Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST219 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 5 holes, with 10mm bar Only to be funded where
T-shape, narrow Titanium used in a service for
which a Medicare Benefit
is payable
ST220 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 6 holes Only to be funded where
double-T-shape, narrow Titanium used in a service for
which a Medicare Benefit
is payable
ST221 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 5 holes Only to be funded where
Y-shape, regular Titanium used in a service for
which a Medicare Benefit
is payable
ST222 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 5 holes, with 8mm bar Only to be funded where
Y-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST223 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 5 holes, with 12mm bar Only to be funded where
Y-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST224 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 6 holes Only to be funded where
double-Y-shape, regular Titanium used in a service for
which a Medicare Benefit
is payable
ST225 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 6 holes, with 8mm bar Only to be funded where
double-Y-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST226 Leibinger Titanium Implant System Leibinger Mini Wurzburg Flexplate: 7 holes Only to be funded where
double-Y-shape, regular Titanium used in a service for
which a Medicare Benefit
is payable
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