Intraocular Lens - Excel

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					                                                                                               INTRAOCULAR LENS SPECIALTY SHEET
                                                                                                 (Prostheses List, August 2005 - Effective 31st October 2005)

Please Note: Items with gaps generally have low utilisation on a national basis                                                                                                                         Highlighted Items may attract a potential gap payment

Billing                                                                                                                                                                Minimum           Maximum
           Product Name                                             Description                                                Sponsor                                                                    Potential Gap Suffix
Code                                                                                                                                                                   Benefit           Benefit
ANTERIOR CHAMBER

Group 1 - Anterior Chamber, aphakic, rigid lenses
AL003      Alcon Laboratories (Aust.) Pty Ltd                       MTAU1-MTAU-7                                           PMMA                                $150.00
AO001      Advanced Medical Optics Australia Pty Ltd                Intraocular Lens: Model AC 51B                                                             $
                                                                                                                           Duralens PMMA, Anterior Chamber IOL150.00                                        Surface Modification Suffix
AO011      Advanced Medical Optics Australia Pty Ltd                                                                       Anterior chamber heparin coated PMMA lenses 352C. Models 812C, 722C, 757C, 808C &Surface Modification Suffix
                                                                    Anterior Chamber IOL; Pharmacia Heparin Surface Modified AC IOL Model 352C                 $190.00        $200.00         $10.00         352C.
AO019      Advanced Medical Optics Australia Pty Ltd                Verisyse AC IOL                                        Aphakic Model                       $150.00        $400.00         $250.00
BL005      Bausch & Lomb Surgical                                                                                          PMMA Chamber Lens                   $150.00
                                                                    Storz (Coburn) Intraocular Lens 121UV; L122UV PMMAA AnteriorAnterior Chamber Intraocular lens 1 piece     $190.00         $40.00
EG009      Emagin Pty Ltd                                           Artisan Anterior Chamber Intraocular Lens              Aphakia ModelComposition: PMMA      $150.00        $253.00         $103.00

Group 2 - Anterior Chamber: phakic, rigid lenses.
AO016      Advanced Medical Optics Australia Pty Ltd                Verisyse AC IOL                                                                                   Composition: PMMA
                                                                                                                               Phakic Intraocular Lens: Model Myopia.$653.40         $700.00              $46.60
AO017      Advanced Medical Optics Australia Pty Ltd                Verisyse AC IOL                                                                                  $653.40          PMMA
                                                                                                                               Phakic Intraocular Lens: Model Hyperopia. Composition:$700.00              $46.60
AO018      Advanced Medical Optics Australia Pty Ltd                Verisyse AC IOL                                            Phakic Intraocular Lens: Model Toric $853.40          $1,400.00            $546.60         Toric Suffix
EG006      Emagin Pty Ltd                                           Artisan Anterior Chamber Intraocular Lens                                                        $653.40
                                                                                                                               Phakic Intraocular Lens: Model MyopiaComposition: PMMA
EG007      Emagin Pty Ltd                                           Artisan Anterior Chamber Intraocular Lens                                                        $653.40
                                                                                                                               Phakic Intraocular Lens: Model HyperopiaComposition: PMMA
EG008      Emagin Pty Ltd                                           Artisan Anterior Chamber Intraocular Lens                                                        $853.40
                                                                                                                               Phakic Intraocular Lens: Model ToricComposition: PMMA $1,286.68            $433.28         Toric Suffix

POSTERIOR CHAMBER
Group 3 - Posterior Chamber: aphakic, rigid lenses
AL002      Alcon Laboratories (Aust.) Pty Ltd                                                                              Other:PMMA                          $150.00
                                                                    Intraocular Lens: MODIFIED C PMMA PC IOL MODEL MZ60BD, MODIFIED PMMA PC IOL Model MZ20BD, CANTILEVER PMMA PC IOL MODEL CVC1U, Modified PMMA PC IOL Model MZ30BD, PMMA PC, I
AO003      Advanced Medical Optics Australia Pty Ltd                                                                       Duralens, PMMA, Posterior Chamber IOL
                                                                                                                                                               $150.00         $190.00
                                                                    Intraocular Lens: Allergan AMO Duralens Posterior Chamber IOL Model PS42ANB, PS53ANB, PS60ANB, PS59NB, PS60AMB              $40.00
AO022      Advanced Medical Optics Australia Pty Ltd                                                                       CeeOn Posterior 352C                $190.00         $200.00          $10.00         Surface Modification Suffix
                                                                    Posterior Chamber IOL; Pharmacia Heparin Surface Modified AC IOL Model chamber, heparin coated , PMMA lenses, One piece, biconvex. 812C, 722C, 757C, 808C CeeOn
BL006      Bausch & Lomb Surgical                                                                                          PMMA Posterior Chamber lens 1 model 6741B,
                                                                                                                                                               $               $190.00          $40.00
                                                                    Posterior chamber IOLS model P359 UV, P399 UV, 68 UV, 95 BUV, or lolab PC One Piece, piece; 150.00 8591B, 8191B; Model EZE-Fit 65

