Medicare Benefits Schedule - Note TN.8.267

Item 45609 applies when in conjunction with a bone-containing free flap (i.e. in association with items 46060 to 46068).

Related Items: 45609 46060 46062 46064 46066 46068

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Multiple Operation Rule

Mandible, maxilla or skull base, reconstruction of, using bony free flap, all osteotomies, shaping, inset and fixation by any means, including all necessary 3 dimensional planning, if performed in conjunction with one or more services covered by items 46060 to 46068 (H)

(Anaes.) (Assist.)

Fee: $910.65 Benefit: 75% = $683.00

(See para TN.8.267 of explanatory notes to this Category)

Multiple Operation Rule

Free transfer of tissue with a vascularised bone component (including chimeric/composite flap), for the repair of major defect of the head or neck or other non-breast defect, all necessary elements of the operation, including (but not limited to):
(a) anastomoses of all required vessels using microvascular techniques; and
(b) harvesting of flap (including osteotomies); and
(c) raising of tissue on a vascular pedicle; and
(d) preparation of recipient vessels; and
(e) transfer of tissue, including fixation of bony element and inset of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than the following:
(g) bony reshaping for purposes of reconstruction of maxilla, mandible or skull base;
(h) a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies
Single surgeon (H)

(Anaes.) (Assist.)

Fee: $2,930.10 Benefit: 75% = $2,197.60

(See para TN.8.267 of explanatory notes to this Category)

Multiple Operation Rule

Free transfer of tissue with a vascularised bone component (including chimeric/composite flap), for the repair of major defect of the head or neck or other non-breast defect, all necessary elements of the operation, including (but not limited to):
(a) anastomoses of all required vessels using microvascular techniques; and
(b) harvesting of flap (including osteotomies); and
(c) raising of tissue on a vascular pedicle; and
(d) preparation of recipient vessels; and
(e) transfer of tissue, including fixation of bony element and inset of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than the following:
(g) bony reshaping for purposes of reconstruction of maxilla, mandible or skull base;
(h) a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies
Conjoint surgery, principal specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $2,802.75 Benefit: 75% = $2,102.10

(See para TN.8.267 of explanatory notes to this Category)

Multiple Operation Rule

Free transfer of tissue with a vascularised bone component (including chimeric/composite flap), for the repair of major defect of the head or neck or other non-breast defect, all necessary elements of the operation, including (but not limited to):
(a) anastomoses of all required vessels using microvascular techniques; and
(b) harvesting of flap (including osteotomies); and
(c) raising of tissue on a vascular pedicle; and
(d) preparation of recipient vessels; and
(e) transfer of tissue, including fixation of bony element and inset of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than the following:
(g) bony reshaping for purposes of reconstruction of maxilla, mandible or skull base;
(h) a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies
Conjoint surgery, conjoint specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $2,102.15 Benefit: 75% = $1,576.65

(See para TN.8.267 of explanatory notes to this Category)

Multiple Operation Rule

Double free flap, including one free transfer of tissue with a vascularized bone component, for the repair of major defect of the head or neck or other non-breast defect, all necessary elements of the operation, including (but not limited to):
(a) anastomoses of all required vessels using microvascular techniques; and
(b) harvesting of flap (including osteotomies); and
(c) raising of tissue on a vascular pedicle; and
(d) preparation of recipient vessels; and
(e) transfer of tissue, including fixation of bony element and inset of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than the following:
(g) bony reshaping for purposes of reconstruction of maxilla, mandible or skull base;
(h) a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies
Conjoint surgery, principal specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $4,204.05 Benefit: 75% = $3,153.05

(See para TN.8.267 of explanatory notes to this Category)

Multiple Operation Rule

Double free flap, including one free transfer of tissue with a vascularized bone component, for the repair of major defect of the head or neck or other non-breast defect, all necessary elements of the operation, including (but not limited to):
(a) anastomoses of all required vessels using microvascular techniques; and
(b) harvesting of flap (including osteotomies); and
(c) raising of tissue on a vascular pedicle; and
(d) preparation of recipient vessels; and
(e) transfer of tissue, including fixation of bony element and inset of tissue at recipient site; and
(f) direct repair of secondary cutaneous defect, if performed;
other than the following:
(g) bony reshaping for purposes of reconstruction of maxilla, mandible or skull base;
(h) a service associated with a service to which item 30166, 30169, 30175, 30176, 30177, 30179, 45501, 45502, 45504, 45505 or 45562 applies
Conjoint surgery, conjoint specialist surgeon (H)

(Anaes.) (Assist.)

Fee: $3,153.25 Benefit: 75% = $2,364.95

(See para TN.8.267 of explanatory notes to this Category)