Unapproved healthcare services

What is an unapproved healthcare service?

An unapproved healthcare service is any drug, device, technique, test and/or other healthcare service that has not been approved by Southern Cross prior to treatment. Unapproved healthcare services are an exclusion and are not covered by Southern Cross.

Why is a healthcare service unapproved?

It is important Southern Cross balances the cover available under its policies with the cost to members, this means that not all healthcare services can be covered.

A healthcare service may not have been approved by Southern Cross for one of the following reasons:

  • The healthcare service has not been assessed for cover by Southern Cross
  • The healthcare service has been assessed by Southern Cross and the decision made to exclude cover.

Healthcare services approved through our health technology assessment process as approved treatment.

Please note: These healthcare services have been approved through our health technology assessment process but are not yet included in policy documents (where relevant). Eligibility criteria and terms and conditions apply, this may include Affiliated Provider restrictions (not all healthcare services are available from all Affiliated Providers or in all areas) and prosthesis and specialised equipment limits (except on UltraCare). To find out if you will be covered for a particular healthcare service you can contact us or your Affiliated Provider

  • 3D low-dose, weight-bearing X-ray (e.g. EOS imaging)
  • Abbreviated breast MRI
  • Botulinum toxin for laryngeal dystonia
  • Bulkamid- Periurethral bulking agent for urinary incontinence.

- A prosthesis maximum of $3,000 applies.

  • Cardiac technician fees for management of appliances or devices (including pacemakers)
  • Drug-eluting balloon angioplasty for in-stent restenosis
  • Eustachian tube balloon dilatation
  • Image-guided percutaneous carpal tunnel release
  • Image-guided percutaneous trigger finger release
  • Implantation of prosthetic iris device (including custom-made artificial iris).

- A prosthesis maximum of $10,250 applies.

  • Implantation of microstents/microshunts for the treatment of glaucoma - Glaukos iStent or Glaukos PreserFlo or Allergan XEN Gel Stent.

- A prosthesis maximum of up to $2,500 applies for an iStent Trabecular Micro-Bypass stent or PreserFlo MicroShunt or Allergan XEN Gel Stent

  • iTrack canaloplasty.

- A prosthesis maximum of up to $1,500 applies for an iTrack canaloplasty microcatheter

  • Intravascular lithotripsy for coronary artery disease
  • Kahook dual blade goniotomy.

- A prosthesis maximum of up to $1,000 applies for a Kahook Dual Blade

  • Laparoscopic liver resection/hepatectomy
  • Liposuction for secondary lymphedema following an oncological intervention
  • Liver elastography (e.g. Fibroscan)
  • MicroPulse Transscleral Cyclophotocoagulation (MP-TSCPC)

- A prosthesis maximum of up to $1,500 applies for a MicroPulse P3 Delivery Device

  • Methylene blue injections (for anal pruritus)
  • Pacemaker (initial appliance) Except for Lead-less pacemaker (Medtronic Micra)

- A prosthesis maximum of $2,760 applies for a single chamber pacemaker  
- A prosthesis maximum of $4,485 applies for a dual chamber pacemaker
- A prosthesis maximum of $10,260 applies for a Biventricular/complex pacemaker

  • Peripheral sensory nerve ablation for cancer-related pain
  • Pressurised intraperitoneal aerosol chemotherapy (PIPAC)
  • Per Oral Endoscopic Myotomy & Zenker's peroral endoscopic myotomy (POEM and ZPOEM)
  • Robotic orthopaedic surgery (including total or partial knee arthroplasty using Stryker Mako, Zimmer Biomet ROSA, Smith and Nephew NAVIO or Johnson & Johnson VELYS)
  • Single fibre electromyogram (SFE)
  • Thyroid nodule ablation
  • Temporomandibular joint (TMJ) replacement

- A prosthesis maximum of $26,000 applies for unilateral
- A prosthesis maximum of $45,000 applies for bilateral

  • Transcoronary ethanol septal ablation (TESA) also known as Transcatheter ethanol septal ablation

List of unapproved healthcare services

Please note: The specialty headings used below are inserted for convenience of reference only and in no way define, limit or affect the meaning or interpretation of the listed unapproved healthcare services. Further, this is not an exhaustive list of unapproved healthcare services. We consider healthcare services which are alternative names for and/or are similar to those listed below to be unapproved healthcare services.

To find out if you will be covered for a particular healthcare service you can contact us or your Affiliated Provider.


