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Hospitals Cover for implantation of hearing devices


Implantation of hearing devices during a hospital admission

The Australian government requires health funds to pay for implantation of hearing devices for silver and gold categories of hospital private health cover, as per the  Private Health Insurance (Prostheses) Rules (No. 4) 2019.

Cover is usually to the amount set by the Federal government, who revise and publish the Prosthesis List three times per year.  The list identifies items related to prosthesis and the amount that health funds must pay when their members meet eligibility criteria.  Items on the Prosthesis list related to implantation of hearing devices requiring hospital admission have been extracted and are listed below.  Most devices on the list may not attract a gap fee, and if so, then an alternative no-gaps device must also be listed.   

Health funds  have the option to offer cover for implantation of hearing devices as part of bronze or basic hospital schemes.  As a result, individual differences between schemes and funds apply at the lower levels of cover. 

In some cases waiting times (when first joining a scheme or changing schemes) and benefit cycles (eg being eligible only every 3 or 5 years) may apply.

Medical specialists and audiology clinics may charge for consultations and other services that may not be covered by the hospital cover, so out of pocket expenses my apply.

Private health funds may offer a scheme that pays for accommodation in a public hospital only.  In such cases, cover for implantation of hearing devices is usually restricted.  Medicare and your health fund benefit will typically be combined to pay the Medicare Schedule Fee for that treatment (ie, what Medicare alone would have paid had you gone public).   As a private patient (in either a public or private hospital) your doctor may charge you fees that are for your own account - ie gap fees.  Check with your fund, your audiologist and your surgeon as to what out of pocket expenses will apply in your case.    

Replacement and Upgrade of Sound Processors (not requiring hospital admission)

Replacement of damaged processors or upgrading to new processors does not require hospitalization and so is not automatically covered by hospital cover, even for the highest levels of cover.  Individual funds set their own rules regarding cover for replacement of sound processors and will typically make a decision on a case by case basis.

Please read the information for your individual fund and consult your fund to check eligibility before agreeing to a replacement or upgrade.

Repairs

Repairs are not generally covered by hospital schemes.  In some cases, those with Extras cover (in addition to hospital cover, in combined packages) may be eligible for small amounts towards repairs and maintenance of implanted hearing devices.

The Prosthesis List - Extraction of items associated with implantation of hearing devices

The table below shows Cochlear Implants, Speech Processors (Initial and Replacement where a hospital admission is required) and Bone Conduction Hearing Systems, as shown in the July 2020 Prosthesis List.  

The full Prosthesis list is available from the Department of Health.

Check the summary of each fund to establish which level of cover provides for this cover and for any additional rules that may apply to a particular fund.

