Schedule 5 - Appendix A - Surgically Implanted Prostheses

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VASCULAR Billing Code Product Further Size Notations GT173 Gore-tex Vascular Grafts Standard Wall Grafts Tapered Diameter 4-7 mm & 6-8mm, Length 40 - 60cm GT174 Gore-tex Vascular Grafts Ringed Grafts Removable Standard 4-7 mm x 45cm - Rings 10cm Wall/Stretch Wall Tapered (ePTFE) GT175 Gore-tex Vascular Grafts Ringed Grafts Removable Standard 4-7 mm x 70cm - Rings 30cm Wall Tapered (ePTFE) GT176 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Standard & Diameter 6 - 10mm x 30 - 70cm Thin Wall (ePTFE) Length ,Ringed Section 20 - 50cm Lengths GT177 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Thin Wall & Diameter 6 - 10mm x 30 - 70cm Ringed Standard Wall (ePTFE) Length, Ringed Section 20 - 50cm Lengths GT178 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6 - 8mm x 60 - 70cm (ePTFE) Length, Ringed Section 30cm GT179 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 5 - 6mm x 70cm Length, (ePTFE) Ringed Section 60cm Length GT180 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 5 - 6mm x 80cm Length, (ePTFE) Ringed Section 60cm Length GT181 Gore-tex Vascular Ring Graft Ringed Grafts Fixed Standard Wall Diameter 6 - 10mm x 30 - 70cm & Stretch Standard Wall (ePTFE) Lengths, Ringed Section 20 - 50cm Lengths GT182 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6mm, Lengths 80 - 90 cm, (ePTFE) Ringed Section 60cm Length GT183 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 8mm, Lengths 80 - 90 cm, (ePTFE) Ringed Section 70cm Length GT184 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6 - 8mm x 70cm Length, Stretch (ePTFE) Ringed Section 30cm Length GT185 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6mm x 80cm Length, Stretch (ePTFE) Ringed Section 30cm Length GT186 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6mm x 70cm Length, Stretch (ePTFE) Ringed Section 60cm Length Page 632 of 638
VASCULAR Billing Code Product Further Size Notations GT187 Gore-tex Vascular Ring Graft Ringed Grafts Removable Thin Wall Diameter 6 - 8mm x 70cm Length, Stretch (ePTFE) Ringed Section 60 - 70cm Length GT192 Gore-tex Vascular Grafts Standard Wall Grafts Tapered 4.5-6.5mm & 6-8mm Diameter x 70-90cm Lengths GT193 Gore-tex Vascular Grafts Standard Wall Grafts (ePTFE) 6-10mm Diameter x 40cm Length GT194 Gore-tex Vascular Graft Standard wall grafts, tapered Diameter 4.5-7mm, lengths 40-50cm GT195 Gore-tex Vascular Graft Standard wall grafts (ePTFE) Diameter 6mm x 20cm length GT196 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin Diameter 4-6mm x 10-15cm, ringed wall (ePTFE) section 2.5-5cm lengths GT197 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin Diameter 8mm x 30cm, ringed wall (ePTFE) section 20cm length GT198 Gore-tex Vascular Ring Graft Ringed grafts fixed standard/thin Diameter 5-8mm x 60-70cm, ringed wall (ePTFE) section 20-30cm lengths GT199 Gore-tex Vascular Ring Graft Ringed grafts fixed thin wall stretch Diameter 6-8mm x 60-80cm, ringed (ePTFE) section 20-30cm lengths GT200 Gore-tex Vascular Graft Standard wall grafts stretch (ePTFE) Diameter 6-12mm x 20cm length GT211 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall Dia 6-8mm, 40cm radial supported of a stretch thin walled graft length x 40cm length GT212 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall Dia 6-8mm, 60cm radial supported of a stretch thin walled graft length x 60cm length GT213 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall Dia 6-8mm, 80cm radial supported of a stretch thin walled graft length x 80cm length GT214 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall Dia 6mm, 5cm radial supported of a stretch and non-stretch walled length x 45cm length - stretch GT215 Gore-Tex Intering Vascular Graft ePTFE integrated rings in the wall Dia 6mm, 5cm radial supported of a stretch and non-stretch walled length x 45cm length - non-stretch GT216 Gore-tex Axillobifemoral Vascular Stretch vascular graft with Diameter 8mm removable rings (ePTFE) Page 633 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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Schedule 5 - Appendix A - Surgically Implanted Prostheses

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