  • External counter pulsation therapy
  • Insertion of implantable cardiac event monitor (e.g. Reveal device)
  • Intravascular lithotripsy (IVL) for peripheral vascular disease
  • Lead-less pacemaker (Medtronic Micra)
  • Minimally invasive aortic valve surgery
  • Replacement pacemaker (appliance)
  • Personalised external aortic root support (PEARS)
  • Pulsed field ablation (PFA) for atrial fibrillation
  • Sutureless cardiac valve and surgery (other than when the valve cost does not exceed the surgically implanted heart valve maximum as listed on the List of Prostheses and Specialised Equipment)
  • Transcatheter aortic valve implantation (TAVI) (other than when using the transfemoral approach)
  • Transcatheter mitral valve repair or replacement (e.g. MitraClip, PASCAL)
  • Transcatheter tricuspid valve repair or replacement (e.g. TriClip, Cardioband, PASCAL)

Ear, nose and throat (ENT)

  • Insertion of bone conduction implant (e.g. BAHA, BONEBRIDGE)
  • Cochlear implant (appliance)
  • Eustachian tube injections
  • Intranasal phototherapy (e.g. Rhinolight)
  • Insertion of LATERA nasal implant
  • Laser ear surgery (except for laser mastoidectomy, laser revision mastoidectomy, laser tympanoplasty, laser second look tympanoplasty, laser middle ear adhesiolysis, laser stapedectomy, laser medial canalplasty, and laser myringotomy)
  • Sleep apnoea surgery
  • Vidian neurectomy

General surgery

  • Anti-reflux mucosal ablation (ARMA)
  • BRAVA assisted breast reconstruction
  • Breast Reconstruction (except when following an eligible Mastectomy)
  • Bulking agents including PTQ silicone microspheres
  • Colon Capsule Endoscopy
  • Colonic chromoendoscopy
  • EndoStim therapy
  • Endoscopic Full Thickness Resection
  • Endobronchial ultrasound (EBUS)
  • Fascia preserving device (FPD) (e.g. Fasciotens)
  • Gastroduodenal artery embolisation
  • Laser ablation of common bile duct stones
  • Lloyd release procedure
  • Portal vein embolisation
  • Roux-en-Y gastric bypass for gastroesophageal reflux disease (except when provided under the gastric banding/bypass allowance)
  • Stretta procedure
  • Transanal total mesorectal excision of the rectum (TaTME)
  • Video-assisted fistula tract/sinus ablation (e.g. VAAFT, VAAPS)


  • Hymenorrhaphy
  • Labiaplasty
  • Laparoscopic ovarian vein clipping
  • Laser treatment for atrophic vaginal changes (e.g. MonaLisa Touch)
  • Laser treatment for urinary incontinence (e.g. FemiLift)
  • MRI-guided ultrasound for ablation of uterine fibroids


  • 123Iodine scan of the thyroid and whole body (Radioactive iodine uptake test, RAIU test)
  • 3D volumetric photography
  • Breast thermography
  • Carotid intima-media thickness test (CIMT)
  • Clinical photography
  • CT calcium scoring
  • CT MARS Bioimaging
  • Gastrointestinal ultrasound (GIUS)
  • Secretin enhanced MRCP
  • Smart seed markers (e.g. Radar “SAVI SCOUT” or Magnetic “Magseed" markers)

Interventional radiology

  • Cryoablation of central or peripheral nerve
  • Prostate Artery Embolisation
  • Radiofrequency ablation of Morton's neuroma
  • Renal aneurysm coiling
  • Renal denervation (RDN)
  • Sclerotherapy, embolisation, or clipping for pelvic vein incompetence or pelvic venous congestion syndrome


  • Embolisation or surgery for cerebrovascular abnormality (including aneurysm)
  • Occipital neurectomy and denervation skull base


  • BioZorb breast implant
  • Intraoperative radiation therapy (IORT)
  • Irreversible electroporation (e.g. NanoKnife)
  • Radioligand therapy
  • Proton beam therapy
  • Rectal spacer (e.g. SpaceOAR Hydrogel)
  • Selective internal radiation therapy (SIRT)
  • Transarterial chemoembolisation (TACE) or Drug-eluting bead transarterial chemoembolisation (DEB-TACE)


