Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations BI227 Kirschner Integrated Shoulder System Neer II Humeral, Chrome Cobalt, Stem 6.3 to 12.7mm Head 15-22mm UHMWPE BI228 Kirschner Modular Shoulder Humeral Head, Modular, Chrome 38-51mm Cobalt BI229 Kirschner Modular Shoulder Humeral Stem, Chrome Cobalt 6.3 -15.9mm BI230 Kirschner Modular Shoulder Glenoid Component, UHMWPE Small, Std BI231 Humeral Replacement System Proximal Shoulder System: Chrome Body: std, +10mm Stem Cobalt, Titanium, UHMWPE 6.5-12.5mm Sleeve 6.5-12.5mm Humeral Head 40-52mm BI342 Copeland Shoulder System Glenoid, UHMWPE One size only BI343 Copeland Shoulder System Humeral, Chrome Cobalt Small, Std, Large (no specific size) BI344 Copeland Shoulder System Glenoid Component, HA Coated, Small, Std, Extra Deep (no specific Chrome Cobalt, UHMWPE size) BI345 Copeland Shoulder System Humeral Component, Chrome Cobalt Small, Std, Large (no specific size) <strong>Prostheses</strong>, Joint, Toe BI021 Total Toe System Metatarsal Component UHMWPE, Small, Medium, Large Extra Large. Titanium BI022 Toe Joint Replacement Phalangeal Component, Titanium Small, Medium, Large Extra Large. <strong>Prostheses</strong>, Leg BI166 Compress Finn Limb Salvage System Distal Femoral Replacement: Anchor 15 plugs, 9 segments, 8 pins, 14 Plug, Femoral segment, transverse sleeves, 26 spindles pins, centering sleeves, spindle. Chrome Cobalt. Screws BI005 Re-Unite Orthopaedic System Rotator Cuff Butress, Lactosorb; One size only PGA/PLA BI012 Re-Unite Orthopaedic System Pop-Rivet - PGA/PLA One size only BI241 Gentle Threads Ligament Fixation Screw, Graft Interference, PGA/PLA 7mm, 8mm, 9mm, 10mm Page 164 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations BI278 Re-Unite Orthopaedic Screws Screw, PGA/PLA (2-5)mm dia x (5-70)mm BI279 Re-Unite Orthopaedic System Plates, PGA/PLA 4 - 7 hole BI808 Reunite Orthopaedic System Plate, dorsal or volar, PGA/PLA Dorsal - long, small; Volar - one size only BI822 Reunite Orthopaedic System Sheet, mesh panel PGA/PLA 50-75mm square BI826 Meniscal Screw Screw PGA/PLA One size only Screws, Bone BI143 Compression Screw Set Supracondylar Plate, Stainless Steel 6-14 hole BI309 Compression Hip Screw Plate, Titanium 2-14 hole x 53-257mm BI311 Compression Hip Screw Support Screw, Titanium, Stainless 4.5 - 6.5 x (14-70mm) Steel BI312 Compression Hip Screw Lag Screw, Titanium, Stainless Steel 12.7, 15mm x (55-150mm) BI315 Compression Hip Screw Plate, Stainless Steel 25-38mm x 2-7 hole for use with plate size 50-150mm BI316 Compression Hip Screw Plate, Stainless Steel 25-38mm x 8-14 hole for use with plate size 50-150mm BI317 Compression Hip Screw Lag Screw, Stainless Steel 12.5,14mm x (50-150mm) BI318 Compression Hip Screw Cortical Screws Pk 10, Stainless 2.7-4.5mm x (10-140mm) BI319 Compression Hip Screw Compression Screw 1.5-4.5 x (6-70mm) BI820 EBI XFIX DynaFix System Screw, HA coated, cortical, Dia 2-6mm De Puy Australia Bone Matrix Implants DP028 A-BSM Bone Cement - 1.0g Caps, Bone DY098 Moss Miami (Titanium) Pin Nut One size only Page 165 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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