Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST447 Wurzburg Bone Plates Wurzburg Mandibular Fracture 4 holes, 40mm Only to be funded where
plate: 45 deg plate Titanium used in a service for
which a Medicare Benefit
is payable
ST448 Wurzburg Bone Plates Wurzburg Mandibular Fracture 4 holes, 50mm Only to be funded where
plate: 45 deg Titanium used in a service for
which a Medicare Benefit
is payable
ST449 Wurzburg Bone Plates Wurzburg Mandibular Fracture 8 holes, 60mm Only to be funded where
plate: straight Titanium used in a service for
which a Medicare Benefit
is payable
ST450 Wurzburg Bone Plates Wurzburg Mandibular Fracture 8 holes, 70mm Only to be funded where
plate: straight Titanium used in a service for
which a Medicare Benefit
is payable
ST451 Wurzburg Bone Plates Wurzburg Mandibular Fracture 16 holes, 120mm Only to be funded where
plate: straight Titanium used in a service for
which a Medicare Benefit
is payable
ST452 Wurzburg Bone Plates Wurzburg Mandibular Fracture 6 holes Only to be funded where
plate: angled, 60 deg Titanium used in a service for
which a Medicare Benefit
is payable
ST466 Leibinger Titanium Implant System Dynamic Mandibular Bar 33mm Length 97.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST467 Leibinger Titanium Implant System Dynamic Mandibular Bar 48mm Length 112.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
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