Medicare Benefits Schedule - Note ON.4.10

There are two maxillae in the skull and for the purpose of these items the mandible is regarded as comprising two bones.  

Hence a bilateral fracture of the mandible would be assessed as:

· Item 53409 x 1½;

· two maxillae and one side of the mandible as Item 53406 x 1½ + 53409 x ¼. 

Splinting in Item 53406 or 53409 refers to cap splints, arch bars, silver (cast metal) or acrylic splints.

Related Items: 53400 53403 53406 53409 53410 53411 53412 53413 53414 53415 53416 53418 53419 53422 53423 53424 53425 53427 53429 53439

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MAXILLA, unilateral or bilateral, treatment of fracture of, not requiring splinting

Fee: $147.15 Benefit: 75% = $110.40 85% = $125.10

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, not requiring splinting

Fee: $179.85 Benefit: 75% = $134.90 85% = $152.90

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring splinting, wiring of teeth, circumosseous fixation or external fixation

(Anaes.) (Assist.)

Fee: $463.20 Benefit: 75% = $347.40 85% = $393.75

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring  splinting, wiring of teeth, circumosseous fixation or external fixation

(Anaes.) (Assist.)

Fee: $463.20 Benefit: 75% = $347.40 85% = $393.75

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, not requiring surgical reduction

Fee: $97.55 Benefit: 75% = $73.20 85% = $82.95

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction by a temporal, intra-oral or other approach

(Anaes.)

Fee: $272.05 Benefit: 75% = $204.05 85% = $231.25

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation at 1 site

(Anaes.) (Assist.)

Fee: $446.70 Benefit: 75% = $335.05 85% = $379.70

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 2 sites

(Anaes.) (Assist.)

Fee: $547.25 Benefit: 75% = $410.45 85% = $465.20

(See para ON.4.10 of explanatory notes to this Category)

ZYGOMATIC BONE, treatment of fracture of, requiring surgical reduction and involving internal or external fixation or both at 3 sites

(Anaes.) (Assist.)

Fee: $628.65 Benefit: 75% = $471.50 85% = $534.40

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction

(Anaes.) (Assist.)

Fee: $496.35 Benefit: 75% = $372.30 85% = $421.90

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction

(Anaes.) (Assist.)

Fee: $496.35 Benefit: 75% = $372.30 85% = $421.90

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s)

(Anaes.) (Assist.)

Fee: $645.20 Benefit: 75% = $483.90 85% = $548.45

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation not involving plate(s)

(Anaes.) (Assist.)

Fee: $645.20 Benefit: 75% = $483.90 85% = $548.45

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of fracture of, requiring open reduction and internal fixation involving plate(s)

(Anaes.) (Assist.)

Fee: $818.80 Benefit: 75% = $614.10 85% = $720.10

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of fracture of, requiring open reduction and internal fixation involving plate(s)

(Anaes.) (Assist.)

Fee: $818.80 Benefit: 75% = $614.10 85% = $720.10

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s)

(Anaes.) (Assist.)

Fee: $702.45 Benefit: 75% = $526.85 85% = $603.75

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction not involving plate(s)

(Anaes.) (Assist.)

Fee: $702.45 Benefit: 75% = $526.85 85% = $603.75

(See para ON.4.10 of explanatory notes to this Category)

MAXILLA, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s)

(Anaes.) (Assist.)

Fee: $959.50 Benefit: 75% = $719.65 85% = $860.80

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a complicated fracture of, involving viscera, blood vessels or nerves, requiring open reduction involving the use of plate(s)

(Anaes.) (Assist.)

Fee: $959.50 Benefit: 75% = $719.65 85% = $860.80

(See para ON.4.10 of explanatory notes to this Category)

MANDIBLE, treatment of a closed fracture of, involving a joint surface

(Anaes.)

Fee: $272.05 Benefit: 75% = $204.05 85% = $231.25

(See para ON.4.10 of explanatory notes to this Category)