare                 tube. Items included in kit/product -
                                                        Sliding retention disc, Insertion wire,
                                                        Gastrostomy tube with attached Dilator
                                                        Catheter, seldinger needle 14g, magna
                                                        port connector, scalpel, Snare (in kit
                                                        with snare)
AY003        Durapeg kit                                Composition - biocompatible                  16F
                                                        Polyurethene tube. Items included in
                                                        kit/product - Sliding retention disc, drum
                                                        wire dispenser, 16 french peg tube,
                                                        pinch clamp, luer lock connector,
                                                        scalpel. Endoscopically removed
AY004        Hide-A-Port                                Composition - biocompatible silicone.        Size: 14 french, length: 1.5cm; Size: 16
                                                        Items included in kit/product - 1 low        french, Length: 1.5, 2.0cm; Size: 18
                                                        profile Balloon Gastrostomy tube,            french, Length: 1.2cm, 1.5cm, 1.7cm,
                                                        Straight extension tube, Extension tube      2.0cm, 2.3cm, 2.5cm, 3.0cm, 3.5cm,
                                                        with right angle adaptor, luer lock          4.0cm; Size: 20 french, Length: 2.0cm,
                                                        syringe, lubricant.                          2.7cm, 3.0cm, 3.5cm, 4.0cm; Size: 24
                                                                                                     french, Length: 1.7cm, 2.0cm, 2.5cm,
                                                                                                     2.7cm, 3.5cm
      Procedure Trays, Surgical
AY001        Flexiflo Stomate - low profile             Composition - biocompatible silicone.        Size: 18 french, length: 2, 2.8, 4.3cm;
             gastrostomy kit                            Items included in kit/product - 1 low        Size 22 french. Length: 1.7, 2.8, 4.3cm
                                                        profile stomate gastronomy tube,
                                                        Obturator, Y port connector with right
                                                        angle adaptor, Lubricant.
AY005        Flexiflo balloon gastrostomy tube          Composition - biocompatible silicone.        16 french, 18 french, 20 french
                                                        Items included in kit/product - sliding
                                                        retention disc and opened edged feeding
                                                         port




Prostheses List February 2005                                                                                                                                       Page 59 of 700
GENERAL/MISCELLANEOUS                                                                                         Minimum   Maximum
Billing Code Product Name                              Description                            Size            Benefit   Benefit    Notation
Advanced Biomedical Pty Ltd
      Grafts, Dura, Biological
AB012        Peri-Strips Dry                           Model No PSD 4506-EN                   One size only                        Temporary
                                                                                                                                   Approval
AB013        Peri-Strips Dry                           Model No PSD 6006-UN                   One size only                        Temporary
                                                                                                                                   Approval
AB014        Peri-Strips Dry                           Model No PSD 4506-ETSN                 One size only                        Temporary
                                                                                                                                   Approval
AB015        Peri-Strips Dry                           Model No PSD 3506-AN                   One size only                        Temporary
                                                                                                                                   Approval
AB016        Peri-Strips Dry                           Model No PSD 3006-N                    One size only                        Temporary
                                                                                                                                   Approval
AB017        Peri-Strips Dry                           Model No PSD 10006-EN                  One size only                        Temporary
                                                                                                                                   Approval
AB018        Peri-Strips Dry                           Model No PSD 4506-UN                   One size only                        Temporary
                                                                                                                                   Approval
AB019        Peri-Strips Dry                           Model No PSD 9006-UN                   One size only                        Temporary
                                                                                                                                   Approval
AB020        Peri-Strips Dry                           Model No PSD 8006-UN                   One size only                        Temporary
                                                                                                                                   Approval
AB021        Peri-Strips Dry                           Model No PSD 7506-EN                   One size only                        Temporary
                                                                                                                                   Approval
AB022        Peri-Strips Dry                           Model No PSD 5506-EN                   One size only                        Temporary
                                                                                                                                   Approval
      Tissue Reconstructive Materials
AB003        Bioglue Surgical Adhesive - 5ml Starter   Model No BG 3005 S (Bioglue Surgical   One size only                        Temporary
             Kit                                       Adhesive)                                                                   Approval
AB004        Bioglue Surgical Adhesive - 10ml          Model No BG 3010 S (Bioglue Surgical   One size only                        Temporary
             Starter Kit                               Adhesive)                                                                   Approval
AB005        Bioglue Surgical Adhesive - 5ml           Model No BG 3005-5 (Bioglue Surgical   One size only                        Temporary
             Solutions Cartridge Shelf Box: 5 pack     Adhesive)                                                                   Approval
AB006        Bioglue Surgical Adhesive - Applicator    Model No BGAT-20 (Bioglue Surgical     One size only                        Temporary
             Tip Extender                              Adhesive)                                                                   Approval
Prostheses List February 2005                                                                                                     Page 60 of 700
GENERAL/MISCELLANEOUS                                                                                                                     Minimum   Maximum
Billing Code Product Name                             Description                               Size                                      Benefit   Benefit    Notation
AB007        Bioglue Surgical Adhesive - 10ml         Model No BG 3010-5 (Bioglue Surgical      One size only                                                  Temporary
             Solutions Cartridge Shelf Box: 5 pack    Adhesive)                                                                                                Approval
AB008        Bioglue Surgical Adhesive - Standard     Model No BGAT (Bioglue Surgical           One size only                                                  Temporary
             Applicator Tip                           Adhesive)                                                                                                Approval
AB009        Bioglue Surgical Adhesive - Applicator   Model No BGAT-10 (Bioglue Surgical        One size only                                                  Temporary
             Tip Extender                             Adhesive)                                                                                                Approval
AB010        Bioglue Surgical Adhesive - Applicator   Model No BGAT-27 (Bioglue Surgical        One size only                                                  Temporary
             Tip Extender                             Adhesive)                                                                                                Approval
AB011        Bioglue Surgical Adhesive - 2ml          Model No BG3002-5 (Bioglue Surgical       One size only                                                  Temporary
             Solutions Cartridge Shelf Box: 5 pack    Adhesive)                                                                                                Approval
Advanced ORT Pty Ltd
      Gastroplasty Bands
OA003        Adjustable Peri Gastric Belt-Midband     Silicon moulded peri gastric band and     Peri gastric band - 2.2 x 17.5 x 0.8cm,
                                                      implantable chamber                       Implantable chamber - one size only
Amersham Health Pty Limited
      Brachytherapy Sources
AH001        Iodine 125 - 'Rapid Strand'              Rapid Strand consists of 10 welded        One size each                                                  Only to be funded
             Brachytherapy Implant, Iodine 125 -      titanium capsules containing iodine-125                                                                  where used in a
             'OncoSeeds' Brachytherapy Implant        absorbed onto a silver rod. OncoSeeds                                                                    service for which
                                                      consists of the loose seeds only.                                                                        a medicare benefit
                                                                                                                                                                is payable
                                                                                                                                                               (current MBS
                                                                                                                                                               items are 37220,
AH002        Iodine 125 - Rapid Strand                I-125 Rapid Strand, code IMC 7000,        One size only                                                  Only to be funded
             Brachytherapy Implant; OncoSeeds         consists of 10 welded titanium capsules                                                                  where used in a
             Brachytherapy Implant                    containing iodine 125. This assembly is                                                                  service for which
                                                      sterile, the acitivity of the capsules                                                                   a medicare benefit
                                                      "seeds" is available from 0.18mCi to                                                                      is payable
                                                      0.70mCi. Individual I-125 capsules                                                                       (current MBS
                                                      (seeds) are also available as OncoSeeds                                                                  items are 37220,
                                                       IMC6711. To be used only if more
                                                      than 120 seeds are used per patient.




Prostheses List February 2005                                                                                                                                 Page 61 of 700
GENERAL/MISCELLANEOUS                                                                                                                 Minimum   Maximum
Billing Code Product Name                           Description                                Size                                   Benefit   Benefit    Notation
Atrium Australia-Pacific Rim Pty Ltd
      Mesh, Polymeric
AC005        Atrium polypropolene mesh - surgical   Polypropolene                              7.5 x 15cm
             mesh
AC006        Atrium polypropolene mesh - surgical   Polypropolene                              30 x 30cm
             mesh
AC007        Atrium polypropolene mesh - surgical   Polypropolene                              15 x 15cm
             mesh
AC008        Atrium polypropolene mesh - surgical   Polypropolene                              26 x 36cm
             mesh
AC009        Atrium polypropolene mesh - surgical   Polypropolene - Pre-shaped with hole       6.5 x 12.5cm
             mesh
AC010        Atrium polypropolene mesh - surgical   Polypropolene                              5 x 10cm
             mesh
AC011        Atrium polypropolene mesh - surgical   Polypropolene mesh plug                    Small, Medium, Large and Extra Large
             mesh
Australasian Medical & Scientific Ltd
      Infusion Pump Administration Sets
AN002        Animas IR Insulin Infusion Cartridge   3.0ml Cartridge, sterile, indicated as     one size only
                                                    reservoir for insulin by the Animas
                                                    infusion pump; not intended for use with
                                                     any other infusion device.
AN003        Animas Insulin Infusion Sets           (INFUSION SET, COMFORT, 23",               one size only
                                                    HOSP 10, INFUSION SET,
                                                    COMFORT 43", HOSP 10) Needle
                                                    guard, soft cannula, adhesive tape,
                                                    introducer needle, cannula housing,
                                                    tubing, connector needle, circular
                                                    protective cap and disconnect cover.




Prostheses List February 2005                                                                                                                             Page 62 of 700
GENERAL/MISCELLANEOUS                                                                                                                  Minimum   Maximum
Billing Code Product Name                             Description                            Size                                      Benefit   Benefit    Notation
AN004        Animas Insulin Infusion Set              (INFUSION SET, COMFORT, 23",           One size only
                                                      STD 5/5 AND INFUSION SET,
                                                      COMFORT, 43" STD 5/5) Needle
                                                      guard, soft cannula, adhesive tape,
                                                      introducer needle, cannula housing,
                                                      tubing, connector needle, circular
                                                      protective cap and disconnect cover.
      Infusion Pumps, Ambulatory, Insulin
AN001        Animas IR 1000 Insulin Infusion Pump                                            One size only
AN005        Animas IR 1200 Insulin Infusion Pump     Ambulatory Insulin Infusion Pump       One size only
             (Insulin Infusion Pump IR 1200 series)
Austramedex (VIC) Pty Ltd
      Dressings, Resorbable, Antiadhesion
AR021        Surgiwrap                                Bio Absorbable Antiadhesion Barrier    All sizes with and without suture holes                        Temporary
                                                                                                                                                            approval - funded
                                                                                                                                                            when clinical
                                                                                                                                                            indications are
                                                                                                                                                            present.
Auto Suture Company, Australia T/A Tyco
      Barrier Dressing, Antiadhesion
AS065        CV Seprafilm Cardiovascular Adhesion     Sodium hyaluronate                     One size only; 6 x 6 inch.                                     Temporary
             Barrier; Seprafilm II.                   carbomethylcellulose membrane;                                                                        Approval -
                                                      Carbomethycellulose.                                                                                  Funded when
                                                                                                                                                            clinical indications
                                                                                                                                                            for use are
                                                                                                                                                            present.
      Injection/Infusion Ports, Implantable
AS052        Chemosite Implantable Venous Access      Port - Single Lumen (ChemoSite*)       7-9 french; 10.5 french.                                       * Trademark of
             System                                                                                                                                         United States
                                                                                                                                                            Surgical
                                                                                                                                                            Corporation




Prostheses List February 2005                                                                                                                              Page 63 of 700
GENERAL/MISCELLANEOUS                                                                                                           Minimum   Maximum
Billing Code Product Name                            Description                        Size                                    Benefit   Benefit    Notation
      Mesh, Polymeric
AS055        Mesh Polyproplene; Monofilament         Multifilament Polypropylene;       7.6cm x 12.7cm Surgipro* mesh (3 x 5                         * Trademark of
             Polyproplylene.                         Monofilament Polypropylene.        inch)                                                        United States
                                                                                                                                                     Surgical
                                                                                                                                                     Corporation
AS056        Mesh Polyproplene; Monofilament         Multifilament Polypropylene;       35.6cm x 22.9cm Surgipro* mesh (14 x                         * Trademark of
             Polyproplylene.                         Monofilament Polypropylene.        9 inch).                                                     United States
                                                                                                                                                     Surgical
                                                                                                                                                     Corporation
AS057        Mesh Polyproplene; Monofilament         Multifilament Polypropylene;       2.5cm x 10.2cm Surgipro* mesh (1 x 4                         * Trademark of
             Polyproplylene.                         Monofilament Polypropylene.        inch)                                                        United States
                                                                                                                                                     Surgical
                                                                                                                                                     Corporation
AS058        Mesh Polyproplene; Monofilament         Multifilament Polypropylene;       15.3cm x 15.3cm Surgipro* mesh (6 x 6                        * Trademark of
             Polyproplylene; SURGIPRO* Non           Monofilament Polypropylene;         inch); SPMM46: 10.2cm x 15.3cm (4 x                         United States
             Absorbable Monofilament                 SURGIPRO, Non-Asborbable            6 inch).                                                    Surgical
             Polypropylene Mesh.                     Polypropylene Monofilament Mesh.                                                                Corporation
AS068        Surgipro Non Absorbable Polypropylene   Polypropylene                      Medium and Large
             Hernia Mate Plug System
      Staples, Tissue
AS091        VERSA TACK* stapler                     Titanium Surgical Stapler          4, 4.8mm (10 staples)                                        Temporary
                                                                                                                                                     Approval
      Tissue Reconstructive Materials
AS096        SepraMesh Biosurgical Composite         SMBC-360                           3 x 6 inch
AS097        SepraMesh Biosurgical Composite         SMBC-480                           4 x 8 inch
AS098        SepraMesh Biosurgical Composite         SMBC-680                           6 x 8 inch
AS099        SepraMesh Biosurgical Composite         SMBC-812                           8 x 12 inch
B Braun Australia Pty Ltd
      Injection/Infusion Ports, Implantable
BB082        Celsite Epoxy Single Access Port        Epoxy/titanium                     Standard/small/baby
BB083        Celsite Epoxy Dual Access Port          Epoxy/titanium                     Standard/small/baby
BB084        Celsite MBS Single Access Port          Methylbutadeine styrene            Standard/small
BB086        Celsite Epoxy Peritoneal Port           Epoxy/titanium                     32x27x13mm
Prostheses List February 2005                                                                                                                       Page 64 of 700
GENERAL/MISCELLANEOUS                                                                                        Minimum   Maximum
Billing Code Product Name       Description                              Size                                Benefit   Benefit    Notation
      Mesh, Polymeric
BB177        Premilene Mesh     Premilene Nonabsorbable                  2.5x10cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB178        Premilene Mesh     Premilene Nonabsorbable                  5x10cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB179        Premilene Mesh     Premilene Nonabsorbable                  7.5x15cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB180        Premilene Mesh     Premilene Nonabsorbable                  10x15cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB181        Premilene Mesh     Premilene Nonabsorbable                  5x30cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB182        Premilene Mesh     Premilene Nonabsorbable                  26x36cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB183        Premilene Mesh     Premilene Nonabsorbable                  7.5x7.5cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB184        Premilene Mesh     Premilene Nonabsorbable                  15x15cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB185        Premilene Mesh     Premilene Nonabsorbable                  30x30cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB186        Premilene Mesh     Premilene Nonabsorbable                  4.5x9.5cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB187        Premilene Mesh     Premilene Nonabsorbable                  6x12.5cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB188        Premilene Mesh     Premilene Nonabsorbable                  4.5x10cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB189        Premilene Mesh     Premilene Nonabsorbable                  6x13.5cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB190        Premilene Mesh     Premilene Nonabsorbable                  4.5x10cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB191        Premilene Mesh     Premilene Nonabsorbable                  6x13.5cm, 5 pieces
                                Polypropylene Surgical Suture Material
BB192        Premilene Mesh     Premilene Nonabsorbable                  Self-Forming Plug-Small, 5 pieces
                                Polypropylene Surgical Suture Material

Prostheses List February 2005                                                                                                    Page 65 of 700
GENERAL/MISCELLANEOUS                                                                                                      Minimum   Maximum
Billing Code Product Name                   Description                              Size                                  Benefit   Benefit    Notation
BB193        Premilene Mesh                 Premilene Nonabsorbable                  Self-Forming Plug-Medium, 5 pieces
                                            Polypropylene Surgical Suture Material
BB194        Premilene Mesh                 Premilene Nonabsorbable                  Self-Forming Plug-Large, 5 pieces
                                            Polypropylene Surgical Suture Material
BB195        Premilene Mesh                 Premilene Nonabsorbable                  Self-Forming Plug-X-Large, 5 pieces
                                            Polypropylene Surgical Suture Material
      Sutures, Polypropylene Monofilament
BB088        Premilene Mesh                 Polypropylene                            2.5x10cm
BB089        Premilene Mesh                 Polypropylene                            4.5x9.5cm
BB090        Premilene Mesh                 Polypropylene                            4.5x10cm
BB091        Premilene Mesh                 Polypropylene                            5x10 cm
BB092        Premilene Mesh                 Polypropylene                            5x30cm
BB093        Premilene Mesh                 Polypropylene                            6x12.5cm
BB094        Premilene Mesh                 Polypropylene                            6x13.5cm
BB095        Premilene Mesh                 Polypropylene                            7.5x7.5cm
BB096        Premilene Mesh                 Polypropylene                            7.5x12.5cm
BB097        Premilene Mesh                 Polypropylene                            7.5x15cm
BB098        Premilene Mesh                 Polypropylene                            10x10cm
BB099        Premilene Mesh                 Polypropylene                            10x12.5cm
BB100        Premilene Mesh                 Polypropylene                            10x15cm
BB101        Premilene Mesh                 Polypropylene                            15x15cm
BB102        Premilene Mesh                 Polypropylene                            26x36cm
BB103        Premilene Mesh                 Polypropylene                            30x30cm
BB104        Premilene Mesh                 Self Forming Plug                        One size only




Prostheses List February 2005                                                                                                                  Page 66 of 700
GENERAL/MISCELLANEOUS                                                                                                        Minimum   Maximum
Billing Code Product Name                         Description                                  Size                          Benefit   Benefit    Notation
Bard Australia Pty Ltd
      Catheterization Kits, Intravenous
BA125        Groshong Catheter                    Groshong Valved - Closed ended               Single Lumen, sizes 3fr-8fr
                                                  catheter, may also include Introducer,
                                                  guidewire, tunneller, drape, gloves,
                                                  needles, scissors, syringes, gauze pads
                                                  and securement device.
BA126        Groshong Catheter                    Groshong Valved - Closed ended               Dual Lumen, sizes 5fr-9.5fr
                                                  catheter, may also include Introducer,
                                                  guidewire, tunneller, drape, gloves,
                                                  needles, scissors, syringes, gauze pads
                                                  and securement device.
      Catheters, Intravenous, Peripheral
BA129        Vascular Catheter                    PICC - may include a Groshong Valved         Single Lumen 3Fr - 6Fr
                                                   - Closed ended PICC, may also
                                                  include, Introducer, guidewire, tunneller,
                                                   drape, gloves, needles, scissors,
                                                  syringes, gauze pads
BA130        Vascular Catheter                    PICC- may include a Groshong Valved          Dual Lumen 4Fr - 7Fr
                                                  - Closed ended PICC, may include,
                                                  Introducer, guidewire, tunneller, drape,
                                                  gloves, needles, scissors, syringes,
                                                  gauze pads
      Catheters, Peritoneal, Long Term Indwelling
BA048        VitaCuff, Broviac Catheters          Silicone, with VitaCuff                      2.4 - 6.6 French Catheter
BA049        Broviac Catheters                    Without VitaCuff, silicone                   2.4 - 6.6 French Catheter
BA050        Hickman Catheters Single             Without VitaCuff, silicone                   7 - 14.4F French Catheter
BA051        Hickman Catheters Dual               Without VitaCuff, silicone                   7 - 9 French Catheter
BA052        Hickman Catheters Triple             Without VitaCuff, silicone                   13.5 French Catheter
BA053        Vitacuff, Hickman Single Lumen       Silicone, with VitaCuff                      7 - 14.4F French Catheter
             Catheters
BA054        Vitacuff, Hickman Dual Lumen         Silicone, with VitaCuff                      7 - 9 French Catheter
BA055        Vitacuff, Hickman Triple Catheters   Silicone, with VitaCuff                      13.5 French Catheter

Prostheses List February 2005                                                                                                                    Page 67 of 700
GENERAL/MISCELLANEOUS                                                                                                       Minimum   Maximum
Billing Code Product Name                             Description                             Size                          Benefit   Benefit    Notation
      Enteral Feeding Kits
BA047        Gastrostomy Tube                         Silicone                                16 - 20 French
BA075        Gauderer Ponsky 20Fr PEG Kits            Genie PEG System                        20 French
      Haemostatic Materials, Animal Origin
BA119        Avitene Ultrafoam                        Hemostatic sponge applied directly to   12.5-7 2 cm x 6.25cm x 7mm
                                                      the source of surgical bleeding
BA120        Avitene Ultrafoam                        Hemostatic sponge applied directly to   50 8cm x 6.25cm x 1cm
                                                      the source of surgical bleeding
BA121        Avitene Ultrafoam                        Hemostatic sponge applied directly to   100 8cm x 12.5cm x 1cm
                                                      the source of surgical bleeding
BA122        Avitene Ultrafoam                        Hemostatic sponge applied directly to   100/Thin 8cm x 12.5cm x 3mm
                                                      the source of surgical bleeding
BA123        Avitene Ultrafoam                        Hemostatic sponge applied directly to   200 8cm x 25cm x 1cm
                                                      the source of surgical bleeding
      Injection/Infusion Ports, Implantable
BA046        The Bard Button Implantable Injection,   Silicone Replacement Gastrostomy        18 - 24 French
             Infusion Port                            Device
BA056        Subcutaneous Ports                       Hickman open-ended catheter, single     8 - 9.6 French Catheter
                                                      lumen
BA057        Groshong Subcutaneous Ports              Single or dual lumen catheter           8 - 9.6 French Catheter
BA058        Cathlink Implanted Port                  Single lumen                            6 - 8 French Catheter
BA059        Dual Lumen Subcutaneous Ports            Silicone, Polyurethane or ChronoFlex    7 - 10 French Catheter
                                                      Open-ended Catheter
BA060        Hickman Subcutaneous Ports               Low-Profile                             6 - 6.6 French Catheter
      Mesh, Polymeric
BA061        Bard Mesh                                PerFix Plug                             Small, Medium, Large
BA062        Bard Mesh                                Visilex Laparoscopic mesh               3 x 6" & 4.5 x 6"
BA063        Bard Mesh                                Composix Ventral mesh                   10"x14"
BA064        Bard Mesh                                Composix Ventral mesh                   12"x12"
BA065        Bard Mesh                                Composix Ventral mesh                   2" x 4"
BA066        Bard Mesh                                Composix Ventral mesh                   3" x 6"
Prostheses List February 2005                                                                                                                   Page 68 of 700
GENERAL/MISCELLANEOUS                                                                                                  Minimum   Maximum
Billing Code Product Name                       Description             Size                                           Benefit   Benefit    Notation
BA067        Bard Mesh                          Composix Ventral mesh   4" x 8"
BA068        Bard Mesh                          Composix Ventral mesh   6" x 8"
BA069        Bard Mesh                          Composix Ventral mesh   8" x 10"
BA070        Bard Mesh                          Flat mesh               Small - 1" x 4" / 2" x 4" / 2" x 12" / 3 " x
                                                                        6" / Pre-shaped 1.8" x 4" / Pre-shaped
                                                                        2.4" x 5.4"
BA071        Bard Mesh                          3D Mesh                 Large Left
BA072        Bard Mesh                          3D Mesh                 Medium Left
BA073        Bard Mesh                          3D Mesh                 Large Right
BA074        Bard Mesh                          3D Mesh                 Medium Right
BA083        Bard Mesh                          Kugel Patch             Small Oval 8 x 12cm
BA084        Bard Mesh                          Kugel Patch             Large Oval 14 x 18cm
BA085        Bard Mesh                          Kugel Patch             Small Circle 8 x 8cm
BA086        Bard Mesh                          Kugel Patch             Large Circle 12 x 12cm
BA087        Bard Mesh                          Kugel Patch             Medium Oval 11 x 14cm
BA096        Bard Composix Kugel Hernia Patch   Small Oval w/e PTFE     8 x 12 cms
BA097        Bard Composix Kugel Hernia Patch   Medium Oval w/e PTFE    11 x 14 cms
BA098        Bard Composix Kugel Hernia Patch   Large Oval w/e PTFE     14 x 18 cms
BA099        Bard Composix Kugel Hernia Patch   Small Circle w/e PTFE   8 x 8cms
BA100        Bard Composix Kugel Hernia Patch   Large Circle w/e PTFE   12 x 12cms
BA101        Bard Composix E/X Mesh             Elliptical              4" x 6" (10 x 15cm)
BA102        Bard Composix E/X Mesh             Elliptical              6" x 8" (15 x 20cm)
BA103        Bard Composix E/X Mesh             Elliptical              7" x 9" (18 x 23cm)
BA104        Bard Composix E/X Mesh             Elliptical              8" x 10" (20 x 25 cm)
BA105        Bard Composix E/X Mesh             Elliptical              10" x 13" (25 x 33 cm)
BA106        Bard Composix E/X Mesh             Rectangle               10" x 14" (25 x 36 cm)
BA107        Bard Dulex Mesh                    Oval Shaped             7.5 x 10 cm, 1mm thickness
BA108        Bard Dulex Mesh                    Oval Shaped             8 x 12cm, 1mm thickness
BA109        Bard Dulex Mesh                    Oval Shaped             10 x 15 cm, 1mm thickness
Prostheses List February 2005                                                                                                              Page 69 of 700
GENERAL/MISCELLANEOUS                                                                                                         Minimum   Maximum
Billing Code Product Name                       Description                                Size                               Benefit   Benefit    Notation
BA110        Bard Dulex Mesh                    Oval Shaped                                15 x 19 cm, 1mm thickness
BA111        Bard Dulex Mesh                    Oval Shaped                                18 x 24 cm, 1mm thickness
BA112        Bard Dulex Mesh                    Oval Shaped                                20 x 30cm, 1mm thickness
BA113        Bard Dulex Mesh                    Oval Shaped                                26 x 34 cm, 1mm thickness
BA114        Bard Dulex Mesh                    Oval Shaped                                10 x 15 cm, 2 mm thickness
BA115        Bard Dulex Mesh                    Oval Shaped                                15 x 19 cm, 2 mm thickness
BA116        Bard Dulex Mesh                    Oval Shaped                                18 x 24 cm, 2 mm thickness
BA117        Bard Dulex Mesh                    Oval Shaped                                20 x 30 cm, 2 mm thickness
BA118        Bard Dulex Mesh                    Oval Shaped                                26 x 34 cm, 2 mm thickness
BA127        Composix Kugel Hernia Patch        Extra large oval - w/e PTFE                20cm X 25cm
BA128        Composix Kugel Hernia Patch        Extra large oval - w/ePTFE                 25cm X 33cm
BA131        Bard Composix Kugel Hernia Patch   The Bard Composix Kugel Hernia             Extra Large Oval w/e PTFE 18cm x
                                                Patch is a self-expanding, non-            23cm
                                                absorbable, sterile prosthesis. Two
                                                layers of monofilament, polypropylene
                                                mesh are stitched to an ePTFE sheet;
                                                an extruded monofilament PET polymer
                                                 "ring" provides memory, adds stability
                                                to the device.
BA132        Bard Modified Kugel Hernia Patch   The Bard Modified Kugel Hernia Patch       7.5 cm (3") diameter
                                                 is a self-expanding, non-absorbable,
                                                sterile prosthesis. It consists of two
                                                layers of monofilament, polypropylene
                                                mesh; an extruded monofilament PET
                                                polymer "ring" provides memory, adds
                                                stability to the device. The positioning
                                                strap facilitates placement, positioning
                                                and suturing of the device.




Prostheses List February 2005                                                                                                                     Page 70 of 700
GENERAL/MISCELLANEOUS                                                                                                       Minimum   Maximum
Billing Code Product Name                       Description                                 Size                            Benefit   Benefit    Notation
BA133        Bard Modified Kugel Hernia Patch   The Bard Modified Kugel Hernia Patch        10 cm (4") diameter
                                                 is a self-expanding, non-absorbable,
                                                sterile prosthesis. It consists of two
                                                layers of monofilament, polypropylene
                                                mesh; an extruded monofilament PET
                                                polymer "ring" provides memory, adds
                                                stability to the device. The positioning
                                                strap facilitates placement, positioning
                                                and suturing of the device.
BA134        Bard Modified Kugel Hernia Patch   The Bard Modified Kugel Hernia Patch        11.5 cm (4.5") diameter
                                                 is a self-expanding, non-absorbable,
                                                sterile prosthesis. It consists of two
                                                layers of monofilament, polypropylene
                                                mesh; an extruded monofilament PET
                                                polymer "ring" provides memory, adds
                                                stability to the device. The positioning
                                                strap facilitates placement, positioning
                                                and suturing of the device.
BA135        Bard Composix Kugel Hernia Patch   The Bard Composix Kugel Hernia              Oval w/e PTFE 16cm x 31.2cm
                                                Patch is a self-expanding, non-
                                                absorbable, sterile prosthesis. Two
                                                layers of monofilament, polypropylene
                                                mesh are stitched to an ePTFE sheet;
                                                an extruded monofilament PET polymer
                                                 "ring" provides memory, adds stability
                                                to the device.
BA136        Bard Ventralex Hernia Patch        The Bard Ventralex Patch is a self-         4.3 cm x 4.3 cm (1.7" x 1.7")
                                                expanding, non-absorbable, sterile
                                                prosthesis. Two layers of monofilament,
                                                 polypropylene mesh are stitched to an
                                                ePTFE sheet; an extruded
                                                monofilament PET polymer "ring"
                                                provides memory, adds stability to the
                                                device. The positioning strap facilitates
                                                placement, positioning and suturing of




Prostheses List February 2005                                                                                                                   Page 71 of 700
GENERAL/MISCELLANEOUS                                                                                                  Minimum   Maximum
Billing Code Product Name                  Description                                 Size                            Benefit   Benefit    Notation
BA137        Bard Ventralex Hernia Patch   The Bard Ventralex Patch is a self-         6.4 cm x 6.4 cm (2.5" x 2.5")
                                           expanding, non-absorbable, sterile
                                           prosthesis. Two layers of monofilament,
                                            polypropylene mesh are stitched to an
                                           ePTFE sheet; an extruded
                                           monofilament PET polymer "ring"
                                           provides memory, adds stability to the
                                           device. The positioning strap facilitates
                                           placement, positioning and suturing of
BA138        Bard 3DMax Mesh               The Bard 3DMax Mesh is a sterile            Extra Large Left 5" x 7"
                                           prosthesis constructed of monofilament
                                           polypropylene mesh. 3DMax mesh is a
                                           three-dimensional, anatomically formed
                                           prosthesis for use in laparoscopic hernia
                                            repair.
BA139        Bard 3DMax Mesh               The Bard 3DMax Mesh is a sterile            Extra Large Right 5" x 7"
                                           prosthesis constructed of monofilament
                                           polypropylene mesh. 3DMax mesh is a
                                           three-dimensional, anatomically formed
                                           prosthesis for use in laparoscopic hernia
                                            repair.
BA157        Bard Mesh                     Flat Mesh                                   Medium - 6" x 6"
BA158        Bard Mesh                     Flat Mesh                                   Large - 10" x 14"
      Stents
BA088        Memotherm Stents              Colorectal, Nitinol, Self-expanding         25-30mm D, 60-100mm Length
Baxter Healthcare Pty Ltd
      Adhesives, Liquid
BX252        CoSeal Surgical Sealant       Composition: two synthetic polyethelene     2ml                                                  Temporary
                                            glycols (PEG's), COH102 and                                                                     approval, pending
                                           COH206, premixed and filled into one                                                             review of product
                                           syringe, a dilute hydrogen chloride                                                              group
                                           solution and a sodium phosphate/sodium
                                            carbonate solution




Prostheses List February 2005                                                                                                              Page 72 of 700
GENERAL/MISCELLANEOUS                                                                                                                      Minimum   Maximum
Billing Code Product Name                               Description                               Size                                     Benefit   Benefit    Notation
BX253        CoSeal Surgical Sealant                    Composition: two synthetic polyethelene   4ml                                                           Temporary
                                                         glycols (PEG's), COH102 and                                                                            approval, pending
                                                        COH206, premixed and filled into a                                                                      review of product
                                                        syringe, a dilute hydrogen chloride                                                                     group+
                                                        solution and a sodium phosphate sodium
                                                         carbonate solution
BX254        CoSeal Surgical Sealant                    Composition: two synthetic polyethelene   8ml                                                           Temporary
                                                         glycols (PEG's), COH102 and                                                                            approval, pending
                                                        COH206, premixed and filled into a                                                                      review of product
                                                        syringe, a dilute hydrogen chloride                                                                     group+
                                                        solution and a sodium phosphate sodium
                                                         carbonate solution
      Infusion Controller Administration Sets
BX245        Patient Control Module                     Sterile infusor devices, spring or        Module 0.5ml dose, Module 2 ml dose
                                                        elastomer driven
      Infusion Pump Administration Sets
BX240        6060 Multi-therapy Infusion Pump                                                     78 inch and 110 inch
BX241        Solution sets for 6060 Multi-therapy       Infusion Administration Sets              (contains DEHP 1.2micron filter) 116
             Infusion Pump                                                                        inch, (contains DEHP 0.22 micron
                                                                                                  filter) 116 inch, (Non DEHP) 78 inch,
                                                                                                  (Non DEHP with 1.2 micron
                                                                                                  filter)116inch, (Non DEHP with 0.22
                                                                                                  micron filter) 116 inch.
BX242        Epidural Set with filter for 6060 Multi-   Epidural Set with filter                  69 inches and 107 inches
             therapy Pump
BX243        Epidural Set for 6060 Multi-therapy                                                  One size only
             Infusion Pump
BX244        Solution Sets for 6060 Multi-therapy       Infusion administration set               Solution set for 6060 pump 78 inch and
             infusion pump                                                                        110 inch
      Spring Infusor, Ambulatory
BX246        Infusor                                    Sterile infusor devices, spring or        SV Half day, 5ml/hr, 60ml vol. LV 10,
                                                        elastomer driven                          10ml/hr, 240ml vol. SV Single day,
                                                                                                  2ml/hr, 48ml vol. LV 5, 5ml/hr, 240ml
                                                                                                  vol.



Prostheses List February 2005                                                                                                                                  Page 73 of 700
GENERAL/MISCELLANEOUS                                                                                                                 Minimum   Maximum
Billing Code Product Name                         Description                            Size                                         Benefit   Benefit    Notation
BX247        Intermate                            Sterile infusor devices, spring or     SV 200 - 200ml/hr, 100ml vol. SV 100 -
                                                  elastomeric driven                     100ml/hr, 100ml vol. LV 250, 250ml/hr,
                                                                                         275ml vol. SV 50 - 50ml/hr, 100ml vol.
                                                                                         LV 100 - 100ml/hr, 275ml vol. LV 50,
                                                                                         50ml/hr, 275ml vol
BX248        Infusor                              Sterile infusor devices, spring or     LV 2, 2ml/hr, 275 ml vol; LV 1.5,
                                                  elastomer driven                       1.5ml/hr, 275ml vol; SV Multi day,
                                                                                         0.5ml/hr. 60ml vol; SV Seven day,
                                                                                         0.5ml/hr, 96ml vol
BX249        Multirate with PCM                   Sterile infusor devices, spring or     Multirate 5, 7 or 12 ml/hr with PCM
                                                  elastomer driven
BX250        Basal/Bolus and Multirate Infusors   Sterile infusor devices, spring or     Basal/Bolus 60, Basal 0.5ml/hr, Bolus
                                                  elastomer driven                       0.5ml/hr x 65ml; Basal/Bolus 15, Basal
                                                                                         0.5ml/hr, Bolus 2ml/hr x 65ml;
                                                                                         Basal/Bolus infusor, Basal 2ml/hr, Bolus
                                                                                          2ml/hr x 65ml; Multirate 5, 7 or 12
                                                                                         ml/hr x 300 ml; Multirate 2, 4, or 6 ml/hr
                                                                                          x 300 ml; Multirate 2, 3, or 5 ml/hr x
                                                                                         300 ml; Multirate 1, 2 or 3 ml/hr x 100
      Tissue Reconstructive Materials
BX213        TISSEEL Duo 500 Two Component        Active ingedients:Sealer Protein       0.5 ml (containing 0.5 ml of Sealer                               Temporary
             Fibrin Sealant Syringe               Solution & Thrombin Solution - deep-   Protein Solution and 0.5 ml of Thrombin                           approval
                                                  frozen, steam treated                   Solution)
BX214        TISSEEL Duo 500 Two Component        Active ingedients:Sealer Protein       1.0 ml (containing 1.0 ml of Sealer                               Temporary
             Fibrin Sealant Syringe               Solution & Thrombin Solution - deep-   Protein Solution and 1.0 ml of Thrombin                           approval
                                                  frozen, steam treated                   Solution)
BX215        TISSEEL Duo 500 Two Component        Active ingedients:Sealer Protein       2.0 ml (containing 2.0 ml of Sealer                               Temporary
             Fibrin Sealant Syringe               Solution & Thrombin Solution - deep-   Protein Solution and 2.0 ml of Thrombin                           approval
                                                  frozen, steam treated                   Solution)
BX216        TISSEEL Duo 500 Two Component        Active ingedients:Sealer Protein       5.0 ml (containing 5.0 ml of Sealer                               Temporary
             Fibrin Sealant Syringe               Solution & Thrombin Solution - deep-   Protein Solution and 5.0 ml of Thrombin                           approval
                                                  frozen, steam treated                   Solution)
Biomet Australia Pty Ltd
      Drug Delivery System
BI280        Septopal Chain Septopal Beads        PMMA, Stainless Steel                  30 bead chain

Prostheses List February 2005                                                                                                                             Page 74 of 700
GENERAL/MISCELLANEOUS                                                                                                                   Minimum   Maximum
Billing Code Product Name                          Description                               Size                                       Benefit   Benefit    Notation
Boston Scientific Pty Ltd
      Stents
BS053        Wallstent Enteral Endoprosthesis      Enteral Endoprosthesis Wallstent with     18mm x 60mm, 18mm x 90mm, 20mm x
                                                   Delivery System:Monofilament wire,         60mm, 20mm x 90mm, 22mm x 60mm,
                                                   self-expanding                            22mm x 90mm
      Stents, Biliary
BS045        Microvasive Ultraflex Diamond         Self expanding, nitinol metallic stent    Length: 4cm, 6cm, 8 cm x 10mm
             Expandable Biliary Stent                                                        diameter
BS050        Stent (Billiary Wallstent)            Wallstent (Non-covered): Monofilament     10mm x 56 to 62 mm, 10mm x 78 to 86
                                                   wire, self-expanding                      mm, 10mm x 101 to 111mm
BS055        Rapid Exchange Biliary Stent System   Flexima Polyurethane with Glidex          Diameter 7 FR - 11.5 FR, length 5 - 15cm
                                                   Hydrophilic Coating, System includes
                                                   Stent, Guide Catheter and Push
      Stents, Bronchial
BS047        Ultraflex Tracheobronchial Stent      Self expanding, nitinol metallic stent,   Diameter 8mm - 20mm, Length 20mm -
                                                   covered and non-covered                   80mm
      Stents, Esophageal
BS046        Microvasive Ultraflex Oesophageal     Self expanding, nitinol metallic stent    Stent Outer Diameter - Distal Release:
             Stents (covered and non-covered)                                                17mm to 22mm, 18mm to 23mm, 23mm
                                                                                             to 28mm Proximal Release: 17mm to
                                                                                             22mm, 18mm to 23mm, 23mm to 28mm
BS048        Covered Oesophageal Wallstent         Wallstent Esophageal II Endoprosthesis:   (Lengths up to 11cm): 100mm,
                                                   Monofilament wire, self-expanding         Diameter: 20-28mm
BS049        Covered Oesophageal Wallstent         Flamingo Wallstent, Wallstent             (Lengths over 11cm): Flamingo: 120mm
                                                   Esophageal II Endoprosthesis:              x 16-24mm (Diameter), 140mm x 20-
                                                   Monofilament wire, self-expanding         30mm (diameter), Wallstent Esophageal
                                                                                              II Endoprosthesis: 150mm x 20-28mm
                                                                                             (diameter)
BS051        Stent (Non-Vascular)                  Wallstent (Non-covered): Monofilament     8mm x 40mm, 8mm x 60mm, 8mm x
                                                   wire, self-expanding                      80mm, 10mm x 42mm, 10mm x 68mm,
                                                                                             10mm x 80mm
BS052        Stent (Non-Vascular)                  Wallstent (Covered): Monofilament         10mm x 40mm, 10mm x 60mm, 10mm x
                                                   wire, self-expanding                       80mm


Prostheses List February 2005                                                                                                                               Page 75 of 700
GENERAL/MISCELLANEOUS                                                                                                                           Minimum   Maximum
Billing Code Product Name                               Description                                  Size                                       Benefit   Benefit    Notation
      Stents, Ureteral
BS054        Flexima Biliary Stent System               Flexima Polyurethane with Glidex             Dia 7 FR - 11.5 FR, length 5 - 15cm
                                                        Hydrophilic Coating, System includes
                                                        Stent, Guide Catheter and Push
      Tubes, Gastrointestinal
BS075        Initial Enteral Feeding Kits (EndoVive):   Composition: silicone. Kits include          Initial Enteral Feeding Kit: 18 to 24 Fr
             Gastrodome Initial Gastrostomy Kit;        Stoma devices,
             One-Step Button Initial Placement          Gastrostomy/Jejunostomy tube and
             Gastrostomy Kit; Thru-The-Peg J Tube       patient care devices
BS076        Replacement Enteral Feeding Devices        Composition: silicone.                       Replacement Enteral Feeding Devices:
             (EndoVive): Button Low-Profile                                                          12 to 28 Fr
             Replacement Gastrostomy Tube, Mini
             Button
Cecil E Mayo Pty Ltd
      Catheter Injection Ports
CM006        Vascular Ports                             Arrow Model No. AP01002, Titanium            Ports - H15.5mm x L28.6mm, Weight
                                                        Port with self sealing silicone septum       9.2grams, Internal Vol. 0.8ml. Catheter
                                                        and polyurethane detachable catheter          75cm
                                                        with Blue Flex Tip
CM007        Vascular Ports                             Arrow Model No.'s VARRX AP01004,             Ports - H15.5mm x L28.6mm, Weight
                                                         AP01005, AP01006, AP01007,                  9.2grams, Internal Vol. 0.8ml. Catheter
                                                        AP01008, AP01009, AP01510,                    75cm
                                                        AP06010, AP06013, AP06014,
                                                        AP06015, AP06018, AP06520.
                                                        Titanium Port with self sealing silicone
                                                        septum and either attached or detached
                                                        silicone catheters
CM008        Vascular Ports                             Arrow Model No.'s AP01515,                   Ports - H15.5/17.1mm x L28.6mm,
                                                        AP01516, AP01517, AP01518,                   Weight 19.9grams, Internal Vol. 0.8 -
                                                        AP02001, AP06527, AP6528,                    1.0ml each side. Catheters 75cm
                                                        AP06530, AP06535, AP07018. Double
                                                         Titanium ports with self sealing silicone
                                                         septums and either attached or
                                                        detached dual lumen silicone catheters.




Prostheses List February 2005                                                                                                                                       Page 76 of 700
GENERAL/MISCELLANEOUS                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                                   Size                                  Benefit   Benefit    Notation
      Catheterization Kits
CM005        Intraspinal Catheter Kit              Arrow Model No. VARRX AP07009,                Intraspinal Catheter - 19Ga x 75cm,
                                                   FlexTip Plus Intraspinal Catheter Kit.        Tuohy Needle 9.8cm 17Ga
                                                   Polyurethane with Titanium Coil
                                                   Catheter with stylet, One Titanium
                                                   Catheter Connector, One Plastic Snap
                                                   Lock Adapter, One Stainless Steel
                                                   Tuohy Needle, One plastic catheter
                                                   anchor.
      Catheterization Kits, Central Venous
CM014        Catheterisation Kits- CS Series       Arrow Model No.'s VARRM CS18703,              7Fr x 35cm & 40cm
                                                    CS28702. Polyurethane double and
                                                   triple lumen catheters with dacron cuff.
      Catheterization Kits, Intravenous
CM011        Arrow Peripherally Inserted Central   Model No.'s VARRC PC01351.                    3Fr x 55cm
             Catheterisation Sets                  Polyurethane single lumen catheters
                                                   with stylet.
CM012        Arrow Peripherally Inserted Central   Model No.'s VARRC PC01451,                    4Fr x 55cm
             Catheterisation Sets                  PR05041, Polyurethane single lumen
                                                   catheters with or without stylet.
CM013        Arrow Peripherally Inserted Central   Model No.'s VARRC PC01552,                    5Fr x 55cm & 70cm
             Catheterisation Sets                  PR05052, PR07051 Polyurethane single
                                                   and double lumen catheters with or
                                                   without stylet.
      Injection/Infusion Ports, Implantable
CM009        L-Port Implantable Vascular Access    Arrow Model No.'s VARRX AP01040,              Ports - H10mm, L25mm, Weight
             System                                 AP01010, AP01011, AP001012,                  9grams, Internal Vol. 0.3ml.
                                                   AP01013, AP01015, AP01017,                    Catheter75cm
                                                   AP06046, AP06016, AP06020,
                                                   AP06012, AP06022, AP06025. Plastic
                                                   low profile port with self sealing silicone
                                                    septum and detached silicone catheters.




Prostheses List February 2005                                                                                                                              Page 77 of 700
GENERAL/MISCELLANEOUS                                                                                                                    Minimum   Maximum
Billing Code Product Name                            Description                                Size                                     Benefit   Benefit    Notation
CM010        L-Port Implantable Vascular Access      Arrow Model No.'s VARRX AP01031,           Ports - H10mm, L25mm, Weight
             System                                   AP01031, AP01032, AP01033,                9grams, Internal Vol. 0.3ml.
                                                     AP01035, AP01037, AP06036,                 Catheter75cm
                                                     AP06040, AP06041, AP06042,
                                                     AP06045. Titanium Low Profile Ports
                                                     with self sealing silicone septum and
                                                     detached silicone catheters.
Device Technologies Australia Pty Ltd
      Adhesives, Liquid
DE161        Advaseal Synthetic Absorbable Sealant   Synthetic bioabsorbable Surgical Sealant   One Size Only
      Stents, Biliary
DE209        Endocoil Billary Stent                  Nickel Titanium Alloy                      5cm, 6cm, 7cm
      Stents, Esophageal
DE210        Esophacoil Oesophageal Stent            Coiled Nitinol-Used for oesophageal        100 x 16mm, 150 x 16mm, 100 x 18mm,
                                                     and rectal                                  150 x 18mm
DE211        Esophacoil Stent                        Coiled Nitinol                             100 x 16mm, 150 x 16mm, 100 x 18mm,
                                                                                                 150 x 18mm
EMT Healthcare Pty Ltd
      Gastroplasty Bands
EM017        MiniMizer Adjustable Gastric Band       Silicon elastomer                          14mm wide, 16.6cm band two phase
                                                                                                closure, 1: 31mm inner diameter, phase
                                                                                                2: 26mm inner diameter. 40cm silicon
                                                                                                tube attached
      Mesh, Polymeric
EM004        Biomesh Reinforcement Mesh              Macro porous 100% polypropylene            2.5 x 10cm; 8 x 13cm; 15 x 15cm
                                                     mesh for laproscopic and open surgical
                                                     approaches
EM005        Biomesh Reinforcement Mesh              Macro porous 100% polypropylene            5 x 10cm; 7 x 15cm
                                                     mesh for laproscopic and open surgical
                                                     approaches
EM006        Biomesh Reinforcement Mesh              Macro porous 100% polypropylene            5cm x 30cm, 6cm x 30cm
                                                     mesh for laproscopic and open surgical
                                                     approaches


Prostheses List February 2005                                                                                                                                Page 78 of 700
GENERAL/MISCELLANEOUS                                                                                                                Minimum   Maximum
Billing Code Product Name                          Description                              Size                                     Benefit   Benefit    Notation
EM007        Biomesh Reinforcement Mesh            Macro porous 100% polypropylene          25 x 36cm; 30 x 30cm
                                                   mesh for laproscopic and open surgical
                                                   approaches
EM008        Intramesh Reinforcement Mesh          Reinforcement mesh made from two         20 x 20cm
                                                   surfaces for intra-peritoneal visceral
                                                   surgery (Polypropylene/ePTFE or
                                                   Polyester/Silicone)
EM009        Intramesh Reinforcement Mesh          Reinforcement mesh made from two         15 x 15cm
                                                   surfaces for intra-peritoneal visceral
                                                   surgery (Polypropylene/ePTFE or
                                                   Polyester/Silicone)
EM010        Intramesh Reinforcement Mesh          Reinforcement mesh made from two         30 x 30cm
                                                   surfaces for intra-peritoneal visceral
                                                   surgery (Polypropylene/ePTFE or
                                                   Polyester/Silicone)
EM015        Biomesh Hernia Reinforcing Mesh Kit   Polypropylene Mesh Hernia Repair Kit     EMT-KIT2BT2PMX2 - 2x15cm x
                                                   - includes Balloons (various) ,          15cm Mesh, 1 x Distension Balloon, 1 x
                                                   Disposable Valve and EMT Ports           Balloon Trocar, 2 x Ports, 1 x
                                                                                            Disposable Valve
EM016        BIOMESH HERNIA REINFORCING            Polypropylene Mesh Hernia Repair Kit     EMT -KIT2NM - 1 x 15cm x 15cm
             MESH KIT                              - includes Balloons (various) ,          Mesh, 1 x Distension Balloon, 1 x
                                                   Disposable Valve and EMT Ports           Balloon Trocar, 1 x Disposable Valve
Endocorp Pty Ltd
      Mesh
EC045        Parietex                              Multifibre Polyester Surgical Mesh       12cm x 8cm to 30cm x 32cm (3D) Single
      Shunts, Peritoneovenous
EC007        Denver Peritoneo-Venous Shunt         Pleural Effusion Shunt PAK               Pump length 7.5 cm Pump Height 1.0
                                                                                            cm Pump Width 1.7 cm (not including
                                                                                            suture pad) Tubing Size: inside
                                                                                            diameter 0.27 cm Outside diameter
      Shunts, Pleuroperitoneal
EC002        Denver Pleuro-Peritoneal Shunt        Ascites - Single Valved High Flow Rate   Pump length 7.5 cm Pump Height 1.0
                                                   (36-48ml/min)                            cm Pump Width 1.7 cm (not including
                                                                                            suture pad) Tubing Size: inside
                                                                                            diameter 0.27 cm Outside diameter

Prostheses List February 2005                                                                                                                            Page 79 of 700
GENERAL/MISCELLANEOUS                                                                                                         Minimum   Maximum
Billing Code Product Name                     Description                             Size                                    Benefit   Benefit    Notation
EC003        Denver Pleuro-Peritoneal Shunt   Ascites - Single Valved Extra High      Pump length 7.5 cm Pump Height 1.0
                                              Flow Rate (48ml/min)                    cm Pump Width 1.7 cm (not including
                                                                                      suture pad) Tubing Size: inside
                                                                                      diameter 0.27 cm Outside diameter
EC004        Denver Pleuro-Peritoneal Shunt   Ascites - Double Valved Standard Flow   Pump length 7.5 cm Pump Height 1.0
                                              Rate (25-40ml/min)                      cm Pump Width 1.7 cm (not including
                                                                                      suture pad) Tubing Size: inside
                                                                                      diameter 0.27 cm Outside diameter
EC005        Denver Pleuro-Peritoneal Shunt   Double Valved Shunt PAK. Flow Rate      Pump length 7.5 cm Pump Height 1.0
                                              (20-35ml/min)                           cm Pump Width 1.7 cm (not including
                                                                                      suture pad) Tubing Size: inside
                                                                                      diameter 0.27 cm Outside diameter
EC006        Denver Pleuro-Peritoneal Shunt   Single Valved Shunt PAK. Flow Rate      Pump length 7.5 cm Pump Height 1.0
                                              (35-48 ml/min)                          cm Pump Width 1.7 cm (not including
                                                                                      suture pad) Tubing Size: inside
                                                                                      diameter 0.27 cm Outside diameter
Endotherapeutics Pty Ltd
      Gastroplasty Bands
ET042        Soft Gastric Banding System      Sterile long term implant for the       One size only
                                              treatment of obesity. Supplied in kit
                                              format with catheter, port and huber
                                              needles
      Injection/Infusion Ports, Implantable
ET021        Jet Port Catheter System         Polyoxymethylene injection port         28mm
      Mesh
ET046        Parietene                        Monofilament Polypropylene Surgical     6cm x 11cm to 30cm x 30cm Single
                                              Mesh
ET047        Parietex                         Multifibre Polyester Surgical Mesh      7cm x 1.5cm to 20cm x 20cm Single
ET048        Parietene                        Monofilament Polypropylene Surgical     6cm x 11cm to 30cm x 32cm (3D) Single
                                              Mesh - three dimensional & X-shape
      Mesh, Polymeric
ET002        Kugel Hernia Patch               Polypropylene mesh                      Large oval
ET003        Kugel Hernia Patch               Polypropylene mesh                      Large circle
ET004        Kugel Hernia Patch               Polypropylene mesh                      Small circle
Prostheses List February 2005                                                                                                                     Page 80 of 700
GENERAL/MISCELLANEOUS                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                                Size                                     Benefit   Benefit    Notation
ET005        Kugel Hernia Patch                    Polypropylene mesh                         Small/medium oval
      Stents, Biliary
ET018        Optimed Biliary Sinus Stent           Nickel Titanium Alloy                      4-12 x 30-100mm
ET019        Sinus-Flex Vascular-Biliary Stent     Nickel Titanium Alloy                      4-12 x 40-80mm
ET020        Sinus-Endoflex-Biliary Sinus Stent    Nickel Titanium Alloy                      40 x 7,8,9,10 mm; 60 x 7,8,9,10 mm; 80
                                                                                              x 7,8,9,10 mm
      Stents, Esophageal
ET001        Ferx Ella Esophageal Stent            Kit includes esophageal stent,             Diam 20mm, Length 80 - 160mm
                                                   introducer, balloon catheter
ev3 Australia Pty Ltd
      Prosthesis, Internal, Stent
EE001        Protégé GPS Self-Expanding Nitinol    Nitinol self-expanding stent, disposable   20 - 150mm length, 6 - 12mm diameter
             Stent with Starport Delivery System   delivery catheter
Femcare Australia Pty Ltd
      Clips, Tube
FE003        Filshie Clips - Sterishot             With Disposable Applicator                 One Size                                                      Temporary
                                                                                                                                                            approval, pending
                                                                                                                                                            review of product
                                                                                                                                                            group
Getz Bros. & Co. (Aust) Pty Ltd
      Infusion Pumps, Implantable
GB111        AccuRx Constant Flow Implantable      Drug Infusion Systems, powered and         One Size Only
             Pump Model                            ancillary equipment
             5304,5305,5306,5307,5308,5309,5310,53
             12,5315,5320,5326,5332
Inamed Australia Pty Ltd
      Gastroplasty Bands
IN001        Lap-Band Adjustable Gastric Banding   -                                          9.75, 10 and 11cm
             (LAGB) System
      Injection/Infusion Ports, Implantable
IN002        Lap-Band Access Port                  For use with the Lap-Band Adjustable       Standard, low profile
                                                   Gastric Banding System
Prostheses List February 2005                                                                                                                              Page 81 of 700
GENERAL/MISCELLANEOUS                                                                                                                Minimum   Maximum
Billing Code Product Name                            Description                                 Size                                Benefit   Benefit    Notation
Incision Pty Ltd
        Tissue Reconstructive Materials
IP007        Durasphere FL                           Composition: Pyrolitically carbon coated    Syringe 1ml
                                                     silica bead in an aqueous gel. Injectable
                                                     bulking agent for the treatment of
                                                     Faecal Incontinence. Syringe plus
IP008        Durasphere FL                           Composition: Pyrolitically carbon coated    Syringe 3ml
                                                     silica bead in an aqueous gel. Injectable
                                                     bulking agent for the treatment of
                                                     Faecal Incontinence. Syringe plus
Jecoli Pty Ltd
        Mesh, Polymeric
JO006        Herniamesh Polypropylene Mesh           Hertra Polypropylene Mesh                   4.5cm x 10cm
JO007        Hertra Oval & Round Patch               Pre-Shrunk Polypropylene Mesh for           Ovals in 8cm x 12cm, 11cm x 14cm,
                                                     Inguinal, Laproscopic & Open Hernia         14cm x 18cm, & 10cm round
                                                     Repairs
Johnson & Johnson Medical Pty Ltd
        Dressings, Resorbable, Antiadhesion
JJ010        Interceed Absorbable Adhesion Barrier   Oxidized Regenerated Cellulose              7.6cm x 10.2cm                                           Temporary
                                                                                                                                                          Approval -
                                                                                                                                                          Funded when
                                                                                                                                                          clinical indications
                                                                                                                                                          for use are
                                                                                                                                                          present.
        Gastroplasty Bands
JJ412        Swedish Adjustable Gastric Band         Silicone                                    One size only
        Injection/Infusion Ports, Implantable
JJ444        Swedish Adjustable Gastric Band -       Titanium implantable infusion port &        One size only
             Injection Port & Locking Connector      locking connector for the Swedish
                                                     Adjustable Gastric Band. Replacement
                                                     port & locking connector to the one
                                                     included with the Swedish Adjustable
                                                     Gastric Band


Prostheses List February 2005                                                                                                                            Page 82 of 700
GENERAL/MISCELLANEOUS                                                                                      Minimum   Maximum
Billing Code Product Name            Description                                   Size                    Benefit   Benefit    Notation
        Mesh
JJ179        VYPRO Mesh              Vicryl (polyglactin 910) / Prolene            30cm x 30cm
                                     (polypropylene) composite mesh
JJ240        VYPRO II Mesh           Composition - equal part Vicryl               Small 6 x 11cm
                                     polyglactin yarn - non-absorbable
                                     Prolene polypropylene yarn. Partly
                                     absorbable lightweight mesh for tension
                                     free-inguinal hernia techniques
JJ241        VYPRO II Mesh           Composition - equal part Vicryl               Medium 12 x 10cm
                                     polyglactin yarn - non-absorbable
                                     Prolene polypropylene yarn. Partly
                                     absorbable lightweight mesh for tension
                                     free-inguinal hernia techniques
JJ242        VYPRO II Mesh           Composition - equal part Vicryl               Large 15 x 10cm
                                     polyglactin yarn - non-absorbable
                                     Prolene polypropylene yarn. Partly
                                     absorbable lightweight mesh for tension
                                     free-inguinal hernia techniques
JJ243        VYPRO II Mesh           Composition - equal part Vicryl               Extra large 15 x 15cm
                                     polyglactin yarn - non-absorbable
                                     Prolene polypropylene yarn. Partly
                                     absorbable lightweight mesh for tension
                                     free-inguinal hernia techniques
JJ434        GYNECARE GYNEMESH* PS   Gynecare Gynemesh* PS is a non-               10cm x 15cm (4" x 6")
                                     absorbable Prolene soft mesh indicated
                                     for tissue reinforcement and long lasting
                                      stabilisation of fascial structures of the
                                     pelvic floor in vaginal wall prolapse.
                                     Gynemesh PS* is constructed of knitted
                                      filaments of extruded polypropylene
                                     identical in composition to Prolene*
                                     polypropylene suture. It is packaged
                                     sterile, one 10 x 15cm piece per box.
        Mesh, Polyglycolic Acid
JJ019        Vypro Mesh              Vicryl/Prolene Composite Mesh                 Medium - 15cm x 15cm
JJ020        Vicryl Mesh             1 sheet/box                                   Large - 30cm x 30cm

Prostheses List February 2005                                                                                                  Page 83 of 700
GENERAL/MISCELLANEOUS                                                                                                                Minimum   Maximum
Billing Code Product Name                           Description                                Size                                  Benefit   Benefit    Notation
JJ173        VICRYL Mesh                            Polyglactin 910 - synthetic absorbable     15cm x 15cm
                                                    mesh.
        Mesh, Polymeric
JJ172        Mersilene Mesh                         Non-absorbable polyester mesh              30cm x 30cm
JJ174        Prolene Mesh                           Small polypropylene monofilament non       2.5cm x 10cm
                                                    absorbable mesh
JJ175        Prolene Mesh                           Medium polypropylene monofilament          7.6cm x 15cm
                                                    non absorbable mesh
JJ176        Prolene Mesh                           Large polypropylene monofilament non       30cm x 30cm
                                                    absorbable mesh
JJ177        Prolene Mesh                           Small keyhole polypropylene                4.6cm x 10.2cm
                                                    monofilament non absorbable mesh
JJ178        Prolene Mesh                           Large keyhole polypropylene                6cm x 13.7cm
                                                    monofilament non absorbable mesh
JJ180        Prolene Hernia System                  Bilayer polypropylene non absorbable       Onlay 4.5-5.5cm x 10cm; Connector
                                                    synthetic mesh with connector              1.91 x 1.27cm; Underlay 7.5-10cm
                                                                                               diameter
JJ222        Prolene Mesh - medium                  Constructed of knitted filaments of        Medium - 6" x 6"
                                                    extruded polypropylene identical to that
                                                    used in Prolene suture. Material is
                                                    approx. 0.027mm thick. Non-
                                                    absorbable mesh for tension free-
                                                    inguinal hernia techniques.
JJ413        Prolene *3D Patch Polypropylene Mesh   Sterile Three-dimensional device           5.49cm x 12.50cm 3DPatch large with
                                                    consisting of a flat mesh onlay patch      preshaped overlay
                                                    secured to a formed expandable
                                                    diamond-shaped mesh patch
JJ414        Prolene *3D Patch Polypropylene Mesh   Sterile Three-dimensional device           5.49cm x 12.50cm 3D Patch with
                                                    consisting of a flat mesh onlay patch      medium preshaped overlay
                                                    secured to a formed expandable
                                                    diamond-shaped mesh patch
JJ415        Prolene *3D Patch Polypropylene Mesh   Sterile Three-dimensional device           5.49cm x 12.50cm 3D Patch medium
                                                    consisting of a flat mesh onlay patch      with extended overlay
                                                    secured to a formed expandable
                                                    diamond-shaped mesh patch

Prostheses List February 2005                                                                                                                            Page 84 of 700
GENERAL/MISCELLANEOUS                                                                                                                    Minimum   Maximum
Billing Code Product Name                              Description                                Size                                   Benefit   Benefit    Notation
JJ416        Prolene *3D Patch Polypropylene Mesh      Sterile Three-dimensional device           5.49cm x 12.50cm 3D Patch large with
                                                       consisting of a flat mesh onlay patch      extended overlay
                                                       secured to a formed expandable
                                                       diamond-shaped mesh patch
        Sponges, Hemostatic, Absorbable
JJ003        Spongostan Absorbable Haemostat           Standard (Box of 20)                       70 x 50 x 10mm
JJ004        Spongostan Absorbable Haemostat           Film (Box of 20)                           200 x 70 x 0.5mm
JJ005        Spongostan Absorbable Haemostat           Special (Box of 20)                        70 x 50 x 1mm
JJ006        Spongostan Absorbable Haemostat           Anal 20s (Box of 20)                       80 x 30mm
JJ007        Spongostan Absorbable Haemostat           Anal 5s (Box of 5)                         80 x 30mm
JJ008        Surgicel Nu-Knit Absorbable               Large (Box of 24)                          7.5 x 10cm
JJ009        Surgicel Fibrillar Absorbable Haemostat   Small (Box of 24)                          2.5 x 5.1cm
JJ012        Surgicel Absorbable Haemostat             Large (Box of 24)                          5 x 35cm or 10 x 20cm
JJ013        Surgicel Absorbable Haemostat             Medium (Box of 24)                         5 x 7.5cm
JJ014        Surgicel Absorbable Haemostat             Small (Box of 24)                          1.2 x 5cm
JJ015        Spongostan Absorbable Haemostat           Dental (Box of 24)                         10 x 10 x 10mm
JJ023        Surgicel Nu-Knit Absorbable               Small (Box of 24)                          2.5 x 2.5cm
JJ029        Surgicel Fibrillar Absorbable Haemostat   Large (Box of 24)                          10.2 x 10.2cm
JJ030        Surgicel Fibrillar Absorbable Haemostat   Medium (Box of 24)                         5.1 x 10.2cm
JJ432        SURGICEL Nu knit Absorbable               High density , oxidised regenerated        1in x 3.5in (2.5cm x 8.75cm)
             Haemostat                                 cellulose, the material is biocompatible
                                                       and also bactericidal. Box of 10.
JJ433        SURGICEL Nu knit Absorbable               High density , oxidised regenerated        6in x 9in (15cm x 22.5cm)
             Haemostat                                 cellulose, the material is biocompatible
                                                       and also bactericidal. Box of 10.
Kendall Australasia Pty Ltd T/A Tyco Healthcare
        Catheters, Peritoneal Dialysis
KA001        Tenckhoff Peritoneal Dialysis Catheter    Adult 2 cuff, Adult 1 cuff, Adult 0 Cuff   42cm to 47cm length. All Peritoneal
                                                                                                  Catheters excluding the Swan Neck
                                                                                                  Fast Flow Catheter, have an internal
                                                                                                  diameter of 2.67mm and an external
                                                                                                  diameter of 4.95 mm.
Prostheses List February 2005                                                                                                                                Page 85 of 700
GENERAL/MISCELLANEOUS                                                                                                                            Minimum   Maximum
Billing Code Product Name                              Description                                    Size                                       Benefit   Benefit    Notation
KA002        Tenckhoff Peritoneal Dialysis Catheter    Paediatric 2 cuff, Paediatric 1 cuff,          31cm to 37 cm length. All Peritoneal
                                                       Neonatal 1 cuff                                Catheters excluding the Swan Neck
                                                                                                      Fast Flow Catheter, have an internal
                                                                                                      diameter of 2.67mm and an external
                                                                                                      diameter of 4.95 mm.
KA003        Fast Flow Peritoneal Dialysis Catheter    Swan Neck, 2 cuff                              Int.diam: 3.2mm; ext diam 5.49mm.All
                                                                                                      Peritoneal Catheters excluding the
                                                                                                      Swan Neck Fast Flow Catheter, have
                                                                                                      an internal diameter of 2.67mm and an
                                                                                                      external diameter of 4.95 mm.
KA004        Swan Neck Curl Peritoneal Dialysis        Adult 2 cuff, left                             62 cm length. All Peritoneal Catheters
             Catheter                                                                                 excluding the Swan Neck Fast Flow
                                                                                                      Catheter, have an internal diameter of
                                                                                                      2.67mm and an external diameter of
                                                                                                      4.95 mm.
KA005        Swan Neck or Swan neck Tenckhoff          Adult-left, Adult-right, Adult, 2 cuff-left,   20 to 25cm external segment or 43cm
             Peritoneal Dialysis Catheter              Adult, 2 cuff-right                            length. All Peritoneal Catheters
                                                                                                      excluding the Swan Neck Fast Flow
                                                                                                      Catheter, have an internal diameter of
                                                                                                      2.67mm and an external diameter of
                                                                                                      4.95 mm.
KA006        Tenckhoff Peritoneal Dialysis Catheter,   Adult, 2 cuffs                                 57 to 62cm length. All Peritoneal
             Curl                                                                                     Catheters excluding the Swan Neck
                                                                                                      Fast Flow Catheter, have an internal
                                                                                                      diameter of 2.67mm and an external
                                                                                                      diameter of 4.95 mm.
      Enteral Feeding Kits
KA015        Entristar Skin Level Gastrostomy Kits     Skin level non-balloon internal retention      16fg x 1.5cm, 16fg x 1.7cm, 16fg x                              Temporary
                                                       bolster gastrostomy kit, including             2.0cm, 16fg x 2.7cm, 16fg x 3.0cm,                              approval, pending
                                                       Entristar gastrostomy tube, accessory          16fg x 3.5cm, 20fg x 1.5cm, 20fg x                              review of product
                                                       bolus and continuous feeding tubes,            2.ocm, 20fg x 2.5cm, 20fg x 3.0cm,                              group
                                                       syringes for inflation and flushin. Patient    20fg x 3.5cm, 20fg x 4.0cm, 20fg x 4.5cm
                                                        handbook
KA016        Kangaroo Gastrostomy Feeding Tubes        100% silicone gastrostomy with internal        12fg, 14fg, 16fg, 18fg, 20fg, 22fg, 24fg
                                                       retention balloon




Prostheses List February 2005                                                                                                                                        Page 86 of 700
GENERAL/MISCELLANEOUS                                                                                                                      Minimum   Maximum
Billing Code Product Name                          Description                                 Size                                        Benefit   Benefit    Notation
KA017        NutriPort Balloon Skin Level          Skin level silicone balloon gastrostomy     12fg x 0.8 - 5.0cm, 14fg x 0.8 - 5.0cm,                          Temporary
             Gastrostomy Kit                       kit, including NutriPort gastronomy tube,   16fg x 0.8 - 5.0cm                                               approval, pending
                                                    accessory bolus and continuous feeding                                                                      review of product
                                                    tubes, syringes for inflation and                                                                           group
                                                   flushing, Patient handbook
Kimberly-Clark Australia Pty Ltd
      Enteral Feeding Kits
KI001        Kimberly-Clark Aust Pty Ltd Enteral   68914 MIC Gastrostomy Tubes Model           MIC* Percutaneous Endoscopic
             Feeding Kit                           100 Series                                  Gastrostomy (P.E.G) Feeding
                                                                                               Tubes/Kits 14, 20, 24 French #0630
                                                                                               Series PUSH (OTW) Method &
                                                                                               #0640Series PULL Method
KI002        Kimberly-Clark Aust Pty Ltd Enteral   68914 MIC Gastrostomy Tubes Model           MIC* Percutaneous Endoscopic
             feeding kit, Mic* Percutaneous        100 Series                                  Gastrostomy (P.E. G) Feeding BASIC
             Endoscopic Gastrostomy (P.E.G)                                                    Tubes/Kits 14, 20, 24 French#0644
             Feeding Tubes/Kits                                                                Series PULL Method
KI003        Kimberly-Clark Aust Pty Ltd Enteral   68914 MIC Gastrostomy Tubes Model           Feeding Adaptors (Universal or Bolus)
             feeding kit, Mic* Percutaneous        100 Series                                  for use with 14, 20 &24 F MIC*
             Endoscopic Gastrostomy (P.E.G)                                                    PEG's#0135 &#0136 Series
             Feeding Tubes/Kits
KI004        Kimberly-Clark Aust Pty Ltd Enteral   68914 MIC Gastrostomy Tubes Model           MIC-KEY* Low Profile Gastrostomy
             feeding kit, MIC-KEY Low Profile      100 Series                                  Feeding Tubes/Kits 14 - 24 French, 0.8
             Gastrostomy Feeding Tubes/Kits                                                    cm - 4.5 cm
KI005        Kimberly-Clark Aust Pty Ltd Enteral   68914 MIC Gastrostomy Tubes Model           SECUR-LOK* Extension Sets & Bolus
             feeding kit, MIC-KEY Low Profile      100 Series                                  Feeding Sets 30.5 cm & 60.9 cm
             Gastrostomy Feeding Tubes/Kits
KI007        MIC* Gastrostomy Feeding Tube;        Medical Grade Silicone Construction.        12fr - 3-5ml balloon, 14fr - 3-5ml
             MIC* Bolus Gastrostomy Tube           Silicone Internal Inflatable Retention      balloon, 16fr - 3-5ml balloon, 18fr - 7-
                                                   Balloon, SECU-LOK* External                 10ml balloon, 20fr - 7-10ml balloon, 22fr
                                                   Retention Ring, Universal Feeding Port       - 7-10ml balloon, 24fr - 7-10ml balloon,
                                                   Connector, Medication Port, Dual Exit       26fr - 7-10ml balloon, 28fr - 7-10ml
                                                   Ports, Tapered Distal Tip, Radiopaque       balloon, 30fr - 7-10ml balloon,
                                                   Strip, Sterile.




