Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
AD019 Bionx Implants - Plates, Absorbable Biosorb FX 1.5 System Plate - 1.0mm thick x 5.5mm wide x 6 Hole Only to be funded where
Scalloped C Plate x 8mm Gap used in a service for
which a Medicare Benefit
is payable
AD020 Bionx Implants - Plates, Absorbable Biosorb FX 1.5 System Plate - 1.0mm thick x 5.5mm wide x 6 Hole Only to be funded where
Scalloped C Plate x 10mm Gap used in a service for
which a Medicare Benefit
is payable
AD021 Bionx Implants - Plates, Absorbable Biosorb FX 2.4 System Plate - 2.4mm thick x 8mm wide x 4 and 6 Only to be funded where
Straight Hole used in a service for
which a Medicare Benefit
is payable
AD022 Bionx Implants - Plates, Absorbable Biosorb FX 2.4 System Plate - 1.4mm thick x 8mm wide x 6 Hole x Only to be funded where
Straight 8 & 12mm Gap used in a service for
which a Medicare Benefit
is payable
AD023 Bionx Implants - Plates, Absorbable Biosorb FX 2.4 System Plate - 1.4mm thick x 8mm wide x 8 & 10 Only to be funded where
Straight Hole used in a service for
which a Medicare Benefit
is payable
AD090 Bionx Implants - plates Biosorb system mesh plate 0.6mm and 0.8mm thick, 10 hole by Only to be funded where
5 hole configuration used in a service for
which a Medicare Benefit
is payable
AD091 Bionx Implants - plates Biosorb system mesh plate 0.6mm and 0.8mm thick, 5 hole by 5 Only to be funded where
hole configuration used in a service for
which a Medicare Benefit
is payable
AD092 Bionx Implants - plates Biosorb system mesh plate 0.6mm and 0.8mm thick, 10 hole by Only to be funded where
10 hole configuration used in a service for
which a Medicare Benefit
is payable
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