Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations LO031 LINK Partial Pelvis Replacement Fixation Screw 20-35mm LO034 CFP Total Hip System including A, B, left and right; titanium/ HA Extra small, small, medium large & Acetabular Cup extra large LO035 Ribbed System - 001A-8 left and right Prostheses, Joint, Knee LO059 LINK Endo-Model SLED Prosthesis: Femoral Component Short, medium-short, medium & large LO060 LINK Endo-Model SLED Prosthesis Tibial Plateau, Metal Backed 7mm-13mm IN 45, 50, 55 diameter Prostheses, Joint, Knee, Patellar Component LO057 LINK Lubinus Total Patella Glide Patella Component Small, medium & large Replacement LO058 LINK Lubinus Total Patella Glide Femoral Component Small, medium, large, extra large Replacement Prostheses, Joint, Knee, Total LO037 Gemini MkII Modular Knee - Extra-small, small, medium-small, Prostheses System medium, large & extra large LO038 LINK Endo Model Rotational Knee Intracondylar Total Rotation Knee Small, medium & large System Joint: Without Patella Flange LO039 LINK Endo Model Rotational Knee Intracondylar Total Rotation Knee Small, medium & large System Joint: With Patella Flange LO040 LINK Endo Model Rotational Knee Intracondylar total rotation knee Small, medium & large System join with Anti Lux device: without patella flange LO041 LINK Endo Model Rotational Knee Intracondylar total rotation knee Small, medium & large System join with Anti Lux device: with patella flange LO042 LINK Endo Model Rotational Knee Patella Component Small, medium & large System LO043 LINK Endo Model Rotational Knee Tibial Spacers Small, medium & large System Page 270 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations LO044 LINK Endo Model Rotational Knee Total Rotational Knee Joint with Small, medium & large System Anti Lux Device, with Patella Flange and Replacement of Femoral and/or Tibial Bone Structures, LO045 LINK Endo Model Rotational Knee Total Rotational Knee Joint with Small, medium & large System Anti Lux Device, with Patella Flange and Replacement of Femoral and/or Tibial Bone Structures, LO046 LINK Endo Model Rotational Knee Total Rotational Knee Joint with Extra small, small, medium & large System Anti Lux Device, with Patella Flange and Replacement of Femoral and/or Tibial Bone Structures, distal femur & proximal tibia LO047 LINK Endo Model Rotational Knee Total hinge knee: without patella Small, medium & large System LO048 LINK Endo Model Rotational Knee Total hinge knee: with patella flange Small, medium & large System LO049 LINK T.A.C.K. Knee Femoral Cementless Extra-small, small, medium & large LO050 LINK T.A.C.K. Knee Rotating Platform Extra-small, small, medium & large LO051 LINK T.A.C.K. Knee Patella cemented Small & large LO052 LINK T.A.C.K. Knee Tibial cementless Extra-small, small, medium & large LO053 LINK T.A.C.K. Knee Bridging Articulating Surface Extra-small, small, medium & large LO054 LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): Extra-small, small, medium & large femoral component LO055 LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): Extra-small, small, medium & large tibial tray LO056 LINK T.A.C.K. Knee Hydroxyapaptite Coated (Hac): 9- 16.5mm tibial plateau Prostheses, Radial Head LO007 Distal Radius Head Replacement - Small, medium & large Page 271 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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