Prostheses List February 2005                                                                                                                                  Page 87 of 700
GENERAL/MISCELLANEOUS                                                                                                                    Minimum   Maximum
Billing Code Product Name                            Description                               Size                                      Benefit   Benefit    Notation
      Tubes, Gastrostomy, Other
KI006        Kimberly-Clark MIC* Transgastric-       Medical Grade Silicone Construction,      16-22 French - 45cm jejunal length - 7-
             Jejunal Feeding Tubes (Surgical         Silicone Internal Retention Balloon,      10ml balloon
             Placement Kits)                         SECUR-LOK* External Retention ring,
                                                     Universal Jejunal Feeding Port
                                                     Connector, Gastric Decompression
                                                     Port, Multiple Gastric & Jejunal Exit
                                                     Ports, Tungsten Weighted Jejunal
                                                     Portion, Tapered Distal Tip, Radiopaque
                                                     Stripe, Sterile

LMT Surgical Pty Ltd
      Clips, Ligating
LM042        Synovis Microclip                       Malleable titanium clip                   One size only                                                  Temporary
                                                                                                                                                              approval, pending
                                                                                                                                                              review of product
                                                                                                                                                              group
      Prostheses, Nerve Sheath
LM017        Neurotube                               Bioabsorbable nerve conduit made of       2.3mm - 8mm
                                                     polyglycolic acid
Medical Specialties Australia Pty Ltd
      Catheterization Kits, Central Venous
MS008        Catheterisation kits(Horizon Medical)   Central Venous Catheter - Apheresis       12.5F
                                                     Bone Marrow Transplantation Catheter,
                                                     silicone
MS009        Catheterisation kits(Horizon Medical)   Central Venous Catheter - right atrial    2.7 -14F
                                                     catheter, silicone
MS010        Catheterisation kits(HDC corp)          Central Venous Catheter - right atrial    2 - 12F
                                                     catheter, silicone
      Infusion Pump Administration Sets
MS029        Medical Specialties Microject Drug      Ambulatory Infusion Pump System,          Microject Drug Administration Sets
             Administration Sets                     Administration Sets and Accessories
MS039        Medical Specialties "Deltec Cozmo       Drug Infusion Reservoir                   3ml Cartridges - Box 25
             Ancillary Equipment"


Prostheses List February 2005                                                                                                                                Page 88 of 700
GENERAL/MISCELLANEOUS                                                                                                             Minimum   Maximum
Billing Code Product Name                             Description                              Size                               Benefit   Benefit    Notation
MS040        Medical Specialties/Unomedical "Deltec   Drug Infusion Set                        Box 20
             Cozmo Ancillary Equipment"
      Infusion Pumps
MS031        Medical Specialties "Deltec Cozmo        Ambulatory Insulin Infusion Pump         Deltec Cozmo Insulin Pump - each
             Insulin Pump"
      Infusion Pumps, Ambulatory, Insulin
MS020        Infusa MPD                               Powered Drug Infusion System, Micro      Small, Medium, Large
                                                      dose battery operated, Syringe type
      Infusion Pumps, Ambulatory, Syringe
MS019        Infusa T, Infusa TS or Infusa DSLT       Powered Drug Infusion System, Battery    Small, Medium, Large
                                                      operated, Syringe type
      Infusion Pumps, General-Purpose
MS021        Medical Specialties "Walkmed Infusion    Ambulatory Infusion Pump System,         Walkmed Infusion Pump System
             Pump System" Powered Drug Infusion       Administration Sets and Accessories
             System and Ancillary Equipment
             (McKinley, USA)
MS022        Medical Specialties "Walkmed Drug        Ambulatory Infusion Pump System,         Walkmed Drug Administration
             Administration Reservoir" (McKinley,     Administration Sets and Accessories      Reservoirs
             USA)
MS023        Medical Specialties "Walkmed Drug        Ambulatory Infusion Pump System,         Walkmed Drug Administration Sets
             Administration Sets" (McKinley, USA)     Administration Sets and Accessories
      Infusion Pumps, Patient-Controlled Analgesic
MS028        Medical Specialties Microject Infusion   Ambulatory Infusion Pump System,         Microject Pumps
             Pump System                              Administration Sets and Accessories
      Injection/Infusion Ports, Implantable
MS014        Injection/Infusion Ports Sterile         Plastic/titanium, single lumen           5-15F
MS015        Injection/Infusion Ports Sterile         Plastic/titanium, dual lumen             10, 10.5, 12F
MS016        Injection/Infusion Ports Sterile         Plastic/titanium, paediatric             5, 6, 7,8, 9.6F
      Mesh
MS030        TiMESH light                             Prosthetic warp-knitted fabric made of   10 x15 cm TiMESH light
                                                      monofil polypropylene threads with an
                                                      encapsulating titanic coating

Prostheses List February 2005                                                                                                                         Page 89 of 700
GENERAL/MISCELLANEOUS                                                                                       Minimum   Maximum
Billing Code Product Name            Description                              Size                          Benefit   Benefit    Notation
MS032        TiMESH extralight       Prosthetic warp-knitted fabric made of   10 x 15cm TiMESH extralight
                                     monfil polypropylene threads with an
                                     encapsulating titanic coating
MS033        TiMESH light            Prosthetic warp-knitted fabric made of   15 x 15cm TiMESH light
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS034        TiMESH extralight       Prosthetic warp-knitted fabric made of   15 x15cm TiMESH extralight
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS035        TiMESH light            Prosthetic warp-knitted fabric made of   20 x 15cm TiMESH light
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS036        TiMESH extralight       Prosthetic warp-knitted fabric made of   20 x 15cm TiMESH extralight
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS037        TiMESH Extra Large      Prosthetic warp-knitted fabric made of   30 x 30cm TiMESH
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS038        TiMESH Extra Large      Prosthetic warp-knitted fabric made of   Extra Large TiMESH
                                     monofil polypropylene threads with an
                                     encapsulating titanic coating
MS041        TiCOVER                 Titanized polypropylene composite.       TiCOVER light
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS042        TiCOVER                 Titanized polypropylene composite.       TiCOVER strong
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS043        TiPLUG/TiPATCH System   Titanized polypropylene composite.       TiPLUG
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.




Prostheses List February 2005                                                                                                   Page 90 of 700
GENERAL/MISCELLANEOUS                                                                                    Minimum   Maximum
Billing Code Product Name            Description                              Size                       Benefit   Benefit    Notation
MS044        TiPLUG/TiPATCH System   Titanized polypropylene composite.       TiPATCH
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS045        TiPLUG/TiPATCH System   Titanized polypropylene composite.       TiPLUG + TiPATCH
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS046        TiLIFT                  Titanized polypropylene composite.       One size
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS047        TiGUARD                 Titanized polypropylene composite.       TiGUARD light 20 x 15cm
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS048        TiGUARD                 Titanized polypropylene composite.       TiGUARD light 30 x 30cm
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS049        TiGUARD                 Titanized polypropylene composite.       TiGUARD strong 20 x 15cm
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
MS050        TiGUARD                 Titanized polypropylene composite.       TiGUARD strong 30 x 30cm
                                     Prosthetic warp-knitted fabric made of
                                     monofilament polypropylene threads
                                     with an encapsulating titanic coating.
Medical Vision Australia Pty Ltd
      Adhesives, Aerosol
MF003        Steritalc               Sterile granules of talc implanted in    3 grams & 4 grams
                                     pleural space to act as permanent
                                     adhesive




Prostheses List February 2005                                                                                                Page 91 of 700
GENERAL/MISCELLANEOUS                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                               Size                                      Benefit   Benefit    Notation
Medtronic Australasia Pty Ltd
      Catheterization Kits
MC070        Medtronic AlgoLIne Catheter System    Model 81104. Radiopaque silicone          85cm
      Catheterization Kits, Intravenous
MC064        Implantable Drug Pump Accessories     8590-8, 8590-9 - Synchromed catheter      20cm; one size only; 38-60cm
                                                   accessory kit - Radiopaque silicone,
                                                   8590RAC - Right angled connector -
                                                   Titanium, polyurethane, 8591-38, 8691-
                                                   60, 8590-41 Tunnelling rods - Stainless
                                                   Steel, 8575 Synchromed connector (40
                                                   degree) with catheter access port, 8577
                                                   Isomed connector (90 degree) without
                                                   catheter access port, Right Angle
                                                   Connectors - Models 8575 40 Deg,
                                                   Model 8577 90 Deg;
      Catheters, Central Venous, Long Term
MC068        Medtronic SynchroMed vascular         Model 8700, 8700A, 8710. Radiopaque       62 to 89cm
                                                   silicone
      Catheters, Cerebrospinal
MC057        Spinal Catheter Model 8703W           Radiopaque Silicone                       2 sections for each catheter. Length of
                                                                                             sections: 38cm distal, 66cm proximal
      Infusion Pump Administration Sets
MC058        Medtronic SynchroMed Catheter Model   Radiopaque Silicone                       89cm
             8709




Prostheses List February 2005                                                                                                                              Page 92 of 700
GENERAL/MISCELLANEOUS                                                                                          Minimum   Maximum
Billing Code Product Name                         Description                               Size               Benefit   Benefit    Notation
MC285        Medtronic MiniMed Insulin Pump       Ambulatory Insulin Infusion Pump          60-110cm
             Infusion Sets                        System Administration Sets and
                                                  Accessories: Quick-set MMT-390,
                                                  MMT-391, MMT-392, MMT-393; Sof-
                                                  set Micro MMT-320, MMT-321; Sof-
                                                  set Ultimate MMT-315, MMT-316 (all
                                                  tubing with cannula for use with MMT-
                                                  507C and MMT-508 insulin infusion
                                                  pump); Silhouette MMT-371, MMT-
                                                  372, MMT-373, MMT-374 (Full Set of
                                                  10 complete sets: 10 sites + 10 tubing,
                                                  OR Combo Set: 10 sites + 5 tubing for
                                                  use with MMT-507C or MMT-508
                                                  insulin infusion pump); Serters MMT-
                                                  395, MMT-300, MMT-385 (For use
                                                  with MMT-511 or MMT-507C or
                                                  MMT-508 insulin infusion pump);
                                                  Polyfin MMT-106, MMT-306, MMT-
                                                  307, Polyfin QR MMT-165, MMT-365,
                                                  MMT-366 (bent needles with wings for
                                                  use with MMT-507C and MMT-508
                                                  insulin infusion pump)

MC286        Medtronic MiniMed Paradigm Insulin   Ambulatory Insulin Infusion Pump          60-110cm
             Pump Infusion Sets                   System Adminstration Sets and
                                                  accessories: Quick-set MMT-396,
                                                  MMT-398, MMT-397, MMT-399; Sof-
                                                  set Micro MMT-324, MMT-325; Sof-
                                                  set Ultimate MMT-317, MMT-318 (all
                                                  tubing with cannula for use with MMT-
                                                  511 insulin infusion pump), Silhouette
                                                  MMT-377, MMT-379, MMT-378,
                                                  MMT-380 (Full Set of 10 complete sets:
                                                   10 sites + 10 tubing, OR Combo Set: 10
                                                   sites + 5 tubing for use with MMT-511
                                                  insulin infusion pump)

MC304        Medtronic Minimed Paradigm Insulin   Reservoir Model MMT - 332A (for use       3.0 ml reservoir
             Infusion Pump Reservoir              with the Paradigm Model MMT - 712).
                                                  Polycarbonate



Prostheses List February 2005                                                                                                      Page 93 of 700
GENERAL/MISCELLANEOUS                                                                                                          Minimum   Maximum
Billing Code Product Name                         Description                            Size                                  Benefit   Benefit    Notation
      Infusion Pumps
MC300        Medtronic MiniMed Insulin Infusion   Model MMT - 508                        One Size Only
             Pump System
MC302        Medtronic Minimed Insulin Infusion   Paradigm Model MMT - 512.              One Size Only
             pump System                          Polycarbonate
MC303        Medtronic Minimed Insulin Infusion   Paradigm Model MMT - 712               One Size Only
             Pump System                          Polycarbonate
      Infusion Pumps, Ambulatory, Insulin
MC283        Medtronic MiniMed Paradigm Insulin   Model MMT-511- One Insulin Pump        One Size Only
             Infusion Pump System                 Only
      Infusion Pumps, Ambulatory, Syringe
MC282        Medtronic MiniMed Insulin Infusion   Ambulatory Insulin Infusion Pump       One Size Only
             Pump Reservoir                       System Administration Sets and
                                                  Accessories; Insulin Infusion Pump
                                                  Reservoir MMT-103A (for use with
                                                  pumps MMT - 507C & MMT - 508)
MC284        Medtronic MiniMed Paradigm Insulin   Paradigm Insulin Infusion Pump         One Size Only
             Infusion Pump Reservoir              Reservoir MMT-326A (for use with
                                                  Model MMT-511 insulin infusion pump)
Morton Surgical Pty Ltd
      Balloons, Gastric, Appetite-Suppressing
MG002        Heliogast Adjustable Gastric Ring    Silicone and Titanium                  HAGM (medium) Inner Diameter
                                                                                         27.5mm; HAGS (small) Inner Diameter
                                                                                          25mm; HAGA (advanced) Inner
                                                                                         Diameter 27mm
N Stenning & Co Pty Ltd
      Appliers
NG042        Weck Hem-o-lok                       Hem-o-lok Automatic Open Applier       15 Clips per applier                                       Temporary
                                                                                                                                                    approval
NG043        Weck Hem-o-lok                       Hem-o-lok Automatic Endo Applier       15 Clips per applier                                       Temporary
                                                                                                                                                    approval




Prostheses List February 2005                                                                                                                      Page 94 of 700
GENERAL/MISCELLANEOUS                                                                                                    Minimum   Maximum
Billing Code Product Name                       Description                          Size                                Benefit   Benefit    Notation
      Clips, Hemostatic
NG025        Hem-o-Lok Polymer Non-Absorbable   Hem-o-lok Medium (M), Medium-        Medium, Medium-Large, Large                              Temporary
             Ligating Clip                      Large (ML) and Large (L) Polymer                                                              Approval
NG044        Hem-o-lok Polymer Non-Absorbable   Hem-o-lok Extra-large (XL) Polymer   Extra-large (XL)
             Ligating Clip                      Clips
      Clips, Ligating
NG006        Horizon Ligating Clips             Ligation Clips Titanium              Small (6 per cartridge)                                  Temporary
                                                                                                                                              Approval
NG007        Horizon Ligating Clips             Ligation Clips Titanium              Small (24 per cartridge)                                 Temporary
                                                                                                                                              Approval
NG008        Horizon Ligating Clips             Ligation Clips Titanium              Medium (6 per cartridge)                                 Temporary
                                                                                                                                              Approval
NG009        Horizon Ligating Clips             Ligation Clips Titanium              Medium (24 per cartridge)                                Temporary
                                                                                                                                              Approval
NG010        Horizon Ligating Clips             Ligation Clips Titanium              Medium/Large (6 per cartridge)                           Temporary
                                                                                                                                              Approval
NG011        Horizon Ligating Clips             Ligation Clips Titanium              Medium/Large (24 per cartridge)                          Temporary
                                                                                                                                              Approval
NG012        Horizon Ligating Clips             Ligation Clips Titanium              Large (6 per cartridge)                                  Temporary
                                                                                                                                              Approval
NG013        Horizon Ligating Clips             Ligation Clips Titanium              Large (24 per cartridge)                                 Temporary
                                                                                                                                              Approval
      Clips, Other
NG014        Hemoclip                           Titanium Clips                       Small, Medium (25 per cartridge);                        Temporary
                                                                                     Large (15 per cartridge)                                 Approval
NG016        Hemoclip                           Titanium Clips                       Medium (10 per cartridge)                                Temporary
                                                                                                                                              Approval
NG017        Hemoclip                           Titanium Clips                       Small (10 per cartridge)                                 Temporary
                                                                                                                                              Approval
NG018        Hemoclip                           Titanium Clips                       Med-large (10 per cartridge)                             Temporary
                                                                                                                                              Approval
NG019        Hemoclip                           Titanium Clips                       Large (10 per cartridge)                                 Temporary
                                                                                                                                              Approval
Prostheses List February 2005                                                                                                                Page 95 of 700
GENERAL/MISCELLANEOUS                                                                                                                       Minimum   Maximum
Billing Code Product Name                            Description                                 Size                                       Benefit   Benefit    Notation
NG023        Hemoclip Plus                           Ligation System Small and Medium            15 small preloaded clips and 20 medium                          Temporary
                                                                                                 preloaded clips                                                 Approval
      Clips, Vascular
NG020        EZLoad Ligating Clips                   Titanium Clip                               Small (25 per cartridge); Med-Large,                            Temporary
                                                                                                 Large (10 per cartridge)                                        Approval
NG021        EZLoad Ligating Clips                   Titanium Clip                               Medium (25 per cartridge)                                       Temporary
                                                                                                                                                                 Approval
NG022        EZLoad Ligating Clips                   Titanium Clip                               Small, Medium (10 per cartridge)                                Temporary
                                                                                                                                                                 Approval
      Gel, Resorbable, Antiadhesion
NG037        SprayGel Adhesion Barrier Polymer Kit   PK-A-6010 SprayGel Polymer Kit; PK-         One size only; PK-A-4210 - 5 Kits/Box                           Temporary
                                                     A-4210 SprayGel Open Surgery                                                                                approval - funded
                                                     Polymer Kit (10ml)                                                                                          when clinical
                                                                                                                                                                 indications for use
                                                                                                                                                                  are present.
      Stents, Bronchial
NG034        Dynamic Stent                           Silicone and stainless steel tracheo-       11, 13, 15 tracheal limb 11.5, 13.5,
                                                     bronchial stent                             15.5mm; 11, 13, 15 bronchial limb 8, 10,
                                                                                                 12mm
      Stents, Tracheal
NG033        Polyflex Stent with Introducer System   Polyflex Stent for Oesophagus - self        One size only
                                                     expanding stent, composition silicone
                                                     with polyester mesh, System includes
                                                     polyflex stent, introducer sleeve, stent
                                                     loader, insertion tube with dilator, soft
                                                     positioner, stopper & stent clamp;
                                                     Polyflex Stent for Trachea or Bronchus
                                                     - self expanding stent, composition
                                                     silicone with polyester mesh, System
                                                     includes polyflex stent, introducer
                                                     sleeve, stent loader/positioner & stopper




Prostheses List February 2005                                                                                                                                   Page 96 of 700
GENERAL/MISCELLANEOUS                                                                                                               Minimum   Maximum
Billing Code Product Name                        Description                                  Size                                  Benefit   Benefit    Notation
      Tubing, Other
NG036        SprayGel Air Assisted Sprayer       SK-A-6001 SprayGel Sprayer Kit; AK-          One size only; AK-A-4210 - 5                               Temporary
                                                 A-4210 SprayGel Open Surgery                 Applicators/Box                                            approval - funded
                                                 Applicator                                                                                              when clinical
                                                                                                                                                         indications for use
                                                                                                                                                          are present.
Nucletron Pty. Limited
      Brachytherapy Sources
NU001        selectSeed                          Nucletron selectSeed Model # 130002          One size only                                              Only to be funded
                                                 consists of cylindrical silver rod, coated                                                              where used in a
                                                 with radioactive Iodine-125 layer.                                                                      service for which
                                                 Active silver rod is encapsulated in                                                                    a medicare benefit
                                                 hollow titanium tube. Laser welding,                                                                     is payable
                                                 using sperical shaped end welds, seals                                                                  (current MBS
                                                                                                                                                         items are 37220,
Olympus Australia
      Stents, Biliary
OL003        Bile Duct Stent                     Fluorinated Ethylene Propylene               8Fr., 3cm ~ 12Fr., 15cm 8Fr., 5cm ~
                                                                                              12Fr., 15cm
OL004        Bile Duct Stent                     Fluorinated Ethylene Propylene               10Fr., 4 ~15cm, 10Fr., 3 ~15cm
OL005        Bile Duct Stent                     Fluorinated Ethylene Propylene               10Fr.~14Fr. , 3~15cm
Orthocare Pty Limited
      Infusion Pumps
OC003        Pain Care 2000L                     Pain Care 2000L System                       One Size Only
OC004        Pain Care 2000L                     "Y" Accessory Kit                            One Size Only
OC005        Pain Care 2000L                     Multiport Catheter 54"                       One Size Only
      Spring Infusor, Ambulatory
OC001        Pain Care 2000                      Pain Care 2000 System                        One size only
OC002        Pain Care 2000                      "Y" Accessory Kit                            One size only
Orthotech Pty Ltd
      Spring Infusor, Ambulatory
OH065        PC2000 Pain Control Infusion Pump   Plastic spring loaded drug delivery device 0.5 ml - 4 ml
Prostheses List February 2005                                                                                                                           Page 97 of 700
GENERAL/MISCELLANEOUS                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                               Size                                      Benefit   Benefit    Notation
OH122        PC2000 Pain Control Infusion Pump     Plastic spring loaded drug delivery device 0.5ml - 4ml
             Connector
Pharmacia Australia Pty Ltd
      Sponges, Hemostatic, Absorbable
PU056        Gelfoam Sterile Sponge                Sterile, pliable, nonantigenic surgical   Size 12 - 20mm x 60mm x 7mm, packet
                                                   sponge prepared from specially treated    of 4; Size 100 - 80mm x 125mm x
                                                   purified gelatin solution                 10mm in individual packet
Promedica Pty Ltd
      Enteral Feeding Kits
PO001        Corflo Cubby LPGD Kit                 Low profile gastronomy device             12 - 24fg x 1.0 - 4.5cm
PO002        Corflo Gastronomy Replacement         Dual and triple gastronomy tubes          Dual 12 - 24fg 5 - 20cc balloon; Triple
                                                                                             16 - 24fg 20cc balloon
PO003        Corflo Max 20fg PEG Kit Complete      Sterile enteral feeding tube with         20fg
             with 7fg Snare - "Pull Type"          accessories
PO004        Corflo Max 20fg PEG Kit "Pull Type"   Sterile enteral feeding tube with         20fg
                                                   accessories
Roche Diagnostics Australia Pty Ltd
      Infusion Controller Administration Sets
RO004        "Disetronic Infusion Sets"            Tender II 17/30                           Pack 20/10
RO010        "Disetronic Infusion Sets"            Tender II 17/60                           Pack 20/10
RO011        "Disetronic Infusion Sets"            Tender II 17/80                           Pack 20/10
RO012        "Disetronic Infusion Sets"            Tender I 17/60                            Pack 10
RO013        "Disetronic Infusion Sets"            Rapid D 6/60                              Pack 15/5
RO014        "Disetronic Infusion Sets"            Rapid D 6/80                              Pack 15/5
RO015        "Disetronic Infusion Sets"            Rapid D 8/60                              Pack 15/5
RO016        "Disetronic Infusion Sets"            Rapid D 8/80                              Pack 15/5
      Infusion Pump Administration Sets
RO003        Disetronic Administration Sets and    Adaptor D-Tron plus                       10/box
             Accessories



Prostheses List February 2005                                                                                                                              Page 98 of 700
GENERAL/MISCELLANEOUS                                                                                                          Minimum   Maximum
Billing Code Product Name                            Description                           Size                                Benefit   Benefit    Notation
      Infusion Pumps, Ambulatory, Insulin
RO001        "Disetronic Insulin Infusion Pump       D-Tron plus                           Large Kit Blue or Anthracite
             System"
RO002        "Disetronic Insulin Infusion Pump       H-Tron plus                           Large Kit Blue or Grey
             System"
RO008        "Disetronic Insulin Infusion Pump       H-Tron plus                           Small Kit Blue or Grey
             System"
RO009        "Disetronic Insulin Infusion Pump       D-Tron plus                           Small Kit Blue or Grey
             System"
Sherwood Davis & Geck T/A Tyco Healthcare Pty
      Enteral Feeding Kits
SG001        Gastrostomy Tube                        EntriStar Single Pass PEG             16fg, 20fg
      Mesh, Polyglycolic Acid
SG002        Dexon Mesh Danbury 7979-00              Beige polyglycolic acid absorbable    18 x 23cm
                                                     surgical mesh fabric
      Mesh, Polymeric
SG004        Surgilene Mesh                          Constructed of knitted filaments of   1x4, 2x4, 3x6 10x14
                                                     polypropylene, non-absorbable
Smiths Medical Australasia Pty Ltd
      Catheters, Epidural
SI020        Injection/Infusion Ports, Sterile -     Port - single lumen                   1.2 mm O.D. polyurethane catheter
             PORT-A-CATH II Epidural Low
SI021        Injection/Infusion Ports, Sterile -     Port - single lumen                   0.9 mm O.D. polyurethane catheter
             PORT-A-CATH II Intraspinal Low
             Profile System
      Infusion Pump Administration Sets
SI024        Medication Cassettes (50ml & 100ml)     Pump                                  50 mL
SI025        Medication Cassettes (50ml & 100ml)     Pump                                  100 mL
SI026        Flexible Medication Reservoir, 250ml,   Pump                                  250 mL
             Model 21-6167-24
SI028        Extention Set (30" & 60")               Pump                                  76 cm

Prostheses List February 2005                                                                                                                      Page 99 of 700
GENERAL/MISCELLANEOUS                                                                                                    Minimum   Maximum
Billing Code Product Name                           Description                             Size                         Benefit   Benefit    Notation
SI029        Extention Set (30" & 60")              Pump                                    152 cm
SI031        CADD-TPN Administration Sets, 0.2      Pump                                    1.2 micron filter
             Micron and 1.2 Micron Filters
SI036        Flexible Medication Reservoir, 250ml   Pump                                    250 mL
             Model 21-6167-24
SI040        Adminstration Set                      Bag Spike, Integral Anti-Siphon Valve   196cm Bag Spike, Box of 12
SI041        Administration Set                     High Volume, with 0.2 Micron Filter,    Box of 15
                                                    Male Luer, Add On Anti Syphon Valve
SI042        Extension Set                          Microbore TOTM with 0.22 Filter, M/M    152cm, Box of 15
                                                    Luers, for Flolan
SI043        Adminstration Set                      1.2 Micron Filter, Add on Anti Syphon   Box of 15
                                                    Valve for TPN
SI044        Administration Set                     High Volume, TOTM- Plasticized Blue     305cm, Box of 15
                                                    Striped with 1.2 Micron Filter, Male
                                                    Luer, Add On Anti-Siphon Valve
      Infusion Pumps, Ambulatory, Other
SI027        CADD Administration Sets, 198cm,       Pump                                    198 cm
             with Bag Spike & Add-on Anti-siphon
             Valve, TOTM Plasticized Tubing,
             Model No. 21-7057-24
SI037        CADD Legacy 1 Model 6400               Pump                                    One size only
             Ambulatory Infusion Pump
SI038        CADD Legacy Plus Model 6500            Pump                                    One size only
             Ambulatory Infusion Pump
      Infusion Pumps, Micro
SI032        CADD-Micro Model 5900 Ambulatory       Pump                                    One size only
             Infusion Pump
      Infusion Pumps, Patient-Controlled Analgesic
SI034        CADD-PRIZM VIP (Variable Infusion      Pump                                    One size only
             Profile) Model 6100; CADD-PRIZM
             PCS Ambulatory Infusion Pump, Model
             6100
SI039        CADD Legacy PCA Model 6300             Pump                                    One size only
             Ambulatory Infusion Pump
Prostheses List February 2005                                                                                                                Page 100 of 700
GENERAL/MISCELLANEOUS                                                                                              Minimum   Maximum
Billing Code Product Name                              Description           Size                                  Benefit   Benefit    Notation
      Injection/Infusion Ports, Implantable
SI001        Injection/Infusion Ports, Sterile -       Port - single lumen   One size only
             PORT-A-CATH II Trans Arterial
             Percuataneous System
SI002        Injection/Infusion Ports, Sterile -       Port - single lumen   One size only
             PORT-A-CATH Intraspinal 501CS
SI003        Injection/Infusion Ports, Sterile -       Port - single lumen   1.9 mm O.D. PolyFlow Polyurethane
             PORT-A-CATH P.A.S Port T2                                       Catheter
SI005        Injection/Infusion Ports, Sterile -       Port - single lumen   One size only
             PORT-A-CATH Peritoneal System
SI006        Injection/Infusion Ports, Sterile -       Port - single lumen   One size only
             PORT-A-CATH Intraspinal 500CS
SI007        Injection/Infusion Ports, Sterile -       Port - single lumen   2.3 mm silicone catheter
             PORT-A-CATH Arterial Titanium
SI008        Injection/Infusion Ports, Sterile -       Port - single lumen   2.8 mm silicone catheter & 9 French
             PORT-A-CATH Titanium Venous                                     introducer set
SI009        Injection/Infusion Ports, Sterile -       Port - single lumen   1.9 mm polyurethane catheter
             PORT-A-CATH Implantable Venous
             Access System
SI010        Injection/Infusion Ports, Sterile -       Port - single lumen   1.9mm polyurethane catheter
             PORT-A-CATH Implantable Access
             System - Venous Portal, with introducer
SI011        Injection/Infusion Ports, Sterile -       Port - single lumen   1.9 mm polyurethane catheter
             PORT-A-CATH Low Profile Titanium
             Venous System
SI012        Injection/Infusion Ports, Sterile -       Port - single lumen   1.9 mm polyurethane catheter
             PORT-A-CATH Low Profile
             Implantable Venous System, with
SI013        Injection/Infusion Ports, Sterile -       Port - single lumen   2.8 mm silicone catheter
             PORT-A-CATH II Titanium Venous
SI014        Injection/Infusion Ports, Sterile -       Port - single lumen   2.8 mm silicone catheter
             PORT-A-CATH II Titanium Venous
             System, with introducer set



Prostheses List February 2005                                                                                                          Page 101 of 700
GENERAL/MISCELLANEOUS                                                                                                               Minimum   Maximum
Billing Code Product Name                            Description                                 Size                               Benefit   Benefit    Notation
SI015        Injection/Infusion Ports, Sterile -     Port - single lumen                         1.9 mm polyurethane catheter
             PORT-A-CATH II Titanium Venous
SI016        Injection/Infusion Ports, Sterile -     Port - single lumen                         1.9 mm polyurethane catheter
             PORT-A-CATH II Titanium Venous
             System with introducer set
SI017        Injection/Infusion Ports, Sterile -     Port - single lumen                         2.6 mm polyurethane catheter
             PORT-A-CATH Titanium Venous
             System with introducer set
SI018        Injection/Infusion Ports, Sterile -     Port - single lumen                         1.9 mm polyurethane catheter
             PORT-A-CATH II Low Profile
             Titanium Venous System
SI019        Injection/Infusion Ports, Sterile -     Port - single lumen                         1.9 mm polyurethane catheter
             PORT-A-CATH II Low Profile
             Titanium Venous System with
SI022        Injection/Infusion Ports, Sterile -     Port - dual lumen                           3.4 mm silicone catheter
             PORT-A-CATH II Dual Lumen
             Titanium Venous system
SI023        Injection/Infusion Ports, Sterile -     Port - dual lumen                           3.4 mm silicone catheter
             PORT-A-CATH II Dual Lumen
             Titanium Venous system and introducer
Stryker Australia Pty Ltd
      Spring Infusor, Ambulatory
SK119        Stryker PainPump                        Vacuum operated pump providing              120ml Infuser
                                                     controlled infusion of a Local
                                                     Anaesthetic directly into a surgical site
                                                     for post-operative pain management.
SK120        Stryker PainPump                        Vacuum operated pump providing              120ml Unit Base Infusion Kits
                                                     controlled infusion of a Local
                                                     Anaesthetic directly into a surgical site
                                                     for post-operative pain management.
SK121        Stryker PainPump                        Vacuum operated pump providing              120ml unit 1-7 Day Infusion Kits
                                                     controlled infusion of a Local
                                                     Anaesthetic directly into a surgical site
                                                     for post-operative pain management.



Prostheses List February 2005                                                                                                                           Page 102 of 700
GENERAL/MISCELLANEOUS                                                                                                 Minimum   Maximum
Billing Code Product Name        Description                                 Size                                     Benefit   Benefit    Notation
SK122        Stryker PainPump    Vacuum operated pump providing              120ml unit Two Pump 2-4 Day Infusion
                                 controlled infusion of a Local              Kits
                                 Anaesthetic directly into a surgical site
                                 for post-operative pain management.
SK123        Stryker PainPump    Vacuum operated pump providing              270ml unit 1-7 Day Infusion Kits
                                 controlled infusion of a Local
                                 Anaesthetic directly into a surgical site
                                 for post-operative pain management.
SK124        Stryker PainPump    Vacuum operated pump providing              270ml unit Base Infusion Kits
                                 controlled infusion of a Local
                                 Anaesthetic directly into a surgical site
                                 for post-operative pain management.
SK125        Stryker PainPump    Vacuum operated pump providing              75-150mm Extra Fenestration Infusion
                                 controlled infusion of a Local              Catheters
                                 Anaesthetic directly into a surgical site
                                 for post-operative pain management.
Surgical Synergies Pty Ltd
      Delivery Kits
SS001        PainBuster          Kit includes catheter, introducer needle,   270ml volume x 2 lines x 2 ml per hour
                                 flow restrictor, filter
SS002        PainBuster          Kit includes catheter, introducer needle,   100ml volume x 2 ml per hour
                                 flow restrictor, filter
SS003        PainBuster          Kit includes catheter, introducer needle,   270ml volume x 2 ml per hour
                                 flow restrictor, filter
SS004        PainBuster          Kit includes catheter, introducer needle,   270ml volume x 5 ml per hour
                                 flow restrictor, filter
SS005        Painbuster Soaker   Kit includes catheter, introducer needle,   270ml volume x 4ml/hr, dual; 2ml per
                                 flow restrictor, filter                     site, 12.5cm soaker
SS006        Painbuster Soaker   Kit includes catheter, introducer needle,   400ml volume x 10ml/hr, 12.5cm soaker
                                 flow restrictor, filter




Prostheses List February 2005                                                                                                             Page 103 of 700
GENERAL/MISCELLANEOUS                                                                                                             Minimum   Maximum
Billing Code Product Name                         Description                               Size                                  Benefit   Benefit    Notation
Tag Medical
      Stents, Bronchial
TM035        Alveolus                             Alveolus stent is laser formed from a     10mm x 20, 30, 40mm. 12mm x 20, 30,
                                                  cylindrical tube of NiTinol, a            40mm. 14mm x 20, 30, 40mm. 16mm x
                                                  compination of nickel and titanium kown   40, 60, 80mm. 18mm x 40, 60, 80mm
                                                   for shape memory and super-elasticity.
                                                   These are 100% covered with
                                                  biocompatible polymer.
Taylor Bryant Pty Ltd
      Sponges, Hemostatic, Absorbable
TB134        Curaspon Absorbable Gelatin Sponge   CUR-D-101010-50 Dental Cubes, Ster,       10 x 10 x 10mm, Bx /50
                                                  Gel Sponge
TB135        Curaspon Absorbable Gelatin Sponge   CUR-D-101010-60 Dental Cubes, Ster,       10 x 10 x 10mm, Bx 2/30
                                                  Gel Sponge
TB136        Curaspon Absorbable Gelatin Sponge   CUR-SP-805001-20 Special 20, Ster,        80 x 50 x 1mm, Bx /20
                                                  Gel Sponges
TB137        Curaspon Absorbable Gelatin Sponge   CUR-ST-1258001-10C Absorb Sterile         100mm, Bx /10
                                                  Gelatin Sponges
TB138        Curaspon Absorbable Gelatin Sponge   CUR-ST-1258010-10 Absorb Sterile          100mm, Bx /10
                                                  Gelatin Sponges
TB139        Curaspon Absorbable Gelatin Sponge   CUR-ST-602007-10 Sterile Gel              60 x 20 x 7mm, Bx /10
TB140        Curaspon Absorbable Gelatin Sponge   CUR-ST-602007-10NSHS Special              Bx /10
                                                  Paper Peel Pack
TB141        Curaspon Absorbable Gelatin Sponge   CUR-ST-805010-10 STD 10, Sterile          80 x 50 x 10mm, Bx /10
                                                  Gel Sponges
TB142        Curaspon Absorbable Gelatin Sponge   CUR-ST-805010-10-NSHS Special             Bx /10
                                                  Paper Peel Pack
TB143        Curaspon Absorbable Gelatin Sponge   CUR-T-8030-05 Tampon 5, Anal Ster,        80 x 30mm, Bx /5
                                                  Gel Sponge
Technology For Life Pty Ltd
      Adhesives, Aerosol
TE002        Sclerosol Pleural Spray              Intrapleural Patch                        5gm

Prostheses List February 2005                                                                                                                         Page 104 of 700
GENERAL/MISCELLANEOUS                                                                                                           Minimum   Maximum
Billing Code Product Name                      Description                                Size                                  Benefit   Benefit    Notation
Ultimate Medical Pty Ltd
      Anesthesia Kits, Other
UM001        LA Bubble                         Balloon based local anaesthetic infusion   One size only
                                               system
W L Gore & Associates
      Mesh, Polymeric
GT084        Gore-Tex MycroMesh Plus           ePTFE                                      1mm Thickness 20cm x 30
GT087        Gore-Tex MycroMesh Plus           ePTFE                                      1mm thickness Oval 26 x 34cm
GT104        Gore-Tex DualMesh PLUS            ePTFE                                      1mm Thickness 7.5 x 10cm
GT107        Gore-Tex DualMesh PLUS            ePTFE                                      15.0 x 19.0cm x 1mm Oval
GT201        Dualmesh Plus Biomaterial         ePTFE                                      8cm x 12cm x 1mm
GT202        Dualmesh Plus Biomaterial         ePTFE, oval                                10cm x 15cm x 1mm
GT203        Dualmesh Plus Biomaterial         ePTFE                                      18cm x 24cm x 1mm
GT204        Dualmesh Plus Biomaterial         ePTFE                                      20cm x 30cm x 1mm
GT205        Dualmesh Plus Biomaterial         ePTFE, oval                                26cm x 34cm x 1mm
GT206        Dualmesh Plus Biomaterial         ePTFE, oval                                10cm x 15cm x 2mm
GT207        Dualmesh Plus Biomaterial         ePTFE, oval                                15cm x 19cm x 2mm
GT208        Dualmesh Plus Biomaterial         ePTFE,                                     18cm x 24cm x 2mm
GT209        Dualmesh Plus Biomaterial         ePTFE,                                     20cm x 30cm x 2mm
GT210        Dualmesh Plus Biomaterial         ePTFE, oval                                26cm x 34cm x 2mm
      Stents, Biliary
GT116        Gore Biliary Endoprostheses       ePTFE                                      Short or Long Catheter 8-10mmx4-8cm
      Tissue Reconstructive Materials, Solid
GT001        GORE - Seamguard Staple Line      1pair of sleeves ePTFE                     One Size Only                                              Temporary
             Reinforcement Material                                                                                                                  Approval
GT065        Gore-Tex ePTFE Mycro-Mesh         ePTFE                                      1mm Thickness 2.5 x 10cm
             Biomaterial
GT066        Gore-Tex Mycro-Mesh Biomaterial   ePTFE                                      1mm Thickness 5 x 10cm (Rectangle),
                                                                                          5 x 10cm (Key Hole)

Prostheses List February 2005                                                                                                                       Page 105 of 700
GENERAL/MISCELLANEOUS                                                                                                                Minimum   Maximum
Billing Code Product Name                          Description                              Size                                     Benefit   Benefit    Notation
GT067        Gore-Tex Mycro-Mesh                   ePTFE                                    1mm Thickness 5 x 13cm (Configured
                                                                                            for Vaginal Prolapse), 5 x 15cm
GT068        Gore-Tex Mycro-Mesh Biomaterial       ePTFE                                    1mm Thickness 18 x 24cm
GT069        Gore-Tex Mycro-Mesh Biomaterial       ePTFE                                    1mm Thickness 20 x 30cm
GT070        Gore-Tex Mycro-Mesh Biomaterial       ePTFE                                    1mm Thickness Oval 26 x 34cm
GT071        Gore-Tex Mycro-Mesh Biomaterial       ePTFE                                    1mm Thickness Oval 10 x 15cm
GT072        Gore-Tex Mycro-Mesh Biomaterial       ePTFE                                    1mm Thickness Oval 15 x 19cm
GT074        Gore-Tex Mycro-Mesh Biomaterial       Configured for Inguinal Hernia repair    1mm Thickness 6cm x 12cm
                                                   ePTFE
GT092        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness 7.5 x 10cm
GT093        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness 8 x 12cm
GT094        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness Oval 10 x 15cm
GT095        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness Oval 15.0 x 19.0cm
GT096        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness 18 x 24cm
GT097        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness 20 x 30cm
GT098        Gore-Tex Dual Mesh                    ePTFE                                    1mm Thickness Oval 26 x 34cm
GT099        Gore-Tex Dual Mesh                    ePTFE                                    2mm Thickness Oval 10 x 15cm
GT100        Gore-Tex Dual Mesh                    ePTFE                                    2mm Thickness Oval 15 x 19cm
GT101        Gore-Tex Dual Mesh                    ePTFE                                    2mm Thickness 18 x 24cm
GT102        Gore-Tex Dual Mesh                    ePTFE                                    2mm Thickness 20 x 30cm
GT103        Gore-Tex Dual Mesh                    ePTFE                                    2mm Thickness Oval 26 x 34cm
GT217        Seamguard Staple Line Reinforcement   1 pair of sleeves ePTFE with self-       Ethicon Endo-Surgery ETS45, USS                               Temporary
             Material                              adhesive loading and pre-trimmed sizes   Endo GIA II 45-4.8, USS Endo GIA II                           approval
                                                                                            60-4.8
William A Cook Aust Pty Ltd
      Catheters, Biliary
WC071        Nasobiliary Drainage Set              Biliary/Pancreatic                       DRAINAGE CATHETER Fr size:
                                                                                            5,6,7,8.5 Length: 250cm Sideports: 5cm
                                                                                             WIRE GUIDE Diameter: .035 inch
                                                                                            Length: 480cm Color Connection purple

Prostheses List February 2005                                                                                                                            Page 106 of 700
GENERAL/MISCELLANEOUS                                                                                                             Minimum   Maximum
Billing Code Product Name                    Description                             Size                                         Benefit   Benefit    Notation
      Catheters, Central Venous, Long Term
WC116        Cook Central Venous Long Term   Cook TPN single lumen catheter          Fr 3, length 55, 65cm; Fr 4, length 65cm,
             Catheter                                                                Fr 6.5, 9.5, length 90cm
WC117        Cook Central Venous Long Term   Cook TPN single lumen catheter set      Fr 3, length 55; Fr 4, length 65cm, Fr 6.5
             Catheter                                                                length 65, 90cm, Fr 9.5, length 90cm
WC118        Cook Central Venous Long Term   Cook TPN double lumen catheter          Fr 5, length special; Fr 7, length 65cm,
             Catheter                                                                Fr 9 length 80, 90cm, Fr 12, length
                                                                                     special
WC119        Cook Central Venous Long Term   Cook TPN double lumen catheter set      Fr 7, length 65cm, Fr 9 length 90cm, Fr
             Catheter Set                                                            12, 90, special
WC121        Cook Central Venous Long Term   Cook TPN triple lumen catheter          Fr 8, length 90cm
             Catheter
WC122        Cook Central Venous Long Term   Cook TPN triple lumen catheter set      Fr 8, length 90cm
             Catheter
      Catheters, Irrigation
WC196        Cook Irrigation Catheter        Chait Percutaneous Cecostomy Set        10fr, Set
                                             consisting of: Suture Anchor Set,
                                             Drainage Catheter, Wireguide,
                                             Cecostomy Catheter Set, Adapter,
                                             Connecting Tube
WC197        Cook Irrigation Catheter        Chait Percutaneous Cecostomy Catheter   10fr, Standard or Extra Long
      Catheters, Jejunostomy
WC098        Cook Jejeunostomy Catheters     Composition - Catheter Radiopaque       12fr, length 66cm
                                             Stripe, includes Wireguide, Airplug,
                                             Fixation Device
WC099        Cook Jejunostomy Catheters      Composition - Catheter Radiopaque       9fr, Length 24cm
                                             Stripe, includes Wireguide, Airplug,
                                             Fixation Device
WC198        Cook Jejunostomy Catheters      Heidelberg Jejunostomy Catheter         12fr, 60cm
      Enteral Feeding Kits
WC070        Gastrostomy Tube                PEG Balloon Replacement Tube -          18, 24fr
WC072        Passport Low Profile Device     Enteral/Gastrostomy                     FEEDING TUBE French Sizes: 20.0,
                                                                                     24.0 Length: 1.2,1.7,2.4,3.4,4.4 cm

Prostheses List February 2005                                                                                                                         Page 107 of 700
GENERAL/MISCELLANEOUS                                                                                                                       Minimum   Maximum
Billing Code Product Name                           Description                               Size                                          Benefit   Benefit    Notation
WC183        Gastrostomy Tube                       PEG Balloon Replacement Tube - Box        18, 24fr
                                                    of 5
WC184        Percutaneous Endsocopic Gastrostomy    PEG Gastrostomy Tube Pull or Push         18, 20, 24fr
             System                                 System - Single
WC185        Percutaneous Endoscopic Gastrostomy    PEG Gastrostoym Tube Pull or Push         18, 20, 24fr
             System                                 system - Box of 2
      Filters, Vena Cava
WC096        Cook Vena Cava Filter                  Universal Femoral and Jugular Filter      Maximum Diameter 30mm, Length 45mm

      Prostheses, Bile Duct
WC001        Cotton-Huibregste Biliary Stent Set                                              7 - 11.5Fr, Length 5 - 15cm
WC006        Cotton-Leung Biliary Stent Only                                                  6 - 11.5Fr, Length 3 - 20cm
WC008        Cotton-Huibregste Biliary Stent Only                                             7 - 11.5Fr, Length 5 - 21cm
WC010        Zimmon Pancreatic Stent Only                                                     5, 7Fr, Length 6, 10, 12cm
WC012        Zimmon Biliary Stent Only                                                        5 - 11.5Fr, Length 3 - 15cm
WC013        Zimmon Biliary Stent Set                                                         5 - 11.5Fr, Length 4 - 30cm
WC017        Cotton-Leung Biliary Stent Set                                                   7 - 11.5Fr, Length 5 - 18cm
WC064        Biliary Stents                         Tannenbaum and Oasis Introducer           Stent: 8.5,10,11.5 Fr. Length Between
                                                                                              Flaps: 5 -->15 cm
WC079        Cook Bile Duct Prostheses              Includes Protective Sleeve for            French 5.0, length 2, 2.5, 4, 6, 8, 10,
                                                    Introduction through the Scope            12cm; French 6.0, Length 2, 2.5, 4, 6, 8,
                                                                                              10, 12cm; French 7.0, Length 2, 2.5, 4,
                                                                                              6, 8, 10, 12cm
WC080        Cook Bile Duct Prostheses              Includes Protective Sleeve for            French 5.0, length 1, 2, 4, 6, 8, 10, 12cm;
                                                    Introduction through the Scope            French 7.0, Length 2, 4, 6, 8, 10, 12cm
WC106        Cook Bile Duct Prostheses              Cotton Leung Biliary Radiopaque           Diameter 10mm, length 5, 7, 9, 12, 15cm
                                                    Polyethylene Stent preloaded in an
                                                    Oasis Introduction System
WC107        Cook Bile Duct Prostheses - Geenan     Radiopaque Polyethylene Stent Includes    Diameter 5, 7mm, length 3, 5, 7, 9, 12cm
             Pancreatic Stent Set                   Stent, Wireguide and Catheter
WC108        Cook Bile Duct Prostheses - Geenan     Radiopaque Polyethylene Stent Set         Diameter 5mm, length 3, 5, 7, 9cm
             Pancreatic Stent Set without Flap      includes Stent, Wirreguide and Catheter

Prostheses List February 2005                                                                                                                                   Page 108 of 700
GENERAL/MISCELLANEOUS                                                                                                                     Minimum   Maximum
Billing Code Product Name                              Description                              Size                                      Benefit   Benefit    Notation
WC123        Prostheses, Bile Duct                     Geenen pancreatic stent                  French 3 - 7, length 3 -12cm
WC124        Cook Bile Duct Prostheses                 Za-Stent endoscopic biliary stent only   Dia 10mm, length 4 - 8cm
      Prostheses, Esophageal
WC007        Cook Esophageal Prostheses                Esophageal Z-Stent with uncoated         Stent length 8 -14mm, introducer length
                                                                                                70, 100cm
WC068        Esophageal                                Z Stent Anti-Reflux                      STENT Flared End Diameter: 25mm
                                                                                                Shaft Diameter: 18mm Length:
                                                                                                8,10,12,14cm INTRODUCER French
                                                                                                Size: 31.0 (10 mm) Length: 70 cm
      Stents
WC100        Colonic Z Stent with Introduction System Composition of Stent Stainless Steel,     Dia 25mm, length 4, 6, 8, 10, 12cm
                                                      includes Stent Introducer Set
      Stents, Biliary
WC016        Cook Biliary Stents                       Gianturco-Rösch Biliary Design           Single, triple and five body
WC062        Biliary Stents                            Miller Set (UBSS-MLR). Double Pigtail    Stent: 10,12,14 Fr Stent Length:
                                                       Stent for Drainage of bile from the      2.5,5,7.5 cm Positioner Length: 25cm.
                                                       Common Duct into the Duodenum
WC078        Cook Biliary Stents                       Composition Plastic, includes Stent,     French 7.0, length 4cm
                                                       Wireguide & Positioner
      Stents, Esophageal
WC066        Covered Esophageal                        Stent                                    Expanded Stent Medial Outer Diameter:
                                                                                                18mm Proximal and Distal Outer
                                                                                                Diameter: 25 mm Stent Length: 10,12,14
                                                                                                cm
WC081        Cook-Z-Stent                              Includes Introducer Set                  Dia 18mm, length 6cm
WC082        Cook-Z-Stents                             Includes Introducer Set                  Dia 18mm, Length 8cm
WC083        Cook-Z-Stent                              Includes Introducer Set                  Dia 18mm, length 10cm
WC084        Cook-Z-Stent                              Includes Introducer Set                  Dia 18mm, length 12cm
WC085        Cook-Z-Stent                              Includes Introducer Set                  Dia 18mm, length 14cm
WC182        Esophageal EZS Stents Polyurethane        Uncoated Flange Esophageal Stent with    8, 10, 12, 14cm
             Coating                                    Z-Speed TM Introducer


Prostheses List February 2005                                                                                                                                 Page 109 of 700
GENERAL/MISCELLANEOUS                                                      Minimum   Maximum
Billing Code Product Name            Description              Size         Benefit   Benefit    Notation
      Tubes, Gastrostomy, Other
WC199        Cook Gastronomy Tubes   Russell Gastronomy Set   14fr, 17cm




Prostheses List February 2005                                                                  Page 110 of 700
MECHANICAL INTERNAL WOUND                                                                                                      Minimum   Maximum
Billing Code Product Name                               Description                              Size                          Benefit   Benefit    Notation
Auto Suture Company, Australia T/A Tyco
      Clip Appliers
AS006        Ligation Clips - Disposable clip applier   Premium Surgiclip*                       Small, medium & large clips                        Temporary
             and ligating clips                                                                                                                     Approval
      Staples, Tissue
AS010        GIA*, ILA* Staplers                        Titanium                                 50 - 60mm (2.5mm, 3.8mm)                           Temporary
                                                                                                                                                    Approval
AS011        GIA*, ILA* Staplers                        Titanium                                 75mm (3.8mm, 4.8mm)                                Temporary
                                                                                                                                                    Approval
AS012        GIA* Reloading Unit                        Titanium. Multifire 60 Cartridge, 90     50-60mm (2.5, 3.8mm)                               Temporary
                                                        Premium Disposable Loading Unit with                                                        Approval
                                                        Titanium Staples, 50 Premium
                                                        Disposable Loading Unit with Titanium
                                                        Staples, Inverted Linear Anastomosis
                                                        Cartridges 3944, 3943, 3978, 3946, 3945,
                                                        3976, 3977
AS013        ILA* 52 Reloading Unit                     Titanium. Multifire 60 Cartridge 90      50 - 60mm (2.5mm, 3.8mm)                           Temporary
                                                        Premium Disposable Loading Unit with                                                        Approval
                                                        Titanium Staples, 50 Premium
                                                        Disposable Loading Unit with Titanium
                                                        Staple, Inverted Linear Anastomosis
                                                        Cartridges 3944, 3943, 3978, 3946, 3945,
                                                        3976, 3977
AS014        GIA*, ILA* Reloading Unit                  Inverted Linear Anastomosis Cartridges   75mm (3.8mm, 4.8mm)                                Temporary
                                                         3944, 3943, 3978, 3946, 3945, 3976,                                                        Approval
                                                        3977. Titanium. Multifire 60 Cartridge
AS015        GIA*, ILA* Reloading Unit                  Inverted Linear Anastomosis Cartridges   80mm (3.8, 4.8mm)                                  Temporary
                                                         3944, 3943, 3978, 3946, 3945, 3976,                                                        Approval
                                                        3977, Titanium. Multifire 60 Cartridge
AS016        GIA*, ILA* Reloading Unit                  Titanium. Multifire 60 Cartridge,         90mm (3.8, 4.8mm)                                 Temporary
                                                        Inverted Linear Anastomosis Cartridges                                                      Approval
                                                         3944, 3943, 3978, 3946, 3945, 3976, 3977




Prostheses List February 2005                                                                                                                      Page 111 of 700
MECHANICAL INTERNAL WOUND                                                                                                         Minimum   Maximum
Billing Code Product Name                             Description                             Size                                Benefit   Benefit    Notation
AS017        GIA*, ILA* Reloading Unit                Titanium. Multifire 60 Cartridge,         100mm (3.8,4.8mm)                                      Temporary
                                                      Inverted Linear Anastomosis Cartridges                                                           Approval
                                                       3944, 3943, 3978, 3946, 3945, 3976, 3977

AS018        TA* Stapler; DST Series* Linear          Premium Multifire TA* Disposable        30mm (2.5, 3.5, 4.8mm); DST TA45-                        Temporary
             Staplers                                 Surgical Stapler and Loading Unit;      3.5; DST TA45-4.8; DST TA60-3.5;                         Approval
                                                      Titanium staples used for hemostatic    DST TA60-4.8; DST TA30-3.5; DST
                                                      closure of specific organs and blood    TA30-4.8; DST TA30V3.
                                                      vessels (ex bowel, stomach and lung).
AS019        PI*, Stapler                             Premium Multifire TA* Disposable        30mm (2.5, 3.5, 4.8mm)                                   Temporary
                                                      Surgical Stapler and Loading Unit                                                                Approval
AS025        TA* Reloading Units; DST Series*         Premium Multifire TA* Disposable        30mm (2.5, 3.5, 4.8mm); DST TA90-                        Temporary
             Linear Stapler Disposable Loading        Surgical Stapler and Loading Unit;      3.5 DLU; DST TA90-4.8 DLU; DST                           Approval
                                                      Titanium staples used for hemostatic    TA45-3.5 DLU; DST TA45-4.8 DLU;
                                                      closure of specific organs and blood    DST TA60-3.5 DLU; DST TA60-4.8
                                                      vessels (ex bowel, stomach and lung)    DLU; DST TA30-3.5 DLU; DST
                                                                                              TA30-4.8 DLU; DST TA30V3 DLU.
AS026        PI*, Reloading Unit                      Premium Multifire TA* Disposable        30mm (2.5, 3.5, 4.8mm)                                   Temporary
                                                      Surgical Stapler and Loading Unit                                                                Approval
AS030        TA* Reloading Units                      Premium Multifire TA* Disposable        90mm (3.5mm, 4.8mm)                                      Temporary
                                                      Surgical Stapler and Loading Unit                                                                Approval
AS033        Power Stapler and Staples (Powered       LDS Instrument & Cartridges             One size only                                            Temporary
             LDS*)                                    (Disposable Loading Unit)                                                                        Approval
AS035        Roticulator*                             Roticulator 30                          30mm (3.5, 4.8mm)                                        Temporary
                                                                                                                                                       Approval
AS036        Roticulator*                             Roticulator 55                          55mm (3.5, 4.8mm)                                        Temporary
                                                                                                                                                       Approval
AS037        ROTICULATOR*                             Polysorb 55 Disposable Loading Unit     55mm (3.5, 4.8mm)                                        Temporary
                                                                                                                                                       Approval
AS072        Staples and Disposable Stapler Applier   Titanium, curved, PPCEEA*; Titanium     21-34mm; 21, 25, 28, 31, 34mm.                           Temporary
             and staples; PPCEEA*.                    Surgical Stapler.                                                                                Approval
AS075        ENDO TA*                                 Titanium Surgical Stapler               30mm                                                     Temporary
                                                                                                                                                       Approval




Prostheses List February 2005                                                                                                                         Page 112 of 700
MECHANICAL INTERNAL WOUND                                                                                                      Minimum   Maximum
Billing Code Product Name                           Description                            Size                                Benefit   Benefit    Notation
AS094        GIA*, ILA* Staplers                    Titanium                               80mm (3.8mm, 4.8mm)                                      Temporary
                                                                                                                                                    Approval. *
                                                                                                                                                    Trademark of
                                                                                                                                                    United States
                                                                                                                                                    Surgical
                                                                                                                                                    Corporation
AS102        DST Series* Linear Staplers            Titanium staples used for hemostatic   DST TA90-3.5; DST TA90-4.8                               Temporary
                                                    closure of specific organs and blod                                                             approval
                                                    vessels (ex bowel, stomach and lung)
AS110        DFS Disposable Fascia Stapler          Stainless Steel                        One Size Only                                            Temporary
                                                                                                                                                    Approval
AS113        DST Series* GIA* Linear Cutter         single use, reloadable stapler         60mm length: sizes 2.5mm, 3.8mm,                         Temporary
             Stapler and single use loading units                                          4.8mm                                                    approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group
AS114        DST Series* GIA* Linear Cutter         Single Use Loading Units               60mm length: Sizes 2.5mm, 3.8mm,                         Temporary
             Stapler and single use loading units                                          4.8mm                                                    approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group
AS115        DST Series* GIA* Linear Cutter         Single use, reloadable stapler         80mm length; Sizes 3.8 and 4.8mm                         Temporary
             Stapler and single use loading units                                                                                                   approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group
AS116        DST Series* GIA* Linear Cutter         Single Use Loading Units               80mm length: Sizes 3.8 and 4.8mm                         Temporary
             Stapler and single use loading units                                                                                                   approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group
AS117        DST Series* GIA* Linear Cutter         Single use, reloadable stapler         100mm length: Sizes 3.8 and 4.8mm                        Temporary
             Stapler and single use loading units                                                                                                   approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group
AS118        DST Series* GIA* Linear Cutter         Single use loading units               100mm length: Size 3.8 and 4.8mm                         Temporary
             Stapler and single use loading units                                                                                                   approval, pending
                                                                                                                                                    review of product
                                                                                                                                                    group



Prostheses List February 2005                                                                                                                      Page 113 of 700
MECHANICAL INTERNAL WOUND                                                                                                               Minimum   Maximum
Billing Code Product Name                              Description                                 Size                                 Benefit   Benefit    Notation
AS119        DST Series* EEA* Circular Stapler         Circular staplers                           21mm to 33mm                                              Temporary
                                                                                                                                                             approval, pending
                                                                                                                                                             review of product
                                                                                                                                                             group
Device Technologies Australia Pty Ltd
        Clips, Hemostatic
DE004        SLS Clips                                 Titanium, (24 Clips)                        Small - Large                                             Temporary
                                                                                                                                                             Approval
DE005        SLS Clips                                 Titanium composition                        Small, Medium, Large; Height 3.6 -                        Temporary
                                                                                                   9mm, Width 4.2 - 8.4mm                                    Approval
DE098        SLS Clips                                 Titanium Clips                              Medium to large                                           Temporary
                                                                                                                                                             Approval
DE206        SLS Clips                                 Titanium                                    Micro, Height 2.6mm, Width 3.1mm                          Temporary
                                                                                                                                                             approval
EMT Healthcare Pty Ltd
        Appliers
EM014        Microline Multi-Fire Clips                Microline M/L-10 Endoscopic Clip            10mm x 10 clip cartridges
                                                       Applier with reusable handpiece and
                                                       disposable Medium/Large Titanium Clip
                                                        Slide Cartridges
        Appliers, Hemostatic Clip, Disposable
EM013        Microline Clip Applier Multi-Fire Clips   The Microline M/L-10 Endoscopic Clip        10 mm instrument                                          Temporary
                                                       Applier has a reusable handpiece and a                                                                approval
                                                       disposable 19 Medium/Large Titanium
                                                       Clip Slide Cartridge
        Clip Appliers
EM012        Surgicon Ligation System                  The Surgicon SpringLock II Ligation         5 mm instrument                                           Temporary
                                                       Sysytem has a 5mm shaft and contains                                                                  approval
                                                       10 medium-large titanium ligators.
Johnson & Johnson Medical Pty Ltd
        Applicators, Clip
JJ186        Ligaclip Endoscopic Multiclip Applier     Metal/plastic stapler with titanium clips   10-12mm shaft diameter                                    Temporary
                                                                                                                                                             Approval

Prostheses List February 2005                                                                                                                               Page 114 of 700
MECHANICAL INTERNAL WOUND                                                                                                         Minimum   Maximum
Billing Code Product Name                            Description                                  Size                            Benefit   Benefit    Notation
JJ187        Ligaclip Allport 5mm Clip Applier       Metal/plastic stapler with titanium clips    5mm shaft diameter                                   Temporary
                                                                                                                                                       Approval
        Clip Appliers
JJ037        Ligaclip* Multiple Clip Applier         Metal/plastic applier preloaded with         3-12 mm; 20 clips per applier                        Temporary
                                                     titanium clips                                                                                    Approval
JJ038        Ligaclip* Multiple Clip Applier         Metal/plastic applier preloaded with         3-12 mm; 30 clips per applier                        Temporary
                                                     titanium clips                                                                                    Approval
JJ039        Ligaclip* Multiple Clip Applier         Metal/plastic applier preloaded with         5; 20 clips per applier                              Temporary
                                                     titanium clips; reloadable                                                                        Approval
        Clips, Hemostatic
JJ033        Ligaclip* Ligating Clips - titanium     Titanium clips contained in a plastic        3-5mm; 6 clips per cartridge                         Temporary
                                                     cartridge                                                                                         Approval
JJ034        Ligaclip* Ligating Clips - titanium     Titanium clips contained in a plastic        9-12 mm; 6 clips per cartage                         Temporary
                                                     cartridge                                                                                         Approval
JJ035        Ligaclip* Ligating Clips - titanium     Titanium clips contained in a plastic        3-5 mm; 15 clips per cartage                         Temporary
                                                     cartridge                                                                                         Approval
JJ036        Absolok* Extra Absorbable Ligating      Polydioxanone clips contained in a           3-12 mm                                              Temporary
             Clips                                   plastic cartridge                                                                                 Approval
JJ040        Ligaclip* 20/20 Reload Unit             Metal reload cartridge containing            5 mm; 20 clips                                       Temporary
                                                     titanium clips                                                                                    Approval
        Cutters
JJ188        Endopath Linear Cutter                  Metal/plastic cutter-stapler with titanium   45mm; short shaft                                    Temporary
                                                     staples                                                                                           Approval
JJ189        Endopath Linear Cutter                  Metal/plastic cutter-stapler with titanium   45mm; long shaft                                     Temporary
                                                     staples                                                                                           Approval
JJ191        Endopath Linear Cutter                  Metal/plastic cutter-stapler with titanium   35mm                                                 Temporary
                                                     staples                                                                                           Approval
        Staples, Tissue
JJ056        Proximate Articulating Linear Stapler   Articulating linear stapler preloaded        55mm                                                 Temporary
                                                     with titanium staples                                                                             Approval
JJ190        Endopath ETS Linear Cutter reload       Titanium staple cartridge                    45mm                                                 Temporary
                                                                                                                                                       Approval


Prostheses List February 2005                                                                                                                         Page 115 of 700
MECHANICAL INTERNAL WOUND                                                                                        Minimum   Maximum
Billing Code Product Name                             Description                                Size            Benefit   Benefit    Notation
JJ192        Endopath ETS Linear Cutter reload        Titanium staple cartridge                  35mm                                 Temporary
                                                                                                                                      Approval
        Surgical Procedure Kit
JJ443        Proximate Intraluminal Stapler PPH       Proximate Hemorrhoidal Circular            One Size Only
                                                      Stapler PPH
        Suture Units, Automatic
JJ041        Proximate* Intraluminal Stapler          Metal/plastic circular straight stapler    21 - 33 mm                           Temporary
                                                      preloaded with titanium staples                                                 Approval
JJ042        Proximate* Intraluminal Stapler          Metal/plastic circular curved stapler      21 - 33mm                            Temporary
                                                      preloaded with titanium staples                                                 Approval
JJ043        Proximate* Linear Cutter with Staples    Metal/Plastic linear cutter preloaded      50 - 60mm                            Temporary
                                                      with titanium staples                                                           Approval
JJ044        Proximate* Linear Cutter with Staples    Metal/Plastic linear cutter preloaded      75 - 80mm                            Temporary
                                                      with titanium staples                                                           Approval
JJ045        Proximate* Linear Cutter with Staples    Metal/Plastic linear cutter preloaded      100mm                                Temporary
                                                      with titanium staples                                                           Approval
JJ046        Proximate* Linear Cutter Staple          Plastic linear cutter reload cartridge     50 - 60mm                            Temporary
             Reload Unit                              containing titanium staples                                                     Approval
JJ047        Proximate* Linear Cutter Staple          Plastic linear cutter reload cartridge     75 - 80mm                            Temporary
             Reload Unit                              containing titanium staples                                                     Approval
JJ048        Proximate* Linear Cutter Staple Reload   Plastic linear cutter reload cartridge     100mm                                Temporary
             Unit                                     containing titanium staples                                                     Approval
JJ049        Proximate* Linear Stapler                Metal/Plastic linear stapler preloaded     30mm                                 Temporary
                                                      with titanium staples                                                           Approval
JJ050        Proximate* Linear Stapler                Metal/Plastic linear stapler preloaded     55 - 60mm                            Temporary
                                                      with titanium staples, manual closure                                           Approval
JJ051        Proximate* Linear Stapler                Metal/Plastic linear stapler preloaded     55 - 60mm                            Temporary
                                                      with titanium staples, automatic closure                                        Approval
JJ052        Proximate* Linear Stapler                Metal/Plastic linear stapler preloaded     90mm                                 Temporary
                                                      with titanium staples                                                           Approval
JJ053        Proximate* Linear Stapler Reload Unit    Plastic linear stapler reload cartridge    30mm                                 Temporary
                                                      containing titanium staples                                                     Approval


Prostheses List February 2005                                                                                                        Page 116 of 700
MECHANICAL INTERNAL WOUND                                                                                                    Minimum   Maximum
Billing Code Product Name                            Description                                   Size                      Benefit   Benefit    Notation
JJ054        Proximate* Linear Stapler Reload Unit   Plastic linear stapler reload cartridge       55 - 60mm                                      Temporary
                                                     containing titanium staples                                                                  Approval
JJ055        Proximate* Linear Stapler Reload Unit   Plastic linear stapler reload cartridge       90mm                                           Temporary
                                                     containing titanium staples                                                                  Approval
JJ184        Endopath Multi Stapler                  Endoscopic titanium stapler with staples      11mm shaft diameter                            Temporary
                                                                                                                                                  Approval
Linvatec Australia
        Applier, Haemostatic Clip, Reusable
LV087        Permaclip Multi-use Reposable           Supplied sterile with a cartridge             medium/large                                   Temporary
             Endoscopic Clip Applier                 containing medium and large titanium                                                         Approval, pending
                                                     clips, with a reposable handle validated                                                     review of product
                                                     for up to 30 uses                                                                            group
        Clips, Ligating
LV085        Permaclip Replacement Cartridge         sterile, single use, containing 10 titanium   medium/large                                   Temporary
                                                      clips                                                                                       Approval, pending
                                                                                                                                                  review of product
                                                                                                                                                  group
LV086        Reflex 5mm Automatic Clip Applier       Autofeeding disposable clip applier.          medium/large                                   Temporary
                                                     Contains 15 non absorbable polymer                                                           Approval, pending
                                                     locking clips                                                                                review of product
                                                                                                                                                  group
Medtel Australia Pty Ltd
        Clip Appliers
ME089        Surgical Dynamics Duraclose Clip        Clip Applier                                  Med / Large / X-Large                          Temporary
             Applier                                                                                                                              Approval
        Suture Units, Automatic
ME090        S.D.sorb Meniscal Stapler               Bioabsorbable Meniscal Repair                 One Size / 6 Staples                           Temporary
                                                                                                                                                  Approval
        Suture Units, Other
ME107        Superstitch                             Suture Mediated Closure Device                Sheath sizes: 6F and 8F                        Temporary
                                                                                                                                                  Approval




Prostheses List February 2005                                                                                                                    Page 117 of 700
MECHANICAL INTERNAL WOUND                                                                                      Minimum   Maximum
Billing Code Product Name                   Description                  Size                                  Benefit   Benefit    Notation
Morton Surgical Pty Ltd
      Mesh, Polymeric
MG001        Aspide Surgimesh               Monofilament polypropylene   AS 59611p - 6 x 11cm Thread 0.14mm
                                                                         Box/5
MG004        Aspide Surgimesh               Monofilament polypropylene   AS 2812p - 8 x 12cm Thread 0.14mm
                                                                         Box/5
MG005        Aspide Surgimesh               Monofilament polypropylene   AS 31013p - 10 x 13cm Thread 0.14mm
                                                                         Box/5
MG006        Aspide Surgimesh               Monofilament polypropylene   AS 511015p - 10 x 15cm Thread
                                                                         0.14mm Box/5
MG007        Aspide Surgimesh               Monofilament polypropylene   AS 41515p - 15 x 15cm Thread 0.14mm
                                                                         Box/5
MG008        Aspide Surgimesh               Monofilament polypropylene   E33Lg - Easyplug Large Box/5
MG009        Aspide Surgimesh               Monofilament polypropylene   E33mg - Easyplug Medium Box/5
MG010        Aspide Surgimesh               Monofilament polypropylene   E33Sgp - Easyplug Small Box/5
Sherwood Davis & Geck T/A Tyco Healthcare Pty
      Clips
SG005        Ligation clip applier reload   Bioabsorbable                One size only                                              Temporary
                                                                                                                                    Approval
SG006        Laproclip                      Bioabsorbable                Medium/Large, 6 clips                                      Temporary
                                                                                                                                    Approval
SG007        Laproclip                      Bioabsorbable                Medium/Large, 2 clips                                      Temporary
                                                                                                                                    Approval
SG008        Laproclip                      Bioabsorbable                Large, 6 clips                                             Temporary
                                                                                                                                    Approval
SG009        Laproclip                      Bioabsorbable                Large, 2 clips                                             Temporary
                                                                                                                                    Approval




Prostheses List February 2005                                                                                                      Page 118 of 700
NEUROSURGICAL                                                                                                 Minimum   Maximum
Billing Code Product Name                         Description                              Size               Benefit   Benefit    Notation
Advanced Neuromodulation Systems Australia Pty
      Cables/Leads, Other
AV001        ANS Spinal Cord Stimulation System   Lead Extension                           10cm, 20cm, 30cm                        When used in pain
             (SCS)                                                                                                                  therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
AV002        ANS Spinal Cord Stimulation System   Octrode Lead. 8 Electrode (thoracic or   30cm, 60cm                              When used in pain
             (SCS)                                cervical placement).                                                              therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
AV003        ANS Spinal Cord Stimulation System   Quattrode Lead. 4 Electrode.             30cm, 60cm                              When used in pain
             (SCS)                                                                                                                  therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
AV007        ANS Spinal Cord Stimulation System   Trial Lead. Temporary Screening Lead     30cm, 60cm                              When used in pain
             (SCS)                                                                                                                  therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.




