Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST338 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: 8 holes, 0.55mm profile Only to be funded where
L-shape, right/left Titanium used in a service for
which a Medicare Benefit
is payable
ST339 Leibinger Titanium Implant System Leibinger Low Profile Bone Plate: 5, 7, 9 holes, 0.55mm profile Only to be funded where
T-shape, double-T-shape, right/left, used in a service for
90 deg Titanium which a Medicare Benefit
is payable
ST340 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: 4, 8, 9 holes, 0.55mm profile Only to be funded where
X-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST341 Leibinger Titanium Implant System Leibinger Micro Bone Plate: 6 holes, 0.55mm profile Only to be funded where
Y-shape, double-Y-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST342 Leibinger Titanium Implant System Leibinger Steinhauser Bone Plate: 8 holes, 0.55mm profile Only to be funded where
Y-shape Titanium used in a service for
which a Medicare Benefit
is payable
ST343 Leibinger Titanium Implant System Leibinger 3D Plating System: micro 3 holes Only to be funded where
triangular plate Titanium used in a service for
which a Medicare Benefit
is payable
ST344 Leibinger Titanium Implant System Leibinger 3D Plating System: micro 8 holes Only to be funded where
circular plate Titanium used in a service for
which a Medicare Benefit
is payable
ST347 Leibinger Titanium Implant System Leibinger Dumbach Mesh System: One size only Only to be funded where
large mandibular segment, right/left used in a service for
Titanium which a Medicare Benefit
is payable
Page 556 of 638