NOTE:   Deleted codes are valid for dates of service on or before the date of deletion.			
NOTE:  Updated codes are in bold.			
NOTE:   The jurisdiction list includes codes that are not payable by Medicare.  Please consult the Medicare			
contractor in whose jurisdiction a claim would be filed in order to determine coverage under Medicare.			
			
HCPCS	DESCRIPTION	JURISDICTION	
			
A0021 - A0999	Ambulance Services	Local Carrier	
A4206 - A4209	"Medical, Surgical, and Self-"	Local Carrier if incident to a physician's	
	Administered Injection	"service (not separately payable).  If other,"	
	Supplies	DME MAC.	
A4210	Needle Free Injection Device	DME MAC	
A4211 	"Medical, Surgical, and Self-"	Local Carrier if incident to a physician's	
	Administered Injection	"service (not separately payable).  If other,"	
	Supplies	DME MAC.	
A4212	Non Coring Needle or Stylet	Local Carrier	
	with or without Catheter		
A4213 - A4215	"Medical , Surgical, and Self-"	Local Carrier if incident to a physician's	
	Administered Injection Supplies	"service (not separately payable).  If  other,"	
		DME MAC.	
A4216 - A4218	Saline	Local Carrier if incident to a physician's	
		"service (not separately payable).  If  other,"	
		DME MAC.	
A4220	Refill Kit for Implantable Pump	Local Carrier	
A4221 - A4250	"Medical, Surgical, and Self-"	Local Carrier if incident to a physician's 	
	Administered Injection Supplies	"service (not separately payable).  If other, "	
		DME MAC.	
A4252 - A4259	Diabetic Supplies	DME MAC	
			
A4261	Cervical Cap for Contraceptive 	Local Carrier	
	Use		
A4262 - A4263	Lacrimal Duct Implants	Local Carrier	
A4264	Contraceptive Implant	Local Carrier	
A4265	Paraffin	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4266 - A4269	Contraceptives	Local Carrier	
A4270	Endoscope Sheath	Local Carrier	
A4280	Accessory for Breast Prosthesis	DME MAC	
A4281 - A4286	Accessory for Breast Pump	DME MAC	
A4290	Sacral Nerve Stimulation Test Lead	Local Carrier	
A4300 - A4301	Implantable Catheter	Local Carrier	
A4305 - A4306	Disposable Drug Delivery	Local Carrier if incident to a physician's	
	System	"service (not separately payable).  If other,"	
		DME MAC.	
A4310 - A4358	Incontinence Supplies/	If provided in the physician's office for a	
	Urinary Supplies	"temporary condition, the item is incident to "	
		the physician's service & billed to the Local	
		Carrier.  If provided in the physician's office 	
		or other place of service for a permanent	
		"condition, the item is a prosthetic device &"	
		billed to the DME MAC.	
A4360 - A4435	Urinary Supplies	If provided in the physician's office for a	
		"temporary condition, the item is incident to the"	
		physician's service & billed to the Local	
		Carrier.  If provided in the physician's office 	
		or other place of service for a permanent	
		"condition, the item is a prosthetic device &"	
		billed to the DME MAC.	
A4450 - A4456	Tape; Adhesive Remover	Local Carrier if incident to a physician's	
		"service (not separately payable), or if supply for implanted prosthetic device.  If other,"	
		DME MAC.	
A4458	Enema Bag	DME MAC	
A4461-A4463	Surgical Dressing Holders	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4465 - A4466	Non-elastic Binder and Elastic Garment	DME MAC	
A4470	Gravlee Jet Washer	Local Carrier	
A4480	Vabra Aspirator	Local Carrier	
A4481	Tracheostomy Supply	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4483	Moisture Exchanger	DME MAC	
A4490 - A4510	Surgical Stockings	DME MAC	
A4520	Diapers	DME MAC	
A4550	Surgical Trays	Local Carrier	
A4554	Disposable Underpads	DME MAC	
A4556 - A4558	Electrodes; Lead Wires; Con-	Local Carrier if incident to a physician's	
	ductive Paste	"service (not separately payable).  If other,"	
		DME MAC.	
