Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
DP287 AMK Coordinate Revision Knee Revision Tibial tray Chrome cobalt Size 1-5
DP288 AMK Coordinate Revision Knee Tibial Insert 10mmThick Size 1-5
DP289 AMK Coordinate Revision Knee Full Wedge Tibial tray Size 1-5
DP290 AMK Coordinate Revision Knee Cemented stem 10mm Chrome cobalt Size 1-6
DP291 AMK Coordinate Revision Knee Revision Fluted stem Chrome cobalt 10-24mm thickness x 95-140mm
length
DP292 AMK Coordinate Revision Knee Fluted Stem Chrome cobalt 8-27mm thickness x 95-140mm
DP293 AMK Coordinate Revision Knee Varus valgus Constrained Insert Size 10-10mm
DP294 AMK Coordinate Revision Knee Insert 4mm Thick Tibial Size 1-5
DP295 AMK Coordinate Revision Knee Tibial Insert Size 1-5
DP348 LCS UNI Knee system AP Glide Bearing Size 1-6
DP349 LCS UNI Knee system LCS AP Glide arm Chrome cobalt Size 1-7
DP350 LCS UNI Knee system UNIV Tibial Cemented Chrome Size 1-7
DP351 LCS UNI Knee system AP GLIDE Tibial Porocoat Chrome Size 1-6
cobalt
DP352 LCS UNI Knee system UNICOMP Femoral Chrome cobalt Std - Lge
DP353 LCS UNI Knee system UNI Meniscal Bearing Size 1-6
DP354 LCS UNI Knee system UNIV Tibial Porocoat Chrome Size 1-7
DP355 LCS UNI Knee system LCS UNIV TN PCR Guide Arm Size 3-4
Chrome cobalt
DP356 LCS UNI Knee system UNIV Rotating platform bearing Sm-Lge+
DP357 LCS UNI Knee system UNIV PCR BRG Sm-Lge+
DP358 LCS UNI Knee system UNICOMP Tibial Chrome cobalt Std-Lge
DP373 LCS All Poly Tibia All Poly Post Cruciate stabiliser Std to Lge+ size 1-6
DP374 AMK Knee system Tibial Insert Size 1-5
DP375 AMK Total Knee system Uni Stem Chrome cobalt Size 10 - 14mm
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