Schedule 5 - Appendix A - Surgically Implanted Prostheses

EAR, NOSE & THROAT
Billing Code Product Further Size Notations
XO027 Ossicular, Incus and Stapes Fluroplastic Causse Large Loop 0.8 x 0.3 x 4.5, 5.0, 6.0mm,0.8 x 0.4 x
6.0mm 0.8 x 0.6 x 4.0, 4.5, 5.0,
6.0mm, 0.8 x 0.8 x 4.5, 5.0mm 0.8
x 0.4 x 6.0mm
XO028 Ossicular, Incus and Stapes Fluroplastic. Causse Loop Piston 0.6 x 0.4 x 6.0mm, 0.6 x 0.6 x 6.0mm
XO029 Ossicular, Incus and Stapes Platinum & Fluroplastic Fisch 0.4 x 4 x 6mm, 0.5 x 4 x 6mm, 0.6 x 4
x 6mm, 0.6 x 8.8 x 10.0mm
XO030 Ossicular, Incus and Stapes SS & Fluroplastic. Fisch Piston 0.4 x 4 x 6mm, 0.5 x 4 x 6mm, 0.6 x 4
x 6mm
XO031 Ossicular, Incus and Stapes Platinum & Fluroplastic. Lesinski 0.6 x 2 x 4.25 - 4.75mm in
Piston increments of 0.25mm
XO032 Ossicular, Incus and Stapes Platinum & Fluroplastic. Piston 0.5 x 2.5 x 4.0 - 4.75mm in
increments of 0.25mm, 0.6 x 2.5 x
4.0 - 4.75mm in increments of
0.25mm
XO033 Ossicular, Incus and Stapes Platinum & Fluroplastic. De La Cruz 0.6 x 1.25 x 3.75 - 5.00mm in
Increments of 0.25mm
XO034 Ossicular, Incus and Stapes SS & Fluroplastic. Schuknecht 0.6 x 3.5 - 5.0mm in increments of
0.25mm
XO035 Ossicular, Incus and Stapes SS & Fluroplastic. Schuknecht 0.8 x 4.0 - 5.0mm in increments of
0.25mm
XO036 Ossicular, Incus and Stapes SS. McGee 0.6 x 3.75 - 4.75mm in increments of
0.25mm, 0.5 x 3.75 - 4.75mm in
increments of 0.25mm, 0.5 x 4.5 -
5.00mm in increments of 0.25mm
XO037 Ossicular, Incus and Stapes SS. Scheer 0.6 x 4.5 - 5.0mm in increments of
0.25mm
XO083 Prostheses Ossicular Incus and Stapes Material H/A flex HA and titanium 1.4 x 3.0 x 2.0 x 5
Schwaber Offset partial with
malleable link
XO084 Prostheses Ossicular Incus and Stapes Materials flex HA with stainless 0.6 x 4.0 x 2.7 x 8.0
steel Moretz Cam Head Total
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