Group 4a - Posterior Chamber: aphakic, foldable, no edge modification, haptic plate lenses
BL010      Bausch & Lomb Surgical                                   Chiroflex Model C11UB                                                                                  Silicone
                                                                                                                               Intraocular Lens Foldable Plate Haptic $270.00 Posterior Chamber Foldable Plate Haptic Lens 1 piece
CS001      ConceptVision Australia Pty Ltd                                                                                     Plate AA4204VF; AA4204VL;
                                                                    Staar foldable silicone intraocular lens: Model AA4203VF; Model haptics 6.0mm; Polymide haptics $270.00                $285.00
                                                                                                                                                                           5.5 or 6.3mm optic;             $15.00
CS002      ConceptVision Australia Pty Ltd                                                                                     Plate haptics 6.0mm optic
                                                                    Staar Toric foldable silicone intraocular lens: Model AA4203TF; Model AA4203TL                         $395.00                                         Toric Suffix
CS006      ConceptVision Australia Pty Ltd                                                                                     5.5mm optic
                                                                    Staar foldable silicone IOLs: Model KS-1 (AS-110NV) preloaded Intraocular lens                         $290.00         $305.00         $15.00          PP
IQ001      IQ Medical                                               UltraChoice 1.0 Rollable Thinlens Model PHC001                                                         multifocal      $650.00         $290.00         accommodating intraocular lens with 50 micron edge
                                                                                                                               Acrylic, single piece, rollable, refractive $360.00 with monofocal function meniscus optic, Aberration Technology Suffix

Group 4b - Posterior Chamber: aphakic, foldable, no edge modification lenses
AO005      Advanced Medical Optics Australia Pty Ltd                                                                          or AMO model SI-40NB Silicone PhacoFlex II SI-40NB Silicone; Foldable IOL
                                                                    Intraocular Lens: Allergan Model SI-30NB Silicone PC IOL; PhacoFlex II SI-30NB Silicone or PC IOL   $270.00
AO015      Advanced Medical Optics Australia Pty Ltd                CEEON R Intraoccular Lens                                                                           $220.00
                                                                                                                              Foldable intraocular lenses - ultraviolet light absorbing posterior chamber intraocular lenses
BL007      Bausch & Lomb Surgical                                   Hydroview Intraocular lens Model H60M                                                               $270.00
                                                                                                                              Foldable Hydrogel Lens Hydrogel Posterior Chamber Foldable lens 1 piece
BL009      Bausch & Lomb Surgical                                                                                             Foldable                                  $270.00
                                                                    Soflex UV Absorbing Silicone Posterior Chamber IOL Model LI61U Intraocular Lens Silicone Posterior Chamber Foldable Lens 3 piece
CS003      ConceptVision Australia Pty Ltd                                                                                                                              $220.00
                                                                    Staar foldable silicone intraocular lens: Model AQ 5010V Polyimide haptics 6.3mm optic - low diopters

Group 4c - Posterior Chamber: aphakic, foldable, posterior edge modification lenses
AL004      Alcon Laboratories (Aust.) Pty Ltd                                                                             Foldable Acrylic Multi-piece PC        $300.00
                                                                    Intraocular Lens: Alcon Acrysof Model MA60BM PC IOL, Alcon Acrysof Model MA30BALensIOL, Alcon Acrysof model MA50BM PC IOL, ACRYSOF IOL MODEL MA60MA
AL012      Alcon Laboratories (Aust.) Pty Ltd                                                                             Foldable acrylic multi-piece lens, asymmetric optic/consistent edge
                                                                    Alcon Acrysof Model MA30AC PC IOL, Alcon Acrysof Model MA60AC PC IOL                         $300.00




                                                                                                                        Intraocular Lens - Specialty Sheet
                                                                                                                          (Prostheses List, August 2005)                                                                                                    Page 1
Billing                                                                                                                                                 Minimum           Maximum
          Product Name                                Description                                                Sponsor                                                                   Potential Gap Suffix
Code                                                                                                                                                    Benefit           Benefit


