Medicare Benefits Schedule - Note TN.8.119

Items 50552 and 50560 apply to fractures that may arise during delivery and at an age when anaesthesia poses a significant risk and thus reduction is usually performed in the neonatal unit or nursery. 

Item 50576 provides for closed reduction in the skeletally immature patient and will require application of a hip spica cast and related aftercare. 

Medicare benefits are payable for services that specify reduction with or without internal fixation by open or percutaneous means, where reduction is carried out on the growth plate or joint surface or both.

Related Items: 50508 50512 50524 50528 50532 50536 50540 50544 50548 50552 50556 50560 50564 50568 50572 50576 50580 50584 50588

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Multiple Operation Rule

Treatment of fracture of distal end of radius or ulna (or both), by closed reduction, for a patient with open growth plates

(Anaes.)

Fee: $450.20 Benefit: 75% = $337.65 85% = $382.70

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of distal end of radius or ulna (or both), by open or closed reduction, with internal fixation, for a patient with open growth plates (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by closed reduction (H)

(Anaes.) (Assist.)

Fee: $465.45 Benefit: 75% = $349.10

(See para TN.8.118, TN.8.119, TN.8.190 of explanatory notes to this Category)

Multiple Operation Rule

Radius or ulna, shaft of, with open growth plate, treatment of fracture of, in conjunction with dislocation of distal radio‑ulnar joint or proximal radio‑humeral joint (Galeazzi or Monteggia injury), by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $750.75 Benefit: 75% = $563.10

(See para TN.8.118, TN.8.119, TN.8.190 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shafts of radius or ulna (or both), by closed reduction, for a patient with open growth plate (H)

(Anaes.)

Fee: $653.20 Benefit: 75% = $489.90

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shafts of radius or ulna (or both), by open or closed reduction, with internal fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $870.90 Benefit: 75% = $653.20

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Olecranon, with open growth plate, treatment of fracture of, by open reduction (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius, with open growth plate, treatment of fracture of head or neck of, by closed reduction of

(Anaes.)

Fee: $300.30 Benefit: 75% = $225.25 85% = $255.30

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Radius, with open growth plate, treatment of fracture of head or neck of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $600.75 Benefit: 75% = $450.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, proximal, with open growth plate, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $518.05 Benefit: 75% = $388.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of proximal humerus, by open or closed reduction, with internal fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, shaft of, with open growth plate, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $540.50 Benefit: 75% = $405.40

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of shaft of humerus, by open or closed reduction, with internal or external fixation, for a patient with open growth plate (H)

(Anaes.) (Assist.)

Fee: $720.70 Benefit: 75% = $540.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by closed reduction (H)

(Anaes.)

Fee: $630.70 Benefit: 75% = $473.05

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Humerus, with open growth plate, supracondylar or condylar, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $840.90 Benefit: 75% = $630.70

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Treatment of fracture of femur, by closed reduction or traction, including application of hip spica (if performed), for a patient with open growth plate

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95 85% = $591.90

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia, with open growth plate, plateau or condyles, medial or lateral, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $720.70 Benefit: 75% = $540.55

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia, distal, with open growth plate, treatment of fracture of, by reduction with or without internal fixation by open or percutaneous means (H)

(Anaes.) (Assist.)

Fee: $690.60 Benefit: 75% = $517.95

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)

Multiple Operation Rule

Tibia and fibula, with open growth plates, treatment of fracture of, by internal fixation (H)

(Anaes.) (Assist.)

Fee: $900.80 Benefit: 75% = $675.60

(See para TN.8.118, TN.8.119 of explanatory notes to this Category)