Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations MA185 AO/ASIF Plates - Steel DCS plate 95 deg, 10 hole - 22 hole, length 100 - 370mm, barrel 25mm. MA189 AO/ASIF Plates - Titanium Specially manufactured plate One size only MA190 AO/ASIF Plates - Titanium Titanium 1.5mm plate MA191 AO/ASIF Plates - Titanium 2.0mm DCP LCDCP, left, right 4 - 20 hole MA192 AO/ASIF Plates - Titanium 2.0mm shaped 2 - 9 hole, right, left & oblique MA193 AO/ASIF Plates - Titanium 2.0mm condylar Left & right MA194 AO/ASIF Plates - Titanium 3.5mm narrow, DCP/LCDCP 4 - 12 hole MA195 AO/ASIF Plates - Titanium 3.5mm, T-PLATE - right & oblique Small , 3 - 6 hole angle MA196 AO/ASIF Plates - Titanium 4.5mm pelvic recon plate 3 - 16 hole MA197 AO/ASIF Plates - Titanium 4.5mm,T-plate - left & right 3 hole - 9 hole MA198 AO/ASIF Plates - Titanium 4.5mm, head buttress plate lateral 5 - 13 hole tibial left & right MA199 AO/ASIF Plates - Titanium 4.5mm condylar buttress plate left & 7 - 15 hole right MA200 AO/ASIF Plates - Titanium 4.5mm, spoon plate 5 - 6 hole MA201 AO/ASIF Plates - Titanium 4.5mm condylar, angled plate, 95 5 - 12 hole, length 50 - 80mm, 5 - 6 degrees hole MA202 AO/ASIF Plates - Titanium 4.5mm, angled plate, 130 degrees 4 - 12 hole, length 50 - 110 mm MA256 AO/ASIF Plates - Steel Osteotomy plate - shoulder Dislocation 80-90 deg. blade length 35 - 40mm MA279 LCP Plate 1/3 Tubular Plate Dia 3.5mm, length 2-16 hole MA280 LCP Plate Distal Tibial Plate, sterile/non Dia 3.5 - 5.0mm, length 4-16 hole MA281 LCP Plate Proximal Tibial Head Plate, Dia 3.5 - 5.0mm, length 4-18 hole Sterile/Non Sterile MA282 LCP Plate Distal Femoral Buttress Plate, Dia 5.0mm, length 4-22 hole Sterile/Non Sterile Page 288 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations MA283 LCP Plate Tomofix Plate, Sterile/Non Sterile Dia 5.0mm, length 2-8 hole MA284 LCP Plate Locking Proximal Humeral Plate, Dia 3.5mm, length 4-10 hole Sterile/Non Sterile MA285 LCP Plates Cloverleaf Plate, Stainless, Dia 3.5mm, length 3-6 hole Sterile/Non Sterile MA286 LCP Plates Oblique left & right and right Dia 3.5mm, length 3 - 6 hole angled plates, Sterile/Non Sterile MA287 LCP Plate L & T Plates, L & T Buttress Plates, Dia 3.5 - 5.0mm, length 2-10 hole Sterile/Non Sterile MA288 LCP Plate Reconstruction Plate, Sterile/Non Dia 3.5 - 5.0mm, length 3-22 hole Sterile MA289 LCP Spacer and LCP Washer Dia 2.7 - 5.0mm MA290 LCP Plate Straight Plate, Sterile/Non Sterile Dia 3.5 - 5.0mm, length 2-20 hole MA310 AO/ASIF Plates Calcaneal, Locking 3.5mm, Long, Short, Left, Right MA314 Proximal Tibial Plate ST.ST Diameter 3.5-4mm, length 2-16 hole MA317 Medial Distal Tibial Plate Stainless steel plate 3.5 and 4.5mm, 6 - 12 hole MA318 Medial Distal Tibial Plate Stainless steel plate 3.5 and 4.5mm, 13 - 18 hole MA387 AO/ASIF Plates Foot plates - steel - multiple hole 2 - 4mm <strong>Prostheses</strong>, Femoral Head MA020 Ceramic Head Small / medium / large Small, medium & large, cone 12/14 - dia 28mm-32mm MA025 Bipolar Head Bipolar prosthesis head Dia 28mm size 42- 58 MA029 Metal on Metal Head Head for MOM articulation - 28mm small/medium/large <strong>Prostheses</strong>, Finger/Thumb MA081 Finger Prosthesis -distal, proximal, L18 D4.0 - L26 D6.0 standard, large Page 289 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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