Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
ST930 System 12 +4mm Acetabular Insert Composition - Duration stabilized 28 and 32mm ID with a 10 degree
polyethylene hood to fit all sizes of System 12
shells
ST931 System 12 Crossfire Insert Composition - Crossfire Fits 46 - 72mm System 12 shells in
28 and 32mm ID with 0 and 10
degree insert orientation
Prostheses, Joint, Hip, Acetabular Component
SK013 Trident Acetabular Component System Elevated Rim Inserts - Crossfire Fits 50-70mm with 28,32 and 36mm
Polyethylene ID Options
ST013 Hip - Trident All Polyethelene Cup Enhanced Polyethylene 40-64mm(Outer Diameter)
ST546 Trident acetabular component system Leteralised cup insert, enhanced 26, 28 & 32mm
polyethylene
ST547 Restoration acetabular gap ring Titanium 48-72mm OD in 2mm increments
ST548 Trident acetabular component system Trident shell, titanium - HA coated 40-74mm OD in 2mm increments
ST549 Trident acetabular component system Trident polyethlene liner, enhanced 22, 26, 28, 32mm dia
polyethlene
ST550 Trident acetabular component system Trident ceramic liner, alumina and 28, 32, 36mm dia
titanium
ST557 Restoration gap II acetabular shell GAP CUP II titanium anatomic (left 48-72mm OD in 2mm increments
& right)
ST565 Alumina acetabular inserts Ceramic insert, alumina 28, 32 & 36mm dia
ST932 Trident Constrained Acetabular Insert Two pre assembled components: Match with 6x Trident shell sizes
Outer insert component and a E, F, G, H, I, J. Insert sizes E and F
captured UHR (Universal Head) require a 22mm head size. Insert
component. Composition - Cobalt sizes G, H, I, J require a 28mm head
chrome alloy and UHMWPE (ultra size.
high molecular weight
polyethylene) with a Titanium
ST933 Trident Multi-Hole Acetabular Shell Composition - Titanium Shell sizes: 42 - 74mm OD
(Ti-6AL-4V) with Arc Deposit
Surface and Pruefix HA Coating
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