Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations Prostheses, Bone, Freeze-Dried AD068 Surgibone Bovine Granulated Bone 4/12 mesh, 12/20 mesh AD069 Surgibone Bovine Granulated Bone 20/30 Mesh AD070 Surgibone Bovine Onlays 50mm, 80mm, 100mm, 120mm AD071 Surgibone Bovine Cubes 3 gram AD072 Surgibone Bovine Cubes 10 gram AD073 Surgibone Bovine Cervical Dowels 12mm, 12.5mm, 14mm, 14.5mm, 16mm AD074 Surgibone Bovine Cervical Blocks 6mm, 8mm, 10mm, 12mm AD075 Surgibone Bovine Threaded Dowels 12mm, 13mm, 15mm AD076 Surgibone Bovine Cavity Blocks 20mm x 20mm x 10mm AD077 Surgibone Bovine Lumbar Blocks 30x10x14mm, 16mm, 18mm, 20mm, 22mm AD078 Surgibone Bovine Lumbar Blocks 30x15x14mm, 16mm, 18mm, 20mm, 22mm AD079 Surgibone Bovine Pins 33mm x 11mm x 5.5mm AD080 Surgibone Bovine Tapered Pins 50mm x 6mm, 8mm AD081 Surgibone Bovine Tapered Disks 40x2x6mm, 8mm,10mm 50x2x6mm, 8mm, 10mm, 12mm, 14mm AD082 Surgibone Bovine Compound Wedge 55x25x10mm, 13mm, 15mm, 60x15x30mm AD083 Surgibone Bovine Plain Wedge 55mm x 15mm x 25mm Prostheses, Carpal AD106 Orthosphere Yttria-stabilized zirconia ceramic 8 - 12mm AD166 Wright Swanson Titanium Carpal Titanium 1, 2, 3, 4, 5 Lunate Implant Page 116 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations AD167 Wright Swanson Titanium Carpal Titanium 1 - 5 left and right Scaphoid Implant Prostheses, Finger/Thumb AD163 WMT Orthopaedic Implants Hand Trapezium silastic 1, 2, 3, 4, 5 AD164 WMT Orthopaedic Implants Hand Silastic tendon spacer 24in long, 3, 4, 5, 6mm wide Prostheses, Joint AD158 WMT Orthopaedic Implants Silastic finger joint 470 series 00, 0, 1, 2 Finger/Thumb without grommets AD159 WMT Orthopaedic Implants Silastic finger joint with Ti 3, 4, 5, 6 Finger/Thumb grommets G470 series Prostheses, Joint, Elbow AD156 Sorbie Questor Elbow System Total joint CoCr and UHMWPE Left and right in sizing 48mm wide, 46mm, 44mm Prostheses, Joint, Hip AD113 Transcend Articulation System Transcend cup - titanium 42 - 74mm in 2mm increments AD114 Transcend Articulation System Metal femoral head CoCr 28 and 32mm, 4 lengths AD115 Transcend Articulation System Ceramic femoral head 28 and 32mm, 3 lengths AD116 Transcend Articulation System Metal liner CoCr Grp 1, Grp 2, Grp 3, Grp 4 AD117 Transcend Articulation System Ceramic liner Grp 1, Grp 2, Grp 3, Grp 4 AD118 Transcend Articulation System Interseal apical plug titanium One size only AD119 Transcend Articulation System Titanium HA coated cup 42 - 74mm in 2mm increments AD120 Transcend Articulation System Bone screw titanium 6.5mm x 1.5 - 6cm in 0.5cm increments long AD121 Infinity Modular Hip System Distal stem titanium 11 - 22mm in 1mm increments, 135 - 175mm long AD122 Infinity Modular Hip System Head ceramic 28mm, 32mm, 3 lengths AD123 Infinity Modular Hip System Head CoCr 28mm, 32mm, 3 lengths Page 117 of 638
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Schedule 5 - Appendix A - Surgicall
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CARDIO-THORACIC Billing Code Produc
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EAR, NOSE & THROAT Billing Code Pro
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ENDOSCOPIC PRODUCTS Billing Code Pr
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GENERAL/MISCELLANEOUS Billing Code
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Page 65 and 66: GENERAL/MISCELLANEOUS Billing Code
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ORTHOPAEDIC Billing Code Product Fu
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PLASTIC AND RECONSTRUCTIVE Billing
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UROGENITAL Billing Code Product Fur
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VASCULAR Billing Code Product Furth
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Schedule 5 - Appendix A - Surgically Implanted Prostheses

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