A4559                 	Coupling Gel	Local Carrier if incident to a physician's service 	
		"(not separately payable).  If other, DME MAC."	
A4561 - A4562	Pessary	Local Carrier   	
A4565	Sling	Local Carrier	
A4566	Shoulder Abduction Restrainer	DME MAC	
A4570	Splint	Local Carrier	
A4575	Topical Hyperbaric Oxygen	DME MAC	
	"Chamber, Disposable"		
A4580 - A4590	Casting Supplies & Material	Local Carrier	
A4595	TENS Supplies	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4600	Sleeve for Intermittent Limb 	DME MAC	
	Compression Device		
A4601	Lithium Ion Battery for	DME MAC	
	Non-Prosthetic Use		
A4604	Tubing for Positive Airway Pressure 	DME MAC	
	Device		
A4605	Tracheal Suction Catheter	DME MAC	
A4606	Oxygen Probe for Oximeter	DME MAC	
A4608	Transtracheal Oxygen Catheter	DME MAC	
A4611 - A4613	Oxygen Equipment Batteries and	DME MAC	
	Supplies		
A4614	Peak Flow Rate Meter	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4615 - A4629	Oxygen & Tracheostomy Supplies	Local Carrier if incident to a physician's	
		"service (not separately payable).  If other,"	
		DME MAC.	
A4630 - A4640	DME Supplies	DME MAC	
A4641 - A4642	Imaging Agent; Contrast Material	Local Carrier	
A4648	"Tissue Marker, Implanted"	Local Carrier	
A4649	Miscellaneous Surgical Supplies	Local Carrier if incident to a physician's	
		"service (not separately payable), or if supply "	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A4650	Implantable Radiation Dosimeter	Local Carrier	
A4651 - A4932	Supplies for ESRD	DME MAC (not separately payable)	
A5051 - A5093	Additional Ostomy Supplies	If provided in the physician's office for a	
		"temporary condition, the item is incident to the"	
		physician's service & billed to the Local	
		Carrier.  If provided in the physician's office 	
		or other place of service for a permanent	
		"condition, the item is a prosthetic device &"	
		billed to the DME MAC.	
A5102 - A5200	Additional Incontinence and	If provided in the physician's office for a	
	Ostomy Supplies	"temporary condition, the item is incident to the"	
		physician's service & billed to the Local	
		Carrier.  If provided in the physician's office 	
		or other place of service for a permanent	
		"condition, the item is a prosthetic device &"	
		billed to the DME MAC.	
A5500 - A5513	Therapeutic Shoes	DME MAC	
A6000	Non-Contact Wound Warming	DME MAC	
	Cover		
A6010-A6024	Surgical Dressing	Local Carrier if incident to a physician's	
		service (not separately payable) or if supply 	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A6025	Silicone Gel Sheet	Local Carrier if incident to a physician's	
		service (not separately payable) or if supply 	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A6154 - A6411	Surgical Dressing	Local Carrier if incident to a physician's	
		service (not separately payable) or if supply 	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A6412	Eye Patch	Local Carrier if incident to a physician's	
		service (not separately payable) or if supply 	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A6413	Adhesive Bandage	"Local Carrier if incident to a physician's service (not separately payable) or if supply for implanted prosthetic device or implanted DME.  If other, DME MAC."	
A6441 - A6512	Surgical Dressings	Local Carrier if incident to a physician's	
		"service (not separately payable), or if supply "	
		for implanted prosthetic device or implanted	
		"DME.  If other, DME MAC."	
