Medicare Benefits Schedule - Note TN.8.145

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Category 3 - THERAPEUTIC PROCEDURES

TN.8.145

Anterior column fusion, with or without implant, or limited vertebrectomy (less than 50%) and anterior fusion (cervical, thoracic and lumbar) - Items 51041 to 51045

Items 51041 to 51045 are for services which include placement of local morcellized, artificial, harvested bone graft, bone morphogenic protein (BMP) and prosthetic devices into the invertebral space. Artificial bone grafting materials must be used in accordance with the manufacturer’s instructions.

Items 51041 to 51045 are to be selected irrespective of surgical approach (anterior, direct lateral or posterior via open or minimally invasive techniques).

For instrumented spinal fusion with interbody and posterolateral bone graft (with or without cages) and decompression, four item numbers are selected: one from one from 51011 to 51015, one from 51020 to 51026, one from 51031 to 51036 and one from 51041 to 51045.

For and instrumented anterior cervical decompression and fusion, (with or without cage) three items are selected: one from 51011 to 51015, one from 51020 to 51026, and one from 51041 to 51045.

Items 51041 to 51045 cannot be claimed with any item between 51051 and 51059 if performed at the same motion segment.

If an assisting surgeon is used at any time during the procedure, then 51160 or 51165 should be used in isolation by the assisting surgeon. If the assisting surgeon needs to perform complex non-spinal surgery, they may use a more appropriate item from outside the spinal surgery schedule.

Related Items: 51041 51042 51043 51044 51045


Related Items

Category 3 - THERAPEUTIC PROCEDURES

51041

51041 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), one motion segment, not being a service associated with a service to which item 51042, 51043, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $1,116.50 Benefit: 75% = $837.40

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51042

51042 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 2 motion segments, not being a service associated with a service to which item 51041, 51043, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $1,563.15 Benefit: 75% = $1,172.40

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51043

51043 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 3 motion segments, not being a service associated with a service to which item 51041, 51042, 51044 or 51045 applies

(Anaes.) (Assist.)

Fee: $1,953.95 Benefit: 75% = $1,465.50

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51044

51044 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 4 motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51045 applies

(Anaes.) (Assist.)

Fee: $2,121.40 Benefit: 75% = $1,591.05

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)

Category 3 - THERAPEUTIC PROCEDURES

51045

51045 - Additional Information

Item Start Date:
01-Nov-2018
Description Updated:
01-Nov-2018
Schedule Fee Updated:
01-Jul-2020

Spinal fusion, anterior column (anterior, direct lateral or posterior interbody), 5 or more motion segments, not being a service associated with a service to which item 51041, 51042, 51043 or 51044 applies

(Anaes.) (Assist.)

Fee: $2,233.05 Benefit: 75% = $1,674.80

(See para TN.8.141, TN.8.145 of explanatory notes to this Category)


Legend

  • Assist - Addition/Deletion of (Assist.)
  • Amend - Amended Description
  • Anaes - Anaesthetic Values Amended
  • Emsn - EMSN Change
  • Fee - Fee Amended
  • Renum - Item Number Change (renumbered)
  • New - New Item
  • NewMin - New Item (previous Ministerial Determination)
  • Qfe - QFE Change