Group 4d - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification lenses
AL011     Alcon Laboratories (Aust.) Pty Ltd                                                                       Foldable Acrylic Single-piece Lens, asymmetric optic/consistent IOL
                                                                                                                                                            $310.00
                                                      Intraocular Lens: Alcon Acrysof Model SA30AL, Alcon Acrysof Model SA60AT, SA30AT Intraocular Lens; Alcon Acrysof PCedgeModel SA65AT
AL016     Alcon Laboratories (Aust.) Pty Ltd          Alcon Acrysof Natural Model SN60AT                                                                    $350.00                                                  Blue
                                                                                                                   Foldable Acrylic Single-piece Lens, asymmetric optic/consistent edge, with blue light protection Light Filter Suffix
AL019     Alcon Laboratories (Aust.) Pty Ltd          AcrySof Model SN60AS                                                                                  $370.00
                                                                                                                   Foldable Acrylic Single-piece lens, in cartridge, with blue light protection                      Blue Light Filter, Pre-Packaged Suffix
AL021     Alcon Laboratories (Aust.) Pty Ltd          Alcon AcrySof SN60WF                                                                                  Blue Light
                                                                                                                   Foldable Acrylic Single-piece Lens with $370.00 Protection and Aspheric Correction                Blue Light Filter, Aberration Tech Suffix
AL023     Alcon Laboratories (Aust.) Pty Ltd          Alcon AcrySof Toric PC IOL Models                                                                     $540.00             single piece lens $150.00 light protection
                                                                                                                   Posterior chamber, UV absorbing, foldable, acrylic, toric,$690.00              with blue          T,BLF
AL024     Alcon Laboratories (Aust.) Pty Ltd          AcrySof SN60WS                                                                                        Blue light
                                                                                                                   Foldable Acrylic Single-piece Lens with $390.00 protection and aspheric correction, in cartridge.
AL025     Alcon Laboratories (Aust.) Pty Ltd          AcrySof MN60MA                                                                                        $340.00
                                                                                                                   Foldable Acrylic multi-piece Lens with Blue light Protection
AL026     Alcon Laboratories (Aust.) Pty Ltd          AcrySof MN60AC                                                                                        $340.00
                                                                                                                   Foldable Acrylic multi-piece Lens with Blue light Protection
AO002     Advanced Medical Optics Australia Pty Ltd                                                                Soft Foldable Acrylic UV
                                                      Sensar AR40 Monofocal Acrylic IOL, Sensar OptiEdge AR40e Acrylic, Foldable,IOL Absorbing, Posterior   $310.00            $360.00            $50.00
AO006     Advanced Medical Optics Australia Pty Ltd   Clariflex, Model CLRFLXB Posterior Chamber Intraocular Lens                                           $310.00
                                                                                                                   Foldable Silicone IOL with OptiEdge design                  $360.00            $50.00
AO013     Advanced Medical Optics Australia Pty Ltd                                                                 Chamber IOL                             $300.00
                                                      Ceeon Model 911A Edge Foldable UV Absorbing Posterior Silicon, foldable, UV absorbable intraocular lens with equibiconvex design and square optic edge
AO014     Advanced Medical Optics Australia Pty Ltd   Tecnis TM Intraocular Lens                                                                            $350.00            $400.00             intraocular lenses
                                                                                                                   Foldable Intraocular Lenses - Ultraviolet light absorbing posterior chamber$50.00                 Aberration Technology Suffix
BL019     Bausch & Lomb Surgical                                                                                   Composition: Hydrophilic acrylic polymer. Packaged in lens folding device in a sterile vial. Modified C-Loop design
                                                      Akreos Fit acrylic foldable posterior chamber intraocular lens                                        $310.00
BL020     Bausch & Lomb Surgical                                                                                    lens                                    $310.00            $340.00
                                                      Akreos Adapt acrylic foldable posterior chamber intraocularComposition: Hydrophilic acrylic polymer. Packaged in lens folding device$30.00   in a sterile vial. Four haptic design
BL021     Bausch & Lomb Surgical                      SoflexSE, Intraocular lenses, Posterior Chamber                                                       $310.00
                                                                                                                   Composition: silicone, Lenses - foldable, posterior chamber intraocular lenses
BL022     Bausch & Lomb Surgical                      SofPort Advanced Optic (AO)                                                                           $350.00                                                  AT
                                                                                                                   Posterior chamber, foldable silicone IOL with anterior optic-haptic square edge, posteriof optic-haptic square edge, 360-degree optic square edge and as
BL023     Bausch & Lomb Surgical                      Akreos Advanced Optic                                                                                 $350.00                                                  AT
                                                                                                                   Posterior chamber, foldable acrylic IOL, with anterior optic-haptic square edge, posterior optic-haptic square edge, 360 degree optic square edge and asp
CS005     ConceptVision Australia Pty Ltd             Staar foldable silicone intraocular lens: KS-3 Model AS310NV Silicone, foldable, polyamide haptics $290.00               $305.00            $15.00             PP
CS007     ConceptVision Australia Pty Ltd                                                                          Plate haptics
                                                      Staar foldable silicone IOLs: Models AQ2010V, AQ2017V and AO2003V 6.0mm; Polymide haptics $270.00     5.5 or 6.3mm optic;$285.00            $15.00
KG001     Kevin Grundy (IBD) Pty Ltd                  Rayner C-Flex                                                                                         $310.00
                                                                                                                   Hydrophilic HEMA-MMA copolymer, foldable with injector
KG002     Kevin Grundy (IBD) Pty Ltd                  Superflex                                                                                             $310.00
                                                                                                                   Hydrophilic HEMA-MMA copolymer, foldable with injector
KG003     Kevin Grundy (IBD) Pty Ltd                  Rayner Standard Toric C-Flex                                                                          $510.00
                                                                                                                   Hydrophilic HEMA-MMA copolymer, foldable with injector$900.00                  $390.00            Toric Suffix
KG004     Kevin Grundy (IBD) Pty Ltd                  Rayner Premium Toric C-Flex                                                                           $510.00
                                                                                                                   HEMA-MMA copolymer, foldable with injector                  $1,800.00          $1,290.00          Toric Suffix
SO028     Spectrum Ophthalmics                        IOLTECH Intraocular Lens: Model Bigbag                                                                $310.00            Tri-haptic,
                                                                                                                   IOLTECH Hydrophilic acrylic, foldable, PC, single piece, $450.00 square$140.00  edge design, UV blocker
SO031     Spectrum Ophthalmics                        IOLTECH Intraocular Lens, Model Stabibag, Model XL Stabi                                              $310.00            $340.00            $30.00
                                                                                                                   IOLTECH hydrophilic acrylic, foldable, CP, single piece, square edge design, UV blocker, Tri-haptic
SO032     Spectrum Ophthalmics                                                                                     IOLTECH hydrophilic acrylic, foldable, CP, single piece, square edge design, UV blocker, Tri-haptic, Ready to use single use pre-loaded
                                                      IOLTECH Intraocular Lens, Model Stabibag RTU, Model XL Stabi RTU                                      $330.00            $360.00            $30.00             PP

