Chapter 16 / Bones, joints and connective tissue/tendon muscle

When a procedure code includes the narrative ‘including arthroscopic’, the majority of specialists do not make additional charges for either a diagnostic or a therapeutic arthroscopy and we do not consider these to be additional procedures (except in unusual circumstances).

We consider that decompression in the subacromial region which is frequently performed arthroscopically is covered by the code for subacromial decompression. This includes EUA, arthroscopy, and decompression of the subacromial region, excision of distal clavicle, reconstruction of acromioclavicular joint, acromioplasty and repair of a small rotator cuff tear. We will not routinely reimburse this as a multiple procedure although we will allow flexibility in individual cases. In such cases, we ask that sufficient clinical detail is provided to allow assessment by an orthopaedic consultant.

Knee arthroscopy. At most knee procedures, in addition to the main procedure, a number of lesser procedures are frequently performed such as excision of sinovium, drilling of cartilage, removal of loose bodies, excision of plica lateral release etc. The code W8500 should be used in isolation for multiple arthroscopic procedures.

EUA/MUA/Injection into joint. With all arthroscopies we consider that EUA/MUA and injection into joint are part of the procedure. The only circumstances we would reimburse as a multiple is where the injection is into a different joint and we ask that this is made clear on the invoice.

Application of plaster of Paris is part of any procedure where immobilisation is routine – e.g. fracture reduction, tendon repairs and various osteotomies. As a rule we will not reimburse extra charges for this procedure.

Where a procedure usually or frequently necessitates bone grafting, additional charges should not be made for this as a separate service.

There is a significant number of other areas where in our opinion orthopaedic procedures have been unreasonably disaggregated in the past. This particularly applies to shoulder procedures. Procedures on the distal clavicle, acromioclavicular joint, glenohumeral arthroscopy, bursas and rotator cuff repair should not be added to subacromial decompression.

Please note that all procedure codes and descriptions include the application of the first cast. For subsequent, additional application of cast use code in Fractures section (16.3).

Please also note that all procedure codes in the fixation/arthrodesis section have been moved to individual areas.

The following definitions are used throughout this section:

Long bones – clavicle, fibula, humerus, radius, scapula, tibia and ulna

Small bones – all bones of hand, wrist, foot, ankle and also the patella

Large joints – ankle, elbow, hip, knee, shoulder and wrist

Small joints – all other joints of the hand and foot

Child Aged 0-15

Adult Aged 16 and over


16.4 - Nerves

Code Description Complexity Procedure fees Fee for general anaesthesia
Unacceptable Combinations
Additional Information



A6030 Transection of peripheral nerve for neuroma Intermediate £250.00 £165.00 Show arrow
A6080 Neurectomy (major nerve) Intermediate £400.00 £165.00
A6110 Excision of lesion of peripheral nerve (eg neurilemoma) Intermediate £300.00 £165.00 Show arrow
A6180 Excision of lesion of major nerve Intermediate £400.00 £165.00 Show arrow
A6300 Graft to peripheral nerve Xmajor £650.00 £275.00 Show arrow
A6302 Graft to major nerve Xmajor £650.00 £275.00 Show arrow
A6400 Repair of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6402 Repair of major nerve Major £300.00 £165.00 Show arrow
A6510 Carpal tunnel release (open) Intermediate £250.00 £165.00 Show arrow
A6580 Carpal tunnel release (open) - bilateral Intermediate £450.00 £275.00 Show arrow
A6600 Release of entrapment of deeply placed peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6700 Release of entrapment of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A6710 Cubital tunnel release (open) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6711 Cubital tunnel release (open) bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A6810 Neurolysis and transposition of peripheral nerve (excludes carpal tunnel release) Intermediate £300.00 £165.00 Show arrow
A6900 Revision of release of peripheral nerve Major £450.00 £165.00 Show arrow
A7010 Implantation of neurostimulator to peripheral nerve Major £550.00 £110.00 Show arrow
A7011 Trial of neurostimulator to peripheral nerve (as sole procedure) not at time of permanent implant Intermediate £450.00 £110.00 Show arrow
A6530 Carpal tunnel release (endoscopic) Intermediate £250.00 £165.00 Show arrow
A6570 Carpal tunnel release (endoscopic) - Bilateral Intermediate £450.00 £275.00 Show arrow
A6740 Cubital tunnel release (endoscopic) (without transposition) Intermediate £250.00 £165.00 Show arrow
A6750 Cubital tunnel release (endoscopic) Bilateral (without transposition) Intermediate £450.00 £275.00 Show arrow
A7310 Biopsy of peripheral nerve Intermediate £250.00 £165.00 Show arrow
A7340 Exploration and grafting of brachial plexus Complex £1,000.00 £660.00 Show arrow

