Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST105 Leibinger Titanium Implant System Leibinger COM/MAND Fixation 4+ 14 holes Only to be funded where
System: bridging plate, right/left used in a service for
Titanium which a Medicare Benefit
is payable
ST106 Leibinger Titanium Implant System Leibinger COM/MAND Fixation 4 + 8 holes Only to be funded where
System: bridging plate, right used in a service for
which a Medicare Benefit
is payable
ST119 Leibinger Titanium Implant System Leibinger M-TAM Mesh System: 20x30mm Only to be funded where
micro augmentation mesh Titanium used in a service for
which a Medicare Benefit
is payable
ST120 Leibinger Titanium Implant System Leibinger M-TAM Mesh System: 40x40mm Only to be funded where
micro augmentation mesh Titanium used in a service for
which a Medicare Benefit
is payable
ST121 Leibinger Titanium Implant System Leibinger M-TAM Mesh System: 55x55mm Only to be funded where
micro augmentation mesh Titanium used in a service for
which a Medicare Benefit
is payable
ST122 Leibinger Titanium Implant System Leibinger M-TAM Mesh System: 60x120mm Only to be funded where
micro augmentation mesh Titanium used in a service for
which a Medicare Benefit
is payable
ST123 Leibinger Titanium Implant System Leibinger Micro Plus Bone plate: 4 holes Only to be funded where
Straight Titanium used in a service for
which a Medicare Benefit
is payable
ST124 Leibinger Titanium Implant System Leibinger Bone plate: LEAD plate 4 holes Only to be funded where
Titanium Transport and base plate used in a service for
which a Medicare Benefit
is payable
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