Prescribed List Reforms - Billing code format (Part A, C and D)

We sought your feedback via the Consultation Hub followed by a stakeholder workshop about the proposed new format for Prescribed List billing codes.

Our initial proposal was a 5-digit ANNNN format.

You raised concerns that the ANNNN format did not allow for sponsor-specific prefixes.

You raised concerns about system changes and implementation timeframes.

You suggested alternative formats:

• a 6-digit format
• using the same format as Part B billing codes (AAANN)
• remapping billing codes
• reusing previously deleted billing codes
• using AANAN format

Other parameters or matters we all identified:

• preference to retain a sponsor-specific prefix
• the format must clearly distinguish between PL and MBS and ARTG codes
• the format must clearly distinguish between medical devices (Part A, C and D) and human tissue products (Part B)
• remapping would require substantial resources
• reusing billing codes would risk losing or mixing historical data between devices and/or sponsors

We reviewed all suggestions, feedback and parameters and decided on the following format:

AXNNN, with AX remaining as a sponsor-specific prefix.

This format addresses all risks and parameters.

There are over 80 previously deleted billing codes that have used this AXNNN format. We will ensure that these billing codes are not reused or reallocated by the Health Products Portal (our online application system for the PL) in the future.

***YOU CAN FIND A TEST XML FILE AND THE IMPLEMENTATION PLAN IN THE 'RELATED' SECTION BELOW***