AUGUST 2009 ONLINE PROSTHESES LIST (CURRENT)

The Prostheses List, which lists the no-gap and gap-permitted prostheses and the benefits payable for them is released twice per year. The most current version of the List is known as the August 2009 Prostheses List. The August 2009 Prostheses List has a commencement date of 15th August 2009.

• 804 new billing codes (298 new products, 300 resulting from expansions, 109 resulting from transfers, 30 resulting from compressions and 67 duplications);
• 2,184 billing codes have had amendments to one or more of the following: benefit/s, product information text, product groups/subgroups; and
• 950 billing codes have been removed (655 at sponsor request, 75 compressed, 110 expanded, 109 transferred and 1 that did not meet listing criteria

No-gap prosthesis means a prosthesis listed in the Schedule where an amount is specified for that prosthesis in the column under the heading "Minimum Benefit" and no amount is specified in the column under the heading "Maximum Benefit". No-gap prostheses are listed with a single benefit, and patients will have no out-of-pocket expenses for these prostheses. For each Medicare Benefit Schedule (MBS) item, it is aimed to have at least one no-gap prosthesis available.

Gap-permitted prostheses have both a minimum and maximum benefit listed. For these prostheses private health insurers are required to pay at least the minimum benefit.

Patients may incur an out-of-pocket expense for these prostheses, which, at a maximum, will be the difference between the minimum and the maximum benefit.

• There are currently 2,122 (22.7%) products with potential gaps in part A of the Prostheses List. Human tissue prostheses in Part B of the Prostheses List do not have gap permitted products.

Currently, there are more than 9,500 products on the Prostheses List, which lists the no-gap and gap-permitted prostheses and the benefits payable for them.

The August 2009 Prostheses List commences on 15th August 2009. The next list to be published after the August 2009 List will be the February 2010 Prostheses List. The February 2010 Prostheses List is scheduled to commence on 8th February 2010.

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