The Prostheses List

The Private Health Insurance (Prostheses) Rules (No. 3) 2019 were registered on the Federal Register of Legislation on 24 October 2019 and commence on 1 November 2019. Schedule 1 to these Rules is commonly known as the November 2019 Prostheses List.

Page last updated: 29 October 2019

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:

Private health insurance reforms: Prostheses List benefit reductions
Agreement between the Government and the Medical Technology Association of Australia (MTAA)

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

PDF version: November 2019 Prostheses List – Part A New Items (PDF 794 KB)
Excel version: November 2019 Prostheses List – Part A New Items (Excel 50 KB)

Part A – Deleted Prostheses Items

PDF version:November 2019 Prostheses List – Part A Deletions (PDF 739 KB)
Excel Version: November 2019 Prostheses List – Part A Deletions (Excel 42 KB)

Part A – Changed Items for Prostheses List

PDF Version: November 2019 Prostheses List – Part A Changes (PDF 431 KB)
Excel Version: November 2019 Prostheses List – Part A Changes (Excel 17 KB)

Part B – Human Tissue

PDF Version: November 2019 Prostheses List – Part B (Human Tissue) (PDF 803 KB)
Excel Version: November 2019 Prostheses List – Part B (Human Tissue) (Excel 42 KB)

Part B – New Human Tissue Items

PDF Version: November 2019 Prostheses List – Part B (Human Tissue) New Items (PDF 308 KB)
Excel Version: November 2019 Prostheses List – Part B (Human Tissue) New Items (Excel 8 KB)

Part B – Deleted Human Tissue Items

PDF Version: November 2019 Prostheses List – Part B (Human Tissue) Deletions (PDF 307 KB)
Excel Version: November 2019 Prostheses List – Part B (Human Tissue) Deletions (Excel 8 KB)

Part B – Changed Human Tissue Items

PDF Version: November 2019 Prostheses List – Part B (Human Tissue) Changes (PDF 322 KB)
Excel Version: November 2019 Prostheses List – Part B (Human Tissue) Changes (Excel 8 KB)

Part C – Other

PDF Version: November 2019 Prostheses List – Part C (Other Prostheses) (PDF 465 KB)
Excel Version: November 2019 Prostheses List – Part C (Other Prostheses) (Excel 18 KB)

Part C - New Other

PDF Version: November 2019 Prostheses List – Part C (Other Prostheses) New Items (PDF 341 KB)
Excel Version: November 2019 Prostheses List – Part C (Other Prostheses) New Items (Excel 9 KB)

Part C - Deleted Other

PDF Version: November 2019 Prostheses List – Part C (Other Prostheses) Deletions (PDF 306 KB)
Excel Version: November 2019 Prostheses List – Part C (Other Prostheses) Deletions (Excel 8 KB)

Part C - Changed Other

PDF Version: November 2019 Prostheses List – Part C (Other Prostheses) Changes (PDF 378 KB)
Excel Version: November 2019 Prostheses List – Part C (Other Prostheses) Changes (Excel 10 KB)

XML file

November 2019 Prostheses List (XML 11367 KB)

PDF version: XML Schema document (PDF 754 KB)
Word version: XML Schema document (Word 129 KB)

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 prostheses@health.gov.au


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