Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations LO021 Waldemar Link MP Reconstruction Stem 14 - 25mm x 210, 250, 290 & Hip Prosthesis 330mm; 12 x 160, 180, 210, 250 - MP; 14 x 160, 180 -MP; 16 x 160, 180 - MP; 18 x 160, 180 - MP; 20 x 160, 180 - MP; 22.5 x 160, 180 -MP; 25 x 160, 180 - MP LO022 Waldemar Link MP Reconstruction Head:Chrome Cobalt Short, medium-short, medium & Hip Prosthesis LO023 Waldemar Link MP Reconstruction Biolox Ceramic Short, medium-short & large Hip Prosthesis LO024 Fixation Screw with Locking Bolt - 38 & 58 mm LO025 Neck Segment - 35-65mm IN 126 & 135 degrees LO026 Proximal Spacers - 10mm LO027 Proximal Spacers - 20mm Prostheses, Joint, Ankle LO001 Star (cemented) Talar Component Small , medium & large LO002 Star (cemented) Tibial Component Small, medium & large LO003 Star (cemented) Polyethylene Sliding Core 6- 10 mm LO004 Hydroxyapatite Coated (Hac) Talar Component Extra extra small, extra small, small, medium & large LO005 Hydroxyapatite Coated (Hac) Tibial Component Extra small, small, medium, large & extra large Prostheses, Joint, Elbow LO008 LINK Elbow Prosthesis Small, medium & large Prostheses, Joint, Hip LO032 CFP Cup ( TOP CUP) - 40 - 68mm LO033 CFP Insert( TOP INSERT) - 40 - 68mm Page 268 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations Prostheses, Joint, Hip, Acetabular Component LO036 Vario Cup - 44-65mm Prostheses, Joint, Hip, Total LO009 LINK Saddle Prosthesis Saddle Saddle Component One size only Prosthesis LO010 LINK Saddle Prosthesis Saddle Base Component 60 - 160mm Prosthesis LO011 LINK Saddle Prosthesis Saddle Set Screw for Base Component One size only Prosthesis LO012 LINK Saddle Prosthesis Saddle Stem 14 - 25mm x 210, 250, 290 & Prosthesis 330mm; 12 x 160, 180, 210, 250 - MP; 14 x 160, 180 - MP; 16 x 160, 180 - MP; 18 x 160, 180 - MP; 20 x 160, 180 - MP; 22.5 x 160, 180 MP; 25 x 160, 180 - MP LO013 Link McMinn Acetabular Cementless Cup HAC Coated 45 - 55 mm Reconstruction Cup System LO014 Link McMinn Acetabular Polyethylene Insert 45 - 55 mm Reconstruction Cup System LO015 LINK Lubinus SP Hip Prosthesis Stem Left & right 01-5 LO016 LINK Lubinus SP Hip Prosthesis Head: Chrome Cobalt Short, medium-short, medium, medium-large, large LO017 LINK Lubinus SP Hip Prosthesis Biolox Ceramic Short, medium-short & large LO018 LINK Lubinus SP Hip Prosthesis Cup: Muller 44 - 58mm, 40mm LO019 LINK Lubinus SP Hip Prosthesis Eccentric 44 - 58mm LO028 LINK Partial Pelvis Replacement Partial Pelvis Replacement 48-67mm LO029 LINK Partial Pelvis Replacement Partial Pelvis Replacement 48-67mm (left/right) with additional Caudal LO030 LINK Partial Pelvis Replacement Hook for Obturator Foramen Width 6-12mm Page 269 of 638
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Schedule 5 - Appendix A - Surgicall
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CARDIO-THORACIC Billing Code Produc
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EAR, NOSE & THROAT Billing Code Pro
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ENDOSCOPIC PRODUCTS Billing Code Pr
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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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