Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
BI574 Distraction Technology System Distractor, Solid Shaft, Facial, 1- 2 inch Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
BI591 W Lorenz Osteosynthesis System Chin Plates, Paulus, 2mm System, 4 - 12mm Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
BI603 W Lorenz Osteosynthesis System Sheet, 1mm System Titanium 202x127x0.2mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI604 W Lorenz Osteosynthesis System Sheet, 1mm System. Titanium 85x50x0.2mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI605 W Lorenz Osteosynthesis System Plate, Matrix, 1.5mm System, 2 x 3 or 2 x 4 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI617 W Lorenz Osteosynthesis System Plate, Straight, 1mm System. 4 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI620 W Lorenz Osteosynthesis System Plate, Straight, low profile, 2.0mm 4 - 8 hole Only to be funded where
System, Titanium used in a service for
which a Medicare Benefit
is payable
BI621 W Lorenz Osteosynthesis System Plate, L , 2.5mm or 2m system, 2 x2 or 3x3 hole Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
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