16.5 - Joints, including replacement/reconstruction (not listed elsewhere)

Code Description Complexity Procedure fees Fee for general anaesthesia
Unacceptable Combinations
Additional Information



W5540 Debridement of infected total joint replacement Major £550.00 £275.00 Show arrow
W5722 Excision reconstruction of small joint Major £500.00 £220.00 Show arrow
W5723 Excision reconstruction of large joint Major £500.00 £220.00 Show arrow
W6912 Total synovectomy of small joint Major £500.00 £220.00 Show arrow
W9050 Shoulder hydrodistension +/- image guidance Minor £150.00 £0.00 Show arrow
W6913 Total synovectomy of large joint Major £500.00 £220.00 Show arrow
W7400 Reconstruction of one or two ligaments not elsewhere specified Major £450.00 £165.00 Show arrow
W7500 Prosthetic open repair of ligament Major £450.00 £165.00 Show arrow
W7881 Release of contracture of interphalangeal joint of finger (excluding trigger finger or Dupuytren's disease) Intermediate £250.00 £220.00 Show arrow
W8150 Arthrotomy of large joint, including removal of loose body from joint Intermediate £350.00 £165.00 Show arrow
W8180 Arthrotomy of small joint, including removal of loose body from joint Minor £100.00 £100.00 Show arrow
W8300 Therapeutic arthroscopy operation on articular cartilage (other than W8200 and W8230) (as sole procedure) Intermediate £350.00 £275.00 Show arrow
W8380 Therapeutic arthroscopy operation on articular cartilage (other than W8200) - bilateral (as sole procedure) Major £550.00 £385.00 Show arrow
W8600 Therapeutic arthroscopy operation on cavity of joint (not otherwise specified) (as sole procedure) Major £550.00 £275.00 Show arrow
W8680 Therapeutic arthroscopy operation on cavity of joint - bilateral (not otherwise specified) (as sole procedure) Complex £800.00 £385.00 Show arrow
W8700 Diagnostic arthroscopic examination of joint, with or without biopsy (not otherwise specified) (as sole procedure) Intermediate £250.00 £220.00 Show arrow
W8780 Diagnostic arthroscopic examination of joint, with or without biopsy - bilateral (not otherwise specified) (as sole procedure) Intermediate £400.00 £275.00 Show arrow
W8782 Flexible arthroscopy, +/- biopsy (as sole procedure) Intermediate £200.00 £165.00 Show arrow
W9017 Yttrium joint injection (with radioactive precautions) Minor £100.00 £0.00 Show arrow
W9020 Dynamic arthrogram of joint Intermediate £100.00 £100.00 Show arrow
W9030 Injection(s) +/- aspiration, into joint, cyst, bursa or soft tissue with image guidance Minor £115.00 £110.00 Show arrow
W9240 Examination/ manipulation of joint under general anaesthetic +/- injection +/- arthrogram (as sole procedure) Minor £150.00 £110.00 Show arrow
W9032 Injection of viscosupplement into joint with image guidance Minor £115.00 £0.00
W9033 Injection of viscosupplement into joint with image guidance - bilateral Minor £135.00 £0.00
W9035 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue, with image guidance Minor £135.00 £0.00 Show arrow
W9042 Injection of viscosupplement into joint Minor £50.00 £0.00
W9043 Injections of viscosupplement into joints - bilateral Minor £75.00 £0.00
W9045 Injection(s) +/- aspiration, into two or more joints, cysts, bursae or soft tissue Minor £115.00 £0.00
W9170 Manipulation of foot/ankle joint under local anaesthetic +/- injection (as a sole procedure) Minor £110.00 £0.00

