Medicare Benefits Schedule - Note TN.8.281

Items 48446-48454 include bone grafting as a mandatory component. The nature of the bone grafting required should be consistent with items 48248-48257.

These items are inclusive of any bone graft harvesting and insertion, arthrotomy, debridement, osteotomy, removal of hardware, or internal fixation performed on that bone. Claiming a bone grafting item (48245-48257) and non-union item on the same occasion on the same bone is not permitted. This does not prevent MBS items that include bone grafting from being claimed for surgery undertaken on another bone on the same occasion.

These items are not inclusive of additional procedures required for the treatment of osteomyelitis. In circumstances where patients require additional surgical treatment for osteomyelitis, the relevant item numbers (43527, 43530, or 43533) can also be claimed.

These items are claimable once per bone treated. For the purposes of item 48446, repair of non-union or malunion located in the left and/or right side of the pelvic bone, sacrum and coccyx can be claimed as separate bones provided all item requirements are met for each bone.

Related Items: 48446 48448 48450 48452 48454

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Multiple Operation Rule

Treatment of non-union or malunion of fracture of pelvis, including bone graft, and including any of the following (if performed):

(a) arthrotomy;

(b) debridement;

(c) osteotomy;

(d) removal of hardware;

(e) internal fixation;

other than a service associated with a service to which item 48245, 48248, 48251, 48254, 48257 or 47929 applies that is performed on the same bone

—one bone (H)

(Anaes.) (Assist.)

Fee: $1,328.20 Benefit: 75% = $996.15

(See para TN.8.281 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of non-union or malunion of fracture of femur, including bone graft, and including any of the following (if performed):

(a) arthrotomy;

(b) debridement;

(c) osteotomy;

(d) removal of hardware;

(e) internal fixation;

other than a service associated with a service to which item 48245, 48248, 48251, 48254, 48257 or 47929 applies that is performed on the same bone

—one bone (H)

(Anaes.) (Assist.)

Fee: $1,328.20 Benefit: 75% = $996.15

(See para TN.8.281 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of non-union or malunion of fracture of tibia or fibula, proximal to ankle, including bone graft, and including any of the following (if performed):

(a) arthrotomy;

(b) debridement;

(c) osteotomy;

(d) removal of hardware;

(e) internal fixation;

other than a service associated with a service to which item 48245, 48248, 48251, 48254, 48257 or 47929 applies that is performed on the same bone

—one bone (H)

(Anaes.) (Assist.)

Fee: $1,203.80 Benefit: 75% = $902.85

(See para TN.8.281 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of non-union or malunion of fracture of humerus, including bone graft, and including any of the following (if performed):

(a) arthrotomy;

(b) debridement;

(c) osteotomy;

(d) removal of hardware;

(e) internal fixation;

other than a service associated with a service to which item 48245, 48248, 48251, 48254, 48257 or 47929 applies that is performed on the same bone

—one bone (H)

(Anaes.) (Assist.)

Fee: $1,203.80 Benefit: 75% = $902.85

(See para TN.8.281 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of non-union or malunion of fracture of radius, ulna, or carpus including bone graft, and including any of the following (if performed):

(a) arthrotomy;

(b) debridement;

(c) osteotomy;

(d) removal of hardware;

(e) internal fixation;

other than a service associated with a service to which item 48245, 48248, 48251, 48254, 48257 or 47929 applies that is performed on the same bone

—one bone (H)

(Anaes.) (Assist.)

Fee: $892.90 Benefit: 75% = $669.70

(See para TN.8.281 of explanatory notes to this Category)