Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations MA062 AO/ASIF Plates Titanium, tubular plate, 3.5mm 1/3 2-12 hole tubular MA063 AO/ASIF Plates Titanium, wrist fusion plate - 8 - 9 hole standard bend, short bend, straight MA064 AO/ASIF Plates - Steel DHS trochanteric stabilizing plate One size only sterile / short MA065 Spinal Plate/Plate System AO/ASIF Posterior cervical hook 1 & 2 hole / 21-39mm length Spinal Implants MA066 Spinal Plate/Plate System AO/ASIF Anterior cervical H plate 5-20 hole / 16 - 21mm holes & hole Spinal Implants spacing MA072 AO/ASIF Plates - Titanium Osteotomy plate - adult 4 Hole /blade 40 - 110mm / 90-130 deg MA075 AO/ASIF Plates - Steel 3.5mm - 1/3 tubular plate 2-12 hole / 25 - 145mm length MA076 AO/ASIF Plates - Steel 3.5mm T plate 3-5 hole shaft / 3-4 hole head (incl. oblique) length 38mm - 78mm MA077 AO/ASIF Plates - Titanium 2.7mm straight, 1/4 tubular & DCP 2-12 hole / length 23-63mm MA078 AO/ASIF Plates - Titanium 2.7mm, shaped, left, right, T 3 hole shaft / 2 hole head MA079 AO/ASIF Plates - Titanium 2.7 condylar Left & right MA087 AO/ASIF Plates - Titanium Distal radius plate - volar plates - One size only left & right MA088 AO/ASIF Plates - Titanium DHS/DCS plate 135-150 deg / 2-5 hole MA094 AO/ASIF K-Wires, Pins, Washers etc Wire mount One size only - Steel MA095 AO/ASIF Plates - Titanium 1.2mm, straight, external, T, Y, 3-4 hole button, plate MA096 AO/ASIF Plates - Titanium 2.4mm unilock, angled, straight, T, 4-20 hole Y, condylar, DCP, LCDCP, left & right, plate MA112 AO/ASIF Screws Titanium LISS screws - locking head & screw 5.0 x 81mm - 5.0 x 85mm hole insert Page 286 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations MA113 AO/ASIF Screws Titanium LISS fixator - Lat. proximal tibia/ 5-13 holes distal femur/ right & left MA168 AO/ASIF Plates - Steel Specially manufactured plate all Custom made MA169 AO/ASIF Plates - Steel Shaped 2.0mm MA170 AO/ASIF Plates - Steel Shaped 2.7mm MA171 AO/ASIF Plates - Steel Straight reconstruction 2.7mm 5 hole MA172 AO/ASIF Plates - Steel 3.5mm reconstruction, straight & 2.7-3.5mm / 5 hole - 24 hole curved MA173 AO/ASIF Plates - Steel 4.5mm semi tubular 2-12 hole MA174 AO/ASIF Plates - Steel 4.5mm narrow DCP/LCDCP 2-24 hole length 34-286mm MA175 AO/ASIF Plates - Steel 4.5mm broad DCP/LCDCP 6-26 hole/ length 106 - 359mm MA176 AO/ASIF Plates - Steel 4.5mm reconstruction 3 - 16 hole MA177 AO/ASIF Plates - Steel 4.5mm lengthening broad 8-10 hole / 30-249mm MA178 AO/ASIF Plates - Steel Hook / double hook plate 4.5mm hook , 5 - 8 hole. MA179 AO/ASIF Plates - Steel Osteotomy Plate - Adult / LC angle 4 hole, 5-6 hole/30-40mm blade blade /cannulated angle blade length/ 90 - 100 deg, 10- 20 mm displacement MA180 AO/ASIF Plates - Steel Osteotomy plate - adolescent 90 deg, blade 40 - 60mm, displ 10 - 15mm MA181 AO/ASIF Plates - Steel Osteotomy plate - infant Child, toddler & infant, 115 deg bifurcated, blade 25 - 45mm, 80 - 100 deg, 4 - 8mm offset, displ 7 - 12mm, height 49- 54mm MA182 AO/ASIF Plates - Steel Osteotomy plate - high tibial 95 deg condylarprox tibia , 50-60 mm, displ 15-20mm MA183 AO/ASIF Plates - Steel Condylar & small condylar, angled 5 - 24 hole, blade length 50 - 90mm, plate 95 degree MA184 AO/ASIF Plates - Steel Angled plate 4 - 12 hole, length 50 - 110mm 130 degree Page 287 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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