Prostheses List February 2005                                                                                                     Page 119 of 700
NEUROSURGICAL                                                                                             Minimum   Maximum
Billing Code Product Name                         Description                             Size            Benefit   Benefit    Notation
AV011        ANS Spinal Cord Stimulation System   Lamitrode Plate Electrode Lead          One size only                        When used in pain
             (SCS)                                                                                                              therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.
AV012        ANS Spinal Cord Stimulation System   Lamitrode Dual 8 Plate Electrode Lead   One size only                        When used in pain
             (SCS)                                                                                                              therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.
      Fittings/Adapters
AV013        ANS Spinal Cord Stimulation System   Boots, Connectors, Anchors, Strain      One size only                        When used in pain
             (SCS)                                Relief                                                                        therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.
      Stimulators
AV008        ANS Spinal Cord Stimulation System   Transmitter Kit 16 Channel              One size only                        When used in pain
             (SCS) RENEW                                                                                                        therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.




Prostheses List February 2005                                                                                                 Page 120 of 700
NEUROSURGICAL                                                                                                 Minimum   Maximum
Billing Code Product Name                          Description                                Size            Benefit   Benefit    Notation
AV009        ANS Spinal Cord Stimulation System    Transmitter Kit 8 Channel                  One size only                        When used in pain
             (SCS) RENEW                                                                                                            therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
AV010        ANS Spinal Cord Stimulation System    Transmitter. 4 Channel - antenna locator   One size only                        When used in pain
             (SCS) 4 Channel Receiver Kit Model-                                                                                    therapy - to be
             904.                                                                                                                  funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
AV017        ANS Spinal Cord Stimulation System    Implantable Pulse Generator - Genesis      One Size Only
             (SCS) GENESIS                         G4 Model 3604
AV018        ANS Spinal Cord Stimulation System    Implantable Pulse Generator - Genesis      One Size Only
             (SCS) GENESIS                         XP Model 3609
AV019        ANS Spinal Cord Stimulation System    Implantable Pulse Generator - Genesis      One Size Only
             (SCS) GENESIS                         XP Dual Model 3644
      Stimulators, Electroanalgesic, Spinal Cord
AV004        ANS Spinal Cord Stimulation System    Dual Receiver 16 Channel (2 x 8            One size only                        When used in pain
             (SCS) RENEW                           channel)                                                                         therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.




Prostheses List February 2005                                                                                                     Page 121 of 700
NEUROSURGICAL                                                                                             Minimum   Maximum
Billing Code Product Name                         Description                             Size            Benefit   Benefit    Notation
AV005        ANS Spinal Cord Stimulation System   Single Receiver 8 Channel (1 x 8        One size only                        When used in pain
             (SCS) RENEW                          channel)                                                                      therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.
AV006        ANS Spinal Cord Stimulation System   Single Receiver. 8 Channel (1 x 8)      One size only                        When used in pain
             (SCS) RENEW                                                                                                        therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation.
AV014        ANS Spinal Cord Stimulation System   Implantable Pulse Generator - Genesis   One size only
             (SCS) GENESIS                        Model 3608
AV015        ANS Spinal Cord Stimulation System   Patient Programmer Model 3850           One size only                        When used in pain
             (SCS) GENESIS                                                                                                      therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation
AV016        ANS Spinal Cord Stimulation System   Communication Magnet Model 1210         One type only                        When used in pain
             (SCS) GENESIS                                                                                                      therapy - to be
                                                                                                                               funded when the
                                                                                                                               patient has
                                                                                                                               undergone a multi-
                                                                                                                               disciplinary
                                                                                                                               assessment and
                                                                                                                               trial of stimulation
AV020        ANS Spinal Cord Stimulation System   QuikLink Patient Programmer Model       One Size Only
             (SCS) GENESIS                        3860



Prostheses List February 2005                                                                                                 Page 122 of 700
NEUROSURGICAL                                                                                                              Minimum   Maximum
Billing Code Product Name          Description                              Size                                           Benefit   Benefit    Notation
Australian Surgical Design & Manufacture Pty Ltd
      Plates, Bone
AE053        ASDM Bone Plates      Custom Skull Mesh Plate, Titanium        One size only
AE054        ASDM Bone Plates      Titanium 1.0mm MF Bone Plate             Small, Single square plate 2x2 holes, T-
                                                                            shape, 90 deg, 5 holes
AE055        ASDM Bone Plates      Titanium 1.0mm MF Bone Plate             Medium, Double square plate, 3x2
                                                                            holes; Double Y-shape, 6 or 7 holes; Y-
                                                                            shape, 6 hole; Double T-shape, 9
                                                                            hole;T-shape, 90 deg, 7 holes;L-shape,
                                                                            right or left, 5 hole;Straight Plate, 8 hole
AE056        ASDM Bone Plates      Titanium 1.0mm MF Bone Plate             Large, Triple square plate, 4x2
                                                                            holes;Curved plate, 8 hole;Straight plate,
                                                                             24 hole;L-shape plate, right or left, 8
                                                                            holes
AE057        ASDM Bone Plates      Titanium 1.7mm MF Bone Plate, Titanium Small, Straight plate, 6-8mm, 4 hole;L-
                                                                          Shape, right or left, 6mm, 4 hole;Curved
                                                                          plate, 6mm, 4 hole
AE058        ASDM Bone Plates      Tiranium 1.7mm MF Bone Plate,            Medium, L-Shape, right or left, 8mm, 4
                                   Titanium                                 hole;Y-Shape, 8mm, 5 hole;T-Shape,
                                                                            10mm, 5 hole;L-shape, right or left, 10-
                                                                            12mm, 4-5 holes;Straight Plate, 8
                                                                            hole;Double Y-Shape, 6-7 holes;Curved
                                                                             plate, 6-8 holes;Single square plate, 2x2
                                                                             holes
AE059        ASDM Bone Plates      Titanium 1.7mm MF Bone Plate, Titanium Large, Triple square plate, 4x2
                                                                          holes;Straight plate, 16 hole
AE060        ASDM Bone Plates      Titanium 2.0mm MF Bone Plate, Titanium Small, Straight plate, 9-13mm, 4
                                                                          holes;Staright plate, 4 holes;L-shape,
                                                                          right or left, 4 holes
AE061        ASDM Bone Plates      Titanium 2.0mm MF Bone Plate, Titanium Medium, Y-Shape, 8 hole;Double Y-
                                                                          Shape, 6 hole;L-Shape, right or left, 5
                                                                          holes;L-Shape, right or left, 9-13mm, 4
                                                                          holes;Straight Plate, 6 hole;Curved
                                                                          plate, 6 hole



Prostheses List February 2005                                                                                                                  Page 123 of 700
NEUROSURGICAL                                                                                                                      Minimum   Maximum
Billing Code Product Name                    Description                               Size                                        Benefit   Benefit    Notation
AE062        ASDM Bone Plates                Titanium 2.0mm MF Bone Plate, Titanium Large, Double square plate, 3x2
                                                                                    holes;Curved plate, 10 hole;Straight
                                                                                    plate, 16 hole;L-shape plate, right or left,
                                                                                     9 holes
AE063        ASDM Bone Plates                Titanium 2.2mm MF Bone Plate, Titanium Small, Straight plate, 8-14mm, 4
                                                                                    holes;Curved plate, 11mm, 4 holes
AE064        ASDM Bone Plates                Titanium 2.2mm MF Bone Plate, Titanium Medium, Straight plate, 8-14mm, 6 holes

AE065        ASDM Bone Plates                Titanium 2.2mm MF Bone Plate, Titanium Large, Straight plate, 11mm, 8
                                                                                    holes;Straight plate, 14 holes;Angled
                                                                                    plate, 6 holes
Australian Surgical Innovations Pty Ltd
      Fixation Device, Internal, Plate
AI004        ASI Plates and Screws           Plate                                     Straight, Left, Right, X, T and Y shaped
AI005        ASI Plates and Screws           Mesh
AI006        ASI Plates and Screws           Custom Mesh
      Fixation Device, Internal, Screw
AI007        ASI Plates and Screws           Screw                                     Width 1.0 - 3.0mm. Length 3.0 - 25mm
B Braun Australia Pty Ltd
      Catheters, Intracranial, Ventricular
BB078        Shunt Accessories               Catheter-Ventricular                      60cm to 120cm
      Clamps, Skull
BB072        Craniofix Titanium Clamps       Titanium                                  11mm
BB073        Craniofix Titanium Clamps       Titanium                                  16mm
BB168        Craniofix                       Titanium skull fixation clamp             20mm
      Clips, Aneurysm
BB108        Aneurysm Clip                   Yasargil                                  4.5mm x 150g to 25.0mm x 200g
BB109        Aneurysm Clip                   Yasargil Phynox Mini                      2.8mm x 110g to 7.0mm x 130g
BB110        Aneurysm Clip                   Yasargil Titanium                         4.9mm x 150g to 20.0mm x 200g
BB111        Aneurysm Clip                   Yasargil Titanium Mini                    2.8mm x 110g to 7.0mm x 110g

Prostheses List February 2005                                                                                                                          Page 124 of 700
NEUROSURGICAL                                                                                                                   Minimum   Maximum
Billing Code Product Name                        Description                             Size                                   Benefit   Benefit    Notation
BB112        Aneurysm Clip                       Yasargil Reinforcing, Titanium/Phynox   One size only
BB175        Yasargil Aneurysm Clip System       Phynox temporary clips are              3mm - 20mm length, phynox temporary
                                                 manufactured from phynox.               clips.
BB176        Yasargil Aneurysm Clip System       Titanium termporary clips are           3mm- 25mm length, titanium temporary
                                                 manufactured from titanium              clips.
BB218        Kopitnik Microneurosurgical AVM     Composition: Phynox (Cobalt-base-       2mm, 3mm, 4mm, 5mm - straight. 2mm,
                                                                                          3mm, 4mm, 5mm - curved.
      Prostheses, Meningeal
BB015        Neuro-Patch                         Polyesterurethane                       12 x 14cm
BB113        Neuropatch Dura Substitute          Polyurethane                            6 x 14cm
BB114        Neuropatch Dura Substitute          Polyurethane                            6 x 8cm
BB115        Neuropatch Dura Substitute          Polyurethane                            4 x 10cm
BB116        Neuropatch Dura Substitute          Polyurethane                            4 x 5cm
BB117        Neuropatch Dura Substitute          Polyurethane                            2 x 10cm
BB118        Neuropatch Dura Substitute          Polyurethane                            1.5 x 3cm
      Reservoirs, Cerebrospinal Fluid
BB081        Shunt Accessories                   Reservoir                               Small, large
      Shunt Adapters
BB079        Shunt Accessories                   Deflector - Burrhole                    Small, large
BB080        Shunt Accessories                   Connector                               Straight, Y, T, X form
      Valves, Hydrocephalic
BB074        Pressure Valve Anti Siphon Device   Shunt Assist Kit                        15/11 to 35/25.7 pressure units
BB075        Hydrocephalus Shunt                 Monostep Valve                          5/3.6 to 16/11.0 pressure units
BB076        Hydrocephalus Shunt                 Paedi-Gav. Valve                        4/14 to 9/29 pressure units
BB077        Hydrocephalus Shunt                 Dual Switch Valve                       10/7.4 to 50/36.8 pressure units
Bard Australia Pty Ltd
      Catheters, Peritoneal, Long Term Indwelling
BA045        Hickman Catheters                   Du Pen Long Term Epidural Catheter      One Size Only


Prostheses List February 2005                                                                                                                       Page 125 of 700
NEUROSURGICAL                                                                                                        Minimum   Maximum
Billing Code Product Name                     Description                             Size                           Benefit   Benefit    Notation
Biomet Australia Pty Ltd
      Fixation Device, Internal, Fracture
BI870        Neurological Packs               Plate, Neuro and screws, Ti             1.5mm or 2mm diameter
      Mesh, Polyglycolic Acid
BI883        RapidFLAP LS                     Cranial Flap Fixation. Includes pre-    One size only
                                              attached applier. PGA/PLA
      Orthopedic Internal Fixation Systems, Other
BI716        W Lorenz Osteosynthesis System   Pre-Contoured Neuro Mesh; Titanium      (80,85) x 53mm x (0.3,0.6)mm
BI717        W Lorenz Osteosynthesis System   Neuro Gap Plate, Titanium               1.5mm system, large
BI718        W Lorenz Osteosynthesis System   Neuro Gap Plate, Titanium               1.5mm system, small
BI719        W Lorenz Osteosynthesis System   Neuro Sub-Temporal Plate, Titanium      1.5mm system, large
BI720        W.Lorenz Osteosynthesis System   Neuro Gap Plate; titanium               1.5 mm system, Medium
BI721        W Lorenz Osteosynthesis System   Plate, Burr Hole, 1.5mm System,         22mm, 25mm
                                              Titanium
BI722        W.Lorenz Osteosythesis System    Pre-contoured Neuro Mesh, titanium      152 x 108 x (0.3, 0.6)mm
BI728        W.Lorenz Osteosynthesis System   Neuro Square Plate, titanium            1.5mm system, 4 hole
BI729        W.Lorenz Osteosynthesis System   Neuro Rectangle Plate, titanium         1.5mm system, 4 hole
BI773        W Lorenz Osteosynthesis System   Neuro sub-temporal plate, 1.5 system,   Small
                                              titanium
BI785        W Lorenz Osteosynthesis          Mesh 1.5mm system, pre-contoured,       40 x 40 x 0.6mm profile
                                              titanium
      Plates, Cranioplasty
BI714        RapidFlap Cranial Clamp          Clamp, Burr Hole or Craniotomy Line,    12, 16, 20mm
                                              Titanium




Prostheses List February 2005                                                                                                            Page 126 of 700
NEUROSURGICAL                                                                                                                            Minimum   Maximum
Billing Code Product Name                      Description                                  Size                                         Benefit   Benefit    Notation
Boston Scientific Pty Ltd
      Catheters, Other
BS028        GDC Delivery Catheters            Delivery systems with nitinol braid,         150-175cm/3-25cm                                                  Only to be funded
                                               Polypropylene promixal, Polyethylene                                                                           when used with a
                                               distal; Tracker 10 Unibody Infusion                                                                            coil
                                               Catheter, Fasttracker Vascular Access
                                                System, Turbo Tracker Infusion
                                               Catheter; Fastracker Vascular Access
                                               System; Turbo Tracker Infusion
                                               Catheters; Tracker Excel
                                               Microcatheter; Renegade Fibre
                                               Braided Microcatheter; Excelsior 1018
                                               Microcatheter.
      Stents, Vascular
BS079        Neuroform 2 Microdelivery Stent   Self-expanding nitinol stent, 3fr delivery   Diameter: 2.5-4.5mm, Length: 10mm-
                                               catheter, peelable sheath, 2fr stabilising   30mm
                                               catheter, rotating haemostasis valve (x2)
CWL Medical Enterprises Pty Ltd
      Catheters, Hydrocephalic
CW007        Cardiac/Peritoneal Catheters      SiliconDistal Catheter, ID 1.3mm, OD         90cm, barium impregnated silicone
                                               2.5mm                                        catheter, closed or open ended, with or
                                                                                            without slits
CW008        Ventricular Catheters             Silicon Ventricular Catheter                 15cm - 25cm, optional flanges or right
                                                                                            angle or endoscopic tip. ID 1.3mm, OD
                                                                                             2.5mm
      Reservoirs, Cerebrospinal Fluid
CW011        Reservoirs                        Shunt component                              9mm to 25mm, with or without
                                                                                            convertible outlet port, burr hole or flat
                                                                                            bottom style
      Shunts, Hydrocephalic
CW002        Neonatal Shunt System             Shunt Assembly, includes separate            Medium, low or low-low pressure
                                               ventricular catheter, integral distal
                                               catheter
CW004        Equi Flow Valves                  Valve only                                   Small (35mm length) or Regular (40mm
                                                                                            length); low, low/medium and medium
                                                                                            pressure
Prostheses List February 2005                                                                                                                                Page 127 of 700
NEUROSURGICAL                                                                                                                                Minimum   Maximum
Billing Code Product Name                          Description                                   Size                                        Benefit   Benefit    Notation
CW005        Equi Flow Shunt Assemblies            CSF Shunt, includes silicone ventricular      Small (35mm length) or Regular (40mm
                                                   and peritoneal catheters, silicone            length); low, low/medium and medium
                                                   encased overdrainage control valve            pressure; various kit configurations
CW006        Lumboperitoneal Shunt Assemblies      CSF LP Shunt includes: silicone               Straight or "T" tube
                                                   catheter, stainless steel trocar, suture
CW009        Burr Hole Valve Shunt Assemblies      Shunt Assembly: silicone encased valve,       16mm or 12mm base; low, medium or
                                                    silicone ventricular and peritoneal          high pressure, various kit configurations
                                                   catheters
      Valves, Hydrocephalic
CW001        Contour-Flex Valves                   Silicone encased CSF Valve                    Small (24mm length) or Regular (28mm
                                                                                                 length), low medium or high pressure
CW003        Contour Flex Valve Shunt Assemblies   Shunt Assembly: silicone encased valve,       Small (24mm length) or Regular (28mm
                                                    silicone ventricular and peritoneal          length); low, low/medium and medium
                                                   catheters                                     pressure; various catheter and valve
                                                                                                 configurations.
CW010        Siphon Limiting Device                Silicone Shunt Accessory for control of       15mm length, 4.5mm height, 10mm
                                                   CSF overdrainage
Device Technologies Australia Pty Ltd
      Embolization Prostheses, Intravascular
DE192        Dendron Coil                          Micro coils, straight, eight shape, pretzel   Micro coils, straight dia 0.26 and
                                                    shape, loop shape, helix shape, cyclone;     0.38mm, length 1-5mm; eight shape dia
                                                    micro meshes; jet coils; electrolytically    2mm, length 10mm; pretzel shape dia 3-
                                                   detachable coils, helix and cyclone           5mm, length 25-45mm; loop shape dia
                                                                                                 5mm, length 50mm; helix shape dia 2-
                                                                                                 8mm, length 20-100mm; cyclone dia
                                                                                                 3/6mm, length 22-85mm; micro meshes
                                                                                                 dia 0.15mm, length 1-2mm; jet coils dia
                                                                                                 0.22, 0.36mm, length 0.3-5cm; EDC dia
                                                                                                 2-20mm, length 1-30cm




Prostheses List February 2005                                                                                                                                    Page 128 of 700
NEUROSURGICAL                                                                                                                             Minimum   Maximum
Billing Code Product Name                         Description                                Size                                         Benefit   Benefit    Notation
DE193        Dendron Detachable Coils             Electrolytically detachable coil, helix,   Dia 2mm x length 1, 2, 3, 4, 6, 8, 10, 22,
                                                  curved tip, multi diameter                 42, 60, 85cm; diameter 2.5mm x length
                                                                                             15cm; diameter 3mm x length 3, 4, 6, 8,
                                                                                             10, 12cm; diameter 4mm x length 4, 6,
                                                                                             8, 10, 12, 15cm; diameter 5mm x length
                                                                                             5, 8, 10, 12, 15, 20, 25, 30cm; diameter
                                                                                             6mm x length 10, 15, 20cm; diameter
                                                                                             7mm x length 10, 20, 30cm; diameter
                                                                                             8mm x length 10, 20, 25cm; diameter
                                                                                             10mm x length 30cm; diameter 12mm x
                                                                                             length 20cm; diameter 15mm x length
                                                                                             20, 30cm; diameter 20mm x length
                                                                                             15cm;
Global Scientific Pty Ltd
      Barrier, Absorbable, Adhesion Prevention
GS199        DuraGen Dural Graft Matrix           Collagen                                   2.5 x 2.5cm
GS200        DuraGen Dural Graft Matrix           Collagen                                   2.5 x 7.5cm
GS201        DuraGen Dural Graft Matrix           Collagen                                   5 x 5cm
GS202        DuraGen Dural Graft Matrix           Collagen                                   7.5 x 7.5cm
GS203        DuraGen Dural Graft Matrix           Collagen                                   10 x 12.5cm
      Catheters, Hydrocephalic
GS134        Shunt                                Lumbar                                     80cm
GS150        Atrial Catheter                      Components - catheter: Atrial Atrial       Length: 46cm, F7. OD: 2.1mm;
                                                  Catheters Hydrocephalux Valve              ID:1.1mm
                                                  Accessories
GS151        Peritoneal Catheter                  Peritoneal Catheters                       Length: 91cm, F7. OD: 2.1mm;
                                                                                             ID:1.1mm
      Catheters, Intracranial, Ventricular
GS001        Heyer-Schulte In Line Valve System   Anti Siphon Device                         One size only
GS015        Heyer-Schulte Pudenz Ventricular     -                                          small, standard, right-angled
             Catheter
GS133        Shunt                                Components - catheter: Atrial              55cm - 60cm, Low - High pressure range
GS135        Shunt                                Peritoneal                                 90 - 120cm
GS136        Shunt                                Ventricular                                14.5cm - 23cm
Prostheses List February 2005                                                                                                                                 Page 129 of 700
NEUROSURGICAL                                                                                                                                Minimum   Maximum
Billing Code Product Name                             Description                                 Size                                       Benefit   Benefit    Notation
GS139        Heyer Schulte Portnoy Flanged            Composition - silicone with tantalum        Length 18cm, outer diameter 8mm
             Ventricular Catheter                     markings
      Guides, Other
GS194        Electa right angle guide                 Silicone                                    One Size Only
      Incision and Drainage Kits
GS207        Ventricular Catheter                     Silicone, with and without right angle      3-15cm, finned, straight and right angle
                                                      connectors
      Reservoirs, Cerebrospinal Fluid
GS008        Heyer-Schulte Braden Flushing            -                                         One size only
GS011        LPV Shunt System                         Standard, mini, Pressure range low - high
GS012        Heyer-Schulte Ommaya CSF Reservoir       Standard, side-inlet, convertible, mini   1.5 - 2.5cm and mini
GS016        Heyer-Schulte Foltz Flushing Reservoir   -                                         One size only
      Shunts, Hydrocephalic
GS002        Spetzler Lumbar-Peritoneal Shunt System Shunt, CSF Reservoir, In-line valve          Catheter length 80 - 105cm, Reservoir
                                                                                                  small & large, Valve pressure range
                                                                                                  low - high
GS006        Novus Hydrocephalic Shunt Kit            Pressure range low, medium                  Standard, mini
GS007        Heyer-Schulte Spetzler Lumbar-           -                                           Small, large
             Peritoneal Low Pressure Flushing
             Reservoir
GS014        Edwards Barbaro Syringo Peritoneal       80 x 3.5cm 5FRT-Tube, 90cm                  One size only
             Shunt                                    peritoneal reflux control catheter
                                                      Step down connector, Foltz CSF
                                                      Reservoir
GS142        Novus Hydrocephalic Shunt - Heyer        Novus valve made from                       Standard size - low & medium pressure;
             Schulte                                  silicone/polysulfone, each valve is         Mini size - low & medium pressure
                                                      packed with a valve and a right angled
                                                      catheter guide
GS144        Spetzler In Line Valve - Heyer Schulte   Composition silicone, valve with integral   Low, Medium, High Pressure
                                                      connectors
GS145        Cordis Omnishunt System, Hakim           Hakim Valve System                          Drainage Cath 110 cm, F7. Vent. Cath
             Valve Series                                                                         15cm, F8.
GS195        Cordis Omnishunt System                  Silicone and Synthetic ruby                 Very low to very high pressures
Prostheses List February 2005                                                                                                                                    Page 130 of 700
NEUROSURGICAL                                                                                                                             Minimum   Maximum
Billing Code Product Name                           Description                                  Size                                     Benefit   Benefit    Notation
      Tubes, Connecting
GS010        Heyer-Schulte Connectors for           Pudenz straight, Pudenz right angled,        Each in one size
             Neurosurgical Use                      Pudenz three-way (Y)
                                                    Threaded straight, Threaded right
                                                    angled, Double threaded straight
GS193        Connectors                             Silicone and Stainless Steel                 Straight, right angle, Y, T
      Valves, Hydrocephalic
GS003        Heyer-Schulte Pudenz Flushing Valve    With Anti Siphon Device, Pressure            12, 16mm
                                                    range low - high
GS004        Heyer-Schulte Pudenz Flushing Valve    Pressure range low - high                    12, 16mm
             with Integral Conn
GS005        Heyer-Schulte Mishler Dual Chamber     Burr-hole and flat bottom designs            Standard, mini
             Flushing Valve System                  Pressure range low - high
GS017        Heyer-Schulte In Line Valve System     Ultra VS Cylindrical Shunt/Valve
                                                    system - Neonate style, Pressure range
                                                    low - high
GS018        Heyer-Schulte In Line Valve System     Ultra VS Shunt Valve, Pressure low -         small, standard
                                                    high
GS137        Shunt                                  Pressure valve (anti-siphon device or        Low - High pressure range
                                                    flushing valve or flush pump)
GS138        Shunt                                  Reservoir                                    Standard, Large
GS140        Heyer Schulte Ultra VS Valve Kit       Comprises of silicone, kit includes valve,   Peritoneal catheter 90cm, ventricular
             Neonatal Style                          peritoneal cather, ventricular catheter     catheter 18cm
                                                    and rickham style reservoir
GS141        Ultra VS Shunt Kit Standard - Heyer    Composition silicone, kits contain           3.8-5.8mm diameter valve, 18cm
             Schulte                                standard valve, ventricular catheter,        ventricular catheter, low, medium high
                                                    peritoneal catheter, rickham reservoir       pressure, 120cm peritoneal catheter
GS143        LPV Shunt System Kit - Heyer Schulte   Composition silicone, kit includes LPV       Standard - low, medium, high pressure;
                                                    valve, peritoneal catheter, ventricular      Mini - low, medium, high pressure
                                                    catheter, right angle catheter guide
GS146        Cordis Standard Valve System           Atlas Valve System                           Drainage Cath 110 cm, F7. Vent. Cath
             Hydrocephalus Valves                                                                15cm, F8.



Prostheses List February 2005                                                                                                                                 Page 131 of 700
NEUROSURGICAL                                                                                                                             Minimum   Maximum
Billing Code Product Name                           Description                                   Size                                    Benefit   Benefit    Notation
GS147        Precision Flow-OSV II Valve System     Lumbar peritoneal OSV11-                      Lumber Catheter 80cm, F5 Peritoneal
                                                    Lumboperitoneal System                        Catheter 110cm, F7
                                                    Hydrocephalus Shunt
GS148        Precision Flow-OSV II Valve System     Ventricular/Atrial OSV11-Ventricular          Drainage Cath 110 cm, F7. Ventricular
                                                    /Atrial Hydrocephalus Shunt                   Catheters 7,9,13 & 15 cm
GS149        Precision Flow-OSV II Valve System     Ventricular/Peritoneal OSV11-                 Drainage Cath 110 cm, F7. Ventricular
                                                    Ventricular/Peritoneal Hyrocephalus           Catheters 7,9,13 & 15 cm
                                                    Shunt
GS196        Gravity Compensating Accessory         Silicone/Stainless steel                      low, medium & high pressures
Johnson & Johnson Medical Pty Ltd
        Catheters, Cerebrospinal
JJ160        Hakim Ventricular Catheter with        Silicone antibiotic impregnated catheter      Ventricular catheter length 14 cm
             Bactiseal Silicone
        Catheters, Intracranial, Ventricular
JJ227        Codman Medos Straight Ventricular      14cm, packaged sterile, silicone rubber       14cm
             Catheter
        Catheters, Peritoneal
JJ163        Hakim Ventricular and Peritoneal       Silicone ventricular/peritoneal catheter      Peritoneal Catheter length 80 cm,
             Catheter Set with Bactiseal Silicone                                                 Ventricular Catheter length 15 cm
JJ229        Codman Medos Peritoneal Catheter       85cm, packaged sterile, silicone rubber       85cm
        Clips, Aneurysm
JJ130        Aneurysm Clips                         Stainless steel alloy AVM Micro Clip          Blade length 2-9.5 mm
JJ131        Aneurysm Clips                         Stainless steel Graft Clip (with teflon       Blade 2-5mm diameter, 3-7mm length
                                                    graft)
JJ134        Aneurysm Clips                         Stainless steel Reinforcing (booster) Clip    Blade length 2-9.5 mm
JJ136        Aneurysm Clips                         Stainless steel large clip, curved            Blade 6mm diameter, 7.5mm length
JJ137        Aneurysm Clips                         Stainless steel large clip, right-angled      Blade 6mm diameter, 5mm length
JJ138        Aneurysm Clips                         Stainless steel large clip, right-angled      Blade 6mm diameter, 7.5-15mm length
JJ139        Aneurysm Clips                         Stainless steel large clip, 30 degree angle   Blade length 12mm
JJ140        Aneurysm Clips                         Stainless steel large clip, bayonet           Blade length 5-12mm
JJ141        Aneurysm Clips                         Stainless steel large clip, fenestrated       Blade 6mm diameter, 24mm length
Prostheses List February 2005                                                                                                                                 Page 132 of 700
NEUROSURGICAL                                                                                                      Minimum   Maximum
Billing Code Product Name       Description                                  Size                                  Benefit   Benefit    Notation
JJ142        Aneurysm Clips     Stainless steel large clip, fenestrated      Blade 6mm diameter, 6 mm length
                                tandem
JJ143        Aneurysm Clips     Stainless steel standard clip, straight to   4.5-10mm length
                                right angled
JJ144        Aneurysm Clips     Stainless steel standard clip, side angle    0.6mm diameter, 10mm length
JJ146        Aneurysm Clips     Stainless steel standard clip, slightly      0.6mm diameter, 15mm length
                                curved
JJ147        Aneurysm Clips     Stainless steel standard clip, right angle   0.6mm diameter, 5.5 mm length
JJ148        Aneurysm Clips     Stainless steel standard clip, straight to   0.5-0.6mm diameter, 5-15mm length
                                right angle
JJ149        Aneurysm Clips     Stainless steel standard clip, straight to   5-25mm length
                                curved
JJ150        Aneurysm Clips     Stainless steel standard clip, slightly      16mm length
                                curved
JJ151        Aneurysm Clips     Stainless steel standard clip, bayonet       9mm length
JJ152        Aneurysm Clips     Stainless steel standard clip, bayonet       15mm length
JJ153        Aneurysm Clips     Stainless steel standard clip, curved        10-14mm length
JJ154        Aneurysm Clips     Stainless steel standard clip, slightly      8-20mm length
                                curved
JJ155        Aneurysm Clips     Stainless steel standard clip, bayonet to    6-25mm length
                                right angle
JJ217        Aneurysm Clips     Stainless steel large clip                   Blade 4-6mm diameter, 5-25mm length
        Covers, Burr Hole
JJ165        Burr Hole Button   Stainless steel ventriculostomy reservoir    One size only
JJ166        Burr Hole Button   Silicone or stainless steel                  14mm diameter
                                ventriculostomy reservoir
JJ167        Burr Hole Button   Silicone ventriculostomy reservoir, flat     One size only
                                bottom
JJ168        Burr Hole Button   Silicone ventriculostomy reservoir,          One size only
                                standard
JJ169        Burr Hole Button   Silicone ventriculostomy reservoir, large    One size only

Prostheses List February 2005                                                                                                          Page 133 of 700
NEUROSURGICAL                                                                                                            Minimum   Maximum
Billing Code Product Name               Description                                 Size                                 Benefit   Benefit    Notation
JJ170        Burr Hole Button           Silicone or stainless steel                 One size only
                                        ventriculostomy reservoir, low profile
JJ171        Burr Hole Button           Silicone or stainless steel                 24mm diameter
                                        ventriculostomy reservoir
JJ284        BIOPLATE Burr hole cover   1.9mm, titanium, flexible contoured burr    18mm
                                        hole cover, packaged non-sterile
JJ285        BIOPLATE Burr hole cover   1.5mm, titanium, flexible contoured burr    12mm
                                        hole cover, packaged non-sterile
JJ286        BIOPLATE Burr hole cover   1.9mm, titanium, rigid contoured burr       18mm
                                        hole cover, packaged non-sterile
JJ287        BIOPLATE Burr hole cover   1.5mm, titanium, rigid contoured burr       12mm
                                        hole cover, packaged non-sterile
JJ288        BIOPLATE Burr hole cover   1.5mm, titanium, rigid contoured burr       18mm
                                        hole cover, packaged non-sterile
JJ289        BIOPLATE Burr hole cover   Titanium, burr hole cover, 6 hole,          12mm flat
                                        packaged non-sterile
JJ290        Burr hole button           Sterile, 10 per package, silicone rubber    Button length 35mm, cover diameter
                                                                                    29mm, stem thickness 4.1mm
JJ291        Burr hole cover            Burr hole cover, sterile, 10 per package,   Seat diameter 10mm, seat depth 6mm
                                        silicone rubber
JJ292        BIOPLATE Burr hole cover   1.5mm, titanium, flexible contoured burr    18mm
                                        hole cover, packaged non-sterile
JJ299        BIOPLATE Burr Hole Cover   1.9mm, titanium, flexible contoured burr    12mm
                                        hole cover, packaged non-sterile
        Mesh
JJ265        ETHISORB Dura Patch        Synthetic Dura substitute, Vicryl fleece,   4 x 6cm
                                         PDS foil, replaces natural dura post
                                        craniotomy, 3 units
JJ266        ETHISORB Dura Patch        Synthetic Dura substitute, Vicryl fleece,   6 x 14cm
                                         PDS foil, replaces natural dura post
                                        craniotomy, 1 unit
JJ267        ETHISORB Dura Patch        Synthetic Dura substitute, Vicryl fleece,   2 x 3cm
                                         PDS foil, replaces natural dura post
                                        craniotomy, 1 unit
Prostheses List February 2005                                                                                                                Page 134 of 700
NEUROSURGICAL                                                                                               Minimum   Maximum
Billing Code Product Name          Description                                 Size                         Benefit   Benefit    Notation
JJ268        ETHISORB Dura Patch   Synthetic Dura substitute, Vicryl fleece,   2 x 3cm
                                    PDS foil, replaces natural dura post
                                   craniotomy, 6 units
JJ269        ETHISORB Dura Patch   Synthetic Dura substitute, Vicryl fleece,   4 x 6cm
                                    PDS foil, replaces natural dura post
                                   craniotomy, 1 unit
        Mesh, Metallic
JJ255        BIOPLATE Biomesh      Titanium, lattice, 48 hole, packaged non-   32 x 44mm
                                   sterile
JJ256        BIOPLATE Biomesh      Titanium cranial biomesh, packaged          0.4mm thickness, 60 x 60mm
                                   non-sterile
JJ257        BIOPLATE Biomesh      Titanium cranial biomesh, packaged          0.4mm thickness, 85 x 90mm
                                   non-sterile
JJ258        BIOPLATE Biomesh      Titanium cranial biomesh, packaged          65 x 65mm, 90 x 92mm
                                   non-sterile
JJ259        BIOPLATE Biomesh      Titanium cranial biomesh, packaged          0.4mm and 0.6mm thickness
                                   non-sterile
JJ260        BIOPLATE Biomesh      Titanium cranial biomesh 3ME,               20 x 20cm
                                   packaged non-sterile
JJ441        Titanium Mesh                                                     15cm x 15cm
        Plates, Bone
JJ270        BIOPLATE Bone plate   Titanium straight plate, 2 hole, 5 per      12mm in length
                                   pack, packaged non-sterile
JJ271        BIOPLATE Bone plate   Titanium Y plate, 5 hole, packaged non-     19mm
                                   sterile
JJ272        BIOPLATE Bone plate   Titanium T-plate, 5 hole, packaged non-     16mm
                                   sterile
JJ273        BIOPLATE Bone plate   Titanium boxcar plate, 6 hole, packaged     9 x 18mm
                                   non-sterile
JJ274        BIOPLATE Bone plate   Titanium boxcar plate, 8 hole, packaged     11 x 25mm
                                   non-sterile
JJ275        BIOPLATE Bone plate   Titanium cranial straight plate, 2 hole,    1.9mm
                                   packaged non-sterile

Prostheses List February 2005                                                                                                   Page 135 of 700
NEUROSURGICAL                                                                                                      Minimum   Maximum
Billing Code Product Name                 Description                                  Size                        Benefit   Benefit    Notation
JJ276        BIOPLATE Bone plate          Titanium curved plate, 8 hole, packaged      30mm
                                          non-sterile
JJ277        BIOPLATE Bone plate          Titanium straight plate, 2 hole, packaged    11mm in length
                                          non-sterile
JJ278        BIOPLATE Bone plate          Titanium cranial straight plate, 16 hole,    1.5mm and 1.9mm
                                          packaged non-sterile
JJ279        BIOPLATE Bone plate          Titanium cranial compression plate, 2        1.5mm and 1.9mm
                                          hole, 3 per pack, packaged non-sterile
JJ280        BIOPLATE Bone plate          Titanium large boxcar plate, 4 hole,         14 x 14mm
                                          packaged non-sterile
JJ281        BIOPLATE Bone plate          Titanium BIO100, 2 hole plate, 5 per         1.5mm
                                          pack, packaged non-sterile
JJ282        BIOPLATE Bone plate          Titanium straight plate, 2 hole, 3 per       14mm in length
                                          pack, packaged non-sterile
JJ283        BIOPLATE Bone plate          Titanium straight plate, 2 hole, packaged    14mm in length
                                          non-sterile
        Resinous Compounds, Cranial
JJ303        Cranioplastic Kit (Type 1)   Cranioplastic kit containing 2 complete      30grams
                                          sets. Consists of 2 bags of sterile
                                          powder, 2 vials sterile liquid, 2 sterile
                                          matrix bags
        Screws, Bone
JJ244        BIOPLATE Bone screw          Titanium alloy self-drilling screws, 5 per   Dia 1.9mm, length 5mm
                                          pack, packaged non-sterile
JJ245        BIOPLATE Bone screw          Titanium alloy self-drilling screws, 5 per   Dia 1.9mm, length 4mm
                                          pack, packaged non-sterile
JJ246        BIOPLATE Bone screw          Titanium alloy self-drilling screw, 1 per    Dia 1.9mm, length 3 - 5mm
                                          pack, packaged non-sterile
JJ247        BIOPLATE Bone screw          Titanium alloy self-drilling screw,          Dia 1.9mm, length 3mm
                                          packaged non-sterile
JJ248        BIOPLATE Bone screw          Titanium alloy self-drilling screw, 5 per    Dia 1.5mm, length 3 - 5mm
                                          pack, packaged non-sterile
JJ249        BIOPLATE Bone screw          Titanium alloy self-drilling screw, 1 per    Dia 1.5mm, length 3 - 5mm
                                          pack, packaged non-sterile
Prostheses List February 2005                                                                                                          Page 136 of 700
NEUROSURGICAL                                                                                                                          Minimum   Maximum
Billing Code Product Name                         Description                                 Size                                     Benefit   Benefit    Notation
JJ250        BIOPLATE Bone screw                  Titanium alloy long screw, 1 per pack,      Dia 1.9mm, length 3, 4, 5, 6, 8, 10mm
                                                  packaged non-sterile
JJ251        BIOPLATE Bone screw                  Titanium alloy long screws, 5 per pack,     Dia 1.9mm, length 3, 4, 5, 6, 8, 10mm
                                                  packaged non-sterile
JJ252        BIOPLATE Bone screw                  Titanium alloy long screw, 1 per pack,      Dia 1.5mm, length 3, 4, 5, 6, 8, 10mm
                                                  packaged non-sterile
JJ253        BIOPLATE Bone screw                  Titanium alloy emergency screws, 5 per      Dia 1.8, length 6mm; Dia 2.3mm, length
                                                  pack, packaged non-sterile                  5mm
JJ254        BIOPLATE Bone screw                  Titanium alloy emergency screw, 1 per       Dia 1.8, length 6mm; Dia 2.3mm, length
                                                  pack, packaged non-sterile                  5mm
        Shunt Adapters
JJ228        Codman Medos Connector               Codman Medos stainless steel shunt          One size only
                                                  connector straight
        Shunts, Hydrocephalic
JJ161        Codman-Medos Non-programmable        Silicone fixed pressure                     Peritoneal Catheter length 25-80cm
             Valve System                         lumber/peritoneal catheter, James design
JJ162        Codman-Medos Non-programmable        Silicone fixed pressure                     Peritoneal Catheter length 65 cm
             Valve System                         lumber/peritoneal catheter, Holter design
JJ164        Siphonguard CSF Control Device       PET shell anti-siphon device for shunt      One size only
JJ218        HOLTER Intracranial Pressure Shunt   HOLTER Ventricular Catheter,                3 - 7cm and 15cm
                                                  packaged sterile, silicone rubber
JJ225        HOLTER Intracranial Pressure Shunt   HOLTER distal peritoneal catheter,          90cm in length
                                                  packaged sterile, silicone
JJ226        HOLTER Intracranial Pressure Shunt   HOLTER distal peritoneal catheter           90cm in length
                                                  Salmon, packaged sterile, silicone
JJ261        ACCU-FLO Intracranial Pressure       ACCU-FLO catheter, packaged sterile,        91cm in length
                                                  silicone rubber
JJ262        ACCU-FLO Intracranial Pressure       ACCU-FLO three way connector,               One size only
                                                  packaged sterile, metal or plastic
JJ263        ACCU-FLO Intracranial Pressure       ACCU-FLO barium ventricular                 One size only
                                                  catheter, packaged sterile, silicone
JJ264        ACCU-FLO Intracranial Pressure       ACCU-FLO right angle connector,             One size only
                                                  packaged sterile, metal or plastic
Prostheses List February 2005                                                                                                                              Page 137 of 700
NEUROSURGICAL                                                                                                                    Minimum   Maximum
Billing Code Product Name                      Description                                   Size                                Benefit   Benefit    Notation
        Valves, Hydrocephalic
JJ156        Hakim Precision Valve System      Precision valve standard. Silicone            Peritoneal Catheter length 80 cm,
                                               casing & catheter; stainless steel ruby       Ventricular catheter length 14 cm
                                               ball in cone mechanism with fixed
JJ157        Hakim Precision Valve System      Precision valve and pre-chamber.              Peritoneal Catheter length 80 cm,
                                               Silicone casing & catheter; stainless         Ventricular catheter length 14 cm
                                               steel ruby ball in cone mechanism with
                                               fixed pressure
JJ158        Hakim Programmable Valve System   Standard system. Silicone casing              One size only
                                               without catheter; stainless steel ruby
                                               ball in cone mechanism with variable
JJ159        Hakim Programmable Valve System   Standard system. Silicone casing with         Peritoneal Catheter length 80 cm,
                                               catheter; stainless steel ruby ball in cone   Ventricular catheter length 14 cm
                                                mechanism with variable pressure
JJ219        Hakim Programmable Valve System   Fixed pressure hydrocephalus shunt,           One size only
                                               packaged sterile, stainless steel and
                                               ruby valve mechanism, silicone rubber
                                               ventricular and peritoneal catheters. In
                                               line or right angled with reservoir.
                                               Valve can be reprogrammed non-
                                               invasively 18 pressure settings available
                                               in 10mm H20 increments. SiphonGuard
                                                anti-siphon device integrated into valve
JJ220        Hakim Precision Valve System      Fixed pressure hydrocephalus shunt,           One size only
                                               packaged sterile, stainless steel and
                                               ruby valve mechanism, silicone rubber
                                               ventricular and peritoneal catheters. In
                                               line or right angled with reservoir.
                                               Opening pressure H20; Very high
                                               130mm, high 100mm, medium 70mm,
                                               low 40mm, very low 10mm. With
                                               integrated anti-siphon device.




Prostheses List February 2005                                                                                                                        Page 138 of 700
NEUROSURGICAL                                                                                                                            Minimum   Maximum
Billing Code Product Name                          Description                                Size                                       Benefit   Benefit    Notation
JJ221        Hakim Precision Valve System          Fixed pressure hydrocephalus shunt,        One size only
                                                   packaged sterile, stainless steel and
                                                   ruby valve mechanism, silicone rubber
                                                   ventricular and peritoneal catheters. In
                                                   line or right angled with reservoir.
                                                   Opening pressure H20; Very high
                                                   130mm, high 100mm, medium 70mm,
                                                   low 40mm, very low 10mm.
JJ436        Codman Hakim Programmable Valves      18 different pressure settings, various    One Size Only
                                                   models
JJ437        Codman Hakim Programmable Valves      18 different pressure settings and         One Size Only
             with Siphonguard                      SIPHONGUARD technology
JJ438        Codman Hakim Precision Valves with    features 5 operating pressures and         Pressure settings 10, 40, 70, 100 and
             Siphonguard, Right Angle Reservoir    SIPHONGUARD technlogy                      130mmH2O
JJ439        Codman Hakim Precision Valve with     features 5 operating pressures and         Pressure settings 10, 40, 70, 100 and
             Siphonguard, Inline Reservoir         SIPHONGUARD technology                     130mmH2O
JJ440        Codman Hakim Precision Valve, Right   features 5 operating pressures             10, 40, 70, 100, and 130mmH2O
             Angle Reservoir
Medical & Optical Instruments Australia Pty Ltd
        Fixation Device, Internal, Plate
MO244        Martin Micro Plate Osteosynthesis     1.5mm Titanium Sterile Drill Free Flap     2 - Hole Plate x 3, 1.5 x 4mm Screws x 6                        Temporary
             System                                Pack Kit                                                                                                   approval, pending
                                                                                                                                                              review of product
                                                                                                                                                              group
Medical Specialties Australia Pty Ltd
        Catheters, Epidural
MS005        E-Catheter                            Silicone epidural catheters                18ga
        Injection/Infusion Ports, Implantable
MS006        Chemoport                             Titanium/ plastic                          19, 20ga
        Valves, Hydrocephalic
MS003        Sterile Hydrocephalic Shunts          Plastic/magnetic. Programmable valve.      3, 8 settings
                                                   Programmer kit and shunts kit.



Prostheses List February 2005                                                                                                                                Page 139 of 700
NEUROSURGICAL                                                                                                Minimum   Maximum
Billing Code Product Name                          Description                               Size            Benefit   Benefit    Notation
Medtronic Australasia Pty Ltd
      Anchor, Fixation
MC094        Stimulator Accessory Kit - Pisces     Model 3550-10 revision kit. 1 x boot, 1 x One size only                        When used in pain
             Quad; Pisces Z Lead Revision Kit;      twistlock anchor, 2 x silicone anchors, 1                                      therapy - to be
             Pisces Quad Revision Kit; Octad        x hex wrench, 1 x epidural needle 15                                          funded when the
                                                   gauge, 1 x percutaneous extension                                              patient has
                                                   (inline) with set screws, 1 x ball-tipped                                      undergone a multi-
                                                   (bent) 28cm stylet for Pisces-Quad                                             disciplinary
                                                   lead, 1 x ball-tipped (straight) 28cm                                          assessment and
                                                   stylet for Pisces-Quad lead, 1 x                                               trial of stimulation.
                                                   screening cable, 1 x short stylet, 1 x
                                                   tunnelling guide, 1 x tunnelling guide tip.
                                                   Silicone, polycarbonate, polyurethane,
                                                   titanium, stainless steel; 3550-22 &
                                                   3550-23 Curved steering stylets,
                                                   Epidural Needle, Guide Wire, Straight
                                                   Steering Stylets, Torque Wrench,
                                                   Percutaneous Extension, Connector
                                                   Boot, PERCUPASS II Tunneling Tool
                                                   & Tunneling Tip, Short Stylet, Twist-
                                                   Lock Screening Cable, Passing Straw,
                                                   Anchors; Model - 3550-R33 - Pisces
                                                   Quad revision kit with 33cm stylet;
                                                   Model 3550-ORK - Octad Revision Kit

      Electrodes, Neuromuscular Stimulator
MC185        Sacral Nerve Stimulation Unilateral   Interstim Temporary test stimulation      One size only                        When used in pain
                                                   lead. Model 3065U. This model is                                                therapy - to be
                                                   temporary for patient trial. Platinum /                                        funded when the
                                                   Iridium, polyurethane.                                                         patient has
                                                                                                                                  undergone a multi-
                                                                                                                                  disciplinary
                                                                                                                                  assessment and
                                                                                                                                  trial of stimulation.
      Infusion Pumps
MC313        Synchro Med II Pump                   Model No's 8637-20 & 8637-40,             20 ml & 40 ml
                                                   Composition - Titanium



Prostheses List February 2005                                                                                                    Page 140 of 700
NEUROSURGICAL                                                                                                   Minimum   Maximum
Billing Code Product Name                              Description                              Size            Benefit   Benefit    Notation
      Infusion Pumps, Implantable
MC059        Medtronic SynchroMed EL Drug              Models 8627-10, 8627L-10, 8627-18,       10 to 18ml
             Infusion Pump                             8627L-18, Titanium
MC060        AlgoMed Infusion System                   Model 84112. Silicone, polyester mesh    50ml
MC061        Medtronic IsoMed Drug Infusion Pump.      Models 8472-20-03, 8472-20-05, 8472-     20ml, 35ml
                                                       20-10, 8472-20-15. Models 8472-35-05,
                                                       8472-35-10, 8472-035-15. Titanium
MC063        Medtronic IsoMed Drug Infusion Pump       Models 8472-60-10, 8472-60-20, 8472- 60 ml
                                                       60-05, 8472-60-25, 8472-60-30, l 8472-
                                                       60-35, 8472-60-15, l 8472-60-40 titanium

MC071        AlgoMed Infusion system                   Model 27438 AlgoMed Control Pad OR       One size only
                                                        Model 27437 Algomed Drug reservoir
                                                       and tubing. Silicone /polypropylene,
                                                       polyester mesh.
MC073        AlgoMed Infusion System                   Model 27439 AlgoMed Catheter Kit.        One size only
                                                       Radiopaque silicone.
MC074        AlgoMed Infusion System                   Model 27442 AlgoMed Stepdown             One size only
                                                       connector. Radiopaque polypropylene.
                                                       OR Model 27443 14G Touhy needle.
                                                       Sterile. Used for catheter insertion.
                                                       Stainless steel.
      Infusion Pumps, Patient-Controlled Analgesic
MC316        Personal Therapy Manager Model 8832                                                One Size Only                        When used in pain
                                                                                                                                      therapy - to be
                                                                                                                                     funded when the
                                                                                                                                     patient has
                                                                                                                                     undergone a multi-
                                                                                                                                     disciplinary
                                                                                                                                     assessment and
                                                                                                                                     trial of stimulation.
      Leads
MC077        Medtronic quadripolar itrel II- 7424DBS   DBS Unilateral: Extension kit for Deep   10-66 cm
              Active implantable stimulators &         Brain Stimulation Model 7495-51,PTFE,
             ancillary equipment sterile                polyurethane,platinum,iridium, nickel
                                                       alloy
Prostheses List February 2005                                                                                                       Page 141 of 700
NEUROSURGICAL                                                                                                           Minimum   Maximum
Billing Code Product Name                              Description                               Size                   Benefit   Benefit    Notation
MC078        Medtronic quadripolar itrel II- 7424DBS   DBS Unilateral: Quadripolar Itrel II      One size only x 1
              Active implantable stimulators &         Model 7424 DBS, titanium
             ancillary equipment sterile
MC305        Low Profile Impedance Extension Kit       Silicone Rubber                           25, 40, 51, 66, 95cm
             for DBS Model 7482
      Leads, Dorsal Column, Implantable
MC102        Mattrix Dual Channel System - Single      Medtronic Pisces Octad Lead Kit           33cm                                        When used in pain
             Octad lead                                Model 3898. Materials -Silicone Rubber,                                                therapy - to be
                                                       Platinum/Iridium                                                                      funded when the
                                                                                                                                             patient has
                                                                                                                                             undergone a multi-
                                                                                                                                             disciplinary
                                                                                                                                             assessment and
                                                                                                                                             trial of stimulation.
MC104        Mattrix Dual Channel System - Pisces      Medtronic Pisces Quad Lead Model          28 - 56cm                                   When used in pain
             Quad leads                                3487A,3487A-56. Pisces Quad Plus                                                       therapy - to be
                                                       Model 3888. Materials -Silicone Rubber,                                               funded when the
                                                        Platinum/Iridium. Pisces Quad                                                        patient has
                                                       Compact Lead Model 3887 -                                                             undergone a multi-
                                                       quadripolar percutaneous lead with four                                               disciplinary
                                                       closely spaced electrodes at the distal                                               assessment and
                                                       end design for delivering stimulation.                                                trial of stimulation.
MC135        Medtronic Australasia, Specify Lead       DCI - Leads: Specify Lead Model           18cm x 1                                    When used in pain
             Model 3998, Active Implantable            3998. (dual lead) Materials - Silicone                                                 therapy - to be
             Stimulators & Ancillary Equipment         Rubber, Platinum/Iridium                                                              funded when the
                                                                                                                                             patient has
                                                                                                                                             undergone a multi-
                                                                                                                                             disciplinary
                                                                                                                                             assessment and
                                                                                                                                             trial of stimulation.




Prostheses List February 2005                                                                                                               Page 142 of 700
NEUROSURGICAL                                                                                                                Minimum   Maximum
Billing Code Product Name                            Description                                Size                         Benefit   Benefit    Notation
      Plugs
MC086        Accessory Kits - Stimulator; EZ         3550-09 - Synergy accessory kit OR         One size only                                     When used in pain
             Anchor; Tunnelling Rod; Percutaneous    3550-01 - Boots & anchors OR 3550-02                                                          therapy - to be
             Lead Introducer; SCS & PNS Model         - Wrenches & screws OR 3550-03,                                                             funded when the
             3550-24; DBS Model 3550-25;             3550-0SCO - Screening cable OR                                                               patient has
                                                     3550-04 - Epidural needle OR 3550-05 -                                                       undergone a multi-
                                                      Percutaneous extension OR 3550-06 -                                                         disciplinary
                                                     Tunnelling tools; 3550-16 - Silicone                                                         assessment and
                                                     rubber anchors; 3555 - Tunneling Rod;                                                        trial of stimulation.
                                                     3550-12 - Coil guide wire & Introducer
                                                     sheaths; Silcone rubber;
      Stimulator, Electrical, Analgesic, Spinal
MC312        Octapolar Extension Model 7471          Silicone rubber                            Lengths: 20, 40, 51, 66 cm
MC315        Low Profile Impedance Extension Kit     Silicone rubber                            10, 25, 40, 51, 66cm
             for SCS Model 7489
      Stimulators
MC247        Patient Activators                      Hand held device Models 7434 & 7435        One size only                                     When used in pain
                                                     to be used with Itrel III and Synergy                                                         therapy - to be
                                                     Implantable Pulse Generators                                                                 funded when the
                                                                                                                                                  patient has
                                                                                                                                                  undergone a multi-
                                                                                                                                                  disciplinary
                                                                                                                                                  assessment and
                                                                                                                                                  trial of stimulation.
MC249        Access Therapy Controller               Handheld device used with the Kinetra      One size only                                     To be funded for
                                                     and Soletra Implantable Pulse                                                                the initial implant
                                                                                                                                                  only.
      Stimulators, Electrical, Brain
MC244        Medtronic Australasia DBS Lead          Deep brain stimulation lead with four      28 - 40cm
             Model 3389, Medtronic quadripolar       platinum iridium electrodes Models 3387
             Itrel II- 7424DBS, Active Implantable    and 3389. Electrode spacing is 1.5mm
             Stimulator & Ancillary Equipment        apart for Model 3387 and 0.5mm apart
                                                     for Model 3389. PTFE, polyurethane,
                                                     platinum/iridium, nickel alloy, tungsten




Prostheses List February 2005                                                                                                                    Page 143 of 700
NEUROSURGICAL                                                                                                 Minimum   Maximum
Billing Code Product Name                             Description                             Size            Benefit   Benefit    Notation
      Stimulators, Electroanalgesic, Dorsal Column
MC110        Itrel 3 System - Lead extension          Medtronic Lead Extension Kit Models     10 - 66cm                            When used in pain
                                                      7495,7496,7498 - Materials Silicone                                           therapy - to be
                                                      rubber, Platinum/Iridium                                                     funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
      Stimulators, Electroanalgesic, Intracerebral/Subcortical
MC001        Kinetra Dual Channel Implantable Pulse   Titanium, polyurethane                  One size only
             Generator Model 7428
MC107        Mattrix Dual Channel System -            Model 3440 DCS Antenna kit. Medical     One size only                        When used in pain
             Antenna Kit                              antenna. External component of                                                therapy - to be
                                                      implantable Mattrix system.                                                  funded when the
                                                      Polyurethane.                                                                patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
MC141        Epidural Stimulator - Leads              Verify Screening lead Model 3862,       45 - 60cm                            When used in pain
                                                      3862-45. Silicone, Platinum/Iridium                                           therapy - to be
                                                                                                                                   funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.
      Stimulators, Electroanalgesic, Spinal Cord
MC105        Mattrix Dual Channel System -            Medtronic Mattrix Receiver Kit Model    One size only                        When used in pain
             Receiver/Extension                       3271, 3272. Materials - Polyurethane,                                         therapy - to be
                                                      epoxy coating                                                                funded when the
                                                                                                                                   patient has
                                                                                                                                   undergone a multi-
                                                                                                                                   disciplinary
                                                                                                                                   assessment and
                                                                                                                                   trial of stimulation.

Prostheses List February 2005                                                                                                     Page 144 of 700
NEUROSURGICAL                                                                                                Minimum   Maximum
Billing Code Product Name                          Description                               Size            Benefit   Benefit    Notation
MC106        Mattrix Dual Channel System -         Medtronic Mattrix Transmitter/Antenna     One size only                        When used in pain
             Transmitter                           Kit 3210. Polycarbonbate                                                        therapy - to be
                                                                                                                                  funded when the
                                                                                                                                  patient has
                                                                                                                                  undergone a multi-
                                                                                                                                  disciplinary
                                                                                                                                  assessment and
                                                                                                                                  trial of stimulation.
MC115        Peripheral Nerve Stimulation -        Medtronic Model 7425 Itrel 3              One size only                        When used in pain
             Unilateral - Pulse Generator          Implantable Pulse Generator. Titanium                                           therapy - to be
                                                                                                                                  funded when the
                                                                                                                                  patient has
                                                                                                                                  undergone a multi-
                                                                                                                                  disciplinary
                                                                                                                                  assessment and
                                                                                                                                  trial of stimulation.
MC137        Medtronic A/Asia, Synergy Dual        DCI - Pulse Generator: Synergy Dual       One size only                        When used in pain
             Channel Implantable Pulse Generator   Channel Implantable Pulse Generator                                             therapy - to be
             Model 7427, Active Implantable        Model 7427. Materials - Titanium                                               funded when the
             Stimulators.                                                                                                         patient has
                                                                                                                                  undergone a multi-
                                                                                                                                  disciplinary
                                                                                                                                  assessment and
                                                                                                                                  trial of stimulation.
      Stimulators, Neuromuscular, Functional
MC079        Control Magnets                       Model 7452 Magnet                         One size only                        When used in pain
                                                                                                                                   therapy - to be
                                                                                                                                  funded when the
                                                                                                                                  patient has
                                                                                                                                  undergone a multi-
                                                                                                                                  disciplinary
                                                                                                                                  assessment and
                                                                                                                                  trial of stimulation.
      Stimulators, Neuromuscular, Therapeutic
MC228        Soletra Model 7426 Neurostimulator    Sterility - Ethylene Oxide.               One size only
                                                   Neurostimualtor comprised of electronic
                                                    circuitry and a battery, which are
                                                   hermatically sealed in a titanium case

Prostheses List February 2005                                                                                                    Page 145 of 700
NEUROSURGICAL                                                                                                                        Minimum   Maximum
Billing Code Product Name                             Description                              Size                                  Benefit   Benefit    Notation
Medtronic Sofamor Danek Australia Pty Ltd
      Anchor, Fixation
SD216        Invisx Locks                             Invisx polymer cranial fixation system   Single pack
SD217        Invisx Locks                             Invisx polymer cranial fixation system   2 pack
      Barrier, Absorbable, Adhesion Prevention
SD257        Medishield                               Medishield is a co-polmer gel composed   3cc Syringe                                                Temporary
                                                       of carboxymethylcellulose and                                                                      approval - funded
                                                      polyethylene.                                                                                       when clinical
                                                                                                                                                          indications are
                                                                                                                                                          present.
      Bone Matrix Implants, Artificial
SD265        Macropore FRP (fast resorbing polymer)   Polylactide and Polyglycolide polymer    1.8mm x 3-8mm
SD266        Macropore FRP (fast resorbing polymer)   Polylactide and Polyglycolide polymer    100mm x 100mm x 0.75mm
SD267        Macropore FRP (fast resorbing polymer)   Polylactide and Polyglycolide polymer    60mm x 80mm x 0.75mm
SD268        Macropore FRP (fast resorbing polymer)   Polylactide and Polyglycolide polymer    50mm x 50mm 0.75mm
SD269        Macropore FRP (fast resorbing polymer)   Polylactide and Polyglycolide polymer    25mm x 25mm x 0.75mm
SD270        Macropore FRP (fast resorbing            Polylactide and Polyglycolide polymer    2.1mm x 3-8mm
             polymer) screw
      Catheters, Hydrocephalic
SD166        Shunt: Components catheter               Ventricular Catheter, CSF Catheter       1.3 - 35cm
SD218        CSF - Ventricular Catheters PSM Range    Non metallic latex free. Barium          ID 1.3mm OD 2.5mm Length 15cm,
                                                      impregnated, include stainless steel     23cm; ID 1.2mm OD 2.1mm Length
                                                      stylet. Model Nos 41101, 41115, 41207,   15cm, 23cm
                                                       41103, 41308, Proximal ventricular
                                                      catheter.
SD219        CSF - Distal Catheters                   Non metallic and latex free, Models   Distal cardiac/peritoneal catheters ID
                                                      43418,43103,43111,43209,43522,43551,2 1.3mm OD 2.5mm Length 90cm, 96cm,
                                                      7211                                   110cm, 120cm, ID 1.2mm, OD 2.1mm,
                                                                                            Length 90cm, 75cm, 58cm
SD278        Peritoneal Catheter PSM range with       Translucent silicone elastomer with      60-90cm
             Bioglide                                 Barium impregnated stripe. Catheter
                                                      surface bonded with Hydrogel.


