Schedule 5 - Appendix A - Surgically Implanted Prostheses

ORTHOPAEDIC
Billing Code Product Further Size Notations
TB175 B2C Espace Acetabular Cup Acetabular component for revision Espace Shell 0 degrees peak, diam
hip system 50mm, with plastic insert, Espace
Shell 0 degrees peak, diam 54mm,
with plastic insert, Espace Shell 0
degrees peak, diam 58mm, with
plastic insert, Espace Shell 0
degrees peak, diam 62mm, with
plastic insert, Espace Shell 20
degrees peak, diam 50mm, with
plastic insert, Espace Shell 20
degrees peak, diam 54mm, with
plastic insert, Espace Shell 20
degrees peak, diam 58mm, with
plastic insert, Espace Shell 20
degrees peak, diam 62mm, with
plastic insert, Espace Shell 8mm
extension, diam 50mm, with plastic
insert, Espace Shell 8mm extension,
diam 54mm, with plastic insert,
Espace Shell 8mm extension, diam
58mm, with plastic insert, Espace
Shell 8mm extension, diam 62mm,
with plastic insert, Espace Shell
14mm extension, diam 50mm, with
plastic insert, Espace Shell 14mm
extension, diam 54mm, with plastic
insert, Espace Shell 14mm
extension, diam 58mm, with plastic
insert, Espace Shell 14mm
extension, diam 62mm, with plastic
insert, Espace Shell 20mm
extension, diam 50mm, with plastic
insert, Espace Shell 20mm
extension, diam 54mm, with plastic
insert, Espace Shell 20mm
extension, diam 58mm, with plastic
insert, Espace Shell 20mm
TB177 GL - Alumina U Liner Acetabular component for total hip 50mm, 52mm, 54mm, 56mm, 58mm,
system, polyethylene 60mm
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