 Code  Supplier Description No Gap Fee
Cochlear Implants      
BD020 Advanced Bionics Australia Pty Ltd HiRes90K Advantage Cochlear Implant with HiFocus 1j Electrode $12,892
BD022 Advanced Bionics Australia Pty Ltd HiRes90K Advantage Cochlear Implant with the HiFocus Mid-Scala Electrode $12,892
BD024 Advanced Bionics Australia Pty Ltd HiRes Ultra Cochlear Implant with the HiFocus Mid-Scala Electrode $12,892
BD026 Advanced Bionics Australia Pty Ltd HiRes Ultra Cochlear Implant with HiFocus Slim-J Electrode $12,892
CO021 Cochlear Limited Nucleus Freedom Implant with Contour Advance Electrode $12,892
CO024 Cochlear Limited Nucleus Freedom Implant with Straight Electrode $12,892
CO046 Cochlear Limited Cochlear™ Nucleus® CI512 Cochlear Implants with Contour Advance Electrode $12,892
CO057 Cochlear Limited Cochlear™ Nucleus® CI422 cochlear implant with Straight Electrode $12,892
CO074 Cochlear Limited Cochlear Nucleus CI522 Cochlear Implant with Slim Straight Electrode $12,892
CO078 Cochlear Limited Cochlear™ Nucleus® CI532 Cochlear Implant with Slim Modiolar Electrode $12,892
CO083 Cochlear Limited Cochlear™ Nucleus® Profile Plus Series (CI632) Cochlear Implant with Slim Modiolar Electrode $12,892
CO084 Cochlear Limited Cochlear™ Nucleus® Plus Series (CI612) Cochlear Implant with Contour Advance Electrode $12,892
CO085 Cochlear Limited Cochlear™ Nucleus® Profile Plus Series (CI622) Cochlear Implant with Slim Straight Electrode $12,892
OI035 Audmet Australia Pty Ltd trading as Oticon Medical Neuro Zti Cochlear Implant $12,892
US008 Med-El Implant Systems Australasia Pty Ltd Mi1000 CONCERTO/ Mi1000 CONCERTO PIN $12,892
US012 Med-El Implant Systems Australasia Pty Ltd Mi1200 SYNCHRONY Cochlear Implant / Mi1200 SYNCHRONY PIN Cochlear Implant $12,892
Speech Processors      
CO069 Cochlear Limited Cochlear ™ Nucleus® CP910 Sound Processor (Initial) $11,392
CO071 Cochlear Limited Cochlear ™ Nucleus® CP920 Sound Processor (Initial) $11,392
CO080 Cochlear Limited Kanso®, Cochlear™ Nucleus® CP950 Sound Processor (Initial) $11,392
US014 Med-El Implant Systems Australasia Pty Ltd SONNET EAS Audio Processor (initial) $12,303
CO064 Cochlear Limited Cochlear ™ Nucleus® CP910 Sound Processor Hybrid™ Mode (Initial) $12,796
CO066 Cochlear Limited Cochlear™ Nucleus® CP920 Sound Processor - Hybrid™ Mode (Initial) $12,796
CO081 Cochlear Limited Cochlear™ Nucleus® CP1000 Sound Processor - Hybrid™ Mode (initial) $12,796
US025 Med-El Implant Systems Australasia Pty Ltd SONNET 2 EAS Audio Processor $12,796
BD023 Advanced Bionics Australia Pty Ltd Naida CI Q90 Sound Processor (Initial Order) $10,925
CO048 Cochlear Limited Cochlear™ Nucleus® CP810 Sound Processor - INITIAL $10,925
OI033 Audmet Australia Pty Ltd trading as Oticon Medical Neuro One Speech Processor $10,925
OI036 Audmet Australia Pty Ltd trading as Oticon Medical Neuro 2 Sound Processor $10,925
US009 Med-El Implant Systems Australasia Pty Ltd RONDO Audio Processor $10,925
US013 Med-El Implant Systems Australasia Pty Ltd SONNET Audio Processor (initial) $10,925
US022 Med-El Implant Systems Australasia Pty Ltd RONDO 2 Audio Processor $10,925
CO070 Cochlear Limited Cochlear ™ Nucleus® CP910 Sound Processor (Replacement) $8,114
CO072 Cochlear Limited Cochlear ™ Nucleus® CP920 Sound Processor (Replacement) $8,114
CO079 Cochlear Limited Kanso®, Cochlear ™ Nucleus® CP950 Sound Processor (Replacement) $8,114
US016 Med-El Implant Systems Australasia Pty Ltd SONNET EAS Audio Processor (replacement) $8,612
CO065 Cochlear Limited Cochlear™ Nucleus CP910 Sound Processor Hybrid™ Mode (Replacement) $9,078
