Medicare Benefits Schedule - Note TN.8.286

A 'complex hip arthroplasty' procedure is one that requires additional pre-operative planning or interoperative management that extends beyond a traditional hip arthroplasty, secondary to underlying abnormalities with bone or soft tissue or systemic health issues. This may include, but is not limited to:

• patients with previous hip surgery or fractures;
• femoral head dysplasia or deformities;
• known skeletal dysplasia or neuromuscular conditions; or
• the presence of infection.

Related Items: 49318 49321

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Multiple Operation Rule

Total arthroplasty of hip, including minor bone grafting (if performed), other than a service associated with a service to which item 48245, 48248, 48251, 48254 or 48257 applies (H)

(Anaes.) (Assist.)

Fee: $1,450.55 Benefit: 75% = $1,087.95

(See para TN.8.191, TN.8.286 of explanatory notes to this Category)

Multiple Operation Rule

Complex primary arthroplasty of hip, with internal fixation, including either or both of the following (if performed):

(a) structural bone graft;

(b) insertion of synthetic substitutes or metal augments;

other than a service associated with a service to which item 48245, 48248, 48251, 48254 or 48257 applies (H)

(Anaes.) (Assist.)

Fee: $1,761.80 Benefit: 75% = $1,321.35

(See para TN.8.286 of explanatory notes to this Category)