Prostheses List February 2005                                                                                                                            Page 146 of 700
NEUROSURGICAL                                                                                                                            Minimum   Maximum
Billing Code Product Name                            Description                                Size                                     Benefit   Benefit    Notation
SD279        Ventricular Catheter PSM range with     Translucent silicone elastomer with        15-23cm
             Bioglide                                Barium impregnated stripe. Catheter
                                                     surface bonded with Hydrogel.
      Reservoirs, Cerebrospinal Fluid
SD167        Pressure valve (anti-siphon device or   Neonatal Reservior, CSF Lumbo              2 - 90cm
             flushing valve or flush pump)           Peritoneal
SD168        Pressure valve (anti-siphon device or   Reservoir, CSF Vent Reservoir, Snap        6 - 90mm
             flushing valve or flush pump)           Assembly Reservoir
      Shunts, Hydrocephalic
SD162        Hydrocephalus Shunt                     Ventricular/Peritoneal. CSF Flow           12mm-90cm
                                                     Control Valves, BioGlide Contoured,
                                                     Ventriculostomy Kit-E, Neonatal Delta
                                                     Snap Shunt
SD280        Strata Shunt, Unitised                  Adjustable CSF valve with five             8-13.5cm x 9-120cm
                                                     symmetric performance level steps.
                                                     Includes strata valve, pre-attached
                                                     ventricular catheter, and a pre-attached
                                                     peritoneal catheter. Right Angle Clip.
                                                     Disposable Quick Release Ventricular
                                                     Catheter Introducer. Disposable
                                                     Subcutaneous Catheter Passer. Tuohy-
                                                     Borst Adapter.
SD289        Delta Shunt Unitised                    Delta valve is a fixed pressure CSF        Delta Unitised Shunt small (Distal
                                                     valve, available in four performance       65cm-90cm, ventricular 11cm) - 0.5,
                                                     levels. Delta Unitised shunt includes a    1.0, 1.5 and 2.0. Delta Unitised Shunt
                                                     delta valve, pre-attached ventricular      regular (Distal 90cm, ventricular
                                                     catheter, and a pre-attached peritoneal    catheter 13cm) - 0.5, 1.0, 1.5 and 2.0
                                                     catheter. Right Angle Clip. Disposable
                                                     Quick Release Ventricular Catheter
                                                     Introducer.
SD290        Delta Shunt Assembly                    Delta valve is a fixed CSF pressure        90-120cm (0.5 - 2.0)
                                                     valve, available in four performance
                                                     levels. Includes an Integral (distal)
                                                     Peritoneal Catheter, Disposable
                                                     Peritoneal Catheter Passer, Female
                                                     Luer Adapter and Prefill Tubing.


Prostheses List February 2005                                                                                                                                Page 147 of 700
NEUROSURGICAL                                                                                                                  Minimum   Maximum
Billing Code Product Name                            Description                                 Size                          Benefit   Benefit    Notation
SD292        Strata Shunt Assembly                   Adjustable CSF valve with five              90-120cm
                                                     symmetric performance level steps. The
                                                      assembly includes an Integrated (distal)
                                                      Peritoneal Catheter. Disposable
                                                     Peritoneal Catheter Passer. Female
                                                     Luer Adapter and Prefill tubing.
      Valves, Hydrocephalic
SD160        Hydrocephalus Shunt                     Lumbar peritoneal                           84cm
SD161        Hydrocephalus Shunt                     Ventricular/Atrial, CSF Flow Control        38cm-90cm
                                                     Shunts, Cont Small Valve
SD163        Hydrocephalus Shunt                     With Hydrostatic Valve, Delta               12mm-90cm
                                                     Valves/Shunts/BioGlide, Vent Catheters
SD169        Valves, Hydrocephalic                   Strata Adjustable Delta Valve               12 -16mm
SD281        Strata Valve Unitised with Bioglide     CSF Flow Valve. Polypropylene and           One size only
             PSM range                               acetal plastic base. Silicone elastomer
                                                     dome.
SD282        Strata Valve Assembly with Bioglide     CSF Flow Valves. Polypropylene and          One size
             PSM range                               acetal plastic base. Silicone elastomer
                                                     dome.
SD283        Strata Valve with Bioglide PSM range    CSF Flow Valve. Polypropylene and           13-16mm x 35-47mm
                                                     acetal plastic base. Silicone elastomer
                                                     dome.
SD284        Strata Valve NSC (non siphon control)   CSF Flow Valve. Polypropylene and           13-16mm x 23-32mm (0.5-2.0)
             PSM range                               acetal plastic base. Silicone elastomer
                                                     dome.
SD285        Strata Valve Unitised NSC (non siphon   Adjustable CSF valve with five              8-120cm
             control) PSM range                      symmetric performance level steps.
                                                     Includes a strata valve, pre-attached
                                                     ventricular catheter, and a pre-attached
                                                     peritoneal catheter. Right Angle Clip.
                                                     Disposable Quick Release Ventricular
                                                     Catheter Introducer. Disposable
                                                     Subcutaneous Catheter Passer. Tuohy-
                                                     Borst Adapter. Polypropylene and
                                                     acetal plastic base. Silicone elastomer
                                                     dome.

Prostheses List February 2005                                                                                                                      Page 148 of 700
NEUROSURGICAL                                                                                                                               Minimum   Maximum
Billing Code Product Name                              Description                                   Size                                   Benefit   Benefit    Notation
SD286        Strata Valve Assembly NSC (non            Adjustable CSF valve with five                One size
             siphon control) PSM range                 symmetrical performance level steps.
                                                       Includes a strata valve, an integral distal
                                                        peritoneal catheter and catheter passer,
                                                        and a female leur adaptor and prefill
                                                       tubing. Polypropylene and acetal plastic
                                                       base. Silicone elastomer dome.
SD287        Delta Valve with Bioglide PSM range       CSF Flow Valve. Polypropylene and         36-40mm x 9-20mm (0.5-2.0)
                                                       acetal plastic base. Silicone elastomer
                                                       dome. Surface of valve bonded with
                                                       hydrogel (Bioglide surface modification).
SD288        Delta Valve Unitised with Bioglide        CSF Flow Valves. Polypropylene and            8-13.5cm x 90-120cm (0.5-2.0)
             PSM range                                 acetal plastic base. Silicone elastomer
                                                       dome. Unitised system includes the
                                                       valve, integral ventricular and peritoneal
                                                        catheter (all components connected).
                                                       Surface of valve bonded with hydrogel
                                                       (Bioglide surface modification).
SD291        Delta Valve Assembly with Bioglide        CSF Flow Valves. Polypropylene and        90-120cm (0.5, 1.0, 1.5, 2.0)
             PSM range                                 acetal plastic base. Silicone elastomer
                                                       dome. Assembly system includes the
                                                       valve, integral peritoneal catheter,
                                                       female luer adapter and prefill tubing.
                                                       Surface of the valve bonded with
                                                       hydrogel (Bioglide surface modification).
N Stenning & Co Pty Ltd
      Embolization Prostheses, Intravascular
NG035        MicroPlex Coil System                     Kit includes delivery pusher, introducer      Coil Size 10, 18 - Loop Diameter 2-
                                                       sheath, MCS complex coil                      14mm, 16,18,20mm, Length 1-4cm, 6-
                                                                                                     13cm, 15-21cm, 23-24cm, 26-28cm, 30-
                                                                                                     34cm, 38-39cm, 43-44cm, 49-50cm
NG038        MicroPlex Coil System; Hydrocoil System                                                 MCS Helical Coils Soft; MCS Helical
                                                                                                     Coil Regular
NG039        MicroPlex Coil System; Hydrocoil System HES Helical Coils Hydrocoils                    2mm Diameter x 3cm Length to 3mm
                                                                                                     Diameter x 7cm Length
NG040        MicroPlex Coil System; Hydrocoil System HES Helical Coils Hydrocoils                    4mm Diameter x 5cm Length to 5mm
                                                                                                     Diameter x 10cm Length
Prostheses List February 2005                                                                                                                                   Page 149 of 700
NEUROSURGICAL                                                                                                                         Minimum   Maximum
Billing Code Product Name                            Description                                 Size                                 Benefit   Benefit    Notation
NG041        MicroPlex Coil System, Hydrocoil System HES Helical Coils Hydrocoils                5mm Diameter x 15cm Length to 20mm
                                                                                                  Diameter x 20cm Length
National Surgical Corporation Pty Ltd
      Clips, Aneurysm
NI142        Medicon Aneurysm Clips                  Aneurysym clips titanium, standard          Small
                                                     titanium
NI143        Medicon Aneurysm Clips                  Aneurysym clips titanium, standard          Large
                                                     titanium, stainless steel
NI144        Medicon Aneurysm Clips                  Aneurysym clips titanium, standard          Small
                                                     stainless steel
NI145        Medicon Aneurysm Clips                  Aneurysym clips titanium, mini titanium     One size only
NI146        Medicon Aneurysm Clips                  Aneurysym clips titanium, mini stainless    One size only
                                                     steel
Stryker Australia Pty Ltd
      Clips
SK370        Universal Neuro                         NeuroClip                                   1.5mm
Taylor Bryant Pty Ltd
      Clips, Aneurysm
TB116        Aneurism Clip                           Sugita Clips, Standard Slightly Curved,     One Size Each
TB117        Aneurism Clip                           Sugita Clip, Temporary Straight/S,          One Size Each
                                                     Sugita Clip, Temporary Straight/L
TB118        Aneurism Clip                           Sugita Clips: Standard Straight-Short       One Size Each
                                                     #1/Long #2
TB119        Aneurism Clip                           Sugita Titanium Anneurysm Clips:            One Size Each
                                                     Standard Straight/s, Straight-L, Bayonet,
                                                     Angled, Straight-Small, STD Temp-
                                                     STD Small, STD Temp-Straight/Large,
                                                     STD Temp-Bayonet, STD Temp-CVD,
                                                     Mini Straight-Small, Mini
                                                     Straight/Large, Mini Curve, Mini




Prostheses List February 2005                                                                                                                             Page 150 of 700
NEUROSURGICAL                                                                             Minimum   Maximum
Billing Code Product Name       Description                               Size            Benefit   Benefit    Notation
TB147        Aneurism Clip      Sugita Titanium Clips: Standard Slight    One Size Each
                                Angle, Side CVD, CVD, Angled,
                                Bayonet-Small/Large, Straight-Medium,
                                Slight CVD, Straight Large, L Angle-
                                Small/Medium/Large, 45D CVD
                                Small/Medium/Large, STD Temp Slight
                                CVD, Temp Mini Straight/Large, Temp
                                Mini Angle, Standard 1/4 Curved-
                                Small/Large, STD Slight Angle,
                                Standard Slight Curve, Curve, 1/4
                                Curve, Mini Curve, Side Curve, Angle,
                                Bayonet,
TB148        Aneurism Clip      Sugita Titanium Clips: Standard Side      One Size Each
                                CVD Bayonet, Small CVD, Side
                                Angled, Slight CVD, J Angle-
                                Small/Medium/Large, Slight CVD
                                Small, Temp Mini Straight Slim,
                                Standard L Curved- Small/Large, Mini
                                Straight Slim, Curve Slim,
TB149        Aneurism Clip      Sugita Titanium Clips: Booster            One Size Each
TB150        Aneurism Clip      Sugita Clips: Mini Straight Slim, CVD     One Size Each
                                Slim
TB151        Aneurism Clip      Sugita Clips: Fenest, Lrg L Shaped        One Size Each
                                W/CVD
TB152        Aneurism Clip      Sugita Clips, Mini CVD Slim               One Size Each
TB153        Aneurism Clip      Sugita Clips, Long                        One Size Each
TB154        Aneurism Clip      Sugita Clip, Large Straight/Short         One Size Each
TB155        Aneurism Clip      Sugita Clip, Temporary Bayonet, Bent      One Size Each
TB156        Aneurism Clip      Sugita Clip, STD Sideward CVD             One Size Each
TB157        Aneurism Clip      Sugita Clip, Large Sideward Bent, Bent,   One Size Each
                                Bayonnet-Short/Large, Straight-
                                Medium/Long
TB158        Aneurism Clip      Sugita Clip, Large L Shaped-              One Size Each
                                Short/Medium/Large, Large J Shaped-
                                Short/Medium/Large, Fenest Large
                                Straight-S/M/L, Large Bent-S/M/L,
                                Fenest Large L Shaped-S/M/L
Prostheses List February 2005                                                                                 Page 151 of 700
NEUROSURGICAL                                                                                                                   Minimum   Maximum
Billing Code Product Name                    Description                               Size                                     Benefit   Benefit    Notation
TB159        Aneurism Clip                   Sugita Clip, Temporary Mini Straight,     5-7mm length x 1.2mm width, closing
                                             Bent, Mini Straight/Short, Bent,          force 125gms
                                             SDEWARD CVD, CVD
TB160        Aneurism Clip                   Sugita Clip, Mini CVD                     4mm length x 1.2mm width, closing
                                                                                       force 120 & 124gms
TB161        Aneurism Clip                   Sugita Clip, Mini CVD                     5mm length x 1.2mm width, closing
                                                                                       force 132gms
TB162        Aneurism Clip                   Sugita Clip, Large Slightly Crv-          One Size Each
                                             Short/Long
TB163        Aneurism Clip                   Sugita Clip, Large 45 D Angle/s,          One Size Each
                                             Slightlyn Crv/s, Temporary Slighly Crv,
                                             Mini Straight Slim, Large 1/4 CVD,
TB164        Aneurism Clip                   Sugita Clip, Large Straight, Bayonet,     One Size Each
                                             Mini Bayonet
TB165        Aneurism Clip                   Sugita Clip, Large L Shaped W/CRV-        One Size Each
                                             S/L, 1/4 CVD-S/L
TB166        Aneurism Clip                   Sugita Clip, Large 45D Angle-M/L          One Size Each
TB167        Aneurism Clip                   Sugita Clip, Fenest Large L Shaped-L,     One Size Each
                                             Bayonet
TB168        Aneurism Clip                   Sugita Clip, Fenest Large L Shaped        One Size Each
                                             W/CVD
TB169        Aneurism Clip                   Sugita Clips, Standard Bayonnet, Bent,    One Size Each
                                             Sideward Bent, Sideward Curve, Slight
                                             Bent
TB170        Aneurism Clip                   Sugita Clips, Standard Sideward Curve,    One Size Each
                                             Curved
TB171        Aneurism Clip                   Sugita Clips, Standard Slight CVD,        11mm length x 1.2 width, closing force
                                                                                       125-160gms; 9mm length x 1.2 width,
                                                                                       closing force 120-155gms
TB294        Mizuho - Titanium Fenestrated   Straight (S/M/L), Bent (S/ M/L), L-       Closing Force 95 to 160 gms
             Aneuysm Clips                   Shaped (S/M/L), Bayonet, L Shaped
                                             curved to left (S/M/L), L-Shaped
                                             curved to right (S/M/L)



Prostheses List February 2005                                                                                                                       Page 152 of 700
NEUROSURGICAL                                                                                                                 Minimum   Maximum
Billing Code Product Name                       Description                             Size                                  Benefit   Benefit    Notation
      Dressing Kits
TB296        Duraseal Dural Sealant             DuraSeal is a Synthetic, absorbable,    5ml of hydrogel sealant                                    Temporary
                                                Polyethylene Glycon, hydrogel sealant                                                              approval, pending
                                                used as an adjunct to sutured dural                                                                review of product
                                                repair to achieve watertight closure.                                                              group
      Leads
TB017        Bipolar Lead                       Model 300-20                            -
      Prosthesis, Internal, Spine, Vertebral Body
TB303        Nubic                              Cervical Fusion Implant in interbody    4x13x14mm, 5x13x14mm, 6x13x14mm,
                                                fusion of the Cervical Spine            7x13x14mm, 8x13x14mm
      Stimulators, Vagus Nerve, Antiseizure
TB130        Pulse Generator - Model 101        Neurocybernetic Prosthesis (NCP)        One size only
                                                System
TB300        VNS Therapy Pulse/Pulse Due        Model 102/102R Generator                one size only
TB301        VNS Therapy Lead                   Model 302                               one size only
Victorian Health Care Association Pty Ltd
      Clips, Aneurysm
VH001        Spetzler Titanium Aneurysm Clips   Permanent Standard & Temporary          5mm-13mm
                                                Clips. Commercially Pure Titanium.
VH002        Spetzler Titanium Aneurysm Clips   Fenestrated Clips. Commercially Pure    5mm-13mm
                                                Titanium.
W L Gore & Associates
      Tissue Reconstructive Materials, Solid
GT056        Preclude Dura Substitute           ePTFE                                   0.3mm Thickness 2 x 10cm
GT057        Preclude Dura Substitute           ePTFE                                   0.3mm Thickness 5 x 6 cm
GT058        Preclude Dura Substitute           ePTFE                                   0.3mm thickness 6 x 10cm
GT059        Preclude Dura Substitute           ePTFE                                   0.3mm thickness 10 x 12cm
William A Cook Aust Pty Ltd
      Embolization Prostheses, Intravascular
WC061        Detachable Coils Detach 18/11      Microembolisation Coils                 Diameters 0.30-0.46mm, Lengths 2cm-
                                                                                        12cm.
Prostheses List February 2005                                                                                                                     Page 153 of 700
NEUROSURGICAL                                                                                                 Minimum   Maximum
Billing Code Product Name                        Description                       Size                       Benefit   Benefit    Notation
Zimmer
      Orthopedic Internal Fixation Systems, Spinal
ZI476        Silhouette Spinal System Implants   Fixed Screw with Tab Extensions   5.5 x 25mm to 8.5 x 60mm




Prostheses List February 2005                                                                                                     Page 154 of 700
OPHTHALMIC                                                                                                                               Minimum   Maximum
Billing Code Product Name                               Description                              Size                                    Benefit   Benefit    Notation
Advanced Medical Optics Australia Pty Ltd
      Aqueous/Vitreous Humor Replacement Media
AO009        Healon 5, Intraocular Viscoelastic Fluid   HEALON5- Sodium hyaluronate              0.6ml
                                                        23mg/ml .
      Aqueous/Vitreous Humor Replacement Medium Kits
AO007        Viscoelastic Fluid: AMO Vitrax (sodium     Surgically Implanted Intraocular         0.65mL
             hyaluronate) 30mg/mL, 0.65mL               Viscoelastic
AO008        Healon, Intraocular Viscoelastic Fluid   Sodium Hyaluronate 10mg/ml                 Healon 0.4ml, 0.55ml & 0.85ml
AO010        Healon GV Intraocular Viscoelastic Fluid Sodium Hyaluronate 14mg/mL                 0.5mm and 0.85ml
      Glaucoma Filtration Implants
AO012        Baerveldt Glaucoma Implant BG 101-         Non-valved artificial drainage device,   Surface area 250, 350, 425mm2
             350, Baerveldt Glaucoma Implant BG         composition silicone - smooth, tumble-
             103-425, Baerveldt Glaucoma Implant        polished finish
             BG 103-250
      Lenses, Intraocular, Anterior Chamber
AO001        Intraocular Lens: Model AC 51B             Duralens PMMA, Anterior Chamber          6.00 mm Optic Diameter x 13.0mm in
                                                        IOL                                      overall length
AO016        Verisyse AC IOL                            Phakic Intraocular Lens: Model           5mm Optic Diameter x 8.5 overall
                                                        Myopia. Composition: PMMA                length; 6mm Optic Diameter x 8.5
                                                                                                 overall length
AO017        Verisyse AC IOL                            Phakic Intraocular Lens: Model           5mm Optic Diameter x 8.5 overall
                                                        Hyperopia. Composition: PMMA
AO018        Verisyse AC IOL                            Phakic Intraocular Lens: Model Toric     5mm Optic Diameter x 7.5 overall
AO019        Verisyse AC IOL                            Aphakic Model                            5mm Optic Diameter x 8.5 overall
      Lenses, Intraocular, Posterior Chamber
AO002        Sensar AR40 Monofocal Acrylic IOL,         Soft Acrylic, Foldable, UV Absorbing,    6 mm Optic Diameter x 13mm in overall
             Sensar OptiEdge AR40e Foldable             Posterior                                 length.
             Acrylic IOL
AO003        Intraocular Lens: Allergan AMO             Duralens, PMMA, Posterior Chamber        5.5mm-6.5 mm Optic Diameter x
             Duralens Posterior Chamber IOL             IOL                                      12.0mm-13.5mm in overall length.
             Model PS42ANB, PS53ANB,
             PS60ANB, PS59NB, PS60AMB


Prostheses List February 2005                                                                                                                                Page 155 of 700
OPHTHALMIC                                                                                                                                   Minimum   Maximum
Billing Code Product Name                            Description                                 Size                                        Benefit   Benefit    Notation
AO004        Intraocular Lens: Allergan AMO Array    Array Multifocal SA40N, Silicone,           6.0 mm Optic Diameter x 13.0mm
             Multifocal UV Absorbing Silicone        Foldable IOL                                overall length.
             Posterior Chamber IOL Model SA-40N
AO005        Intraocular Lens: Allergan Model SI-    PhacoFlex II SI-30NB Silicone or            6.0 mm Optic Diameter x 13.0mm in
             30NB Silicone PC IOL; or AMO model      PhacoFlex II SI-40NB Silicone;              overall length.
              SI-40NB Silicone PC IOL                Foldable IOL
AO006        Clariflex, Model CLRFLXB Posterior      Foldable Silicone IOL with OptiEdge         One size only
             Chamber Intraocular Lens                design
AO011        Posterior Chamber IOL; Pharmacia        CeeOn Posterior chamber, heparin            812C:+8.0 to +40.0 diopter increments,                           Also grouped in
             Heparin Surface Modified AC IOL         coated , PMMA lenses, One piece,            722C: +8.0 to +30.0 diopter increments,                          Intraocular Lens
             Model 352C                              biconvex. 812C, 722C, 757C, 808C            757C: -10.0 to +7.0 diopter increments                           Group 3 (M)
                                                     CeeOn Anterior chamber heparin              808C: +8.0 to +30.0 diopter increments
                                                     coated PMMA lenses 352C. Models             and 352C: - +8.0 to +30.0 diopter
                                                     812C, 722C, 757C, 808C & 352C.              increments
AO013        Ceeon Model 911A Edge Foldable UV       Silicon, foldable, UV absorbable            5 - 10D in 1.0 diopter increments, 10.5 -
             Absorbing Posterior Chamber IOL         intraocular lens with equibiconvex           30D in 0.5 diopter increments
                                                     design and square optic edge
AO014        Tecnis TM Intraocular Lens              Foldable Intraocular Lenses -               5-10 dioptre in 1.0 dioptre increments;
                                                     Ultraviolet light absorbing posterior       10.5 - 30 dioptre in 0.5 increments
                                                     chamber intraocular lenses
AO015        CEEON R Intraoccular Lens               Foldable intraocular lenses - ultraviolet   5-10 dioptre in 1.0 dioptre increments;
                                                     light absorbing posterior chamber           1.3-30 dioptre in 0.5 dioptre increments
                                                     intraocular lenses
AO020        ReZoom Acrylic Multifocal Intraocular   Acrylic, foldable, posterior chamber,       6.0mm Optic Diameter x 13.0mm
             Lens                                    intraocular lens                            overall length
      Ophthalmic Accessories
AO021        Stabileyes Capsular Tension Ring        Polymethylmethacrylate (PMMA)               12mm ring, and 13mm ring
                                                     Implant
Alcon Laboratories (Aust.) Pty Ltd
      Aqueous/Vitreous Humor Replacement Media
AL007        VISCOAT Viscoelastic Fluid              Chondroitin sulfate and sodium              0.5mL packs
                                                     hyaluronate




Prostheses List February 2005                                                                                                                                    Page 156 of 700
OPHTHALMIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                          Description                                Size                           Benefit   Benefit    Notation
      Aqueous/Vitreous Humor Replacement Medium Kits
AL006        PROVISC VISCOELASTIC                  PROVISC contains sodium hyaluronate        0.55mL & 0.85mL packs
             SOLUTION
AL015        Cellugel viscoelastic fluid           Hypromellose 2%
      Fluids, Mechanical Therapeutic Use
AL013        Perfluoron Kits                       Perfluoro-n-octane for use as a retinal    5mL
                                                   surgery additive
AL014        Perfluoron Kits                       Perfluoro-n-octane for use as a retinal    7mL
                                                   surgery additive
AL018        SILIKON 1000 Vitreoretinal Surgical   Purified polydimethylsiloxane (silicone    10 mL
             Device                                oil) for use as a post-operative retinal
                                                   tamponade during vitreoretinal surgery.
      Lenses, Intraocular, Anterior Chamber
AL003        MTAU1-MTAU-7                          PMMA                                       + 4 to 28 D
      Lenses, Intraocular, Posterior Chamber
AL002        Intraocular Lens: MODIFIED C          Other:PMMA                                 Range of Powers:-10 to +34 D
             PMMA PC IOL MODEL MZ60BD,
             MODIFIED PMMA PC IOL Model
             MZ20BD, CANTILEVER PMMA PC
             IOL MODEL CVC1U, Modified
             PMMA PC IOL Model MZ30BD,
             PMMA PC, IOL Model MC60BD,
             PMMA PC, IOL Model MC50BD,
             PMMA PC, IOL Model CZ70BD,
             MODIFIED C PMMA PC IOL
             MODEL 251.60 (MC50BM),
             MODIFIED C PMMA PC IOL
             MODEL 251.61 (MC51BM),
             MODIFIED C PMMA PC IOL
             MODEL 551.61 (MC60CM), Alcon
             JF30BD Cantilever PMMA PC IOL,
             Alcon Cantilever Model LX90BD
             PMMA PC IOL, Alcon Cantilever
             Model LX10BD PMMA PC IOL,
             Alcon Cantilever Model LC80BD
             PMMA PC IOL, PMAA PC

Prostheses List February 2005                                                                                                                    Page 157 of 700
OPHTHALMIC                                                                                                                                Minimum   Maximum
Billing Code Product Name                            Description                                   Size                                   Benefit   Benefit    Notation
AL004        Intraocular Lens: Alcon Acrysof Model   Foldable Acrylic Multi-piece Lens             Range of Powers: -5 to +30 D
             MA60BM PC IOL, Alcon Acrysof
             Model MA30BA PC IOL, Alcon
             Acrysof model MA50BM PC IOL,
             ACRYSOF IOL MODEL MA60MA
AL011        Intraocular Lens: Alcon Acrysof Model   Foldable Acrylic Single-piece Lens,           Range of Powers: +6 to +40 D
             SA30AL, Alcon Acrysof Model             asymmetric optic/consistent edge
             SA60AT, SA30AT Intraocular Lens;
             Alcon Acrysof PC IOL Model
AL012        Alcon Acrysof Model MA30AC PC           Foldable acrylic multi-piece lens,            +10 to +30 D
             IOL, Alcon Acrysof Model MA60AC         asymmetric optic/consistent edge
             PC IOL
AL016        Alcon Acrysof Natural Model SN60AT      Foldable Acrylic Single-piece Lens,           +6 to +40D
                                                     asymmetric optic/consistent edge, with
                                                     blue light protection
AL017        Alcon AcrySof ReSTOR PC                 Posterior Chamber, UV absorbing,              +10.0 to +30.0 D
             Diffractive IOL Model SA60D3            foldable, acrylic, single piece lens with
                                                     apodised diffractive optic
AL019        AcrySof Model SN60AS                    Foldable Acrylic Single-piece lens, in        +6 to +40 D
                                                     cartridge, with blue light protection
AL020        AcrySof Model SA60AS                    Foldable Acrylic Single-piece Lens, in        +6 to +40 D
                                                     cartridge
AL021        Alcon AcrySof SN60WF                    Foldable Acrylic Single-piece Lens with       +16.0 D to +26.0 D
                                                     Blue Light Protection and Aspheric
                                                     Correction
AL022        Alcon AcrySof ReSTOR PC                 Posterior Chamber, UV absorbing,              +10.0 to +30.0 D
             Diffractive IOL Natural Model           foldable, acrylic, single piece lens with
                                                     apodised diffractive optic and blue light
                                                     protection.
AL023        Alcon AcrySof Toric PC IOL Models       Posterior chamber, UV absorbing,              SN60T3 (1.50 D cylinder), SN60T4
                                                     foldable, acrylic, toric, single piece lens   (2.25 D cylinder), SN60T5 (3.00 D
                                                     with blue light protection                    cylinder), SN60T6 (3.75 D cylinder),
                                                                                                   SN60T7 (4.50 D cylinder), SN60T8
                                                                                                   (5.25 D cylinder), SN60T9 (6.00 D
                                                                                                   cylinder)



Prostheses List February 2005                                                                                                                                 Page 158 of 700
OPHTHALMIC                                                                                                               Minimum   Maximum
Billing Code Product Name             Description                               Size                                     Benefit   Benefit    Notation
      Ophthalmic Accessories
AL001        Capsular Tension Rings   -                                         10.0 - 12.0 compressed, 12.3 - 14.5
                                                                                uncompressed
      Procedure Trays, Surgical
AL005        DUOVISC VISCOELASTIC     PROVISC contains sodium hyaluronate,      Small & large packs
                                       VISCOAT contains chondroitin sulfate
                                      and sodium hyaluronate
Austmed Pty Limited
      Elastomers, Silicone Rubber
AP002        Mira: Scleral Implants   Silicone Sponge- Retinal Implant Used     Sponge- Mira 502 Cylinder 2mm, Mira
                                      in Scleral Buckling (Silicone Elastomer   5025 Cylinder 2.5mm, Mira 503
                                      Sponge)                                   Cylinder 3mm, Mira 504 Cylinder 4mm,
                                                                                Mira 505 Cylinder 5mm, Mira 505G
                                                                                Grooved cylinder 5mm, Mira 505T
                                                                                Packer tunnel cylinder 5mm, Mira 510
                                                                                Half cylinder 5mm, Mira 515 Brucker
                                                                                two-thirds cylinder 5mm, Mira 501
                                                                                Masciulli oval 2.5mm by 4mm, Mira 506
                                                                                 Vaiser oval 3mm by 5mm, Mira 506G
                                                                                Vaiser grooved oval 3mm by 5mm,
                                                                                Mira 507 oval 5.5mm by 7.5mm, Mira
                                                                                507G Grooved oval 5.5mm by 7.5mm,
                                                                                Mira 507T Packer tunnel oval 5.5mm
                                                                                by 7.5mm, Mira 511 Half oval 7.5mm,
                                                                                Mira 517 Brucker two-thirds oval
                                                                                7.5mm, Mira 509 Fuller flat oval 3.5mm
                                                                                by 7.5mm, Mira 509G Fuller grooved
                                                                                flat oval 3.5mm by 7.5mm, Mira 518
                                                                                Frederick grooved flat oval 2.5mm by
                                                                                12mm, Mira 508 Frederick flat oval
                                                                                4mm by 12mm, Mira 508G Frederick
                                                                                grooved flat oval 4mm by 12mm, Mira
                                                                                513 Snyder 3+ meridional 7mm by 4mm,
                                                                                 Mira 514 Snyder 4+ meridional 8mm by
                                                                                 5mm, Mira 516G Tapered groove
                                                                                6.4mm, Mira 519G Tapered groove
                                                                                7.5mm by 3.2mm.



Prostheses List February 2005                                                                                                                Page 159 of 700
OPHTHALMIC                                                                                                              Minimum   Maximum
Billing Code Product Name             Description                              Size                                     Benefit   Benefit    Notation
AP003        Mira: Scleral Implants   Solid Silicone-                          Tires-Mira 286 Wendel Symmetrical
                                      Tire/Meridional/Wedge/Pad. Retinal       Oval Tire 6mm, Mira Symmetrical Oval
                                      Implant used in Scleral Buckling          Tire 7mm, Mira 287WG Murray wide
                                      (Dimethylmethylvinyl Siloxane            (3.5mm) grooved symmetrical tire,
                                      Copolymer)                               10mm wide, Mira 288 ross symmetrical
                                                                               grooved tire, low profile 10mm wide by
                                                                               2.5mm, Mira 289 Symmetrical oval tire
                                                                               10mm, Mira 277Symmetrical tire 7mm,
                                                                               Mira 279 Symmetrical tire 9mm, Mira
                                                                               78G Grooved symmetrical tire 10mm,
                                                                               Mira 281 Symmetrical tire 12.5mm,
                                                                               Mira 275 Munsen Asymmetrical tire
                                                                               6mm, Mira 276 Asymmetrical tire 7mm,
                                                                                Mira 278 Brockhurst asymmetrical tire
                                                                               8.5mm, Mira 280LG Large grooved
                                                                               asymmetrical tire 10mm, Mira 77G
                                                                               Grooved hemisphere 26mm. Meridional-
                                                                                Mira 106 Meridional Implant 6mm by
                                                                               10.5mm, Mira 112 Curved Meridional
                                                                               implant 12mm by 12mm, Mira 103
                                                                               Meridional implant 4mm by 15mm.
                                                                               Wedge- Mira 135 Pruett maxi wedge
                                                                               14mm, Mira Pruett midi wedge 12mm,
                                                                               Mira 190 Spencer sub-implant 5mm by
                                                                               10mm. Pad- Mira 80 Pad 4mm by 8mm,
                                                                                Mira 22 Button 5mm by 5mm

AP004        Mira: Scleral Implants   Solid Silicone-Sleeve. Retinal Implant   Sleeves-Mira 70 Sleeve 1mm I.D., Mira
                                      used in Scleral Buckling                  71 Sleeve 1mm I.D., Mira 72 McNutt
                                      (Dimethylmethylvinyl Siloxane            Sleeve 1.57mm I.D., Mira 270 Sleeve
                                      Copolymer)                               0.76mm I.D.




Prostheses List February 2005                                                                                                               Page 160 of 700
OPHTHALMIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                          Description                                Size                                     Benefit   Benefit    Notation
AP006        Mira: Scleral Implants                Solid Silicone-Band/Strip/Boat/Clip.       Bands-Mira 40 Circling Band 2mm,
                                                   Retinal Implant used in Scleral Buckling   Mira 240 Circling Band 2.5mm. Strips-
                                                   (Dimethylmethylvinyl Siloxane              Mira 41 Strip 3.5mm, Mira 42 Strip
                                                   Copolymer)                                 4mm, Mira 20 Strip 4mm, Mira 219
                                                                                              Strip 4.5mm, Mira 31 Strip 4.5mm, Mira
                                                                                               32 Strip 5mm, Mira 225 Oval Strip
                                                                                              5mm, Mira 220 Strip 6mm. Boats-Mira
                                                                                              60 Boat 2mm, Mira 260 Boat 2.5mm.
                                                                                              Clips-Mira 50 Double Tantalum Clip
                                                                                              2mm, Mira 250 Double Tantalum Clip
                                                                                              2.5mm, Mira 51 Singla Tantalum Clip
                                                                                              3.5mm, Mira 52 Joondeph Single
                                                                                              Tantalum Clip 4mm

Austramedex (VIC) Pty Ltd
      Tubes, Lacrimal
AR022        Medpor Coated Tear Drain              Jones Tube with polyethylene coating.      11 sizes, 3.5mm x 14mm to 3.5mm x
                                                   Models 81114 - 81120, 81122, 81124,        28mm
                                                   81126 and 81128
Bausch & Lomb Surgical
      Aqueous/Vitreous Humor Replacement Media
BL008        Ocucoat Intraocular Fluid             20mg/mL hydroxypropylmethyl cellulose 1mL sterile
                                                    for intraocular use
BL015        Amvisc Plus injection                 15mg/mL Sodium Hyaluronate for             0.5mL and 0.8mL
                                                   intraocular use
      Fluids, Mechanical Therapeutic Use
BL001        Adato Sil-ol Silicone Oil (various    Adato Sil-Ol Silicone Oil 1000             10mL
             viscosities)
BL002        Adato Sil-ol Silicone Oil (various    Adato Sil-Ol Silicone Oil 5000             10mL
             viscosities)
BL003        Adeto Deca (various)                  Adato Deca Perfluorodecacarbon             5mL
BL004        Adato Octa                            Adato Octa Perfluorooctacarbon             5mL
BL016        Oxane LMWC Fractioned Silicone Oil    Purified fractioned silicone oil           10mL
BL017        Perfluo-octane (Oktaline) Okta-Line   Perfluorocarbon Liquid for use as a        5mL
                                                   retinal surgery additive

Prostheses List February 2005                                                                                                                              Page 161 of 700
OPHTHALMIC                                                                                                                                    Minimum   Maximum
Billing Code Product Name                              Description                                 Size                                       Benefit   Benefit    Notation
BL018        DK Line 100% purified perfluorodecalin    Perfluorodecalin                            7ml
      Lenses, Intraocular, Anterior Chamber
BL005        Storz (Coburn) Intraocular Lens           PMMA Anterior Chamber Intraocular           13.75mm length. 6.0mm optic size,
             121UV; L122UV PMMAA Anterior              lens 1 piece                                diopter range 3-30d. L122UV: 6.0mm
             Chamber Lens                                                                          optic, 13.75mm length, power range; 5.0
                                                                                                    to 30.0 Diopters
      Lenses, Intraocular, Posterior Chamber
BL006        Posterior chamber IOLS model P359         PMMA Posterior Chamber lens 1               12.25mm to 13.75mm length. 5.5mm to
             UV, P399 UV, 68 UV, 95 BUV, or                                                        7mm optic size, diopter range -4.5 - 45d
             lolab PC One Piece, model 6741B,                                                      to 10 - 34d; EZE-Fit 65: 6.5mm optic,
             8591B, 8191B; Model EZE-Fit 65                                                        13.35mm length, Power range: 10.0 to
                                                                                                   30.0 Diopter
BL007        Hydroview Intraocular lens Model          Foldable Hydrogel Lens Hydrogel             12.50mm length, 6.0mm optic size,
                                                       Posterior Chamber Foldable lens 1           diopter range 15-30d
BL009        Soflex UV Absorbing Silicone              Foldable Intraocular Lens Silicone      13.00mm length, 6.0mm optic size,
             Posterior Chamber IOL Model LI61U         Posterior Chamber Foldable Lens 3 piece diopter range 5-30d
BL010        Chiroflex Model C11UB                     Intraocular Lens Foldable Plate Haptic      10.50m length, 6.0mm optic size, diopter
                                                       Silicone Posterior Chamber Foldable          range 10-30d
                                                       Plate Haptic Lens 1 piece
BL019        Akreos Fit acrylic foldable posterior     Composition: Hydrophilic acrylic            10.0 to 15.0 Diopter in 1.0 Diopter
             chamber intraocular lens                  polymer. Packaged in lens folding           increments; 15.0 to 25.0 Diopter in 0.5
                                                       device in a sterile vial. Modified C-       Diopter increments; 25.0 to 30.0
                                                       Loop design                                 Diopter in 1.0 Diopter increments
BL020        Akreos Adapt acrylic foldable posterior   Composition: Hydrophilic acrylic            10.0 to 15.0 Diopter in 1.0 Diopter
             chamber intraocular lens                  polymer. Packaged in lens folding           increments
                                                       device in a sterile vial. Four haptic       15.0 to 25.0 Diopter in 0.5 Diopter
                                                       design                                      increments
                                                                                                   25.0 to 30.0 Diopter in 1.0 Diopter
                                                                                                   increments
BL021        SoflexSE, Intraocular lenses, Posterior   Composition: silicone, Lenses - foldable,   Range of powers: 5.0 to 30.0 Diopter -
             Chamber                                   posterior chamber intraocular lenses        Optic diameter 6.0mm; 13.0mm length
      Retinal, Detachment, Repair, Prostheses
BL011        Storz E5381 Silicone Strip                Silicone Sleeve                             1.65mm to 2.2mm diameter, length
                                                                                                   6.1mm to 30mm


Prostheses List February 2005                                                                                                                                     Page 162 of 700
OPHTHALMIC                                                                                                                                Minimum   Maximum
Billing Code Product Name                                Description                             Size                                     Benefit   Benefit    Notation
BL012        Storz E5395 3 Cylindrical Sponge            Retinal Fixation Device                 2.3mm x 2.5mm x 80mm, to 7.5mm x
             Implant                                                                             7.5mm x 100mm
BL013        Storz E5381 Silicone Strip                  Silicone Tire                           Outside diameter 30.2m to 33.6mm,
                                                                                                 inner diameter 26mm, overall length
                                                                                                 10.4mm to 125mm
BL014        Storz E5381 Silicone Strip                  Circling Band                           Overall length 10.4mm to 125mm
BR & CT Enterprises Pty Ltd
      Eyelid Weights, Implantable
BC005        LIDCHAIN Platinum Eyelid Implant            Platinum                                Weights - 0.8, 1.0, 1.2, 1.4, 1.6, 1.8
                                                                                                 grams
ConceptVision Australia Pty Ltd
      Lenses, Intraocular, Posterior Chamber
CS001        Staar foldable silicone intraocular lens:   Plate haptics 6.0mm; Polymide haptics   10.8mm - 13.5mm length; KS-1 5.5mm,                           Also grouped in
             Model AA4203VF; Model AA4204VF;             5.5 or 6.3mm optic; KS-1 5.5mm, KS-3    KS-3 6.0mm;                                                   Intraocular Lens
             AA4204VL; Model AQ2010V; Model              6.0mm Dia preloaded foldable                                                                          Group 4b
             AQ2017V; Model AQ2003V; KS-1 &              intraocular lens
             KS-3 Preloaded Intraocular Lens
CS002        Staar Toric foldable silicone intraocular   Plate haptics 6.0mm optic               10.8mm - 11.2mm length
             lens: Model AA4203TF; Model
             AA4203TL
CS003        Staar foldable silicone intraocular lens:   Polyimide haptics 6.3mm optic - low     14.0mm length
             Model AQ 5010V                              diopters
CS004        C & C Vision Crystalens Model AT-45         Silicon Multipiece Folding              Optic Diameter: 4.5mm; Overall
                                                         Accommodating Intraocular Lens          Length: 11.5mm
Cytosol Ophthalmics Australia Pty Ltd
      Intracorneal Rings
CY001        OII PMMA Capsular Tension Ring              Capsular Tension Ring - PMMA            12mm and 13mm
Design for Vision Pty Ltd
      Intracorneal Rings
DV003        DORC Retinal Implants                       Bands and strips                        Bands 2 - 2.5mm, strips 2 - 4mm
DV009        Morcher Capsular Tension Ring               PMMA Implant                            14, 14A, 14C
DV010        Morcher Coloboma Diaphram                   PMMA Implant                            96G, 96L
Prostheses List February 2005                                                                                                                                 Page 163 of 700
OPHTHALMIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                    Description                                  Size                                       Benefit   Benefit    Notation
DV013        DORC Retinal Implants           Tantalum clips                               2 - 2.5mm
DV014        DORC Retinal Implants           Sleeves                                      0.76 x 1.65mm and 1 x 2.1mm
DV015        DORC Retinal Implants           Tires                                        1 - 1.9mm thick, 7 - 11mm wide: 4 styles
DV016        DORC Retinal Implants           Sponges                                      3 - 5mm round, 3 - 5.5mm oval
      Prostheses, Eyelid
DV005        Gold Eyelid Load                Small Range - standard                       0.6g, 0.8g, 1.0g, 1.2g, 1.4g, 1.6g
DV007        Gold Eyelid Load                Large Range                                  1.8g, 2.0g, 2.2g, 2.4g, 2.6g, 2.8g
DV012        Gold Eyelid Load                Small range - thin profile                   0.6g, 0.8g, 1.0g, 1.2g, 1.4g, 1.6g
      Tubes, Lacrimal
DV021        Eyetec DCR Tubes                Stainless steel, silicone tubing, Crawford   32cm
                                             lacrimal intubation set
DV022        Eyetec DCR Tubes                Stainless steel, silicone tubing, Bodkin     30cm
                                             lacrimal intubation set
DV023        Eyetec DCR Tubes                Stainless steel, silicone tubing,            30cm
                                             Canaliculus lacrimal intubation set
      Valves, Eye
DV011        Ahmed Glaucoma Valve            Silicone Implant                             Adult or Paediatric
DV017        Molteno Implant                 Single plate                                 One size only
DV018        Molteno Implant                 Single plate - dual chamber                  One size only
DV019        Molteno Implant                 Double plate                                 One size only
DV020        Molteno Implant                 Double plate - dual chamber                  One size only
Device Technologies Australia Pty Ltd
      Clips, Ligating
DE201        Labtician Tantalum Clips        Tantalum                                     2, 2.5mm
      Eyelid Weights, Implantable
DE182        Lid Load Gold Eyelid Weights;   Gold                                         1.8, 2.0, 2.2, 2.4, 2.6, 2.8 grams
DE183        Lid Load Gold Eyelid Weights;   Gold                                         0.6, 0.8, 1.0, 1.2, 1.4, 1.6 grams




Prostheses List February 2005                                                                                                                            Page 164 of 700
OPHTHALMIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                      Description                                 Size                                   Benefit   Benefit    Notation
      Fluids, Mechanical Therapeutic Use
DE204        Arcaline (Perfluorodecaline)      Liquid perfluorocarbon aid for retinal      3ml, 5ml, 7ml
                                               surgery, operative device for retinal
                                               surgery, in particular retinal detachment
                                               (RD), RD with giant tear etc.
DE205        Arcotane (Perfloro-N-Octane)      Liquid perfluoro-N-Octane aid for           5mL
                                               retinal surgery, pre-operative device for
                                               retinal surgery, in particular retinal
                                               detachment (RD), RD with giant tear,
                                               RD with proliferative vitreal retinopathy
                                                (PVR) etc.
DE227        LSO Silicone Oil                  Silicone oil for tamponade use in           Vial - 10 ml
                                               vitreoretinal surgery
DE228        LSO Silicone Oil                  Silicone oil for tamponade use in           Syringe - 10 ml
                                               vitreoretinal surgery
DE229        LSO Silicone Oil                  Silicone oil for tamponade use in           Combo Pack with Syringe - 10 ml
                                               vitreoretinal surgery
      Intracorneal Rings
DE207        Hanita EndoCapsular Ring (ECR)    Maintains the stability and a perfect       One Size Only
                                               circular contour of the capsular bag
                                               equator in cases of intraoperative,
                                               traumatic or congenital zonular dialysis.
      Prostheses, Evisceration
DE188        Acrylic Implant                   Acrylic                                     12, 14, 16, 18, 20mm.
DE202        John Weiss Glass Mule Globes      Glass                                       No: 12, 14, 16, 18, 20mm
DE203        Katena Plastic Eye Sphere's Non   Acrylic                                     No: 10, 12, 14, 16, 18, 20, 22mm
      Scleral Buckling Devices
DE176        Silicon Retinal Implant           Mould                                       One size only
DE178        Silicon Retinal Implant           Sponge                                      2.5 x 4.0 x 80mm, 3.0 x 5.0 x 100mm,
                                                                                           3.25 x 7.0 x 80mm, 5.5 x 7.5 x 80mm,
                                                                                           1.5 x 80mm, 2.0 x 80mm, 2.5 x 80mm,
                                                                                           3.0 x 80mm, 4.0 x 80mm, 5.0 x 80mm,
                                                                                           7.0 x 80mm
DE179        Silicon Retinal Implant           Tire                                        7.0, 9.0, 12.5, 6.0, 8.5, 10.0mm
Prostheses List February 2005                                                                                                                         Page 165 of 700
OPHTHALMIC                                                                                                                              Minimum   Maximum
Billing Code Product Name                             Description                             Size                                      Benefit   Benefit    Notation
DE180        Silicon Retinal Implant                  Sleeve                                  1mm, .76mm, 1.5mm
DE181        Silicon Retinal Implant                  Band                                    0.75 x 2.0 x 125mm, 0.60 x 2.5 x
                                                                                              125mm, 0.75 x 2.5 x 125mm
      Sleeves
DE187        P-K Flat Headed Peg and Sleeve Set       Titanium                                One size only
      Spheres, Eye
DE184        Hydroxyapatite Ocular Implant (orbital   Coral                                   16 - 22mm
             sphere)
      Tubing, Other
DE177        Lester Jones Tear Duct Tubes             Glass                                   3 x 9 to 16mm, 3.5 x 9 to 18mm, 4.0 x 9
                                                                                               to 24mm, 5.0 x 9mm
DE199        The Gladston/Putterman Tubes by          Glass                                   3.0mm x 10 to 16mm; 3.5mm x 9 to
             Gunther Weiss                                                                    18mm; 4.0mm x 12 to 19mm
DE200        Bayliss Tubes by Gunther Weiss           Glass                                   3.0mm x 10 to 16mm; 3.5mm x 9 to
                                                                                              18mm; 4.0mm x 12 to 19mm
Emagin Pty Ltd
      Intracorneal Rings
EG004        Intracorneal Rings                       PMMA                                    Thickness 0.210mm - 150 degrees Arc
                                                                                              Length; Thickness 0.250mm - 150
                                                                                              degrees Arc Length; Thickness
                                                                                              0.275mm - 150 degrees Arc Length;
                                                                                              Thickness 0.300mm - 150 degrees Arc
                                                                                              Length; Thickness 0.325mm - 150
                                                                                              degrees Arc Length; Thickness
                                                                                              0.350mm - 150 degrees Arc Length;
                                                                                              Thickness 0.400mm - 150 degrees Arc
                                                                                              Length; Thickness 0.450mm - 150
                                                                                              degrees Arc Length
      Lenses, Intraocular, Anterior Chamber
EG006        Artisan Anterior Chamber Intraocular     Phakic Intraocular Lens: Model Myopia   5.00mm Optic Diameter x 7.5 in overall
             Lens                                                                             length; 5.00mm Optic Diameter x 8.5 in
                                                                                              overall length; 6.00mm Optic Diameter
                                                                                              x 8.5 in overall length


Prostheses List February 2005                                                                                                                               Page 166 of 700
OPHTHALMIC                                                                                                                                  Minimum   Maximum
Billing Code Product Name                            Description                                   Size                                     Benefit   Benefit    Notation
EG007        Artisan Anterior Chamber Intraocular    Phakic Intraocular Lens: Model                5.00mm Optic Diameter x 8.5 in overall
             Lens                                    Hyperopia                                     length
                                                     Composition: PMMA
EG008        Artisan Anterior Chamber Intraocular    Phakic Intraocular Lens: Model Toric          5.00mm Optic Diameter x 7.5 in overall
             Lens                                    Composition: PMMA                             length
EG009        Artisan Anterior Chamber Intraocular    Aphakia Model                                 5.00mm Optic Diameter x 8.5 in overall
             Lens                                    Composition: PMMA                             length
      Ophthalmic Accessories
EG001        Capsular Tension Rings Clear            PMMA Implant                                  10/08, 12/10, 13/11mm
EG002        Iris Prosthetic System Single Element   PMMA Implant                                  1/4, 1/3mm
EG003        Iris Prosthetic System Double Element   PMMA Implant                                  2/3, 2/4mm
EG005        Capsular Tension Rings Coloured         PMMA Implant                                  10/08, 12/10, 13/11mm
Hydron Pty Limited t/a Cooper Vision Surgical
      Corneas, Artificial
HY001        AlphaCor A & P                          Composition poly 2 (hydroxyethyl              AlphaCor A - Diameter 7mm, thickness
                                                     methacrylate)                                  0.6mm, radius of curvature 8.0/8.0mm;
                                                                                                   AlphaCor P - Diameter 7.0, thickness
                                                                                                   0.6mm, radius of curvature 9.0/9.0mm
IQ Medical
      Aqueous/Vitreous Humor Replacement Media
IQ002        Ocuvis and Ocumax 2%                    20mg/mL hydroxypropylmethyl cellulose 2mL sterile
             Hydroxypropylmethylcellulose             for intraocular use. Pre-loaded in a
                                                     sterile syringe with one cannula for
                                                     injection, in a sterile Tyvek pouch
      Lenses, Intraocular, Posterior Chamber
IQ001        UltraChoice 1.0 Rollable Thinlens       Acrylic, single piece, rollable, refractive   Dioptric powers from 10.0 to 30.0 D
             Model PHC001                            multifocal with monofocal function
                                                     meniscus optic, accommodating
                                                     intraocular lens with 50 micron edge
Kevin Grundy (IBD) Pty Ltd
      Lenses, Intraocular, Posterior Chamber
KG001        Rayner C-Flex                           Hydrophilic HEMA-MMA copolymer,               5.75mm dia optic, 12.00mm dia overall
                                                     foldable with injector
Prostheses List February 2005                                                                                                                                   Page 167 of 700
OPHTHALMIC                                                                                                                                Minimum   Maximum
Billing Code Product Name                               Description                              Size                                     Benefit   Benefit    Notation
KG002        Superflex                                  Hydrophilic HEMA-MMA copolymer,          6.25mm dia optic, 12.5mm dia overall
                                                        foldable with injector
KG003        Rayner Standard Toric C-Flex               Hydrophilic HEMA-MMA copolymer,          5.00mm dia optic, 12.00mm dia overall,
                                                        foldable with injector                   cyls 2.0D to 6.0D in 2D increments
KG004        Rayner Premium Toric C-Flex                HEMA-MMA copolymer, foldable with        5.75mm dia optic, 12.00mm dia overall,
                                                        injector                                 cyls 1.5D to 11.0D in 0.5D increments
Spectrum Ophthalmics
      Aqueous/Vitreous Humor Replacement Medium Kits
SO025        Ophthalin 1% w/v sodium hyaluronate        Aqueous/vitreous humour replacement      1 x 1.0mL
                                                        medium kits
      Fluids, Mechanical Therapeutic Use
SO022        FCI Purified Silicone Oil (Solvent Free)   Viscosity: 1000 cst/5000 cst: solvent    10ml
                                                        free purified silicone oil
SO023        FCI - DECA, FCI - OCTA                     FCI - DECA: Purified perfluorodecalin,   5ml
                                                        FCI - OCTA: Purified perfluoro-N-
                                                        octane
SO024        FCI - DECA, FCI - OCTA                     FCI - DECA: Purified perfluorodecalin,   7ml
                                                        FCI - OCTA: Purified perfluoro-N-
                                                        Octane
      Glaucoma Filtration Implants
SO001        T.Flux: Non-Absorbable Galucoma Drain -                                             One size only
      Intracorneal Rings
SO002        Tensiobag: Capsular Tension Ring           PMMA                                     Diameter 10 - 14mm
SO026        Flexiring Capsular Tension Ring            Flexizone Hard and Soft Acrylic          Diameter 10 - 14 mm
      Prostheses, Eyelid
SO017        FCI Ptose-up                               Expanded PTFE                            15cm long x 2 or 3mm wide x 0.35mm
                                                                                                 thick
SO018        FCI Eyelid Spacer (Upper & Lower           Expanded PTFE                            Upper Lid: 20 x 4-16 x 0.35mm; Lower
                                                                                                 Lid: 20 x 4-16 x 1mm




Prostheses List February 2005                                                                                                                                 Page 168 of 700
OPHTHALMIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                   Description                                 Size                                       Benefit   Benefit    Notation
      Prostheses, Orbital Rim
SO006        FCI Orbital Implants           Orbital Implant, Bioceramic (Aluminium      Bioceramic diameter, 12, 14, 16, 18, 20,
                                            Oxide)/Hydroxyapatite (Synthetic)           21, 22mm; Synthetic Diameter, 10, 12,
                                                                                        14, 16, 18, 20, 22mm
SO007        FCI Orbital Implants           Mesh wrapped orbital implant: mesh          Bioceramic diameter: 16, 18, 20, 22mm;
                                            wrapped bioceramic (aluminium oxide),       Synthetic Hydroxyapatite diameter: 16,
                                            mesh wrapped hydroxyapatite                 18, 20, 22mm
                                            (synthetic), mesh wrap (polyglycolic
                                            acid)
SO008        FCI Orbital Implants           Dexon Mesh (Polyglycolic Acid Mesh)         Mesh: 8 x 8 cm, 4-0 Suture: 45 cm
                                            includes resorbable 4-0 polyglycolic acid
                                             suture
SO019        FCI Obrbital Implants          Peg & Sleeve                                Standard Large
      Scleral Buckling Devices
SO009        FCI Scleral Buckling Devices   Band/strip: solid silicone                  Band - 2.0 x 0.75mm Type 40, 3.5 x
                                                                                        0.75mm Type 41, 4.0 x 1.25mm Type
                                                                                        42, 2.5 x 0.6mm Type 240, Morin 3.5 x
                                                                                        0.6mm
                                                                                        Strip - 5.7mm Type 20, 7.2mm Type 31,
                                                                                         9.2mm Type 32, 6mm Type 219,
                                                                                        7.5mm Type 220, 8mm Type 225
SO010        FCI Scleral Buckling Devices   Fixation Sleeve: Solid silicone             O.D: 1.65 to 2.41mm, Length 30mm
SO011        FCI Scleral Buckling Devices   Tire: Solid Silicone                        Symmetrical: (2.5 mm Groove, 7 to
                                                                                        9mm wide), Biconvex: (2.5mm Groove,
                                                                                        7 to 10mm wide), Asymetrical: (2.5mm
                                                                                        Groove, 7 to 10mm wide)
SO012        FCI Scleral Buckling Devices   Sponge/Cord: Silicone                       Cord: 1.0 to 5.0mm O.D. x 150mm
                                                                                        length; Half Cord: 3.0mm to width
                                                                                        x1.5mm to 2.5mm height x150mm;
                                                                                        Circular Sponge: 3 to 5mm; Oval
                                                                                        Sponge: 2 to 5.5mm x 4 to 12mm; Half
                                                                                        Sponge: 2 to 3.1mm x 4 to 7.5mm;
                                                                                        Grooved Sponge: 3 to 5mm x 5 to
                                                                                        12mm; Gain Sponge: 6 x 2.5mm; Sahal
                                                                                        Sponge: 4 to 5mm x 5 to 7mm



Prostheses List February 2005                                                                                                                          Page 169 of 700
OPHTHALMIC                                                                                                          Minimum   Maximum
Billing Code Product Name                   Description                   Size                                      Benefit   Benefit    Notation
SO013        FCI Scleral Buckling Devices   Strip: Solid Silicone         Strip: 1.4 x 4.4 x 100mm, Morin Strip:
                                                                          7mm wide x 100mm long, Caputo Zip
                                                                          Strip: 7 to 9mm wide x 120mm long,
                                                                          Korobelnik Oval Strip: 2 x 5mm
SO014        FCI Scleral Buckling Devices   Band: Solid Silicone          Devin Band: 1 x 4 x 120mm, Ducournau
                                                                           Band: height 2 to 2.5 x 5.5 to 7.5mm x
                                                                          length 120mm, Ducournau Band II: 2.1
                                                                          x 5.5 x 120mm
SO015        FCI Scleral Buckling Devices   Band: Expanded PTFE           Ducournau Band: 2.5 x 5.5 to 7.0mm x
                                                                          120mm, Band: 0.5mm to 2.1 x 2.5mm to
                                                                           15 x 120mm
SO016        FCI Scleral Buckling Devices   Sponge/Strip: Expanded PFTE   Circular Sponge: 3 to 5 x 90mm, Oval
                                                                          Sponge: 2 to 4mm x 3 to 5 x 90mm,
                                                                          Half Sponge: 2.5 x 7.5 x 120mm; Strip:
                                                                          9 x 90mm




Prostheses List February 2005                                                                                                           Page 170 of 700
OPHTHALMIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                  Description                           Size                                      Benefit   Benefit    Notation
      Tubes, Lacrimal
SO020        FCI Lacrimal Intubation Set   Silicone Tubing/Silicone Plug/Metal   Bika: 0.64mm O.D. Tube/80 x 0.8mm
                                           Probes/Polypropylene Thread           probes, Bika 1.18: 1.18mm O.D.
                                                                                 Tube/40 x 1.2mm probes, Bika for
                                                                                 DCR: 0.94mm O.D. Tube/50 x 0.8mm
                                                                                 probes, Infant Bika 0.64mm O.D.
                                                                                 Tube/55 x 0.7mm probes, Infant Bika II:
                                                                                  0.64mm O.D. Tube/60 x 0.8mm
                                                                                 probes, Besancon-Nancy Probe:
                                                                                 0.64mm O.D. Tube/80 x 0.8mm probes,
                                                                                  Crawford Probe: 0.64mm O.D.
                                                                                 Tube/0.7mm thick probes, FCI 2 Probe:
                                                                                 0.64mm O.D. Tube/80 x 0.8mm probes,
                                                                                  Ptosis Probe: Tube/80 x 0.8mm probes,
                                                                                  Mini Monoka: 0.64 x 40mm Tube/2mm
                                                                                 Plug, Perforated Mini Monoka: 0.64 x
                                                                                 40mm Tube/2mm, Perforated Plug,
                                                                                 Medium Collarette Monoka, Wide
                                                                                 Collarette Monoka: 0.64mm O.D.
                                                                                 Tube/80 x 0.8mm probes/4mm Plug,
                                                                                 Wide Collarette Monoka for Infants:
                                                                                 0.64mm O.D. Tube/60 x 0.8mm
                                                                                 probes/4mm Plug, Ritleng Lacrimal
                                                                                 Intubation Set: 0.64mm O.D. Tube/
                                                                                 Polypropylene thread, Self-Threading
                                                                                 Monoka Ritleng Type: 0.64mm O.D.
                                                                                 Tube/Polypropylene thread/4mm Plug,
                                                                                 Medium Collarette Self-Threading
                                                                                 Monoka Ritleng Type




Prostheses List February 2005                                                                                                                  Page 171 of 700
OPHTHALMIC                                                                                                            Minimum   Maximum
Billing Code Product Name                  Description                      Size                                      Benefit   Benefit    Notation
SO021        FCI Lacrimal Intubation Set   PVP Coated Silicone Tubing/PVP   PVP Bika: 0.64mm O.D. Tube/80 x
                                           Coated Silicone Plug/Metal       0.8mm probes, PVP Differential Bika:
                                           Probes/Polypropylene Thread      0.64 & 1.18mm O.D. Tube/40 x 1.2mm
                                                                             probes, PVP Bika for DCR: 0.94mm
                                                                            O.D. Tube/50 x 0.8mm probes, PVP
                                                                            Infant Bika 0.64mm O.D. Tube/55 x
                                                                            0.7mm probes, PVP Infant Bika II:
                                                                            0.64mm O.D. Tube/60 x 0.8mm probes,
                                                                             PVP Besancon-Nancy Probe: 0.64mm
                                                                            O.D. Tube/80 x 0.8mm probes, PVP
                                                                            Ritleng Lacrimal Intubation Set: 0.64mm
                                                                             O.D. Tube/Polypropylene thread, PVP
                                                                            Mini Monoka: 0.64 x 40mm Tube/2mm
                                                                            Plug, Wide Collarette PVP Monoka:
                                                                            0.64mm O.D. Tube/80 x 0.8mm
                                                                            probes/4mm Plug, Self-Threading PVP
                                                                            Monoka Ritleng Type: 0.64mm O.D.,
                                                                            Tube/ Polypropylene thread/4mm Plug,
                                                                            PVP Metaireau Tube Oval Collar:
                                                                            40mm Tube/4mm Plug, PVP Metaireau
                                                                             Tube Round Collar: 40mm Tube/4mm
                                                                            Plug, Lacosystem: Tube
                                                                            /Probe/Polypropylene thread

Surgical House
      Fixation Device, Internal, Screw
SU195        Calcanea Locking Screw        Cortical Screw, Titanium         Diameter 3.5mm, Length 20mm to




Prostheses List February 2005                                                                                                             Page 172 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                               Description                              Size                                Benefit   Benefit    Notation
Advanced Surgical Technologies
      Bone Matrix Implants, Artificial
AD150        Osteoset Bone Void Filler                  Calcium Sulphate                         50cc
AD151        Osteoset Bone Void Filler                  Calcium Sulphate                         4.8mm Pellets 10cc
AD152        Osteoset T Pellets                         Calcium sulphate with tobramycin         10, 20cc
AD153        Osteoset T Pellets                         Calcium sulphate with tobramycin         5cc
AD155        Osteoset T Pellets                         Calcium sulphate with tobramycin         50cc
AD209        Osteoset Pellets - Bone Graft Substitute   Calcium Sulphate                         4.8mm Pellets 20cc
AD221        Osteoset Bone Void Filler                  Calcium Sulphate                         3mm & 4.8mm Pellets 5cc
AD222        Osteoset Bone Void Filler                  Calcium Sulphate                         3mm Syringe 1.25cc
AD223        Osteoset Bone Void Filler                  Calcium Sulphate                         4.8mm Syringe 5cc
AD224        Osteoset Bone Void Filler                  Calcium Sulphate                         3mm Pellets 10cc
AD225        Osteoset MIIG                              Injectable Calcium Sulphate Bone Void    15cc
                                                        Filler, Includes Syringe
AD227        Osteoset MIIG X3                           Injectable Calcium Sulphate Bone Void    5cc
                                                        Filler, Includes Syringe
AD228        Osteoset MIIG X3                           Injectable Calcium Sulphate Bone Void    15cc
                                                        Filler, Includes Syringe
AD240        Osteoset MIIG                              Injectable Calcium Sulphate Bone Void    5cc
                                                        Filler, Includes Syringe
      Cement, Orthopedic
AD104        Osteoset BVF Kit                           Kit contains calcium sulfate, diluent,   20cc and 30cc
                                                        mould, spatula and mixing bowl
AD208        OSTEOSET - BVT KIT                         Mini Bead Kit                            5cc Standard/Fast Cure
             (STANDARD CURE, FAST CURE)
      Fixation Device
AD257        OSSStaple Osteosynthesis Staple            Dynamic Compression Implants OSS         Large - Sizes 20x20x20, 25x22x22,
                                                        Staple - Biocompatible Nitonol           30x30x30
                                                        Construction




Prostheses List February 2005                                                                                                                            Page 173 of 700
ORTHOPAEDIC                                                                                                                               Minimum   Maximum
Billing Code Product Name                      Description                                   Size                                         Benefit   Benefit    Notation
AD258        OSSStaple Osteosynthesis Staple   Dynamic Compression Implants OSS              Small - Sizes 5x7x5, 7x9x7, 8x11x8,
                                               Staple - Biocompatible Nitonol                10x11x10, 10x13x10, 12x15x12
                                               Construction
AD259        OSSStaple Osteosynthesis Staple   Dynamic Compression Implants OSS              Asymmetric - 11x15x13, 11x17x15,
                                               Staple - Asymmetric Staples -                 11x17x19, 18 x 18 x 18
                                               Biocompatible Nitonol Construction
AD260        OSSStaple Osteosynthesis Staple   Dynamic Compression Implants OSS              Plate Staple - 15x6, 15x8, 15x10
                                               Plate Staple - Biocompatible Nitonol
                                               Construction
      Gel, Resorbable, Antiadhesion
AD065        Adcon Anti-Adhesion Barrier Gel   Adcon L                                       5 gram                                                            Temporary
                                                                                                                                                               Approval -
                                                                                                                                                               Funded when
                                                                                                                                                               clinical indications
                                                                                                                                                               for use are
                                                                                                                                                               present.
AD066        Adcon Anti-Adhesion Barrier Gel   Adcon L                                       3 gram                                                            Temporary
                                                                                                                                                               Approval -
                                                                                                                                                               Funded when
                                                                                                                                                               clinical indications
                                                                                                                                                               for use are
                                                                                                                                                               present.
AD067        Adcon Gel for Tendons             Adcon TN                                      3 gram                                                            Temporary
                                                                                                                                                               Approval -
                                                                                                                                                               Funded when
                                                                                                                                                               clinical indications
                                                                                                                                                               for use are
                                                                                                                                                               present.
      Orthopedic Internal Fixation Systems, Fracture
AD101        LOCON-T Radius Plating System     Stainless steel cortical bone screw           1.8, 2.7, 3.5mm dia x 6 - 40mm length in
                                                                                              2mm increments
AD102        LOCON-T Radius Plating System     Stainless steel volar plate, left and right   1.2 - 1.5mm thick, left and right - small,
                                               distal plates, lateral plate extender         medium, large
AD207        LOCON-T Radius Plating System     Stainless Steel Lateral Plate Extender        One size only



