Schedule 5 - Appendix A - Surgically Implanted Prostheses

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VASCULAR Billing Code Product Further Size Notations ET008 Embospheres - .5ml per implant ET033 Nit-Occlud Coil System System for transcatheter occlusions Dia 4 x 4mm - 14 x 6mm of PDA with spiral coils. Includes Nit-Occlud spiral coil with deployment handle Occluders, Vascular ET027 Duct-Occlud Spiral Coil Stainless Steel Spiral Coil Standard - 4 x 3,4, 5mm; Standard - 5 x 6,7 mm; Standard - 6 x 7 mm; Reinforced - 5 x 7mm; Reinforced - 6 x 9,11 mm Stents ET023 IntraStent Expandable Stent Stainless Steel 2.8 x 10,16,26,36,56, 76 mm ET029 Vivant Z Stent Coronary stent made of alloyed Dia 2.5 - 4.0mm, length 9 - 28mm medical grade stainless steel Stents, Vascular ET022 Intracoil Stent Nickel titanium alloy 40 x 4,5,6,7,8 mm ET024 Optimed Tips Sinus Stent Sinus-wave nitinol stent 10-12mm x 50-90 mm ET025 Optimed Iliac Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm ET026 Optimed Femoral Sinus Stent Sinus-wave nitinol stent 4-12mm x 30-100mm ET030 Aspire Covered Stent Expandible Nitinol Stent covered Dia 6-14mm, Length 2.5-10cm with ePTFE ET037 SX-Ella Endovascular Stent Uncovered, self-expanding nitinol Dia 6-16mm, length 22-77mm Five Corners Pty Ltd Stents, Vascular FC001 Endoluminal Stent Graft and Delivery Multiple sizes of stent graft on Dia 15-27mm, Length 87-189mm System pre-loaded catheter shaft for delivery and deployment, comprised of Pet & Nitinol Page 614 of 638
VASCULAR Billing Code Product Further Size Notations Getz Bros. & Co. (Aust) Pty Ltd Embolization <strong>Prostheses</strong>, Intravascular GB084 Micrus ACT Platinum Microcoil Platinum/tungsten alloy wire Spherical 2 - 20mm, Helical 2mm x Delivery System 2cm - 10mm x 30cm Filters, Vena Cava GB027 Amplatzer Vena Cava Filter Blood filter One size only Grafts, Vascular, Synthetic GB009 Intervascular Vascular Grafts Ultra Low Porosity Woven - 6mm x 40cm - 38mm x 40cm GB010 Intervascular Vascular Grafts Ultra Low Porosity Woven 12mm x 6mm - 24mm x 12mm GB011 Intervascular Vascular Grafts Low Porosity Woven Straight 6mm x 60 cm - 24mm x 40cm GB012 Intervascular Vascular Grafts Low Porosity Woven Bifurcated 12mm x 6mm - 24mm x 12mm GB013 Intervascular Vascular Grafts Ochsner 200 Woven Straight 8mm x 60cm - 22mm x 60cm GB014 Intervascular Vascular Grafts Ochsner 200 Woven Bifurcated 16mm x 8mm - 22mm x 11mm GB015 Intervascular Vascular Grafts Micron Knitted Graft Bifurcated 16mm x 8mm GB016 Micron Carotid Patches Synthetic 6 x 75mm - 14 x 75mm <strong>Prostheses</strong>, Blood Vessel, Biological GB017 Intergard W Woven Straight 6mm x 30cm - 38mm x 30cm GB018 Intergard W Woven Bifurcated 18mm x 9mm - 24mm x 12mm GB019 Intergard W Woven Aortic Arch 24mm x 10mm x 8mm x 8mm x 50cm - 30mm x 10mm x 8mm x 8mm GB020 Intergard K Knitted Straight 6mm x 40cm - 24mm x 40cm GB021 Intergard K Knitted Bifurcated 12mm x 6mm - 24mm x 12mm GB022 Intergard K Knitted Radially Supported 6mm x 70cm - 8mm x 60cm GB023 Intergard K Knitted Axillobifemoral Diameter (mm) Length (cm) 8 x 8 100/60; 10 x 10 100/60; 8 x 6 x 6 85/55; 8 x 8 85/55; 8 x 8 100/55 Page 615 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 563 and 564: PLASTIC AND RECONSTRUCTIVE Billing
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Schedule 5 - Appendix A - Surgically Implanted Prostheses

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