Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations BI165 AGC Total Knee System Femoral <strong>Prostheses</strong>, 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 Page 160 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations BI202 Repicci II Unicondylar Knee System Tibial Component, Cemented, 32-42mm UHMWPE BI203 Repicci II Unicondylar Knee System Femoral Component, Cemented, 45-60mm Chrome Cobalt BI204 Repicci II Unicondylar Knee System Tibia Plate, Modular, Cemented, Std, Large, Xlarge Titanium BI205 Repicci II Unicondylar Knee System Tibial Bearing, Modular, UHMWPE Std, Large, Xlarge BI821 AGC Total Knee System Tibial augments, titanium 6-16mm <strong>Prostheses</strong>, Joint, Knee, Total BI167 Maxim Complete Knee System Primary Anatomic Femoral, 55-80mm Uncemented, Chrome Cobalt BI168 Maxim Complete Knee System Primary Anatomic Femoral, 55-80mm Cemented, Chrome Cobalt BI169 Maxim Complete Knee System Tibial Plate Primary, Cemented, 59-91mm Titanium BI170 Maxim Complete Knee System Tibial Plate Primary, Uncemented, 59-91mm Titanium BI171 Maxim Complete Knee System Tibial Stem, Titanium 40mm 80mm BI172 Maxim Complete Knee System Tibial Bearing Primary, UHMWPE 59-91mm BI173 Maxim Complete Knee System Tibial Locking Bar, Titanium One size only BI174 Maxim Complete Knee System Femoral Component, Posterior 55-80mm Stabilised, Porous, Chrome Cobalt BI175 Maxim Complete Knee System Femoral Component, Constrained , 55-80mm Porous Chrome Cobalt BI176 Maxim Complete Knee System Patella Button, UHMWPE size 25 to 37mm BI177 Maxim Complete Knee System One Piece Revision Tibial Plate and 59-91mm Stem Boss, Ti BI178 Maxim Complete Knee System Femoral Component, Posterior 55-80mm Stabilised Anatomic Chrome Cobalt Page 161 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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OPHTHALMIC Billing Code Product Fur
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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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