Medicare Benefits Schedule - Note TN.8.287

Bone grafting is a mandatory component of item 48919 and should not be separately claimed. Where the only bone grafting performed is minor grafting within the surgical site of the shoulder replacement, 48918 is the appropriate item.

A bone graft harvested from the excised humeral head and inserted into the glenoid during a shoulder replacement procedure is not considered to be minor grafting and will allow the requirements of this item to be met.

Related Items: 48918 48919

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Multiple Operation Rule

Anatomic or reverse total shoulder replacement, including any of the following (if performed):

(a) associated rotator cuff repair;

(b) biceps tenodesis;

(c) tuberosity osteotomy;

other than a service associated with a service to which another item in this Schedule applies if the service described in the other item is for the purpose of performing a procedure on the shoulder region by open or arthroscopic means (H)

(Anaes.) (Assist.)

Fee: $1,658.20 Benefit: 75% = $1,243.65

(See para TN.8.287 of explanatory notes to this Category)

Multiple Operation Rule

Anatomic or reverse total shoulder replacement with bone graft, including any of the following (if performed):

(a) associated rotator cuff repair;

(b) biceps tenodesis;

(c) tuberosity osteotomy;

other than a service associated with:

(d) a service to which another item in this Schedule applies that is performed on the shoulder region by open or arthroscopic means; or

(e) a service to which item 48245, 48248, 48251, 48254 or 48257 applies that is performed on the same joint

(H)

(Anaes.) (Assist.)

Fee: $1,877.60 Benefit: 75% = $1,408.20

(See para TN.8.287 of explanatory notes to this Category)