Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
HW184 First Step High Tibial Osteotomy Proximal Component 10mm Step - 60 to 90mm in 5mm increments
Vitallium
HW185 First Step High Tibial Osteotomy Proximal Component 15mm Step - 60 to 90mm in 5mm increments
Vitallium
HW186 First Step High Tibial Osteotomy Distal Component - Vitallium 30 to 55mm in 5mm increments
HW187 First Step High Tibial Osteotomy Total Procedure - Vitallium 60 to 90mm in 5mm increments
30mm to 55mm in 5mm increments
HW257 Wichita Fusion Nail System Femoral Component - Vitallium 18mm
HW258 Wichita Fusion Nail System Tibial Component - Vitallium 12mm
HW259 Wichita Fusion Nail System Compression Screw - Vitallium One size only
HW260 Wichita Fusion Nail System Transverse Screw - Vitallium 30-60mm in 5mm increments
Orthopedic Internal Fixation Systems, Spinal
HW384 Xia Spine System Polyaxial Screw Dia 4.5 - 8.5mm Length 25 - 60mm
HW385 Xia Spine System Monoaxial Screw Dia 4.5 - 8.5mm Length 25 - 60mm
HW386 Xia Spine System Rod Clamp - Parallel, Axial One size only
HW387 Xia Spine System Lamina Hook - Angled, Reduced, Large Medium, Small
Extended, Standard Blade, Narrow
Blade, Offset
HW388 Xia Spine System Pedicle Hook Large, Small
HW389 Xia Spine System Rod - Titanium alloy 70, 100, 480mm
HW390 Xia Spine System Cross Link Length 40, 60, 80mm
HW391 Xia Spine System Connector - Axial, Dual, Offset One Size
HW392 Xia Spine System Sacral Block One size only
HW393 Xia Spine System Bone Screw One size only
Plates, Bone
HW376 Profyle - Hand and Small Fragment Condylar Plates - Titanium 1.7mm, 2.3mm
System
Page 246 of 638