16.6 - Hand

Code Description Complexity Procedure fees Fee for general anaesthesia
Unacceptable Combinations
Additional Information



Incision/excision

T7440 Injection into cord for Dupuytren’s Contracture (including post injection finger extension) Minor £250.00 £0.00 Show arrow
T5202 Dupuytren’s fasciectomy palm only Intermediate £350.00 £165.00 Show arrow
T5203 Dupuytren’s fasciectomy single digit with proximal interphalangeal joint Intermediate £350.00 £165.00 Show arrow
T5210 Dupuytren’s fasciectomy multiple digits with proximal interphalangeal joints Major £600.00 £275.00 Show arrow
T5222 Dupuytren’s dermofasciectomy and graft, or for recurrent disease – single digit Major £650.00 £275.00 Show arrow
T5223 Dupuytren’s dermofasciectomy and graft, or for recurrent disease – multiple digits Major £650.00 £275.00 Show arrow
T5410 Dupuytren’s subcutaneous fasciotomy Minor Minor £200.00 £110.00 Show arrow
W0282 Total excision of trapezium Xmajor £700.00 £275.00 Show arrow
W0283 Total excision of trapezium with spacer Xmajor £700.00 £275.00 Show arrow
W0284 Total excision of trapezium and ligament reconstruction Xmajor £700.00 £275.00 Show arrow
W0285 Trapezio-metacarpal joint surface replacement Major £700.00 £275.00 Show arrow


Repair/reconstruction

W1641 Osteotomy of short bone of hand (including fixation and bone grafting) Intermediate £350.00 £165.00 Show arrow
T6710 Primary repair of extensor of hand Intermediate £250.00 £165.00 Show arrow
T6820 Secondary repair or reconstruction of extensor of hand/forearm Major £500.00 £165.00 Show arrow
T6914 Tenolysis of extensor tendon of hand Intermediate £350.00 £165.00 Show arrow
T6750 Primary repair of flexor of hand (excluding Zone II) Intermediate £500.00 £165.00 Show arrow
T6752 Primary repair of flexor of hand in Zone II Major £500.00 £165.00 Show arrow
T6830 Secondary or second repair of 1st stage reconstruction of flexor of hand Major £550.00 £220.00 Show arrow
T6832 Second stage reconstruction of flexor of hand Major £550.00 £220.00 Show arrow
T6982 Tenolysis of flexor tendon of hand Intermediate £450.00 £165.00 Show arrow
T6402 Tendon transfer of hand – single Major £300.00 £165.00 Show arrow
T6410 Tendon transfer of hand – multiple (eg for radial nerve injury) Major £600.00 £220.00 Show arrow
W0120 Pollicisation of finger for thumb reconstruction Complex £1,000.00 £165.00
W0512 Interpositional silastic arthroplasty of MCP/PIP joints – single Major £600.00 £165.00 Show arrow
W0513 Interpositional silastic arthroplasty of MCP/PIP joints - multiple Major £600.00 £165.00 Show arrow
W0514 Prosthetic surface arthroplasty of interphalanageal/metacarpo-phalangeal joint – single joint (both cemented and uncemented) Major £600.00 £165.00 Show arrow
W5310 Total prosthetic replacement of wrist joint Xmajor £700.00 £275.00 Show arrow
W8830 Diagnostic arthroscopic examination of wrist joint, with or without biopsy (as sole procedure) Intermediate £250.00 £220.00 Show arrow
W8602 Therapeutic arthroscopy of wrist joint (sole procedure) Major £550.00 £165.00 Show arrow
W7482 Scaphoid lunate ligament reconstruction Major £700.00 £220.00 Show arrow
W7483 Triquetrolunate ligament reconstruction Major £700.00 £220.00 Show arrow
W7484 Multiple ligament reconstruction Xmajor £700.00 £220.00 Show arrow
W7485 Small joint (eg interphalangeal/metacarpo-phalangeal joint) ligament reconstruction Major £550.00 £220.00 Show arrow
W7486 Carpo-metacarpal joint ligament reconstruction Major £550.00 £220.00 Show arrow
W6230 Vascular implantation to carpal bone Xmajor £700.00 £385.00 Show arrow
W0110 Toe to hand transfer (as sole procedure) including closure of secondary defect Complex £1,000.00 £165.00