Prostheses List February 2005                                                                                                                                 Page 174 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                           Description                              Size                               Benefit   Benefit    Notation
      Procedure Trays, Surgical
AD196        Tenofix Tendon Repair System           2 Anchors, sutures, 2 pre-applied stop   One size only
                                                    bead installation devices,
AD197        Tenofix Tendon Repair System           Pre-applied stop bead and 2/0 suture     One size only
AD198        Tenofix Tendon Repair System           Pre-applied stop bead crimper            One size only
AD199        Tenofix Tendon Repair System           Installation device with anchor          One size only
AD204        Tenofix Tendon Repair System           Repair system and removal device         One size only
      Prostheses, Bone, Freeze-Dried
AD068        Surgibone                              Bovine Granulated Bone                   4/12 mesh, 12/20 mesh
AD070        Surgibone                              Bovine Onlays & Pins                     50mm, 80mm, 100mm, 120mm, 33mm x
                                                                                              11mm x 5.5mm
AD071        Surgibone                              Bovine Cubes                             3 gram
AD072        Surgibone                              Bovine Cubes                             10 gram
AD075        Surgibone                              Bovine Threaded Dowels                   12mm, 13mm, 15mm
AD076        Surgibone                              Bovine Cavity Blocks & Granulated        20mm x 20mm x 10mm, 20/30 Mesh
                                                    Bone
AD078        Surgibone                              Bovine Lumbar Blocks                     30x15x14mm, 16mm, 18mm, 20mm,
                                                                                             22mm
AD081        Surgibone                              Bovine Tapered Disks, Cervical Blocks    40x2x6mm, 8mm,10mm, 50x2x6mm,
                                                    & Dowels, Lumbar Blocks                  8mm, 10mm, 12mm, 14mm,
                                                                                             30x10x14mm, 16mm, 18mm, 20mm,
                                                                                             22mm
AD082        Surgibone                              Bovine Compound Wedge                    55x25x10mm, 13mm, 15mm,
                                                                                             60x15x30mm
AD083        Surgibone                              Bovine Plain Wedge & Tapered Wedge       55mm x 15mm x 25mm, 50mm x 6mm,
                                                                                             8mm
      Prostheses, Carpal
AD106        Orthosphere                            Yttria-stabilized zirconia ceramic       8 - 12mm
AD167        Wright Swanson Titanium Carpal         Titanium                                 1 - 5 left and right
             Scaphoid, Carpal Lunate, Basal Thumb
             Implant


Prostheses List February 2005                                                                                                                       Page 175 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                    Description                             Size                                    Benefit   Benefit    Notation
      Prostheses, Finger/Thumb
AD163        WMT Orthopaedic Implants Hand   Trapezium silastic                      1, 2, 3, 4, 5
AD164        WMT Orthopaedic Implants Hand   Silastic tendon spacer                  24in long, 3, 4, 5, 6mm wide
      Prostheses, Joint
AD159        WMT Orthopaedic Implants        Silastic finger joint with/without Ti   00, 0, 1, 2, 3, 4, 5, 6
             Finger/Thumb                    grommets 470 series
      Prostheses, Joint, Elbow
AD156        Sorbie Questor Elbow System     Total joint CoCr and UHMWPE             Left and right in sizing 48mm wide,
                                                                                     46mm, 44mm
      Prostheses, Joint, Hip
AD113        Transcend Articulation System   Transcend cup - titanium                42 - 74mm in 2mm increments
AD114        Transcend Articulation System   Metal femoral head CoCr                 28 and 32mm, 4 lengths                                       Also grouped in
                                                                                                                                                  Hip Group 14b
AD115        Transcend Articulation System   Ceramic femoral head                    28 and 32mm, 3 lengths
AD116        Transcend Articulation System   Metal CoCr & Ceramic Liner              Grp 1, Grp 2, Grp 3, Grp 4                                   Also grouped in
                                                                                                                                                  Hip Group 20d
AD118        Transcend Articulation System   Interseal apical plug titanium          One size only
AD119        Transcend Articulation System   Titanium HA coated cup                  42 - 74mm in 2mm increments
AD120        Transcend Articulation System   Bone screw titanium                     6.5mm x 1.5 - 6cm in 0.5cm increments
                                                                                      long
AD121        Infinity Modular Hip System     Distal stem titanium                    11 - 22mm in 1mm increments, 135 -
                                                                                     175mm long
AD122        Infinity Modular Hip System     Head ceramic                            28mm, 32mm, 3 lengths                                        Also grouped in
                                                                                                                                                  Hip Group 14c
AD123        Infinity Modular Hip System     Head CoCr                               28mm, 32mm, 3 lengths
AD124        Infinity Modular Hip System     Trochanteric module titanium HA and     A, B, C, D, E, F                                             Also grouped in
                                             porous coated                                                                                        Hip Group 6b &
AD128        WMT Perfecta Hip System         Porous titanium                         10.5, 12, 12.7, 13.5, 14.2, 15, 16.5,                        Also grouped in
                                                                                     18mm width, 140 - 175 long                                   Hip Group 5g
AD129        WMT Perfecta Hip System         HA coated titanium                      10.5, 12, 12.7, 13.5, 14.2, 15, 16.5,
                                                                                     18mm width, 140 - 175 long

Prostheses List February 2005                                                                                                                    Page 176 of 700
ORTHOPAEDIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                          Description                           Size                                    Benefit   Benefit    Notation
AD130        WMT Perfecta Hip System               Cemented CoCr                         10.5, 12, 13.5, 15, 16.5, 18mm width,                        Also grouped in
                                                                                         140 - 170 long                                               Hip Group 3b
AD131        WMT Perfecta Hip System               PMMA cement spacer/Bone Plug          9 - 21mm in 1mm increments
AD177        Nexus II Hip System                   Distal Cement Spacer                  9-21mm in 1mm increments
      Prostheses, Joint, Hip, Acetabular Component
AD103        Lineage Acetabular System             Titanium                              Shells 40 - 80mm in 2mm increments
AD125        WMT Acetabular Cups All Poly          UHMWPE                                42 - 68mm in 2mm increments
AD126        WMT Interseal Acetabular Shells and   Titanium acetabular shell             42 - 68mm in 2mm increments
             Liners
AD127        WMT Interseal Acetabular Shells and   Duramer UHMWPE Liner                  Grp 1, Grp 2, Grp 3, Grp 4
             Liners
AD261        Procotyl-E cup ceramic inserts        acetabular cup                        Group 1 - 3, Size 28 and 32
AD262        Procotyl-E cup                        acetabular cup titanium alloy         52mm - 76mm, in 2mm increments
AD263        Procotyl-E cup                        polyethylene liner                    Group 1 - 3 sizes 22 - 32
AD264        Procotyl-E T Plate                    titanium alloy                        One size only for left and right
AD265        Procotyl-E screws                     titanium alloy                        Diameter 5.5mm, Length 15 - 60mm
AD266        Procotyl-E double plate               titanium alloy                        4, 5 and 6 holes left and right sides
AD267        Procotyl-E hooks                      titanium alloy                        18mm, 23mm, 28mm
AD268        Procotyl-E L Plates                   titanium alloy                        One size only for left and right
AD270        SLR Biploar Acetabular Shell          Cast Cobalt Chrome Alloy              38mm - 65mm in millimetre increments
AD271        SLR Bipolar Acetabular Liners         UHMWPE                                22mm - 32mm ID, ranging from 38mm
                                                                                         to 65mm
      Prostheses, Joint, Hip, Femoral Component
AD112        Conserve Hip Resurfacing Hemi         Cobalt chrome                         32 - 66mm in 2mm increments
AD212        CONSERVE Femoral Surface              CoCr SLT Taper Femoral Head           Sizes 38mm-54mm in 2mm increments,
             Replacement                                                                 -3.5 to +3.5 Neck
AD269        SLR Bipolar Endoprosthesis            SLR Bipolar Taper Femoral Head Cast   22.5mm - 32mm Femoral Head and
                                                   Cobalt Chrome Alloy                   neck ranging from -3.5mm to +7mm




Prostheses List February 2005                                                                                                                        Page 177 of 700
ORTHOPAEDIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                          Description                              Size                                   Benefit   Benefit    Notation
      Prostheses, Joint, Hip, Total
AD213        CONSERVE PLUS Total Hip               Titanium Acetabular Shell - Super        ID 36 - 52mm, OD 46 - 62mm
             Resurfacing System                    Polished
AD220        CONSERVE PLUS Total Hip               CoCr Femoral Head - Super Polished       Sizes 36mm - 52mm in 2mm increments
             Resurfacing System
AD226        Lineage Acetabular System             Titanium Deep Profile Multi Hole         46 - 74mm in 2mm increments
                                                   Acetabular Shell
AD229        Conserve Plus Total Hip Resurfacing   Titanium Thin Acetabular Shell - Super   36 - 54mm ID in 2mm Increments
             System                                Polished
      Prostheses, Joint, Knee
AD193        Ortholoc Modular Total Condylar       Tibial Components Stemless or            Small, Small Plus, Medium, Medium
                                                   W/Modular Stem Base (Porous Coated)      Plus, Large, Large Plus, Xlarge
                                                   Titanium
      Prostheses, Joint, Knee, Total
AD133        Advance Total Knee System             Femoral PS components CoCr               1, 2, 3, 4, 5, 6
AD135        Advance Total Knee System             Tibial base CoCr and titanium metal      1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6
                                                   base cemented
AD136        Advance Total Knee System             Tibial base insert UHMWPE                1, 2, 3, 4, 5, 6
AD137        Advance Total Knee System             All poly patella UHMWPE                  25, 28, 32, 35, 38, 41mm
AD138        Advance Total Knee System             Traditional tibial insert                1, 2, 3, 4, 5, 6 in 10 - 30mm in 2mm
                                                                                            increments
AD139        Advance Total Knee System             Metal pivot UHMWPE tibial                1, 2, 3, 4, 5, 6 in 10 - 30mm in 2mm
                                                                                            increments
AD140        Advance Total Knee System             Femoral CoCr PCR component porous        1, 2, 3, 4, 5, 6                                            Also grouped in
                                                   and HA                                                                                               Knee Groups 1k,
                                                                                                                                                        1m, 1n
AD141        Advance Total Knee System             Femoral CoCr component PCR               1, 2, 3, 4, 5, 6                                            Also grouped in
                                                                                                                                                        Knee Group 1b
AD142        Advance Revision Knee System          Femoral Augments titanium                1 - 5, 5mm thick, 10mm thick and
                                                                                            posterior
AD143        Advance Revision Knee System          Femoral component CoCr                   1, 2, 3, 4, 5, 6
AD144        Advance Revision Knee System          Femoral stem titanium                    6 - 22mm in 1mm increments, standard
                                                                                            and offset length 50 - 150mm
Prostheses List February 2005                                                                                                                          Page 178 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                      Description                              Size                                    Benefit   Benefit    Notation
AD145        Advance Revision Knee System      PS and CCK Insert UHMWPE                 1, 2, 3, 4, 5, 6 in 10 - 30mm in 2mm
                                                                                        increments
AD146        Advance Revision Knee System      Tibial augments/wedges titanium          15 degree, sizes 1, 2/1+, 3/2+, 4/3+,
                                                                                        5/4+, 6/5+
AD147        Advance Revision Knee System      Tibial component titanium                1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6
AD148        Advance Revision Knee System      Tibial stem titanium                     6 - 22mm in 1mm increments, standard
                                                                                        and offset length 50 - 150mm
AD149        Advance Revision Knee System      Bone screw titanium                      6.5mm x 1.5 - 6cm in 0.5cm increments
                                                                                         long
AD168        Advantim Total Knee System        Femoral Components CoCr Total            Small, Medium, Large, Xlarge                                 Also grouped in
                                               Condylar (Porous Coated)                                                                              Knee Group 1k
AD169        Advantim Total Knee System        Femoral Components CoCr Total            Small, Medium, Large, Xlarge                                 Also grouped in
                                               Condylar (Non Porous Coated)                                                                          Knee Group 1b
AD170        Advantim Total Knee System        All Poly Tibial UHMWPE                   Small, Medium, Large, Xlarge
AD171        Advantim Total Knee System        Tibial Inserts Total Condylar            10-36mm in 2mm increments
AD172        Advantim Total Knee System        Tibial Primary Smooth/Finned Titanium    3" Length in Small-Xlarge
                                               CoCr
AD173        Advantim Total Knee System        Tibial Primary Smooth/Finned Titanium    6" Length in Small-Xlarge
                                               CoCr
AD174        Advantim Total Knee System        Patellae All Poly UHMWPE                25,28,32mm
AD175        Advantim Total Knee System        Patellae Metal Backed                   25,28,32mm
AD176        Advantim Total Knee System        Bone Screws Tibial and Femoral Titanium 6.5mm x 1.5-6cm in 0.5cm increments
                                                                                       long
AD183        Advance Total Knee System         Tibial base porous or HA titanium or     1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6
                                               CoCr
AD185        Ortholoc 11 Revision Knee         Femoral components CoCr Revision         Small, Medium, Large, Xlarge
                                               (Porous Coated)
AD186        Ortholoc Modular Total Condylar   Femoral components CoCr Posterior        Small, Medium, Large, Xlarge
                                               Stabilised (Porous Coated)
AD187        Ortholoc 11 Revision Knee         Tibial Revision Smooth/Finned Titanium   6" Length in Small - Xlarge
AD188        Ortholoc 11 Revision Knee         Tibial inserts posterior stabilised      10-36mm in 2mm increments
                                               UHMWPE

Prostheses List February 2005                                                                                                                       Page 179 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                         Description                             Size                                          Benefit   Benefit    Notation
AD189        Ortholoc Advantim HA Porous Coated   Tibial base HA Ti Components            Small, Small Plus, Medium, Medium
             Knee System                                                                  Plus, Large, Large Plus, Xlarge
AD190        Ortholoc 11 Revision Knee            Tibial Components Modular Stem Thick    Small, Small Plus, Medium, Medium
                                                  Base (Porous Coated)                    Plus, Large, Large Plus, Xlarge
AD191        Ortholoc 11 Revision Knee            Tibial Components Modular Stem          Small, Small Plus, Medium, Medium
                                                  Wedged Base (Porous Coated)             Plus, Large, Large Plus, Xlarge
AD192        Ortholoc Modular Total Condylar      Tibial Components Modular Stem Base     Small, Small Plus, Medium, Medium
                                                  (Non Porous Coated) CoCr                Plus, Large, Large Plus, Xlarge
AD194        Ortholoc Advantim HA Porous Coated   Femoral components CoCr HA coated       Small, Medium, Large, Xlarge                                       Also grouped in
             Knee System                          femoral components                                                                                         Knee Group 1n
AD195        Ortholoc 11 Revision Knee            Femoral stems titanium                  5 Degree 6", 7 Degree 6"
AD200        Advance-Unicondylar Knee System      Metal-backed tibial component           1,2,3,4 in 10,11,12mm
AD205        Advance-Unicondylar Knee System      Femoral component - cobolt chrome       Sizes 1, 2, 3, 4
AD206        Advance-Unicondylar Knee System      All poly tibial component               Sizes 1, 2, 3, 4 in 7mm, 8mm, 9mm, 10mm

AD214        ADVANCE Total Knee System            Stemmed condylar femoral medial pivot   1, 2, 3, 4, 5, All in left & right                                 Also grouped in
                                                  component - porous                                                                                         Knee Group 1k
AD215        ADVANCE Total Knee System            Spiked tibial base - porous             1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+
AD216        ADVANCE Total Knee System            Spiked tibial base - nonporous          1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+
AD217        ADVANCE Total Knee System            Offset tibial Block Augments            1, 2/1, 3/2, 4/3, 5/4, 6/5, All in 5mm,
                                                                                          10mm, 15mm
AD218        ADVANCE Total Knee System            Offset tibial base - nonporous          1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+ in Left &
                                                                                          Right
AD219        ADVANCE Total Knee System            Stemmed condylar femoral medial pivot   1, 2, 3, 4, 5 All in Left & Right                                  Also grouped in
                                                  component - nonporous                                                                                      Knee Group 1b
      Prostheses, Joint, Shoulder
AD184        Olympia-Total Shoulder System        Cobolt chrome head standard & +/-       40,44,48,52,56,60mm
AD201        Olympia - Total Shoulder System      Slotted and non slotted stem            Length 72 & 125mm, width 6 - 16mm
AD202        Olympia - Total Shoulder System      Revision stem                           Length 175 & 225mm, width 10 - 16mm
AD203        Olympia - Total Shoulder System      All poly finned glenoid                 40, 44, 48, 52, 56, 60mm



Prostheses List February 2005                                                                                                                               Page 180 of 700
ORTHOPAEDIC                                                                                                                              Minimum   Maximum
Billing Code Product Name                          Description                                 Size                                      Benefit   Benefit    Notation
      Prostheses, Joint, Toe
AD100        Metal Orthopaedic Toe Joint Implant   Metal Hemi toe implant, cobalt chrome       11 x 16 x 12mm, 13 x 19 x 14mm, 15 x
                                                                                               22 x 16mm
AD107        WMT Orthopaedics Implants Hinge       Hammertoe implant titanium                  1, 1S, 1L, 1W, 2, 2L, 2S
             Toe and Hammertoe Implant
AD108        WMT Orthopaedics Implants Hinge       Silastic flexible hinge toe HP100-426       6&7
             Toe and Hammertoe Implant             without grommets
AD109        WMT Orthopaedics Implants Hinge       Silastic flexible hinge toe HP100-G426      0, 1, 2, 3, 4, 5
             Toe and Hammertoe Implant             with grommets
AD110        Wright Titanium Great Toe             Great toe titanium                          0,1, 2, 3, 4
AD111        Conserve Plus Femoral Surface         Cobalt chrome (CoCr)                        32 - 66mm in 1mm increments
             Replacement System
AD277        LPT Great Toe Implant                 Titanium LPT Metatarsal Component           Sizes 1, 2 & 3 Regular Great Toe
                                                   available in Regular and Angled Toe         Implants. Sizes 1 & 2 Angled Great Toe
                                                                                                Implants
      Prostheses, Joint, Wrist
AD160        WMT Orthopaedic Implants              Radial head implant HP silastic             1, 1.5, 2, 2.5, 3
             Radial/Ulna Head
AD161        WMT Orthopaedic Implants              Radial head titanium                        1, 1.5, 2, 2.5, 3
             Radial/Ulna Head
AD162        WMT Orthopaedic Implants              Ulna head titanium                          1, 1.5, 2, 2.5, 3
             Radial/Ulna Head
AD211        SWANSON II Wrist Joint Implant        Silicone Intermedullary Stemmed             1, 2, 3, 4, 5
                                                   Implant - Titanium Grommet Optional
      Prostheses, Radial Head
AD157        Radial Head Prostheses                Titanium/UHMWPE                             Stem 6.5 and 8mm Mod head size 19
                                                                                               and 22mm
      Prostheses, Radial/Ulna Head
AD105        Evolve Modular Radial Head            Cobalt chromium alloy, 75 different         Stem 5.5 - 9.5mm, head 20 - 28mm
                                                   combinations, 5 stem sizes, 15 head sizes
      Prosthesis, Internal, Hip, Joint, Total
AD230        Profemur Total Hip System             Titanium cemented proximal body             X-small, Small, Standard 1, Standard 2,
                                                                                               Standard 3, Standard 4, Large
Prostheses List February 2005                                                                                                                                Page 181 of 700
ORTHOPAEDIC                                                                                                                                    Minimum   Maximum
Billing Code Product Name                             Description                                Size                                          Benefit   Benefit    Notation
AD231        Profemur Total Hip System                Titanium tapered Splined Straight Stem     Length 135mm, Diameter 10-22mm
AD232        Profemur Total Hip System                Titanium EHS-E Stem - without HA           1 Standard - 9 Standard
                                                      Plasma Spray
AD233        Profemur Total Hip System                Titanium EHS-E Stem - without HA           1 Plus - 9 Plus
                                                      Plasma Spray
AD234        Profemur Total Hip System                Titanium uncemented proximal body -        X-Small, Small, Standard 1, Standard 2,
                                                      HA Plasma sprayed                          Standard 3, Standard 4, Large
AD235        Profemur Total Hip System                Titanium tapered Splined Bowed Stem        Length 135 - 215mm, Diameter 10 -
                                                                                                 22mm
AD236        Profemur Total Hip System                Titanium Femoral Necks                     Length 27 - 38.5mm; Neutral to
                                                                                                 Ante/Retro - Varus Valgus 2
AD237        Profemur Total Hip System                Anca-fit Femoral Stem with 1/3             9.5, 11, 12, 13, 14, 15, 16, 17.5, left and
                                                      proximal HA Plasma Spray                   right
AD238        Profemur Total Hip System                Titanium Tapered Femoral Stem              Standard Length Sizes 1 - 9
AD239        Profemur Total Hip System                Titanium Tapered Femoral Stem              Long Sizes 1 - 9
AD278        Profemur Total Hip System                Titanium Tapered Stem - HA Plasma          Sizes 9 to 18 in 1 mm increments
                                                      Spray
AD279        Profemur Total Hip System                Titanium Stem with HA Plasma Spray         Size 11 with Fixed Neck Standard
                                                                                                 Offset and High Offset, Standard and
                                                                                                 Plus Flare. Size 12 to 17 - Standard
                                                                                                 flare and Plus Flare. Size 18 - Standard
      Prosthesis, Internal, Joint, Custom-Made
AD241        Limb Salvage System for the skeletally   Repiphysis non invasive expandable         Custom Made
             immature - Repiphysis                    custom designed Tibial Extension.
                                                      Comprised of tibial base, axial bushing,
                                                      axial pin - CoCr, Titanium, UHMWPE
AD242        Limb Salvage System for the Skeletally   Repiphysis non invasive expandable         Custom Made
             Immature - Repiphysis                    custom designed Distal Hinge Femoral
                                                      Extension. Distal hinge femur, stem
                                                      fixation pin, spring housing tube, anti-
                                                      rotation cylinder & pins, end cap,
                                                      retaining tube, spring, antenna, isolant
                                                      ring - CoCr, Titanium, PEEK Polyacetal
                                                       Ceramic


Prostheses List February 2005                                                                                                                                      Page 182 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                        Description                             Size                                   Benefit   Benefit    Notation
AD243        Guardian Limb Salvage System        Guardian Femoral Neck & Mid-Section     40, 50, 60, 70, 90, 110, 140mm
                                                 - Standard Taper - Titanium
AD244        Guardian Limb Salvage System        Guardian Distal Femur Regular Axial     Left & Right
                                                 Pin - CoCr, Titanium
AD245        Guardian Limb Salvage System        Guardian Tibial Hinge Assembly          One Size only
                                                 With/Without Rotational Stop Pin -
AD246        Guardian Limb Salvage System        Guardian Distal Femur Quick Snap        Left & Right
                                                 Axial Pin - CoCr, Titanium
AD247        Guardian Limb Salvage System        Guardian Distal Femoral Tibial Hinge    1-4
                                                 Base - Titanium
AD248        Guardian Limb Salvage System        Guardian Tibial Sleeve                  1-5
AD249        Guardian Limb Salvage System        Guardian Duramer Tibial Sleeve Spacer   8, 10, 12, 16, 20mm
                                                 - UHMWPE
AD250        Guardian Limb Salvage System        Guardian Male-Male Mid-Section Taper    40, 50, 60, 70, 90, 110, 140mm
                                                 - Titanium
AD251        Guardian Limb Slavage System        Guardian Non Porous Femoral Stem        11, 13, 15, 17mm x 152mm
                                                 Straight/Tapered - Titanium
AD252        Guardian Limb Salvage System        Guardian Proximal Tibia - Titanium      One Size Only
AD253        Guardian Limb Salvage System        Guardian Resurfacing Femur - CoCr,      2, 3, 4, Left & Right
                                                 Titanium
AD254        Guardian Limb Salvage System        Guardian femoral Stem Straight With     9, 11, 13 x 120mm
                                                 Plasma Collar - Titanium
AD255        Guardian Limb Salvage System        Guardian porous Collared Femoral Stem   11, 13, 15, 17mm x 152mm
                                                 Straight/Tapered - Titanium
AD256        Guardian Limb Salvage System        Guardian Femoral Stem Straight -        9, 11, 13 x 120mm
                                                 Titanium
      Prosthesis, Internal, Joint, Knee, Total
AD275        Advance HA Coated Femoral           HA Coated Femoral Component             1 - 6 Left and Right                                        Also grouped in
                                                                                                                                                     Knee Group 1n
AD276        Advance HA Coated Tibial Base       Titanium HA coated Tibial Base          1, 1+, 2, 2+, 3, 3+, 4, 4+, 5, 5+, 6




Prostheses List February 2005                                                                                                                       Page 183 of 700
ORTHOPAEDIC                                                                                                                                  Minimum   Maximum
Billing Code Product Name                            Description                               Size                                          Benefit   Benefit    Notation
AD280        Advance Double High Tibial Insert       Double-High Tibial Insert - UHMWPE        All inserts are available in Left and                              Also grouped in
                                                                                               Right: Sizes 1.5, 0, 1, 2, 3, 4, 5, & 6, in                        Knee Group 5c
                                                                                               the following increments of 10, 12, 14,
                                                                                               17, 20 & 25mm
      Prosthesis, Internal, Radial Head
AD272        Evolve Radial Head Plate                Evolve Radial Plate System Stainless      32mm x 20 - 26mm in 2mm increments
                                                     Steel
AD273        Evolve Radial Head Plate                Evolve Radial Plate System Stainless      37mm x 20 - 26mm in 2mm increments
                                                     Steel
AD274        Evolve Locking Cancellous Bone Screws The Evolve stainless steel locking screw    2.0mm x 14 - 28mm
      Restrictors, Orthopedic Cement
AD178        Bone Plug                               PMMA Cement                               8, 10, 12, 14, 16mm
Aus Systems Pty Ltd
      Plates, Bone
AU001        Aus Systems Titanium Miniplates (Bone   2hole x 2hole Strip Plate Stiff           1.2mm profile, 4, 6, 8mm length                                    Only to be funded
             Plates)                                                                           between inner holes                                                where used in a
                                                                                                                                                                  service for which
                                                                                                                                                                  a Medicare
                                                                                                                                                                  Benefit is payable
Austofix
      Nails, Bone
AX001        Austofix Intramedullary Nail            Humeral Nail, stainless steel             7mm and 8mm
AX004        Austofix Intramedullary Nail            Femoral & Tibial Nails, stainless steel   8mm, 9mm, 10mm
AX005        Austofix Intramedullary Nail            Supracondylar Nail, stainless steel       10mm & 13mm
AX006        Austofix Intramedullary Nail            Hip Nail, stainless steel                 120 & 130 Degree
AX007        Austofix Intramedullary Nail            Long Hip Nail, stainless steel            13/10mm
AX008        Austofix Intramedullary Nail            Proximal Tibial Nail, stainless steel     10/9mm
AX009        Austofix Intramedullary Nail            Custom Nails, stainless steel             5-13mm
AX010        Austofix Intramedullary Nail            F2 Cannulated Femoral Nail, stainless     11mm, 12mm, 13mm
                                                     steel
AX013        Proximal Humeral Nail                   Stainless Steel                           Diameter 8 mm, Length 170 mm

Prostheses List February 2005                                                                                                                                    Page 184 of 700
ORTHOPAEDIC                                                                                                                    Minimum   Maximum
Billing Code Product Name                           Description                             Size                               Benefit   Benefit    Notation
      Screws, Bone
AX002        Austofix Intramedullary Screws         Nail Locking Screw, stainless steel     3.5mm, 4.0mm & 4.5mm
AX003        Austofix Intramedullary Screws         Humeral Head Screw, stainless steel     4.3mm
AX011        Austofix Intramedullary Screws         F2 Locking Screw, stainless steel       5.5mm, 6.2mm, 6.5mm
AX012        Austofix Intramedullary Screws         Proximal Thread Locking Screw,          4.0mm & 4.5mm
                                                    stainless steel
Australian Surgical Design & Manufacture Pty Ltd
      Plates, Bone
AE036        Opening Wedge Tibial Ostectomy Plate   Titanium                                6mm - 20mm
      Prostheses, Joint, Hip, Acetabular Component
AE037        Heco Hip System                        Polyethylene Insert                     42mm - 76mm
AE038        Heco Hip System                        Titanium Cup Implant                    42mm - 76mm
      Prostheses, Joint, Knee
AE066        Active Uni Compartmental Knee          Uni compartmental knee resurfacing      All sizes for Femoral Component:
                                                    prostheses, consisting of a Femoral
                                                    component manufactured from Chrome
                                                    Cobalt Molybdenum alloy, and a Tibial
                                                    component manufactured from Ultra
                                                    high Molecular Weight Polyethylene
AE067        Active Uni Compartmental Knee          Uni compartmental knee resurfacing      All sizes for Tibial Component
                                                    prostheses, consisting of a Femoral
                                                    component manufactured from Chrome
                                                    Cobalt Molybdenum alloy, and a Tibial
                                                    component manufactured from Ultra
                                                    high Molecular Weight Polyethylene
      Prostheses, Joint, Knee, Total
AE039        Active Knee System                     Active Knee - Cemented Femoral          Sizes 1-5 Left & Right
                                                    Component
AE040        Active Knee System                     Tibial Component Cemented               Sizes 1-5
AE041        Active Knee System                     Active Knee - Cementless Femoral        Sizes 1-5 Left & Right
                                                    Component
AE042        Active Knee System                     Bone Screw Titanium                     20mm - 50mm

Prostheses List February 2005                                                                                                                      Page 185 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                      Description                              Size                                  Benefit   Benefit    Notation
AE043        Active Knee System                Tibial Component Cementless              Sizes 1-5
AE044        Active Mobile Bearing             Tibial Tray - Cemented                   Sizes 1-5
AE045        Active Mobile Bearing             Tibial Tray - Cementless                 Sizes 1-5
AE046        Active Mobile Bearing             Meniscal Insert                          Sizes 1 - 5 Thickness 6 - 9.5mm
AE047        Other Active Knee Components      Posterior Stabilised Meniscal Insert     Sizes 1 - 5 Thickness 6 - 15.5mm
AE048        Other Active Knee Components      All Polyethylene Tibial Implant          Sizes 1 - 5 Thickness 6 - 15.5mm
AE049        Other Active Knee Components      Meniscal Insert                          Sizes 1 - 5 Thickness 6 - 15.5mm
AE050        Other Active Knee Components      Patella                                  Sizes 1 - 5
      Screws, Bone
AE007        MF-Cortex Screw                   Titanium                                 1.0 - 2.7mm dia, length 2 - 40mm
AE012        ASDM Bone Screw                   Titanium                                 2.0 - 6.5mm dia, length 4-150mm
AE013        Shaft Screw, Pure                 Threaded Pin, Manufactured from pure     3.2 x 50 - 100mm, 4.0 x 70 - 110mm
                                               Titanium
AE020        Cortex Screws                     Stainless Steel                          1.5mm length 6-20mm
AE021        Cortex Screw                      Stainless Steel                          2.0mm length 6-38mm
AE022        Cortex Screws                     Stainless Steel                          2.7mm length 6-40mm
AE023        Cortex Screws                     Stainless Steel                          3.5mm length 10-110mm
AE024        Small Cannulated Screws           Short Thread Stainless Steel             3.5mm length 10-50mm
AE025        Small Cannulated Screws           Internally threaded, manufactured from   3.2 x 0 comp, 3.2 x 2 comp, 4.0 x 0
                                               pure Titanium                            comp, 4.0 x 2 comp
AE026        Cancellous Bone Screws            Fully Threaded Stainless Steel           4.0mm length 10-60mm
AE027        Cancellous Bone Screws            Short Thread Stainless Steel             4.0mm length 10-50mm
AE028        Large Cannulated Screws           Stainless Steel 16mm Thread              7.0mm dia, length 30-150mm
AE029        Large Cannulated Screws           Stainless Steel 32mm thread              7.0mm dia, length 45-150mm
AE030        Large Cannulated Screws           Fully Threaded Stainless steel           7.0mm dia, length 70-100mm
AE031        Cortex Screw                      Stainless Steel                          4.5mm length 14-140mm
AE032        Malleolar Screws                  Stainless Steel                          4.5mm length 25-70mm
AE033        Cancellous Bone Screws Threaded   Stainless Steel 16mm Thread              6.5mm dia, length 30-120mm
AE034        Cancellous Bone Screws Threaded   Stainless Steel 32mm thread              6.5mm dia, length 45-150mm
Prostheses List February 2005                                                                                                                     Page 186 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                      Description                      Size                                     Benefit   Benefit    Notation
AE035        Cancellous Bone Screws            Fully Threaded Stainless Steel   6.5mm dia, length 20-110mm
AE051        ASDM Bone screw                   Titanium                         Dia 7 - 9 mm, length 20 - 40mm
      Wires, Bone, Implantable
AE052        ASDM K-wire                       Stainless steel - sterile        Dia 0.7 - 2.5mm, length 100 - 230mm                           To be funded
                                                                                                                                              where any or all
                                                                                                                                              K-wires used in a
                                                                                                                                              procedure are
                                                                                                                                              used as an implant.
Australian Surgical Innovations Pty Ltd
      Orthopedic Internal Fixation Systems, Spinal
AI001        Oria Zenith                       Plate                            Length 23 - 97mm
AI002        Oria Zenith                       Screw                            Diameter: 4.0 - 4.5mm. Length - 10 -
                                                                                22mm
AI003        Oria Natura                       Interbody Cage                   Height - 9 - 14mm, Length 20 - 25mm
AI008        Oria Claris                       Screw                            Diameter 3.5 - 7.5mm / Length 10 -
                                                                                60mm
AI009        Oria Claris                       Locking Component                nut, self-breaking nut
AI010        Oria Claris                       Connector                        Extremity, off-set, omniaxial, lateral
AI011        Oria Claris                       Rod                              Diameter 4-6mm. Length 40-200mm
AI012        Oria Claris                       Transverse Link                  Connector and Rod
B Braun Australia Pty Ltd
      Fixation Device, Internal, Plate
BB248        PACH Plate                        Titanium                         28 & 32mm
      Nails, Bone
BB053        BRAUN AUST Intramedullary Nails   Targon Ti Tibial Nail            Dia 8mm-9mm, Length 285mm-345mm
BB054        BRAUN AUST Intramedullary Nails   Targon Tibial Nail               Dia 10mm-12mm, Length 285mm-345mm

BB055        BRAUN AUST Intramedullary Nails   Targon Femoral Nail              Dia 11mm-13mm, Length 360mm-440mm

BB107        BRAUN AUST Intramedullary Nails   Nail for small bones             Dia 3mm-8mm


Prostheses List February 2005                                                                                                                Page 187 of 700
ORTHOPAEDIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                       Description                     Size                                        Benefit   Benefit    Notation
      Orthopedic Internal Fixation Systems, Spinal
BB001        Spine System Evolution             Hook Pin                        Length 25 - 60mm
BB002        Spine System Evolution             Hook, Left and right            For 5.2 and 6mm rods, Thoracic,
                                                                                pedicle, laminar
BB003        Spine System Evolution             Counter/angled/universal hook   Universal - short, long; Counter - small,
                                                                                medium; Angled - left, right
BB004        Spine System Evolution             Lateral Connector               Small, medium, large
BB005        Spine System Evolution             Sacral Screw                    Length 24 - 52mm
BB006        Spine System Evolution             Sacral Plate                    Left/right for 5.2 and 6mm rods
BB007        Spine System Evolution             Clamp for Cross Plate           For 5.2 and 6mm rods
BB008        Spine System Evolution             Cross Plate                     For 5.2 and 6mm rods, length 50 - 100mm

BB009        Spine System Evolution             Rod Connector                   For 5.2 and 6mm rods
BB010        Spine System Evolution             Rod                             Dia 5.2 and 6mm , length 40 - 500mm
BB011        Spine System Evolution             Screw                           Dia 5 - 8mm, length 30 - 55mm
BB012        Spine System Evolution             Locking Screw                   For 5.2 and 6mm rods, length 30 -
BB013        Spine System Evolution             Head for Polyaxial Screw        For 5.2 and 6mm rods
BB014        Spine System Evolution             Nut                             For screws for 5.2 and 6mm rods
BB061        Socon Spinal System                Socon Transpedicular Screw      Length 35mm-65mm, Dia 5mm-7mm
BB062        Socon Spinal System                Socon Connecting Rods           Length 40mm-200mm, Dia 6mm
BB063        Socon Spinal System                Socon Angled Rod                Length 45mm-80mm,Dia 6mm
BB064        Socon Spinal System                Socon Clamps                    One size only
BB065        Socon Spinal System                Socon Crossbar                  Length 50mm-80mm
BB066        Socon Spinal System                Cross Bar Clamp                 One size only
BB070        Prospace Block                     Titanium                        9mm-11mm
BB164        MACS TL Implant Set - Clamp        Titanium                        1.2cm - 0.9cm
BB165        MACS TL Implant Set - Nut          Titanium                        Dia 15mm
BB166        MACS TL Implant Set - Bone Graft   Titanium                        1.6 x 1cm
             Clamp

Prostheses List February 2005                                                                                                                   Page 188 of 700
ORTHOPAEDIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                          Description                                Size                                  Benefit   Benefit    Notation
BB211        KLA Anterior Lumbar Cage System       Anterior Lumbar Cage - PEEK                9mm x 5 degrees, 11mm x 5 degrees,
                                                                                              13mm x 5 degrees, 11mm x 9 degrees,
                                                                                              13mm x 9 degrees, 15mm x 9 degrees,
                                                                                              13mm X 13 degrees, 15mm X 13
BB212        CBK Anterior Cervical Cage System     Anterior Cervical Cage - PEEK              4.5mm, 5.5mm, 6.2mm, 7mm, 8mm,
                                                                                              9mm
BB213        CO Posterior Lumbar Cage System       Posterior Lumbar Cage - PEEK               L23.5 x 9mm x h8mm, L23.5 x 9mm x
                                                                                              h9mm, L23.5 x 10mm x h10mm, L23.5
                                                                                              x 10.7mm x h11mm, L23.5 x 11.7mm x
                                                                                              h12mm, L23.5 x 12.7mm x h13mm,
                                                                                              L23.5 x 13.7mm x h14mm, L23.5 x
                                                                                              14.7mm x h15mm, L23.5 x 9mm x
BB214        CC Posterior Lumbar Cage System       Posterior Lumbar Cage - PEEK               L23.5 x 10-12.5mm x h8mm, L23.5 x
                                                                                              10-12.5mm x h9mm, L23.5 x 10-
                                                                                              12.5mm x h10mm, L23.5mm x 11-
                                                                                              13.5mm x h11mm, L23.5 x 11-13.5mm
                                                                                              x h12mm, L23.5mm x 11-13.5mm x
                                                                                              h13mm, L23.5 x 11-13.5mm x 14mm,
                                                                                              L23.5mm x 10-12.5mm x h6mm
BB215        Adonys Posterior Lumbar Cage System   Posterior Lumbar Cage - PEEK -             8mm x 4 degrees, 12mm x 4 degrees,
                                                   Standard                                   8mm x 10 degrees, 12mm x 10 degrees
BB216        Adonys Posterior Lumbar Cage System   Posterior Lumbar Cage - Short              8mm x 4 degrees, 10mm x 4 degrees,
                                                                                              12mm x 4 degrees, 8mm x 10 degrees,
                                                                                              10mm x 10 degrees, 12mm x 10
BB217        Samarys Anterior Cervical Cage        Anterior Cervical Cage - PEEK              L15 x w17 x h5mm, L15 x w17 x
                                                                                              h6mm, L15 x w17 x h7mm, L15 x w17
                                                                                              x h8mm, L13 x w17 x h5mm, L13 x
                                                                                              w17 x h6mm, L15 x w20 x h5mm, L15
BB219        S4 Pedicle Screw System               S4 Straight Rod - Titanium                 35mm - 60mm
BB220        S4 Pedicle Screw System               S4 Straight Rod - Titanium                 70mm - 180mm
BB221        S4 Pedicle Screw System               S4 Straight Rod - Titanium                 200mm - 500mm
BB222        S4 Pedicle Screw System               S4 Pre-bent Rod - Titanium                 35mm - 55mm
BB223        S4 Pedicle Screw System               S4 Pre-bent Rod - Titanium                 60mm - 100mm
BB224        S4 Pedicle Screw System               Polyaxial Screw - titanium various sizes   Diameter 4.5mm & 5mm - all lengths
                                                                                              25 - 60mm

Prostheses List February 2005                                                                                                                           Page 189 of 700
ORTHOPAEDIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                      Description                                Size                                   Benefit   Benefit    Notation
BB225        S4 Pedicle Screw System           Polyaxial Screw - Titanium various sizes   Diameter 6.0mm, 7.0mm & 8.0mm - all
                                                                                          lengths 25 - 60mm
BB226        S4 Pedicle Screw System           Monoaxial Screw - titanium various sizes Diameter 4.5mm & 5mm - all lengths
                                                                                        25 - 60mm
BB227        S4 Pedicle Screw System           Monoaxial Screw - titanium various sizes Diameter 6.0mm, 7.0mm & 8.0mm - all
                                                                                        lengths 25 - 60mm
BB228        S4 Pedicle Screw System           S4 Cross Connector - titanium              Rigid 22mm - 41mm
BB229        S4 Pedicle Screw System           S4 Cross Connector - titanium              Variable 43mm - 75mm
BB230        S4 Pedicle Screw System           Set Screw - titanium                       one size
      Pins, Bone
BB071        Kirshner Wires all Sizes          Steel                                      Dia 0.8mm-3.0mm, Length 70mm-310mm                          To be funded
                                                                                                                                                      where any or all
                                                                                                                                                      K-wires used in a
                                                                                                                                                      procedure are
                                                                                                                                                      used as an implant.
      Pins, Bone, Absorbable
BB060        BRAUN AUST Intramedullary Nails   Isosorb Resorbable Fixation Pin            2mmx60mm-3.5mmx80mm
      Plates, Bone
BB067        Caspar Cervical Plate             Titanium and Steel                         24mm-90mm
BB068        Caspar Screws                     Stainless Steel                            10mm-28mm
BB069        Caspar Screws                     Titanium                                   10mm-28mm
BB135        Advanced Biomechanical Concept    Titanium, rigid                            Medium 34 - 64mm length
BB140        Advanced Biomechanical Concept    Titanium, rigid                            Large 67 - 103mm length
BB153        Advanced Biomechanical Concept    Titanium, rigid                            Small 20 - 32mm Length
BB167        MACS Stabilisation Plates         Titanium, rigid                            Length 45 - 100mm
      Prostheses, Femoral Head
BB250        Ceramic Head                      Biolox forte                               26 - 32mm diameters, short, standard
                                                                                          and long
      Prostheses, Joint, Hip, Acetabular Component
BB036        BI-CONTACT HIP SYSTEM             Unipolar Cup                               Dia 42-54mm
BB037        BI-CONTACT HIP SYSTEM             Bipolar Cup                                Dia 39-55mm
Prostheses List February 2005                                                                                                                        Page 190 of 700
ORTHOPAEDIC                                                                                              Minimum   Maximum
Billing Code Product Name                  Description              Size                                 Benefit   Benefit    Notation
BB049        Down Asiana Hip System        Cemented Stem            Size 40-45
BB050        Down Asiana Hip System        Cemented Cup             Size 40-43
      Prostheses, Joint, Hip, Total
BB029        BI-CONTACT HIP SYSTEM         Stem - Cementless        Size 10-21                                                Also grouped in
                                                                                                                              Hip Group 7b
BB032        BI-CONTACT HIP SYSTEM         Stem Revision            13-19                                                     Also grouped in
                                                                                                                              Hip Group 7g
BB033        BI-CONTACT HIP SYSTEM         Stem Revision Curved     15-19                                                     Also grouped in
                                                                                                                              Hip Group 7g
BB034        BI-CONTACT HIP SYSTEM         Isodur Head CoCr         Dia 22.2-32mm, short-xxlong
BB047        Downs Austin-Moore Hip        Stem                     39-54mm
BB048        Downs Thompson Stem           Stem                     38-55mm
BB235        Plasmacup Ceramic Insert      Biolox forte             44mm-68mm
BB236        Polyethylene Acetabular Cup   Chirulen                 22.2mm-32mm articulations; 40mm-
                                                                    64mm diameters
BB237        Plasmacup PE insert           Chirulen                 44mm-68mm diameters, 22.2mm-32mm
                                                                     articulations
BB238        Acetabular Fixation Screws    Isotan                   16mm-68mm
BB239        BiContact Cementless          Femoral stem             8-21                                                      Also grouped in
                                                                                                                              Hips Groups 7b,
                                                                                                                              5h, 7h
BB240        BiContact cemented            Femoral stem             8-18                                                      Also grouped in
                                                                                                                              Hip Group 4a
BB243        Plasmacup                     Isotan                   44mm-68mm                                                 Also grouped in
                                                                                                                              Hips Groups 19h,
                                                                                                                              19a, 19g
BB245        Distal centraliser            PMMA                     7mm - 18mm
BB246        Isodur C Head                 Hip Prosthesis Head      22.2mm - 54mm diameters, short,                           Also grouped in
                                                                    standard, long, X-long and XX-long                        Hips Group 14b
BB247        Reconstruction Shell          Isotan                   52-64mm, left and right
BB249        Bipolar Head                  Hemi Arthroplasty Head   38 - 60mm

Prostheses List February 2005                                                                                                Page 191 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                        Description                                Size                         Benefit   Benefit    Notation
      Prostheses, Joint, Knee, Total
BB148        Search Total Knee System            Cemented Femoral Implant                   Left & Right F1 - F5
BB149        Search Total Knee System            Tibial Insert LC/LCR                       E10 - E16. T1 - T5
BB150        Search Total Knee System            Tibial Plateau LC/PS                       T1 - T5
BB151        Search Total Knee System            Tibial Plateau                             T1 - T5
BB152        Search Total Knee System            Revision Tibial Block/Coin                 4 - 8mm, T1 - T5
BB154        Search Total Knee System            Revision TKA Accessory Block               4 - 8mm, T1 - T5
      Prosthesis, Internal, Joint, Knee, Total
BB204        Columbus TKS                        Tibial component                           T1 to T5
BB205        Columbus TKS                        Femoral component                          F1 - F7, Left and Right                           Also grouped in
                                                                                                                                              Knee Group 1b
BB206        Columbus TKS                        Femoral component - posterior stabilized   F1 - F7, Left and Right
BB207        Columbus TKS                        Gliding Surface                            T1 - T5
BB208        Columbus TKS                        Patellar Components, 3 pegs                P1 - P4
BB209        Columbus TKS                        Gliding Surface with Screw                 T1 - T5
BB210        Columbus TKS                        Obturator - Extension Stem                 Small & Large D12 to 14
BB231        Columbus TKS                        Tibial Component - Cementless              T1 - T5                                           Also grouped in
                                                                                                                                              Knee Group 3m
BB232        Emotion TKS                         Femoral Component - Cementless             F1 - F8, Left and Right                           Also grouped in
                                                                                                                                              Knee Group 1n
BB233        Emotion TKS                         Tibial Component - Cementless              T1 - T8
BB234        Columbus TKS                        Femoral Component - Cementless             F1 - F7, Left and Right                           Also grouped in
                                                                                                                                              Knee Group 1n
BB241        End cap                             Modular tibial component                   12mm, 14mm
BB242        Extension stem                      Modular tibial component                   12mm, 14mm, short and long
      Prosthesis, Internal, Joint, Knee, Unicondylar
BB196        Emotion TKS                         Femoral Component-posterior stabilized     F1 - F7, Left and Right
BB197        Emotion TKS                         Femoral Component                          F1 - F8, Left and Right
BB198        Emotion TKS                         Articulating surface                       T1 to T8 Size: 10 to 24mm

Prostheses List February 2005                                                                                                                Page 192 of 700
ORTHOPAEDIC                                                                                                                                 Minimum   Maximum
Billing Code Product Name                           Description                                 Size                                        Benefit   Benefit    Notation
BB199        Emotion TKS                            Articulating surface-posterior stabilized   T1 to T8 Sizes: 10 to 24mm
BB200        Emotion TKS                            Extension Shaft                             Short, D: 10 to 20 , Medium, D: 10 to
                                                                                                20, Long, D: 10 to 20
BB201        Emotion TKS                            Tibial component                            T1 to T8, left and right
BB202        Emotion TKS                            Patella - 1 - Peg and 3 - Pegs              P1 to P6, 26 - 41 x 7 - 12mm
BB203        Emotion Unicondylar                    Uni gliding surface                         F1 and F5, 3mm
      Screws, Bone
BB051        BRAUN AUST Intramedullary Nails        Compression Nail                         100mmx10.5mm-610mmx12.5mm
BB052        BRAUN AUST Intramedullary Nails        Compression Screw                        4.5mmx64mm-4.5mmx102mm
BB056        BRAUN AUST Intramedullary Nails        Fixation Screws                          Dia 4.5mm-6mm,Length 20mm-96mm
BB057        BRAUN AUST Intramedullary Nails        Closure Screws                           Length 8mm-10mm
BB059        BRAUN AUST Intramedullary Nails        Huckstep Fine Thread Screw               4.5mmx19mm-4.5mmx57mm
BB158        Advanced Biomechanical Concept Screw   Titanium with locking mechanism          Dia 4 - 4.5mm, length 10 - 28mm
BB159        Bone Screw                             MACS Polyaxial & Stabilisation, Titanium Dia 6.5 - 7mm, length 30 - 50mm

BB160        Bone Screw                             HMA Polyaxial, Titanium                     Dia 12mm, length 26 - 38mm
BB161        Bone Screw                             HMA Monoaxial, Titanium                     Dia 12mm, length 26 - 38mm
BB162        Bone Screw                             MACS Locking, Titanium                      Dia 12mm, length 4mm
BB163        Bone Screw                             MACS Graft, Titanium                        Dia 5mm, length 35mm
BB174        MACS TL Bone Screws                    Polyaxial screw - XL                        30mm and 40mm
Baxter Healthcare Pty Ltd
      Prostheses, Joint, Ankle, Tibial Component
BX238        Alpha OSG Ankle Replacement - Tibia    Cementless, HA, Titanium Nitride            1 to 4
                                                    Surface
BX239        Alpha OSG Ankle Replacement -          Bearing, UHMWPE - Bearing                   Size 1 - 5, 7, 9, 11, & 13mm, Size 2 - 5,
                                                                                                7, 9, 11, & 13mm, Size 3 - 5, 7, 9, 11, &
                                                                                                13mm, Size 4 - 5, 7, 9, 11, & 13mm
BX251        Alpha OSG Ankle Replacement - Talus    Cementless Titanium Nitride Surface         Size 1, 2, 3, 4



Prostheses List February 2005                                                                                                                                   Page 193 of 700
ORTHOPAEDIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                          Description                             Size                             Benefit   Benefit    Notation
Biomet Australia Pty Ltd
      Anchor, Fixation
BI320        Arthrotek Harpoon System              Suture Anchor, Metal, Stainless Steel   2.0mm & 3.0mm
      Bone Matrix Implants, Artificial
BI023        Endobon Pins                          Cylinder, Hydroxyapatite                13-16mm
BI024        Bone Cement Endobon Bone Substitute   Cylinder, Hydroxyapatite                9-12mm
             Material
BI025        Bone Cement Endobon Bone Substitute   Granules, Hydroxyapatite                Type I or Type II
             Material
BI026        Bone Cement Endobon Bone Substitute   Block, Hydroxyapatite                   5x5x10, 12.5x12.5x10, 20x20x10
             Material
BI686        Calcigen-NaP                          Bone Substitute, Calcium Sodium         5-25gms
                                                   Phosphate
BI691        Calcigen-S                            Bone substitute, Calcium Sodium         5-25mls
                                                   Phosphate
      Cement, Orthopedic
BI242        Palamed                               Bone Cement, PMMA                       40gm
BI243        Palamed G Bone Cement                 Bone Cement, Gentamicin, PMMA           40gm
BI844        Palamed G Bone Cement                 Bone Cement, Methyl methacrylate,       40 gm (2 x 20 gm)
                                                   Gentamicin
BI845        Palamed G Bone Cement                 Bone Cement, Methyl methacrylate,       80 gm (2 x 40 gm)
                                                   Gentamicin
BI846        Generation 4 Bone Cement              Bone Cement, Methacrylate- Styrene      40gm pack
                                                   copolymer
BI847        Generation 4 Bone Cement              Bone Cement, Methacrylate- Styrene      80gm pack
                                                   copolymer
BI879        Palamed Bone Cement                   Bone Cement, Methyl methacrylate,       20gm (1 x 20 gm)
                                                   Gentamicin
      Nails, Bone
BI248        SST Small Bone Locking Nail           Forearm Nail, Titanium                  3.5mm x (180-260mm)
BI249        SST Small Bone Locking Nail           Screw, Distal Fixator, Titanium         One size only

Prostheses List February 2005                                                                                                                   Page 194 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                           Description                              Size                                      Benefit   Benefit    Notation
BI250        SST Small Bone Locking Nail            Set Screw w/holder, Titanium             One size only
BI251        SST Small Bone Locking Nail            Nail End Cap, titanium                   low profile, one size only
BI252        SST Small Bone Locking Nail            Fibula Nail, titanium                    (3.5, 4.5mm) x 150mm
BI281        Femoral Interlocking Nail              Nail, Interlocking, Titanium             (10-15mm) x (300 - 440mm)
BI282        Femoral Interlocking Nail              Screws, Femoral Nail, Titanium           5mm x (25-70mm)
BI283        Femoral Interlocking Nail              Screws, Femoral Nail, Titanium           6.4mm x (70-120mm)
BI284        Femoral Interlocking Nail              Screws, Femoral Nail, Titanium           6mm x (30-100mm)
BI285        Femoral Interlocking Nail              Femoral Nail End Cap                     10-11mm & 12-16mm
BI286        Uniflex Tibial Nail                    Tibial Nail, Titanium                    8-14mm x 240-420mm
BI287        Uniflex Tibial Nail                    Tibial Nail Transverse Screw, Titanium   4.0, 5.0mm x (20-70mm)
BI288        Uniflex Tibial Nail                    Tibial Nail, Ti                          8 - 9mm x (240-380mm)
BI289        Uniflex Tibial Nail                    Tibial Nail, Ti                          10 - 11mm x (240-420mm)
BI290        Uniflex Tibial Nail                    Screw, Tibial Nail, Ti                   4 - 5mm x (20-70mm)
BI291        Uniflex Tibial Nail                    Nail, End Cap, Ti                        4 - 18mm diameter
BI292        Humeral Nail                           Humeral Nail, Titanium                   8.0- 9.0mm x (180-280mm)
BI293        Humeral Nail                           Screws, Transverse Humeral Nail,         (4.0-4.5mm) x (16-46mm)
                                                    Titanium
BI294        Humeral Nail                           Nail, Humeral, Titanium                  (8.0- 9.0mm) x (180-280mm)
BI295        Kuntscher Cloverleaf Medullary Nails   Stainless Steel                          6-12mm x (140-520mm)
BI296        Kuntscher Cloverleaf Medullary Nails   Stainless Steel                          13-16mm x (280-520mm)
BI297        Kuntscher Cloverleaf Medullary Nails   Stainless Steel                          17-20mm x (300-750mm)
BI299        Kuntschner Y Nail                      Stainless Steel                          1.0-3.0mm x (100-310mm)
BI803        ST Pro Nailing System                  End cap, stainless steel                 Dia 8-16mm
BI804        ST Pro Nailing System                  Fixation screws, stainless steel         Fully threaded - dia 4-6mm, 20-100mm
                                                                                             length; Partially threaded - dia 6.4mm,
                                                                                             length 70-120mm
BI805        ST Pro Femoral Nail                    Cannulated, stainless steel              Dia 10-16mm, length 260-520mm
BI806        ST Pro Humeral Nail                    Solid, stainless steel                   Dia 8-9mm, length 180-280mm
BI807        ST Pro Tibial Nail                     Cannulated, solid, stainless steel       Dia 8-11mm, length 240-420mm

Prostheses List February 2005                                                                                                                              Page 195 of 700
ORTHOPAEDIC                                                                                                                                 Minimum   Maximum
Billing Code Product Name                          Description                                  Size                                        Benefit   Benefit    Notation
      Orthopedic External Fixation Systems, Fracture
BI697        Small Fragment Set                    Stainless Steel Screws                       3.5, 4.0mm length, Sizes 10 - 60mm
BI698        Small Fragment Set                    Stainless Steel Plates                       Plates 25 - 125mm
BI775        EBI XFIX DynaFix System               Distal radius fixator, wristfix, sterile,    One size only
                                                   complete
      Orthopedic External Fixation Systems, Other
BI262        EBI XFIX Dynafix System               Bone Screw, Cortical, tapered,               2.4mm to 6.00mm diameter
                                                   Cancellous, Stainless Steel
BI264        EBI XFIX Dynafix System               Distal Radius Fixator, Dimension,            One size only
                                                   Stainless Steel, Aluminium
BI265        EBI XFIX Dynafix System               Hybrid Fixation System, Stainless Steel,     Rings - 1/3, 2/3, Rotating, 100mm-
                                                   Aluminium                                    220mm. Ring Bolt - Xsmall, adult. Ring
                                                                                                 to fixator connector. Rotation adaptor -
                                                                                                 male, female, Xsmall, adult. Variable
                                                                                                wire (1 size) or Variable Screw
                                                                                                Carriage (fixed and angulating). Wire
                                                                                                (1.6-2mm x 350-400mm). Washer (9 -
BI267        EBI XFIX Dynafix System               Fixator Complete - includes T-Clamp,         Standard, Small, Extra Small
                                                   Compression/Distraction, Dynamisation,
                                                   Articulating Ankle Clamp
BI270        EBI XFIX Dynafix System               Pelvic Fixator Screws, Stainless Steel,      One size only
                                                   Aluminium
BI271        EBI XFIX Dynafix System               Wire Straight or Olive with Washer,          160 or 200mm x (1.6 or 2.0mm)
                                                   Chrome Cobalt
BI272        EBI XFIX Dynafix System               Distal Radius Fixator, Wristfix, Stainless   One size only
                                                   Steel, Aluminium
BI776        EBI XFIX DynaFix System               OptiROM Articulating Fixator Complete        One size only
BI777        EBI XFIX DynaFix System               Mini fixator/lengthener with comp/dist       Small, Medium, Long, 100mm, 150mm
BI818        EBI XFIX Dynafix System               Rail (Aluminium/Titanium)                    100-420mm
BI819        EBI XFIX Dynafix System               Multi Axial Correction and Metaphyseal       4-8cm, Xsmall - Adult
                                                   Arc Module complete with T-clamp
BI823        Alveolar Ridge Distraction System -   distraction device, single tooth             10-20mm
             titanium

Prostheses List February 2005                                                                                                                                   Page 196 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                              Size                             Benefit   Benefit    Notation
BI824        Alveolar Ridge Distraction System -   distraction device, multi tooth          10-20mm
             titanium
BI825        Alveolar Ridge Distraction System -   Shim plate, titanium                     1-3mm
             titanium
BI827        EBI XFIX Vision System                Rod Clamps/Connector, stainless          Dia 9.5mm
                                                   steel/aluminium
BI828        EBI XFIX Vision System                Clamp/Rod, stainless steel/aluminium     4mm/6mm, 3-5 hole, 50-150mm
BI829        EBI XFIX Vision System                Screw, Transfixing, Stainless steel      4 - 6mm diameter
BI830        EBI XFIX Vision System                Ring Connector Assembly, stainless       1 or 2 bolt model
                                                   steel/aluminium
BI831        EBI XFIX Vision System                Post, Bone Screw, Telescoping,           One size only
                                                   stainless steel
BI832        EBI XFIX Vision System                Rods, Bars, stainless                    Dia 9.5mm, 150-400mm length
                                                   steel/aluminium/carbon fibre
BI849        EBI XFIX DynaFix System               OptiROM Passive Distractor Module        One Size Only
BI850        EBI XFIX DynaFix System               Hip Distractor Aluminium, Stainless      One Size Only
                                                   Steel, Titanium
BI851        EBI XFIX Dynafix System               Clamp (Straight, Transport, Rotational   Ex Small, Small, Adult, 4-6mm
                                                   T-clamp, Adaptor, Lenghtener, Shim,
                                                   Single)
BI852        EBI XFIX Dynafix System               Clamp (Rotational Serrated T-clamp,      Ex Small, Small, Adult, 4-6mm
                                                   Swivel, Translational, Uniplaner, CD)
BI853        EBI XFIX Dynafix System               CD Clicker                               Ex Small, Small, Adult, 5-20cm
BI854        EBI XFIX Dynafix System               Rail Accessory (Adaptor, CD Support,     Ex Small, Small, Adult, 4-6mm
                                                   Dynamization, Bridge)
BI855        EBI XFIX Dynafix System               Wrench                                   Ex Small, Small, Adult, 4-6mm
BI856        EBI XFIX Dynafix System               Rail (Carbon Fiber)                      100-420mm
      Orthopedic Internal Fixation Systems, Fracture
BI253        BMP Cable System                      Cable Chrome Cobalt                      1.6mm or 2.0mm
BI254        BMP Cable System                      Cable Sleeve, Chrome Cobalt, Stainless   One Size only
                                                   Steel
BI255        BMP Cable System                      Trochanteric Grip, Chrome Cobalt         1.6mm or 2.0mm
Prostheses List February 2005                                                                                                                    Page 197 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                         Description                              Size                          Benefit   Benefit    Notation
BI256        BMP Cable System                     Cable, Stainless Steel                   1.6mm or 2.0mm
BI258        BMP Cable System                     Dynamic Compression Plate, 3 hole,       One size only
                                                  Stainless Steel
BI259        BMP Cable System                     Dynamic Compression Plate, 5 hole,       One size only
                                                  Stainless Steel
BI260        BMP Cable System                     Dynamic Compression Plate, 7 hole,       One size only
                                                  stainless steel
BI261        BMP Cable System                     Dynamic Compression Plate, 9 hole,       One size only
                                                  Stainless Steel
BI768        Mandibular Fracture System           Screw, IMF 2./2.4 Mandibular Fracture,   2.0 x (9-13)mm                                     Only to be funded
                                                  Titanium                                                                                    where used in a
                                                                                                                                              service for which
                                                                                                                                              a Medicare
                                                                                                                                              Benefit is payable
BI769        Mandibular Fracture System           Screw, IMF, 2.0/2.4 Mandibular           Dia 2.0 x 5.0, 7.0mm length                        Only to be funded
                                                  Fracture, Titanium                                                                          where used in a
                                                                                                                                              service for which
                                                                                                                                              a Medicare
                                                                                                                                              Benefit is payable
      Orthopedic Internal Fixation Systems, Other
BI206        Arthrotek Ligament Fixation System   Washerloc Fixator, Screw, and Fixator    Fixator 16mm, Screw 24-60mm
                                                  Titanium
BI233        Arthrotek Ligament Fixation System   Suture Button, HMWPE                     15mm, 19mm
BI234        Arthrotek Ligament Fixation System   Ligament Washer, Titanium                14mm, 18mm
BI235        Arthrotek Ligament Fixation System   Bone Screw, Ligament, Titanium           30,35,40mm
BI236        Arthrotek Ligament Fixation System   Bone Screw, Titanium                     3.5mm (10-40mm)
BI237        Arthrotek Ligament Fixation System   Channel Ligament, Clamp, Titanium        10mm, 13mm 15mm
BI238        Arthrotek Ligament Fixation System   Channel Ligament, Cortical Screws Pk     3.5mm (10-40mm)
BI239        Arthrotek Ligament Fixation System   Interference Screw, Titanium             15-30mm
BI240        Arthrotek Ligament Fixation System   Screw, Bicortical, Titanium              30-60mm
BI246        Arthrotek Ligament Fixation System   Bone Mulch Screws, Titanium              10.5mm x (20-35mm)



Prostheses List February 2005                                                                                                                Page 198 of 700
ORTHOPAEDIC                                                                                                    Minimum   Maximum
Billing Code Product Name                    Description                                 Size                  Benefit   Benefit    Notation
BI576        Distraction Technology System   Distractor, Flexible Shaft, Facial, Titanium 1 - 3inch                                 Only to be funded
                                                                                                                                    where used in a
                                                                                                                                    service for which
                                                                                                                                    a Medicare
                                                                                                                                    Benefit is payable
BI580        Distraction Technology System   Distractor, Midface, Drive Screw with       20 - 30mm                                  Only to be funded
                                             Sleeve. Titanium                                                                       where used in a
                                                                                                                                    service for which
                                                                                                                                    a Medicare
                                                                                                                                    Benefit is payable
BI582        Distraction Technology System   Plate, Anterior or Posterior, Mid Face      Standard or Long                           Only to be funded
                                                                                                                                    where used in a
                                                                                                                                    service for which
                                                                                                                                    a Medicare
                                                                                                                                    Benefit is payable
BI586        Distraction Technology System   Mandibular, Straight Plate or Distractor    10-25mm                                    Only to be funded
                                             Tree                                                                                   where used in a
                                                                                                                                    service for which
                                                                                                                                    a Medicare
                                                                                                                                    Benefit is payable
BI588        Distraction Technology System   Distractor, Paediatric, Titanium            10 - 30mm                                  Only to be funded
                                                                                                                                    where used in a
                                                                                                                                    service for which
                                                                                                                                    a Medicare
                                                                                                                                    Benefit is payable
BI789        Ascent Knee System              Femoral augmentation block, posterior       4, 8, 12mm
                                             or distal, titanium
BI790        Ascent Total Knee System        Femoral, cruciate retaining, anatomic,      X-Small to XX-Large
                                             cemented, chrome cobalt
BI794        Ascent Total Knee System        Femoral, cruciate retaining, anatomic,      X-Small to XX-Large
                                             uncemented, chrome cobalt, titanium
                                             porous coat
BI795        Ascent Total Knee System        Femoral, anatomic, posterior stabilised,    X-Small to X-Large
                                             open box, cemented, chrome cobalt
BI796        Ascent Total Knee System        Femoral, anatomic, posterior stabilised,    X-Small to X-Large
                                             open box, uncemented, chrome cobalt,
                                             titanium porous coat
Prostheses List February 2005                                                                                                      Page 199 of 700
ORTHOPAEDIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                             Description                              Size                                   Benefit   Benefit    Notation
BI798        Ascent Total Knee System                 Tibial bearing, cruciate retaining,      59, 63/67, 71/75, 79/83, 87/91mm
                                                      UHMWPE, curved or lipped                 widths, 10-20mm thicknesses
BI799        Ascent Total Knee System                 Femoral Anatomic, posterior stabilised   X-Small to X-Large                                          Also grouped in
                                                      or constrained, closed box, cemented,                                                                Knee Group 1c
                                                      chrome cobalt
BI800        Ascent Total Knee System                 Femoral revision stem w/screw, coronal   5 or 7 degree, 100mm, 150mm lengths,
                                                      slot, titanium                           10-24mm diameters
BI801        Ascent Total Knee System                 Tibial bearing, posterior or anterior    59-91mm width x 8-20mm thickness                            Also grouped in
                                                      stabilised, UHMWPE                                                                                   Knee Group 5c
BI802        Ascent Total Knee System                 Tibial bearing, constrained, UHMWPE      59, 63/67, 71/75, 79/83, 87/91mm
                                                                                               widths, 10-20mm thicknesses
      Orthopedic Internal Fixation Systems, Spinal
BI709        Vuelock Anterior Cervical Plate System   Plate, Cervical, Four Level, Titanium    60 - 92mm
BI710        Vuelock Anterior Cervical Plate System   Plate, Cervical, Three Level, Titanium   44 - 66mm
BI711        Vuelock Anterior Cervical Plate System   Plate, Cervical, Two Level, Titanium     26 - 42mm
BI712        Vuelock Anterior Cervical Plate System   Plate, Cervical, One Level, Titanium     12 - 24mm
BI713        Vuelock Anterior Cervical Plate System   Screw, Titanium                          Dia 4 - 5mm, length 12 - 16mm
      Pins, Bone
BI232        Moore Pins                               Scan Pin, Stainless Steel                16mm x 51-152mm
BI298        Rush Intramedullary Pins                 Stainless Steel                          2.4-6mm x (30-440mm)
BI302        Knowles Hex Drive Pins                   Stainless Steel                          4.0, 4.7mm x (57-152mm)
BI303        Rush Intramedullary Pins                 Stainless Steel                          2.4mm x (30-35mm)
BI304        Rush Intramedullary Pins                 Stainless Steel                          3.2mm x (100-250mm)
BI305        Rush Intramedullary Pins                 Stainless Steel                          (2.4, 4.8)mm dia x (30-360)mm
BI306        Rush Intramedullary Pins                 Stainless Steel                          6.4mm x (280-440mm)
      Pins, Bone, Absorbable
BI275        Lactosorb Suture Anchors                 Suture Anchor, Lactosorb, PGA/PLA        2.0mm, 3.0mm
BI276        Readsorbable Meniscal Staple             PGA/PLA                                  11mm, 13mm
BI277        Re-Unite Orthopaedic Bone Pin            Bone Pin, PGA/PLA                        (1-4)mm dia x (20-70)mm
BI797        Weil-Carver Hammertoe Implant            PGA/PLA                                  One size only
Prostheses List February 2005                                                                                                                             Page 200 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                       Description                           Size                                    Benefit   Benefit    Notation
BI809        Lactosorb Suture Anchor            Threaded, PGA/PLA                     Dia 3.5mm, 5.5mm
      Plates, Bone
BI145        Vari-Angle Hip System              Compression Hip Screw, Lag + Plate,   2-14 hole plate, 4.5mm to 15mm screws
                                                Stainless Steel
BI834        EBI XFIX DynaFix System            Screw, VS Osteotomy System, Ti        6mm x (30mm-110mm)
BI843        EBI XFIX DynaFix System            Plate, VS Osteotomy Ti                4 hole, 6 hole
      Plugs
BI780        Optiplug Cement Restrictor         Restrictor, PEGT/PBT                  10-20mm Diameter
      Prostheses, Femoral Head
BI089        Hap Impact Stem (Various)          Femoral Segment, Metaphyseal, HAP     Size 3-6, Small/Medium
                                                Coated, Uncemented, Titanium
BI782        M2a Modular Head Component &       Metal on Metal Head, Chrome Cobalt    38 - 60mm, -6 mm to +12mm
             Acetabular Cup
BI783        M2a Modular Head Component &       Metal on Metal Acetabular, Chrome     48-70 mm
             Special Acetabular Cup             Cobalt, Ti
      Prostheses, Joint
BI055        Biomet Alternate Bearing Surface   Metal on Metal Acetabular Shell,      46 - 70mm
                                                Titanium
BI056        Biomet Alternate Bearing Surface   Metal on Metal head, Chrome Cobalt    28mm -6mm to +12mm
BI057        Biomet Alternate Bearing Surface   Metal Acetabular Insert, Chrome       Standard
      Prostheses, Joint, Elbow
BI016        IBP Elbow                          Cemented, UHMWPE, Titanium,           Small Standard, Large, Xlarge
                                                Cobalt Chrome
BI017        Kudo Elbow                         Humeral Component, Cemented ,         Small, Large
                                                Cobalt Chrome
BI018        Kudo Elbow                         Ulnar Component, Cemented, Titanium   Small, Large
BI019        Kudo Elbow                         Humeral Component, Uncemented,        Small, Large
                                                Cobalt Chrome
BI020        Kudo Elbow                         Ulnar Component, Uncemented, Titanium Small, Large



