Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
SD204 Macropore Screws 2.0 x 4mm - 2.7 x 14mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD205 Macropore Tacks 1.5 x 4mm - 2.0 x 6mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD215 Macropore Locks 2 - 20mm Only to be funded where
used in a service for
which a Medicare Benefit
is payable
Orthopedic Internal Fixation Systems, Other
SD143 TiMesh Maxillary Prosthesis One size only Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD144 TiMesh Full Mandible One size only Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD145 TiMesh Mandibular Angle, Left/Right One size only Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD146 TiMesh Hemimandible, Left/Right One size only Only to be funded where
used in a service for
which a Medicare Benefit
is payable
SD147 TiMesh Mandibular Symphysis One size only Only to be funded where
used in a service for
which a Medicare Benefit
is payable
Page 489 of 638