Prosthesis appliances or devices surgically implanted during a hospital stay are subject to two benefit types, either ‘no gap’ or ‘gap permitted’. These items are listed on the Commonwealth Prosthesis Schedule .
When a “gap permitted” benefit applies the insurer will pay the recommended minimum benefit as shown on the Schedule. The Schedule will have at least one no gap prosthesis or device item for every in hospital procedure on the Medical Benefit Schedule (MBS) for which the insurer provides cover.
No benefit is payable where the hospital charges for a prosthetic appliance or device not listed on the Schedule.
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