A6513 	Compression Burn Mask	DME MAC	
A6530 - A6549	Compression Gradient Stockings	DME MAC	
A6550 	Supplies for Negative Pressure	DME MAC	
	Wound Therapy Electrical Pump		
A7000 - A7002	Accessories for Suction Pumps	DME MAC	
A7003 - A7039	"Accessories for Nebulizers, "	DME MAC	
	Aspirators and Ventilators		
A7040 - A7041	Chest Drainage Supplies	Local Carrier	
A7042 - A7043	Pleural Catheter	Local Carrier	
A7044 - A7046	Respiratory Accessories	DME MAC	
A7501-A7527	Tracheostomy Supplies	DME MAC	
A8000-A8004	Protective Helmets	DME MAC	
A9150 	Non-Prescription Drugs	Local Carrier	
A9152 - A9153	Vitamins	Local Carrier	
A9155	Artificial Saliva	Local Carrier	
A9180	Lice Infestation Treatment	Local Carrier	
A9270	Noncovered Items or Services	DME MAC	
A9272	Disposable Wound Suction Pump	DME MAC	
A9273	"Hot Water Bottles, Ice Caps or Collars, and Heat and/or Cold Wraps"	DME MAC	
A9274 - A9278	Glucose Monitoring	DME MAC	
A9279	Monitoring Feature/Device	DME MAC	
A9280	Alarm Device	DME MAC	
A9281	Reaching/Grabbing Device	DME MAC	
A9282	Wig	DME MAC	
A9283	Foot Off Loading Device	DME MAC	
A9284	Non-electric Spirometer	DME MAC	
A9300	Exercise Equipment	DME MAC	
A9500 - A9700	Supplies for Radiology Procedures	Local Carrier	
A9900 	Miscellaneous DME Supply or 	Local Carrier if used with implanted DME.  If 	
	Accessory	"other, DME MAC."	
A9901	Delivery	DME MAC	
A9999	Miscellaneous DME Supply or 	Local Carrier if used with implanted DME.  If 	
	Accessory	"other, DME MAC."	
B4034 - B9999	Enteral and Parenteral Therapy	DME MAC	
D0120 - D9999	Dental Procedures	Local Carrier	
E0100 - E0105	Canes	DME MAC	
E0110 - E0118	Crutches	DME MAC	
E0130 - E0159	Walkers	DME MAC	
E0160 - E0175	Commodes	DME MAC	
E0181 - E0199	Decubitus Care Equipment	DME MAC	
E0200 - E0239	Heat/Cold Applications	DME MAC	
E0240 - E0248	Bath and Toilet Aids	DME MAC	
E0249	Pad for Heating Unit	DME MAC	
E0250 - E0304	Hospital Beds	DME MAC	
E0305 - E0326	Hospital Bed Accessories	DME MAC	
E0328 - E0329	Pediatric Hospital Beds	DME MAC	
E0350 - E0352	Electronic Bowel Irrigation System	DME MAC	
E0370	Heel Pad	DME MAC	
E0371 - E0373	Decubitus Care Equipment	DME MAC	
E0424 - E0484	Oxygen and Related Respiratory	DME MAC	
	Equipment		
E0485 - E0486	Oral Device to Reduce Airway	DME MAC	
	Collapsibility		
E0487	Electric Spirometer	DME MAC	
E0500	IPPB Machine	DME MAC	
E0550 - E0585	Compressors/Nebulizers	DME MAC	
E0600 	Suction Pump	DME MAC	
E0601	CPAP Device	DME MAC	
E0602 - E0604	Breast Pump	DME MAC	
E0605	Vaporizer	DME MAC	
E0606	Drainage Board	DME MAC	
E0607 	Home Blood Glucose Monitor	DME MAC	
E0610 - E0615	Pacemaker Monitor	DME MAC	
E0616	Implantable Cardiac Event	Local Carrier	
	Recorder		
E0617	External Defibrillator	DME MAC	
E0618 - E0619 	Apnea Monitor	DME MAC	
E0620	Skin Piercing Device	DME MAC	
E0621 - E0636	Patient Lifts	DME MAC	
E0637 - E0642	Standing Devices/Lifts	DME MAC	
E0650 - E0676	Pneumatic Compressor and	DME MAC	
	Appliances		
			
E0691 - E0694	Ultraviolet Light Therapy Systems	DME MAC	
E0700	Safety Equipment	DME MAC	
E0705	Transfer Board	DME MAC	
E0710	Restraints	DME MAC	
E0720 - E0745	Electrical Nerve Stimulators	DME MAC	
E0746	EMG Device	Local Carrier	
E0747 - E0748	Osteogenic Stimulators	DME MAC	
E0749	Implantable Osteogenic Stimulators	Local Carrier	
E0755	Reflex Stimulator	DME MAC	
E0760	Ultrasonic Osteogenic Stimulator	DME MAC	
E0761	Electromagnetic Treatment Device	DME MAC	
E0762	Electrical Joint Stimulation Device	DME MAC	
E0764	Functional Neuromuscular 	DME MAC	
	Stimulator		
E0765	Nerve Stimulator	DME MAC	
E0769	Electrical Wound Treatment Device	DME MAC	
E0770	Functional Electrical Stimulator	DME MAC	
E0776	IV Pole	DME MAC	
E0779 - E0780	External Infusion Pumps	DME MAC	
E0781 	Ambulatory Infusion Pump	Billable to both the local carrier and the DME	
		MAC.  This item may be billed to the DME 	
		MAC whenever the infusion is initiated in the	
		physician's office but the patient does not	
		return during the same business day.	
