Document ID: chunk:federal_register_of_legislation:F2025L00198:schedule:1:p1
Version: federal_register_of_legislation:F2025L00198
Segment Type: schedule
Provision Reference: sch 1 (pt 1/706)
Character Range: 42633–45854

Schedule 1
Prescribed List -Part A

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

01.01 - ANTERIOR CHAMBER INTRAOCULAR LENSES
01.01.01 - Aphakic
  01.01.01.01 - Rigid
     ALCON LABORATORIES (AUSTRALIA) PTY LTD
AL003  MTA2UO - MTA6UO  PMMA  +5 to +30 D  $126.00

     BAUSCH & LOMB (AUSTRALIA) PTY LTD
LL004  Loop Guardian PMMA AC IOL Model B60130S  PMMA, 1-piece, anterior chamber IOL  +6.0 D to +30.0 D (0.5 D increments)  $126.00

BL005  Storz (Coburn) Intraocular Lens  121UV; L122UV PMMA Anterior Chamber Lens  PMMA Anterior Chamber Intraocular lens 1 piece  13.75mm length. 6.0mm optic size, diopter range 3-30d. L122UV: 6.0mm optic, 13.75mm length, power range; 5.0 to 30.0 Diopters  $126.00

  ifc
     IQ MEDICAL PTY LTD
IQ029  Artisan Anterior Chamber Intraocular Lens  Aphakia Model      5.00mm Optic Diameter x 8.5 in overall length  $203.00
                                                  Composition: PMMA

01.01.02 - Phakic
  01.01.02.01 - Rigid
     IQ MEDICAL PTY LTD
IQ031  Artisan Anterior Chamber IOL  Phakic Intraocular Lens Myopic / Hyperopic  5.00mm Optic Diameter x 8.5 in overall length;  $552.00

  t1, ifc
     IQ MEDICAL PTY LTD
IQ033  Artisan Toric (Custom) T1  AC Iris clip IOL Toric  5.00mm Optic Diameter x 7.5 Overall  $934.00

  t2, ifc
     IQ MEDICAL PTY LTD
IQ034  Artisan Toric (Custom) T2  AC Iris clip IOL Toric  5.00mm Optic Diameter x 7.5 Overall  $1,180.00

  01.01.02.02 - Foldable
     IQ MEDICAL PTY LTD
IQ030  Artiflex Anterior Chamber Intraocular Lens  Optic: Hydrophobic Polysiloxane. Haptic: PMMA  6mm optic diameter x 8.5 in overall length  $565.00

01.02 - POSTERIOR CHAMBER INTRAOCULAR LENSES
01.02.01 - Rigid
     ALCON LABORATORIES (AUSTRALIA) PTY LTD
AL002  Model CZ70BD  Other:PMMA  Range of Powers: +10.0D to +30.0D  $126.00

01.02.02 - Foldable
  01.02.02.01 - Microincision
     CARL ZEISS PTY. LIMITED
CZ040  CT SPHERIS 209M  Micro incision, Spherical aberrated, foldable square-edged single-piece intraocular lens for capsular bag fixation.  Diopter range :0.00 to + 32.0. Optic Size : 6mm  Overall Length  : 11mm  $232.00

  at
     CARL ZEISS PTY. LIMITED
CZ016  CT ASPHINA 409M  ZEISS Micro Incision Aspheric (aberration neutral) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation  6mm optic, 11mm overall diameter. Diopter range 0.0 to +32.0D (0.5D steps from 10.0 to 30.0D, 1.0D outside this range)  $263.00

CZ017  CT ASPHINA 509M  ZEISS Micro Incision Aspheric (aberration correcting) IOL: Foldable, square-edged, single piece IOL for capsular bag fixation  6mm Optic, 11mm overall diameter. Diopter range 0.0 to +32.0D (0.5D steps from 10.0 to 30.0D, 1.0D outside this range)  $263.00

  at, pl
     BAUSCH & LOMB (AUSTRALIA) PTY LTD
BL026  Akreos AO Micro Incision Lens  Micro Incision, posterior chamber, foldable acrylic, aphakic, anterior & posterior edge modification, preloaded, with aberration control, intraocular lens  6mm optic overall diameter 11.0mm(10D-15D), 10.7mm (15.50-22D), 10.5mm (22.50-30D)  $270.00

     CARL ZEISS PTY. LIMITED
CZ037  CT ASPHINA 509MP  Preloaded, micro incision, aspheric (aberration correcting), foldable square-edged