PHI 73/19 - Prostheses List - Benefit Reduction February 2020

This circular provides information for stakeholders about the February 2020 Prostheses List benefit reductions.

Page last updated: 12 November 2019

PHI 73/19 - Prostheses List - Benefit Reduction February 2020 (PDF 144 KB)

This circular provides information for stakeholders about the February 2020 Prostheses List benefit reductions.

As per the Government-MTAA Agreement, the final round of benefit reductions payable by private health insurers for devices on the Prostheses List will take effect 1 February 2020. The reduction is calculated on the basis of the Prostheses List benefit on 31 January 2020. The following groups are exempt: 03.01.01, 08.17.01, 08.18.01 and 08.18.02.

The table below shows the reduction percentages that apply.

Benefit Reductions effective 1 February 2020
Ophthalmic
      Except Groups

      Foldable

      Viscoelastic

-5%

-8.5%

-10%

Ears Nose Throat
      Except Groups (Cochlear Implants, Speech Processors, Sound Processor Accessory Kits, Implantable Bone Conduction Hearing System)
-5%

-

General Miscellaneous
      Except Groups (Infusion Pumps, Balloon Based; Sponges; Pliable Patches, Internal Adhesives, Ligating Devices; Staples & Tackers)
-5%

-7%

Neurosurgical
-5%
Urogenital
-
Specialist Ortho
      Except Groups (Screws; Surgical Accessories; Bone Cement)
-

-3%

Plastic and Reconstructive
-
Cardiac
      Except Group (Cardiac Defect Occluders)
-7.5%

-10%

Cardiothoracic
-
Vascular
      Except Assessment Bodies (Vascular Patches; Arterial Closure Devices; Long Term Vascular Access Devices); and

      Groups (Occlusion Devices – Particle; Coil, Peripheral; Polymer; Delivery Device For Occlusion Media)

-5%

-10%

Hip
-4.5%
Knee
-2.5%
Spinal
-3.75%

Additional information on the benefit reductions can be found at:

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


Draft Prostheses List available to Sponsors via PLMS.18 November 2019
Deadline for feedback25 November 2019
February 2020 Prostheses List published2 December 2019
February 2020 Prostheses List effective1 February 2020