Prostheses List February 2005                                                                                                                     Page 201 of 700
ORTHOPAEDIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                        Description                             Size                                      Benefit   Benefit    Notation
BI695        Liverpool Radial Head Replacement   Porous Coated CO CR Stem                16 x 18mm length, 18 x 14 - 28mm
             System                                                                      Length
BI781        Discovery Elbow System              UHMWPE, Ti                              3 - 6 mm x 75 - 150 mm
      Prostheses, Joint, Hip, Acetabular Component
BI065        Vision Acetabular System            Acetabular Cup System, Cemented,        9-19mm
                                                 Cementless, Titanium, Chrome Cobalt,
                                                 UHMWPE
BI091        Kasselt Acetabular Cup System       Acetabular Cup, UHMWPE                  46-70mm
BI096        Tripolar Acetabular Cup Series      Ringloc Series, UHMWPE, Chrome          24-28mm                                                        Also grouped in
                                                 Cobalt                                                                                                 Hip Group 19k
BI142        Mars Acetabular System              Acetabular Shell, Titanium              Sizes 48 to 60mm
BI699        McLauglin Plus 5 Acetabular Shell   Acetabular Titanium Shell               46 - 80mm
BI700        Par 5 Protrusio Acetabular System   Obturator Hook - Titanium Metal         One size only
BI701        Par 5 Protrusio Acetabular System   Blade - Titanium Metal                  One size only
BI702        Par 5 Protrusio Acetabular System   Screws - Titanium Metal                 6.5mm
BI703        Par 5 Protrusio Acetabular System   Acetabular Flange - Titanium Metal      Short (L,R,N), Medium (L,R,N), Long
                                                                                         (L,R,N)
BI704        Par 5 Protrusio Acetabular System   Acetabular Shells - Titanium Metal      56 - 72mm
BI770        Exceed Acetabular System            Shell, Ti                               Shell sizes 40-70mm
BI836        Par 5 Protrusio Acetabular System   Acetabular Shell CrCo, Ti, Ha Coated    56 - 72mm
BI841        Resurfacing Hip System              Acetabular Shell CoCr, Ti               44 - 66mm
BI842        Resurfacing Hip System              Acetabular Shell CoCr, Ti, HA Coated    44 - 66mm
BI872        MAX-Ti Modular Protrusio Cage       Modular Protrusion Cage, Ti             Protrusio Cage 52, 56, 60, 64, 68, 72mm
                                                                                          Left & Right
BI874        MAX-Ti Modular Protrusio Cage       Modular Protrusion Cage, Ti             Iliac Flange Augment 6mm Flat &
                                                                                         Wedge
      Prostheses, Joint, Hip, Femoral Component
BI015        Reach Revision Hip System           Modular Reach Proximal Body -           Proximal Body #1-6
                                                 Collared/Collarless; Titanium, Chrome
                                                 Cobalt
BI034        Osteocap RS Hip System              Femoral Stem, Titanium, Cementless      9-17mm
Prostheses List February 2005                                                                                                                          Page 202 of 700
ORTHOPAEDIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                  Description                                Size                                  Benefit   Benefit    Notation
BI036        Rx90 Hip System               Primary Femoral Stem, Chrome Cobalt,       9-17mm
                                           Cemented
BI037        Rx90 Hip System               Revision Femoral Stem 200mm,               13-19mm
                                           Chrome Cobalt, Cemented
BI038        Rx90 Hip System               Acetabular Cup and liner, Titanium         40-70mm
                                           Alloy, UHMWPE, Cementless /
                                           Cemented
BI039        Integral Hip System           Femoral Centraliser, Cemented , Cobalt     9-17mm
                                           Chrome
BI040        Integral Hip System           Titanium Alloy, Cementless, Porus          Length from 125mm to 175mm, 9-
                                           Stem, 3 variations: Standard, Laterised
                                           or reduced profile
BI041        Integral Hip System           Titanium Alloy, Cementless, Porus          Length from 180mm to 225mm, 9-
                                           Stem, 3 variations: Standard, Laterised
                                           or reduced profile
BI042        Answer Hip System             Femoral Stem, Chrome Cobalt,               9-17mm
BI046        Biogroove Femoral Component   Femoral Stem, Titanium, Cementless         7-14mm
BI047        Hip Fracture System           Femoral Stem, Chrome Cobalt,               8-16mm
                                           Cemented/Cementless
BI048        Balance Hip System            Femoral Stem and Head, Cementless,         7 - 18mm
BI692        Reach Revision Hip System     Titanium porous coated bowed stem          Sizes 13 - 19 (L&R) by 200mm Length
BI693        Reach Revision Hip System     Titanium porous coated bowed stem          Sizes 13 - 19 (L&R) by 250mm Length
BI694        Reach Revision Hip System     Titanium porous coated straight stem       Sizes 13 - 19 by 200mm Length
BI696        Olympia Stem                  Anatomic design CO CR femoral stem         L & R 6 sizes (1 to 6)
BI778        PLR Splined Revision Stem     Splined Straight Stem, Ti                  14-24mm x 270mm
BI779        CDH Hip System                Femoral Stem, porous coated, Ti            8-12 mm Diameter
BI837        Reach Revision Hip System     Modular Reach Proximal Body -              Proximal Body #1 - 6
                                           Collared/Collarless, CrCo, Ti, HA Coated

BI838        Resurfacing Hip System        Femoral Head CoCr, Ti, HA Coated           38 - 60mm
BI839        Resurfacing Hip System        Femoral Head CoCr, Cemented                38 - 60mm
BI840        Resurfacing Hip System        Femoral Head CoCr, Ti                      38 - 60mm
Prostheses List February 2005                                                                                                                   Page 203 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                       Description                             Size                                         Benefit   Benefit    Notation
BI877        Freedom 36 mm Modular Head         Modular Head                            36mm, -6mm to +9mm
BI889        Orthpaedic Salvage System          Proximal Femoral Component, Letson      7cm Left or Right
                                                or Finn, Anatomic, Ti
BI895        M2A Magnum Prosthesis              Taper Insert, Cobalt chrome             42 - 50mm, -6, -3, STD, +3, +6, +9; 52 -
                                                                                         60mm, -6, -3, STD,
                                                                                        3, +6, +9
BI896        M2A Magnum Prosthesis              Femoral Modular Head, Cobalt Chrome     38, 40, 42, 44, 46, 48, 50,52, 54, 56, 58,
                                                                                        60mm
      Prostheses, Joint, Hip, Total
BI027        Asian Hip System                   Femoral Stem, Chrome Cobalt,            7-13mm
BI028        Asian Hip System                   Acetabular Cup, UHMWPE, Chrome          28mm x (44-60mm)
                                                Cobalt Cemented
BI029        Scientific Hip Prostheses System   Femoral Component, Chrome Cobalt,       6 sizes, 0-6
                                                Cemented
BI030        Scientific Hip Prostheses System   Acetabular Component UHMWPE,            22, 26,28mm x (46-60mm)
                                                Cemented
BI045        Scientific Hip Prostheses System   Head, Chrome Cobalt                     28mm, -6mm to +12mm
BI049        Bi-Metric Hip System               Porous Stem, Titanium, Cementless       7-17mm
BI050        Bi-Metric Hip System               Interlok Stem, Titanium,                7-17mm
                                                Cemented/Cementless
BI051        Bi-Metric Hip System               Head Neck Revision Femoral Stem,        9-15mm
                                                Chrome Cobalt, Cemented
BI052        Bi-Metric Hip System               Revision 200 Stem, Titanium, Cemented   9-17mm
BI053        Bi-Metric Hip System               Revision 250 Stem, Titanium, Cemented   9-17mm
BI054        Bi-Metric Hip System               Revision 300mm Femoral Stem,            9-17mm
                                                Titanium, Cemented
BI058        Modular Ceramic System             Ceramic Head                            28-32mm -6mm to +12mm                                             Also grouped in
                                                                                                                                                          Hip Group 13g
BI060        Austin Moore Self Locking Hip      Straight Standard Femoral Prostheses,   38-55mm
             Prosthesis System                  Titanium
BI061        Austin Moore Self Locking Hip      Modular Femoral Stem and Modular        38-61mm Head, Std or Narrow stem
             Prosthesis System                  Head, Titanium.

Prostheses List February 2005                                                                                                                            Page 204 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                           Description                               Size                            Benefit   Benefit    Notation
BI062        FR Thompson Hip Prosthesis System      Modular Curved Femoral Stem,              38mm - 55mm
                                                    Titanium.
BI063        Bimetric Hip System                    Stem, Modular, Titanium, Chrome Cobalt 7-17mm
BI064        Bioclad Hip System                     Acetabular Cup, UHMWPE                 22,28,32mm, size 39-69mm
BI066        Stanmore Total Hip System              Modular Femoral Stem - Standard and    Size 1-5
                                                    Straight, Chrome Cobalt
BI067        Stanmore Total Hip System              Acetabular Cup, UHMWPE                    25-32mm x size 40-53mm
BI068        Stanmore Total Hip System              Modular Head, Chrome Cobalt               28mm, -6mm to +12mm
BI069        Biomet Taperloc Hip System             Femoral Stem, Standard or Laterised.      7.5mm to 20mm diameter
                                                    Titanium, Cemented
BI070        Biomet Taperloc Hip System             Modular Head, Chrome Cobalt            28mm, -6 to +12mm
BI072        Modular Calcar Mallory Head Revision   STS Distal Femoral Component, Titanium 14mm to 20mm
             Hip System
BI073        Modular Ceramic System                 Acetabular Ceramic/ Polyethylene          28mm, 32mm, -6 to +12mm
                                                    Liner, UHMWPE
BI074        Biomet Taperloc Hip System             Primary Femoral Stem, Titanium,           7.5mm - 22.5mm
                                                    Uncemented
BI075        Biomet Taperloc Hip System             Femoral Stem, HA, Titanium,               7.5mm - 22.5mm
                                                    Uncemented
BI077        Austin Moore Self Locking Hip          Femoral Component, Long Stem,             38 to 56mm
             Prosthesis System                      Titanium
BI081        Impact Modular Total Hip System        Femoral Segment, Diaphyseal,              10-21mm                                              Also grouped in
                                                    Standard. Titanium                                                                             Hip Group 8g
BI082        Impact Modular Total Hip System        Femoral Segment, Metaphyseal. Titanium Size 1-6 x Small/Medium
BI086        Impact Modular Total Hip System        Femoral Segment, Metaphyseal,          Size 3-6 Small/Medium
                                                    Revision Cemented , Titanium
BI087        Impact Modular Total Hip System        Femoral Segment, Metaphyseal,             Size 3-6, Small/Medium
                                                    Uncemented , Titanium
BI092        Mallory Head Hip System                Acetabular Liner, Constrained, Ringloc,   28-38mm
                                                    UHMWPE
BI094        Mallory Head Hip System                Femoral Head, Offset, Chrome Cobalt       28,32mm
BI097        Kent Hip System                        Femoral Component, Titanium               Narrow, Std. Size 6 - 16 hole
Prostheses List February 2005                                                                                                                     Page 205 of 700
ORTHOPAEDIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                           Description                            Size                                     Benefit   Benefit    Notation
BI098        Kent Hip System                        Transverse Screws, Titanium            4.5mm x (26-55mm)
BI100        Bi Hapro Hip System                    Femoral Stem, Uncemented, Cobalt       Size 1 to 8
                                                    Chrome
BI101        Bi Hapro Hip System                    Ringloc Cup, HAP Coating uncemented    46mm to 70mm
BI105        Bi Hapro Hip System                    Acetabular Screws, Titanium Alloy      6.5mm x(15 to 50mm)
BI106        Mallory Head Hip System                Acetabular Liner, UHMWPE               28 & 32mm, Sizes 21 to 28mm
BI107        Mallory Head Hip System                Acetabular Liner, UHMWPE               22 & 26mm, Sizes 21 to 28mm
BI109        Mallory Head Hip System                Screw, Acetabular                      (6.5 - 5.5)mm dia x (15 - 70)mm length
BI110        Mallory Head Hip System                Acetabular Shell, HAP Coated,          40-80mm
BI111        Mallory Head Hip System                Acetabular Shell, Titanium             40-80mm
BI112        Mallory Head Hip System                Acetabular Shell, Solid, HAP Coated,   40-80mm
                                                    Titanium
BI116        Mallory Head Hip System                Acetabular PMI Component, Titanium     44-72mm
BI118        Mallory Head Hip System                Femoral Stem, Calcar, Titanium         220mm, Size 9-19mm
BI119        Mallory Head Hip System                Femoral Stem, Calcar, Titanium         260mm, Size 9-19mm
BI120        Mallory Head Hip System                Femoral Stem, Calcar, HAP Coated,      220mm, Size 9-19mm
                                                    Titanium
BI121        Mallory Head Hip System                Femoral Stem, Calcar, HAP Coated,      260mm, Size 9-19mm
                                                    Titanium
BI122        Mallory Head Hip System                Trochanter Bolt, Titanium              Round/Oblong
BI123        Mallory Head Hip System                Trochanter Plate, Titanium             Sizes 40-70
BI124        Modular Calcar Mallory Head Revision   Trochanteric Claw, Titanium            Medium, Large
             Hip System
BI125        Modular Calcar Mallory Head Revision   Trochanteric Connector                 Sizes 40-70mm
             Hip System
BI126        Modular Calcar Mallory Head Revision   Femoral Component, Proximal.           34, 45, 55 resection levels x size
             Hip System                                                                    a,b,c,d,e
BI127        Modular Calcar Mallory Head Revision   Femoral Component, Distal. Titanium    170-300mm
             Hip System
BI128        Modular Calcar Mallory Head Revision   Femoral Component, Proximal,           34, 45, 55 resection levels x size
             Hip System                             Revision, HAP Coated. Titanium         a,b,c,d,e

Prostheses List February 2005                                                                                                                           Page 206 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                  Description                            Size                                       Benefit   Benefit    Notation
BI129        Mallory Head Hip System       Acetabular Cup, UHMWPE                 40-80mm
BI130        Bio-Plug Cement Restrictor    Canal Plug, UHMWPE                     10-20mm
BI131        Mallory Head Hip System       Femoral Sleeve, UHMWPE                 9-17mm
BI132        Mallory Head Hip System       Femoral Stem, Cobalt Chrome            7-19mm                                                          Also grouped in
                                                                                                                                                  Hip Group 2b
BI134        Mallory Head Hip System       Femoral Modular Head, Chrome Cobalt    28 to 38mm -6 to +12mm                                          Also grouped in
                                                                                                                                                  Hip Group 14b
BI135        Mallory Head Hip System       Femoral Stem, Revision, Titanium       250mm, size 7 to 19mm
BI136        Mallory Head Hip System       Femoral Stem, Revision, HAP Coated,    250mm, size 7 to 19mm
                                           Titanium
BI137        Mallory Head Hip System       Femoral Stem, Revision, Titanium       300mm, size 7 to 19mm
BI138        Mallory Head Hip System       Femoral Stem, Revision, HAP Coated,    300mm, size 7 to 19mm
                                           Titanium
BI139        Mallory Head Hip System       Femoral Stem, Primary, Titanium        7-19mm x 135 -180mm
BI140        Mallory Head Hip System       Acetabular Shell, Ringloc.             Size 1
                                           Replacement Ring, Titanium alloy
BI141        Mallory Head Hip System       Femoral Stem, Primary, HAP Coated,     7-19mm
                                           Titanium
BI144        Bio-Plug Cement Restrictor    Compression plug, PMMA                 Sizes 8-25mm
BI247        Bio-Plug Cement Restrictor    Bone Plug, HMWPE                       7-18mm
      Prostheses, Joint, Knee
BI031        Oxford Meniscal Knee System   Mark III Femoral Component, Chrome     Small, Medium, Large, Extra Large.
                                           Cobalt, Cemented
BI032        Oxford Meniscal Knee System   Mark III Tibial Bearing , UHMWPE       Small Standard, Large, Xlarge, sizes 3-9
BI033        Oxford Meniscal Knee System   Mark III Tibial Tray, Chrome Cobalt,   (38-53mm) x sizes 26-34
                                           Cemented
BI146        AGC Knee System               Revision System consisting of : Femoral 60-75mm, 80-120mm, 63-83 mm, 63-83
                                           Component; Femoral Stem, Femoral &       mm
                                           Tibial Augmentation; Tibial Component.,
                                           UHMW
BI147        AGC Knee System               Femoral Component, Anatomic,           55-80mm
                                           Chrome Cobalt
Prostheses List February 2005                                                                                                                    Page 207 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                         Description                                 Size                                     Benefit   Benefit    Notation
BI148        AGC Knee System                      Tibial Component, High Post Posterior       63-87mm
                                                  Stabilised, Chrome Cobalt, UHMWPE
BI149        AGC Total Knee System                Tibial Bearing, 'Tradition' Cruciate        59-91mm                                                       Also grouped in
                                                  Retaining, UHMWPE                                                                                         Knee Group 5c
BI150        AGC Knee System                      Femoral Component, Anatomic, Post.          55 to 80mm
                                                  Stabilised Chrome Cobalt
BI152        AGC Knee System                      Femoral Component, Universal, Chrome        55-80mm
                                                  Cobalt
BI153        AGC Knee System                      Tibial Component, Moulded, V2,              63-91mm
                                                  UHMWPE, Chrome Cobalt
BI158        AGC Knee System                      Femoral Prosthesis, Posterior Stabilised,   55-80mm
                                                  Universal. Chrome Cobalt
BI159        AGC Total Knee System                Femoral Prostheses, Anatomic, Porous        55-80mm
                                                  Coat, CoCr, Ti
BI165        AGC Total Knee System                Femoral Prostheses, Posterior               55-80mm
                                                  Stabilised, Uncemented, Chrome Cobalt
BI191        TRAC Knee System                     Femoral Component, Posterior                55-80mm                                                       Also grouped in
                                                  Stabilised CoCr                                                                                           Knee Groups 3f, 5d

BI192        TRAC Knee System                     Femoral Component, Porous, Posterior        55-80mm                                                       Also grouped in
                                                  Stabilised CoCr, Ti                                                                                       Knee Group 3l
BI193        Finn Knee System                     Resurfacing and Segmental System.           Segmental tibial 110 - 152, segmental
                                                  UHMWPE, Chrome Cobalt                       components (10-24cm) x (11-
                                                                                              17mmdiam) yoke std or long, lock pin,
                                                                                              locking screw (3), bushing (2)
                                                                                              axleFemoral Comp: R or L, std, +5cm
                                                                                              Mod. Stem 89, 152 x (9-22mm) Tibial
                                                                                              plate 67-81mm Tibial augment 67-83mm
                                                                                               Tibial insert 12-22mm
BI201        AGC Total Knee System - Dual         Femoral, Tibial, Bearing, Stems and         Size 55 to 75mm Fem, Size 59 to 83mm
             Articular Knee System                augments/wedges. Chrome Cobalt,              Bearing, Size 37 to 126mm stems, Size
                                                  UHMWPE                                      55 to 70mm augment, Size 63 to 91mm
                                                                                              tibial
BI202        Repicci II Unicondylar Knee System   Tibial Component, Cemented, UHMWPE 32-42mm


Prostheses List February 2005                                                                                                                              Page 208 of 700
ORTHOPAEDIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                         Description                              Size                                       Benefit   Benefit    Notation
BI203        Repicci II Unicondylar Knee System   Femoral Component, Cemented,             45-60mm
                                                  Chrome Cobalt
BI204        Repicci II Unicondylar Knee System   Tibia Plate, Modular, Cemented, Titanium Std, Large, Xlarge

BI205        Repicci II Unicondylar Knee System   Tibial Bearing, Modular, UHMWPE          Std, Large, Xlarge
BI821        AGC Total Knee System                Tibial augments, titanium                6-16mm
BI859        Oxford Meniscal Knee System          Mark III Femur, Porous or HA Coated,     Small - Extra Large
                                                  CoCr, Ti, HA.
BI860        Oxford Meniscal Knee System          Mark III Tibial Tray, HA or Porous       (38-53) x (26-34)mm
                                                  coated, CoCr, HA, Ti.
BI861        Oxford Meniscal Knee System          Mark III Tibial Bearing, Anatomic,       (Small - Extra Large) x (3-9)
                                                  UHMWPE.
BI863        AGC Knee System                      Tibial Component, Moulded, V2 Porous     (63-91) x (8-22)mm
                                                  coated UHMWPE, Chrome Cobalt, Ti
BI905        AGC Total Knee System                Tibial Bearing 'Tradition' Posterior     59-91mm
                                                  Stabilised, UHMWPE
BI906        TRAC Knee System                     Tibial Tray CoCr                         59 -91mm
BI907        TRAC Knee System                     Bearing Posterior Stabilised UHMWPE      59 - 91mm
BI908        TRAC Knee System                     Tibial Tray, Porous CoCr                 59 - 91mm
      Prostheses, Joint, Knee, Femoral Component
BI897        Vanguard Total Knee System           Femoral Component, Posterior             55, 57.5, 60, 62.5, 65, 67.5, 70, 75, 80
                                                  Stabilised, Cemented, anatomic, CoCr.    Left and Right
BI898        Vanguard Total Knee System           Femoral Component, CR, Cemented,         55, 57.5, 60, 62.5, 65, 67.5, 70, 75, 80
                                                  anatomic, CoCr.                          Left and Right
BI902        ROCC Knee Prosthesis                 Femoral Component, cemented,             1-8
                                                  anatomic, CoCr
      Prostheses, Joint, Knee, Patellar Component
BI899        ROCC Knee Prosthesis                 Patella Component, all PE, cemented, 1   1-8
                                                  peg, UHMWPE
BI901        ROCC Knee Prosthesis                 Patella Component, rotating,             1-8
                                                  uncemented, 3 pegged, HA or Porous
                                                  HA, CoCr, UHMWPE, Ti, HA

Prostheses List February 2005                                                                                                                             Page 209 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                  Description                              Size                                      Benefit   Benefit    Notation
BI903        ROCC Knee Prosthesis          Patella Component, rotating, cemented,   1-8
                                           3 pegged, CoCr, UHMWPE
      Prostheses, Joint, Knee, Tibial Component
BI900        ROCC Knee Prosthesis          Tibial Baseplate, uncemented, HA         1-8
                                           coated or Porous HA coated, CoCr, Ti,
                                           HA, UHMWPE
BI904        Vanguard Total Knee System    Tibial Bearing, PS, UHMWPE               59, 63/67, 71/75, 79/83, 87/91, widths,
                                                                                    10. 12, 14, 16, 18, 20, 22, 24mm
                                                                                    thicknesses
      Prostheses, Joint, Knee, Total
BI167        Maxim Complete Knee System    Primary Anatomic Femoral,                55-80mm
                                           Uncemented, Chrome Cobalt
BI168        Maxim Complete Knee System    Primary Anatomic Femoral, Cemented,      55-80mm
                                           Chrome Cobalt
BI169        Maxim Complete Knee System    Tibial Plate Primary, Cemented, Titanium 59-91mm
BI170        Maxim Complete Knee System    Tibial Plate Primary, Uncemented,        59-91mm
                                           Titanium
BI171        Maxim Complete Knee System    Tibial Stem, Titanium                    40mm 80mm
BI172        Maxim Complete Knee System    Tibial Bearing Primary, UHMWPE           59-91mm
BI173        Maxim Complete Knee System    Tibial Locking Bar, Titanium             One size only
BI174        Maxim Complete Knee System    Femoral Component, Posterior             55-80mm
                                           Stabilised, Porous, Chrome Cobalt
BI175        Maxim Complete Knee System    Femoral Component, Constrained ,         55-80mm
                                           Porous Chrome Cobalt
BI176        Maxim Complete Knee System    Patella Button, UHMWPE                   size 25 to 37mm
BI177        Maxim Complete Knee System    One Piece Revision Tibial Plate and      59-91mm
                                           Stem Boss, Ti
BI178        Maxim Complete Knee System    Femoral Component, Posterior             55-80mm
                                           Stabilised Anatomic Chrome Cobalt
BI179        Maxim Complete Knee System    Tibial Bearing, Posterior Stabilised     59-91mm
                                           UHMWPE
BI180        Maxim Complete Knee System    Constrained Anatomic Femoral             60-75mm
                                           Component, Anatomic. Chrome Cobalt
Prostheses List February 2005                                                                                                                     Page 210 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                          Description                              Size                                       Benefit   Benefit    Notation
BI181        Maxim Complete Knee System            Tibial Bearing, Contrained. UHMWPE       59-91mm
BI182        Maxim Complete Knee System            One Piece Tibial Plate and Stem, CoCr.   59-91mm
BI183        Maxim Complete Knee System            Tibial Femoral Wedge or Augmentation     55-80mm
                                                   Block, Titanium
BI184        Maxim Complete Knee System            Tibial or Femoral Stem, Modular,         55-80mm
                                                   Titanium
BI185        Maxim Complete Knee System            Femoral Component, HA Coated,            55-80mm
                                                   Chrome Cobalt
BI186        Maxim Complete Knee System            Tibial Tray, HA Coated, Ti               59 - 91mm
BI194        Oxford Tricompartmental Knee System   Patella Button, UHMWPE, Chrome           Size 25 to 37mm
                                                   Cobalt
BI195        Oxford Tricompartmental Knee System   Femoral Component, Posterior             60-75mm                                                         Also grouped in
                                                   Stabilised, Cemented, CoCr                                                                               Knee Groups 1k,
                                                                                                                                                            1n
BI196        Oxford Tricompartmental Knee System   Tibial Component, Chrome Cobalt          63-87mm
BI197        Oxford Tricompartmental Knee System   Tibial Bearing, UHMWPE                   60-75mm
BI771        Oxford Tricompartmental Knee System   Tibial component, Porous, CoCr, Ti       63-87mm                                                         Also grouped in
                                                                                                                                                            Knee Group 3m
BI810        Maxim Complete Knee System            Tibial bearing & tray, ' Pop Top'        51-91mm                                                         Also grouped in
                                                   Cruciate Retaining, CoCr UHMWPE                                                                          Knee Group 3d
BI811        Maxim Complete Knee System            Offset tibial tray & adapter, fixation   Width 59-91mm offset tibial trays
                                                   screws, chrome cobalt, titanium          neutral; 2.5mm, 5.0mm offset tibial tray
                                                                                            adapters
BI892        Rotating Hinge Knee (RHK)             Femoral Component, Resurfacing,          Small, Standard, Large; Left and Right
                                                   cemented,anatomic, CoCr
BI909        Oxford Tricompartmental Knee System   Tibial Component, Porous, HA Coated,     63 - 87mm
                                                   CoCr, Ti, HAP
BI910        Oxford Tricompartmental Knee System   Femoral Component, Posterior             60 - 75mm
                                                   Stabilised, Porous, CoCr, Ti
BI912        Maxim Complete Knee System            Tibial bearing & tray, 'Pop Top'         51 - 91mm
                                                   Posterior Stabilised, CoCr UHMWPE
      Prostheses, Joint, Shoulder
BI207        Bi-Angular Shoulder System            Humeral Prostheses, Titanium             6.5mm-14mm
Prostheses List February 2005                                                                                                                              Page 211 of 700
ORTHOPAEDIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                           Description                               Size                                 Benefit   Benefit    Notation
BI208        Bi-Angular Shoulder System             Bi Polar Shell, Titanium/                 Size 40-60mm
                                                    UHMWPE/Chrome Cobalt
BI209        Bi-Angular Shoulder System             Bi Polar Head, Chrome Cobalt              Std to +4mm
BI210        Bi-Angular Shoulder System             Glenoid Metal backed. UHMWPE,             Small Medium Large x 4 or 7mm
                                                    Titanium
BI211        Bi-Angular Shoulder System             Glenoid, UHMWPE                           Small Medium Large x 4 or 7mm
BI212        Bi-Angular Shoulder System             Humeral Head, Chrome Cobalt               40-52mm
BI213        Bio-Modular Shoulder System            Bi-Polar cup                              40-60mm
BI214        Bio-Modular Shoulder System            Bi-Polar shell/ Titanium, chrome Cobalt   40-60mm
BI215        Bio-Modular Shoulder System            Humeral Head, Chrome Cobalt               40-54mm
BI216        Bio-Modular Shoulder System            Humeral Stem, titanium                    6-15mm
BI217        Bio-Modular Shoulder System            Glenoid Component, Cemented,              Small, Medium, Large x 4 or 7mm
                                                    Titanium/UHMWPE
BI218        Bio-Modular Shoulder System            Modular Head, Chrome Cobalt               Std, +2, +4mm
BI219        Bio-Modular Shoulder System            Glenoid Liner Noncemented,                Low Profile
BI220        Bio-Modular Shoulder System            Glenoid Screw                             5mm x (15-40mm)
BI221        Bio-Modular Shoulder System            Glenoid Shell, Titanium                   Low Profile
BI222        Bio-Modular Shoulder System            Shoulder Offset Head, Chrome Cobalt       40-54mm
BI223        Nottingham Shoulder System             Humeral Stem, Chrome Cobalt,              6-12mm
BI224        Nottingham Shoulder System             Humeral Head, Chrome Cobalt               Std +2, +4mm
BI225        Nottingham Shoulder System             Glenoid Tray, Chrome Cobalt               Size 3, 4, 5.
BI226        Nottingham Shoulder System             Glenoid Bearing, UHMWPE                   Size 3, 4, 5.
BI227        Kirschner Integrated Shoulder System   Neer II Humeral, Chrome Cobalt,           Stem 6.3 to 12.7mm Head 15-22mm
                                                    UHMWPE
BI228        Kirschner Modular Shoulder             Humeral Head, Modular, Chrome Cobalt      38-51mm
BI229        Kirschner Modular Shoulder             Humeral Stem, Chrome Cobalt               6.3 -15.9mm
BI230        Kirschner Modular Shoulder             Glenoid Component, UHMWPE                 Small, Std
BI231        Humeral Replacement System             Proximal Shoulder System: Chrome          Body: std, +10mm Stem 6.5-12.5mm
                                                    Cobalt, Titanium, UHMWPE                  Sleeve 6.5-12.5mm Humeral Head 40-
                                                                                              52mm

Prostheses List February 2005                                                                                                                          Page 212 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                        Description                               Size                                        Benefit   Benefit    Notation
BI342        Copeland Shoulder System            Glenoid, UHMWPE                           One size only
BI343        Copeland Shoulder System            Humeral, Chrome Cobalt                    Small, Std, Large (no specific size)
BI344        Copeland Shoulder System            Glenoid Component, HA Coated,             Small, Std, Extra Deep (no specific size)
                                                 Chrome Cobalt, UHMWPE
BI345        Copeland Shoulder System            Humeral Component, Chrome Cobalt          Small, Std, Large (no specific size)
BI835        Bio-Modular Shoulder System         Extended Articular Surface Humeral        40 - 54mm
                                                 Head, CrCo
BI880        Mosaic Humeral Replacement System   Mosaic System - CoCr, Ti                  Proximal Body - Std to +20
BI881        Mosaic Humeral Replacement System   Mosaic System - CoCr, Ti                  Segment - 80 to 140 mm
BI882        Mosaic Humeral Replacement System   Mosaic System - CoCr, Ti                  Stem - 6.5 to 14.5 mm x 50 to 200 mm
      Prostheses, Joint, Toe
BI021        Total Toe System                    Metatarsal Component UHMWPE,              Small, Medium, Large Extra Large.
                                                 Titanium
BI022        Toe Joint Replacement               Phalangeal Component, Titanium            Small, Medium, Large Extra Large.
      Prostheses, Leg
BI166        Compress Finn Limb Salvage System   Distal Femoral Replacement: Anchor        15 plugs, 9 segments, 8 pins, 14 sleeves,
                                                 Plug, Femoral segment, transverse pins,    26 spindles
                                                 centering sleeves, spindle. Chrome
                                                 Cobalt.
      Prosthesis, Internal, Joint, Hip, Acetabular Component
BI878        Freedom Constrained Liner           Constrained Acetabular Liner -            23 to 62
                                                 UHMWPE, Ti
      Prosthesis, Internal, Joint, Hip, Hemi
BI875        Endo II Head                        Modular Head - CoCr                       41 mm through 61mm
BI876        Endo II Head                        Modular Head Taper Insert - CoCr          -6mm to +6mm
      Prosthesis, Internal, Joint, Knee, Total
BI890        Rotating Hinge Knee (RHK)           Augments, Femoral and Tibial, CoCr, Ti    Femoral; 10, 20, 30mm LL, LM, RL,
                                                                                           RM, Tibial; 10, 15mm RM/LL, RL/LM,
                                                                                           20mm
BI891        Rotating Hinge Knee (RHK)           Resurfacing Tibial Tray, Modular and      Stemmed 59, 63, 67, 71mm widths;
                                                 Stemmed                                   Modular 59, 63, 67, 71, 75, 79, 83mm
                                                                                           widths
Prostheses List February 2005                                                                                                                              Page 213 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                          Description                               Size                                       Benefit   Benefit    Notation
BI893        Rotating Hinge Knee (RHK)             Interlocking Components: Bearing          Bearing Insert - 12, 14, 16, 18, 20mm
                                                   Insert, Yoke, Tibial and Femoral          thicknesses, Yoke - short and long, Axle
                                                   Bushings, Axle, Axle Locking Pin,          - one size, Axle Lock Pin - one size,
                                                   UHMWPE, Ti, CoCr                          Tibial and Femoral Bushings - one size

      Prosthesis, Internal, Joint, Knee, Unicondylar
BI871        Vanguard unicondylar Knee System      Tibial Component, CoCr UHMWPE             (A-E) x (5-8)
      Prosthesis, Internal, Joint, Shoulder, Total
BI884        Comprehensive Fracture Stem           Fracture Stem Cobalt Chrome, Titanium     4,6,8,10,12,14mm
      Prosthesis, Internal, Knee, Femoral Component
BI864        Orthopaedic Salvage System            Stem, Cemented or Porous, Ti              (9-19)mm diameter x (90-300)mm length
BI865        Orthopaedic Salvage System            Femoral Component, Resurfacing or         30 - 70mm
                                                   Segmental, CoCr,Ti
BI866        Orthopaedic Salvage System            Femoral or Tibial Augment, Ti             Femoral Sleeve - One Size; Femoral
                                                                                             Flange - One Size; Tibial Block
                                                                                             Augment 10-20mm; Tibial Augment
                                                                                             Sleeve - Small/Large
BI868        Orthopaedic Salvage System            Diaphyseal Segment or Diaphyseal          Diaphyseal Segment 3-23cm,
                                                   Coupler, Stacking Adapter and Locking     Diaphyseal coupler 10-30cm
                                                   Screws, Ti
BI886        Vanguard Total Knee System            Femoral Component, CR, uncemented,        55, 57.5, 60, 62.5, 65, 67.5, 70, 75, 80
                                                   anatomic, CoCr, Ti                        Left and Right
BI887        ROCC Knee Prosthesis                  Femoral Component, uncemented,            1-8
                                                   anatomic, HA Coated, CoCr, HA
BI911        Oxford Tricompartmental Knee System   Femoral Component, Posterior              60 -75mm
                                                   Stabilised, Porous, HA Coated, CoCr,
                                                   Ti, HAP
      Prosthesis, Internal, Knee, Tibial Component
BI867        Orthopaedic Salvage System            Femoral/Tibial Interlocking               One size only except for Locking Screw
                                                   devices:Locking Pin, Femoral and Tibial    - Small or Large; Tibial Bearing - 12-
                                                    Bushings, Tibial Bearing, Axle,          22mm
                                                   Reinforced Yoke, Locking Screws.
                                                   CoCr, Ti


Prostheses List February 2005                                                                                                                               Page 214 of 700
ORTHOPAEDIC                                                                                                                              Minimum   Maximum
Billing Code Product Name                       Description                                Size                                          Benefit   Benefit    Notation
BI869        Orthopaedic Salvage System         Tibial Component, Resurfacing or           63-83mm
                                                Segmental, Modular and non Modular,
                                                CoCr, Ti
BI885        ROCC Knee Prosthesis               Rotating Platform Bearing, ARCOM           1-6 (tray size), 10-20mm (bearing size)
                                                UHMWPE
BI888        Vanguard Total Knee System         Tibial Bearing, CR, curved or lipped,      59, 63/67, 71/75, 79/83, 87/91 widths, 10,
                                                UHMWPE                                      12, 14, 16, 18, 20mm thicknesses
BI894        ROCC Knee Prosthesis               Tibial Baseplate, Cemented, Chrome         1-8
                                                Cobalt, UHMWPE
      Screws
BI005        Re-Unite Orthopaedic System        Rotator Cuff Butress, Lactosorb;           One size only
                                                PGA/PLA
BI012        Re-Unite Orthopaedic System        Pop-Rivet - PGA/PLA                        One size only
BI241        Gentle Threads Ligament Fixation   Screw, Graft Interference, PGA/PLA         7mm, 8mm, 9mm, 10mm
             Screws
BI278        Re-Unite Orthopaedic Screws        Screw, PGA/PLA                             (2-5)mm dia x (5-70)mm
BI279        Re-Unite Orthopaedic System        Plates, PGA/PLA                            4 - 7 hole
BI808        Reunite Orthopaedic System         Plate, dorsal or volar, PGA/PLA            Dorsal - long, small; Volar - one size only
BI822        Reunite Orthopaedic System         Sheet, mesh panel PGA/PLA                  50-75mm square
BI826        Meniscal Screw                     Screw PGA/PLA                              One size only
      Screws, Bone
BI143        Compression Screw Set              Supracondylar Plate, Stainless Steel       6-14 hole
BI309        Compression Hip Screw              Plate, Titanium                            2-14 hole x 53-257mm
BI311        Compression Hip Screw              Support Screw, Titanium, Stainless Steel   4.5 - 6.5 x (14-70mm)
BI312        Compression Hip Screw              Lag Screw, Titanium, Stainless Steel       12.7, 15mm x (55-150mm)
BI313        Cannulated Screws                  Fixator, Ulson, Complete Stainless Steel   25mm x 135-200mm
BI314        Cannulated Screws                  Fixator, Ulson, Clamp Assembly             One size only
BI315        Compression Hip Screw              Plate, Stainless Steel                     25-38mm x 2-7 hole for use with plate
                                                                                           size 50-150mm
BI316        Compression Hip Screw              Plate, Stainless Steel                     25-38mm x 8-14 hole for use with plate
                                                                                           size 50-150mm

Prostheses List February 2005                                                                                                                                Page 215 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                       Description                                Size                                      Benefit   Benefit    Notation
BI317        Compression Hip Screw              Lag Screw, Stainless Steel                 12.5,14mm x (50-150mm)
BI318        Compression Hip Screw              Cortical Screws Pk 10, Stainless Steel     2.7-4.5mm x (10-140mm)
BI319        Compression Hip Screw              Compression Screw                          1.5-4.5 x (6-70mm)
BI321        Cannulated Screws (Various)        Ulsan Fixator, Percutaneous Pins (Pair)    135, 200mm
BI820        EBI XFIX DynaFix System            Screw, HA coated, cortical, cancellous     Dia 2-6mm
      Stimulators, Bone Growth
BI245        EBI Bone Healing System            DC Generator, Titanium, Platium, Silver,   1, 2 or 4 lead models
                                                Silicone
      Wires, Bone, Implantable
BI857        Kirschner Wires                    Stainless Steel wire                       (1-3.2mm) diameter x (100 to 310mm)                            To be funded
                                                                                           length                                                         where any or all
                                                                                                                                                          K-wires used in a
                                                                                                                                                          procedure are
                                                                                                                                                          used as an implant.
Corin Australia Pty Ltd
      Cement, Orthopedic
CR055        Coriplast 1                        Acrylic bone cement standard vicosity      One size only
CR056        Coriplast 3                        Acrylic bone cement low vicosity           One size only
      Fixation Device
CR070        Alpha Lock Titanium Counter Sunk   Titanium Counter Sunk Screw                Length (mm) 15, 20, 25, 30, 35, 40, 45,
             Screw                                                                         50, 55, 60, 65 & 70
CR071        Alpha Lock, Locking Screw          Locking Screw, Titanium                    One Size Only
      Orthopedic Internal Fixation Systems, Fracture
CR046        FixClip                            Stainless Steel Clip to hold Wires,        0.75mm - 4mm
                                                Screws & Nails
      Plates, Bone
CR039        Corifix Compression Plate System   T Plate, Stainless Steel                   3,4 or 5 holes
CR052        Corifix Compression Plate System   1/3 Tubular Plates                         6-8 holes
      Prostheses, Femoral, Upper
CR040        Dynamic Hip Screw                  Stainless steel lag screw                  50mm -145mm length

Prostheses List February 2005                                                                                                                            Page 216 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                          Description                             Size                                 Benefit   Benefit    Notation
CR053        Corifix Dynamic Hip Screw System      Dynamic Hip Compression Plate 135       2 or 4 hole
                                                   Deg Stainless Steel
      Prostheses, Joint, Hip
CR016        Cormet 2000 - Modular Endo Head       CoCr alloy                              Short 40mm - Long 56mm
CR017        Cormet 2000 Resurfacing Hip System    Resurfacing femoral head Cobalt         Dia 40 - 56mm
                                                   chrome HAP coated
CR018        DC Fit Cup Metal Backed               Cemented CoCr cup with UHMPWE           38-62mm
                                                   spacers
CR019        DC Fit Cup Metal Backed               CoCr cup, Cor plasma spray with HAP     42mm-70mm
                                                   coating, with/without screws
CR020        Metalok Femoral Head                  Carbon Cobalt Chrome Alloy              Head 28mm (short/med/long neck)
CR021        Freeman -Morgan Stem - Special Ti -   TiAlloy with HAP Coat                   14mm-22mm
             Dual Coat
CR022        DC Fit Cup Metal Backed               Acetabular Liner 0 & 10 deg offset      Sz 1- Sz 6
CR023        Freeman -Morgan Stem, Special Ti -    Ti Alloy                                12-22mm
             Mod Smooth
CR041        Hardinge Canal Occluder               UHMWPE                                  One size only
CR042        Cenator Hip System                    Acetabular Cup, Ultra High Molecular    Dia 40 - 62mm, 22, 26, 28 heads
                                                   weight Polyethylene
CR044        Taper Fit Hip System                  Canal Occluder Polymethyl Methacrylate Small & Standard
CR045        Femoral Head                          Stainless Steel Modular Femoral Head   Dia 22, 26, 28 & 32mm, Short, Std,
                                                                                          Long & Extra Long Neck Length
CR047        Cormet 2000 Resurfacing Hip           Resurfacing femoral head Cobalt         Dia 40 -56mm
                                                   chrome cemented
CR048        Cormet 2000 Resurfacing Hip           Acetabular cup for resurfacing head     Dia 40 -56mm
                                                   Cobalt chrome TiAlloy and HAP bicoat
CR054        DC Fit Acetabular Cup System          Bone screw, cancellous CoCr             Diameter 6.5mm, length 10-50mm
CR081        Oxford Hip System                     Cement Wiper                            One size only
CR082        Oxford Hip System                     Distal Stem Revision                    250mm 60mm Split, Diameter 12 -                           Also grouped in
                                                                                                                                                     Hip Group 6h
CR083        Oxford Hip System                     Distal Stem Revision                    300mm 60mm Split, Diameter 12-20mm                        Also grouped in
                                                                                                                                                     Hip Group 8h
Prostheses List February 2005                                                                                                                       Page 217 of 700
ORTHOPAEDIC                                                                                                                                   Minimum   Maximum
Billing Code Product Name                            Description                                Size                                          Benefit   Benefit    Notation
CR084        Modular Endo Heads                      Modular Endo Head is made of Cobalt        41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51,
                                                     Chrome                                     52, 53, 54, 55, 56, 58, & 60mm
CR087        Cormet Dysplasia Cup                    High Carbon Cobalt Chrome                  48, 52, 56, 60, 64mm
      Prostheses, Joint, Hip, Acetabular Component
CR062        Metal Insert for Alpha Cera Fit Cup     Endocast SL                                28mm Inner Diameter for 48-74mm
CR063        Ceramic Insert for Alpha Cera Fit Cup   Biolox Forte                               28mm Inner Diameter for 48-74mm
CR072        Alpha Lock, Plug Screw                  Plug Screw, Titanium                       One Size Only
CR073        Alpha Lock, (UHMWPE) Inlays             UHMWPE Inlays 28mm                         28mm x 48 - 70mm
CR074        Alpha Lock Plus Titanium Hip Cup        Titanium hip cup with special pre-closed   42 - 70mm Diameter
                                                      fixation holes for self-tapping counter
                                                     sunk screws, UHMWPE inlay.
CR075        PE Inserts for Alpha Cera Fit Cups      (UHMWPE) Ultra High Molecular              22-28mm Diameter for cup sizes: 42-
             (UHMWPE)                                Weight Polyethylene                        74mm
      Prostheses, Joint, Hip, Femoral Component
CR064        Ball Heads 12 - 24 Taper (Tin Coated)   Tin Coated (Titanium Nitride)              28mm x Small; 28mm x Medium; 28mm
                                                                                                 x Large; 28mm x XLarge; 28mm x
                                                                                                XXLarge; 28mm x XXXLarge
CR065        Ball Heads 12 - 14 Taper (Alumina)      Alumina Ball Head (28mm)                   28mm x Small; 28mm x Medium; 28mm
                                                                                                 x Large; 28mm x XLarge; 28mm x
                                                                                                XXLarge; 28mm x XXXLarge
CR066        Ball Heads 12 - 14 Taper (Endocast)     Forged Metal (Endocast SL)                 28mm x Small; 28mm x Medium; 28mm
                                                                                                 x Large; 28mm x XLarge; 28mm x
                                                                                                XXLarge; 28mm x XXXLarge
CR067        (ZrOz) Ball Heads 12 - 14 Taper         Zirconia (ZrOz) Ball Head 28mm             28mm x Small; 28mm x Medium; 28mm
             (Zirconia)                                                                          x Large; 28mm x XLarge; 28mm x
                                                                                                XXLarge; 28mm x XXXLarge
CR068        Alpha Cera Fit Hip (Stem) Prostheses    Titanium Alloy with Titanium Plasma &      8mm - 22mm Diameters; 128mm -
             12-14 Taper                             Bonit Coating in the Proximal Area         176mm Lengths; Standard and
                                                                                                Proximally Modified
CR069        Alpha Fit Hip (Stem) Prostheses 12-14   Titanium Alloy with Titanium Plasma &      7.5mm - 20mm Diameters; 120mm -
             Taper                                   Bonit Coating in the Proximal Area         160mm Lengths; Standard, Proximally
                                                                                                Modified, Mini; L43 - L49 Offsets



Prostheses List February 2005                                                                                                                                     Page 218 of 700
ORTHOPAEDIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                             Description                              Size                                   Benefit   Benefit    Notation
CR086        Tri-Fit Hip                              Titanium stem proximally coated with     6, 7.5, 10, 12.5, 15, 17.5 & 20mm
                                                      titanium plasma spray and
                                                      Hydroxyapartite
      Prostheses, Joint, Hip, Total
CR024        Taper Fit Hip System                     Double taper stainless steel total hip   sizes 1-4
CR025        Cenator Total Hip System                 Femoral stem CoCr                        Stems ex-narrow, narrow, std & large
                                                                                               Cups heads 22,26,28mm OD40-52mm
CR026        Cenator Total Hip System                 Femoral stem polished Co cr              Stems ex-narrow, narrow,std & large
                                                                                               Cups heads22,26,28mm OD40-52mm
CR027        Freeman -Morgan Total Hip System         Canal occluder                           12,14,16mm diameter
CR028        Femoral Head 28mm                        Zirconia ceramic                         22,26,28,32mm
CR029        Femoral Head 28mm                        CoCr modular femoral                     22,26,28,32mm
CR030        Freeman -Morgan Total Hip System         Stem: modular cemented CoCr              14mm-22mm diameter
CR076        Oxford Universal Hip System              Proximal femoral stem CoCr               Extra small to Large                                        Also grouped in
                                                                                                                                                           Hip Group 4a, 6h,
                                                                                                                                                           8h
CR077        Oxford Universal Hip System              Proximal femoral stem Cocr -HAP          Extra small to Large                                        Also grouped in
                                                                                                                                                           Hip Group 4a, 6h,
                                                                                                                                                           8h
CR078        Oxford Universal Hip System              Distal femoral stem Cocr                 10mm-20mm diameter,120-150mm length                         Also grouped in
                                                                                                                                                           Hip Group 6h
CR079        Oxford Universal Hip System              Distal stem lock nut                     One size only
CR080        Oxford Universal Hip System              Cement restrictor                        22, 26, 28 & 32mm
      Prostheses, Joint, Knee
CR001        Rotaglide + Total Knee System, Tibial    Latched, Porous Coat                     Ex Sml - Ex Lge
             Component
CR003        Rotaglide + Total Knee System, Stem      Cobalt chrome                            30mm - 70mm
             Extensions
CR004        Rotaglide + Total Knee System            Tibial Augmentation Blocks               Small 4mm - Large12mm
CR005        Rotaglide + Total Knee System, Patella   Asymmetric                               Sml (35/29mm)) - Lg (43/37mm)
             UHMWPE


Prostheses List February 2005                                                                                                                             Page 219 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                             Description                              Size                           Benefit   Benefit    Notation
CR006        Rotaglide + Total Knee System, Patella   Dome                                     Sml (26mm OD) - Lg (34mm OD)
             UHMWPE
CR007        Rotaglide + Total Knee System, Tibial    Mobile                                   7mm - 17mm
             Insert UHMWPE
CR008        Rotaglide + Total Knee System, Tibial    Fixed                                    9.5mm - 17mm
             Insert UHMWPE
CR009        Rotaglide + Total Knee System, Tibial    Latched, HAP Coat                        Ex Sml - Ex Lge                                     Also grouped in
             Component                                                                                                                             Knee Group 3m
CR010        Rotaglide + Total Knee System, Tibial    Latched, Cemented                        Ex Sml - Ex Lge
             Component
CR011        Rotaglide + Total Knee System,           Pegged, Hap Coat                         Ex Sml - Ex Lge                                     Also grouped in
             Femoral Component                                                                                                                     Knee Group 1n
CR012        Rotaglide + Total Knee System,           Pegged, Porous Coat                      Ex Sml - Ex Lge                                     Also grouped in
             Femoral Component                                                                                                                     Knee Group 1k
CR013        Rotaglide + Total Knee System,           Pegged, Cemented                         Ex Sml - Ex Lge                                     Also grouped in
             Femoral Component                                                                                                                     Knee Group 1b
CR014        Rotaglide + Total Knee System,           Stemmed, HAP Coat                        Ex Sml - Ex Lge                                     Also grouped in
             Femoral Component                                                                                                                     Knee Group 1n
CR015        Rotaglide + Total Knee System,           Stemmed, Cemented                        Ex Sml - Ex Lge                                     Also grouped in
             Femoral Component                                                                                                                     Knee Group 1b
      Prostheses, Joint, Knee, Femoral Component
CR058        AMC Uni Condylar, Femur                  Femoral Component, Cobalt Chrome,        1-4
             Component, Bonit Coat                    Titanium Nitrate Ceramic Coated, Bonit
                                                      (Calcium Phosphate) ingrowth surface
CR059        AMC Uni Condylar, Cemented Femur         Cemented Femur, Cobalt Chrome with       1-4
                                                      Titanium Nitrite Coating
      Prostheses, Joint, Knee, Tibial Component
CR057        AMC Uni Condylar Tibial Component -      Tibial Base Plate, Cobalt Chrome,        1-8
             Bonit Coat                               Titanium Nitrate Ceramic Coated, Bonit
                                                      (Calcium Phosphate) Ingrowth Surface
CR061        AMC Uni Condylar, Cemented Tibial        AMC Uni Condylar Tibial Component        Sizes 1 - 8 inclusive
             Base Plate                               (CoCr) Cemented with Titanium Nitrite
                                                      Ceramic Coating


Prostheses List February 2005                                                                                                                     Page 220 of 700
ORTHOPAEDIC                                                                                                                               Minimum   Maximum
Billing Code Product Name                         Description                               Size                                          Benefit   Benefit    Notation
      Prostheses, Joint, Knee, Total
CR060        AMC Uni Condylar, Tibial Insert      UHMWPE Bearings                           Height 4, 5, 6, 7, 8, 9, 10, 11, 12mm;
             Bearings                                                                       Size 1-4
      Prostheses, Ligament
CR032        Lars Ligamanet Augmentation          Woven polyester prosthetic ligaments      60,80,100 & y shaped fibres
             reconstruction system
      Prostheses, Radial Head
CR002        Corifix Radial Head Implant          Cobalt chrome                             Small - Large
      Prosthesis, Internal, Hip, Joint, Total
CR085        Alpha Cera Fit Hip Cup               Cup is made of High Grade Titanium        42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62,
                                                  Alloy with Bonit coating                  64, 66, 68, 70, & 74mm
      Screws, Bone
CR031        Corifix Ligament Anchor Soft Screw   Titanium rounded thread cannulated        7,8,9,10mm diam :20-35mm length
                                                  ligament screw
CR033        Corifix Bone Screw                   Titanium interforence screw for use       7,8,9,mm diameter 25-30mmlength
                                                  with above L.A.D
CR034        Corifix Bone Screw                   Stainless steel - screw bone cannulated   3.5mm diam 20-60mm length
CR035        CorifixCortical Screw                Stainless steel screw                     2.7mmD 6-40mm L
CR036        Corifix Bone Screw                   Cancellous Bone Screw 4.0mmShort          10-55mm
                                                  Thread, Stainless Steel
CR037        Corifix Cortical Screw               Stainless steel screw                     4.5mmD 12-70mmL
CR038        Corifix Cancellous Screw             Cancellous Bone Screw 6.5mm, Full         10-55mm
                                                  Thread, Stainless Steel
CR049        Corifix Bone Screw                   Cannulated Bone Screw 7.0mm Long          35-130mm
                                                  Thread, Stainless Steel
CR050        Corifix Bone Screws                  Cancellous Bone Screw 4.0mm Full          10-26mm
                                                  Thread, Stainless Steel
CR051        Corifix Bone Screws                  Cancellous Bone Screw 6.5mm Long          25 -105mm length
                                                  Thread, Stainless Steel
      Washers, Bone Screw
CR043        Corfix Washer for Bone Screws        Washer for Bone Screws, Stainless         Small 7mm & Large 13mm

Prostheses List February 2005                                                                                                                                 Page 221 of 700
ORTHOPAEDIC                                                                                                            Minimum   Maximum
Billing Code Product Name                       Description                         Size                               Benefit   Benefit    Notation
De Puy Australia
      Bone Matrix Implants, Artificial
DY353        Conduit TCP                        Bone matrix implant                 10cc
DY354        Conduit TCP                        Bone matrix implant                 15cc
DY355        Conduit TCP                        Bone matrix implant                 30cc
DY361        Conduit TCP                        Conduit Blocks                      Size 1. 15x15x20mm to 25x25x20mm
DY362        Conduit TCP                        Conduit Cylinder                    H8-14 x D16-20mm
DY363        Conduit TCP                        Conduit Wedge                       H6-18 x D15 x L15
DY364        Conduit TCP                        Conduit                             20cc
DY427        Conduit TCP                        Bone matrix implant                 5cc
DY428        Conduit TCP                        Bone matrix implant                 20cc
      Caps, Bone
DY098        Moss Miami (Titanium)              Pin Nut                             One size only
      Cement, Orthopedic
DP107        CMW Bone Cement                    CMW Bone Cement Various without     20, 40 grams
                                                Antibiotic
DP108        CMW Antibiotic Bone Cement         CMW Bone Cement Various with        20, 40 grams
                                                Antibiotic
DP919        CMW Endurance Gentamicin Cement    CMW Endurance Gentamicin Cement     20, 40, 60, 80 grams
DY061        Calcium Phosphate Cement           Bio Fill Cement                     One size only
DY084        A-BSM Bone Cement                                                      2.5g
DY085        A-BSM Bone Cement                                                      5.0g
DY086        A-BSM Bone Cement                                                      10.0g
DY097        Vetebrplastic Cement                                                   One size only
      Collars
DP012        Wroblewski Resection Stem Collar   -                                   2.0cm - 10.0cm
      Device Kits With Drugs
DP445        Vacu Mix Plus CMW Cement           Vacu-Mix Plus Pre Loaded With CMW   50, 80 grams
                                                Bone Cement with Antibiotic

Prostheses List February 2005                                                                                                              Page 222 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                      Description                             Size                              Benefit   Benefit    Notation
DY199        Cemvac Ultra Prepacked with CMW   Cemvac Cement Various Without           60, 100 grams
                                               Antibiotic
DY200        Cemvac Ultra Prepacked with CMW   Cemvac Cement Various With Antibiotic 60, 100 grams
      Electromanometers
DP447        Biosel 2                          BIOSEL II Dose 5G (Calcium              5g
                                               Phosphates)
      Fixation Device
DY332        Summit Cervical Rod System        Occipital Plates "Y" or "T"             31-45mm
DY333        Summit Cervical Rod System        Occipital Bone Screw                    4.5 - 5.25 Dia x 6 -16mm length
DY334        Summit Cervical Rod System        Transition Rod                          3.0/4.0/3.0mm
DY335        Summit Cervical Rod System        Dual Diameter Rod                       3x150mm/4.75 - 5.5mm x 270mm
DY336        Summit Cervical Rod System        Cross Connector                         One size only
DY337        Summit Cervical Rod System        Open Cable Connector                    One size only
DY338        Summit Cervical Rod System        Cancellous Bone Screw                   3.5-4.5mm x 12-48mm
DY339        Summit Cervical Rod System        Mini Polyaxial Screw Standard or High   3.5mm x 12-50mm
DY340        Summit Cervical Rod System        Mini Polyaxial Outer Nut                One size only
DY341        Summit Cervical Rod System        Pin Nut with Flange or No Flange        One size only
DY342        Summit Cervical Rod System        Connectors Left or Right or Neutral     One size only
DY343        Summit Cervical Rod System        Rod                                     3mm x 70-200mm
DY344        Summit Cervical Rod System        Transverse Connector Hook               One size only
DY345        Summit Cervical Rod System        Transverse Connector Screw              One size only
DY346        RECO Spinal System                Pedicale Screw                          4-7mm
DY347        RECO Spinal System                Block                                   4-7mm
DY348        RECO Spinal System                Rod                                     4 or 6mm dia x 70-130mm
DY349        RECO Spinal System                Rod                                     4 or 6mm dia x 480mm Length
DY350        RECO Spinal System                Set Screw                               One size only
DY351        RECO Spinal System                Tranverse Connector                     4 or 6mm
DY380        Versa Nail                        TTC Fusion Nail Sterile                 10mm x 15cm up to 12mm x 25cm
DY381        Versa Nail                        TTC Fusion Nail Unsterile               10mm x 15cm up to 12mm x 30cm
Prostheses List February 2005                                                                                                                Page 223 of 700
ORTHOPAEDIC                                                                                                                Minimum   Maximum
Billing Code Product Name                      Description                            Size                                 Benefit   Benefit    Notation
DY382        Versa Nail                        TTC Nail Cap Unsterile Impinging and   One Size
                                               Non Impinging
DY383        Versa Nail                        TTC Nail Cap Sterile Impinging and     One Size
                                               Non Impinging
DY386        Hoffman Wrist Kit                 Hoffman Sterile Wrist Kit              One size only
      Fixation Device, Internal, Screw
DY401        Monarch Monoaxial Pedicle Screw                                          4.75mm - 8.5mm x 25 to 80mm length
      Fixation Device, Internal, Wire
DP363        Control Cable                     Control Cable sleeve                   One size only
DP364        Control Cable with Sleeve         Control Cable with sleeve              One size only
      Grafts, Bone, Synthetic
DP509        Brantigan I/F Cage                AETI (Endoscopic) C/F Cage             Wedge 7-13mm x 9-15mm x 21-25 mm
DP510        Brantigan I/F Cage                PLIF C/F Cage                          Straight / Wedge
DP511        Brantigan I/F Cage                ALIF C/F Cage                          Small - Large 9-15mm
DP513        Brantigan I/F Cage                Stackable Cage                         Small-Large
                                               (Cervical/Thoracic/Lumbar)
DP514        Brantigan I/F Cage                Cervical Brantigan Cage                Standard/Large 4-10mm
      Immobilizers, Cervical
DY294        Bremer Halo Crown System          Aluminium Crown & Vest                 Standard & 3D
DY295        Bremer Halo Crown System          Titanium Skull Pins                    Standard & Hi-Fix
      Mesh, Metallic
DP426        Surgical Titanium Mesh System     Mesh - Long/Oval                       26 x 33mm x 50 - 90mm
DP427        Surgical Titanium Mesh System     Mesh - Curved or Long/Oval             14mm x 130mm or 17 - 22 x 22 -
                                                                                      28mm x 50 - 150mm Hgt
DP430        Moss Miami (Stainless Steel)      Washers - slotted, angled              Slotted/Angled or 3-5mm
DP436        Surgical Titanium Mesh System     Mesh - Oval or Flat or Long/Round      17-22 x 22-28mm - 10-15mm Hgt or
                                                                                      90mm x 90mm or 10 - 16mm x 30 -
                                                                                      100mm Hgt
DP438        Surgical Titanium Mesh System     Mesh - Oblong                          12 - 13 x 15 -17mm x 10 - 20mm


Prostheses List February 2005                                                                                                                  Page 224 of 700
ORTHOPAEDIC                                                                                                                       Minimum   Maximum
Billing Code Product Name                    Description                                 Size                                     Benefit   Benefit    Notation
DY087        Surgical Titanium Mesh System   End Plate or Screws or End Cap              17-22mm x 22-33mm
                                             (Round / Oblong / Trapezoidal)
DY088        Surgical Titanium Mesh System   Rings (Standard and Angled)                 17-26mm x 22-33mm
      Nails, Bone
DP528        Nancy Nail System               Pediatric Flexible Nail                     2.5 or 3.0 mm x 190 -290mm
DP529        Nancy Nail System               Pediatric Flexible Nail                     3.5 mm x 270-350mm
DP531        Nancy Nail System               Pediatric Flexible Nail                     4.0 mm x 330-450mm
DY323        Ace Trochanteric Nail           Trochanteric Lag Screw Sterile              60 to 120mm
DY324        Ace Trochanteric Nail           Trochanteric Anti Rotation Screw Sterile    60 to 100mm
DY325        Ace Trochanteric Nail           Trochanteric End Cap Sterile                5 to 25mm
DY326        Ace Trochanteric Nail           Trochanteric Nails Sterile in Standard or   320 x 11 x 130 up to 420 x 13 x 130 or
                                             Left or Right                               125 to 140 Deg from 9 to 13mm dia
      Orthopedic External Fixation Systems, Fracture
DP391        Ace External Fixator            Pin Holder Bolt - Titanium                  15mm
DY218        Ace External Fixator            Olive wire - stainless steel                1.5-1.8mm
DY219        Ace External Fixator            Wire bayonet point - titanium               1.5mm
DY220        Ace External Fixator            Olive wire bayonet point - stainless        1.5 or 1.8mm
                                             steel, packet of 3
DY221        Ace External Fixator            Wire bayonet point - stainless steel        1.8mm
DY223        Ace External Fixator            Ring, aluminium                             1/3 ring small 6" diameter
DY225        Ace External Fixator            Ring, composite                             1/3 ring large
DY226        Ace External Fixator            Ring, composite                             1/3 ring medium
DY227        Ace External Fixator            Ring, composite                             1/3 ring small
DY228        Ace External Fixator            Threaded Rod, titanium                      1/4" x 10cm
DY229        Ace External Fixator            Threaded Rod, titanium                      1/4" x 15cm
DY230        Ace External Fixator            Threaded Rod, titanium                      1/4" x 20cm
DY231        Ace External Fixator            Threaded Rod, titanium                      1/4" x 25cm
DY234        Ace External Fixator            Titanium half pin thread                    15-80mm, 155 x 5mm to 220 x 5mm
DY236        Ace External Fixator            Spacer with bolt, titanium                  2.5-5mm

