Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
MO048 Martin Mandibular Fracture System Straight Plate Titanium 16 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO049 Martin Mandibular Fracture System Angled Plate Titanium 6 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO050 Martin Mandibular Fracture System Angled Plate Titanium 8 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO051 Martin Mandibular Fracture System Curved Plate Titanium 4 hole Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO052 Martin Miniplate Osteosynthesis L Plate Titanium 4 to 6 hole, 1mm profile Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO053 Martin Miniplate Osteosynthesis Multi Fragment 4 to 8 hole, 1mm profile Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO054 Martin Miniplate Osteosynthesis Straight Plate Titanium 2 hole, 1mm profile Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO055 Martin Miniplate Osteosynthesis Straight Plate Titanium 4 hole, 1mm profile Only to be funded where
used in a service for
which a Medicare Benefit
is payable
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