Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
BI738 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Large Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI739 W.Lorenz Osteosynthesis System Orbital Floor Plate; Titanium 1.5mm system, Medium Only to be funded where
used in a service for
which a Medicare Benefit
is payable
BI740 W.Lorenz Osteosynthesis System Orbital Floor Plate (Small) or NOE Small or NOE plate Only to be funded where
plate, 1.5mm System, Titanium used in a service for
which a Medicare Benefit
is payable
BI774 W Lorenz Osteosynthesis System Lefort plate, 1.5mm system, 0.6mm Flat, 2-11mm Only to be funded where
thickness, titanium used in a service for
which a Medicare Benefit
is payable.
BI784 Lorenz 2.4mm Locking Condyle screw, titanium One size only Only to be funded where
Reconstruction System used in a service for
which a Medicare Benefit
is payable.
BI786 Lorenz 2.4mm Locking Screw, bending inserts, titanium One size only Only to be funded where
Reconstruction System used in a service for
which a Medicare Benefit
is payable.
BI792 Lorenz 2.4mm Locking Condyle left or right, chrome cobalt One size only Only to be funded where
Reconstruction System (CoCr) used in a service for
which a Medicare Benefit
is payable.
Prostheses, Joint, Mandible
BI559 TMJ System Mandibular Component, Left or (40 - 60mm), 5-13 hole Only to be funded where
Right, Titanium used in a service for
which a Medicare Benefit
is payable
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