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Schedule 5 - Appendix A - Surgically Implanted Prostheses

Schedule 5 - Appendix A - Surgically Implanted Prostheses

Schedule 5 - Appendix A - Surgically Implanted Prostheses

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UROGENITAL<br />

Billing Code Product Further Size Notations<br />

<strong>Prostheses</strong>, Testicle<br />

AM015 AMS Testicular <strong>Prostheses</strong> Solid silicone elastomer with suture Small, Medium, Large When provided in<br />

hole association with<br />

Medicare Benefits<br />

<strong>Schedule</strong> Item 45051<br />

preparatory to a<br />

subsequent surgical<br />

service not precluded from<br />

<strong>Prostheses</strong>, Urethral<br />

AM003 Urolume Plus TM Endo Urethral Endourethral wall stent for urethral Range: 1.5 - 4.0cm When provided in<br />

prostheses strictures, DESD and BPH association with<br />

Medicare Benefits<br />

<strong>Schedule</strong> Item Number<br />

<strong>Prostheses</strong>, Urethral Sphincter<br />

AM001 Artificial Urinary Sphincter Cuff, Pump, Pressure Regulating Cuff range: 4 - 11cm Balloon range:<br />

Balloon, Accessory Package, 51 - 80cm<br />

Deactivation Package<br />

AM006 Urovive TM Self Detachable Balloon Uretheral delivery system for Balloon Capacity: 0.9cc<br />

System treatment of urinary stress<br />

incontinence due to ISD<br />

Prosthesis, Bowel Sphincter<br />

AM002 Artificial Bowel Sphincter Cuff, Pump, Pressure Regulating Narrow cuff range: 7 - 14cm,<br />

Balloon, Accessory Package, Standard cuff range: 8 - 14cm<br />

Deactivation Package Balloon range: 71 - 100cm<br />

Screws, Bone<br />

AM010 Influence Bone Screw Bone screw with pre-attached 5.5 x 1.7 mm<br />

polypropylene monofilament suture.<br />

For incinsionless tranvaginal sling<br />

procedure. Loop Screw Bone Screw<br />

AM011 Influence Bone Screw Bone screw with pre-attached 5.5 x 1.7 mm<br />

polypropylene monofilament suture.<br />

For incinsionless tranvaginal sling<br />

procedure. In-Fast Bone Screw<br />

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