Document ID: chunk:federal_register_of_legislation:F2024L01386:schedule:1:p652
Version: federal_register_of_legislation:F2024L01386
Segment Type: schedule
Provision Reference: sch 1 (pt 652/696)
Character Range: 22626709–22651492

a clamp.                                                                                                                                                                                                                                    One size only                         $5,095.00

10 - Vascular
Billing Code                                                     Product Name                                                                                          Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Size                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Minimum Benefit  Condition
10.11 - Vascular Reconstruction
10.11.01 - Drug-coated Balloon Catheter
     BARD AUSTRALIA PTY. LIMITED
QQ268                                                            Lutonix Drug Coated Balloon PTA Catheter                                                              The Lutonix Drug Coated Balloon PTA Catheter consists of an over the wire catheter with a drug coated balloon fixed at the distal tip. The balloon is coated with a specialized formulation that includes the drug, paclitaxel. There are three different Models available depending on guidewire compatibility.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Balloon Length (mm)*: 20-300 Catheter Length (cm)*: 75-150 Balloon Diameter (mm)*: 2-12   (*Range across all three models)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      $1,245.00

     BIOTRONIK AUSTRALIA PTY LIMITED
BT255                                                            Passeo-18 Lux                                                                                         Paclitaxel releasing PTA Balloon Catheter                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Length   40, 80, 120mm     Diameter   4F:2, 2.5, 3, 3.5, 4mm   5F:5, 6, 7mm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     $1,245.00

     BOSTON SCIENTIFIC PTY LTD
BS424                                                            Ranger/Ranger SL Paclitaxel Coated Balloon Catheter                                                   Peripheral angioplasty balloon catheter, drug-eluting                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      Balloon Length: 30-200 mm; Diameter: 2.00 - 8.00 mm;                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $1,245.00

     MEDTRONIC AUSTRALASIA PTY LTD
MI507                                                            IN.PACT Admiral Paclitaxel-Coated PTA Balloon Catheter                                                The FreePac™ drug coating on the balloon of the IN.PACT Admiral DCB consists of the drug paclitaxel and the excipient urea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                The IN.PACT Admiral DCB variations are: Balloon Diameter: 4 -12mm; Balloon Length: 40 to 250 mm; Catheter Usable Length: 40 to 130 cm.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          $1,245.00
QQ646                                                            IN.PACT 018 Paclitaxel-coated PTA Balloon Catheter                                                    The FreePac drug coating on the balloon of the IN.PACT 018 DCB consists of the drug paclitaxel and the excipient urea.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     Balloon Diameter: 4 to 7 mm; Balloon Length: 40 to 150 mm; Catheter Usable Length: 80 to 130 cm                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 $1,245.00

Prescribed List -Part D

03 - General Miscellaneous
Billing Code                                                     Product Name                                                                                          Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                Size                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            Minimum Benefit  Condition
03.02 - DRUG DELIVERY DEVICES
03.02.02 - Infusion Pumps, Balloon Based
  03.02.02.01 - Fixed Flow Rate
     B BRAUN AUSTRALIA PTY LTD
BB349                                                            Easypump                                                                                              Disposable Elastomeric infusion pump system                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                LT: Filling Volume: 60ml - 400ml, Flow Rate: 0.5ml/h - 10ml/h                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   $28.00
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  ST: Filling Volume: 50ml - 500ml, Flow Rate: 50ml/h - 500ml/h

     EPIC MEDICAL PTY LTD
QQ831                                                            SMARTeZ Rigid Shell Single Use Elastomeric Infusion Pump - Chemotherapy                               SMARTeZ Rigid Shell Single use Elastomeric Infusion Pump - Chemotherapy-rated pumps are available with and without a bonded closed system transfer device attachment. (CSTD) providing a true closed system for the safety of both the patient and caregivers. Product is used for a single patient only.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  Size, 60ml - 275ml. Flow rates: 0.5mL/hr to 100mL/hr                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            $28.00
QQ828                                                            SMARTeZ Plus Painbloc Single Use Elastomeric Infusion pump - Fixed Flow rate - Single patient use     The SMARTeZ Plus PainBloc pump is a single use soft-shell elastomeric pump, for single patient use only. The Painbloc pump provides continuous delivery of medication (local anesthetics & analgesics) to or around surgical wound sites