Medicare Benefits Schedule - Note ON.4.8

The fee and benefit for these items include the various forms of internal or dental fixation, jaw immobilisation, the transposition of nerves and vessels and bone grafts taken from the same site. 

Bone grafts taken from a separate site, e.g. iliac crest, would attract additional benefit under Item 52318 or 52319 for the harvesting, plus item 52130 or 52131 for the grafting. 

Where the site of grafting under item 52131 requires closure by single stage local flap, item 52300 may be claimed where clinically appropriate.  Clinically appropriate in this instance means that the flap is required to close defects because the defect cannot be closed directly. 

A local skin flap is an area of skin or subcutaneous tissue designed to be elevated from the skin adjoining a defect requiring closure.  The flap remains partially attached by pedicle and is moved to the defect by rotation, advancement or transposition, or a combination of these manoeuvres. 

Benefits are only payable where the flap is required for adequate wound closure.  A secondary defect will be created which may be closed by direct suture, skin grafting or sometimes a further local skin flap.  This latter procedure will also attract benefit if closed by graft or flap repair but not been closed by direct suture. 

By definition, direct wound closure (e.g. by suture) does not constitute skin flap.  Similarly, angled, curved or trapdoor incisions which are used for exposure and which are sutured back into the same position relative to the adjacent tissues are not skin flap repairs. Undermining of the edges of the wound prior to suturing is considered a normal part of wound closure and is not considered to skin flap repair. 

For the purposes of these items, a reference to maxilla includes the zygoma.

Related Items: 52342 52345 52348 52351 52354 52357 52360 52363 52366 52369 52372 52375

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MANDIBLE or MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $1,064.15 Benefit: 75% = $798.15

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE or MAXILLA, unilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination

(Anaes.) (Assist.)

Fee: $1,200.10 Benefit: 75% = $900.10

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE or MAXILLA, bilateral osteotomy or osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $1,356.15 Benefit: 75% = $1,017.15

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE or MAXILLA, bilateral osteotomy of osteectomy of, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination

(Anaes.) (Assist.)

Fee: $1,523.05 Benefit: 75% = $1,142.30

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE or MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $1,544.00 Benefit: 75% = $1,158.00

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE or MAXILLA, osteotomies or osteectomies of, involving 3 or more such procedures on the 1 jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination

(Anaes.) (Assist.)

Fee: $1,738.20 Benefit: 75% = $1,303.65

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $1,773.25 Benefit: 75% = $1,329.95

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, osteotomies or osteectomies of, involving 2 such procedures of each jaw, including transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination

(Anaes.) (Assist.)

Fee: $1,994.80 Benefit: 75% = $1,496.10

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $1,950.75 Benefit: 75% = $1,463.10

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of 1 jaw and 2 such procedures of the other jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination

(Anaes.) (Assist.)

Fee: $2,193.40 Benefit: 75% = $1,645.05

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site

(Anaes.) (Assist.)

Fee: $2,128.30 Benefit: 75% = $1,596.25

(See para ON.4.8 of explanatory notes to this Category)

MANDIBLE and MAXILLA, complex bilateral osteotomies or osteectomies of, involving 3 or more such procedures of each jaw, including genioplasty when performed and transposition of nerves and vessels and bone grafts taken from the same site and stabilisation with fixation by wires, screws, plates or pins, or any combination (H)

(Anaes.) (Assist.)

Fee: $2,383.80 Benefit: 75% = $1,787.85

(See para ON.4.8 of explanatory notes to this Category)