Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST468 Leibinger Titanium Implant System Dynamic Mandibular Bar 63mm Length 127.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST469 Leibinger Titanium Implant System Dynamic Mandibular Bar 78mm Length 142.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST470 Leibinger Titanium Implant System Dynamic Mandibular Bar 93mm Length 157.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST471 Leibinger Titanium Implant System Dynamic Mandibular Bar 108mm Length 172.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST472 Leibinger Titanium Implant System Dynamic Mandibular Bar 123mm Length 187.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST473 Leibinger Titanium Implant System Dynamic Mandibular Bar 138mm Length 202.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST474 Leibinger Titanium Implant System Dynamic Mandibular Bar 153mm Length 217.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
ST475 Leibinger Titanium Implant System Dynamic Mandibular Bar 168mm Length 232.5mm Only to be funded where
Reconstruction Bridging Plate used in a service for
which a Medicare Benefit
is payable
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