FOI 4874 Document 1
s22
From:
s47F
Sent:
Thursday, 26 October 2023 11:23 AM
To:
PLATONA, Adriana
Cc:
RINTOUL, Andrew; s22
Subject:
FW: Condition on billing codes for surgical guides and biomodels [SEC=OFFICIAL]
Hi Adriana,
We have concerns about the implementation timeframes on the changes for surgical guides and biomodels that
were announced on 18 October, with further clarification issued on 20 October. There still appears to be a lack of
clarity around the impact of the changes and how they will be implemented. We also understand that a number of
surgeries will now be cancelled. To ensure a smooth implementation and minimal impact on patients, we ask that
this change is delayed while further detail and clear communications about the change is worked through with
hospitals.
Happy to discuss further.
s47F
From: s22
@Health.gov.au>
Sent: Tuesday, 24 October 2023 12:16 PM
To: s47F
@Health.gov.au>
ACT 1982 (CTH)
Cc: RINTOUL, Andrew <xxxxxx.xxxxxxx@xxxxxx.xxx.xx>; PLATONA, Adriana <xxxxxxx.xxxxxxx@xxxxxx.xxx.xx>;
s22
@health.gov.au>
Subject: RE: Condition on billing codes for surgical guides and biomodels [SEC=OFFICIAL]
HEALTH AND AGED CARE
Dear s47F
INFORMATION
Some background and detail about the new condition for surgical guides and biomodels that was announced on 18
October 2023 and effective 1 November 2023 for your information.
The outcome of the post‐listing review into surgical
FREEDOM OF
guides and biomodels was presented to the MDHTAC for
consideration and advice at the September 2023 meeting. The key points
THIS DOCUMENT HAS BEEN RELEASED UNDER considered were:
THE
o The post‐listing review of surgical guides and biomodels was triggered by many concerns raised by
BY THE DEPARTMENT OF
stakeholders (including private health insurers, some sponsors and clinicians) regarding the
questions about whether these devices meet the PL Part A criteria for listing.
o The review report (that was undertaken by an external reviewer) concluded that surgical guides and
biomodels have an established role in clinical practice predominantly in craniomaxillofacial (CMF)
and oral surgery, and achieve comparable or improved outcomes by improving accuracy of implant
placement, decreased operative and/or ischaemic time, reduced intraoperative fluoroscopy and
reduced complication rates.
o The review further advised that surgical guides and biomodels are considered eligible for listing on
PL Part A, but their eligibility depends on the clinical circumstances in which they are used.
o The department undertook additional targeted consultation with some clinical societies after the
review report was received – specifically in the orthopaedic and spinal categories.
o Formulating conditions that could be imposed to restrict PL reimbursement for billing codes under
certain clinical scenarios is difficult.
The MDHTAC members discussed the findings of the review and the types of clinical categories that are
relevant for reimbursement of these devices. The key points were:
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FOI 4874 Document 2
s22
From:
s22
Sent:
Wednesday, 18 October 2023 8:37 PM
To:
s47F
Cc:
s22
Subject:
FOR INFORMATION: PHI CIRCULAR - NOVEMBER 2023 UPDATE OF THE PL AND
ADVICE ABOUT 10% REDUCTION AND CONDITIONS FOR SURGICAL GUIDES AND
BIOMODELS [SEC=OFFICIAL]
PHI 66/23 Private Health Insurance (Medical Devices and Human Tissue Products) Rules (No. 2) 2023 | Australian
Government Department of Health and Aged Care
s47F
Please see the link to the PHI circular that was published on the Department website earlier this evening. The
MDHTP Rules (legislation) has been registered on the Federal Register of Legislation.
Regards
s22
A/g Assistant Secretary, Prescribed List Reform Taskforce
Technology Assessment & Access Division | Health Resourcing Group
ACT 1982 (CTH)
Australian Government Department of Health
T: 02 6289 s22
| E:s22
@health.gov.au
M: s22
Location: Sirius Buildings22
HEALTH AND AGED CARE
GPO Box 9848, Canberra ACT 2601, Australia
INFORMATION
The Department of Health acknowledges the traditional owners of country throughout Australia, and their continuing
connection to land, sea and community. We pay our respects to them and their cultures, and to elders past and
present.
I do not expect you to respond to my email outside your working hours. At the Department of Health and Aged Care
we value and encourage flexible working Feel free to
FREEDOM OF read, act on or respond at a time that works for you.
THIS DOCUMENT HAS BEEN RELEASED UNDER
THEBY THE DEPARTMENT OF
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