Schedule 5 - Appendix A - Surgically Implanted Prostheses

OPHTHALMIC
Billing Code Product Further Size Notations
SO012 FCI Scleral Buckling Devices Sponge/Cord: Silicone Cord: 1.0 to 5.0mm O.D. x 150mm
length; Half Cord: 3.0mm to width
x1.5mm to 2.5mm height x150mm;
Circular Sponge: 3 to 5mm; Oval
Sponge: 2 to 5.5mm x 4 to 12mm;
Half Sponge: 2 to 3.1mm x 4 to
7.5mm; Grooved Sponge: 3 to 5mm
x 5 to 12mm; Gain Sponge: 6 x
2.5mm; Sahal Sponge: 4 to 5mm x 5
to 7mm
SO013 FCI Scleral Buckling Devices Strip: Solid Silicone Strip: 1.4 x 4.4 x 100mm, Morin
Strip: 7mm wide x 100mm long,
Caputo Zip Strip: 7 to 9mm wide x
120mm long, Korobelnik Oval
Strip: 2 x 5mm
SO014 FCI Scleral Buckling Devices Band: Solid Silicone Devin Band: 1 x 4 x 120mm,
Ducournau Band: height 2 to 2.5 x
5.5 to 7.5mm x length 120mm,
Ducournau Band II: 2.1 x 5.5 x
120mm
SO015 FCI Scleral Buckling Devices Band: Expanded PTFE Ducournau Band: 2.5 x 5.5 to
7.0mm x 120mm, Band: 0.5mm to 2.1
x 2.5mm to 15 x 120mm
SO016 FCI Scleral Buckling Devices Sponge/Strip: Expanded PFTE Circular Sponge: 3 to 5 x 90mm,
Oval Sponge: 2 to 4mm x 3 to 5 x
90mm, Half Sponge: 2.5 x 7.5 x
120mm; Strip: 9 x 90mm
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