Group 5a - Posterior Chamber: aphakic, foldable, multifocal/bifocal lenses
AO004     Advanced Medical Optics Australia Pty Ltd                                                            Array Multifocal SA40N, Silicone, Foldable SA-40N
                                                                                                                                                        $320.00
                                                      Intraocular Lens: Allergan AMO Array Multifocal UV Absorbing Silicone Posterior Chamber IOL Model IOL               $360.00          $40.00
AO020     Advanced Medical Optics Australia Pty Ltd   ReZoom Acrylic Multifocal Intraocular Lens                                                        $320.00
                                                                                                               Acrylic, foldable, posterior chamber, intraocular lens     $420.00          $100.00

Group 5b - Posterior Chamber: aphakic, foldable, anterior and posterior edge modification, multifocal/bifocal lenses.
AL017     Alcon Laboratories (Aust.) Pty Ltd                                                                                                         $750.00        $950.00            $200.00
                                                      Alcon AcrySof ReSTOR PC Diffractive IOL Model SA60D3 Posterior Chamber, UV absorbing, foldable, acrylic, single piece lens with apodised diffractive optic
AL022     Alcon Laboratories (Aust.) Pty Ltd                                                                 Posterior                               $790.00        $1,040.00          $250.00        BLF
                                                      Alcon AcrySof ReSTOR PC Diffractive IOL Natural Model SN60D3 Chamber, UV absorbing, foldable, acrylic, single piece lens with apodised diffractive optic and blue light protection.
SO029     Spectrum Ophthalmics                        IOLTECH Intraocular Lens: Model MF4                                                            foldable,
                                                                                                             Multifocal IOLTECH hydrophilic acrylic, $650.00 PC single piece, Tri-haptic, square edge design, UV blocker

Group 5c - Posterior Chamber: aphakic, foldable, multifocal, accommodative lenses.
CS004     ConceptVision Australia Pty Ltd             C & C Vision Crystalens Model AT-45                                                             $650.00
                                                                                                                 Silicon Multipiece Folding Accommodating Intraocular Lens

Group 6b - Posterior Chamber: Pseudo-phakic, piggy back, multifocal
SO030     Spectrum Ophthalmics                        IOLTECH Intraocular Lens: Model ACOR                                                         $500.00              $680.00           $180.00
                                                                                                                 Pseudo Phakic IOL, IOLTECH hydrophilic acrylic, foldable, PC, single piece, square edges, UV blocker




                                                                                                          Intraocular Lens - Specialty Sheet
                                                                                                            (Prostheses List, August 2005)                                                                                                     Page 2

				
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