Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
MO121 Martin Micro Plate Osteosynthesis 1.5mm system Burr Hole Cover 12 to 17mm, 0.6mm profile Only to be funded where
System Titanium used in a service for
which a Medicare Benefit
is payable
MO122 Martin Micro Plate Osteosynthesis 1.5mm Screw Titanium 1.5mm diameter, 3.5 to 8mm length Only to be funded where
System used in a service for
which a Medicare Benefit
is payable
MO123 Martin Micro Plate Osteosynthesis 1.5mm Screw Titanium 1.5mm diameter, 9mm length Only to be funded where
System used in a service for
which a Medicare Benefit
is payable
MO124 Martin Micro Plate Osteosynthesis 1.5mm Screw Titanium 1.5mm diameter, 11 to 13mm length Only to be funded where
System used in a service for
which a Medicare Benefit
is payable
MO125 Martin Micro Plate Osteosynthesis 1.5mm Screw Titanium 1.5mm diameter, 15mm length Only to be funded where
System used in a service for
which a Medicare Benefit
is payable
MO126 Martin Micro Plate Osteosynthesis 1.5mm Screw Emergency Titanium 1.8mm diameter, 3 to 7mm length Only to be funded where
System used in a service for
which a Medicare Benefit
is payable
MO127 Titan Mesh Mesh Sheet Titanium 13 hole 1, 1.5, 2mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
MO128 Titan Mesh Mesh Plates Titanium 2 hole strip 1, 1.5, 2mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
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