Schedule 5 - Appendix A - Surgically Implanted Prostheses

PLASTIC AND RECONSTRUCTIVE
Billing Code Product Further Size Notations
ST484 Wurzburg Bone Plates Wurzburg Bone plate: L-shape, 4 holes Only to be funded where
regular/long/medium, right/left, used in a service for
with/without bar Titanium which a Medicare Benefit
is payable
ST485 Wurzburg Bone Plates Wurzburg Bone plate: L-shape, long 5 holes Only to be funded where
bar/ extended long, right/left used in a service for
which a Medicare Benefit
is payable
ST486 Wurzburg Bone Plates Wurzburg Bone plate: T-shape, 5, 6 holes Only to be funded where
with/without bar, 90 deg, used in a service for
regular/long Titanium which a Medicare Benefit
is payable
ST487 Wurzburg Bone Plates Wurzburg Bone plate: T-shape, 5 holes Only to be funded where
long, 80 deg, long, right/left used in a service for
which a Medicare Benefit
is payable
ST488 Wurzburg Bone Plates Wurzburg Bone plate: Y-shape 5 holes Only to be funded where
plate, regular/long Titanium used in a service for
which a Medicare Benefit
is payable
ST489 Wurzburg Bone Plates Wurzburg Bone plate: Z-shape plate, 4 holes Only to be funded where
100/110 deg, right/left Titanium used in a service for
which a Medicare Benefit
is payable
ST490 Wurzburg Bone Plates Wurzburg Bone Screws: 2x4-19mm, 2.3x7-9mm. Pack of 10 Only to be funded where
self-tapping Titanium used in a service for
which a Medicare Benefit
is payable
ST491 Wurzburg Bone Plates Leibinger 3D Plating System: 2x2 holes Only to be funded where
square Titanium used in a service for
which a Medicare Benefit
is payable
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