Document ID: chunk:federal_register_of_legislation:F2024L01386:schedule:1:p1
Version: federal_register_of_legislation:F2024L01386
Segment Type: schedule
Provision Reference: sch 1 (pt 1/696)
Character Range: 1926–36388

Schedule 1—Amendments

Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 2) 2024

1 Schedule 1

Repeal the Schedule 1, substitute: the updated Schedule 1 – Listed medical devices and human tissue products.

Schedule
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
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
     Emagin Pty Ltd
EG009                                                           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
     Emagin Pty Ltd
EG012                                                           Artisan Anterior Chamber IOL                                                                                         Phakic Intraocular Lens Myopic / Hyperopic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                5.00mm Optic Diameter x 8.5 in overall length;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             $552.00

  t1, ifc
     Emagin Pty Ltd
EG019                                                           Artisan Toric (Custom) T1                                                                                            AC Iris clip IOL Toric                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    5.00mm Optic Diameter x 7.5 Overall                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        $934.00

  t2, ifc
     Emagin Pty Ltd
EG020                                                           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
     Emagin Pty Ltd
EG010                                                           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,