Schedule 5 - Appendix A - Surgically Implanted Prostheses

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CARDIO-THORACIC Billing Code Product Further Size Notations St. Jude Medical Australia Pty Ltd Defibrillators, Automatic, Implantable SJ004 Brady Pacing - ATP, Cardioversion, Ventritex Defibrillator - Profile MD 70-109g, weight 34-57cc, volume Defibrillation with Atrial Model V-186HV3, Contour MD 11-15mm, width Discrimination (Morphology Model V-175AC, Contour MD Model V-175D (double header); Can: Titanium, Header: Medical grade thermoplastic elastomer, Septum: Silicone, Power Source: Lithium/silver vanadium oxide. SJ006 Photon DR, Model V-230HV Dual Chamber, Implantable 46cc Defibrillator Cardioverter SJ009 Photon Micro DR Model V-232 37cc Defibrillators/Cardioverters SJ010 Photon Micro VR Model V-194 36cc Defibrillators/Cardioverters SJ011 Atlas DR Model V-240 Dual chamber implantable 37cc cardioverter defibrillator with rate SJ012 Atlas VR Model V-199 Single chamber implantable 36cc cardioverter defibrillator with rate response Leads, Implantable Defibrillator SJ016 Riata Transvenous Tachyarrhythmia Quadripolar, dual-coil, steroid One size only Lead Model 1580 & Model 1581 eluting, active fixation Leads, Implantable Defibrillator/Pacemaker SJ005 SPL - Single Lead Endocardial Ventritex SPL Transvenous Lead 70cm-100cm, length, 17cm-21cm, Defibrillation System Models SP01, SP02, SP03, SP04. electrode spacing Connectors: MP35N, Insulation: 100% Silicone, Electrodes: Platinum iridium Page 26 of 638
CARDIO-THORACIC Billing Code Product Further Size Notations Leads, Pacemaker, Implantable Endocardial SJ013 Transvenous Superior Vena Cava Lead TVL lead system models SV01, SV01- 100cm; SV02 - 45cm; SV03 - Model SV01, Transvenous Superior SV02, SV03 transvenous leads 55cm Vena Cava Lead Model SV02, Transvenous Superior Vena Cava Lead Model SV03 Tag Medical Annuloplasty Rings TM001 AnnuloFlo Annuloplasty System Annuloflex Ring or AnnuloFlo Ring 26-36mm <strong>Prostheses</strong>, Cardiac Valve, Artificial TM002 CarboSeal Ascending Aortic Mechanical Conduit AP 21-33mm Prosthesis, sterile, CarboSeal Ascending Aortic Prosthesis with Handle Model AP21, Model AP23, Model AP25, Model AP27, Model AP29, Model AP31, Model AP33 TM003 SuMit - Supra-Annular Mitral Valve: Mechanical Valve 16mm to 33mm Carbomedics Aortic Model S500 Supra Annular Prosthetic Heart Valve: Carbomedics Model 700 Mitral Prosthetic Heart Valve: CarboMedics Aortic Model A500 Prosthetic Heart Valve: CarboMedics Aortic Model R500 Reduced Tissue Annulus Diameter Prosthetic Heart Valve Terumo Corporation Australia Stents, Vascular, Coronary TU001 Intra Coronary Stent Stainless Steel mounted on balloon Diameter 2.0mm - 4.0mm, Length catheter 10mm - 30mm length Page 27 of 638
Page 1 and 2: Schedule 5 - Appendix A - Surgicall
Page 3 and 4: CARDIO-THORACIC Billing Code Produc
Page 25: 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
Page 71 and 72: MECHANICAL INTERNAL WOUND CLOSURE B
Page 73 and 74: NEUROSURGICAL Billing Code Product
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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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