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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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GENERAL/MISCELLANEOUS<br />

Billing Code Product Further Size Notations<br />

Infusion Pumps, Patient-Controlled Analgesic<br />

SI034 CADD-PRIZM VIP (Variable Infusion Pump One size only<br />

Profile) Model 6100; CADD-PRIZM<br />

PCS Ambulatory Infusion Pump,<br />

Model 6100<br />

SI039 CADD Legacy PCA Model 6300 Pump One size only<br />

Ambulatory Infusion Pump<br />

Injection/Infusion Ports, Implantable<br />

SI001 Injection/Infusion Ports, Sterile - Port - single lumen One size only<br />

PORT-A-CATH II Trans Arterial<br />

Percuataneous System<br />

SI002 Injection/Infusion Ports, Sterile - Port - single lumen One size only<br />

PORT-A-CATH Intraspinal 501CS<br />

SI003 Injection/Infusion Ports, Sterile - Port - single lumen 1.9 mm O.D. PolyFlow<br />

PORT-A-CATH P.A.S Port T2 System Polyurethane Catheter<br />

SI004 Injection/Infusion Ports, Sterile - Port - single lumen 1.9 mm O.D. PolyFlow<br />

PORT-A-CATH P.A.S Port T2 Fluoro Polyurethane Catheter<br />

Free System<br />

SI005 Injection/Infusion Ports, Sterile - Port - single lumen One size only<br />

PORT-A-CATH Peritoneal System<br />

SI006 Injection/Infusion Ports, Sterile - Port - single lumen One size only<br />

PORT-A-CATH Intraspinal 500CS<br />

SI007 Injection/Infusion Ports, Sterile - Port - single lumen 2.3 mm silicone catheter<br />

PORT-A-CATH Arterial Titanium<br />

SI008 Injection/Infusion Ports, Sterile - Port - single lumen 2.8 mm silicone catheter & 9 French<br />

PORT-A-CATH Titanium Venous introducer set<br />

SI009 Injection/Infusion Ports, Sterile - Port - single lumen 1.9 mm polyurethane catheter<br />

PORT-A-CATH Implantable Venous<br />

Access System<br />

SI010 Injection/Infusion Ports, Sterile - Port - single lumen 1.9mm polyurethane catheter<br />

PORT-A-CATH Implantable Access<br />

System - Venous Portal, with<br />

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