Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST413 Luhr Fixation System Luhr Pan Fixation System: 4 holes, 12mm Only to be funded where
double-T-shape plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST414 Luhr Fixation System Luhr Pan Fixation System: ladder 10 holes, 39 x 9mm Only to be funded where
plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST415 Luhr Fixation System Luhr Pan Fixation System: L-shape 4 holes, 16 x 9mm, 22 x 9mm Only to be funded where
plate, 90 deg Vitallium used in a service for
which a Medicare Benefit
is payable
ST416 Luhr Fixation System Luhr Pan Fixation System: L-shape 4 holes, 16 x 9mm, 22 x 9mm Only to be funded where
plate, 110 deg Vitallium used in a service for
which a Medicare Benefit
is payable
ST417 Luhr Fixation System Luhr Pan Fixation System: straight 4 holes, 21mm Only to be funded where
plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST418 Luhr Fixation System Luhr Pan Fixation System: straight 6 holes, 33mm Only to be funded where
plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST419 Luhr Fixation System Luhr Pan Fixation System: straight 8 holes, 45mm Only to be funded where
plate Vitallium used in a service for
which a Medicare Benefit
is payable
ST420 Luhr Fixation System Luhr Pan Fixation System: straight 16 holes, 93mm Only to be funded where
plate Vitallium used in a service for
which a Medicare Benefit
is payable
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