Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
BI622 W Lorenz Osteosynthesis System Z-Shape Plate, Left or Right, 1.5mm 2 x 2 hole Only to be funded where
or 2mm System. Titanium used in a service for
which a Medicare Benefit
is payable
BI623 W Lorenz Osteosynthesis System T-Plate, Left or Right, 1.5mm System. 3x3 hole, 7x7 hole Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
BI624 W Lorenz Osteosynthesis System T-Plate 90 degrees, Left or Right, 2x5hole, 3x3hole, 2x3hole Only to be funded where
2mm System. Titanium used in a service for
which a Medicare Benefit
is payable
BI625 W Lorenz Osteosynthesis System Plate, Y, Double Y, X, 1.5mm System One size only Only to be funded where
or 2.0mm System, Titanium used in a service for
which a Medicare Benefit
is payable
BI627 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System, 4 or 6 hole Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
BI628 W Lorenz Osteosynthesis System Plate, Straight, 1.5mm System or 16 hole Only to be funded where
2mm System. Titanium used in a service for
which a Medicare Benefit
is payable
BI629 W Lorenz Osteosynthesis System Plate Straight, 1.0mm, 1.5mm, 2.0mm 24 hole Only to be funded where
System, Titanium used in a service for
which a Medicare Benefit
is payable
BI630 W Lorenz Osteosynthesis System L Plate, Left or Right, 2mm System. 3x2 hole Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
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