Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST141 Leibinger Titanium Implant System Leibinger Burr Hole Cover: curved 7, 10, 14mm Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
ST142 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x2-6mm, 0.55mm height Only to be funded where
used in a service for
which a Medicare Benefit
is payable
ST143 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x7-10mm, 0.55mm height Only to be funded where
used in a service for
which a Medicare Benefit
is payable
ST144 Leibinger Titanium Implant System Leibinger 3D plate Titanium 1.2x11-12mm, 0.55mm height Only to be funded where
used in a service for
which a Medicare Benefit
is payable
ST151 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone 4 holes, 0.55mm height Only to be funded where
plate: regular Titanium used in a service for
which a Medicare Benefit
is payable
ST152 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone 4 holes, 6mm, 8mm, 10mm bar, Only to be funded where
plate: with bar Titanium 0.55mm height used in a service for
which a Medicare Benefit
is payable
ST153 Leibinger Titanium Implant System Leibinger Steinhauser plate: long 4 holes, 0.55mm height Only to be funded where
with bar Titanium used in a service for
which a Medicare Benefit
is payable
ST154 Leibinger Titanium Implant System Leibinger Mini Wurzburg Bone 6 holes, 0.55mm height Only to be funded where
plate: regular Titanium used in a service for
which a Medicare Benefit
is payable
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