Medicare Benefits Schedule - Note TN.8.282

Items 48456 includes bone grafting as a mandatory component. The nature of the bone grafting required should be consistent with items 48248-48257.

Items 46401 and 48456 are both for the operative treatment of non-union of the phalanx or metacarpal of hand. 46401 should be claimed where no bone grafting meeting the threshold of 48248-48257 has been performed.

Item 48456 is 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 item 48456 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.

Item 48456 is not inclusive of additional procedures required for the treatment of osteomyelitis. In circumstances where patients require additional surgical treatment for osteomyelitis in the hand, item 43527 can also be claimed.

Item 48456 is claimable once per bone treated.

Related Items: 46401 48248 48251 48254 48257 48456

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Multiple Operation Rule

Operative treatment of non-union of phalanx or metacarpal of hand, including internal fixation (if performed)

(Anaes.) (Assist.)

Fee: $457.45 Benefit: 75% = $343.10 85% = $388.85

(See para TN.8.190, TN.8.282 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of non-union or malunion of fracture of hand, distal to wrist, 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.8.282 of explanatory notes to this Category)

Multiple Operation Rule

Harvesting and insertion of bone graft (autograft) via separate incisions, including internal fixation of the graft or fusion fixation (or both) (H)

(Anaes.) (Assist.)

Fee: $533.15 Benefit: 75% = $399.90

(See para TN.8.177, TN.8.282 of explanatory notes to this Category)

Multiple Operation Rule

Harvesting and insertion of osteochondral graft (autograft) via separate incisions at the same joint or joint complex (H)

(Anaes.) (Assist.)

Fee: $438.75 Benefit: 75% = $329.10

(See para TN.8.177, TN.8.282 of explanatory notes to this Category)

Multiple Operation Rule

Harvesting and insertion of pedicled bone flap (autograft), including internal fixation of the bone flap (if performed), other than a service associated with a service to which item 45562, 45504 or 45505 applies (H)

(Anaes.) (Assist.)

Fee: $1,005.20 Benefit: 75% = $753.90

(See para TN.8.177, TN.8.282 of explanatory notes to this Category)

Multiple Operation Rule

Preparation and insertion of metallic, cortical or other graft substitute (allograft), where substitute is structural cortico-cancellous bone or structural bone (or both), including internal fixation (if performed) (H) 

(Anaes.) (Assist.)

Fee: $438.75 Benefit: 75% = $329.10

(See para TN.8.177, TN.8.178, TN.8.282 of explanatory notes to this Category)