Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations ST767 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.5mm diameter x 6mm Fragment System, emergency cross-slot screw, Titanium ST768 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 4 holes Fragment System, compression plate with bar, Titanium ST769 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 5 holes Fragment System, compression plate with bar, Titanium ST770 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 6 holes Fragment System, compression plate with bar, Titanium ST771 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 7 holes Fragment System, compression plate with bar, Titanium ST772 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 8 holes Fragment System, compression plate with bar, Titanium ST773 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 6 holes Fragment System, compression plate, 90 deg, L-shape, right/lef, Titanium ST774 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 6 holes Fragment System, compression plate, T-shape, 90 deg, Titanium ST775 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3mm system, 6 holes Fragment System, compression plate, T-shape, oblique, right/left, ST776 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.3x5mm, 2.3x6mm, 2.3x8mm, Fragment System, screw and 2.3x9mm, 2.3x10mm, 2.3x12mm, emergency screw, Titanium 2.3x13mm, 2.3x14mm, 2.3x15mm ST777 Leibinger Titanium Implant System Leibinger Profyle Hand & Small 2.5mm diameter Fragment System, screw, Titanium Page 360 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations ST778 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates, Palmar Fracture Plate - Medium Titanium ST779 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates, Palmar Fracture Plate - Large Titanium ST780 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates, Dorsal Fracture Plate Medium Left Titanium and Right ST781 Leibinger Titanium Implant System Rogachefsky Distal Radius Plates, Dorsal Fracture Plate Large Left Titanium and Right ST782 Leibinger Titanium Implant System Rogachefsky Distal Radius Screws, 2.7mm diameter - 12mm-38mm in 2 Titanium mm increments, ST783 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 2.3x8mm, 2.3x10mm, 2.3x12mm, System, screw, Titanium 2.3x14mm ST784 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 2.7x12mm, 2.7x14mm, 2.7x16mm, System, screw, Titanium 2.7x18mm, 2.7x20mm,2.7x22mm ST785 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 3.0x14mm, 3.0x16mm, 3.0x18mm System, emergency screw, Titanium ST786 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 4 holes System, straight plate, Titanium ST787 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 6 holes System, straight plate, Titanium ST788 Leibinger Titanium Implant System Leibinger Forefoot Reconstruction 4 holes System, curved plate, Titanium ST789 Leibinger Titanium Implant System Leibinger Plates - Wrist 8 and 12 holes Arthrodesis Plates, partial and total, right/left, Titanium ST790 Alpha Stryker cervical plates Reflex anterior cervical plate, 12 - 84mm (2mm increments) Molybdenum, zirconium and iron ST791 Alpha Stryker cervical plates Reflex anterior cervical plate, 4mm x 10mm - 18mm (2mm Molybdenum, zirconium and iron, increments) 4.5mm x 12 - 16mm bone screw (2mm increments) ST983 Stryker Plating System DuPont Distal Humeral Plate 7,9,11,13 holes Page 361 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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