Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
DP984 SROM Total HIP System (Titanium) Std Lat 16 x 11 x 150mm to 24 x 19 x
175mm NK36+8
DP985 SROM Total HIP System (Titanium) Special left right or neutral 12 x 06 x 155mm NK30, 14 x 09 x
205mm NK36
DP986 SROM Total HIP System (Titanium) Trochanteric Washer 40 x 31, 60 x 45, 70 x 54
DP987 SROM Total Hip System (Titanium) SROM Hip Cup Diaphaseal size 0 to 4
DP988 SROM Total Hip System (Titanium) Unipolar 38-66mm
DP989 SROM Total Hip System (Titanium) ACE, A2 32mm size 54, 57,60DP
DP990 SROM Total Hip System (Titanium) Polythene Liner D71PFC 22, 26, 28, 32mm size 40-70
DP991 SROM Total Hip System (Titanium) SROM Fully Porous coated hip stem Size 1-10
DP992 SROM Total Hip System (Titanium) 12/14SROM Fem STD & Calcar 14 x 8 x 130/30 to 24 x 19 x
175/36+21nck
DP993 SROM Total Hip System (Titanium) 12/14SROM Fem DDH 12X6X115/30 or 12X7X115/30
DP994 SROM Total Hip System (Titanium) 12/14SROM Lat 14 x 09 x130/30+4 to 24 x 19 x
175/36+8
DP995 SROM Total Hip System (Titanium) Arthropor I 22mm and 28mm DP sizes 39-51
DP996 SROM Total Hip System (Titanium) Arthropor I, S22 48mm
DP997 SROM Total Hip System (Titanium) Arthropor II, XL46 & DP+6 54- 75mm
DP998 SROM Total Hip System (Titanium) Acetabular Apical Hole Plug One size only
DP999 SROM Total Hip System (Titanium) Unipolar Adaptor Sleeve +10
DY001 SROM Total Hip System (Titanium) X-Long 36+21+8L, left or right 26 x 21 x275
DY002 SROM Total Hip System (Titanium) X-Long 36+21+8L or CR in left, 22 x 17 x 275
right or neutral
DY003 SROM Total Hip System (Titanium) X-Long 36+21+8L or CR in left, 24 x 19 x 275
right or neutral
DY004 SROM Total Hip System (Titanium) X-Long 36+21+8L or CR in left, 18 x 13 x 255
right or neutral
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