Medicare Benefits Schedule - Note ON.4.10

There are two maxillae in the skull and for the purpose of these items the mandible is regarded as comprising two bones.  

Hence a bilateral fracture of the mandible would be assessed as:

· Item 53409 x 1½;

· two maxillae and one side of the mandible as Item 53406 x 1½ + 53409 x ¼. 

Splinting in Item 53406 or 53409 refers to cap splints, arch bars, silver (cast metal) or acrylic splints.

Related Items: 53400 53403 53406 53409 53410 53411 53412 53413 53414 53415 53416 53418 53419 53422 53423 53424 53425 53427 53429 53439

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MAXILLA, unilateral or bilateral, treatment of fracture of, not requiring splinting

Fee: $142.15 Benefit: 75% = $106.65 85% = $120.85

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, not requiring splinting

Fee: $173.75 Benefit: 75% = $130.35 85% = $147.70

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation

(Anaes.) (Assist.)

Fee: $447.55 Benefit: 75% = $335.70 85% = $380.45

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring  splinting, wiring of teeth, circumosseous fixation or external fixation

(Anaes.) (Assist.)

Fee: $447.55 Benefit: 75% = $335.70 85% = $380.45

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, not requiring surgical reduction

Fee: $94.25 Benefit: 75% = $70.70 85% = $80.15

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction by a temporal, intra-oral or other approach

(Anaes.)

Fee: $262.85 Benefit: 75% = $197.15 85% = $223.45

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site

(Anaes.) (Assist.)

Fee: $431.60 Benefit: 75% = $323.70 85% = $366.90

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites

(Anaes.) (Assist.)

Fee: $528.75 Benefit: 75% = $396.60 85% = $449.45

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites

(Anaes.) (Assist.)

Fee: $607.40 Benefit: 75% = $455.55 85% = $516.30

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction

(Anaes.) (Assist.)

Fee: $479.55 Benefit: 75% = $359.70 85% = $407.65

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction

(Anaes.) (Assist.)

Fee: $479.55 Benefit: 75% = $359.70 85% = $407.65

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s)

(Anaes.) (Assist.)

Fee: $623.40 Benefit: 75% = $467.55 85% = $529.90

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s)

(Anaes.) (Assist.)

Fee: $623.40 Benefit: 75% = $467.55 85% = $529.90

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction and internal fixation involving plate(s)

(Anaes.) (Assist.)

Fee: $791.10 Benefit: 75% = $593.35 85% = $692.40

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation involving plate(s)

(Anaes.) (Assist.)

Fee: $791.10 Benefit: 75% = $593.35 85% = $692.40

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s)

(Anaes.) (Assist.)

Fee: $678.70 Benefit: 75% = $509.05 85% = $580.00

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s)

(Anaes.) (Assist.)

Fee: $678.70 Benefit: 75% = $509.05 85% = $580.00

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s)

(Anaes.) (Assist.)

Fee: $927.05 Benefit: 75% = $695.30 85% = $828.35

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s)

(Anaes.) (Assist.)

Fee: $927.05 Benefit: 75% = $695.30 85% = $828.35

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a closed fracture of, involving a joint surface

(Anaes.)

Fee: $262.85 Benefit: 75% = $197.15 85% = $223.45

(See para ON.4.10 of explanatory notes to this Category)