Schedule 5 - Appendix A - Surgically Implanted Prostheses

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CARDIO-THORACIC Billing Code Product Further Size Notations Leads, Implantable Defibrillator/Pacemaker MC018 Medtronic Sprint Lead Model Model 6942-65, Model 6942-75, 65 - 100cm, 58 - 100cm 6942RV/SVC; Medtronic Sprint Lead Model 6942-100; Silicone Model Model 6945 6945-58, Model 6945-65; Silicone, Model 6945-75, Model 6945-100; Silicone MC025 Medtronic Sprint Lead Model Model 6932-65, Model 6932-75, 65 - 100cm, 58 - 100cm 6932RV; Medtronic Sprint Lead Model 6932-100; Silicone Model 6943-58, Model 6943-65, Model 6943-75, Model 6943-100; Silicone MC208 Medtronic Sprint Quattro Secure Lead Leads, Defibrillator, Implantable, 58-100cm Model 6947 Silicone, polyurethane, platinized tantalum coils, steroid eluting tip Leads, Pacemaker, Implantable Endocardial MC008 Medtronic Capsurefix Model 6940, Silicone Polyurethane 30 - 85cm Pacing Lead; Medtronic Tined IS-1 Model 4557M; Medtronic Capsurefix Model 4067/8/4568 Pacing Leads; Medtronic Capsurefix Model 5067 Pacing Leads; Medtronic Capsurefix Model 5068 Pacing Leads; Medtronic Capsurefix Model 5568 Pacing Leads; Capsure SP Novus Pacing Lead Model 4092; Capsure SP Novus Pacing Lead Model 4592 MC010 Medtronic Capsure SP Novus Model Silicone Polyurethane 45 -110cm 5092; Capsure SP Novus Lead Model 5592; Medtronic Capsure Model 4023 Lead; Medtronic Capsure Model 4024 Lead (med.dexamethasone) Medtronic Capsure Model 4523(MED) Medtronic Capsure Model 4524 Lead; Medtronic Capsure Model 5023M Lead; Medtronic Model 5024M Capsure Lead; Medtronic Model 5024M Capsure Lead; Medtronic Capsure Model 5524M SP Bipolar Page 20 of 638
CARDIO-THORACIC Billing Code Product Further Size Notations MC037 Medtronic Attain Cardiac Vein Pacing Polyurethane; 4 FR Polyurethane, 5 58 - 75cm: 85cm/75cm/110cm or Lead Model 2187; Medtronic FR Electrode Tip, Kit Includes: 75-110cm; 75cm/85cm Coronary Sinus Pacing Lead Model Stylet x 3, Valve lifter, Attain Lead 2188; Medtronic Attain SD Model & Anchoring Sleeve; 4 FR 4189; Medtronic Attain Side-Wire Polyurethane Body, 6.1FR MC051 Capsure Z Model 5034/5534 Silicone 58, 53cm MC052 Medtronic Capsure Z Novus Model Silicone; Contents: 1 x lead with 25 - 110cm; 45-110cm 5054 Pacing Lead; Medtronic Capsure anchoring sleeve, stylet & guide, 1 x Z Novus Model 5554 Pacing Lead; vein lifter, 2 x fixation tools, extra Medtronic Capsure VDD2 Model stylets 5038 AV 11.5cm Pacing Lead; Medtronic Capsure VDD2 Model 5038 AV 13.5cm Pacing Lead; Medtronic Capsure VDD2 Model 5038 AV 15.5cm Pacing Lead; Medtronic Capsurefix Novus Lead Model 5076 MC216 Vitatron Excellence PS+Model IMK Titanium, polyurethane 52-65cm MC217 Vitatron Excellence SS+Model IML Titanium, polyurethane 52-65cm MC218 Vitatron Excellence PS+Model IMK Titanium, polyurethane 45-53cm 49JB MC219 Vitatron Excellence SS+Model IML Titanium, polyurethane 45-53cm 49JB MC220 Vitatron Brilliant S+Model IMW Vitatron Brilliant S+Models IMW 52-65cm Pacemaker 14Q, IMW 15Q, IMW 16Q, IMW 17Q, IMW 18Q, titanium, MC221 Vitatron Crystalline Actfix Model Titanium, polyurethane 52-65cm ICF09 Pacemaker MC225 Attain Over the Wire Model 4193 Titanium, polyurethane 78-88cm MC229 Medtronic Capsure SP Novus Model Silicone, platinum 30-100cm 5594 Lead 30cm MC231 Vitatron Crystalline Lead Model Titanium, polyurethane 30-53cm Lengths ICL08JB Leads, Pacemaker 30cm, 45cm, 53cm Page 21 of 638
Page 1 and 2: Schedule 5 - Appendix A - Surgicall
Page 3 and 4: CARDIO-THORACIC Billing Code Produc
Page 19: CARDIO-THORACIC Billing Code Produc
Page 29 and 30: EAR, NOSE & THROAT Billing Code Pro
Page 41 and 42: ENDOSCOPIC PRODUCTS Billing Code Pr
Page 43 and 44: 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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