Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
BI165 AGC Total Knee System Femoral Prostheses, Posterior 55-80mm
Stabilised, Uncemented, Chrome
Cobalt
BI187 TRAC Knee System Femoral Component, Anatomic, 55-80mm
Cemented, Chrome Cobalt
BI188 TRAC Knee System Femoral Component, Anatomic, 55-80mm
Uncemented, Chrome Cobalt
BI189 TRAC Knee System Femoral Component, Anatomic, HA 55-80mm
Coated, Uncemented Chrome Cobalt
BI190 TRAC Knee System Tibial Component, HA Coated, 55-80mm
Chrome Cobalt, Uncemented
BI191 TRAC Knee System Femoral Component, Tibial 55-80mm femoral, 59-91mm
Component, Bearing, Cemented. tibial&bearing
UHMWPE, Chrome Cobalt,
BI192 TRAC Knee System Femoral Component, Tibial 55-80mm femoral, 59-91mm
Component, Bearing, Uncemented. tibial&bearing
UHMWPE, Chrome Cobalt,
BI193 Finn Knee System Resurfacing and Segmental System. Segmental tibial 110 - 152,
UHMWPE, Chrome Cobalt segmental components (10-24cm) x
(11-17mmdiam) yoke std or long,
lock pin, locking screw (3),
bushing (2) axleFemoral Comp: R
or L, std, +5cm Mod. Stem 89, 152 x
(9-22mm) Tibial plate 67-81mm
Tibial augment 67-83mm Tibial
BI198 Oxford Meniscal Knee System Femoral Component CoCr Small to Xlarge
BI199 Oxford Meniscal Knee System Meniscal Bearing UHMWPE Sizes 3 to 9
BI200 Oxford Meniscal Knee System Tibial Plate, CoCr (38-53) x (26-34)mm
BI201 AGC Total Knee System - Dual Femoral, Tibial, Bearing, Stems and Size 55 to 75mm Fem, Size 59 to
Articular Knee System augments/wedges. Chrome Cobalt, 83mm Bearing, Size 37 to 126mm
UHMWPE stems, Size 55 to 70mm augment,
Size 63 to 91mm tibial
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