Document ID: chunk:federal_register_of_legislation:F2025L00198:schedule:1:p648
Version: federal_register_of_legislation:F2025L00198
Segment Type: schedule
Provision Reference: sch 1 (pt 648/706)
Character Range: 2119352–2123032

unit whole with or without tibial block     $4,013.00

PBT20  Femur - Proximal (shaft, trochanter, neck)        $5,210.00

PBT33  Humerus - Entire with rotator cuff  Humerus - Entire with rotator cuff     $6,173.00

PBT47  Meniscal Graft        $2,036.00

PBT15  Fascia Lata - Large (15cm x 10cm)        $1,685.00

PBT24  Femoral Rings        $1,908.00

PBT35  Humerus - Proximal        $2,968.00

PBT13  Radius        $1,908.00

PBT34  Humerus - Proximal with rotator cuff        $4,452.00

PBT32  Hemipelvis - Tricortical iliac wedge        $1,590.00

PBT11  Cartilage - costal segments        $318.00

PBT18  Femur - Entire head removed        $8,480.00

PBT16  Fascia Lata - Small (10cm x 5cm)        $905.00

     Sydney Local Health District
CSA01  Femoral Head  Femoral Head, whole, frozen, non-irradiated  Single, whole femoral head  $3,367.00

01 - Cardio-thoracic
Billing Code  Product Name  Description  Size  Minimum Benefit  Condition

     Donor Tissue Bank of Victoria
TBV56  Conduit - Aortic  Conduit - Aortic     $2,423.00

TBV01  Valve - Aortic  Valve - Aortic     $11,223.00

TBV03  Conduit - Pulmonary  Conduit - Pulmonary     $2,423.00

TBV50  Pericardium  Pericardium     $2,949.00

TBV02  Valve - Pulmonary  Valve - Pulmonary     $11,223.00

     METRO SOUTH HOSPITAL AND HEALTH SERVICE
QHV01  Valve and Valved Conduit        $10,240.00

QHV07  Patch, Conduit and Pericardium        $3,195.00

QHV11  Vascular Graft (Various)        $4,071.00

     ST. VINCENT'S HOSPITAL SYDNEY LIMITED
SHV02  Valve - Pulmonary  Valve - Pulmonary     $11,421.00

SHV01  Valve - Aortic  Valve - Aortic     $11,421.00

SHV03  Conduit - Arterial  Conduit - Arterial     $4,499.00

02 - Ophthalmic
Billing Code  Product Name  Description  Size  Minimum Benefit  Condition

     Lions Eye Bank of Western Australia
LEW03  Cornea for Endothelial Keratoplasty        $3,525.00

LEW01  Cornea        $2,950.00

LEW02  Sclera        $295.00

     Lions Eye Donation Service
LEM01  Cornea        $3,200.00

LEM05  Cornea Preloaded for Endothelial Keratoplasty  This is an additional preparation step to LEM04 Cornea for Endothelial Keratoplasty. Descemet's Membrane Endothelial Keratoplasty (DMEK) donor tissue is prepared and then trephinated, stained, and loaded into a transport/injector cartridge by the eye bank and then shipped to the surgeon   N/A -  DMEK tissue itself is 12 microns thick and trephined to 8mm  $4,800.00

LEM04  Cornea for Endothelial Lamellar Keratoplasty        $4,000.00

LEM02  Sclera        $500.00

     Lions Eye Institute Limited
LAB01  FROZEN CORNEA  FROZEN CORNEA for tectonic/patch grafts  one corneo-scleral disc - frozen  $550.00

     METRO SOUTH HOSPITAL AND HEALTH SERVICE
MAB03  Cornea - Lamellar   Cornea - Lamellar      $2,610.00

MAB01  Cornea for Endothelial Keratoplasty  Pre-cut cornea for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)  Variable  $3,777.00

MAB04  Sclera - Patch  Sclera - Patch     $434.00

QEB01  Cornea        $3,161.00

QEB02  Sclera – Whole        $650.00

     NSW HEALTH SERVICE - SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT
NCC74  Cornea for Endothelial Keratoplasty        $3,300.00

NCC71  Cornea        $2,801.00

NCC73  Cornea For Lamellar        $1,682.00

NCC72  Sclera        $420.00

     Southern Adelaide Local Health Network Incorporated
SAA02  Cornea for Endothelial Keratoplasty  Cornea for Endothelial Keratoplasty     $3,525.00

SAA03  Sclera  Sclera     $300.00

SAA01  Cornea  Cornea     $2,950.00

04 - Dermatologic
Billing Code  Product Name  Description  Size  Minimum Benefit  Condition

     AUSTRALIAN