Part A - Prostheses List February 2011

Part A - Prostheses ListFebruary 2011 CARDIO-THORACICB illing Code Product NameDescriptionSizeNotationsMinimum BenefitMaximum BenefitGroup 1- Cardiothoracic Mechanical ValvesGroup 1c - Bi-Leaflet, rotatableMedtronic Australasia Pty LtdMC292 Advantage Heart Valve - Aortic Model A7760A7760 - Pyrolytic carbon, PETD iameter 19-31 mm$6, Supra Aortic Heart ValveMechanical Heart Valve Pyrolite Carbon leaflets Pyrolite carbon ringDiameter (mm): 19 - 25$6, MitralMechanical Heart Valve23mm-33mm$6, Pivot Heart Valve (Model 500FA)Open Pivot Heart Valve (Model 500DM)Pyrolythic Carbon, Double Velour Polyester, Titanium16-33mm$6, Pivot Heart Valve (Model 501DA)Open Pivot Heart Valve (Model 501DM)Pyrolythic Carbon, Double Velour Polyester, Titanium16-33mm$6, HealthcareRH001 Aortic On-X Prosthetic Heart Valve Models ONXA-19; ONXA-21; ONXA.

Part A - Prostheses List February 2011 CARDIO-THORACIC Billing Code Product Name Description Size Notations Minimum Benefit Maximum Group 1- Cardiothoracic Mechanical Valves

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