Schedule 5 - Appendix A - Surgically Implanted Prostheses

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ORTHOPAEDIC Billing Code Product Further Size Notations SZ099 Resurfacing hip prosthesis Head resurfacing - CoCr alloy 38/D to 56/B SZ100 MS30 Hip - Cups Cemented Low Profile with Metasul - PE with 38 to 58mm special metal alloy SZ101 MS30 Hip - Cups Cemented Low Profile - PE 22/36 to 32/64 SZ102 CLS, CLW Prosthesis - Cups Uncemented Cup for CLS & CLW - 46 to 62mm Ti alloy SZ103 Fitmore Cup Uncemented Cup - Fitmore - Ti alloy 42 to 68mm SZ104 Uncemented Cup- Metasul Press Fit Metasul - CoCr /PE/Ti Press Fit 48 to 64mm, Artek 46mm alloy - & Artek Metasul Ti/CoCr to 58mm SZ105 Resurfacing - Uncemented Cups Resurface cup - special metal alloys 44/D to 62/V SZ107 Press Fit - Uncemented Cup Uncemented Press fit Cup - PE / Ti 22/40 to 32/64mm alloy SZ108 Inserts for Cups PE (CLS, CLW, Fitmore, Allofit) 22, 28, 32mm Size 46 to 62 SZ109 Inserts for Cups Metasul (CLS, CLW, Fitmore, 48 to 68mm Allofit) - PE / CoCr - special alloy (Metasul) SZ110 Acetabular Reinforcement Roof Ring - Ti alloy 44 to 58mm SZ111 Acetabular Reinforcement Roof Ring with Hook - Ti alloy 36/23 to 64/23mm SZ112 Acetabular Reinforcement Protrusio Cage - Ti alloy 44 to 50mm (left and right) SZ114 Acetabular Reinforcement Revision XS to XL, Ti alloy SZ121 Wagner Acetabular Reinforcement Cage - Ti 5 x 52 to 6 x 68mm /CoCr alloy SZ122 Wagner PE Insert suitable for Wagner 28/52 to 32/68mm Reinforcement Cage - PE SZ123 Wagner Acetabular Cage Metasul Insert - 52 to 68mm special metal alloy / PE <strong>Prostheses</strong>, Joint, Knee SZ001 SAL Knee <strong>Prostheses</strong> Porous Femur, CoCrMo, left and A, B, C, D, E Page 382 of 638
ORTHOPAEDIC Billing Code Product Further Size Notations SZ125 SAL Knee -Tibial Plate Standard - Ti / CoCr alloy XS to XL SZ126 SAL Knee -Tibial Plate Special Size/Shape - Ti / CoCr alloy XS to XL SZ127 High Tibia Osteotomy High Tibia Osteotomy - Ti alloy L shaped steel alloy plate; Standard & Long SZ149 Natural Knee System Tibial Spacers - special metal alloy 4 to 8mm Size 00 to 5 SZ150 Natural Knee System Spacer Screw/Peg - special metal One size only SZ167 SAL Knee Prosthesis Total - metal alloy / PE Sizes O, A to E/ 60/AOA to 92E SZ168 Natural Knee All Poly Tibia - PE 00 to 5 SZ169 Natural Knee Constrained Tibial Insert - PE 00 to 5 SZ170 Natural Knee Tibial Spacer Screw - Ti alloy One size only SZ171 Natural Knee Tibial Spacer Peg - Ti alloy One size only SZ172 Natural Knee PE Insert Mobile Bearing 00 to 22mm SZ173 Natural Knee PE Tibial Baseplate Insert - P.S. 00 to 22mm SZ174 Natural Knee PE Tibial Baseplate Insert 00 to 22mm SZ175 Natural Knee PE Tibial Baseplate Insert -Ultra 9 to 22mm Congruent SZ176 Natural Knee Primary Tibial Baseplate Insert with Size 00 to 5 Stem Porous - Ti alloy SZ177 Natural Knee Primary Tibial Baseplate - without Size 00 to 5 Stem (Resurfacing) Porous - Ti alloy SZ178 Natural Knee Primary Tibial Baseplate -with Stem Size 00 to 5 Cemented - Ti alloy SZ179 Natural Knee Primary Tibial Baseplate - Mobile Size 00 to 5 Bearing Porous - CoCr alloy SZ180 Natural Knee Primary Tibial Baseplate - Mobile Size 00 to 5 Bearing Non Porous - CoCr alloy SZ181 Natural Knee Revision -Tibial Baseplate - Ti alloy 0 to 5 Page 383 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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Schedule 5 - Appendix A - Surgically Implanted Prostheses

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