Prostheses List February 2005                                                                                                                         Page 225 of 700
ORTHOPAEDIC                                                                                                         Minimum   Maximum
Billing Code Product Name           Description                                 Size                                Benefit   Benefit    Notation
DY237        Ace External Fixator   Ring, aluminium                             2/3 ring, large 10" diameter
DY238        Ace External Fixator   Ring, composite                             2/3 ring, medium
DY240        Ace External Fixator   Ring, aluminium                             2/3 ring, small 6" diameter
DY241        Ace External Fixator   Ring, composite                             2/3 ring, small
DY242        Ace External Fixator   Stainless steel transfix pin                250/300 x 5mm with 40-70mm thread
DY243        Ace External Fixator   Titanium Transfix Pin                       250/300 x 5mm with 40-70mm thread
DY244        Ace External Fixator   GRUB screw ACE/FISCHER, titanium            5mm
DY245        Ace External Fixator   TIP CapS, polyethylene                      5mm
DY246        Ace External Fixator   Peg, titanium                               5mm
DY248        Ace External Fixator   Adaptor rod, titanium                       8mm
DY249        Ace External Fixator   Pin holder adaptor, aluminium               90"
DY251        Ace External Fixator   Anchor assembly, titanium                   One size only
DY252        Ace External Fixator   Articulation, titanium                      One size only
DY253        Ace External Fixator   Bolt clevis, titanium                       One size only
DY256        Ace External Fixator   Locking nut, titanium                       One size only
DY257        Ace External Fixator   Nut, stainless steel                        One size only
DY258        Ace External Fixator   Position pins I/C foot plate, titanium      One size only
DY259        Ace External Fixator   Ring adapter bolt, titanium                 One size only
DY260        Ace External Fixator   Ring connector, titanium                    One size only
DY262        Ace External Fixator   Spherical nut and washer, titanium          One size only
DY263        Ace External Fixator   U rings, aluminium                          One size only
DY264        Ace External Fixator   Universal joint, titanium                   One size only
DY266        Ace External Fixator   Wire bolt hinge, titanium                   One size only
DY267        Ace External Fixator   Wire fixation bolt, cannulated or slotted   One size only
                                    (stainless steel)
DY268        Ace External Fixator   Connecting rod, aluminium                   X-Short, short, medium or long
DY270        Ace External Fixator   External fixator, aluminium                 One size only
DY271        Ace External Fixator   Ring adaptor, titanium                      One size only

Prostheses List February 2005                                                                                                           Page 226 of 700
ORTHOPAEDIC                                                                                                                    Minimum   Maximum
Billing Code Product Name                    Description                                Size                                   Benefit   Benefit    Notation
      Orthopedic Internal Fixation Systems
DY442        Summit SI System                Polyaxial Screw - Mini Favoured Angle      3.5 or 4mm diameter x 12-48mm length
DY443        Summit SI System                Connectors                                 Various
DY444        Summit SI System                Inner Set Screw                            one size
DY456        Expedium Spine System           Washers                                    Various
      Orthopedic Internal Fixation Systems, Fracture
DP330        Tibial Nail System              Tibial Nail or Dynamic Tibial Nail         8-13mm x 25.5-42.5cm
                                             Titanium Unsterile or Sterile
DP331        Tibial Nail System              End Cap Titanium                           One size only
DP338        Tibial Nail System              Solid Cortical Titanium Screw Unsterile    6.5mm x 20 -120mm
                                             or Sterile
DP339        Femoral Nail                    End Cap Titanium                           One size only
DP342        Femoral Nail System             Solid Cortical Screw Titanium Sterile or   4.5 or 5.5mm x 20-80mm
                                             Unsterile
DP343        Femoral Nail System             Femoral Nail Titanium Sterile or           9-15mm x 30- 50cm
                                             Unsterile
DP366        Supacondylar Nail System        Solid End Cap Titanium Unsterile or        One size only
                                             Sterile
DP367        Humeral Nail System             Humeral Nail Titanium Sterile or           7-9mm x 22cm-30cm
                                             Unsterile
DP371        Humeral Nail System             End Cap Various Titanium Unsterile or      One size only
                                             Sterile
DP571        Art Retrograde Nail             Femoral Nail Titanium Unsterile or         9 -12mm x 30 - 50cm
                                             Sterile
DP590        Compression Hip Screw           6.5mm Solid Lag Screw Stainless Steel      22mm Thread length 40 to 100mm
DP592        Small / Large Fragment Set      Cannulated Cancellous Lag Screw            6.8 or 8mm Dia 25-120mm Length 22
                                             Titanium                                   or 40mm Thread
DP593        Small / Large Fragment Set      Cannulated Cancellous Screw                4mm or 16mm or 32mm Thread, 26-
                                                                                        120mm Length
DP597        Small / Large Fragment Set      Solid Cortical Screw Titanium              3.5 mm 10-48 mm Length
DP598        Small / Large Fragment Set      Cannulated Cortical. Bone Screw            3.5 mm length 50-60 mm

Prostheses List February 2005                                                                                                                      Page 227 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                          Description                           Size                                   Benefit   Benefit    Notation
DP605        Small / Large      Fragment Set       Cancellous Lag Screw Titanium         4.8 mm Dia 30mm to 60mm
DP608        Small / Large      Fragment Set       Straight Plate Titanium               3-12 Hole
DP609        Small / Large      Fragment Set       100 Tube Plate Titanium               3.5mm Dia and 3 to 8 holes
DP610        Small / Large      Fragment Set S/S   Femoral Condylar Plate                4-8 Hole
DP611        Small / Large      Fragment Set       Reconstruction T Plate Titanium       4-8 Hole
DP612        Small / Large      Fragment Set       Active Compression Plate Titanium     3.5mm 5 to 10 Hole
DP613        Small / Large      Fragment Set       Humeral and Radial Plate Titanium     Wide - Narrow - Long - Extra Long
                                                   Various
DP615        Small / Large Fragment Set            Universal Reconstruction Ribbon       3.5mm with 8 to 10 holes
                                                   Titanium
DP617        Small / Large Fragment Set            Universal Reconstruction Ribbon       3.5mm with 14 holes
                                                   Titanium
DP618        Small / Large Fragment Set            Universal Reconstruction Ribbon       3.5mm with 3 to 7 holes
                                                   Titanium
DP627        Small / Large Fragment Set            Solid Cancellous Screw Titanium       4mm or 5mm Dia 10-48 mm Length
DP632        Small / Large Fragment Set            Solid Cancellous Screw Titanium       5.0mm Length 50 - 80mm
DP635        Small / Large Fragment Set            Solid Cancellous Lag Screw Partial    4mm Dia 10-60mm Length
                                                   Thread Titanium
DP638        Small / Large Fragment Set            Solid Cancellous Bone Screw Full      4mm Dia 50-110mm Length
                                                   Thread Titanium
DP640        Small / Large Fragment Set            Cancellous Cannulated Lag Screw       4mm 10 to 70mm Length
                                                   Partial Thread
DP643        Small / Large Fragment Set            Cannulated Cancellous Screw Full      4mm or 7mm x 10 -100mm Length
                                                   Threaded - Stainless Steel
DP646        Small / Large Fragment Set            Washer Titanium -                     One size only
DP650        Small / Large Fragment Set S/S        Cortical Screw - Stainless Steel      1.5 or 2 or 2.7 or 3.5mm x 22 - 44mm
                                                                                         Length
DP654        Small / Large Fragment Set S/S        Cortical Screw Diameter - Stainless   3.5 or 4.5 x 12 - 48mm Length
DP655        Small / Large Fragment Set S/S        Cortical Self Tapping Screw           3.5 or 4.5 mm x 8-60 mm Length
DP656        Small / Large Fragment Set S/S        Malleolar Stainless Steel Screw -     25 - 70mm
                                                   Stainless Steel

Prostheses List February 2005                                                                                                                       Page 228 of 700
ORTHOPAEDIC                                                                                                               Minimum   Maximum
Billing Code Product Name                     Description                               Size                              Benefit   Benefit    Notation
DP657        Small / Large Fragment Set S/S   Malleolar Cann Cor Stainless Steel        25 - 70mm
                                              Screw - Stainless Steel
DP658        Small / Large Fragment Set S/S   Cortical Stainless Steel Cannulated       3.5 x 8-70 mm
                                              Screw - Stainless Steel
DP660        Small / Large Fragment Set S/S   Cannulated Screw Diameter partially       Dia 4 x 10-60
                                              threaded - Stainless Steel
DP662        Small / Large Fragment Set S/S   Cannulated Cancellous Screw 16 or 32      6.5mm x 25-140mm Length
                                              Thread
DP663        Small / Large Fragment Set S/S   Cannulated Cancellous Screw Part          4mm or 6.5mm x 10- 140mm Length
                                              Thread Screw
DP664        Small / Large Fragment Set S/S   Cannulated Cancellous Screw 16 or 32      7mm x 25-140mm Length
                                              Thread
DP665        Small / Large Fragment Set S/S   CHS Compression Screw - Stainless         Neutral to +2
DP668        Small / Large Fragment Set S/S   CHS Lag Screw Stainless Steel Sterile     Length 50-145mm
                                              and Unsterile
DP670        Small / Large Fragment Set S/S   Tronchanteric Support Plate               Small-Large
DP672        Small / Large Fragment Set S/S   CHS Plate Standard & Short Barrel         2-8 Hole 95 to 150 Deg
                                              Sterile
DP673        Small / Large Fragment Set S/S   SCS Plate Sterile                         3-9 Hole
DP675        Small / Large Fragment Set S/S   Broad Bone Plate Stainless Steel          3-6 Hole for 1.5mm
DP678        Small / Large Fragment Set S/S   Small or Narrow DCP Plate                 2.7mm or 3.5mm with 2 - 12 Hole
DP683        Small / Large Fragment Set S/S   Cerclage Wire Loop Stainless Steel        0.8-1.2mm x 280-600
DP689        Small / Large Fragment Set S/S   Condylar Plate & Mini Condylar Plate      1.5mm or 2mm
DP692        Small / Large Fragment Set S/S   Cloverleaf Plate Stainless Steel          3-4 Hole
DP693        Small / Large Fragment Set S/S   T-Plate Stainless Steel                   3 up to 8 Hole
DP695        Small / Large Fragment Set S/S   Y-Plate Stainless Steel                   2 + 2 + 4 or 4 + 4 + 4 Slots
DP696        Small / Large Fragment Set S/S   Plates - Mini T or L, Oblique, Straight   2.0mm or 2.7mm with 2-12 Hole
DP701        Small / Large Fragment Set S/S   Bored K/Wire Stainless Steel              2.0-3.0mm x 80/30-200-15
DP702        Small / Large Fragment Set S/S   Threaded K/Wire                           1.5-2.5mm
DP705        Small / Large Fragment Set S/S   Reconstruction Plate                      3.5mm 3-12 Hole
DP708        Small / Large Fragment Set S/S   Reconstruction Plate                      3.5mm 14 to 18 Hole
Prostheses List February 2005                                                                                                                 Page 229 of 700
ORTHOPAEDIC                                                                                                            Minimum   Maximum
Billing Code Product Name                     Description                              Size                            Benefit   Benefit    Notation
DP709        Small / Large Fragment Set S/S   Reconstruction Plate                     3.5mm 20-28 Hole
DP714        Small / Large Fragment Set S/S   Reconstruction Plate                     2.7mm 8-26 Hole
DP719        Small / Large Fragment Set S/S   Reconstruction Plate                     4.5 - 6.5mm 3-8 Hole
DP723        Small / Large Fragment Set S/S   Reconstruction Plate                     4.5 - 6.5mm 9 - 18 Hole
DP725        Small / Large Fragment Set S/S   Cortical Screw Diameter                  3.5 or 4.5 x 55 - 110mm
DP733        Small / Large Fragment Set S/S   Angle Blade Plate DCP Stainless Steel    95 Degrees 14-18 Hole
DP734        Small / Large Fragment Set S/S   Angle Blade Plate DCP                    95 Degrees 5 - 12 Hole
DP735        Small / Large Fragment Set S/S   Angle Blade Plate Stainless Steel        95 Degrees 45mm x 8mm
DP737        Small / Large Fragment Set S/S   Angle Blade Plate                        90 Degrees 35-50mm x 8-10mm
DP739        Small / Large Fragment Set S/S   Angle Blade Plate                        90 Degrees 60 to 65 x 10-15mm
DP741        Small / Large Fragment Set S/S   Broad DCP Plate                          6 to 10 Hole
DP744        Small / Large Fragment Set S/S   Broad DCP Plate                          11 to 14 Hole
DP746        Small / Large Fragment Set S/S   Broad DCP Plate                          16 to 17 Hole
DP749        Small / Large Fragment Set S/S   Broad DCP Plate                          18 to 26 Hole
DP753        Small / Large Fragment Set S/S   Blade Plate Stainless Steel              95 Degrees 5-6 Hole
DP754        Small / Large Fragment Set S/S   Cannulated Screw Diameter                4mm x 10-60mm Length
DP758        Small / Large Fragment Set S/S   Cerclage                                 0.8-2.5mm D898
DP759        Small / Large Fragment Set S/S   Washer Spiked, Standard, Cancellous,     One size only
                                              Cortical & Fastening Wire
DP761        Small / Large Fragment Set S/S   Cancellous Screw                         4mm Dia and 10 - 28 Length
DP766        Small / Large Fragment Set S/S   Cancellous Screw 32 Thread - Stainless   Dia 6.5mm x 130-140mm
                                              Steel
DP772        Small / Large Fragment Set S/S   Cancellous Screw                         6.5mm x 14-110mm Length
DP774        Small / Large Fragment Set S/S   Cancellous Screw 16 or 32 Thread         6.5mm x 25 - 130mm Length
DP776        Small / Large Fragment Set S/S   CHS Plate Standard & Short Barrel        10 Hole 135-150 Deg
                                              Sterile or Unsterile
DP777        Small / Large Fragment Set S/S   CHS Plate Standard & Short Barrel        12 Hole 135-150 Deg
                                              Sterile or Unsterile
DP778        Small / Large Fragment Set S/S   CHS Plate Standard & Short Barrel        12-14 Hole 135-150 Deg
                                              Sterile or Unsterile
Prostheses List February 2005                                                                                                              Page 230 of 700
ORTHOPAEDIC                                                                                                                Minimum   Maximum
Billing Code Product Name                     Description                              Size                                Benefit   Benefit    Notation
DP780        Small / Large Fragment Set S/S   CHS Plate Standard & Short Barrel        5-14 Hole 135-150 Deg
                                              Sterile or Unsterile
DP784        Small / Large Fragment Set S/S   CHS Plate Stainless Steel                16 Hole 135-150 Deg
DP786        Small / Large Fragment Set S/S   Cortical Screw Self Tapping              3.5 or 4.5 x 30 - 110mm Length
DP793        Small / Large Fragment Set S/S   K/Wire Stainless Steel                   0.8 to 3.0 mm x 6-9" or 150-500mm
DP796        Small / Large Fragment Set S/S   Narrow Bone Plate                        5-18 Hole
DP802        Small / Large Fragment Set S/S   Small or Narrow DCP Plate                2.7mm or 3.5mm 8-16 Hole
DP809        Small / Large Fragment Set S/S   K-wire standard                          1/8 inch
DP810        Small / Large Fragment Set S/S   K-Wire Double Point each                 5/32 inch
DP812        Small / Large Fragment Set S/S   SCS Plate Sterile                        10-12 Hole 95 Degrees
DP813        Small / Large Fragment Set S/S   SCS Plate Sterile                        14-16 Hole 95 Degrees
DP814        Small / Large Fragment Set S/S   Threaded Steinmann Pin                   0.5-3mm
DP820        Small / Large Fragment Set S/S   Cortical Screw Diameter                  3.5 or 4.5 x 45 -100mm
DP835        Peak Channelled Plate System     Channel Plate                            2 - 8 Segment
DP836        Peak Channelled Plate System     Channel Plate Locking Washer             9 x 13mm
DP837        Peak Channelled Plate System     Cortical Bone Screw                      3.5mm
DP929        Supacondylar Nail System         Supracondylar Titanium Nail Sterile or   10 to 12 mm x 15-30cm
                                              Unsterile
DP931        Small / Large Fragment Set S/S   Solid Cortical Screw Titanium            6.5mm x 40 - 100mm
DY131        Small / Large Fragment Set       Low Profile Cannulated Cancellous        4mm x 10mm - 48mm Length
                                              Screw, Partially Thread
DY162        Fragment Set Small/Large         Low Profile Cannulated Cancellous        4mm x 50 - 75mm
                                              Screw, Partially Thread
DY164        Small / Large Fragment Set       Low Profile Cannulated Cancellous        4mm x 10 - 50mm Length
                                              Screw, Fully Thread
DY165        Fragment Set Small/Large         Low Profile Cannulated Cancellous        4mm x 55 - 75mm
                                              Screw, Fully Thread
      Orthopedic Internal Fixation Systems, Other
DP039        Orthosorb Absorbable Pin         Orthosorb K-Wire - Stainless Steel       L300 D2.0mm Thread Each
DP099        Coventry Screw System S/S        Cannulated Screws                        7.00 mm dia
Prostheses List February 2005                                                                                                                  Page 231 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                              Description                              Size                                    Benefit   Benefit    Notation
DP102        Coventry Screw system                     Cannulated Screws                        4mm and 4.50 mm
DP105        Coventry Screw system S/S                 Standard or Heavy or Extra Heavy         2 -4 or 3- 4 Hole Standard or 130 Deg
                                                       Duty Plate
DP106        Coventry Screw system S/S                 Cancellous Screw                         4mm or 4.5mm 16-90mm Length
DP854        Songer Cable System - Titanium            Flex Bar - Large/Small or Flanged        35mm/30mm
                                                       Crimp 2 Hole Bar /Flat Bar (Pk 2)
DP858        Songer Cable System - Stainless Steel     Flanged Crimp/Flat Bar (Pk2) or 2 Hole   One size only
                                                       Bar (Pk 2)
DP859        Songer Cable System   - Stainless Steel   Isola Single Cable & Crimp (Pkt 6)       One size only
DP860        Songer Cable System   - Stainless Steel   Double Loop Cable with 2 Crimps          One size only
DP862        Songer Cable System   - Titanium          Double Loop Cable with 2 Crimps          One size only
DP864        Songer Cable System   - Titanium          Isola Single Cable & Crimp (Pkt 6)       One size only
      Orthopedic Internal Fixation Systems, Spinal
DP251        DOC Ventral Stabilisation System          Doc Plate                                1-3 Level
DP252        Acroflex Lumbar Artificial Disc           Lumbar Disc Replacement Device           One size only
DP299        Moss Miami (Stainless Steel)              Hooks - Pedicle                          One size only
DP300        Moss Miami (Stainless Steel)              Hooks - Laminar as Wide or Narrow or     One size only
                                                        Angled or Reduced Distance Supra-
                                                       laminar or Offset or Extended Body
DP301        Moss Miami (Stainless Steel)              Transverse Connector - Complete          One size only
DP304        Moss Miami (Stainless Steel)              Inner Screw and Outer Nut                3 - 5mm
DP305        Moss Miami (Stainless Steel)              Axial Connector                          5mm/5mm and 5mm/7mm
DP306        Moss Miami (Stainless Steel)              Monoaxial Screws                         5 - 8mm x 25 - 60mm
DP307        Moss Miami (Stainless Steel)              Polyaxial Screws                         5 - 7mm x 25 - 60mm
DP311        Moss Miami (Stainless Steel)              Transverse Connector Rod or Screw or     One size
                                                        Hook
DP315        Moss Miami (Stainless Steel)              Pre-Cut Rod                              5mm x 30 - 90mm
DP329        Moss Miami (Stainless Steel)              Hooks - Translation (Pedicle/Reduced     One size only
                                                       Distance/Narrow/Wide Blade)
DP394        Moss Miami (Titanium)                     Pre-Cut Rod                              5.5mm x 30 - 90mm

Prostheses List February 2005                                                                                                                               Page 232 of 700
ORTHOPAEDIC                                                                                                                       Minimum   Maximum
Billing Code Product Name                                Description                            Size                              Benefit   Benefit    Notation
DP400        Moss Miami (Titanium)                       Rod - Standard                         5.5mm x 12 - 48cm
DP405        Moss Miami (Titanium)                       Outer Nut or Inner Screw               One Size Only
DP407        Moss Miami (Titanium)                       Monoaxial Screw                        5 - 8mm x 25 - 60mm
DP408        Moss Miami (Titanium)                       Polyaxial Screw                        5 - 8mm x 25 - 60mm
DP410        Moss Miami (Titanium)                       Hooks - Pedicle                        3-5 mm
DP411        Moss Miami (Titanium)                       Hooks - Laminar as Wide or Narrow or   One size only
                                                          Angled or Reduced Distance Supra-
                                                         laminar or Offset or Extended Body
DP412        Moss Miami (Titanium)                       Transverse Connector - Complete        One size only
DP413        Moss Miami (Titanium)                       Axial Connector                        5mm/5mm
DP416        Moss Miami (Titanium)                       Washers - Slotted / Angled             One Size Only
DP418        Moss Miami (Titanium)                       Hooks - Translation                    One size only
DP420        Moss Miami (Titanium)                       Transverse Connector Hook or Screw     One Size
                                                         or Rod
DP422        Moss Miami 4mm Anterior System (SS)         12 Sided Outie                         One size only
DP449        Kaneda SR (Smooth Rod) Anterior             Closed Screw                           1/4" - 6.25mm x 25 - 60mm
DP450        Kaneda SR (Smooth Rod) Anterior             Plates                                 Small/Large - Caudal or Rostral
DP451        Kaneda SR (Smooth Rod) Anterior             Transverse Coupler                     1/4" x 13 - 16mm
DP452        Kaneda SR (Smooth Rod) Anterior             Pre Cut Rod                            1/4" x 45 - 150mm
DP453        Isola Paediatric System (Stainless Steel)   Threadless TRC - Closed or Open        3/16"
                                                         Body without Rod
DP454        Isola System (Titanium)                     Slotted Connectors Standard or         1/4" & 3/16"
                                                         Extended or Offset or Angled or Open
                                                         or Twister
DP459        Isola System (Titanium)                     Jaw Clamp                              1/4" & 3/16"
DP460        Isola System (Titanium)                     Right Hand Nut                         5/16"
DP461        Isola System (Titanium)                     Spinal Rod                             1/4" & 3/16" x 18" & 24"
DP462        Isola System (Stainless Steel)              Wedding Band                           1/4 " & 3/16"
DP463        Isola System (Titanium)                     Set Screw                              6.35mm
DP464        Isola System (Titanium)                     Closed Hooks                           1/4" x 3/16" x 5-11mm
Prostheses List February 2005                                                                                                                         Page 233 of 700
ORTHOPAEDIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                                Description                            Size                        Benefit   Benefit    Notation
DP465        Isola System (Titanium)                     Open Hook and / or Cap                 1/4" & 3/16" x 5-11mm
DP466        Isola System (Titanium)                     Wedding Band                           1/4" & 3/16"
DP469        Isola System (Stainless Steel)              Slotted Connectors - Standard or       1/4" & 3/16"
                                                         Extended or Offset or Angled or Open
                                                         or Twister
DP470        Isola System (Stainless Steel)              Transverse Rod Connector or Dual Rod   1/4" & 3/16"
                                                         Connector
DP471        Isola System (Stainless Steel)              Closed Hooks                           1/4" & 3/16" x 5-11mm
DP472        Isola System (Stainless Steel)              Open Hook Cap or Open                  1/4" & 3/16" x 5-11mm
DP473        Isola System (Stainless Steel)              Iliac Screw                            6.25 & 7.0mm
DP474        Isola System (Stainless Steel)              Jaw Clamp                              1/4" & 3/16"
DP475        Isola System (Stainless Steel)              Right Hand Nut                         5/16"
DP476        Isola System (Stainless Steel)              Eye Rod                                1/4" & 3/16" x 18" - 24"
DP477        Isola System (Stainless Steel)              Spinal Rod Standard                    1/4" & 3/16" x 18" & 24"
DP480        Isola System (Stainless Steel)              Wire with Button or Beaded Wire        One size only
DP485        Isola System (Stainless Steel)              Dual Diameter Rod                      3/16" to 1/4" x 18 - 24"
DP487        Isola Paediatric System (Stainless Steel)   Side Tightening Hook - Opened/Closed   3/16" x 3.5mm - 11mm
DP488        Isola Paediatric System (Stainless Steel)   Pre-Bent Rod                           3/16 "
DP489        Isola Paediatric System (Stainless Steel)   Cable Wire Screw                       4.75 - 5.50mm x 25 - 30mm
DP490        Isola Paediatric System (Stainless Steel)   Wedding Band                           3/16"
DP492        Isola System (Titanium)                     Iliac Screws                           6.25mm & 7.0mm
DP494        Isola System (Stainless Steel)              Spinal Rod Hex Ends - Easy/Premium     1/4" x 18"
DP495        Isola Paediatric System (Stainless Steel)   Growth/Tandem Connector                3/16"
DP496        Isola Paediatric System (Stainless Steel)   Threadless TRC - Closed / Open Body    3/16"
                                                         with Rod
DP499        Isola System (Titanium)                     Transverse Connector or Dual Rod       1/4" & 3/16"
                                                         Connector
DP501        Isola System (Stainless Steel)              Set Screw                              One size only
DP502        Anterior Isola System (SS)                  Single Hole Washer and Staples         16-22mm
DP504        Anterior Isola System (SS)                  Open / Closed Screw                    1/4" x 5.5-7mm x 20-55mm
Prostheses List February 2005                                                                                                                   Page 234 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                             Description                           Size                         Benefit   Benefit    Notation
DP505        Anterior Isola System (SS)               Rod with Hex End                      1/4" x 18"
DP515        I/F Ramp                                 PLIF C/F Ramp                         7-11 x 11-15 x 21 - 25 mm
DP564        Peak Polyaxial Anterior Cervical Plate   Anterior Cervical Plate               1 - 4 Segment
             System
DP567        Peak Polyaxial Anterior Cervical Plate   Graft Screw or Safety Locking Screw   4mm x 9 -15mm
             System
DP569        Peak Polyaxial Anterior Cervical Plate   Primary Locking Screw                 4mm x 10 -16mm
             System
DP576        Kaneda Anterior Scoliosis System S/S     Open Screw - Standard or Blunt        3/16" - 6.25mm x 25 - 50mm
DP577        Kaneda Anterior Scoliosis System S/S     Closed Screw - Standard or Blunt      3/16" - 6.25mm x 25 - 50mm
DP580        Kaneda Anterior Scoliosis System S/S     Radiused Caps for Open Screws         3/16"
DP581        Kaneda Anterior Scoliosis System S/S     Staple Single or Double Hole          Small - Large
DP828        Profile Anterior Thoracolumbar Plate     Plates - Thoracolumbar                50 - 120mm
             System
DP829        Profile Anterior Thoracolumbar Plate     Plates - High Thoracic                40 - 110mm
             System
DP830        Profile Anterior Thoracolumbar Plate     Cancellous Screw                      6mm x 20 - 60mm
             System
DP831        Profile Anterior Thoracolumbar Plate     Cancellous Bolt                       7mm x 25 - 60mm
             System
DP832        Profile Anterior Thoracolumbar Plate     Locking Inner Screw                   One size only
             System
DP833        Profile Anterior Thoracolumbar Plate     Graft Screw                           15 - 30mm
             System
DP834        Profile Anterior Thoracolumbar Plate     Locking Outer Nut                     One size only
             System
DP842        Moss Miami (Stainless Steel)             Sacral Extender                       5mm x 5 - 20mm length
DP843        Moss Miami (Titanium)                    Sacral Extender                       5mm x 5 - 20mm length
DP845        Moss Miami 4mm Anterior System (SS)      Hooks                                 4mm
DP846        Moss Miami 4mm Anterior System (SS)      Rods                                  4.0mm x 30 - 48cm
DP847        Moss Miami 4mm Anterior System (SS)      Screws - Monoaxial                    6mm x 25 - 55mm

Prostheses List February 2005                                                                                                                Page 235 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                          Description                              Size                             Benefit   Benefit    Notation
DP848        Moss Miami 4mm Anterior System (SS)   Screws - Polyaxial                       6mm x 25 - 55mm
DP849        Moss Miami 4mm Anterior System (SS)   Washer or Staple or 12 sided outie       One size only
DP851        Surgical Titanium Mesh System         Standard & Trapezoidal                   10-16mm x 8-17mm Hgt
DY039        TiMX Low Back System                  Pedicle Screws (Standard or +5 No        5.5 - 7.75mm x 30 - 50mm
DY041        TiMX Low Back System                  Sacral Connector (Left & Right Offset    One size only
                                                   or Rod)
DY042        TiMX Low Back System                  VSP Bone Plate                           One/One & 1/2/Shortened/Double
                                                                                            Half/Triple Half Slot
DY044        TiMX Low Back System                  VSP Bone Plate                           Two/Two & 1/2/Three Slot
DY050        TiMX Low Back System                  Slotted Connector (Left & Right Offset   1/4"
                                                   or Straight or Extended or Twister)
DY054        TiMX Low Back System                  Hexlobe Set Screw or Spherical Nut       One size only
DY057        TiMX Low Back System                  Washers - Standard / Tapered             3mm & 4.5mm
DY059        TiMX Low Back System                  Modular Cross Connector Hex Lobe         One size only
                                                   Set Screw
DY062        Brazenor Device                       Custom Cervical Buttress                 One size only
DY078        Kaneda SR Anterior                    Kaneda SR Anterior Open Screw            1/4"-6.25mm x 25-60mm, 3/16"
DY094        Isola Paediatric System               Stainless Steel, Slotted Connector       3/16"
                                                   Downsized
DY100        Isola System (Stainless Steel)        Threadless TRC - Closed or Open          1/4" & 3/16"
                                                   Body with Rod
DY102        Isola System (Stainless Steel)        Threadless TRC - Closed / Open Body      1/4" & 3/16"
                                                   - No Rod
DY103        Isola System (Stainless Steel)        Modular Cross Connector Set Screw        One Size Only
DY105        Isola System (Titanium)               Eye Rod                                  1/4" x 18"
DY106        Isola System (Titanium)               Modular Cross Connector Set Screw        One size only
DY107        Carbon Fibre Cages                    Stackable Cage Titanium Interface        One size only
                                                   Screw Nuts
DY108        Isola System                          Titanium, Locking Screw                  60-120mm
DY109        Carbon Fibre Cages                    Stackable Cage Titanium Protective       5-15mm
                                                   Sleeve

Prostheses List February 2005                                                                                                                    Page 236 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                              Description                              Size                                 Benefit   Benefit    Notation
DY110        Carbon Fibre Cages                        Stackable Cage Titanium Interface        M4 / M5
                                                       Screws
DY170        Monarch Spinal System                     Bolts - Pedicle & Reduction              4.75 - 8.5 mm x 30 - 55mm
DY171        Monarch Spinal System                     Pedicle Screws - Polyaxial               4.75 - 8.5 mm x 30 - 55mm
DY174        Monarch Spinal System                     Bone Plate                               ½ to 1½ or 2 - 3 or 3½
DY176        Monarch Spinal System                     Washers and Set Screws                   One size only
DY178        Monarch Spinal System                     Hooks - Closed (Narrow Tapered /         5 - 11 mm
                                                       wide Blade)
DY179        Monarch Spinal System                     Slotted Connectors                       One size only
                                                       (Straight/Extended/Offset/Twister/Mini
                                                       Offset)
DY182        Monarch Spinal System                     Rods                                     6.35 & 5.5mm x 450mm
DY184        Monarch Spinal System                     Dual Rod Connectors End to End or        6.35 to 6.35mm or 6.35 to 5.5mm or
                                                       Side by Side                             6.35 to 4.75mm
DY185        Monarch Spinal System                     Plate J-Hooks                            3.5 - 11 mm
DY186        Monarch Spinal System                     Band Clamp Connector                     6.35 & 5.5mm
DY198        Carbon Fibre Cages                        ALIF 1 C/F Cage                          5 - 10 deg Sm to Lg 10 - 18 mm
DY289        Crossover System (Titanium)               Crossconnector                           Small 18-30mm
DY290        Crossover System (Titanium)               Crossconnector                           Medium 32-45mm
DY292        Crossover System (Titanium)               Crossconnector                           Large 45-107mm
DY293        Crossover System (Titanium)               Crossover Nut or Ball Screw              One size only
DY297        Slim-loc Anterior Cervical Plate System   Plates - one level                       22-37mm
DY298        Slim-loc Anterior Cervical Plate System   Plates - two level                       39-53mm
DY299        Slim-loc Anterior Cervical Plate System   Plates - three level                     54-78mm
DY300        Slim-loc Anterior Cervical Plate System   Screws - Self Tapping                    4.5 x 12-26mm
DY301        Slim-loc Anterior Cervical Plate System   Screws - Large Diameter                  4.8 x 12-16mm
DY302        Slim-loc Anterior Cervical Plate System   Screws - Self Drilling                   4.5 x 12-18mm
DY303        Monarch Spinal System                     Typhoon Cap and Domed Nuts               One size only
DY304        Monarch Spinal System                     Hooks - Open (Pedicle/Narrow             5-11mm
                                                       Tapered/Wide Blade)

Prostheses List February 2005                                                                                                                            Page 237 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                           Description                          Size                                   Benefit   Benefit    Notation
DY306        Isola System (Titanium)                Threadless TRC - open body with or   1/4" & 3/16"
                                                    without rod
DY309        Frontier Anterior Scoliosis System     Bone Screws                          5.5 x 25-40mm, 6.5 x 25-60mm, 7.5 x
             (Titanium)                                                                  35-60mm
DY310        Frontier Anterior Scoliosis System     Spinal Rod                           4.75 x 200-450mm
             (Titanium)
DY311        Frontier Anterior Scoliosis System     Twist on Internal Cap                One size only
             (Titanium)
DY313        Monarch Spinal System                  Rods - Pre Cut/Lordosed              6.35 & 5.5mm x 45 - 95mm
DY316        Isola System (Stainless Steel)         Eye Rod Connector Open or Closed     1/4" & 3/16"
DY317        Isola System (Stainless Steel)         Band Clamp Connector or Tandem       1/4" & 3/16"
                                                    Connector
DY318        Isola System (Stainless Steel)         Pre-Cut Rod                          3/16" x 35 - 90mm
DY322        Carbon Fibre Interbody Fusion Device   Stackable C/F Cage System Wedges     11 Degree Small-Large
DY327        Frontier Anterior Scoliosis System     Staple/Washer                        One size only
DY356        SB Charite Disc Prosthesis             End Plates Parallel & Oblique        1-5
DY359        Sliding Core                           -                                    7.5 -11.5mm, 8.5mm, 10.5mm
DY406        Leopard 5 Lodotic Carbon Fibre Body    Carbon Fibre cage                    7 - 18mm
             Fusion Device
DY407        Leopard Parallel Carbon Fibre Body     Carbon Fibre Cage                    7 - 18mm
             Fusion Device
DY420        X-Tenz                                 Telescopic VBR Cage                  16mm
DY421        X-Tenz                                 Telescopic VBR Cage                  22mm
DY422        Saber Cage                             PLIF Cage                            Parallel/Wedge
DY429        X-Tenz                                 Telescopic VBR Cage                  26mm
DY430        X-Tenz                                 Telescopic VBR Cage                  28mm
DY431        Expedium Spine System                  Si Polyaxial Screw                   5,6 or 7mm diameter x 25-55mm length
DY432        Expedium Spine System                  Si Screw Set                         one size
DY434        Expedium Spine System                  Dual Connectors                      Various
DY435        Expedium Spine System                  Rod                                  5.5mm diameter x 12-48cm

Prostheses List February 2005                                                                                                                       Page 238 of 700
ORTHOPAEDIC                                                                                                        Minimum   Maximum
Billing Code Product Name            Description                             Size                                  Benefit   Benefit    Notation
DY436        Expedium Spine System   Rod - Prelordosed                       5.5mm diameter x 35-95mm length
DY437        Expedium Spine System   Hooks (Pedicle, Reduced, Angled,        one size
                                     Narrow, Wide)
DY438        Expedium Spine System   Hooks (Left/Right Angled, Left/Right    One size
                                     Offset, Extended Body)
DY439        Expedium Spine System   Di Set Screw                            one size
DY440        Expedium Spine System   Di Polyaxial Screw                      5, 6, or 7mm diameter x 25-55mm
DY441        Expedium Spine System   Monoaxial Screw                         4.35, 5, 6, 7 or 8mm diameter x 25-
                                                                             55mm length
DY445        Saber Cage System       Posterior Lumbar Interbody Fusion       Various
                                     Carbon Fibre Reinforced Polymer
                                     (CFRP) Cage - wedged plate 5/10 plate
DY446        Saber Cage System       Posterior Lumbar Interbody Fusion       Various
                                     Carbon Fibre Reinforced Polymer
                                     (CFRP) Cage - Parallel Cage
DY447        Swift Spine System      Titanium Anterior Cervical Plate        Level 1 size 15 - 29mm
                                     System - Various size plates
DY448        Swift Spine System      Titanium Anterior Cervical Plate        Level 2 size 30 - 42mm
                                     System - various size plates
DY449        Swift Spine System      Titanium Anterior Cervical Plate        Level 3 size 45 - 63mm
                                     System - various size plates
DY450        Swift Spine System      Titanium Anterior Cervical Plate        Level 4 size 60 - 100mm
                                     System - various size Plates
DY451        Swift Spine System      Titanium Anterior Cervical Plate        46 - 102mm
                                     System - Corpectomy Plate
DY452        Swift Spine System      Titanium Anterior Cervical Plate        10 - 18mm
                                     System - 3.8mm Self-Drilling/Tapping
                                     Screw
DY453        Swift Spine System      Titanium Anterior Cervical Plate        18mm
                                     System - 4.2mm Self-Drilling/Tapping
                                     Screw
DY454        Swift Spine System      Titanium Anterior Cervical Plate        10 - 28mm
                                     System - 3.8mm Bicortical Screw


Prostheses List February 2005                                                                                                          Page 239 of 700
ORTHOPAEDIC                                                                                                                   Minimum   Maximum
Billing Code Product Name                     Description                               Size                                  Benefit   Benefit    Notation
DY455        Swift Spine System               Titanium Anterior Cervical Plate          10mm
                                              System - Graft Screw
      Pins, Bone
DP088        Orthosorb Absorbable Pin         Orthosorb - Polydiaxanone Fixation Pins   2mm
DP089        Orthosorb Absorbable Pin         Orthosorb Pkt3 - Polydiaxanone            40mm x2mm
DP090        Orthosorb Absorbable Pin         Orthosorb Pkt 3 - Polydiaxanone           1mm x 40mm x 1.3mm
DP091        Orthosorb Absorbable Pin         Orthosorb Pkt 1 - Polydiaxanone           40 x 2.0mm
DP092        Orthosorb Absorbable Pin         Orthosorb K Wire - Stainless Steel        1 x 40mm x 1.3mm Pk 3
                                              Tapered Pins
DP093        Orthosorb Absorbable Pin         Orthosorb -Polydiameterxanone             1.3mm
DP094        Orthosorb Absorbable Pin         Orthosorb Pk 2 - Polydiaxanone            40mm x 2.0mm
DP095        Orthosorb Absorbable Pin         Orthosorb Arthroscopic Fix-Set -          1.3MM
                                              Polydiaxanone
DP572        Nancy Nail System                Pediatric Flexible Nail                   2.0 mm x 130mm
DP892        Rockwood Clavical Pin            Rockwood Clavicle Pin + Nut S/S           2.5 to 4.5mm
DP893        Rockwood Clavical Pin            Nut Clavical Pin S/S                      2.5 to 4.5mm
DY272        Clavicle Pin (Sterile)           Clavicle pin assembly                     2.5-4.5mm
      Pins, Bone, Absorbable
DP584        PLA Centraliser                  Poly Lactic Acid+D108 Centraliser         9-20mm
      Plates, Bone
DP045        Isola System (Stainless Steel)   Double Wire                               One size only
DP046        VSP System (Titanium)            Pedicle Screw (Standard or +5 No Cut)     4.75-7.75mm x 25-50mm
DP049        VSP System (Titanium)            Washers - Standard / Tapered              3 & 5mm
DP051        VSP System (Titanium)            VSP Bone Plate                            One - Two Slot
DP052        VSP System (Titanium)            VSP Bone Plate                            Two ½ - Three ½ or Four - Five Slot
DP058        Isola System (Stainless Steel)   Modular Cross Connector Hex Nut           One size only
DP060        VSP System (Stainless Steel)     Sacral Connector - Left & Right Offset    One size only
DP072        Isola System (Titanium)          Modular Cross Connector J-Hooks           1/4 & 3/16"
DP073        Isola System (Titanium)          Modular Cross Connector Plates            0 - 70mm

Prostheses List February 2005                                                                                                                     Page 240 of 700
ORTHOPAEDIC                                                                                                          Minimum   Maximum
Billing Code Product Name                       Description                                Size                      Benefit   Benefit    Notation
DP074        Isola System (Titanium)            Modular Cross Connector Hex Nut            One size only
DP075        Isola System (Stainless Steel)     Modular Cross Connector Plates             0 - 70mm
DP076        Isola System (Stainless Steel)     Modular Cross Connector J-Hooks            1/4 & 3/16"
DP869        Bridge Plates                      Bridge P.F.P. Femoral / Humeral            90 and 140-170mm
DP888        Calcaneal Periarticular Plate      Calcaneal Periarticular Plate - Titanium   Extra small to Ex Large
DP904        Periarticular Plating System       Plate Calcaneal - Titanium                 Small - Large
DP905        Periarticular Plating System       Fibula Composite Plate - Titanium          5 Hole
DP906        Periarticular Plating System       Medial Pilon Plate - Titanium              3 Hole
DP907        Periarticular Plating System       Meta Plate - Titanium                      Sm - Lge 3 Hole
DP908        Periarticular Plating System       Periarticular Pilon Plate - Titanium       4 to 10 hole
DP909        Periarticular Plating System       SPIDER Plate.(2p/p) Titanium               Sm
DP910        Periarticular Plating System       SPIDER Plate (2p/p) and offset Titanium    Lg
DP911        Periarticular Plating System       Meta Plate - Titanium                      Sm -Lge 5 Hole
DP912        Periarticular Plating System       Fibula Composite Plate - Titanium          11 Hole
DP913        Periarticular Plating System       Fibula Composite Plate - Titanium          7 Hole
DP914        Periarticular Plating System       Fibula Composite Plate - Titanium          9 Hole
DP915        Periarticular Plating System       Medial Pilon Plate - Titanium              5 Hole
DP916        Periarticular Plating System       Medial Pilon Plate - Titanium              7 Hole
DP917        Periarticular Plating System       Periarticular Spider Washer - Titanium     One size only
DP921        DOC Ventral Stabilisation System   Outer Bone Screw                           4.0mm x 12-16mm
DP922        DOC Ventral Stabilisation System   Inner Bone Screw                           12 - 16mm
DP923        DOC Ventral Stabilisation System   Platform - Straight Non Locking Screw      3.5 - 4mm
DP924        DOC Ventral Stabilisation System   Platform - Angled Screw 20Deg              3.5 - 4mm
                                                Lockable
DP927        DOC Ventral Stabilisation System   Assembly - Various single or two or        30-110mm
                                                three level
DP928        DOC Ventral Stabilisation System   Platform/Cross Connector Locking           3.5 - 4mm
                                                Screw or Graft Screw


Prostheses List February 2005                                                                                                            Page 241 of 700
ORTHOPAEDIC                                                                                                                    Minimum   Maximum
Billing Code Product Name                            Description                              Size                             Benefit   Benefit    Notation
DY064        Protrusio Cage                          Left and right Cobalt Chrome/Titanium    Size 52OD X 49ID, 56OD X 53ID,
                                                                                              60OD X 57ID
DY066        Codman Anterior Cervical Plate System   Anterior Cervical Plate                  24 - 48mm
DY069        Codman Anterior Cervical Plate System   Anterior Cervical Plate                  50 - 70mm
DY070        Codman Anterior Cervical Plate System   Anterior Cervical Plate                  74 - 110mm
DY096        DOC Ventral Stabilization System        Graft Platform or Cross Connector        One size only
DY121        VSP System (Stainless Steel)            Pedicle Screw (Standard or +5 No Cut)    4.75-7.75mm x 25-50mm
DY123        VSP System (Stainless Steel)            VSP Bone Plate                           One-Two Slot
DY124        VSP System (Stainless Steel)            VSP Bone Plate                           Two 1/2-Three 1/2 Slot
DY125        VSP System (Stainless Steel)            VSP Bone Plate                           Four-Five Slot
DY127        VSP System (Stainless Steel)            Washers - Standard / Tapered             3 & 5mm
DY305        VSP System (Titanium)                   Sacral Connector - Left & Right Offset   One size only
      Plugs
DY077        Apex Hole eliminator                    Hole eliminator screw Titanium           One size only
      Prep Kits
DP446        Vacu Mix Plus CMW Cement                Vacu-Mix Plus Pre Loaded With CMW        50, 80 grams
                                                     Bone Cement without Antibiotic
      Prostheses, Femoral Head
DP249        AML Modular Heads                       Ceramic Head Various Tapers & Neck       22 or 26 or 28 or 32 or 36mm                          Also grouped in
                                                     Lengths                                                                                        Hip Group 14c
      Prostheses, Femoral, Upper
DP013        Wroblewski Resection Stem               Stainless steel                          200mm, 250mm
DP172        PLAD                                    Wroblewski Cup Angle bore Left and       22mm
                                                     Right UHMWP
DP173        PLAD                                    PLAD for cups S/S and Polyethylene       22.225mm, 26mm and 28mm
DP546        C- Stem                                 Standard or High Offset or CDH           Size 1-8 or size 2-5 or CDH
                                                     Ortron stems
DP549        C- Stem                                 C-Stem Heads Ortron                      Size -3 to +8                                         Also grouped in
                                                                                                                                                    Hip Group 14b
DP550        C- Stem                                 Revision Stem Ortron                     Size 4-8 x 200-240 mm length
Prostheses List February 2005                                                                                                                      Page 242 of 700
ORTHOPAEDIC                                                                                                     Minimum   Maximum
Billing Code Product Name                  Description                                 Size                     Benefit   Benefit    Notation
      Prostheses, Finger/Thumb
DP002        Roseland Thumb                Trap CIM                                    Small, Large
DP015        Roseland Thumb                Meta 1/3 HAC & CIM                          Small, Large, Xlarge
DP017        Roseland Thumb                Trap HAC                                    Small, Large
DP573        Neuflex Finger                Neuflex MCP implant - Anasil Silicone       Size 0-60
DY400        Neuflex Finger                Neuflex PIP                                 1 to 20
      Prostheses, Foot
DY135        Barouk Screws                                                             2.5mm x 10-22mm
      Prostheses, Joint, Ankle
DP871        Agility Ankle System          Agility Ankle Talar                         Size 1 - 6
DY082        Agility Ankle System          Agility Ankle Tibial Shell Right and Left   Size 1-6
DY083        Agility Ankle System          Agility Ankle Tibial Insert and +2          Size 1-6
DY408        Agility Ankle System          Mobile Bearing                              1-6 from 3-11mm
DY409        Agility Ankle System          Wide Ankle Talus                            1 to 6
DY418        Mobile Ankle System           Tibial Tray                                 Size 1-6
DY419        Mobile Ankle System           Talus                                       Size 1-6
      Prostheses, Joint, Elbow
DY137        Acclaim Elbow                 Humeral Stem, Std/Lge                       100-200mm
DY138        Acclaim Elbow                 Ulnar Stem, Std/Lge-Left/Right              60-85mm
DY139        Acclaim Elbow                 Humeral Bobbin                              One size only
DY140        Acclaim Elbow                 Linked Ulnar Metal Bearing or               One size only
                                           Polyethylene Yoke
DY142        Acclaim Elbow                 Pin Assembly or Pin or Poly sleeve or       One size only
                                           Unlinked Poly Ulnar
DY146        Acclaim Elbow                 Linked Ulnar Bearing Screw                  One size only
DY288        Acclaim Elbow                 Unconstrained Ulnar Poly Bearing            15mm
      Prostheses, Joint, Hip, Acetabular Component
DP014        Duraloc Constrained Liner     Constrained liner with titanium alloy ring 28mm or 32mm, 48 - 74mm
DP551        Bantam Shells                 Bantam Titanium                            Size 38 - 46
Prostheses List February 2005                                                                                                       Page 243 of 700
ORTHOPAEDIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                        Description                               Size                                    Benefit   Benefit    Notation
DP552        Bantam Liners                       Bantam Enduron Polyethylene               10 Degree 22.225 & 26 & 28mm size
                                                                                           38-46
DP557        Duraloc Cup                         Sector or 100 series Polished inner or    Inner 48 to 66
                                                 polisherd Titanium or HA
DP558        Duraloc 100 Series Cup              100 series Titanium                       Size 48 - 66
DP563        Wroblewski Cup                      Golf Ball Left and right UHMWP            22mm size 40-53mm
DP944        Octopus Cup System                  Screw                                     6.5mm Diameter length 15-65mm
DP945        Octopus Cup System                  Cup                                       Size 50, 55mm
DP946        Octopus Cup System                  Hooded Liner                              22.2, 28 and 32mm Size 55, 50
DP947        Octopus Cup System                  Reorientation Liner                       22.2, 28 and 32mm Size 50-55mm
DP948        Octopus Cup System                  Ring Right and Left                       Size 50-55mm
DP949        Octopus Cup System                  Ring Long left and right                  Size 50-55mm
DY031        Option Cup system                   Option Ha                                 46-66 mm
DY032        Option Cup system                   Liner LPW or STD                          38-80 mm
DY034        Option Cup system Liner             Option Ceramic                            46-66 mm
DY036        Duraloc Marathon Acetabular Liner   Marathon Polyetholene Neutral or 10       28 or 32 mm size 48 - 66
                                                 Degree
DY169        Ultima Acetabular Ring              Ultima Acetabular Ring                    40 - 62mm
DY210        Pinnacle Acetabular Cup System      Pinnacle Marathon Liner + 4 or            38 - 80 mm x 22.225 or 26 or 28 or 32
                                                 Neutral or 10 Degree or Lipped            or 36mm
DY211        Pinnacle Acetabular Cup System      Pinnacle Metal or Ceramic Insert          48 - 80 mm 22.225 or 28 or 32 or 36
DY215        Pinnacle Cup/Liners                 CoCr "M" Femoral Heads Various            28 or 36 mm
                                                 Tapers and Neck Lengths
DY278        Pinnacle Acetabular Cup System      Pinnacle 100 or 300 or Sector or 1200,    38-80mm
                                                 STD or HA Acetabular Cup
DY280        Pinnacle Acetabular Cup System      Pinnacle GVF +4 or Neutral or 10          38-80mm x 22.225 or 26 or 28 or 32 or
                                                 Degree or Lipped Liners                   36mm
      Prostheses, Joint, Hip, Femoral Component
DP001        Reef Hip System                     Stem Wings, Titanium alloy                Sizes 1, 2, 3
DP005        Reef Hip System                     Stem Trochanteric Components,             25 or 35mm
                                                 Titanium alloy, Collared and Collarless
Prostheses List February 2005                                                                                                                          Page 244 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                           Description                              Size                                    Benefit   Benefit    Notation
DP009        Reef Hip System                        Stem, Titanium alloy                     Dia 10 - 20mm, Length 225 - 375mm
DP561        IPS HIP Titanium Femoral Hip System    Titanium IPS Stem Left and Right         Size 1 to 7
DP562        IPS HIP Titanium Femoral Hip System    Revision IPS Stem Titanium               Size 12 - 20
DP884        Streamline Centraliser                 -                                        Size 11-16
DP943        Corail Hip System                      Titanium Stem collar or collarless or    Size K9 to K20 or in lengths 130-
                                                    Coxa Vara or High offset
DY025        Unirom Total Hip System Femoral Stem   PFC / Ultima Taper 10/12 CoCr Head       Size -3 to +6
DY132        Corail Hip System                      Kar Femoral Stem                         Size 12 - 20
DY134        Summit Hip System                      Summit Femoral Stem DUOFIX               Size 1-10
                                                    Coated, Standard or High Offset
DY147        C-Stem End Cap                                                                  One size only
DY160        Ultima Monk Bi-Articular Head                                                   42 - 56mm
DY161        Unirom Total Hip System Femoral Stem   Stem Taper 11/13                         11-17 mm or 16B sml to 22F XXL                               Also grouped in
                                                                                                                                                          Hip Group 5d
DY166        G2 Hip System                          G2 Stem Uncemented                       1 - 12L
DY167        G2 Hip System                          G2 Stem Cemented                         1 - 11L
DY168        G2 Hip System                          Distal Centraliser                       1 - 11
DY402        ASR Hip System                         Modular Cathcart Unipolar Head           41 to 60mm
DY403        Modular Cathcart Unipolar Spacers                                               -3 to +10mm
DY423        Proxima Hip System                     Standard Offset Left/Right               Size 1 to 8
DY424        Proxima Hip System                     High Offset Left/Right                   Size 1 to 8
      Prostheses, Joint, Hip, Total
DP112        Duraloc Enduron Liner                  Enduron Liner                            28 or 32mm +4 size 48-66
DP115        Duraloc Enduron Liner                  Polythene Liner in Neutral or 10 or 20   22.225 or 26 or 28 or 32mm size 48-74                        Also grouped in
                                                    Degree or +4                                                                                          Hip Group 20a
DP119        Solution Implantable Hip System        Revision Standard & MMA 8 straight       6" size 10.5 - 22.5                                          Also grouped in
                                                    or bowed Porous coated                                                                                Hip Group 5c
DP121        Solution Implantable Hip System        Revision straight or bowed & Calcar or   10" size 13.5 - 22.5
                                                    10" both left and right


Prostheses List February 2005                                                                                                                            Page 245 of 700
ORTHOPAEDIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                        Description                               Size                                     Benefit   Benefit    Notation
DP124        Solution Implantable Hip System     CoCr Femoral Head Various Tapers &        22 or 26 or 28 or 32 mm size                                  Also grouped in
                                                 Neck Lengths                                                                                            Hip Group 13b
DP167        Thompson Implantable Hip            Thompson stems Ortron                     Size 41-54
DP168        Austin Moore Hip Prosthesis         Narrow or Standard Ortron                 Size 38-54mm
DP170        Austin Moore Hip Prosthesis         Ortron                                    Custom sizes
DP171        Hastings HIP                        Head                                      Size 36 - 56
DP175        Charnley Hip System                 Orton stems or Tumor or Revision or       10" or 12" or 15" stem or Longstem 40
                                                 Other                                     or EH40 or FL 40 or Resection, LG.
                                                                                           NK 1& 2, or 1 & 2 EH, Longstem LG.
                                                                                           NK 1 & 2
DP176        Charnley Hip System                 CDH Ortron                                CDH
DP178        Charnley Hip System                 Ortron                                    Round Back SNS 35, STS 35
DP180        Charnley Hip System                 RB 40, RB 40 NRW, RB 45 Ortron Stem       RB 40, RB 40 NRW, RB 45
DP181        Charnley Hip System                 Ortron Stem                               EH 40 or Fl 35 or 40 or Fl 45 or EH 45
DP182        Charnley Hip System                 Polythene, OGEE or LPW or FLANGED         22.225 or 28 or 32, 40 to 53mm
DP188        Thackray Hip System                 Acetabular Cup Self centering cup         28mm size 39-65
DP192        Thackray Hip System                 Charnley cement restrictor EA             One size only
                                                 Polymethylmethacrylate
DP199        Elite Modular Hip System            Elite Plus Stem Ortron                    CDH
DP203        Elite Modular Hip System            Elite Plus Stem High Offset Ortron        Size 2 - 5
DP205        Elite Modular Hip System            Stem Ortron                               Custom size
DP208        Elite Modular Hip System            Elite Plus Stem Primary Ortron            Size 40 or 1-4
                                                 Roundback
DP209        Elite Modular Hip System            Elite Plus Stem Primary Ortron Flanged    Size 2 - 5
DP212        Elite Modular Hip System            Elite Plus Stem Revision Ortron           4-8 length 190 - 250mm or STD or
                                                                                           Long Neck
DP222        Thackray Hip System                 Poly Liner Custom                         Made to order
DP223        Thackray Hip System                 Acetabular Mesh Ortron 90                 One size only
DP224        Thackray Hip System                 Charnley Spring Wires - Stainless Steel   0.5mm to 3.00mm
DP250        Anatomic Medullary Locking System   Locking Rings Titanium                    Size 38 - 74

Prostheses List February 2005                                                                                                                           Page 246 of 700
ORTHOPAEDIC                                                                                                                        Minimum   Maximum
Billing Code Product Name                       Description                                Size                                    Benefit   Benefit    Notation
DP277        Stability Hip System               Stem HA or Porocoat Coated                 Sm, Lge, XLge size 10A - 18B                                 Also grouped in
                                                                                                                                                        Hip Group 6b
DP296        Cementraliser                      Cementraliser                              Size 10 -13
DP297        Cementraliser Stem Centraliser     Distal Centralisers                        10-18mm
DP298        Centralisers                       Centraliser                                Size 11 - 18
DP360        Sector Cups                        Sector (Titanium)                          Size 48 to 66
DP361        Solution Deep Profile Cup          Deep Profile Titanium                      Size 56 - 80 mm
DP968        SROM Total Hip System              UHMWPE or Polythene Liner                  22 or 26 or 28 or 32mm size M28 - XL
                                                                                           46mm
DP969        SROM Total Hip System              UHMWPE Constrained                         0Deg, 10 Deg, 28mm, 32mm,
DP975        SROM Total Hip System (Titanium)   Obolong Ace both left and right            28mm & 32mm size 51+E15N - 66+E15N

DP976        SROM Total Hip System (Titanium)   Locking Pin Acetabular                     5.0mm
DP977        SROM Total Hip System (Titanium)   XX-Long, 36 x +21CR or +4 or +8 or         16 x 11 x 300 up to 24 x 19 x 325
                                                right, left or neutral in 11/13 or 14/14
                                                Taper
DP978        SROM Total Hip System (Titanium)   X-Long 36 or +21CR or +4L or +8L in        16 x 11 x 240 up to 24 x 19 x 275
                                                left, right or neutral or 11/13 or 12/14
                                                Taper
DP979        SROM Total Hip System (Titanium)   Long NK26 or 36 x +21CR or +4L or          14 x 9 x 205 up to 24 x 19 x 230
                                                +8L or left right or neutral or 11/13 or
                                                12/14 Taper
DP980        SROM Total Hip System (Titanium)   Stem                                       STD 14 x 09 x 130 NK36mm to 24 x 19
                                                                                           x 175 NK42mm
DP981        SROM Total Hip System (Titanium)   ZT/HA                                      Small / Large /XX Large size 14B-24F                         Also grouped in
                                                                                                                                                        Hip Group 6b, 6c,
                                                                                                                                                        6d, 8a, 8b, 8c, 8d
DP982        SROM Total Hip System (Titanium)   ZTT Cone                                   Small / Large / XX large size 14B-24F                        Also grouped in
                                                                                                                                                        Hip Group 6c, 6d,
                                                                                                                                                        8a, 8c, 8d
DP983        SROM Total Hip System (Titanium)   ZTT                                        OS/ Under Size SM-XXLG size 14B-24F                          Also grouped in
                                                                                                                                                        Hip Group 6d, 8b,
                                                                                                                                                        8d

Prostheses List February 2005                                                                                                                          Page 247 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                       Description                                Size                                      Benefit   Benefit    Notation
DP984        SROM Total Hip System (Titanium)   Standard NK30 or 36 or 42 or 21CR or       14 x 9 x 130mm to 24 x 19 x 175mm
                                                11/13 or 12/14 Taper
DP986        SROM Total Hip System (Titanium)   Trochanteric Washer                        40 x 31, 60 x 45, 70 x 54
DP988        SROM Total Hip System (Titanium)   Unipolar                                   38-66mm                                                        Also grouped in
                                                                                                                                                          Hip Group 14b, 15
DP998        SROM Total Hip System (Titanium)   Acetabular Apical Hole Plug                One size only
DP999        SROM Total Hip System (Titanium)   Unipolar Adaptor Sleeve                    +10
DY007        SROM Total Hip System (Titanium)   STD or Long or X-Long or XX-Long           26 x 21 x 175 or 230 or 275 or 325mm
                                                NK26 or 36 x +21CR or +4L or +8L           length
                                                left, right or neutral in 11/13 or 12/14
                                                Taper
DY010        SROM Total Hip System (Titanium)   ZTT1 & 2 or arthropor 1& 2 or Super        39 - 72 mm
                                                Cup or Gripper
DY018        SROM Total Hip System (Titanium)   Special Stem with either 230 to 325 in     12 x 06 x 155mm NK30, 14 x 09 x
                                                Left right Neutral or 11/13 or 12/14       205mm NK36
                                                Taper
DY020        SROM Total Hip System (Titanium)   Trochanteric Screw                         42mm, 52mm, 62mm
DY021        Ultima Total Hip System            Ultima Metal on metal, Titanium            Size Std 28mm 0D and Avg 28mm 10D
DY022        Ultima Total Hip System            Ultima Metal on metal shell with 3 hole    Size 48-68
                                                 Titanium
DY026        Elite Hemi Head                    Elite Plus Hemi Head                       42 - 60 mm
      Prostheses, Joint, Knee
DP003        LCS Complete System                Femoral Porocoat                           Small - large
DP004        LCS Complete System                Femoral Cemented                           Small - xlarge
DP008        LCS Complete System                APG Insert or APG Guide Arm                small - xlarge, sizes 10 - 20mm or Size
                                                                                           1-7
DP026        LCS Complete System                RP Tibial Insert                           Small - large, size 10 - 30mm                                  Also grouped in
                                                                                                                                                          Knee Group 5d
DP031        LCS Complete System                MBT Porocoat Keeled or Porocoat            Sizes 1 - 7
                                                Tibial Tray
DP032        LCS Complete System                MBT Cemented Keeled or Cemented            Sizes 1 - 7
                                                Tibial Tray

Prostheses List February 2005                                                                                                                            Page 248 of 700
ORTHOPAEDIC                                                                                              Minimum   Maximum
Billing Code Product Name            Description                              Size                       Benefit   Benefit    Notation
DP035        LCS Complete System     MBT DuoFix or Universal Tibial Trays     Tibial sizes 1 - 7
                                     HA on Porocoat
DP130        PFC Knee System Range   PFC CK cemented or Modular Tibial        Size 1-6
                                     Tray
DP143        PFC Knee System Range   PFC Flute Tib Rod & Extension            Size 75-150mm
DP145        PFC Knee System Range   PFC Sigma PLI or CVD or CS inserts       Size 1-6                                        Also grouped in
                                     or TCS                                                                                   Knee Group 6b
DP148        PFC Knee System Range   PFC Sigma C/R porous                     Size 1-6                                        Also grouped in
                                                                                                                              Knee Group 2a
DP149        PFC Knee System Range   PFC Sigma C/S                            Size 1-6                                        Also grouped in
                                                                                                                              Knee Group 5d
DP150        PFC Knee System Range   PFC Sigma TC3 Femur                      Size 1-5
DP151        PFC Knee System Range   PFC Sigma CVD or PLI Poly tibial         Size 1-6                                        Also grouped in
                                                                                                                              Knee Groups 3l,
DP152        PFC Knee System Range   PFC Sigma Patella or Universal insert    Size SM - LG. Or 25-32mm
                                     patella
DP153        PFC Knee System Range   PFC Sigma ROD or FC femoral              Size 5 Deg to 7 Deg
DP154        PFC Knee System Range   PFC Sigma FEM AUG                        Size 2-5
DP155        PFC Knee System Range   PFC Sigma Femoral stem / Bolt / Collar   Neutral to +2
DP158        PFC Knee System Range   PFC Sigma Femoral Distal or Post         Size 1-6
                                     Augments or Combo augments
DP161        PFC Knee System Range   PFC Mod PL TB WDG Types Hemi/            Size 2-5
                                     Stp / Full or Augmented tibial wedges
DP162        PFC Knee System Range   PFC Sigma Knee Duofix insert             Size 1-6
DP163        PFC Knee System Range   PFC Sigma Knee Offset Tibial Tray or     Size 1-6                                        Also grouped in
                                     Modular Plus tibial Tray                                                                 Knee Group 11
DP166        PFC Knee System Range   PFC Sigma Knee PR Insert                 Size 1-6
DP235        LCS Knee system         Textured PCR or Rotating Platform or     Std to Lge ++                                   Also grouped in
                                     PCR tibial tray Chrome cobalt                                                            Knee Group 3l
DP237        LCS Total Knee System   Femoral Tray Chrome cobalt               Sm+ to Lge++
DP238        LCS Total Knee System   Meniscal or Rotating Platform Bearings   10-17.5mm Std to Lge+                           Also grouped in
                                     Standard and Deep Dish                                                                   Knee Group 5d
Prostheses List February 2005                                                                                                Page 249 of 700
ORTHOPAEDIC                                                                                                                Minimum   Maximum
Billing Code Product Name                   Description                               Size                                 Benefit   Benefit    Notation
DP240        LCS Total Knee system          Cemented Cruciate retention Tibial        Std to Lge ++
                                            Chrome cobalt
DP285        AMK All Poly Tibia             All Poly Tibial tray                      Size 1/2 to 5
DP287        AMK Coordinate Revision Knee   Revision Tibial tray or Full wedge Tray   Size 1-5
                                            Chrome cobalt
DP290        AMK Coordinate Revision Knee   Cemented stem 10mm Chrome cobalt          Size 1-6 or 8-27mm Thickness x 95-
                                            or Fluted stem STD - Revision             140mm Length
DP294        AMK Coordinate Revision Knee   Insert 4 and 10mm Thick Tibial inserts    Size 1-5
DP351        LCS UNI Knee system            AP GLIDE Tibial Porocoat Chrome           Size 1-6
                                            cobalt
DP377        AMK Total Knee system          Poly Patella                              Size 30 - 38mm
DP378        AMK Total Knee system          Co ordinate Femoral wedge DIS / Post      Size 1-5
                                            Chrome cobalt
DP380        AMK Total Knee system          Posterior or Congruency stabilised        Size 1-5
                                            femoral or STD Femoral post Chrome
                                            cobalt
DP381        AMK Total Knee system          Cemented Femoral left and right           Size 1-5                                                  Also grouped in
                                                                                                                                                Knee Group 1b
DP383        AMK Total Knee system          Revision Pin Tibial Chrome cobalt         One size only
DP384        AMK Total Knee system          Primary Locking Pin S/S                   One size only
DP388        AMK Total Knee system          Posterior stabilised or Tibial or         Size 1-5
                                            Congruency or Constrained insert
DP444        AMK Chrome CobaltTray          Cemented CoCr Keeled tray and             Size 1-5                                                  Also grouped in
                                            Porous Coated trays                                                                                 Knee Groups 3f,
                                                                                                                                                3h, 3l
DP518        LCS Universal Knee             LCS Ultra Femorals Chrome cobalt          Sm - Lge+
DP519        LCS Universal Knee             LCS Ultra Tibial Chrome cobalt            Std - Lge+
DP520        LCS Universal Knee             LCS Ultra Patella                         Sm - Lge+
DP521        LCS Universal Knee             LCS Ultra inserts                         Sm - Lge+
DP570        AMK Coordinate Revision Knee   Tibial Ultra or STD Tibial or Varus       Size 1-5 or 2-10mm
                                            Valgus Constrained Inserts


