E828

PDF page 615 / N35

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
 SKULL AND MANDIBLE
                                                                                                 Asst  Surg     Anae
      Application of craniofacial suspension wires and external fixation devices (not to be billed in
      addition to maxillary repair).
# F143 - middle ¼ facial ...................................................................      6    577.65     8
# E830      - with mini-plate(s)**, per major fracture line ................ add                       107.20
# F144 - cranial-facial separation .....................................................          6   1594.90    10
# E830      - with mini-plate(s)**, per major fracture line ................ add                       107.20
      Note:
      ** Where mini-plate(s) are used, one mini-plate fee per each major fracture line (e.g.
      infraorbital, malar-zygomatic, nasal-frontal, LeFort I, LeFort II and III) (per major fracture line
      per side) should be billed.
      Mandible
  UVC     - no reduction........................................................................      visit fee
# F138 - closed reduction, includes maxillary-mandibular fixation ...                             6    350.00     7
         Note:
         Maxillary-mandibular fixation includes any external fixation technique.
# F139   - open reduction, per fracture, to include intermaxillary
           fixation ................................................................................ 6 761.50 6
# E828     - rigid internal fixation, any method, to F139 ................ add                         193.50
      Note:
      Rigid internal fixation may include the use of a mini-plate(s), or other internal fixation device(s).

PDF page 615 / N35

Payment rules:
         1.E828 is limited to one service for each major fracture line (e.g. infraorbital, malar zygomatic,
           nasal-frontal, LeFort I, LeFort II and III) when a mini-plate is used.
         2.Z239, Z240, R652 or D062 are not eligible for payment in addition to F138 or F139.
# F140 - removal of intermaxillary fixation device(s) ........................                      100.00
      Payment rules:
      1.A maximum of one F140 is eligible for payment per patient per day.
         2.F140 is not eligible for payment in addition to F138 or F139.

Master, record 1523. Record Layout PDF, page 1.

E82820260401999999990000193500000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.