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: $154.60 Benefit: 75% = $115.95 85% = $131.45

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

MANDIBLE, treatment of fracture of, not requiring splinting

Fee: $188.95 Benefit: 75% = $141.75 85% = $160.65

(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 (H)

(Anaes.) (Assist.)

Fee: $486.65 Benefit: 75% = $365.00

(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 (H)

(Anaes.) (Assist.)

Fee: $486.65 Benefit: 75% = $365.00

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

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

Fee: $102.50 Benefit: 75% = $76.90 85% = $87.15

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

Zygomatic bone, treatment of fracture of, requiring surgical reduction, by temporal, intra‑oral or other approach (H)

(Anaes.)

Fee: $285.85 Benefit: 75% = $214.40

(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 one site (H)

(Anaes.) (Assist.)

Fee: $469.30 Benefit: 75% = $352.00

(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 (H)

(Anaes.) (Assist.)

Fee: $574.95 Benefit: 75% = $431.25

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

Zygomatic bone, treatment of, requiring surgical reduction and involving internal or external fixation or both at 3 sites (H)

(Anaes.) (Assist.)

Fee: $660.50 Benefit: 75% = $495.40

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

Maxilla, treatment of fracture of, requiring open reduction (H)

(Anaes.) (Assist.)

Fee: $521.45 Benefit: 75% = $391.10

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

Mandible, treatment of fracture of, requiring open reduction (H)

(Anaes.) (Assist.)

Fee: $521.45 Benefit: 75% = $391.10

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

Maxilla, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (H)

(Anaes.) (Assist.)

Fee: $677.90 Benefit: 75% = $508.45

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

Mandible, treatment of fracture of, requiring open reduction and internal fixation not involving a plate (H)

(Anaes.) (Assist.)

Fee: $677.90 Benefit: 75% = $508.45

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

Maxilla, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H)

(Anaes.) (Assist.)

Fee: $860.25 Benefit: 75% = $645.20

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

Mandible, treatment of fracture of, requiring open reduction and internal fixation involving a plate (H)

(Anaes.) (Assist.)

Fee: $860.25 Benefit: 75% = $645.20

(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 a plate (H)

(Anaes.) (Assist.)

Fee: $738.00 Benefit: 75% = $553.50

(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 a plate (H)

(Anaes.) (Assist.)

Fee: $738.00 Benefit: 75% = $553.50

(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 a plate (H)

(Anaes.) (Assist.)

Fee: $1,008.10 Benefit: 75% = $756.10

(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 a plate (H)

(Anaes.) (Assist.)

Fee: $1,008.10 Benefit: 75% = $756.10

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

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

(Anaes.)

Fee: $285.85 Benefit: 75% = $214.40 85% = $243.00

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