41603 - 41604 Osseointegration procedure—fixation of abutment or implantation of titanium fixture for use with implantable bone conduction hearing system device, in a specified patient group. $186.50 to $503.85 375 $72,217 Ossicular chain reconstruction $1089.90 to $1194.25 241 $191,618 41545 to 41564 Mastoidectomy $521.25 to $1876.95 depends on complexity 1013 $953,267 45794 to 45797 Osseointegration procedure – placement of TORP/PORP for ossicular reconstruction surgery. $186.50 to $503.85 67 $9066 (Commonwealth of Australia, 2014) Regulatory status The VSB is the sole partially implantable MEI available for the treatment of CHL or MHL that is listed on the Australian Register of Therapeutic Goods (ARTG). Table 11: MEI components listed on the ARTG ARTG Product Indication 170179 Amade audio processor External sound processor 161702 Vibrating ossicular prosthesis 502X Internal, crimped to vibratory structure of middle ear 185533 Vibroplasty coupler Internal, couples transducer to vibratory structure of middle ear. (Commonwealth of Australia, 2014) Proposed Listing and Options for MSAC Consideration Table 12 shows the proposed MBS listing. It should be noted that the proposed MBS Scheduled fee for the vibroplasty required to position the MEI is considerable higher than the fee for the osseointegration procedure required to position the BCI. 41542
Attachment A Current MBS Items by Medical Service, Hearing Loss Type and Hearing Loss Cause MBS item Descriptor Medical Service Hearing loss type Hearing loss cause 41527 Myringoplasty, trans-canal approach (Rosen incision) Procedure using a skin graft to repair a perforated in tympanic membrane (eardrum). May include drain fluid from middle ear and insertion of typanostomy tube. CHL Severe ear infection or otitis media Perforation of tympanic membrane and intermittent discharge. 41539 Ossicular chain reconstruction Ossiculoplasty to repair or reconstruct middle ear and restore function. May include: total ossicular replacement prosthesis (TORP) partial ossicular replacement prosthesis (PORP) tympanoplasty (repair of tympanic membrane) stapedectomy or stapedotomy (partial or full replacement of stapes, for patients with otosclerosis or congenital malformation). CHL (moderate to severe) Trauma, neoplasms, inflammatory processes and/or cholesteatoma. Discontinuity of ossicular chain caused by eroded incudostapedial joint, absent incus, or absent incus and stapes superstructure. Fixation of ossicular chain caused by malleus head ankylosis or ossicular tympanosclerosis. Ossicular chain reconstruction and myringoplasty 41545 Mastoidectomy (cortical) The mastoidectomy procedure varies according to extent of infection: simple: mastoid bone is exposed, infected air cells removed, incision in eardrum to drain middle ear. radical: tympanic membrane and most middle ear structures are removed, CHL (moderate to severe) Ear infections such as otitis media (chronic or acute) or mastoiditis. Cholesteatoma. Complications such as intra-temporal or intracranial suppuration, abscess formation, lateral venous sinus thrombosis. Failure to respond to IV antibiotics. 41548 Obliteration of the mastoid cavity 41551 Mastoidectomy, intact wall technique, with myringoplasty
Eustachian tube is closed. Stapes usually retained. modified radical: retains ossicles. Tympanic membrane is reconstructed by tympanoplasty. complete (canal wall up): removal of mastoid air cells, tegmen, sigmoid sinus, presigmoid dural plate, posterior wall of external auditory canal. Posterior wall of external auditory canal is retained. canal wall down: complete mastoidectomy plus removal of posterior and superior osseous external auditory canal. Tympanic membrane reconstructed to separate the middle ear and mastoid cavity and ear canal. With or without myringoplasty and/or ossiculoplasty. Lateral skull base neoplasms. 41554 Mastoidectomy, intact wall technique, with myringoplasty and ossicular chain reconstruction 41557 Mastoidectomy (radical or modified radical) 41560 Mastoidectomy (radical or modified radical) and myringoplasty 41563 Mastoidectomy (radical or modified radical), myringoplasty and ossicular chain reconstruction 41564 Mastoidectomy (radical or modified radical), obliterate mastoid cavity, blind sac closure of external auditory canal and obliterate Eustachian tube 41566 Revision of mastoidectomy (radical, modified radical or intact wall), including myringoplasty
patients (as for 41603). 41608 Stapedectomy Procedure to partially or fully replace stapes. Diseased part of stapes footplate is removed and replaced with a prosthesis which is attached to incus restoring continuity of ossicular movement. This enables sound to be transmitted from eardrum to inner ear. May be part of ossiculoplasty (repair or reconstruction of middle ear). CHL with air bone gap of ≧30dB Otosclerosis Congenital malformation of stapes Severe middle ear infections Previous middle ear surgery 41611 Stapes mobilisation Procedure to remobilise stapes footplate. 41614 Round window surgery including repair of cochleotomy Procedures may be used to: correct a defect in round or oval window (or both) to prevent perilymph fistula (PLF) from leaking from inner ear to middle ear. Using trans-canal approach, small soft tissue grafts are used to patch fistula. correct superior canal dehiscence syndrome by reinforcing the round and oval windows fascia from a post-auricular incision. CHL MHL SNHL Otosclerosis Trauma (head or ear) Perforated eardrum Ear block (plane descent or scuba diving) Rapid increase in cranial pressure Superior canal dehiscence syndrome 41615 Oval window surgery including repair of fistula, not being a service associated with a service to which any other item in this Group applies.
41617 Cochlear implant, insertion of, including mastoidectomy Procedure to implant CI device which bypasses damaged inner ear and directly stimulates the auditory nerve. External component captures sound and transforms it into electromagnetic signal. Signal is conveyed to implant located behind auricle and changed into vibration which is conveyed to cochlea stimulating auditory nerve. Adult – bilateral severe-profound SNHL Children: 2-17 yr: SNHL 12-24 mth: profound SNHL Damaged hair cells in the cochlear (inner ear) and/or nerve to brain 41632 Middle ear, insertion of tube for DRAINAGE OF (including myringotomy) Procedure to insert a tube to drain fluid from middle ear in peoples with severe ear infection or otitis media with effusion. With or without myringotomy to enable release of fluid from middle ear. CHL Otitis media with effusion. Cholesteatomas from severe infection, perforated eardrum, chronic middle ear problems or congenital issues. 41635 Clearance of middle ear for granuloma, cholesteatoma and polyp, 1 or more, with or without myringoplasty Procedure to remove granuloma, cholesteatomas and polyps from middle ear. May be performed with: myringoplasty (skin graft to repair perforated tympanic membrane). insertion of typanostomy tube. ossiculoplasty (41638). 41638 Clearance of middle ear for granuloma, cholesteatoma and polyp, 1 or more, with or without myringoplasty with ossicular chain reconstruction
45794 procedure - extra-oral, implantation of titanium fixture, not for implantable bone conduction hearing system device Placement of titanium prostheses as part of a TORP or PORP procedure to repair or reconstruct the middle ear (ossicular chain reconstruction). Reconstruction of the external ear with osseo-integrated prostheses. Auricular deficit or absence may or may not be associated with hearing loss. CHL severe MHL Discontinuity or fixation of ossicular chain, trauma, neoplasm, inflammatory processes, cholesteatoma. Auricular deficit due to aplasia, auricle avulsion or amputation injuries, blunt trauma, burns, composite defect, frost bite, lacerations, superficial defects. 45797 procedure, fixation of transcutaneous abutment, not for implantable bone conduction hearing system device