Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations BX012 Rotaglide + Total Knee System, Tibial Non-Latched, HAP Coat Ex Sml - Ex Lge Component BX013 Rotaglide + Total Knee System, Tibial Non-Latched, Porous Coat Ex Sml - Ex Lge Component BX015 Rotaglide + Total Knee System, Tibial Latched, HAP Coat Ex Sml - Ex Lge Component BX017 Rotaglide + Total Knee System, Tibial Latched, Cemented Ex Sml - Ex Lge Component BX018 Rotaglide + Total Knee System, Pegged, Hap Coat Ex Sml - Ex Lge Femoral Component BX025 Rotaglide + Total Knee System, Pegged, Porous Coat Ex Sml - Ex Lge Femoral Component BX026 Rotaglide + Total Knee System, Pegged, Cemented Ex Sml - Ex Lge Femoral Component BX027 Rotaglide + Total Knee System, Stemmed, HAP Coat Ex Sml - Ex Lge Femoral Component BX028 Rotaglide + Total Knee System, Stemmed, Porous Coat Ex Sml - Ex Lge Femoral Component BX029 Rotaglide + Total Knee System, Stemmed, Cemented Ex Sml - Ex Lge Femoral Component BX030 Rotaglide + Total Knee System, Tibial Non-Latched, Cemented Ex Sml - Ex Lge Component BX033 CSR UNI - Condylar Knee System Tibial - Insert UHMWPE Small 5.0mm - Ex-Large 9.5mm BX034 CSR UNI - Condylar Knee System Tibial - Metal Tray Small - Ex-Lge BX035 CSR UNI - Condylar Knee System Femoral Component Sml - Lge BX122 Rotaglide Total Knee System Tibial Insert Mobile UHMWPE 7,9.5,12,14.5 &17mm thick BX123 Rotaglide Total Knee System Patella UHMWPE Small, Medium, Large BX124 Rotaglide Total Knee System Tibial Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, Porous Coating Large Page 140 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations BX125 Rotaglide Total Knee System Tibial Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, HAP Coat Large BX190 Rotaglide Total Knee System Tibial Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, Cemented Large BX191 Rotaglide Total Knee System Femoral Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, Cemented Large BX192 Rotaglide Total Knee System Femoral Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, Porous Coating Large BX193 Rotaglide Total Knee System Femoral Component Cobalt Chrome Small Sml-Med, Medium Med-Lge, HAP Coat Large BX212 CSR Unicondylar Knee Tibial component UHMWPE Extra small, small, medium, large, extra large Prostheses, Joint, Shoulder BX126 Lawrence Shoulder Humeral & glenoid compts One size only Prostheses, Ligament BX131 Lars Ligamanet Augmentation Woven polyester prosthetic 60,80,100 & y shaped fibres reconstruction system Prostheses, Radial Head BX004 Corifix Radial Head Implant Cobalt chrome Small - Large Screws, Bone BX127 Suture Lok - One size only BX130 Corifix Ligament Anchor Soft Screw Titanium rounded thread cannulated 7,8,9,10mm diam :20-35mm length ligament screw BX132 Corifix Bone Screw Titanium interforence screw for use 7,8,9,mm diameter 25-30mmlength with above L.A.D BX133 Corifix Bone Screw Cannulated Bone Screw 7.0mm Short 35-130mm Thread, Stainless Steel BX134 Corifix Bone Screw Stainless steel - screw bone 3.5mm diam 20-60mm length Page 141 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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MECHANICAL INTERNAL WOUND CLOSURE B
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NEUROSURGICAL Billing Code Product
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Page 89 and 90: NEUROSURGICAL Billing Code Product
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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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