Document ID: chunk:federal_register_of_legislation:F2024L01386:schedule:1:p641
Version: federal_register_of_legislation:F2024L01386
Segment Type: schedule
Provision Reference: sch 1 (pt 641/696)
Character Range: 22512507–22533395

used in procedures like breast reconstruction, hernia repair, wound healing, and other soft tissue reconstructions.                                                                                                                    181 to 300cm²                                                                                                                                                                                                                                                                                                                                       $13,028.00
ADD38                                                                                                                                          Acellular Dermal Matrix 26 to 60cm²                                                        ADM is derived from full thickness human skin, that has been processed to remove cells and cellular components while preserving the extracellular matrix (ECM). The extracellular matrix is the structural framework that provides support and organization to tissues. It consists of various proteins, such as collagen, elastin, and other growth factors, that contribute to tissue strength and regeneration. The resulting acellular dermal matrix serves as a scaffold for tissue repair and regeneration. It can be used in procedures like breast reconstruction, hernia repair, wound healing, and other soft tissue reconstructions.                                                                                                                       26 to 60cm²                                                                                                                                                                                                                                                                                                                                        $3,257.00
ADD41                                                                                                                                          Acellular Dermal Matrix 121 to 180cm²                                                      ADM is derived from full thickness human skin, that has been processed to remove cells and cellular components while preserving the extracellular matrix (ECM). The extracellular matrix is the structural framework that provides support and organization to tissues. It consists of various proteins, such as collagen, elastin, and other growth factors, that contribute to tissue strength and regeneration. The resulting acellular dermal matrix serves as a scaffold for tissue repair and regeneration. It can be used in procedures like breast reconstruction, hernia repair, wound healing, and other soft tissue reconstructions.                                                                                                                      121 to 180cm²                                                                                                                                                                                                                                                                                                                                       $8,142.00

     JOHNSON & JOHNSON MEDICAL PTY LTD
SYN06                                                                                                                                          Skin 181 to 300cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $14,000.00
SYN14                                                                                                                                          Skin 121 to 180cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $9,900.00
SYN07                                                                                                                                          Skin > 300cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 $27,000.00
SYN05                                                                                                                                          Skin 61 to 120cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             $5,700.00
SYN04                                                                                                                                          Skin 26 to 60cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              $3,500.00
SYN03                                                                                                                                          Skin < 25cm² - acellular dermal matrix allograft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  $2,200.00

     METRO SOUTH HOSPITAL AND HEALTH SERVICE
QBB73                                                                                                                                          Skin 50-200cm² (graft from human origin, multiple sizes), Frozen                           Skin 200cm² - frozen skin graft from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        $933.00

     NSW HEALTH SERVICE - SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT
NCC69                                                                                                                                          Skin                                                                                       Frozen skin from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        111 to 150 cm²                                                                                                                                                                                                                                                                                                                                      $619.00
NCC66                                                                                                                                          Skin                                                                                       Frozen skin from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        <50 cm²                                                                                                                                                                                                                                                                                                                                             $206.00
NCC68                                                                                                                                          Skin                                                                                       Frozen skin from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        81 to 110 cm²                                                                                                                                                                                                                                                                                                                                       $454.00
NCC67                                                                                                                                          Skin                                                                                       Frozen skin from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        51 to 80 cm²                                                                                                                                                                                                                                                                                                                                        $330.00
NCC70                                                                                                                                          Skin                                                                                       Frozen skin from human origin                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        151 to 200 cm²                                                                                                                                                                                                                                                                                                                                      $826.00

Prescribed List -Part C

03 - General Miscellaneous
Billing Code                                                                                                                                   Product Name                                                                               Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Size                                                                                                                                                                                                                                                                                                                                                Minimum Benefit  Condition
03.02 - DRUG DELIVERY DEVICES
03.02.03 - Infusion Pumps, Battery Powered
  03.02.03.02 - Insulin infusion pump (as 3.2.3.1) with integral calculator to determine boluses and active insulin
  DE, SS
     AUSTRALASIAN