Fixation/arthrodesis

W3200 Open reduction and internal fixation of cancellous bone graft scaphoid non-union Major £550.00 £220.00 Show arrow
W3202 Open reduction and internal fixation wedge reconstruction bone graft scaphoid non-union Major £550.00 £220.00 Show arrow
W3203 Early open reduction and internal fixation of scaphoid fracture ie within 6 weeks of fracture Major £550.00 £220.00 Show arrow
W6202 Partial fusion of wrist Intermediate £550.00 £275.00 Show arrow
W6200 Total fusion of all joints of wrist with or without graft and with or without internal fixation Major £550.00 £275.00 Show arrow
W5930 Fusion of digit joint(s) of hand with or without graft and with or without internal fixation Intermediate £300.00 £220.00 Show arrow


Other (eg amputation)

X0710 Forequarter amputation Complex £1,000.00 £385.00 Show arrow
X0720 Disarticulation of shoulder Xmajor £800.00 £440.00
X0750 Amputation of arm Major £400.00 £220.00 Show arrow
X0820 Partial amputation of digit Intermediate £300.00 £165.00 Show arrow
X0822 Amputation of whole ray Major £300.00 £165.00 Show arrow
X0880 Amputation through mid-carpal/transmetacarpal Intermediate £300.00 £165.00 Show arrow
X0910 Hindquarter amputation Complex £1,000.00 £440.00 Show arrow

16.7 - Shoulder

Code Description Complexity Procedure fees Fee for general anaesthesia
Unacceptable Combinations
Additional Information



Incision/excision

W0610 Total excision of cervical rib Major £600.00 £275.00 Show arrow
W0890 Excision distal clavicle, as sole procedure Major £450.00 £220.00 Show arrow


Repair/reconstruction

A7340 Exploration and grafting of brachial plexus Complex £1,000.00 £660.00 Show arrow
W4900 Shoulder hemiarthroplasty, as sole procedure Xmajor £650.00 £220.00 Show arrow
W4930 Revisional shoulder hemiarthroplasty Xmajor £700.00 £220.00 Show arrow
W5050 Reverse polarity arthroplasty of shoulder Xmajor £650.00 £220.00 Show arrow
W4902 Shoulder hemiarthroplasty with reconstruction for fracture Xmajor £700.00 £275.00 Show arrow
W5000 Primary total shoulder replacement Xmajor £800.00 £275.00 Show arrow
W5030 Revision total shoulder replacement Complex £1,000.00 £495.00 Show arrow
W4920 Conversion of hemiarthroplasty to total shoulder replacement Complex £800.00 £220.00 Show arrow
W5600 Primary repair of rupture of acromioclavicular or sternoclavicular joint +/- internal fixation Xmajor £750.00 £220.00 Show arrow
W5630 Secondary repair of acromioclavicular or sternoclavicular joint +/– internal fixation Xmajor £750.00 £220.00 Show arrow
W7713 Primary stabilisation of multi-directional instability of shoulder joint +/- tendon repair Major £550.00 £220.00 Show arrow
W7714 Primary open or arthroscopic shoulder stabilisation pocedure (including labral/SLAP/tendon repair) Major £600.00 £220.00 Show arrow