Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
BI454 Lorenz 2.4mm Locking Plate, Straight, Std or low profile, 8 hole Only to be funded where
Reconstruction System 2.4mm System, Titanium used in a service for
which a Medicare Benefit
is payable
BI455 Lorenz 2.4mm Locking Plate, Double Angled, 2.4mm 5 x (22 or 24) x 5 hole Only to be funded where
Reconstruction System System, Titanium used in a service for
which a Medicare Benefit
is payable
BI457 Lorenz 2.4mm Locking Screw, Locking Reconstruction 2.4 x (6-18)mm Only to be funded where
Reconstruction System Modular. Titanium used in a service for
which a Medicare Benefit
is payable
BI464 Lorenz 2.4mm Locking Screw, Locking Reconstruction 2.7 x (6-18)mm Only to be funded where
Reconstruction System Modular. Titanium used in a service for
which a Medicare Benefit
is payable
BI471 Lorenz 2.4mm Locking Screw Head, Plate Locking Modular 2.4mm Only to be funded where
Reconstruction System used in a service for
which a Medicare Benefit
is payable
BI472 Lorenz Pectus Bar Pectus Bar, Stainless Steel 178-432mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI483 Lorenz Pectus Bar Stabilizer, Triangular or Elongated, One size only Only to be funded where
Stainless Steel used in a service for
which a Medicare Benefit
is payable
BI485 Distraction Technology System Drive Screw with Flex Connect. 20 - 30mm Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
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