Document ID: chunk:federal_register_of_legislation:F2024L01386:schedule:1:p642
Version: federal_register_of_legislation:F2024L01386
Segment Type: schedule
Provision Reference: sch 1 (pt 642/696)
Character Range: 22531824–22543710

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 MEDICAL & SCIENTIFIC LIMITED
AN014                                                                                                                                          t:slim X2 Insulin Pump                                                                     Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       One size only.                                                                                                                                                                                                                                                                                                                                      $8,077.00

     Managing Diabetes Pty Ltd
DF004                                                                                                                                          DANA-i Insulin Pump                                                                        ACE (Alternate Control Enabled) secure Bluetooth low energy insulin pump.  EC certified to be connected to approved CGM systems and approved control algorithms (APS - Artificial Pancreas Systems).                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 97mm x 44mm x 20mm 85grams                                                                                                                                                                                                                                                                                                                          $8,077.00

     ROCHE DIABETES CARE AUSTRALIA PTY LIMITED
RB001                                                                                                                                          Accu-Chek Combo System                                                                     Insulin delivery device capable of remotely receiving and acting on information about blood glucose levels, performing bolus calculation and bolus advice on additional parameters than what is normally provided.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   The Accu-Chek Combo System is only available in one size.                                                                                                                                                                                                                                                                                           $8,077.00

  DE, SS, MP
     ROCHE DIABETES CARE AUSTRALIA PTY LIMITED
RB006                                                                                                                                          Accu-Chek Solo micropump - starter kit                                                     Starter kit supply of insulin pump system to accommodate first year of use of Accu-Chek Solo micropump system. Starter kit includes insulin pump base components, blood glucose monitoring system handset control with integrated insulin bolus advisor (diabetes manager) and accessory pack.                                                                                                                                                                                                                                                                                                                                                                                                                                                                       Micropump: 68 x 40 x 15 mm  Handset control (diabetes manager): 124 x 64 x 17 mm                                                                                                                                                                                                                                                                    $2,375.00

  03.02.03.03 - Device has capability to automatically adjust the insulin delivery based on continuous glucose monitoring data
  DE, SS
     AUSTRALASIAN MEDICAL & SCIENTIFIC LIMITED
AN017                                                                                                                                          t:slim X2 Insulin Pump with Basal-IQ Technology                                            Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability and incorporating Basal-IQ Predictive Low Glucose Suspend (PLGS) Technology.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          One size only.                                                                                                                                                                                                                                                                                                                                      $8,574.00
AN018                                                                                                                                          t:slim X2 Insulin Pump with Control-IQ Technology                                          Ambulatory insulin infusion pump with real-time continuous glucose monitoring (CGM) capability and incorporating Control-IQ Technology.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              One size only                                                                                                                                                                                                                                                                                                                                       $8,574.00

  DE, SS, ABD
     MEDTRONIC AUSTRALASIA PTY LTD
MI330                                                                                                                                          Medtronic MiniMed 770G Insulin Pump                                                        MiniMed 770G Insulin Pump with SmartGuard Hybrid Closed Loop (HCL) technology, with Bluetooth® connectivity and continuous glucose monitoring (CGM) capability which can be programmed to automatically adjust delivery of basal insulin based on CGM, and can suspend delivery of insulin when the sensor glucose value falls below or is predicted to fall below predefined threshold values.                                                                                                                                                                                                                                                                                                                                                                      One size only                                                                                                                                                                                                                                                                                                                                       $8,574.00
MI452                                                                                                                                          MiniMed 780G Insulin Pump                                                                  MiniMed 780G Insulin Pump with SmartGuard advanced Hybrid Closed Loop (HCL) technology capable of operating in Manual Mode or Auto Mode, with Bluetooth® connectivity and continuous glucose monitoring (CGM) capability.  Provides 3 user selectable targets and can be set to automatically adjust delivery of basal insulin based on CGM. This includes automatically suspending insulin delivery or providing