E0782 - E0783	"Infusion Pumps, Implantable"	Local Carrier	
E0784	"Infusion Pumps, Insulin"	DME MAC	
E0785 - E0786	Implantable Infusion Pump 	Local Carrier	
	Catheter		
E0791	Parenteral Infusion Pump	DME MAC	
E0830	Ambulatory Traction Device	DME MAC	
E0840 - E0900	Traction Equipment	DME MAC	
E0910 - E0930	Trapeze/Fracture Frame	DME MAC	
E0935 - E0936	Passive Motion Exercise Device	DME MAC	
E0940	Trapeze Equipment	DME MAC	
E0941	Traction Equipment	DME MAC	
E0942 - E0945	Orthopedic Devices	DME MAC	
E0946 - E0948	Fracture Frame	DME MAC	
E0950 - E1298	Wheelchairs	DME MAC	
E1300 - E1310	Whirlpool Equipment	DME MAC	
E1353 - E1392	Additional Oxygen Related	DME MAC	
	Equipment		
E1399	Miscellaneous DME	"Local Carrier if implanted DME.  If other, DME"	
		MAC.  	
E1405 - E1406	Additional Oxygen Equipment	DME MAC	
E1500 - E1699	Artificial Kidney Machines and	DME MAC  (not separately payable)	
	Accessories		
E1700 - E1702	TMJ  Device and Supplies	DME MAC	
E1800 - E1841	Dynamic Flexion Devices	DME MAC	
E1902	Communication Board	DME MAC	
E2000	Gastric Suction Pump	DME MAC	
E2100 - E2101	Blood Glucose Monitors with	DME MAC	
	Special Features		
E2120	Pulse Generator for Tympanic	DME MAC	
	Treatment of Inner Ear		
E2201 - E2397	Wheelchair Accessories	DME MAC	
E2402	Negative Pressure Wound	DME MAC	
	Therapy Pump		
E2500 - E2599	Speech Generating Device	DME MAC	
E2601 - E2633	Wheelchair Cushions and Accessories	DME MAC	
E8000 - E8002	Gait Trainers	DME MAC	
G0008 - G0329	Misc. Professional Services	Local Carrier	
G0333	Dispensing Fee	DME MAC	
G0337 - G0365	Misc. Professional Services	Local Carrier	
G0372	Misc. Professional Services	Local Carrier	
G0378 - G9186	Misc. Professional Services	Local Carrier	
J0120 - J3570	Injection	Local Carrier if incident to a physician's	
		service or used in an implanted infusion pump.	
		"If other, DME MAC."	
J3590	Unclassified Biologicals	Local Carrier	
J7030 - J7131	Miscellaneous Drugs and	Local Carrier if incident to a physician's	
	Solutions	service or used in an implanted infusion pump.	
		"If other, DME MAC."	