  • BlephEx treatment
  • Ellex 2RT ophthalmic laser (other than for the treatment of significant macular oedema)
  • Eyelid warming (e.g. Blephasteam, EyeGiene, MGDRx eye bag, LipiFlow)
  • Insertion of implantable telescope (e.g. CentraSight)
  • Intense pulsed light (IPL) therapy for dry eye treatment
  • Minimally invasive glaucoma surgery (MIGS) (except for Kahook Dual Blade goniotomy, iTrack canaloplasty, implantation of trabecular bypass microstent - Glaukos iStent, Micropulse transscleral cyclophotocoagulation (mpTSCPC), implantation of minimally invasive subconjunctival filtration device (microshunt) - Allergan XEN or Glaukos PreserFlo)
  • Neural vision correction technology (e.g. NeuroVision therapy)
  • YAG laser vitreolysis for vitreous floaters

Oral surgery

  • Partial glossectomy using laser

Orthopaedic surgery

  • Chitosan-based biomaterial (e.g. BST-CarGel)
  • Collagen nerve wrap/conduit (e.g. Neuragen nerve guide)
  • Interspinous dynamic stabilisation (e.g. Coflex, DIAM, Wallis, X-STOP)
  • Lumbar/thoracic disc replacement
  • Osteochondral grafting (e.g. OATS procedure, Mosaicplasty)
  • Sinus tarsi spacer for posterior tibialis reconstruction surgery
  • Spinal cord stimulation (SCS) including dorsal root ganglion (DRG) stimulation
  • Subtalar implants (e.g. ProStop, BIOARCH)
  • Thermosensitive hydrogel (e.g. JointRep)

Plastic surgery

  • Abdominoplasty and/or repair of rectus divarication
  • Apronectomy/panniculectomy
  • Brow lift
  • Liposuction (except when used for an eligible breast reconstruction or revision surgery and secondary lymphedema following an oncological intervention)
  • Secondary lymphoedema reconstruction


  • Intralesional cryotherapy
  • Laser treatment of skin lesions/conditions
  • Microwave therapy for the treatment of axillary hyperhidrosis (e.g. miraDry)
  • Photodynamic therapy (PDT)
  • Phototesting for light sensitive dermatological disorders


  • Cxbladder test
  • Endocrine stimulation testing
  • Gastric alimetry
  • Hepatic venous pressure gradient test (HVPG)
  • InflammaDry MMP
  • Liquid biopsy (e.g. Guardant360, FoundationACT)
  • Prenatal tests (except for amniocentesis, maternal serum screening, triple X test and chorionic villus sampling)
  • Saline suppression test / Saline infusion test
  • Tilt table test


  • Allium prostatic stent
  • Drug Coated Urological Balloon e.g Optilume 
  • Percutaneous tibial nerve stimulation (PTNS)
  • Periurethral bulking agent for urinary incontinence (e.g. Macroplastique) (except for Bulkamid)
  • Prostatic urethral lift surgery (e.g. UroLift)
  • Renal dialysis
  • Resonance metallic ureteral stent
  • Water vapour therapy for benign prostatic enlargement (e.g. Rezum)


  • Covered endovascular reconstruction of aortic bifurcation (CERAB)
  • Fenestrated endovascular aneurysm repair (FEVAR)


  • Acellular dermal matrix / Biological mesh (except when used in breast reconstruction, rotator cuff repair, gastrointestinal surgery, gynaecological surgery, and head and neck surgery)
  • Blood injections/transfusions/infusions (except when used for chemotherapy treatment)
  • Botulinum toxin injections (e.g. Botox, Dysport) (except when used in the treatment of anal fissures or the bladder or urethra)
  • Colonic irrigation
  • Custom made prosthesis (except Temporomandibular joint (TMJ) replacement)
  • Deoxycholic acid injection (e.g. Belkyra, Kybella)
  • ExAblate system
  • Extracorporeal shock wave therapy (other than for lithotripsy for the treatment of kidney stones)
  • Fat grafting and fat grafts (except when used for an eligible breast reconstruction or revision surgery, or as part of eligible ENT, oral, orthopaedic and neurosurgical procedures)
  • Feeding therapy
  • Hilotherapy
  • Hyperbaric oxygen therapy
  • Laser treatment of ingrown toenails
  • Laser haemorrhoidoplasty +/- mucopexy
  • Oolo-Austin Trigenics (OAT) procedure
  • Platelet-rich plasma (PRP) injections
  • Radiofrequency neurotomy (except for thermal radiofrequency neurotomy of the medial branch nerves of the spine)
  • Radiotherapy treatment for the benign conditions plantar fasciitis, heterotopic ossification, pigmented villonodular synovitis (PVNS), keloid scars and Dupuytren's contracture
  • Stem cell therapy 
  • Therapeutic phlebotomy / Therapeutic venesection
  • Viscosupplementation / Hyaluronic acid injection (e.g. Intra-articular injection of Durolane, Synvisc, Sodium hyaluronate)