Device Reimbursement

Under the Private Health Insurance Act 2007, private health insurers are required to pay mandatory benefits for a range of prostheses that are provided as part of an episode of hospital treatment (or hospital substitute treatment) where a Medicare benefit is payable for the associated professional service (surgery).

We can help strategise your medical device reimbursement pathway in Australia and prepare applications for submission to the Prostheses List Advisory Committee (PLAC) on your behalf. We have extensive experience in the preparation and submission of applications to the Australian Prosthesis Committee, a ministerial appointed committee within the Department of Health and Aging.

Medical Device Reimbursement in Australia is a complex process where the Sponsor needs to demonstrate not only that the device is eligible for addition to the Prosthesis List based on certain set criteria, but that the device, through clinical and published evidence, is efficacious and able to be favourably compared against any competitors. Applications for adding a medical device to the prosthesis list typically require literature reviews in addition to cost analysis, both of which we can undertake to assist you in realising your market ambitions.

We can also help in determining Medical Benefit Scheme (MBS) Item Numbers appropriate to your product. Where no MBS Item Number exists, we can help you develop a reimbursement strategy and prepare applications for a new item number.