J7178	Fibrinogen	Local Carrier	
J7180 - J7195	Antihemophilic Factor	Local Carrier	
J7196 - J7197	Antithrombin III	Local Carrier	
J7198	Anti-inhibitor;  per I.U. 	Local Carrier	
J7199	Other Hemophilia Clotting Factors	Local Carrier	
J7300 - J7307	Intrauterine Copper Contraceptive	Local Carrier	
J7308 - J7309	Aminolevulinic Acid HCL	Local Carrier	
J7310	"Ganciclovir, Long-Acting Implant"	Local Carrier	
J7311 - J7315	Ophthalmic Drugs	Local Carrier	
J7321 - J7326	Hyaluronan	Local Carrier	
J7330	"Autologous Cultured Chondrocytes,"	Local Carrier	
	Implant		
J7335	Capsaicin	Local Carrier 	
J7500 - J7599 	Immunosuppressive Drugs	Local Carrier if incident to a physician's	
		service or used in an implanted infusion pump.	
		"If other, DME MAC."	
J7604 - J7699 	Inhalation Solutions	Local Carrier if incident to a physician's	
		"service.  If other, DME MAC."	
J7799	"NOC, Other than Inhalation Drugs"	Local carrier if incident to a physician's 	
	through DME	"service.  If other, DME MAC."	
J8498	Anti-emetic Drug	DME MAC	
J8499	"Prescription Drug, Oral, Non"	Local carrier if incident to a physician's	
	Chemotherapeutic	"service.  If other, DME MAC."	
J8501 - J8999	Oral Anti-Cancer Drugs	DME MAC	
J9000 - J9999	Chemotherapy Drugs	Local Carrier if incident to a physician's	
		service or used in an implanted infusion pump.	
		"If other, DME MAC."	
K0001 - K0108	Wheelchairs	DME MAC	
K0195	Elevating Leg Rests	DME MAC	
K0455	Infusion Pump used for 	DME MAC	
	Uninterrupted Administration of		
	Epoprostenal 		
K0462	Loaner Equipment	DME MAC	
K0552	External Infusion Pump Supplies	DME MAC	
K0601 - K0605	External Infusion Pump Batteries	DME MAC	
K0606 - K0609	Defibrillator Accessories	DME MAC	
K0669	Wheelchair Cushion	DME MAC	
K0672	Soft Interface for Orthosis 	DME MAC	
K0730	Inhalation Drug Delivery System	DME MAC	
K0733	Power Wheelchair Accessory	DME MAC	
K0738	Oxygen Equipment 	DME MAC	
K0739	Repair or Nonroutine Service for DME	"Local Carrier if implanted DME.  If other, DME MAC"	
K0740	Repair or Nonroutine Service for Oxygen Equipment	DME MAC	
K0743 - K0746	Suction Pump and Dressings	DME MAC	
K0800 - K0899	Power Mobility Devices	DME MAC	
L0112 - L4631	Orthotics	DME MAC	
L5000 - L5999	Lower Limb Prosthetics	DME MAC	
L6000 - L7499	Upper Limb Prosthetics	DME MAC	
L7510 - L7520	Repair of Prosthetic Device	Local Carrier if repair of implanted prosthetic	
		"device.  If other, DME MAC."	
L7600	Prosthetic Donning Sleeve	DME MAC	
L7900-L7902	Vacuum Erection System	DME MAC	
L8000 - L8485	Prosthetics	DME MAC	
L8499	Unlisted Procedure for 	Local Carrier if implanted prosthetic device.	
	Miscellaneous Prosthetic Services	"If other, DME MAC."	
L8500 - L8501 	Artificial Larynx; Tracheostomy	DME MAC	
	Speaking Valve		
L8505	Artificial Larynx Accessory	DME MAC	
L8507 	"Voice Prosthesis, Patient Inserted"	DME MAC	
L8509	"Voice Prosthesis, Inserted by a Licensed Health Care Provider"	Local Carrier for dates of service on or after 10/01/2010.  DME MAC for dates of service prior to 10/01/2010	
L8510	Voice Prosthesis	DME MAC	
L8511 - L8515	Voice Prosthesis	"Local Carrier if used with tracheoesophageal voice prostheses inserted by a licensed health care provider.  If other, DME MAC"	
L8600 - L8699	Prosthetic Implants	Local Carrier	
L9900	Miscellaneous Orthotic or 	Local Carrier if used with implanted prosthetic	
	Prosthetic Component or 	"device.  If other, DME MAC."	
