Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST389 Luhr Fixation System Luhr Mandibular Reconstruction 8mm Only to be funded where
System: ramus joint screw Vitallium used in a service for
which a Medicare Benefit
is payable
ST390 Luhr Fixation System Luhr Micro and Pan Fixation 40x60mm Only to be funded where
Systems: Micro mesh Vitallium used in a service for
which a Medicare Benefit
is payable
ST391 Luhr Fixation System Luhr Micro and Pan Fixation 60x100mm Only to be funded where
Systems: Micro mesh Vitallium used in a service for
which a Medicare Benefit
is payable
ST392 Luhr Fixation System Luhr Micro Fixation System: micro 6 holes, 6x7mm Only to be funded where
double-T-shape plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST393 Luhr Fixation System Luhr Micro Fixation System: micro 7 holes, 10x10mm Only to be funded where
double-T-shape plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST394 Luhr Fixation System Luhr Micro Fixation System: micro 11 holes, 10/18mm Only to be funded where
double-T-shape plate, Y-shape plate, used in a service for
ladder plate Vitallium which a Medicare Benefit
is payable
ST395 Luhr Fixation System Luhr Micro Fixation System: micro 5 holes, 14x2.5mm, 14x4mm, 7 Only to be funded where
L-shape plate Vitallium holes, 22x4mm used in a service for
which a Medicare Benefit
is payable
ST396 Luhr Fixation System Luhr Micro Fixation System: micro 4 holes, 14mm Only to be funded where
straight plate Vitallium used in a service for
which a Medicare Benefit
is payable
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