Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST265 Leibinger Titanium Implant System Leibinger Bridging plate: straight 14 holes Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
ST266 Leibinger Titanium Implant System Leibinger Bridging plate: straight 17 holes Only to be funded where
Titanium used in a service for
which a Medicare Benefit
is payable
ST267 Leibinger Titanium Implant System Leibinger Bridging plate: angled, 4 +8 holes Only to be funded where
right/left Titanium used in a service for
which a Medicare Benefit
is payable
ST268 Leibinger Titanium Implant System Leibinger Bridging plate: angled, 4 +11 holes Only to be funded where
right/left Titanium used in a service for
which a Medicare Benefit
is payable
ST269 Leibinger Titanium Implant System Leibinger Bridging plate: angled, 4 +14 holes Only to be funded where
right/left Titanium used in a service for
which a Medicare Benefit
is payable
ST270 Leibinger Titanium Implant System Leibinger Full Mandibular Bridging 4 +17 + 4 holes Only to be funded where
plate Titanium used in a service for
which a Medicare Benefit
is payable
ST271 Leibinger Titanium Implant System Leibinger Full Mandibular Bridging 4 +19 + 4 holes Only to be funded where
plate Titanium used in a service for
which a Medicare Benefit
is payable
ST289 Leibinger Titanium Implant System Titanium Osteosynthesis and 8 holes, pack of 1 Only to be funded where
Reconstruction plate: straight used in a service for
which a Medicare Benefit
is payable
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