	Accessory		
M0064 - M0301	Medical Services	Local Carrier	
P2028 - P9615	Laboratory Tests	Local Carrier	
Q0035	Influenza Vaccine; Cardio-	Local Carrier	
	kymography		
Q0081	Infusion Therapy	Local Carrier 	
Q0083 - Q0085	Chemotherapy Administration	Local Carrier 	
Q0091	Smear Preparation	Local Carrier	
Q0092	Portable X-ray Setup	Local Carrier	
Q0111 - Q0115	Miscellaneous Lab Services	Local Carrier	
Q0138-Q0139	Ferumoxytol Injection	Local Carrier 	
Q0144	Azithromycin Dihydrate	Local Carrier if incident to a physician's	
		"service.  If other, DME MAC."	
Q0162 - Q0181	Anti-emetic	DME MAC	
Q0478 - Q0506	Ventricular Assist Devices	Local Carrier	
Q0510 - Q0514	Drug Dispensing Fees	DME MAC	
Q0515	Sermorelin Acetate	Local Carrier	
Q1004 - Q1005	New Technology IOL	Local Carrier	
Q2004	Irrigation Solution	Local Carrier	
Q2009	Fosphenytoin	Local Carrier	
Q2017	Teniposide	Local Carrier	
Q2026-Q2027	"Injectable Dermal Fillers     (Effective July 1, 2010)"	Local Carrier	
Q2034 - Q2039	Influenza Vaccine	Local Carrier	
Q2043	Sipuleucel-T	Local Carrier	
Q2049	Lipodox 	"Local Carrier if incident to a physician's service or
used in an implanted infusion pump.  
If other, DME MAC."	
Q3001	Supplies for Radiology Procedures	Local Carrier	
Q3014	Telehealth Originating Site 	Local Carrier	
	Facility Fee		
Q3025 - Q3026	Vaccines	Local Carrier	
Q3031	Collagen Skin Test	Local Carrier	
			
Q4001 - Q4051	Splints and Casts	Local Carrier	
Q4074	Inhalation Drug 	Local Carrier if incident to a physician's	
		"service.  If other, DME MAC."	
Q4081	Epoetin	Local Carrier	
Q4082	Drug Subject to Competitive	Local Carrier	
	Acquisition Program		
Q4100 - Q4136	Skin Substitutes	Local Carrier	
Q5001 - Q5010	Hospice Services	Local Carrier	
Q9951 - Q9954	Imaging Agents	Local Carrier	
Q9955 - Q9957	Microspheres	Local Carrier	
Q9958 - Q9969	Imaging Agents	Local Carrier	
R0070 - R0076	Diagnostic Radiology Services	Local Carrier	
V2020 - V2025	Frames	DME MAC	
V2100 - V2513	Lenses	DME MAC	
V2520 - V2523	Hydrophilic Contact Lenses	Local Carrier if incident to a physician's	
		"service.  If other, DME MAC."	
V2530 - V2531	"Contact Lenses, Scleral"	DME MAC	
V2599	"Contact Lens, Other Type"	Local Carrier if incident to a physician's	
		"service.  If other, DME MAC."	
V2600 - V2615	Low Vision Aids	DME MAC	
V2623 - V2629	Prosthetic Eyes	DME MAC	
V2630 - V2632	Intraocular Lenses	Local Carrier	
V2700 - V2780	Miscellaneous Vision Service	DME MAC	
V2781	Progressive Lens	DME MAC	
V2782 - V2784	Lenses	DME MAC	
V2785	Processing--Corneal Tissue	Local Carrier	
V2786	Lens	DME MAC	
V2787 - V2788	Intraocular Lenses	Local Carrier	
V2790	Amniotic Membrane	Local Carrier	
V2797	Vision Supply	DME MAC	
V2799	Miscellaneous Vision Service	DME MAC	
V5008 - V5299	Hearing Services	Local Carrier	
V5336 	Repair/Modification of	DME MAC	
	Augmentative Communicative		
	System or Device		
V5362 - V5364	Speech Screening	Local Carrier	
			
			
			
			
			
