Schedule 5 - Appendix A - Surgically Implanted Prostheses

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UROGENITAL Billing Code Product Further Size Notations Medtronic Australasia Pty Ltd Electrodes, Dorsal Column MC180 Sacral Nerve Stimulation Unilateral Interstim Temporary test stimulation 28 cm lead. (Medtronic model # 3080 and 3886 Sacral Nerve Stimulation Lead). Platinum / Iridium, Electrodes, Neuromuscular Stimulator MC175 Neo-anal sphincter stimulator implant Implantable intramuscular assist 35-50 cm lead, Dynamic Graciloplasty Lead. Platinum iridium, polyurethane, Stimulators, Neuromuscular, Functional MC186 Sacral Nerve Stimulation Accessories Model 041827-002 Auxiliary One size only; 9-12.5cm Only to be used with screener cable kit. Polypropylene. Medtronic Itrel II pulse OR Model 041828-002 Foramen generator, model 7424. Needle (box of 6). Sterile individual units. Stainless steel. Stimulators, Urinary MC188 Sacral Nerve Stimulation Unilateral Activator. Model 3031. One size only Only to be used with Medtronic Itrel II pulse generator, model 7424. Mentor Medical Systems Anchor, Fixation MN009 CINCH Bladder Neck Suspension Anchor fixation device 4mm Anchors Anchor Prostheses, Penile MN005 Inflatable Penile Prostheses-Implant Saline filled penile implant 10cm,12,14,16,18,20,22. When provided in Start-Up Pack association with Medicare Benefits Schedule Item 37429, Page 594 of 638
UROGENITAL Billing Code Product Further Size Notations MN006 Malleable Penile Prostheses Malleable rod implant 9ml,11ml and 13ml When provided in association with Medicare Benefits Schedule Item 37429, Prostheses, Testicle MN007 # Testicular Prosthesis Saline and gel filled implant Small, Medium, Large When provided in association with Medicare Benefits Schedule Item 45051 preparatory to a subsequent surgical service not precluded from Prostheses, Urethral Sphincter MN008 Urethrin Teflon Paste Kit Female or male kit One size only Monarch Medical Stents, Ureteral MH002 Ureteral Stents Soft vertex, hydrophilically coated 7/10F only, length 20, 22, 24, 26, with radiopaque markers 28, 30cm N Stenning & Co Pty Ltd Stents, Ureteral NG001 Ureteric Stent Ureteric Stent Set with Guidewire 5Fr 22-30cm, 6Fr 22-30cm, 7Fr and Pusher 22-30cm, 8Fr 22-30cm NG002 Ureteric Stent Ureteric Stent Set with Guidewire 4.7Fr: 22, 24, 26, 28, 30cm, 4Fr: 22, and Pusher; 24, 26, 28, 30cm, 5Fr: 22, 24, 26, 28, 30cm, 6Fr: 22, 24, 26, 28, 30cm, 7Fr: 22, 24, 26, 28, 30cm, 8Fr: 22, 24, 26, 28, 30cm, 9Fr: 22, 24, 26, 28, 30cm, 10Fr: 22, 24, 26, 28, NG003 Ureteric Stent Ureteric Stent and Pusher only; 5Fr 22-30cm, 6Fr 22-30cm, 7Fr aliphatic polyurathane 22-30cm, 8Fr 22-30cm Page 595 of 638
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Schedule 5 - Appendix A - Surgicall
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CARDIO-THORACIC Billing Code Produc
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EAR, NOSE & THROAT Billing Code Pro
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ENDOSCOPIC PRODUCTS Billing Code Pr
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GENERAL/MISCELLANEOUS Billing Code
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MECHANICAL INTERNAL WOUND CLOSURE B
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NEUROSURGICAL Billing Code Product
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OPHTHALMIC Billing Code Product Fur
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ORTHOPAEDIC Billing Code Product Fu
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PLASTIC AND RECONSTRUCTIVE Billing
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Page 543 and 544: PLASTIC AND RECONSTRUCTIVE Billing
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Page 601 and 602: VASCULAR Billing Code Product Furth
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Schedule 5 - Appendix A - Surgically Implanted Prostheses

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