Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations SD063 Colorado Spinal System Break off Nut One size only SD064 CD-Horizon C-ring One size only SD065 CD-Horizon Staples One size only SD066 Novus System Plif Cage: Cage 12 - 50mm SD067 CD Horizon Eclipse Pedicle Screw Diameter 5.5 - 7.5mm, Lengths 25-55mm SD068 CD Horizon Eclipse: 4.5mm Rod 40 - 600mm SD082 Telamon Carbon Cage 8 - 16mm SD083 Telamon Titanium Cage 8 - 16mm SD084 Telamon Contour, Carbon Cage 8 - 16mm SD085 Telamon Contour, Titanium Cage 8 - 16mm SD086 Interfix Titanium Cage 12 x 20mm - 24 x 50mm SD087 Lordotec Titanium Cage 18-28mm SD088 TSRH 3D Screw 30-55mm SD089 TSRH 3D Extended Post Screw 30-50mm SD090 TSRH 3D Rod, 5.5mm 20-500mm SD091 TSRH 3D Connector, 5.5mm 6-12mm SD092 Union Carbon Cage 10 - 16mm SD095 Z Plate II Plate 4cm SD096 Z Plate II Plate 5cm SD097 Z Plate II Plate 6cm SD098 Z Plate II Plate 7cm SD099 Z Plate II Plate 8cm SD100 Z Plate II Plate 9cm SD101 Z Plate II Plate 10cm Page 302 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations SD102 Z Plate II Plate 11cm SD103 Z Plate II Plate 12cm SD104 Z Plate II Plate 13cm SD105 Z Plate II Bolt & Nut 30mm - 55mm SD106 Z Plate II Non Breakoff Nut One size only SD107 Z Plate II Screw 20 - 60mm SD108 Z Plate II Slot Washer One size only SD109 Axis Cervical Plating System Plate 11mm SD110 Axis Cervical Plating System Plate 13mm SD111 Axis Cervical Plating System Plate 15mm SD112 Axis Cervical Plating System Plate Longer than 15mm SD113 Axis Cervical Plating System Screw: Cancellous 6 - 24mm SD114 Axis Cervical Plating System Screw: Cortical 26 - 54mm SD115 Orion Anterior Cervical System Convergent or Divergent Plates 21.5 - 47.5mm SD116 Orion Anterior Cervical System Convergent or Divergent Plates 50 - 60mm SD117 Orion Anterior Cervical System Convergent or Divergent Plates 62.5 - 77.5mm SD118 Orion Anterior Cervical System Convergent or Divergent Plates 80 - 95mm SD119 Orion Anterior Cervical System Convergent or Divergent Plates 100 - 110mm SD120 Orion Anterior Cervical System Cancellous Screw 10 - 17mm SD121 Orion Anterior Cervical System Locking screw One size only SD122 TSRH Titanium Spinal Implant Washer One size only SD123 Apofix Support Rod One size only SD124 Apofix Clamp Single Rod Upper/lower SD125 Tenor Pedicle Screw (incl Self Breaking 30 - 55mm Nuts) Page 303 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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