Document ID: chunk:federal_register_of_legislation:F2024L01386:schedule:1:p639
Version: federal_register_of_legislation:F2024L01386
Segment Type: schedule
Provision Reference: sch 1 (pt 639/696)
Character Range: 22465894–22508067

with rotator cuff                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  $4,452.00
PBT15                                                                            Fascia Lata - Large (15cm x 10cm)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     $1,685.00
PBT24                                                                            Femoral Rings                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         $1,908.00
PBT38                                                                            Bone - Milled 30-50g Freeze Dried                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     $900.00
PBT16                                                                            Fascia Lata - Small (10cm x 5cm)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      $905.00
PBT11                                                                            Cartilage - costal segments                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           $318.00
PBT18                                                                            Femur - Entire head removed                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           $8,480.00
PBT47                                                                            Meniscal Graft                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        $2,036.00
PBT13                                                                            Radius                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                $1,908.00
PBT32                                                                            Hemipelvis - Tricortical iliac wedge                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  $1,590.00
PBT37                                                                            Bone - Milled <30g Freeze Dried                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       $750.00
PBT35                                                                            Humerus - Proximal                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    $2,968.00

     Sydney Local Health District
CSA01                                                                            Femoral Head                                                                                          Femoral Head, whole, frozen, non-irradiated                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           Single, whole femoral head                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                $3,367.00

02 - Ophthalmic
Billing Code                                                          Product Name                                   Description                                                                                                                                                                                                                                                                                       Size                                                                Minimum Benefit  Condition
     Lions Eye Bank of Western Australia
LEW03                                                                 Cornea for Endothelial Keratoplasty                                                                                                                                                                                                                                                                                                                                                                                  $3,525.00
LEW01                                                                 Cornea                                                                                                                                                                                                                                                                                                                                                                                                               $2,950.00
LEW02                                                                 Sclera                                                                                                                                                                                                                                                                                                                                                                                                               $295.00

     Lions Eye Donation Service
LEM01                                                                 Cornea                                                                                                                                                                                                                                                                                                                                                                                                               $3,200.00
LEM05                                                                 Cornea Preloaded for Endothelial Keratoplasty  This is an additional preparation step to LEM04 Cornea for Endothelial Keratoplasty. Descemet's Membrane Endothelial Keratoplasty (DMEK) donor tissue is prepared and then trephinated, stained, and loaded into a transport/injector cartridge by the eye bank and then shipped to the surgeon   N/A -  DMEK tissue itself is 12 microns thick and trephined to 8mm  $4,800.00
LEM04                                                                 Cornea for Endothelial Lamellar Keratoplasty                                                                                                                                                                                                                                                                                                                                                                         $4,000.00
LEM02                                                                 Sclera                                                                                                                                                                                                                                                                                                                                                                                                               $500.00

     Lions Eye Institute Limited
LAB01                                                                 FROZEN CORNEA                                  FROZEN CORNEA for tectonic/patch grafts                                                                                                                                                                                                                                                           one corneo-scleral disc - frozen                                    $550.00

     METRO SOUTH HOSPITAL AND HEALTH SERVICE
QEB02                                                                 Sclera – Whole                                                                                                                                                                                                                                                                                                                                                                                                       $650.00
MAB01                                                                 Cornea for Endothelial Keratoplasty            Pre-cut cornea for Descemet Stripping Automated Endothelial Keratoplasty (DSAEK)                                                                                                                                                                                                                  Variable                                                            $3,777.00
MAB04                                                                 Sclera - Patch                                 Sclera - Patch                                                                                                                                                                                                                                                                                                                                                        $434.00
MAB03                                                                 Cornea - Lamellar                              Cornea - Lamellar                                                                                                                                                                                                                                                                                                                                                     $2,610.00
QEB01                                                                 Cornea                                                                                                                                                                                                                                                                                                                                                                                                               $3,161.00

     NSW HEALTH SERVICE - SOUTH EASTERN SYDNEY LOCAL HEALTH DISTRICT
NCC74                                                                 Cornea for Endothelial Keratoplasty                                                                                                                                                                                                                                                                                                                                                                                  $3,300.00
NCC71                                                                 Cornea                                                                                                                                                                                                                                                                                                                                                                                                               $2,801.00
NCC73                                                                 Cornea For Lamellar                                                                                                                                                                                                                                                                                                                                                                                                  $1,682.00
NCC72                                                                 Sclera                                                                                                                                                                                                                                                                                                                                                                                                               $420.00

     Southern Adelaide Local Health Network Incorporated
SAA02                                                                 Cornea for Endothelial Keratoplasty            Cornea for Endothelial Keratoplasty                                                                                                                                                                                                                                                                                                                                   $3,525.00
SAA03                                                                 Sclera                                         Sclera                                                                                                                                                                                                                                                                                                                                                                $300.00
SAA01                                                                 Cornea                                         Cornea                                                                                                                                                                                                                                                                                                                                                                $2,950.00

01 - Cardio-thoracic
Billing Code                                  Product Name                    Description          Size  Minimum Benefit  Condition
     Donor Tissue Bank of Victoria
TBV03                                         Conduit - Pulmonary             Conduit - Pulmonary        $2,423.00
TBV56                                         Conduit - Aortic                Conduit - Aortic           $2,423.00
TBV01                                         Valve - Aortic                  Valve - Aortic             $11,223.00
TBV50                                         Pericardium                     Pericardium                $2,949.00
TBV02                                         Valve - Pulmonary               Valve - Pulmonary          $11,223.00

     METRO SOUTH HOSPITAL AND HEALTH SERVICE
QHV11                                         Vascular Graft (Various)                                   $4,071.00
QHV07                                         Patch, Conduit and Pericardium                             $3,195.00
QHV01                                         Valve and Valved Conduit                                   $10,240.00

     ST. VINCENT'S HOSPITAL SYDNEY LIMITED
SHV01                                         Valve - Aortic                  Valve - Aortic             $11,421.00
SHV02                                         Valve - Pulmonary               Valve - Pulmonary          $11,421.00
SHV03                                         Conduit - Arterial              Conduit - Arterial         $4,499.00

04 - Dermatologic
Billing Code                                                                                                                                   Product Name                                                                               Description                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          Size                                                                                                                                                                                                                                                                                                                                                Minimum Benefit  Condition
     AUSTRALIAN TISSUE DONATION NETWORK LIMITED
ADD39                                                                                                                                          Acellular Dermal Matrix > 300cm²                                                           ADM is derived from full thickness human skin,