Prostheses List February 2005                                                                                                                  Page 250 of 700
ORTHOPAEDIC                                                                                                                 Minimum   Maximum
Billing Code Product Name                   Description                            Size                                     Benefit   Benefit    Notation
DP889        AMK Chrome CobaltTray          Cobalt Chrome Tibial TEX or TX FX      Size 1-5
                                            Tray
DP891        AMK Chrome CobaltTray          Duofix Cobalt Chrome tibial Tray HA    Size 1-5
                                            coated
DY148        LCS Complete Revision System   LCS Complete Revision Femoral          Small - Large
                                            Cemented Right and Left
DY149        LCS Complete Revision System   LCS Complete Revision Femoral          Small - Large
                                            Porocoat Right and Left
DY151        LCS Complete Revision System   MBT Revision Trays Cemented or         1-7
                                            porocoat
DY153        LCS Complete Revision System   LCS Complete Revision Femoral Distal   Small 5mm - Large + 15mm
                                            or Posterior Augments
DY156        LCS Complete Revision System   LCS Complete PFC Sigma Revision        20 - 46mm
                                            Femoral Sleeves Porocoat
DY157        LCS Complete Revision System   MBT Revision Tibial Sleeve Porous      37 - 61mm
                                            Coated
DY158        LCS Complete Revision System   LCS Complete Revision Insert           Small 10mm - large + 30mm
DY159        LCS Complete Revision System   MBT Step Wedge or revision Tibial      1, 5mm - 7, 15mm
                                            Augment
DY368        LCS Complete System            Modular Femur Cemented CoCr            Sml to Lg + Left and Right                                    Also grouped in
                                                                                                                                                 Knee Group 11
DY369        LCS Complete System            Tibial Inserts                         Small to Large + thickness 10-25mm
DY370        LCS Complete System            MBT DuoFix CoCr or Universal Tibial    1-6                                                           Also grouped in
                                            Trays HA on Porocoat                                                                                 Knee Group 3m
DY371        LCS Complete System            PS Femur CoCr Cemented TiNi            Sml to Lge Plus Left and Right
DY372        LCS Complete System            PS Tibial Insert - Mobile              Sml to Lge Plus 10-25mm
DY373        LCS Complete System            Femoral Porocoat TiNi                  Small - Large Plus Left and Right
DY374        LCS Complete System            Femoral Cemented TiNi                  Small - Large Plus Left and Right
DY375        LCS Complete System            APG Insert or APG Guide Arm TiNi       Aml - Xlrge, sizes 10-20mm or Size 1-7
DY376        LCS Complete System            RP Tibial Insert for TiNi              Small - Large + from thickness 10-
DY377        LCS Complete System            MBT Porocoat Keeled or Porocoat        1-6
                                            Tibial TiNi
Prostheses List February 2005                                                                                                                   Page 251 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                          Description                             Size                                      Benefit   Benefit    Notation
DY378        LCS Complete System                   Cemented Keeled or Cemented Tibial      1-6
                                                   Tray TiNi
DY379        LCS Complete System                   MBT DuoFix or Universal Tibial Trays    1-6
                                                   HA on Porocoat TiNi
      Prostheses, Joint, Knee, Femoral Component
DY367        PFC Knee System Range                 PFC Sigma RP TC3                        Size 1.5 to 5 thickness of 15.5 to 30mm
      Prostheses, Joint, Knee, Patellar Component
DP523        LCS 3 Pegged Patella                  Cemented & Textured or porous coated    Sm - Lge+                                                      Also grouped in
                                                    3 peg Patella                                                                                         Knee Group 9d
DP524        LCS 3 Pegged Patella                  All Poly & all Poly 3peg Patella        Std - Lge+
DY111        LCS Patellofemoral Joint Prosthesis   LCS PFJ Trochlear Components Right      Small - Large                                                  Also grouped in
                                                   and Left                                                                                               Knee Group 8
      Prostheses, Joint, Knee, Total
DP254        SROM Knee System                      Noiles Hinge Femoral Comp               XSml-Lge
DP255        SROM Knee System                      Noiles Replacement Bumper Noiles        XSml - Medium                                                  Also grouped in
                                                   Modular or Replacement Hinge Bearing                                                                   Knee Group 11
DP257        SROM Knee System                      NRH Tibial Plateau size                 XSml - Med
DP259        SROM Knee System                      Noiles Modular Tibial Base              XSml-Xlge                                                      Also grouped in
                                                                                                                                                          Knee Groups 3j, 3l
DP260        SROM Knee System                      SROM Noiles Tibial Augments             4-10mm size 2-6
DP261        SROM Knee System                      Noiles Modular Tibial Sleeve            37-61mm
DP262        SROM Knee System                      Noiles Cap with Screw for Tibial Base   One size only                                                  Also grouped in
                                                                                                                                                          Knee Group 11
DP264        SROM Knee System                      Noiles UHMWPE & Poly Patella            Size 30-38
DP266        SROM Knee System                      SROM Noiles Femoral Extension with      11 x 100mm to 129 x 100mm
                                                   screws
DP267        SROM Knee System                      PLUG Modular Sleeve with Screw          One size only
DP268        SROM Knee System                      Femoral Component                       XSml -Lge
DP269        SROM Knee System                      SROM Noiles Femoral Augmentation        1-6 4-16mm
                                                   Blocks
DP270        SROM Knee System                      NPS Tibial Plateau                      XSml -Lge
Prostheses List February 2005                                                                                                                            Page 252 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                   Description                            Size                                  Benefit   Benefit    Notation
DP271        SROM Knee System               Noiles Femoral Sleeve Por Coated       Size 31-46mm
DP272        SROM Knee System               Noiles Femoral Stem Extn/Screw         Size 9 x 100 to 19 x 150
DP273        SROM Knee System               PROM Insert Curved & Stabilised        Size 2-5                                                   Also grouped in
                                            (Noiles)                                                                                          Knee Group 5d
DP821        LCS Revision Knee system       Revision Femoral Chrome cobalt         STD - LGE+
DP822        LCS Revision Knee system       Revision tibial Tray Chrome cobalt     STD- LGE+
DP823        LCS Revision Knee system       Stem Extension Chrome cobalt           10 x 55mm to 22x110mm
DP824        LCS Revision Knee system       LCS DIST or Post or BLK Femoral        SM-LGE+
                                            Augments Chrome cobalt
DP825        LCS Revision Knee system       LCS Revision Bearings                  SML+ to LGE++ 10m-25mm in each size
DP826        LCS Revision Knee system       Revision Textured Tibial Tray Chrome   Size 1-7
                                            cobalt
DP827        LCS Revision Knee system       Revision Textured femoral Chrome       Size SM - LG+
                                            cobalt
DY112        Preservation Miu Knee System   MIU Cemented Femoral                 Size 1-5
DY113        Preservation Miu Knee System   MIU Porous Femoral                   Size 1-5
DY114        Preservation Miu Knee System   MIU All Poly Tibials RM/LL and LM/RL 1, 7mm - 5, 11.5mm

DY115        Preservation Miu Knee System   MIU Fixed or Mobile Bearing Inserts    1, 9.5mm - 5, 13.5mm
                                            RM/LL and LM/RL
DY117        Preservation Miu Knee System   MIU Fixed or mobile Tibial Tray        Size 1-5
                                            Cemented RM/LL and LM/RL
DY118        Preservation Miu Knee System   MIU Fixed Tibial Tray Porous or        Size 1-5
                                            Mobile RM/LL and LM/RL
DY404        RPF Cemented Femur                                                    Size 1 to 6
DY405        RPF PS Tibial Inserts                                                 Size 1 to 6 from 10 to 17.5mm
      Prostheses, Joint, Shoulder
DP020        Global Advantage Shoulder      Eccentric Head, Cobalt chrome alloy    44- 56mm x 18, 21mm
DP029        Global Advantage Shoulder      Revision Stem Titanium alloy           8mm x 200mm - 14mm x 220mm
DP030        Global Advantage Shoulder      Stem Standard, Titanium alloy          6mm - 16mm


Prostheses List February 2005                                                                                                                Page 253 of 700
ORTHOPAEDIC                                                                                                           Minimum   Maximum
Billing Code Product Name                Description                            Size                                  Benefit   Benefit    Notation
DP077        Global Advantage Shoulder   Global Advantage Stem STD or Long      Size 8 to 14 or Length 6-16mm
                                         Chrome
DP081        Global Shoulder             Global Advantage HUM HD                Size 44 - 52 by size x 15 /18 or 21
DP086        Global Shoulder             Global FIN/ Peg Glenoid                Size 40-56
DP898        S-Fit Metal Glenoid         S-FIT Glenoid Bearing                  Size 40-52
DP899        S-Fit Metal Glenoid         S-FIT M/B Glenoid                      Size 40-52
DP950        Delta Shoulder system       Standard Metaglene INOX/ ST. Steel     One size only
                                         + Aluminia+HAC
DP951        Delta Shoulder system       Revision Metaglene INOX/ ST. Steel +   One size only
                                         Aluminia+HAC
DP952        Delta Shoulder system       Centror Glenoid INOX / ST.Steel /      Size 36-40 /42
                                         Nichtrostender St.
DP954        Delta Shoulder system       Metaglene Screw Stainless Steel        3.5mm and 4.5mm
DP956        Delta Shoulder system       Cementless Diaphysis INOX/ ST. Steel   Size 1-4
                                         + Aluminia+HAC
DP957        Delta Shoulder system       Cemented Epiphysis INOX/ ST. Steel +   Size 1-4 in 26-42mm
                                         Aluminia+HAC
DP958        Delta Shoulder system       Humeral Cup Laterilised Polyethylene   36-42mm in +0 to +6 /STD / LAT
                                                                                /STD Retentive
DP962        Delta Shoulder system       DELTA Humeral Head INOX /              36 - 42 mm in +0-+4
                                         ST.Steel / Nichtrostender St.
DP964        Delta Shoulder system       Humeral Spacer INOX / ST.Steel /       Dia 36/42 + 9
                                         Nichtrostender St.
DP965        Delta Shoulder system       Revision Cementless Diaphysis INOX /   Size 1-4
                                         ST. Steel + Aluminia+HAC
DP966        Global FX Shoulder          Global FX Stem Chrome                  6-12mm and STD and revision 160-
                                                                                220mm length
DY129        Global Advantage CTA Head                                          44 x 18 - 56 x 23
DY273        Global FX Porocoat          FX PC Stem Standard / Long             6-12mm
DY360        Global Advantage Shoulder   Anchor Peg Glenoid                     40 to 56 mm



Prostheses List February 2005                                                                                                             Page 254 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                         Description                          Size                                  Benefit   Benefit    Notation
      Prostheses, Joint, Toe
DP883        Barouk SCR Sys Staples and Buttons   Barouk Screw System Button           8-20mm
                                                  Prosthesis - SS or Ceramic
      Prostheses, Joint, Wrist
DP127        Biax Wrist                           Biax Wrist STD and Long              Small - Large
      Prostheses, Leg
DY187        Limb Preservation System             Proximal Femoral Body Component      Neutral in Std, Trochanter body
                                                  Left/Right
DY188        Limb Preservation System             Distal Femoral Replacement           Extra small
                                                  Component Left/Right
DY189        Limb Preservation System             2cm LPS Femoral Stem Cemented        11 mm diameter x 150 mm length - 17
                                                  (Bowed)                              mm diameter x 200 mm length
DY190        Limb Preservation System             2cm LPS Femoral Stem Porous Coated   12.5 mm diameter x 150 mm length -
                                                  (Bowed)                              18.5 mm diameter x 200 mm length
DY191        Limb Preservation System             Total Femoral Segment Component      55 mm
                                                  (Male/Male)
DY192        Limb Preservation System             Segmental Component (Male/Female)    25 to 65mm Length
DY193        Limb Preservation System             Standard Cemented Stem (straight)    9 mm diameter x 100 mm length - 17
                                                                                       mm diameter x 125 mm length
DY194        Limb Preservation System             Standard Porous Stem (straight)      10.5 mm diameter x 100 mm length -
                                                                                       18.5 mm diameter x 125 mm length
DY195        Limb Preservation System             Tibial Replacement Component         X-Sm - Med
DY196        Limb Preservation System             Tibial Hinge Insert                  X-Sm 12mm height - Med 31 mm height
DY217        Limb Preservation System             Intercalary Segment Component        55mm
                                                  (Male/Female)
DY425        Limb Preservation System             Segmental Component (Male/Female)    85 to 125mm length
DY426        Limb Preservation System             Proximal Femoral Body Component      15 degrees Std, Trochanter body
                                                  Left/Right
      Prostheses, Soft Tissue
DY136        Restore Orthobiologic Soft Tissue    Restore Patch                        One size only
             Implant


Prostheses List February 2005                                                                                                                    Page 255 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                            Description                               Size                                     Benefit   Benefit    Notation
      Prosthesis, Internal, Hip, Joint, Total
DY328        ASR Hip System                          Acetabular Cup                            38.5-64.5mm
DY329        ASR Hip System                          Large Modular Head Adaptor / Sleeve       9/10 or 11/13 or 12/14 taper
DY330        ASR Hip System                          Large Modular Head                        38.5-64.5mm
DY331        ASR Hip System                          Resurfacing Femoral Head                  38.5-64.5mm
      Prosthesis, Internal, Joint, Digit
DY410        Hand and Foot Fracture Systems          FRST wist off screw                       11 to 14mm
DY411        Hand and Foot Fracture Systems          FRSStandard Staple, Straight              8 to 10mm
DY412        Hand and Foot Fracture Systems          FRS Screw                                 10mm to 34mm L x 2.5mm Diameter
DY413        Hand and Foot Fracture Systems          FRS .S.O.C Pin                            9 to 40 mm Thread Length
      Prosthesis, Internal, Joint, Elbow, Radial Component
DY414        Guepar Radial Implants                  Radial Stem, Radial Head                  +0 to+4
DY415        Guepar Radial Implants                  Radial Stem, Radial Head                  14/12mm to 16/16mm
      Prosthesis, Internal, Joint, Shoulder, Total
DY416        Total Shoulder System                   Global CAP Conserv Head PC, Global        40 x 15 to 56 x 21
                                                     CAP Conserv Head HA
DY417        Total Shoulder System                   Global CAP Conserv Head PC, Global        40 x 15 to 56 x 21
                                                     CAP Conserv Head Porous Coated
      Restrictors, Orthopedic Cement
DP233        Hardinge Cement Restrictor              Hardinge cement Restrictor (ea)           One size only
DP448        BIO Stop G                              Biostop Restrictor (Gelatin, Glkycerol,   size 8-20
                                                     PHBM, Water)
DP575        C-Stem End Cap                          End Cap Biostop Restrictor (Gelatin,      Size 8- 20
                                                     Glycerol, PHBM, water)
      Screws
DY321        Codman Anterior Cervical Plate System   Rescue screw                              12 & 15mm
      Screws, Bone
DP040        Bone Screw                              Screw Cancellous Titanium                 Dia 3.5 or 5 or 6.5 or 7mm length 15 -
                                                                                               110mm
DP042        Chandler Plate                          Tibial Osteotomy Plate -Stainless Steel   50-70mm
Prostheses List February 2005                                                                                                                               Page 256 of 700
ORTHOPAEDIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                            Description                             Size                                   Benefit   Benefit    Notation
DP043        Chandler Plate                          Self Tap Screw 4.5mm Length -           60-100mm
                                                     Stainless steel
DP868        Barouk Screw System                     Barouk Screw - Titanium                 10-34mm Length
DP882        Twistoff Screw                          TwistOff Screw Titanium                 11-14mm Long
DP894        Rockwood Shoulder Screw                 Rockwood Shoulder Screw S/S             One size only
DP895        Rockwood Shoulder Screw                 Rockwood Shoulder washer S/S            One size only
DP896        AC Percu Screw                          AC Percu screw S/S                      Size 32-52mm
DP897        AC Percu Screw                          AC Percu Screw Washer S/S               One size only
DP900        Albizza Nail                            Albizza Nail - Stainless Steel          240-320mm Length
DP901        Albizza Nail                            Albizza Nail Cotter Screw               3.5 or 4.5 0r 5.5 mm 25-75 mm length
DY074        Codman Anterior Cervical Plate System   Cancellous Bone Screw - Standard/Self   10 - 26mm
                                                     Tapping/Variable Depth
      Sleeves
DP574        C-Stem Centraliser                      Centraliser Polymethylmethacrylate      One size only
                                                     (PMMA)
DP872        Charnley Centraliser                    Charnley Centraliser EA                 Size 1 and 2
                                                     Polymethylmethacrylate
      Staples, Bone
DP878        Barouk System Staples                   Varisation Staple Stainless Steel       26-90Deg x 8-10mm
DP879        Barouk System Staples                   Memory Staple - Titanium Alloy          13-20mm Long
DP880        Barouk System Staples                   TIFLEX Staple / Pin - Titanium          1.6 - 2.5 Dia 7-24mm width 13/15-
                                                                                             36/50mm Length
      Sutures, Stainless Steel Monofilament
DP232        Suture Wire                             Wire Suture Stainless Steel             0.5 to 5mm
Device Technologies Australia Pty Ltd
      Anchor, Fixation
DE063        Parachute Corkscrew Suture Anchor       PLA & Titanium                          3.5mm - 5mm
DE064        Corkscrew Suture Anchor                 Titanium alloy                          3.5 - 6.5mm x 5.0mm
DE066        FASTak Titanium Suture Anchor           Titanium alloy                          One size only
DE074        Fastak II Anchor                        Titanium alloy                          One size only
Prostheses List February 2005                                                                                                                           Page 257 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                        Description                              Size                                       Benefit   Benefit    Notation
DE162        FASTak Suture Anchor (Small Bone)   Titanium suture anchor, preloaded with   Dia 2.4mm x length 7.5mm
                                                 polyester suture
DE196        Corkscrew Suture Anchor             Titanium alloy with Fibrewire suture     3.5mm - 6.5mm
DE198        Fastak Suture Anchor (Small Bone)   With Fibrewire Suture                    Dia. 2.4mm x Length 7.5mm
DE225        Fastak Anchor                       Titanium with fibrewire suture           2.8mm x 11.7mm
      Bone Matrix Implants, Artificial
DE194        Salu Cartilage                      Osteochondral implant                    5mm - 25mm
      Fixation Device, Internal, Plate
DE236        Carpal Button                       Titanium                                 X3 sizes with various screw hole options
      Fixation Device, Internal, Screw
DE214        Cortical Screw                      Titanium                                 10-24mm x 2.3mm
DE230        Scaminos Screws                     Titanium                                 13-31mm length
DE238        Carpal Screw                        Titanium                                 2.5mm diameter in sizes 12mm-20mm
DE247        Minos Screws                        Titanium                                 2-3mm diameter x 9-21mm length
DE249        Weil Screws                         Titanium                                 7-17mm
      Grafts, Bone, Synthetic
DE082        Hatric Bone Substitute              Ceramic                                  7mm - 15mm
DE130        MBCP                                Micro & Macroporous Biphasic             0.5-1mm (1cc)
                                                 Calcium Phosphate, composition -
                                                 ceramic consituting calcium phosphate
                                                 hydroxyapatic 60% and tricalcium
                                                 phosphate beta (TCP) 40%, granules
DE131        MBCP                                Micro & Macroporous Biphasic             0.5-1mm (2cc)
                                                 Calcium Phosphate, composition -
                                                 ceramic consituting calcium phosphate
                                                 hydroxyapatic 60% and tricalcium
                                                 phosphate beta (TCP) 40%, granules
DE132        MBCP                                Micro & Macroporous Biphasic             1-2mm (2cc)
                                                 Calcium Phosphate, composition -
                                                 ceramic consituting calcium phosphate
                                                 hydroxyapatic 60% and tricalcium
                                                 phosphate beta (TCP) 40%, granules

Prostheses List February 2005                                                                                                                            Page 258 of 700
ORTHOPAEDIC                                                                               Minimum   Maximum
Billing Code Product Name       Description                             Size              Benefit   Benefit    Notation
DE133        MBCP               Micro & Macroporous Biphasic            1-2mm (10cc)
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, granules
DE134        MBCP               Micro & Macroporous Biphasic            2-3mm (2cc)
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, granules
DE135        MBCP               Micro & Macroporous Biphasic            2-3mm (10cc)
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, granules
DE136        MBCP               Micro & Macroporous Biphasic            2-3mm (16cc)
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, granules
DE137        MBCP               Micro & Macroporous Biphasic            5 x 5 x 10-20mm
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, sticks
DE138        MBCP               Micro & Macroporous Biphasic            5-12mm
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, wedges,
                                basis
DE139        MBCP               Micro & Macroporous Biphasic            6-12mm
                                Calcium Phosphate, composition -
                                ceramic consituting calcium phosphate
                                hydroxyapatic 60% and tricalcium
                                phosphate beta (TCP) 40%, wedges,
                                round off


Prostheses List February 2005                                                                                 Page 259 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                        Description                                  Size                                      Benefit   Benefit    Notation
      Ligators
DE059        Arthrex Meniscal Dart               PLA                                          10mm - 14mm
DE140        Bio-Fastak                          Composition - Poly (L-lactide-co-D, L-       3-11mm
                                                 lactide) with an insert molded eyelet of
                                                 non-absorbable polyester suture
DE197        Bio - Fastak                        with Fibrewire suture                        3mm x 11mm
DE218        Arthrex Mini Bio-Anchor             PLDLA, with Fibre Wire                       2.4mm x 7mm
      Nails, Bone
DE061        Fixion Nailing System               Stainless Steel                              18x 6.7mm - 440 x 12mm
DE095        Fixation IM Nail - Proximal femur   Stainless steel                              Dia 10 x 220mm, length 12 x 380mm
DE096        Fixion IM nail - Humeral            Stainless steel                              Dia 6.7 - 8.5mm (reduced), length 180 -
                                                                                               280mm
      Orthopedic External Fixation Systems
DE231        MiniFix                             Finger Mini Fixator System                   One size only
DE235        RadioFix                            Radial Fixator system                        One size                                                       Temporary
                                                                                                                                                             approval, pending
                                                                                                                                                             review of product
                                                                                                                                                             group
DE244        Poing Fix                           Wrist Fixator System                         One size
DE245        Wrist Fixator PFII                  Wrist Fixator System                         One size
DE246        MicroFix                            Finger Mini Fixator system                   One size
      Orthopedic Internal Fixation Systems, Spinal
DE164        Expandable Spinal Fusion System     Composition - titanium, locking ring         Dia 4.85/10 - 9/15mm x Length 22 -
                                                 nickel titanium                              25mm
      Pins, Bone
DE070        TransFix Implant Screw System -     Titanium alloy                               40mm & 50 mm
DE124        Fixion Hip Pin                      Stainless Steel                              Diameter 5mm x length 60-100mm
DE129        Fixion Peg                          Stainless steel peg with inflatable distal   Diameter 8mm x lengths 80, 90, 100,
                                                 part                                         110, 120mm
      Pins, Bone, Absorbable
DE080        Tissue Button                       PLA                                          6.5mm - 10mm
Prostheses List February 2005                                                                                                                               Page 260 of 700
ORTHOPAEDIC                                                                                                             Minimum   Maximum
Billing Code Product Name                      Description                                  Size                        Benefit   Benefit    Notation
DE126        Chondral Dart                     Polylactide Compositition                    Length 18mm
DE127        Bio-Transfix                      Composition Poly (L-lactide)                 Diameter 5mm, length 50mm
      Plates, Bone
DE055        Osteotomy Plates                  Osteotomy, Tibial - Stainless Steel          5mm - 17.5mm
DE078        Osteotomy Plates                  Osteotomy, Femoral - Stainless Steel         7.5mm - 17.5 mm
DE094        Osteotomy Plates                  Anterior/posterior sloped. Stainless steel   5 - 15mm length
DE215        Arthrex Osteotomy Plates          Metatarsal                                   2mm - 5mm
DE216        Arthrex Osteotomy Plates          Tibial, Composition Titanium                 3mm - 17.5mm
DE217        Arthrex Osteotomy Plates          Femoral, Titanium                            5mm - 17.5mm
      Prostheses, Joint, Shoulder
DE168        Univers 3D Shoulder Prostheses    Stem                                         6-12mm
DE169        Univers 3D Shoulder Prostheses    Glenoid Metal Back                           Small, Medium, Large
DE170        Univers 3D Shoulder Prostheses    Glenoid PE-Inlay                             Small, Medium, Large
DE171        Univers 3D Shoulder Prostheses    Metal Head                                   43/15 - 51/22
DE172        Univers 3D Shoulder Prostheses    Cemented glenoid                             Small, Medium, Large
DE173        Univers Fracture Prostheses       Shaft                                        8-13mm
DE174        Univers Fracture Prostheses       Metal head                                   43/15 - 51/22
      Prosthesis, Internal, Joint, Digit
DE232        MCP Finger Prosthesis "Ariadna"   Distal part, Stainless Steel                 1, 2 or 3                                        Temporary
                                                                                                                                             approval, pending
                                                                                                                                             review of product
                                                                                                                                             group
DE233        PIP Finger Prosthesis "DGT"       Proximal part, Stainless Steel textured in   1,2 or 3                                         Temporary
                                               Cobalt Chrome                                                                                 approval, pending
                                                                                                                                             review of product
                                                                                                                                             group
DE234        MCP Finger Prosthesis "Ariadna"   Proximal part, Stainless Steel               1, 2 or 3                                        Temporary
                                                                                                                                             approval, pending
                                                                                                                                             review of product
                                                                                                                                             group


Prostheses List February 2005                                                                                                               Page 261 of 700
ORTHOPAEDIC                                                                                                                                  Minimum   Maximum
Billing Code Product Name                           Description                                  Size                                        Benefit   Benefit    Notation
DE237        Trapezio Metacarpal Prosthesis DLC     Stem - Cobalt Chrome                         1 or 2                                                           Temporary
                                                                                                                                                                  Approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE239        Elektra Stem                           Cobalt Chromium/Hydroxyapatite               6-8mm                                                            Temporary
                                                                                                                                                                  Approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE240        Elektra Neck                           Cobalt Chromium                              Extra short, short, medium, long                                 Temporary
                                                                                                                                                                  Approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE242        Trapezio Metacarpal Prosthesis DLC     Cup, polyethylene                            One size only                                                    Temporary
                                                                                                                                                                  Approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE243        Trapezio Metacarpal Prosthesis DLC     Neck - Cobalt Chrome                         short, medium or long                                            Temporary
                                                                                                                                                                  Approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE248        PIP Finger Prosthesis "DGT"            Distal part, Stainless Steel textured with   1, 2 or 3                                                        Temporary
                                                    Cobalt Chrome                                                                                                 approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
DE250        Elektra Cup                            Cobalt Chromium and Hydroxyapatite           One size only                                                    Temporary
                                                    Coating                                                                                                       approval, pending
                                                                                                                                                                  review of product
                                                                                                                                                                  group
      Prosthesis, Internal, Ligament, Anchor
DE220        Bio-Suturetak                          PLDLA Bioabsorbable Suture Anchor            Diameter 3mm, Length 14.5mm
      Prosthesis, Internal, Spine, Vertebral Body
DE226        B-Twin Vertebral Body Reconstruction   Titanium, locking ring Nitinol               Diameter - 11.5/13 - 15.5/17, length 25 -
             System                                                                              27mm
      Rods
DE163        Bio-Post & Washers                     PLLA composition                             Implant 35mm - 50mm, Washers 16mm

Prostheses List February 2005                                                                                                                                    Page 262 of 700
ORTHOPAEDIC                                                                                                               Minimum   Maximum
Billing Code Product Name                    Description                           Size                                   Benefit   Benefit    Notation
      Screws
DE069        Interference Screws             Bio-Cortical - PLA                    8 x 17 - 11 x 17mm and 8 x 20 - 10 x
                                                                                   20mm
DE072        Bio-Interference Screw          PLA                                   7mm - 9mm
DE075        Arthrex Headed Bio-absorbable   PLA                                   8mm
             Corkscrew
DE081        Tissue Tak                      PLDLA                                 3mm - 4.5mm
DE125        Bio-Corkscrew                   Composition - polylactide, eyelet -   3.5-6.5mm
                                             polyester
DE166        Bio-Tenodesis Screw             Composition PLLA                      Dia 5.5-9mm
DE167        Bio-Interference Screw          Composition - PLLA, delta tapered     Dia6.5 - 10.5mm to 8 - 12mm x 28 -
                                                                                   35mm length
DE195        Bio Corkscrew                   With Fibrewire Suture                 3.5mm - 6.5mm
DE224        Retro Screw                     Composition PLLA                      8-10mm x 20mm
      Screws, Bone
DE060        Avulsion Screw                  Titanium                              45mm
DE067        Interference Screws             ARTHREX Sheathed                      7 x 23mm - 12 x 23mm
DE068        Interference Screws             ARTHREX Non-sheathed                  7 x 28mm - 12 x 28mm
DE077        Cancellous Bone Screws          Low Profile                           30mm - 40mm
DE128        Cortical Screw                  Self locking screws, cancellous and   Diameter 3.5-6mm, length 10-110mm
                                             cortical
      Staples, Bone
DE062        Ligament Staples                Cobalt Chromium Molybdenium Alloy     6mm - 16mm
DE241        Memofix Staples                 Nitinol                               10-17mm x 12-20mm length
      Washers, Bone Screw
DE071        Arthrex Spiked Washer           Titanium alloy                        14 - 15mm
Dj Orthopaedics Pty Ltd
      Screws, Bone
DJ001        ACL Bone Screws                 -                                     Dia 5 - 10mm, length 20 - 50mm


Prostheses List February 2005                                                                                                                 Page 263 of 700
ORTHOPAEDIC                                                                                                                             Minimum   Maximum
Billing Code Product Name                             Description                               Size                                    Benefit   Benefit    Notation
Endotec Australia Pty Ltd
      Prostheses, Joint, Ankle
EA001        B.P.U. Revision Total Ankle Prosthesis   Ceramic coated titanium                   1-6
EA002        Buechel-Pappas Total Ankle Prosthesis    Ceramic coated titanium                   1 to 6
             - replacement
      Prostheses, Joint, Hip
EA003        Buechel-Pappas Integrated Total Hip      Acetabular Cup-Ceramic coated             45mm to 69mm
             Replacement System
EA004        Buechel-Pappas Integrated Total Hip      Acetabular Bearing                        45mm to 65mm
             Replacement System
EA005        Buechel-Pappas Integrated Total Hip      Femoral Head-Ceramic coated titanium      28mm to 58mm
             Replacement System
      Prosthesis, Internal, Joint, Knee, Total
EA006        Buechel-Pappas Ultracoat Total Knee      Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat Primary Femoral
             Replacement System (Primary and          Tibial components with mobile             sizes 1-6(inc) Left & Right
             Revision)                                Polyethylene inserts, all polyethylene
                                                      patella ceramic coated, titanium backed
                                                      polyethylene mobile patella
EA007        Buechel-Pappas Ultracoat Total Knee      Ceramic Coated, Titanium Femoral and      BP TKR Cemented Primary Femoral
             Replacement System (Primary and          Tibial components with mobile             sizes 1-6(inc) Left & Right
             Revision)                                Polyethelene inserts, all polyethelene
                                                      patella ceramic coated, titanium backed
                                                      polyethylene mobile patella
EA008        Buechel-Pappas Ultracoat Total Knee      Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat Primary Tibial sizes
             Replacement System (Primary and          Tibial components with mobile             1-6(inc)
             Revision)                                polyethelene inserts all polyethelene
                                                      patella ceramic coated, titanium backed
                                                      polyethelene mobile patella
EA009        Buechel-Pappas Ultracoat Total Knee      Ceramic Coated, Titanium Femoral and      BP TKR Cemented Primary Tibial sizes
             Replacement System (Primary and          Tibial components with mobile             1-6(inc)
             Revision)                                polyethelene inserts all polyethelene
                                                      patella ceramic coated, titanium backed
                                                      polyethelene mobile patella



Prostheses List February 2005                                                                                                                               Page 264 of 700
ORTHOPAEDIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                          Description                               Size                                     Benefit   Benefit    Notation
EA010        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR mobile bearing insert sizes 1-
             Replacement System (Primary and       Tibial components with mobile             6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA011        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat Mobile Patella sizes
             Replacement System (Primary and       Tibial components with mobile             1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA012        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP All Poly Patella sizes 1-6(inc)
             Replacement System (Primary and       Tibial components with mobile
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA013        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat Revision Femoral
             Replacement System (Primary and       Tibial components with mobile             sizes 1-6(inc) Left & Right
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA014        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Cemented Revision Femoral
             Replacement System (Primary and       Tibial components with mobile             sizes 1-6(inc) Left & Right
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA015        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat Revision tibial sizes
             Replacement System (Primary and       Tibial Components with mobile             1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA016        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Cemented Revision tibial sizes
             Replacement System (Primary and       Tibial components with mobile             1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella




Prostheses List February 2005                                                                                                                             Page 265 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                          Description                               Size                                      Benefit   Benefit    Notation
EA017        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat revision hinged
             Replacement System (Primary and       Tibial components with mobile             femoral assembly sizes 1-6(inc) Left &
             Revision)                             polyethelene inserts all polyethelene     Right
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA018        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Cemented revision hinged
             Replacement System (Primary and       Tibial components with mobile             femoral assembly sizes 1-6(inc) Left &
             Revision)                             polyethelene inserts all polyethelene     Right
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA019        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat hinged tibial sizes 1-
             Replacement System (Primary and       Tibial components with mobile             6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA020        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Cemented hinged tibial sizes
             Replacement System (Primary and       Tibial components with mobile             1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA021        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Ultracoat thick hinged tibial
             Replacement System (Primary and       Tibial components with mobile             sizes 1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA022        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Cemented thick hinged tibial
             Replacement System (Primary and       Tibial components with mobile             sizes 1-6(inc)
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella
EA023        Buechel-Pappas Ultracoat Total Knee   Ceramic Coated, Titanium Femoral and      BP TKR Revision stems 10-16(inc)
             Replacement System (Primary and       Tibial components with mobile
             Revision)                             polyethelene inserts all polyethelene
                                                   patella ceramic coated, titanium backed
                                                   polyethelene mobile patella




Prostheses List February 2005                                                                                                                              Page 266 of 700
ORTHOPAEDIC                                                                                                                           Minimum   Maximum
Billing Code Product Name                            Description                               Size                                   Benefit   Benefit    Notation
EA024        Buechel-Pappas Ultracoat Total Knee     Ceramic Coated, Titanium Femoral and      BP Rebar Screws 9-20mm(inc)
             Replacement System (Primary and         Tibial components with mobile
             Revision)                               polyethelene inserts all polyethelene
                                                     patella ceramic coated, titanium backed
                                                     polyethelene mobile patella
Endotherapeutics Pty Ltd
      Anchor, Fixation
ET044        Resofix Anchor                          Resofix anchor is a 2-shell expansion     Resofix - S Anchor - 10mm; Resofix -
                                                     bolt made of amorphous poly DL-           P Anchor - 10mm
                                                     Lactide resorbablel polyester
Global Manufacturing Technology Pty Limited
      Bone Matrix Implants, Artificial
GM036        Callos Bone Void Filler                 Calcium Phosphate                         10cc
GM037        Callos Bone Void filler                 Calcium Phosphate                         5cc
      Cement, Orthopedic
GM009        C-ment1, C-ment 3, Genta C-ment ,       Acrylic Bone Cement                       40 grams
             Genta C-ment 3
GM018        C-ment 1, C-ment 3, Genta C-ment,       Acrylic Bone Cement with Gentamicin       40 grams
             Genta C-ment 3
      Fixation Device
GM020        Optimal Spinal System                   Hooks-open & closed-pedical &             Various
GM025        Maxima/Optima Anterior Cervical Plate   Cancellous Bone Screws                    3.5 x 10mm to 20mm; 4.0 x 10mm to
             System                                                                            20mm
GM026        Maxima/Optima Anterior Cervical Plate   Anterior cervical Plates                  24mm to 108mm
             System
GM027        NeoIC (Neo Interbody Fusion Cage)       Interbody Fusion Cage                     Various
GM029        Optimal Spinal System                   Axial/Lateral Connectors                  Various
GM031        Optimal Spinal System                   Traverse Link Assembly                    40 to 80mm
GM032        Optimal Spinal System                   Set Screw                                 9 x 1.5 to 10 x 1.5mm
GM033        Optimal Spinal System                   Rod                                       6 x 40 to 6 x 600mm
GM034        Optimal Spinal System                   Pedicle Screw Monoaxial Type              4 x 25 to 8 x 55mm

Prostheses List February 2005                                                                                                                             Page 267 of 700
ORTHOPAEDIC                                                                                                                         Minimum   Maximum
Billing Code Product Name                            Description                           Size                                     Benefit   Benefit    Notation
GM035        Optimal Spinal System                   Pedicle Screw-Poly Type               5 x 30 to 8 x 55mm
GM039        Prima OCT Spinal System                 Occiput Plate                         One size only
      Prostheses, Joint, Hip, Acetabular Component
GM001        Rim Cup                                 Acetabular Cup Inserts Ceramic 28mm   23 to 26mm
GM010        Batcup                                  Including locking ring and lugs       21 to 24mm
GM011        Batcup                                  6.5mm Ti Cancellous Bone Screws       12mm to 45mm
GM012        Rim Cup                                 Acetabular Cup Inserts UHMWPE         21 to 26mm
GM013        Rim Cup                                 Acetabular Shell Porous/HA Ti         44 to 64mm
      Prostheses, Joint, Hip, Femoral Component
GM008        Edinburgh Total Hip System (Hip Stem)   Femoral Head CoCr                     28mm
GM019        Edinburgh Total Hip System (Hip Stem)   Femoral Head Biolox Ceramic           28mm
GM038        Edinburgh Total Hip System (Hip Stem)   Femoral stem cemented CoCr            CDH to Size 4 Narrow: Size 1 to Size 4
                                                                                           Standard
      Prostheses, Joint, Hip, Total
GM014        Helios Hip System                       Revision Hip Uncemented Stem          10 x 120mm to 20 x 280mm
GM015        Helios Hip System                       Revision Neck with Screw              40mm to 80mm
      Prosthesis, Internal, Joint, Hip, Acetabular Component
GM016        Cer-Met 11 (Acetabular Component)       Acetabular cup Inserts UHMWPE         46mm to 62mm
                                                     28mm and 32mm
GM017        Cer-Met Series 11 (Acetabular           Acetabular Shell Porous/HA Ti         46mm to 62mm
             Component)
GM021        Classic Marathon (Acetabular            Bi-Polar                              40mm to 54mm
             Component)
GM022        Edinburgh Total Hip System              Acetabular Cup UHMWPE                 44mm to 56mm
             (Acetabular Component)
GM023        Cer-Met Series 11 (Acetabular           6.5mm Ti Cancellous Bone Screws       15mm to 50mm
             Component)
GM024        Cer-Met Series 11 (Acetabular           Acetabular cup Inserts Ceramic 28mm   46mm to 62mm
             Component)                              and 32mm



Prostheses List February 2005                                                                                                                           Page 268 of 700
ORTHOPAEDIC                                                                                   Minimum   Maximum
Billing Code Product Name                     Description              Size                   Benefit   Benefit    Notation
      Prosthesis, Internal, Joint, Shoulder, Total
GM002        Lobe Lok System                  Bone Screw               4 x 15mm to 4 x 30mm                        Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM003        Lobe Lok System                  Glenoid                  small to large                              Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM004        Lobe Lok System                  Humeral Coupling         single size                                 Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM005        Lobe Lok System                  Humeral Head - Ceramic   40 to 56mm                                  Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM006        Lobe Lok System                  Humeral Head - CoCr      42 to 54mm                                  Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM007        Lobe Lok system                  Humeral stem             135 to 155mm                                Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005
GM028        Lobe Lok System                  Neck Extension           126 to 135                                  Temporary
                                                                                                                   approval, pending
                                                                                                                   review of
                                                                                                                   application in
                                                                                                                   August 2005


Prostheses List February 2005                                                                                     Page 269 of 700
ORTHOPAEDIC                                                                                                              Minimum   Maximum
Billing Code Product Name                Description                            Size                                     Benefit   Benefit    Notation
GM030        Lobe Lok System             A/P insert with locking screw          Size 1 to 3                                                   Temporary
                                                                                                                                              approval, pending
                                                                                                                                              review of
                                                                                                                                              application in
                                                                                                                                              August 2005
Global Orthopaedic Technology
      Bone Matrix Implants, Artificial
GO051        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   10ml, 2-5 & 5-10mm
                                         based bone matrix
GO052        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   20ml, 2-5 & 5-10ml
                                         based bone matrix
GO053        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   40ml, 2-5 & 5-10mm
                                         based bone matrix
GO054        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   High Volume Grafting Kit. 2-5 & 5-10mm
                                         based bone matrix
GO055        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   4cc block
                                         based bone matrix
GO056        ApaPore                     ApaPore 60. Sterile, hydroxyapatite-   10cc block
                                         based bone matrix
GO057        ApaPore                     ApaPore 70. Sterile, hydroxyapatite-   10ml, 2-5mm
                                         based bone matrix
GO058        ApaPore                     ApaPore 70. Sterile, hydroxyapatite-   20ml. 2-5 & 5-10mm
                                         based bone matrix
GO059        ApaPore                     ApaPore 70. Sterile, hydroxyapatite-   High Volume Grafting Kit. 2-5 & 5-10mm
                                         based bone matrix
GO060        ApaPore                     ApaPore 70. Sterile, hydroxyapatite-   4cc block
                                         based bone matrix
GO061        ApaPore                     ApaPore 70. Sterile, hydroxyapatite-   10cc block
                                         based bone matrix
GO062        ApaPore                     ApaPore 80. Sterile, hydroxyapatite-   10ml. 2-5mm
                                         based bone matrix
GO063        ApaPore                     ApaPore 80. Sterile, hydroxyapatite-   20ml. 2-5mm
                                         based bone matrix


Prostheses List February 2005                                                                                                                Page 270 of 700
ORTHOPAEDIC                                                                                                               Minimum   Maximum
Billing Code Product Name           Description                                  Size                                     Benefit   Benefit    Notation
GO064        ApaPore                ApaPore 80. Sterile, hydroxyapatite-         4cc block
                                    based bone matrix
GO065        ApaPore                ApaPore 80. Sterile, hydroxyapatite-         10cc block
                                    based bone matrix
GO066        ApaPore                Pore-Si. Sterile, hydroxyapatite-based       10cc
                                    bone matrix
GO067        ApaPore                Pore-Si. Sterile, hydroxyapatite-based       20cc
                                    bone matrix
GO068        ApaPore                ApaPore 80. Sterile, hydroxyapatite-         High Volume Grafting Kit. 2-5 & 5-10mm
                                    based bone matrix
      Prostheses, Joint, Hip
GO009        Consensus Hip System   Femoral head CoCr                            22-32mm
GO010        Consensus Hip System   Femoral head Biolox ceramic                  28-32mm
GO011        UniSyn Hip System      a) Stem fluted straight, b) Stem porous      a) 10 x 130 to 20 x 170mm, b) 14-20 x
                                    plasma sprayed straight, c) Stem porous      140-170mm, c) 14-18 x 140-160mm, d)
                                     plasma sprayed bowed, d) Stem fluted        10-20 x 130-170mm
                                    tapered
GO012        UniSyn Hip System      a) Stem fluted straight Ti, b) Stem fluted   a) 10-20 x 170-210mm, b) 12-24 x
                                     bowed Ti; c) Stem porous plasma             210mm, c) 14-25 x 180-210mm, d) 14-
                                    sprayed straight, d) Stem porous plasma      25 x 210mm, e) 10-25 x 170-210mm
                                     sprayed bowed; e) Stem fluted tapered
GO013        UniSyn Hip System      a) Stem fluted bowed Ti; b) Stem             a) 12-24 x 260mm, b) 14-25 x 260mm,
                                    porous plasma sprayed straight, c) Stem      c) 14-25 x 260mm, d) 10-25 x 260mm
                                     porous plasma sprayed bowed; d) Stem
                                     fluted tapered
GO014        UniSyn Hip System      a) Neck standard Ti, b) Body standard        a) 30-36 x 34-46mm, b) 22-30 x 22-
                                    plasma sprayed Ti, c) Body standard Ti       34mm, c) 22-30 x 22-34mm, d) 22-
                                    HA coated, d) Body cone Ti plasma
                                    sprayed,
GO015        UniSyn Hip System      a) Neck calcar Ti, b) Body standard          a) 36-55 x 34-46mm, b) 22-30 x 22-
                                    plasma sprayed Ti HA body, c) Body           34mm, c) 22-30mm
                                    cone Ti HA coated
GO016        UniSyn Hip System      a) Body cone Ti plasma sprayed HA            a) 22-30mm, b) 22-30mm
                                    coated, b) Body calcar Ti plasma

Prostheses List February 2005                                                                                                                 Page 271 of 700
ORTHOPAEDIC                                                                                                                               Minimum   Maximum
Billing Code Product Name                            Description                            Size                                          Benefit   Benefit    Notation
GO017        UniSyn Hip System                       Body calcar Ti HA coated               22-30mm
GO018        UniSyn Hip System                       Body calcar Ti plasma sprayed HA       22-30mm
                                                     coated
GO019        UniSyn Hip System                       Locking nut Ti                         30-54mm
GO020        UniSyn Hip System                       a) Stem fluted bowed Ti, b) Stem       a) 12-24 x 310mm, b) 14-25 x 310mm,
                                                     porous plasma sprayed bowed, c) Stem   c) 10-25 x 310mm
                                                     fluted tapered
GO033        UniSyn Hip System                       Neck non-standard Ti                   24-55mm x 38-50mm
GO034        UniSyn Hip System                       Stem/Body/Monoblock Porous/HA          0 to 6
                                                     Fluted Ti
GO036        Consensus Hip System                    Femoral stem cemented CoCr             Sizes 6 to 14                                                      Also grouped in
                                                                                                                                                               Hip Group 1b
GO037        Consensus Hip System                    Femoral Stem Porous/HA Coated CoCr     Sizes 6 to 14                                                      Also grouped in
                                                                                                                                                               Hip Group 8h
GO038        Consensus Hip System                    Acetabular Cup Inserts UHMWPE          42mm to 68mm
                                                     22mm to 32mm
GO039        Consensus Hip System                    Acetabular Cup Inserts Ceramic 28mm    42mm to 68mm
                                                     to 32mm
GO040        Consensus Hip System                    Acetabular Shell Porous/HA Ti          42mm to 68mm
GO041        Consensus Hip System                    6.5mm Ti Cancellous Bone Screws        15mm to 50mm
GO042        Consensus Hip System                    Protrustion Spacer Ti                  42mm to 68mm
GO043        Consensus Hip System                    Femoral head - Modular CoCr            38-58mm
GO044        Consensus Hip System                    Acetabular cup porous coated CoCr      44-66mm
GO045        Consensus Hip System                    Dysplasia cup porous coated + screws   46-66mm
GO046        Consensus Hip System                    Femoral Head Cemented CoCr             38-58mm
      Prostheses, Joint, Knee
GO035        RBK Total Knee System - Femoral         Trochlear Component, no coating        Size 1 to 5
             Component                               CoCrMo
      Prostheses, Joint, Knee, Femoral Component
GO032        Global re-surfacing uni-compartmental   CoCrMo                                 Size 1-5 Right medial/left lateral; Size 1-
             knee femoral implant                                                           5 Left medial/right lateral

Prostheses List February 2005                                                                                                                                 Page 272 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                            Description                              Size                                     Benefit   Benefit    Notation
      Prostheses, Joint, Knee, Total
GO001        RBK Total Knee System - Patellar        Polyethylene                             28-32mm
             component
GO002        RBK Total Knee System - Tibial insert   Polyethylene                             1-5, 10-20mm
GO003        RBK Total Knee System - Tibial base     No coatings                              1-5
GO004        RBK Total Knee System - Tibial base     Porous coating                           1-5
GO005        RBK Total Knee System - Tibial base     Porous and hydroxyapatite coating        1-5
GO006        RBK Total Knee System - Femoral         No coatings                              1-5
             Component
GO007        RBK Total Knee System - Femoral         Porous coating                           1-5
             Component
GO008        RBK Total Knee System - Patella         Polyethylene/metal/hydroxyapatite        sizes 1 - 5
             component                               coating
GO021        Consensus Knee System                   Femoral component nonporous CoCr         1-6 L & R
                                                     and PS
GO022        Consensus Knee System                   Femoral component porous CoCr            1-6 L & R
GO023        Consensus Knee System                   Femoral component porous CoCr/Ti         1-6 L & R
GO024        Consensus Knee System                   a) Stemmed tibial baseplate nonporous    a) 1-6 L & R; b) 1-6 L & R
                                                     CoCr; b) Stemmed tibial baseplate
                                                     CCM nonporous Ti
GO025        Consensus Knee System                   Resurfacing tibial baseplate porous Ti   1-6 L & R
GO026        Consensus Knee System                   Stemmed tibial baseplate porous          1-6 L & R
GO027        Consensus Knee System                   Congruent tibial insert UHMWPE           1-2 to 5-6 L & R 10-18mm
GO028        Consensus Knee System                   a) PCL substituting tibial insert; b)    a) 1-2 to 5-6 L & R 10-18mm; b) 1-2 to
                                                     Posterior stabilized tibial insert        5-6 L & R 10mm-18mm
GO029        Consensus Knee System                   Patellar component porous Ti/UHMWPE 10mm sz 1-3
GO030        Consensus Knee System                   Patellar component all UHMWPE       7.5mm sz 0-2; 10mm sz 1-3
      Prostheses, Tibial
GO031        Global re-surfacing uni-compartmental   UHMWPE                                   Size 1-5 6.5mm-9.5mm regular and                              Also grouped in
             knee tibial implant                                                              elongated plans                                               Knee Group 6a


Prostheses List February 2005                                                                                                                              Page 273 of 700
ORTHOPAEDIC                                                                                                               Minimum   Maximum
Billing Code Product Name                          Description                         Size                               Benefit   Benefit    Notation
      Prosthesis, Internal, Hip, Joint, Total
GO047        ICON Hip System                       Femoral Head - Modular CoCr         38-58mm
GO048        ICON Hip System                       Acetabular Cup Porous Coated CoCr   44-66mm cups
GO049        ICON Hip System                       Femoral Head Cemented CoCr          38-58mm head
GO050        ICON Hip System                       Dysplasia Cup Porous Coated with    46-66mm
                                                   Screws CoCr
Global Scientific Pty Ltd
      Prostheses, Cerclage, Bone
GS154        PLUS Endoprothetik Cerclage Systems   CCG Band - Pure Titanium            Length 27cm
GS155        PLUS Endoprothetik Cerclage Systems   CCG-GF Band - Pure Titanium         Length 27cm
GS181        PLUS Endoprothetik Cerclage System    CCG Stabilizer with Band            XS - L
      Prostheses, Joint, Hip, Acetabular Component
GS214        Bicon - PLUS                          Cementless Cup                      01, 0, 1, 2, 3, 4, 5, 6, 7, 8, 9
      Prostheses, Joint, Hip, Total
GS156        Prostheses, Joint, Hip, Total         SL PLUS & Lateral Stem              1 to 12
GS157        PLUS Hip Joint Prostheses System      SL PLUS Ti/Ha Stem                  1 to 12
GS158        PLUS Hip Joint Prostheses System      Revision SLR-PLUS Ti Stem           1 to 12
GS159        PLUS Hip Joint Prostheses System      Revision SLR-PLUS Stem              3 to 11
GS160        PLUS Hip Joint Prostheses System      Revision Modular Proximal Stem      1 to 12
GS161        PLUS Hip Joint Prostheses System      Revision Modular Component          1 to 12
GS162        PLUS Hip Joint Prostheses System      CPS-PLUS Stem                       1 to 5
GS163        PLUS Hip Joint Prostheses System      CPS-PLUS Rev Stem                   1 to 5
GS164        PLUS Hip Joint Prostheses System      Bicon-PLUS PE - Liner               1 to 9
GS165        PLUS Hip Joint Prostheses System      Bicon-PLUS PE - Hooded Liner        1 to 9
GS166        PLUS Hip Joint Prostheses System      Bicon-PLUS / Ceramic Liner          3 to 9
GS167        PLUS Hip Joint Prostheses System      Bicon-PLUS Met Liner                1 to 9
GS168        PLUS Hip Joint Prostheses System      Bicon-PLUS Porous Cup               1 to 9
GS169        PLUS Hip Joint Prostheses System      EP Fit PLUS Ti/HA Cup               40 - 68mm Dia

Prostheses List February 2005                                                                                                                 Page 274 of 700
ORTHOPAEDIC                                                                                                   Minimum   Maximum
Billing Code Product Name                        Description                         Size                     Benefit   Benefit    Notation
GS170        PLUS Hip Joint Prostheses System    EP Fit Multi/Hole Cup               40 - 68mm Dia
GS171        PLUS Hip Joint Prostheses System    EP Fit PE Liner                     40 - 68mm Dia
GS172        PLUS Hip Joint Prostheses System    EP Fit Ceramic Liner                48 - 68mm Dia
GS173        PLUS Hip Joint Prostheses System    EP Fit PLUS Met Liner               48 - 68mm Dia
GS174        PLUS Hip Joint Prostheses System    EP Fit Rex Pol Liner                42 - 68mm Dia
GS182        PLUS Hip Joint Prostheses System    Fem Head Metal                      S-XXL                                         Also grouped in
                                                                                                                                   Hip Group 13b
GS183        PLUS Hip Joint Prostheses System    Fem Head Ceramic                    S,M,L
GS184        PLUS Hip Joint Prostheses System    Fem Head Plusmet                    S-XXL
GS185        PLUS Hip Joint Prostheses System    Unipolar Head                       38-60
GS186        PLUS Hip Joint Prostheses System    Bipolar Head                        39mm-60mm
GS187        PLUS Hip Joint Prostheses System    Bofor Rev Shell                     48-70mm dia                                   Also grouped in
                                                                                                                                   Hip Group 29
GS188        PLUS Hip Joint Prostheses System    CPS Centralizer                     1 to 5
GS189        Prostheses, Joint, Hip, Total       Screws Cancellous EPF/Plus fit.     15-60mm long 6.4mm dia
                                                 Titanium
GS190        Prostheses, Joint, Hip, Total       Revision Module                     1 to 12
GS191        Prostheses, Joint, Hip, Total       Bofor PE Hooded Liner               48 -70mm dia
GS192        Prostheses, Joint, Hip, Total       All Poly Cup PR Plus                42 -64mm dia
      Prostheses, Joint, Knee
GS175        PLUS Knee Joint Prostheses System   TC-PLUS Solution (Cemented) Fem     2 to 12
GS176        PLUS Knee Joint Prostheses System   TC-PLUS Solution (Cementless) Fem   2 to 12                                       Also grouped in
                                                                                                                                   Knee Groups 3b,
                                                                                                                                   5e, 10
GS177        PLUS Knee Joint Prostheses System   TC-PLUS Tibial Cementless           2 to 12                                       Also grouped in
                                                                                                                                   Knee Group 3i
GS178        PLUS Knee Joint Prostheses System   TC-PLUS Tibial Cemented             2 to 12
GS179        PLUS Knee Joint Prostheses System   TC-PLUS Tibial Insert PE            2 to 12                                       Also grouped in
                                                                                                                                   Knee Group 5d
GS180        PLUS Knee Joint Prostheses System   TC-PLUS Patella                     26mm, 29mm, 32mm

Prostheses List February 2005                                                                                                     Page 275 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                          Description                          Size                                         Benefit   Benefit    Notation
GS213        UC-PLUS Solution - Unicompartmental                                        Femoral - 4, 6, 8, 10. Tibial - 40 (8, 10,
             Knee Prostheses                                                            12, 14mm) 44, (8, 10, 12, 14mm), 48 (8,
                                                                                        10, 12, 14mm), 52 (8, 10, 12, 14mm), 56
                                                                                        (8, 10, 12, 14mm)
      Prostheses, Joint, Knee, Tibial Component
GS211        PLUS SB Total Knee Replacement -      Ti-Plasma Sprayed Tibial Component   2, 4, 6, 8, 10, 12
             Uncemented Tibial Component
GS212        UC-PLUS Tibial Component All Poly     Tibial Component All Poly            40 (8mm, 10mm, 12mm, 14mm), 44
                                                                                        (8mm, 10mm, 12,, 14mm), 48 (8mm,
                                                                                        10mm, 12mm, 14mm), 52 (8mm, 10mm,
                                                                                        12mm, 14mm), 56 (8mm, 10mm, 12mm,
                                                                                        14mm)
      Prostheses, Joint, Toe
GS152        Toefit - Plus                         Titanium alloy                       Metatarsal Component XS-L
GS153        Toefit - Plus                         Titanium Alloy                       Phalangeal Component XS-L
GS208        Toefit - Plus                         Chromium Cobalt                      Distal Insert 13 - 17mm
GS209        Toefit - Plus                         Polyethylene                         Polyethylene Distal Insert 11 - 15mm
GS210        Toefit - Plus                         Chromium Cobalt                      Proximal Insert 6, 7, 8
Halas Dental Pty Ltd
      Tissue Reconstructive Materials
HD001        Bio-Oss Bone Natural Bone Mineral     Derived from bovine bone             0.25gm                                                            Only to be funded
                                                                                                                                                          where used in a
                                                                                                                                                          service for which
                                                                                                                                                          a Medicare
                                                                                                                                                          Benefit is payable.
HD002        Bio-Oss Bone Natural Bone Mineral     Derived from bovine bone             0.5gm                                                             Only to be funded
                                                                                                                                                          where used in a
                                                                                                                                                          service for which
                                                                                                                                                          a Medicare
                                                                                                                                                          Benefit is payable.




Prostheses List February 2005                                                                                                                            Page 276 of 700
ORTHOPAEDIC                                                                                                                            Minimum   Maximum
Billing Code Product Name                          Description                              Size                                       Benefit   Benefit    Notation
HD003        Bio-Oss Bone Natural Bone Mineral     Derived from bovine bone                 2.0gm                                                           Only to be funded
                                                                                                                                                            where used in a
                                                                                                                                                            service for which
                                                                                                                                                            a Medicare
                                                                                                                                                            Benefit is payable.
Hipokrat Australia Pty Ltd
      Prostheses, Joint, Hip, Femoral Component
HP011        Austin Moore Hip Prostheses           Standard and Narrow Stem                 Standard- Head Diam. 38mm-58mm,
                                                                                            Stem Length 127mm-154mm; Narrow -
                                                                                            Head Diam. 38mm-58mm, Stem
                                                                                            Length 140mm-152mm
Howmedica Incorporated
      Anchor, Fixation
HW373        Howmedica Mainstay Soft Tissue        With suture - Titanium                   4.5 anchor with #2 and #5 suture, 2.7
                                                                                            anchor with #0 suture
HW374        Howmedica Mainstay Soft Tissue        Without suture - Titanium                4.5, 3.5 and 2.7 anchor
HW375        Howmedica Mainstay Soft Tissue        Zip anchor - Titanium                    Sip 4.5 anchor with #5 suture and #2
                                                                                            suture 2 strands, zip 3.5 anchor with #2
                                                                                            suture and #0 suture 2 strands, zip 2.7
                                                                                            anchor with #0 suture
      Cement Dispensers, Orthopedic
HW003        Exeter Cement Security System         Exeter Bone Pug - PMMA                   6, 8, 10, 12, 14, 16, 18, 20mm
HW006        Exeter Cement Security System         X-Change Bone Plug - PMMA                10, 12, 14, 16, 18, 20mm
      Cement, Orthopedic
HW320        Antibiotic Simplex Bone Cement with   Polymethyl Methacrylate, Styrene         40 grams
             Tobramycin                            Copolymer, Barium Sulfate
HW321        Antibiotic Simplex Bone Cement        Erythromycin and Colistin - Polymethyl   40 grams
                                                   Methacrylate, Styrene Copolymer,
                                                   Barium Sulfate
HW322        Surgical Simplex P Radiopaque Bone    Polymethyl Methacrylate, Styrene         40 grams
             Cement                                Copolymer, Barium Sulfate




Prostheses List February 2005                                                                                                                              Page 277 of 700
ORTHOPAEDIC                                                                                                                          Minimum   Maximum
Billing Code Product Name                         Description                               Size                                     Benefit   Benefit    Notation
      Nails, Bone
HW370        Supracondylar Nail                   SCN - Orthinox                            170,200,230,260, 280,300,320 mm length
                                                                                             x11mm width
HW371        Supracondylar Nail                   Condyle Screw - Orthinox                  40 - 90mm
HW372        Supracondylar Nail                   Nut for Condyle Screw - Orthinox          One size only
      Orthopedic External Fixation Systems, Other
HW328        Howmedica Dynamic Joint Distractor   Complete Straight Body Frame -            One size only
                                                  Stainless Steel
      Orthopedic Internal Fixation Systems, Fracture
HW261        Alta Modular Trauma System           CFX - Titanium - complete                 11, 13, 15mm width, 300-480mm length
HW262        Alta Modular Trauma System           Rod - Titanium                            11, 13, 15mm width, 300-480mm length
HW263        Alta Modular Trauma System           Distal Screws - Titanium                  5mm x 14-100mm
HW264        Alta Modular Trauma System           Proximal Screws - Titanium                6 - 5mm x 25-100mm
HW265        Alta Modular Trauma System           Cap Screws - Titanium                     One size only
HW266        Alta Modular Trauma System -         Channel Plate and 10 Cortical Screws -    4,6,8 hole
             complete procedure costs             Titanium
HW267        Alta Modular Trauma System -         Distal Fracture plate and Channel plate   6,8 hole
             complete procedure costs             with Screws - Titanium
HW268        Alta Modular Trauma System -         Femoral Rod and 4 Cross Screws -          10-16mm x 280-480mm
             complete procedure costs             Titanium
HW269        Alta Modular Trauma System -         Femoral Rod , Rod Connector, Lag and      10-16mm x 280-480mm
             complete procedure costs             Cross Screws - Titanium
HW270        Alta Modular Trauma System -         Hip Bolt and Channel Plate Assembly       130-150 Degrees, 3 Hole
             complete procedure costs             with Lag Screw and 6 cortical screws -
                                                  Titanium
HW271        Alta Modular Trauma System -         Supraconondylar Plate with Lag Screw      95 Degrees, 3 Hole
             complete procedure costs             and Screws - Titanium
HW272        Alta Modular Trauma System -         Tibial/Humeral Rod, Cross Screws, Tab     6-14mm x 210-420mm
             complete procedure costs             and cap screw - Titanium
HW273        Alta Modular Trauma System -         Compression Screw Assembly -              5mm
             Components                           Titanium


Prostheses List February 2005                                                                                                                            Page 278 of 700
ORTHOPAEDIC                                                                                                                     Minimum   Maximum
Billing Code Product Name                   Description                            Size                                         Benefit   Benefit    Notation
HW274        Alta Modular Trauma System -   Cortical Screw/Screw Nut Assembly -    5mm
             Components                     Titanium
HW275        Alta Modular Trauma System -   Dome and Doulock Plunger - Titanium    40-120mm
             Components
HW276        Alta Modular Trauma System -   Plate - Channel - Titanium             4,6,8 hole
             Components
HW277        Alta Modular Trauma System -   Plate - Distal Fracture - Titanium     6,8 Hole
             Components
HW278        Alta Modular Trauma System -   Plate - Proximal Angled - Titanium     130-150 degrees, 4 holes
             Components
HW279        Alta Modular Trauma System -   Plate - Small Bone - Titanium          4,6,8 holes
             Components
HW280        Alta Modular Trauma System -   Plate - Supracondylar - Titanium       95 degrees, 3 holes
             Components
HW281        Alta Modular Trauma System -   Plate Connector - Titanium             One size only
             Components
HW282        Alta Modular Trauma System -   Rod Connector and Locking Shoe -       13 & 15mm
             Components                     Titanium
HW283        Alta Modular Trauma System -   Rod - Femoral - Titanium               9,10,11,12,13,14,15,16mm width, 280-
             Components                                                            480mm length
HW284        Alta Modular Trauma System -   Rod -Tibial/Humeral - Titanium         6, 7, 8.25, 9, 10, 11, 12, 13, 14mm width,
             Components                                                             210-420 mm length
HW285        Alta Modular Trauma System -   Cancellous - Titanium                  4.2mm dia
             Components Screws
HW286        Alta Modular Trauma System -   Cancellous - Titanium                  6.5mm dia
             Components Screws
HW287        Alta Modular Trauma System -   Cortical (fully threaded) - Titanium   3.7mm dia
             Components Screws
HW288        Alta Modular Trauma System -   Cortical (fully threaded) - Titanium   5.0mm dia
             Components Screws
HW289        Alta Modular Trauma System -   Cross Locking - Titanium               3.7mm dia
             Components Screws
HW290        Alta Modular Trauma System -   Lag - Titanium                         40-130mm dia
             Components Screws
Prostheses List February 2005                                                                                                                       Page 279 of 700
ORTHOPAEDIC                                                                                                                      Minimum   Maximum
Billing Code Product Name                       Description                             Size                                     Benefit   Benefit    Notation
HW291        Alta Modular Trauma System -       Rod Cap Screw - Titanium                Standard, +1cm
             Components Screws
HW292        Alta Modular Trauma System -       Cross Locking - Titanium                5mm
             Components Screws
HW293        Alta Modular Trauma System -       Tibial/Humeral Rod Tab - Titanium       1,2
             Components Screws
HW294        Alta Modular Trauma System -       Washer - Cancellous Screw - Titanium    One size only
             Components Screws
HW338        Gamma Locking Nail                 Gamma Complete - Orthinox               125,130,135 degrees x 180mm length
HW339        Gamma Locking Nail                 Long Complete - Orthinox                125,130,135 degrees x 340-440mm length

HW340        Gamma Locking Nail                 Standard - Orthinox                     125,130,135 degrees x 180mm length
HW341        Gamma Locking Nail                 Long Nail - Orthinox                    125,130,135 degrees x 340-440mm length

HW342        Gamma Locking Nail                 Distal Screw - Orthinox                 25-95mm length
HW343        Gamma Locking Nail                 Lag Screw - Orthinox                    85-120mm length
HW344        Gamma Locking Nail                 Set Screw - Orthinox                    8mm dia x 22-27 mm length
HW345        Gamma Locking Nail                 Proximal Plug - Orthinox                17mm
HW346        Grosse & Kempf Locking Nail        Femoral - Rods and Screws - Stainless   10,11,12,13,14,15, 16mm width, 260-
                                                Steel                                   380mm length
HW347        Grosse & Kempf Locking Nail        Tibial - Rods and Screws - Stainless    7.5,9,10,11,12,13, 14,15mm width, 240-
                                                Steel                                   375mm length
HW348        Grosse & Kempf Locking Nail        Unreamed - Stainless Steel              7.5mm dia, 240 - 390mm length
HW349        Grosse & Kempf Locking Nail        Cross Screw - Stainless Steel           6.28mm x 15-95mm
HW350        Grosse & Kempf Locking Nail        Cross Screw - Stainless Steel           3.7mm x 25-70mm
HW351        Grosse & Kempf Locking Nail        Cross Screw - Stainless Steel           4.6mm x 20-70mm
HW352        Grosse & Kempf Locking Nail        Cross Screw - Stainless Steel           6.35mm x 50-90mm
HW354        Metaizeau Nail                     Stainless Steel                         2-4mm x 400-500mm
      Orthopedic Internal Fixation Systems, Other
HW183        First Step High Tibial Osteotomy   Proximal Component 5mm Step -           60 to 90mm in 5mm increments
                                                Vitallium

Prostheses List February 2005                                                                                                                        Page 280 of 700
ORTHOPAEDIC                                                                                                            Minimum   Maximum
Billing Code Product Name                       Description                        Size                                Benefit   Benefit    Notation
HW184        First Step High Tibial Osteotomy   Proximal Component 10mm Step -     60 to 90mm in 5mm increments
                                                Vitallium
HW185        First Step High Tibial Osteotomy   Proximal Component 15mm Step -     60 to 90mm in 5mm increments
                                                Vitallium
HW186        First Step High Tibial Osteotomy   Distal Component - Vitallium       30 to 55mm in 5mm increments
HW187        First Step High Tibial Osteotomy   Total Procedure - Vitallium        60 to 90mm in 5mm increments 30mm
                                                                                   to 55mm in 5mm increments
HW257        Wichita Fusion Nail System         Femoral Component - Vitallium      18mm
HW258        Wichita Fusion Nail System         Tibial Component - Vitallium       12mm
HW259        Wichita Fusion Nail System         Compression Screw - Vitallium      One size only
HW260        Wichita Fusion Nail System         Transverse Screw - Vitallium       30-60mm in 5mm increments
      Orthopedic Internal Fixation Systems, Spinal
HW384        Xia Spine System                   Polyaxial Screw                    Dia 4.5 - 8.5mm Length 25 - 60mm
HW385        Xia Spine System                   Monoaxial Screw                    Dia 4.5 - 8.5mm Length 25 - 60mm
HW386        Xia Spine System                   Rod Clamp - Parallel, Axial        One size only
HW387        Xia Spine System                   Lamina Hook - Angled, Reduced,     Large Medium, Small
                                                Extended, Standard Blade, Narrow
                                                Blade, Offset
HW388        Xia Spine System                   Pedicle Hook                       Large, Small
HW389        Xia Spine System                   Rod - Titanium alloy               70, 100, 480mm
HW390        Xia Spine System                   Cross Link                         Length 40, 60, 80mm
HW391        Xia Spine System                   Connector - Axial, Dual, Offset    One Size
HW392        Xia Spine System                   Sacral Block                       One size only
HW393        Xia Spine System                   Bone Screw                         One size only
      Pins, Bone
HW362        Osteo Kirschner Wire               Kirschner - Stainless Steel        28-62 x 4/9                                              To be funded
                                                                                                                                            where any or all
                                                                                                                                            K-wires used in a
                                                                                                                                            procedure are
                                                                                                                                            used as an implant.


Prostheses List February 2005                                                                                                              Page 281 of 700
ORTHOPAEDIC                                                                                                                  Minimum   Maximum
Billing Code Product Name                        Description                                 Size                            Benefit   Benefit    Notation
HW363        Osteo Kirschner Wire                Kirschner Threaded - Stainless Steel        28-62 x 4/10                                         To be funded
                                                                                                                                                  where any or all
                                                                                                                                                  K-wires used in a
                                                                                                                                                  procedure are