Private Health Insurance (Prostheses) Rules
The Private Health Insurance (Prostheses) Rules provide the legal basis on which the Prostheses List operates.
The Prostheses List is the list of surgically implanted prostheses, human tissue items and other medical devices that private health insurers must pay benefits for when:
- they are provided to a patient with appropriate health insurance cover
- they are provided as part of hospital treatment or hospital substitute treatment, and
- there is a Medicare benefit payable for the service.
The list is aimed at Private Health Insurers, prostheses device manufacturers and other sponsors. To find consumer-specific information on private health insurance cover for prostheses go to the Private Health Insurance - Cover for Prostheses page.
Prostheses Benefit Reductions
On Friday 13 October 2017 the Minister for Health announced that the minimum benefits payable by private health insurers for devices on the Prostheses List would be reduced. Additional information is available at:
Benefit Changes from 1 March 2019
Private Health Insurance Circular 09/19 informs stakeholders about changes to benefits that appear in the March 2019 Prostheses List:
- Benefits for 464 groupings of prostheses were either increases or decreased by $1 to address an issue with incorrect rounding of benefits when they were reduced in August 2018;
- Benefits for 24 groupings of prostheses were reduced by removal of the benefit premium for “superior clinical performance”, under the Government Agreement with the Medical Technology Association of Australia.
These benefit changes are reflected in the report of Part A - Changed Items for Prostheses List below.
November 2019 Prostheses List – commencing 1 November 2019
The Department of Health publishes the current Prostheses List for the use of stakeholders to update their claims and payments systems.
While care has been taken in the preparation of these documents, the information they contain does not take precedence over the latest copy of the Private Health Insurance (Prostheses) Rules registered and in force on the Federal Register of Legislation.
These documents reflect the Private Health Insurance (Prostheses) Rules (No. 3) 2019(as amended by the Amendment Rules).
Prostheses List in parts
Part A – Prostheses List
PDF version: November 2019 Prostheses List – Part A (PDF 16063 KB)
Excel version: November 2019 Prostheses List – Part A (Excel 1253 KB)
Part A – New Prostheses Items
Part A – Deleted Prostheses Items
Part A – Changed Items for Prostheses List
Part B – Human Tissue
Part B – New Human Tissue Items
Part B – Deleted Human Tissue Items
Part B – Changed Human Tissue Items
Part C – Other
Part C - New Other
Part C - Deleted Other
Part C - Changed Other
Contacts for further information
The Department of Health has made every effort to ensure these documents meet accessibility requirements. If you are experiencing difficulty accessing the information contained within this webpage, or cannot find the information you need, please contact the Prostheses secretariat by email at firstname.lastname@example.org