R652

PDF page 612 / N32

MUSCULOSKELETAL SYSTEM SURGICAL PROCEDURES
SKULL AND MANDIBLE
                                                                                                     Asst         Surg          Anae
    Application of dental arch bars, or splint, for facial osteotomy
# Z239 - one arch bar .......................................................................           6         133.00          6
# Z240 - two arch bars......................................................................            6         204.80          7
# R354 Interdental wiring for temporomandibular joint disorder..........                                6         154.00          7
# R652 - Removal intermaxillary fixation devices under general
           anaesthesia - as sole procedure ........................................                               102.35          6
     Note:
     * Includes harvesting and grafting of bone or cartilage grafts.

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 4877. Record Layout PDF, page 1.

R65220260401999999990000102350000000000000000000000000000095760000000957600

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.