Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations Prostheses, Joint, Hip, Acetabular Component MA021 Modular Shell CBF cup with fin & screws 46 mm - 68mm OD MA022 MOM Liner CBF inlay metal.metal 28/48 - 28/68 MA023 RM cup with MOM Polyethylene titanium coating, Dia 46mm -64mm chrome, cobalt lining MA024 CCE Ring CCE roof reinforcement ring - TICP Dia 46 - 58mm for cup O dia MA027 CCB Cemented Cup Full profile / low profile special cup 28/32 ID - 42/64 OD / UJMWPE MA030 PE Liner CBF cup liner id Size 28mm ID/46mm - 68mm OD MA031 RM Cementless Cup RM bevelled / monomesh / ceros 80 46mm-size 64 & 28mm IDX46mm coated/ ti coated OD - 28mm IDX64mm OD MA104 Consensus Hip System Cemented and cementless acetabular Cluster & no-hole / PC-TI 46-68mm cup shells Prostheses, Joint, Hip, Femoral Component MA016 CCA Cemented Stem Straight / standard / lateral sterile 7.50mm -17.5mm MA017 FULFIX Cemented Stem Standard modular / lateral modular 3.0mm - 12.5mm sterile MA018 PE Plug Medullary Small , medium, large, extra large MA019 CBC Cementless Stem Titanium femoral stem 9.00mm - 16.25mm MA026 Centraliser For fullfix stem - PMMA Dia 8.0/9.5mm - 15/12mm MA028 Metal Heads hip prosthesis head - total - hemi / Cone 12/14 dia 28mm-58mm metal - small/ medium/ large MA107 Option 3000 Cementless Stem Uncemented 0.5 - 7.0mm Prostheses, Joint, Hip, Total MA102 Consensus Hip System Cementless femoral stem HA/TI & PC-TI / size 10 - 15 MA103 Consensus Hip System Cemented femoral stem - with collar Size 8-14 Page 290 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations MA105 Consensus Hip System Acetabular cup liners and poly cups With hood 46-68mm MA106 Consensus Hip System Proximal and distal centralisers 12-18mm Prostheses, Joint, Knee, Femoral Component MA100 Consensus Knee Femoral component Size 1-6 MA108 Balansys Femoral Component Left & right A - E Prostheses, Joint, Knee, Patellar Component MA101 Consensus Knee Patella - All PE Size 1-3 / 10mm MA111 Balansys Patella Component Polyethylene Dia 25mm Prostheses, Joint, Knee, Total MA099 Consensus Knee Tibial Insert - congruent, PCL SUB / Sizes 1/2, 3/4, 5/6, / 10-18mm PS / left, right MA311 Balansys Knee System Tibial Polyethylene Component 64/8mm - 85/15.5mm Mobile Bearing MA312 Balansys Knee System Tibial Base Plate Mobile Bearing 64/8mm - 85/15.5mm MA316 Balansys Tibial Component Tibial component - mobile bearing - 60 -90mm tibial insert Prostheses, Joint, Shoulder MA033 RM Shoulder With & without shaft/ distal/ Distal 9-11 / proximal 11-14 / proximal/ diaphyseal prosthesis/ length 70-110mm / head 38-50 / shoulder tumor prosthesis stem 9-14 / shaft 30mm - 150mm MA080 Radial Head Prosthesis / Type A & B D20, D08 - D24, D10 Prostheses, Tibial MA098 Consensus Knee Tibial base plate - stemmed NPC/PC Size 1-6 left & right MA109 Balansys Tibial Base Plate Metal back 64mm - 85mm MA110 Balansys Tibial Component Tibial insert Insert 64/8 - 85/15.5 MA315 Balansys Tibial Base Plate Mobile bearing, metal back 60-90mm Page 291 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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