CO067 Cochlear Limited Cochlear™ Nucleus® CP920 sound Processor - Hybrid™ Mode (Replacement) $9,078
CO082 Cochlear Limited Cochlear™ Nucleus® CP1000 Sound Processor - Hybrid™ Mode (replacement) $9,078
US024 Med-El Implant Systems Australasia Pty Ltd SONNET 2 EAS Audio Processor (replacement) $9,078
BD015 Advanced Bionics Australia Pty Ltd Neptune Sound Processor replacement part is the external part of the cochlear implant system. Also includes Neptune Connect $7,648
BD025 Advanced Bionics Australia Pty Ltd Naida CI Q90 Sound Processor (Replacement Order) $7,648
CO049 Cochlear Limited Cochlear™ Nucleus® CP810 Sound Processor - REPLACEMENT $7,648
OI034 Audmet Australia Pty Ltd trading as Oticon Medical Neuro One Speech Processor (Replacement) $7,648
OI037 Audmet Australia Pty Ltd trading as Oticon Medical Neuro 2 Sound Processor Replacement $7,648
US010 Med-El Implant Systems Australasia Pty Ltd RONDO Audio Processor Replacement $7,648
US015 Med-El Implant Systems Australasia Pty Ltd SONNET Audio Processor (Replacement) $7,648
US023 Med-El Implant Systems Australasia Pty Ltd RONDO 2 Audio Processor - Replacement $7,648
Bone Conduction Hearing Systems      
MI193 Medtronic Australasia Pty Ltd Sophono Alpha Bone Conduction Hearing System, Sound Processor $6,175
OI023 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Sound Processor $6,175
CO075 Cochlear Limited Cochlear Baha 5 Sound Processor $6,484
CO076 Cochlear Limited Cochlear Baha 5 SuperPower Sound Processor $6,484
CO077 Cochlear Limited Cochlear Baha 5 Power Sound Processor $6,484
OI029 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Plus Sound Processor $6,484
OI032 Audmet Australia Pty Ltd trading as Oticon Medical Ponto 3 Sound Processor $6,484
OI038 Audmet Australia Pty Ltd trading as Oticon Medical Ponto 4  $6,484
US017 Med-El Implant Systems Australasia Pty Ltd Bonebridge Samba BB Audio Processor $6,484
CO050 Cochlear Limited Baha BA210 Abutment $850
OI025 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Abutment $850
CO052 Cochlear Limited Baha BA300 abutment. $889
CO032 Cochlear Limited Flange fixture - self tapping fixture with pre-mounted abutment $1,833
MI194 Medtronic Australasia Pty Ltd Sophono Alpha Bone Conduction Hearing System, Implant $1,833
OI026 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Abutment and Implant $1,833
CO063 Cochlear Limited Cochlear ™ Baha® BIA400 Implant with Abutment $2,087
CO053 Cochlear Limited Baha BIA300 implants with abutments $1,916
OI031 Audmet Australia Pty Ltd trading as Oticon Medical Ponto BHX Implant and Abutment $1,916
OI024 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Implant $983
CO051 Cochlear Limited Baha® BI300 Implant $1,028
OI030 Audmet Australia Pty Ltd trading as Oticon Medical Ponto BHX Implant $1,028
CO062 Cochlear Limited Cochlear™ Baha®  BA400 DermaLock™ Abutment $1,059
US001 Med-El Implant Systems Australasia Pty Ltd Bonebridge- Bone Conduction Implant Kit $2,222
US027 Med-El Implant Systems Australasia Pty Ltd BCI 602 Implant $2,222
US011 Med-El Implant Systems Australasia Pty Ltd Bonebridge BCI Lifts $196
US026 Med-El Implant Systems Australasia Pty Ltd BCI 602 Lifts (1mm) $196
CO068 Cochlear Limited Cochlear™ Baha® BIM400 Implant Magnet $1,059
CO028 Cochlear Limited BAHA - Cover screw unigrip $135
CO054 Cochlear Limited Baha Cover Screw conical $135
OI027 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Healing Cap $135
OI028 Audmet Australia Pty Ltd trading as Oticon Medical Ponto Cover Screw $135
US003 Med-El Implant Systems Australasia Pty Ltd Bonebridge - Cortical screws (Bonebridge Surgical Tool Kit) $135


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